The patient was a 56-year-old male. He had a history of alcoholism since 1975 and diabetes mellitus since 1978. He was treated with insulin therapy. But the control of diabetes mellitus was very poor and he had six hypoglycemic comas attacks. He had diabetic triopathy but no symptoms of gait disturbance, dementia and incontinence. Brain computerized tomography and magneting resonance imaging revealed severe communicating hydrocephalus with mild brain atrophy.¹¹¹In-DPTA cisternography revealed retension of isotope in the ventricle after 48 hours. The pressure of cerebrospinal fluid was normal.
This case report is interesting as it suggests the relationship between normal pressure hydrocephalus and hypoglycemia.

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

An 78-year-old woman visited our hospital with the chief complaints of abdominal pain, nausea, vomiting and diarrhea. She was operated on for gastric ulcer when she was 56 years old and complained of abdominal discomfort after operation. One day she wished to take Confrey (Symphytum officinale), but she took digitalis leaves (Digitalis purpurea) by mistake. On admission she was drowsy and the systolic blood pressure was 60 mmHg on palpation. Electrocardiograms showed bradycardia, irregular AV-nodal rhythm and ST depressions and T wave inversions with the shortening of the QT interval. Serum levels were potassium, 6.4 mEq/1 ; BUN, 34.4 mg/di ; creatinine, 1.5 mg/di ; digoxin, 2.0 ng/ml (therapeutic level, up to 2.0 ng/ml); and digitoxin, 111ng/ml (therapeutic level, up to 25 ng/ml). Hemodynamic data showed HR, 49 beats/min ; CO, 2.81/min; CI, 2.31/min/m²; SV, 57 ml/beat and SI, 47 ml/beat/m² on administration of dopamine 7μg/kg/min. So VVI pacing was started at 70 bpm and CO increased to 3.6 1/min after pacing. But unfortunately she died of ventricular fibrillation. The digitalis leaves resemble the Confrey leaves and it is easy to mix up these two plants. Although this is a rare case, digitalis intoxication can be life-threatening. So we should prepared ourselves for the treatment of patients poisoned with digitalis and other poisonous herbs.

This report concerns a 62-year-old woman with Wegener's granulomatosis. She complained cough, macroscopic hematuria and oligulia. She had a consolidation without a cavity in the left upper lung field, massive proteinuria (2.5 g/day) and massive hematuria. The serum creatinine level was 2.5 mg/dl. The C-ANCA was positive. Renal biopsy revealed crescentic glomerulonephritis. She wa treated with prednisone and trimethoprim-sulfamethoxazole. The lung shadow, proteinuria and hematuria disappeared in one month. The C-ANCA titer also decreased. The use of trimethoprimsulfamethoxazole which may eliminate an infection as a cause to promote Wegener's granulomatosis should be actively included in the conventional treatment.

A 47-year-old man had suffered from high grade fever and dyspnea for 10 days. He was transferred to our hospital in a condition of shock. Echocardiography showed severe diffuse hypokinesis of left ventricle (EF 21%), and multiple mobile thrombi in the left ventricle. Under a diagnosis of LV thrombi due to acute myocarditis, transatrial removal of LV thrombi was performed using video-assisted cardioscopy. He was weaned from cardiopulmonary bypass under IABP support. Postoperatively, he suffered from thromboembolism of the cerebral and right brachial artery. Thrombectomy of the right brachial artery and anticoagulation therapy was performed. IABP was removed on POD 3, and he no longer needed respiratory control on POD 4. Echocardiography on POD 6 showed marked improvement of the LV contraction (EF 52%). After rehabilitation, he was discharged on POD 23 on foot. Video-assisted cardioscopy allowed transatrial removal of LV thrombi, and preserved left ventricular function by avoiding ventriculotomy. Perioperative thromboembolism must be taken care of for a patient with multiple LV thrombi.

We report a case of reactive hypoglycemic coma in a 77-year-old man. Seven months after partial gastrectomy for early gastric cancer, he presented with syncopal attacks and seizure. His plasma glucose and insulin levels at coma were 18 mg/dl and 27μU/ml. Insulinoma was neglected with computerized tomography, magnetic resonance imaging and angiography. Because dietary control was insufficient, oral diazoxide therapy was done. But diazoxide did not protectthe overresponse of the insulin and reactive hypoglycemia in 75 g GTT. Octreotide (100 micrograms IM) inhibited insulin release and prevented hypoglycemia. Acarbose delayed the response of insulin butdid not inhibited insulin release. However, acarbose also prevented reactive hypoglycemia. We concluded that acarbose is an effective therapy for reactive hypoglycemic coma.

Since 1983, we have experienced endovascular treatment of intracranial AVMs.2)3) Superselective catheterization of feeding artery, embolization or feeding artery occlusion of the cerebral AVMs have been performed for 73 cases in 134 sessions. Endovascular treatment of intracranial AVMs such as embolization or feeding artery occlusion have been performed for 57 cases of AVMs in 95 sessions. In each time, endovascular approach was performed for two to five feeding arteries, so more than 300 feeding arteries were catheterized by microcatheters or balloon catheters. In this report, we present our experiences of endovascular treatment of intracranial AVMs and discuss embolic materials and the role of endovascular treatment of intracranial. AVMs.
Arteries ; Catheterization ; Catheters

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically.
Aged ; Biopsy ; Female ; Hematologic Neoplasms ; Hepatic Veins ; Histiocytic Sarcoma* ; Humans ; Iron ; Liver ; Magnetic Resonance Imaging*