Seizure recurrence in infants with neonatal convulsions. A follow-up study. Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.


Brain SPECT in the pre-surgical evaluation of epileptic patients. Preliminary results. Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.


Effects of stimulation intensity, gender and handedness upon auditory evoked potentials. Left handers and women show less anatomical brain asymmetry, larger corpus callosum and more bilateral representation of specific functions. Sensory and cognitive components of cortical auditory evoked potentials (AEP) have been shown to be asymmetric in right handed males and to be influenced by stimulus intensity. In this study the influence of sex, handedness and stimulus intensity upon AEP components is investigated under basal conditions of passive attention. 14 right handed males, 14 right handed females, 14 left handed males, and 14 left handed females were studied while lying awake and paying passive attention to auditory stimulation (series of 100 binaural clicks, duration 1 msec, rate 1/sec, at four intensities). Cz, C3 and C4 referenced to linked mastoids and right EOG were recorded. Analysis time was 400 msec, average evoked potentials were based on 100 clicks. Stimulus intensity and gender affect early sensory components (P1N1 and N1P2) at central leads, asymmetry is influenced only by handedness, right handers showing larger P1N1 amplitudes over the right hemisphere.


[Normal values of neural conduction velocity in a group of 101 subjects]. Motor and sensory nerve conduction velocities were analysed in a group of 101 normal Brazilians. The normal values were obtained considering the group age, the distal and proximal segments of each nerve, the differences in the right and left side for each nerve. A significant decline in the conduction was found for the elderly aged group.


AIDS. A CSF laboratory experience on 470 cases in a 7 year time period. In a seven year time period (July 1984 to June 1991) were studied CSF samples of 36,216 new patients, 470 of them infected by HIV. Number of AIDS patients represents 1.30% of total cases examined in the laboratory during this time period. Normal CSF was observed in only 16 cases (3.4%). Associated pathologies occurred in 66% of cases. Opportunistic infections predominated among them (227 cases). Data support indication for CSF examination in HIV infected patients. This exam must be as complete as possible.


[Peripheral facial paralysis in Petropolis]. The author presents 83 cases of "a frigore" peripheral facial palsy, occurred in the mountain city of Petropolis which has characteristics such as a tropical climate without any traces of a dry season and an average temperature of 50 degrees F to 73.5 degrees F. The author relates them with virus infections which appear within a year period. Fifty six patients belong to his clinic and have a follow up, while other 25 patients proceed from another clinics and from them he only has reports on sex, age, side of palsy and the beginning of illness. He shows that the largest number of cases occurred along the months of May, August, September and October. Season distribution for southern hemisphere is analysed. He also considers etiology, incidence, prevalence, treatment and results on patients studied.


[Neurologic changes in congenital heart diseases: a neuropathologic study]. A neuropathologic study in 190 consecutive autopsies of patients with congenital cardiopathy was performed: 116 cases underwent a surgical procedure (S group) and the remaining 74 were non-surgical (NS group). Neuropathologic alterations were observed in 71 cases (41 in the S group and 30 in the NS group). However, most of the 129 cases with a normal examination had died in the first 72 hours either after surgery or the clinical events responsible for the death. Almost all the neuropathologic alterations were hypoxic ischemic. Infarctions, single or multiple, were found in 41 cases (23 in the S and 18 in the NS group). An embolic mechanism could be detected in 12 cases. Diffuse hypoxic changes were present in 17 cases (10 in the S and 7 in the NS group). Hemorrhages were found in 11 (6 in the S and 5 in NS group), 4 of which were related to a disseminated intravascular coagulation. In 17 cases (5 in the NS and 12 in the S group), the picture was of a periventricular leukomalacia. All these cases concerned children under 6 months of age. In 7 cases inflammatory alterations were present (diffuse micro-abscesses in 6 and a frontal lobe abscess in 1). Almost all cases in both groups presented clinical complications, isolated or associated, potentially harmful to the brain, as cardiac arrest, cardiac low output, hypoxemia, and respiratory distress. If was impossible to determine in each case the magnitude of the factor or factors responsible for the correspondent pattern of neuropathologic damage. There was no difference as to the neuropathologic pattern between congenital cardiopathies leading to increased or decreased pulmonary blood flow.


[Motor neuron disease: metabolic evaluation]. The authors studied serum and urinary calcium and phosphorus levels, as well as abnormalities on the spine of 30 patients with motor neuron disease. The authors believe in multifactorial aspects in the pathogenesis of motor neuron disease, calling special attention to toxic and metabolic factors.


[Factors involved in the prognosis of walking in cerebral paralysis]. With the objective of studying the prognosis for walking in children with cerebral palsy a retrospective survey of 100 children being treated at the Associação de Assistência à Criança Defeituosa was made during the period from 1979 to 1988. The following parameters were analysed: (1) degree of motor dysfunction; (2) age of acquisition of sitting balance; (3) function of upper limbs; (4) degree of mental retardation; (5) presence of primitive reflexes. All the above parameters were analysed with respect to the capability of children acquiring or not walking. The results of our study show that the following factors are indicative of bad prognosis for walking: (1) severity of motor dysfunction; (2) acquisition of sitting posture after 3 years old; (3) precarius function of upper limbs; (4) severe mental retardation associated with severe physical deficiency. Clinical evaluation of primitive reflexes did not reveal direct relation to the walking prognosis.


[Characteristics of the demand for cranial computerized tomography: reasons and costs of the exam]. It was reviewed a series of 2860 cerebral computed tomography (CCT) in order to compare the main reasons at referral to investigation with the CCT results and the costs with normal and abnormal CCT. It was also studied the age and sex of the patients. Data were collected from one out of three diagnostic centers in Salvador, Brasil, for a three years period. The 2860 CCT exclude all investigation carried out for the follow-up of a previously diagnosed abnormality. CCT abnormalities were detected in 1152 (40.3%). The following reasons showed the highest proportion of abnormal CCT, for males and females respectively: demential syndrome (91.7 and 83.3%); cerebrovascular accidents (85.1 and 73.6%); infectious and parasitary diseases (76.5 and 78.6%); tumors (65.8 and 55.4%); and head injuries, 63.6% for males. In the female group, 65.0% of the CCT were normal, in a range of 65.0 to 80.0% for the age groups under 54 years old. In the male group, the highest proportion of normal CCT was found in the age groups: 25-34 (68.4%), < 15 (62.9%) and 35-44 (62.7%). The most common reasons for normal CCT for males and females were: headache (81.3 and 87.5%); dizziness/vertigo (79.3 and 78.6%); seizures (67.3 and 70.0%); psychomotor deficiency (72.0 and 67.7%) and "endocrine disorders", 75.0% for each sex. The highest proportion of normal CCT (65.3%) was requested by medical "convenios". The cost with normal CCT reached US$565,225 and with the abnormal ones, US$381,247. Costs with normal CCT were 2.2 higher for medical "convenios" as compared to those of the National Institute of Security requests and 2.8 more than those of private medicine.


[Zinc in the treatment of hepatolenticular degeneration: report of 3 cases]. Three patients with symptoms and signs of hepatolenticular degeneration (HLD) who developed serious renal side effects of D-penicillamine (DP) had their therapeutic schedule changed to zinc. Patient 1, a 55 year-old man had been well until 12 years old, when skeletal changes (osteomalacia) due to tubular renal disturbance began. His diagnosis of HLD had first been established at age of 32 when he presented with "wing-beat" tremor. He was then begun on DP and his neurological symptoms resolved within one year of initiating therapy but skeletal abnormalities remained unchanged as a sequel. During the next 22 years the patient was continued on DP therapy but with poor compliance. Then the reappearance of his neurological manifestations occurred several times. By the age of 53, after one year without therapy, his neurological status has worse. DP was reinstituted but some weeks later his renal laboratory parameters became severely affected. DP was discontinued and zinc sulfate (220 mg three times daily) was introduced. On this therapeutic regimen his renal laboratory parameters returned to previous level after one month. Within one year on this therapeutic regimen neurological manifestations were resolved. After 31 months on zinc treatment he remains neurologically asymptomatic and his renal function is satisfactory. Patient 2, a 41 year old woman had been her diagnosis of HLD at age of 20, when following the diagnosis of the disease in her old brother, she was found to have the laboratory features of HLD and bilateral Kayser-Fleischer rings. DP treatment was recommended at that time but she quit the follow-up. When she was 23, an esophageal variceal bleeding occurred.(ABSTRACT TRUNCATED AT 250 WORDS)


Evidence for a modular structure of the homologous repetitive C-terminal carbohydrate-binding sites of Clostridium difficile toxins and Streptococcus mutans glucosyltransferases. The homologous C-terminal repeats of Clostridium difficile toxins (ToxA and ToxB) and streptococcal glucosyltransferases appear to mediate protein-carbohydrate interactions at cellular binding sites with sugar moieties as substrates. A consensus sequence of 134 repeating units from gram-positive bacteria indicates that these repeats have a modular design with (i) a stretch of aromatic amino acids proposed to be involved in the primary carbohydrate-protein interaction, (ii) an amplification of this interaction by repetition of the respective sequences, and (iii) a second domain, not characterized, that is responsible for carbohydrate specificity.


Interleukin-11: a novel stroma-derived cytokine. Interleukin-11 (IL-11) is a novel stroma-derived cytokine that acts on both hematopoietic progenitors and stromal cells. IL-11 was originally identified in a medium conditioned by the macaque bone marrow-derived stromal cell line PU-34 and cloned as a growth factor for the IL-6-dependent plasmacytoma cell line T1165. IL-11 stimulates T-cell dependent development of antibody-producing B cells and is synergistic with IL-3 to stimulate megakaryocyte colony formation. Adipogenesis inhibitory factor (AGIF) was cloned from the human bone marrow-derived stromal cell line KM-102. The AGIF cDNA sequence was revealed to be identical to that of the IL-11 cDNA. AGIF inhibits the process of adipogenesis of the bone marrow-derived preadipocyte cell line H-1/A. Other biological activities such as stimulation of stem-cell proliferation, erythropoiesis, lymphohematopoiesis and hepatic acute-phase response are also summarized. The human IL-11 gene consists of five exons and four introns, and was mapped on chromosome 19 at band 19q13.3-q13.4. A single class of high-affinity IL-11 receptor (IL-11R) of 151 kDa is present on 3T3-L1 preadipocytes. A protein-tyrosine kinase pathway may be involved in the initiation of the IL-11R-mediated signal transduction.


Interleukin 10: an overview.

Interleukin 10: an overview. Since the original description of interleukin-10, a wealth of information concerning its biological properties has been gathered. Studies in vitro have rapidly identified both immunostimulatory and immunosuppressive activities for IL-10. Based on these findings, in vivo studies were initiated in a variety of animal disease models to assess the importance of these activities. This review will summarize the pleiotropic properties of IL-10 and will survey current research regarding the potential of IL-10 to regulate acute and chronic inflammatory reactions.


Clinical applications of interleukin-2.

Clinical applications of interleukin-2. Interleukin-2 (IL-2) is a cytokine with potent immunomodulating properties which has shown considerable antitumour activity in preclinical models. In clinical trials, the effects of IL-2 given by various routes and schedules have been investigated. IL-2 has been administered either as single drug or in combination with other cytokines and immunomodulating agents, chemo therapeutic agents, or reinfusions of ex vivo activated autologous cytotoxic effector cells. The results of published clinical studies with IL-2 based immunotherapy are reviewed in this paper.


Evaluation of the role of cytokines in autoimmune disease: the importance of TNF alpha in rheumatoid arthritis. Cytokines and growth factors are involved in all important biological processes. Hence it is anticipated that they will be of importance in autoimmune disease. The pathogenesis of autoimmune diseases involves a number of stages, initiation, perpetuation and tissue damage, each of which involves different cell and molecular interactions. In this review, we will discuss an outline of the cytokine involvement in the various stages of autoimmune development, prior to focusing on the analysis of cytokines in rheumatoid arthritis. Cytokines exert their effect via high affinity cell surface receptors. Thus an understanding of cytokines involves the analysis of receptor expression, and also of cytokine inhibitors. Currently there is only adequate knowledge of these aspects in rheumatoid arthritis (RA), and as such the emphasis of this review is on RA. One of the major reasons for being interested in the role of cytokines in autoimmunity is to define possible therapeutic targets. There is now considerable evidence that TNF alpha is such a target in RA, and the effect of anti TNF alpha monoclonal antibody therapy in RA is discussed.


The molecular and cellular biology of insulin-like growth factor II. Insulin-like growth factor II (IGF-II) is a 67 amino acid polypeptide that belongs to the family of insulin-like peptides. The IGF-II gene is coupled to the insulin gene and paternally imprinted. Multiple IGF-II mRNAs with identical coding regions and 3' untranslated regions (UTRs) but different 5' UTRs are generated from 3 promoters. The transcripts are translationally discriminated and inactivated by a specific endonucleolytic cleavage in their 3' UTR. These features may be important in the control of IGF-II production. IGF-II functions in an auto- and paracrine manner and binds to two types of receptors. The IGF-I receptor that is a tyrosine kinase and closely related with the insulin receptor and the IGF-II/mannose 6-phosphate (IGF-II/Man 6-P) receptor that is identical with the cation-independent mannose 6-phosphate receptor. The mitogenic and metabolic actions of IGF-II are propagated by the IGF-I receptor. In contrast, the IGF-II/Man 6-P receptor, that target lysosomal enzymes from the Golgi apparatus or the plasma membrane to the lysosomes, mediates the rapid internalization and degradation of IGF-II. IGF-II is expressed at high levels during foetal life and it is a major growth factor for the foetus in rodents. The developmental profiles and tissue distribution of the IGF-I and the maternally imprinted IGF-II/Man 6-P receptors both parallel that of IGF-II. In this scenario IGF-II promotes the growth of the embryo through the IGF-I receptor, whereas the IGF-II/Man 6-P receptor balance the activity by controlling the extracellular level of IGF-II.


Volatile N-nitrosamines in salted fish samples from high- and low-risk areas for NPC in China. Four carcinogenic volatile nitrosamines (N-dimethylnitrosamine, NDMA; N-diethylnitrosamine, NDEA; N-nitrosopyrroline, NPYR; and N-nirosopiperilidine, NPIP) were screened in twenty specimens of salted fish collected from areas in China with different nasopharyngeal carcinoma (NPC) mortality rates. The highest NDMA, NDEA and total N-nitrosamine contents (322.92, 50.27 and 373.19 micrograms/kg, respectively) were found in the samples from Sihui, one of the areas with highest NPC mortality. The lowest contents (12.64, 7.65 and 20.29 micrograms/kg, respectively) were seen in the samples from Shanghai, the area with the lowest mortality from NPC in the study. These results confirm that there are appreciable levels of nitrosamines in the salted fishes consumed by residents in high-risk areas of NPC in China.


Detection of point mutations of the phenylalanine hydroxylase gene and prenatal diagnosis of phenylketonuria. The known mutant alleles of the human phenylalanine hydroxylase (PAN) gene were analyzed in 25 phenylketonuria (PKU) families from North China by using polymerase chain reaction and allele-specific oligonucleotide dot blot hybridization techniques. The results showed that the six mutations analyzed accounted for 62% of all PKU genes. The three most frequent mutations were R243Q, R413P and Y204C. Seven prenatal gene diagnoses were carried out in 6 PKU families and were confirmed after birth or by examination of aborted materials.


Study of experimental hypoparathyroidism in rats. III. Fluidity changes in brain synaptolemma. The changes of brain synaptolemma fluidity in experimental parathyroidectomized (PTX) rats were studied by using fluorescence polarization and differential scanning calorimetry (DSC) techniques. The results showed that microviscosity (eta) of the rat brain synaptolemma in the cerebral cortex, hippocampus, midbrain and striatum were decreased after a 2-month period of continuous hypocalcemia, and in the hippocampus and cerebral cortex it was decreased significantly as compared with control. These results suggest that the fluidity of the synaptolemma in the brains of hypocalcemic rats is increased. In addition, hypocalcemia also lowered the Tc of hippocampus synaptolemma lipid, which indicates that both fluidity and permeability had increased in these rats.


An epidemiological survey of deformities and disabilities among 14257 leprosy patients in 11 counties. This study was planned and conducted in 11 counties in Yangzhou Prefecture, which had formerly had a high prevalence of leprosy. Out of 14257 leprosy patients, 8122 (56.97%) with permanent deformities and disabilities were found. The disability rate was much higher among patients with multibacillary (MB) leprosy (81.15%) than among those with paucibacillary (PB) leprosy (53.04%). The statistical data involving the patients and the types of deformities and disabilities are presented in this paper, and the influences of various host factors and disease factors are discussed.


The value of hysteroscopy in the diagnosis of infertility and habitual abortion. Ninety cases of infertility and habitual abortion were analyzed by hysteroscopy between April 1983 and July 1990 in PUMC hospital. Abnormal changes of the uterine cavity were seen in 74.4%. The result of hysterosalpingography corresponded with that of hysteroscopy in 62.5%, and the result of B-ultrasound corresponded to that of hysteroscopy in 52.5%. The diagnosis of adhesion and polyps of the uterine cavity was made accurately by hysteroscopy, and both could be operated under hysteroscopy. After operative removal of the adhesion, an IUD should be put into the uterine cavity for 3 months. In 60 cases operations were performed during or after hysteroscopy. Of the 45 patients followed, 19 achieved pregnancy. Five patients achieved pregnancy after operative removal of the adhesion. It is concluded that hysteroscopy is more important than B-ultrasound and hysterosalpingography in the examination and treatment of infertility.


Application of ABCD double feedback management in quality assurance of diagnostic radiology. This method combines modern management and statistical methods with traditional film-reading systems to form a new retrospective and prospective film-reading system for quality assurance in X-ray diagnostic imaging. This method also provides feedback information with A, B, C, D and W factors which reflect the drawbacks of the radiographs. The ABCD double-feedback management system is an imaging quality evaluation system which concentrates on several important time and space periods in the radiographic engineering process. It incorporates adjustment of the X-ray apparatus and its functional capacity, selection of X-ray equipment, and application of the technician's experience and duty in the X-ray room and dark room.


The effect of multi-glycosides of Tripterygium wilfordii Hook f. (GTW) on the survival time of cardiac allografts in rats. Heterotopic heart transplantation was carried out in rats and the influence of multi-glycosides of Tripterygium wilfordii Hook f. (GTW) and a subtherapeutic dose of cyclosporine A (CsA) on the mean survival time (MST) of the cardiac allografts was investigated. The results showed that the MSTs of cardiac allografts in both the GTW and CsA-treated groups were significantly prolonged (P < 0.01 vs control). The rate of allograft rejection in the drug-treated groups was much lower than that in the control group.


The diagnosis and steroid "pulse" therapy of systemic lupus erythematosus associated with mental disturbances in the general hospital. Twenty-eight patients suffering from systemic lupus erythematosus (SLE) associated with mental disturbances were analyzed clinically (1983-1990). Although no characteristic features of the mental disturbances of SLE were found, it should be differentiated from steroid- or chronic renal failure-induced mental disorders. One gram of methylprednisolone intravenously daily for 3 days was recommended as a pulse therapy to treat the mental disturbances of SLE. In this group, the mental disturbances of SLE showed improvement or disappearance in 18 of 25 patients (72%) after pulse therapy.


Advances in research on leptospira and human leptospirosis in China. Leptospirosis exists in 26 of 30 provinces (exclusive of Taiwan province) in China. Up to now, a total of 18 serogroups and 70 serovars of pathogenic leptospires have been identified, including 35 serovars first found in China. A great deal of work has gone into the study of the leptospires and leptospirosis, and the present paper reviews these works, concentrating on serovar lai (the major serovar in China) and pulmonary diffuse hemorrhage (PDH), a traumatic consequence of leptospirosis.


[Diaphanization: modifications of organ weight and volume]. The diaphanization of organs previously injected with coloured substances is an excellent auxiliary method of numerous morphological studies. The authors studied 52 organs, among 15 were taken from human beings and 37 from dogs, with the aim of knowing theirs weight and volume modifications after diaphanization. The organs were diaphanizated with several impregnations in 10% formaldehyde, perydrol, acetone and at least embedding in a mixture of methylsalicylate and benzyl benzoate by vacuum process. After each embedding, weight and volume of each organ were measured. The variations that the organs suffered were statistically considered, under a few aspects: 1-global organs' variations after each embedding 2-different organs' variations 3-comparison between human being and experimental animals. In all cases, the authors noticed a great decrease of weight and volume, especially after dehydration steps with acetone and clearing with the mixture of methylsalicylate and benzyl benzoate. We also didn't find any significant difference between human organs and those taken from dogs.


[Vascularization of the common fibular nerve]. The vascularization of the common fibular nerve (CFN) let us suppose that one have to take anatomy and physiology of vasa nervorum in consideration in the genesis of neurologic lesions. This study is based on fresh cadavers dissections, with intra arterial injection of minimum colored latex. The results emphasize the causes of the CFN susceptibility while compression and stretching injury.


Histochemical localization of salivary glycoproteins in the submandibular gland of aging rats. It is known that submandibular glands produce serous saliva in the serous demilune cells and mucous saliva in the mucous acinar cells which is a viscous, rich in glycoproteins substance. The aim of this study was the comparative histochemical investigation of acid and neutral salivary glycoproteins in the acinar cells of the submandibular gland in adult and aging rats. Three groups of female Wistar rats were studied: a) young adult rats, 3 months old, b) aged rats 25 months old, c) aged rats 30 months old. Each group included 5 animals. The animals were sacrificed with ether in toxic dose. The submandibular glands were dissected and placed in 10% formaldehyde solution. After fixation they were embedded in paraffin. The paraffin sections were stained with various techniques. We used the: a) Alcian-Blue PH 2,5-Neutral Red b) Periodic-acid/Schiff/Diastase c) Alcian-Blue PH2,5 and Periodic-acid/Schiff/Diastase. We observed that the acinar cells of the aged submandibular glands were filled with acid glycoproteins, while the neutral glycoproteins were localized only in the group of the adult rats. Our results confirm the theory, that lithiasis and chronic inflammations of the submandibular gland, which often happen after the 4th decade of the life, are due to alterations of the mucosubstance composition of the acinar cells.


Congenital syndromes connected with tongue malformations. Malformations of the tongue, are structural defects, present at birth and happening during embryogenesis. Developmental anomalies or defects may be major or minor, single or multiple, depending on their size, site and effect. The aim of this study was to present and to describe congenital syndromes which are associated with tongue malformations and to classify these malformations in groups, according to the tongue's clinical manifestations. The most common malformations of the tongue combined with syndromes associated with them, are fully discussed in this review article. Malformations of the tongue which are discussed in this review article, have been classified in the following categories: 1. Aglossia 2. Microglossia 3. Tongue hemiatrophy 4. Tongue hemihypertrophy 5. Macroglossia 6. Long tongue 7. Ankyloglossia 8. Cleft or bifid tongue 9. Syndromes that affect tongue and cannot be classified in a special condition Each category is discussed separately in this article.


[Drainage of the erectile organs in the rat]. The retro-pubic veinous circle of the male rat was investigated on the both sides: anatomic and functional aspect. The dorsal vein of penis in the male rat run into a retro-pubic veinous circle. This circle receive the anterior vesical veins too. The internal pudendal vein and the anastomotic vein begin in this circle, and go together to the iliac vein. From the retro-pubic veinous circle, there is a triangular circulation between the internal pudendal vein, the anastomotic vein and the iliac vein. Angiographies performed on rats in vivo, indicates that the anastomotic vein is effical for the drainage of the retro-pubic circle only if the flow of the penis dorsal vein is sufficient. These conclusions are proved by experimentation on dead rats.


[Investigation of interleukin 2 receptor and T cell subsets in the patients with tuberculous meningitis]. Interleukin 2 receptor (IL-2R) on lymphocyte and T cell subsets of peripheral blood(PB), defined by monoclonal antibodies, were studied in 25 patients with tuberculous meningitis. 25 staff members served as PB control. Dynamic changes of IL-2R positive cells and T cell subsets were observed in 10 of 25 patients at sixth week after chemotherapy. IL-2R positive cells showed higher percentages in the patients than in healthy controls. Percentages of CD5and CD4cells were lower than those of healthy control. With chemotherapy, the percentages of CD4cells raised. The results indicated that M. tuberculosis might stimulate T cell to express IL-2R. A lower cell mediated immunity function in the patients with tuberculous meningitis was characterized by CD4 lymphopenia.


[Clinical analysis of 41 cases of pulmonary atypical mycobacteriosis]. This paper reported forty-one patients with pulmonary atypical mycobacteriae infection from Jan. 1988 to Oct. 1990 in our hospital. 25 male and 16 female. The age ranged from 27 to 70 years, average 50.9 years. According to Runyon classification of mycobacterium diseases, there are 4 cases with Mycobacterisos kansasii, 2 with M. scrofulaceum, 14 with M. intracellulare or M. avium, 9 with M. chelonae and 12 with M. fortuitum, respectively. Characteristics of this disease were long history, mild symptom and unsatisfactory therapeutic effect by anti-tuberculosis drugs.


[Determination of interleukin 2 activity in patients with pulmonary tuberculosis]. The activity of Interleukin-2 (IL-2) in 34 patients with pulmonary TB and 25 normal adults were determined by means of the bioassay. The results showed that the activity of IL-2 determined by immediate stimulating method (Ohs IL-2) and delayed stimulating method (24hs IL-2) are markedly increased in the mild cases than that of controls; In the advanced cases and the controls, no significant difference was found between the activities of ohs IL-2, but the activity of 24hs IL-2 is markedly reduced in the former group. All these showed that the activity of IL-2 is depended on the serious degree of illness and the clinical type, it can also reflect the condition of immune function in the patients with pulmonary TB.


[Experimental studies of lung lesions in rabbits caused by Streptomyces thermohygroscopicus]. Imitating the natural way of infection of Farmer's lung disease, we succeeded in inducing acute lesions of Farmer's lung disease in rabbits by the dry powder of thermohygroscopicus. Histopathological examination revealed typical interstitial pneumonitis, alveolitis and bronchiolitis. One week after the inhalation of the dry powder of thermohygroscopicus, the precipitins could be detected in the rabbits' serum by immunoblotting. Depending on the lung lesions of rabbits, we discussed the pathogenetic mechanisms of Farmer's Lung.


[Pulmonary clearance of 99mTC-DTPA aerosol in patients with silicosis]. 99mTc-DTPA clearance was studied in 11 healthy nonsmokers, 20 patients with simple or complicated silicosis (5 of simple, 15 of complicated). The results indicated that both the patients with simple silicosis (T1/2 32.8 +/- 14.4min) and complicated silicosis (T1/2 26.6 +/- 8.5min) showed faster clearance of inhaled 99mTc-DTPA than observed in healthy nonsmokers (77.9 +/- 11.7min, p < 0.01). Regional clearance apico-basal difference was found in patients with silicosis. This study presents evidence of increased pulmonary epithelial permeability and regional distribution of pulmonary epithelial permeability in silicosis.


[A quantitative analysis of pulmonary arterioles in 402 cases of cor pulmonale]. A quantitative analysis of pulmonary arterioles were made in 402 cases of cor pulmonale. The results showed that arteriole muscularization and medial hypertrophy, intimal fibrosis of pulmonary small arteries were important lesions. The authors found that right ventricular hypertrophy was bound to follow intimal fibrosis of pulmonary small arteries but was not along with medial hypertrophy and arteriole muscularization, and that the lesion of pulmonary arteries was not balanced with the course of disease. The authors considered that these results were related to vessel dilatation and medial atrophy because of intimal pressure in late stage of the disease.


[Effect of ligustrazine controlled release capsule on pulmonary hemodynamic and right ventricular systolic time intervals in patients with cor pulmonale]. Before and after oral administration of Ligustrazine controlled release capsule, pulmonary hemodynamic and right ventricular systolic time intervals, arterial blood gas and TXA2/PGI2 were studied. It was shown that decreasing of pulmonary arterial pressure and pulmonary vessel resistance, and heart rate, increasing of cardiac output, right ventricular systolic time intervals and arterial blood gas improving after one course of treatment with Ligustrazine controlled release capsule. It suggested that vasodilation caused by Ligustrazine is probably related to its vasodilating pulmonary vessela and improving imbalance between TXA2/PGI2 in patients with Cor Pulmonale.


[A comparative study of the effects of control ventilation and synchronized intermittent mandatory ventilation on hemodynamic and blood gases in patients with chronic obstructive pulmonary disease]. Effects of control ventilation (CV) and synchronized intermittent mandatory ventilation (SIMV) were comparatively studied in 9 patients with chronic obstructive pulmonary disease. Cardiac index (from 2.99 +/- 0.65 to 3.60 +/- 0.651.min-1.m-2, P < 0.05) and oxygen delivery index (from 537 +/- 89 to 645 +/- 101 ml.min-1.m-2, P < 0.05) were significantly increased during SIMV comparing with CV. Mixed venous oxygen tension (from 5.63 +/- 0.66 to 6.06 +/- 0.59 kPa, P < 0.01) was improved by SIMV. The results showed that SIMV could improve cardiac output, oxygen delivery and oxygen supply of tissue.


[Effects of inhaled aerosol of platelet activating factor on pulmonary function and airway responsiveness in normal subjects]. Platelet activating factor (PAF), which was given as an aerosol to normal subjects, caused immediate bronchoconstriction. After the first inhalation of PAF, percentage fall of VP30 was 43.2% +/- 7.1% at five minute. Subsequent inhalations of PAF, bronchoconstriction effect of PAF gradually attenuated. There was an increase in the airway responsiveness to methacholine following inhalation of PAF. The mean PC40 fell from 18.57 +/- 1.69 g.L-1 to 7.01 +/- 2.24g.L-1 (P < 0.01) on day three and returned to baseline in 1 to 2 weeks. DLCO decreased from 3.3 +/- 0.7ml.kPa-1/s to 2.9 +/- 0.4ml.kPa-1/s (P < 0.01) on day three. Chlorpheniramine partially inhibited the bronchoconstriction effect of PAF in a double blind, crossover study. These data suggest that PSF may contribute to the pathogenesis of airway hyperresponsiveness in asthma and the bronchoconstriction induced by inhaled PAF is mediated in part by histamine release.


[The effect of dilution and heparin on the blood gas analysis]. The effect of heparin on the measurement of blood gases is mainly caused by dilution, which substantially reduces the PCO2 and HCO3- values. Excess heparin will change the pH, PCO2 and 3- as a consequence of an alternation in H+ ionconcentration. The effect of dilution on electrolytes depends on the respective electrolyte concentration in diluent. Dilution reduces the glucose value, but to a higher degree as could be expected from a dilution effect. Heparin binds electrolytes and influences the results, especially the calcium ion. As a result of this investigation we recommend the 20IU or less heparin be used for multi-electrolyte determination with or without blood gas analysis, and that the dilution of sample be maintained at less than 5%. In other words, at least a 3ml or 2ml blood sample should be collected in a 5ml or 2ml glass syringe, the corresponding heparin concentration is 400kU/L or less.


[Clinical and radiological studies on 15 cases of acute phosgene poisoning]. A clinical and radiological observation on 15 cases of acute phosgene poisoning were reported. The pulmonary edema after acute phosgene poisoning can be classified into two types: interstitial and alveolar. The X-ray findings were described in detail in correlation with the clinical symptoms. Taking X-ray early can benefit on preventing and treating acute pulmonary edema. Meanwhile, the patients with chronic respiratory or digestive diseases can develop pulmonary encephalopathy or upper gastrointestinal bleeding after acute phosgene poisoning.


Changing spectrum of clinical and laboratory profile of infective endocarditis. The clinical profile of 28 consecutive patients admitted with infective endocarditis (IE) between 1987 and 1988 was studied. There were 21 males and seven females with a mean age of 24 +/- 11 years. Rheumatic heart disease (RHD) was the commonest underlying disease (68%) followed by congenital heart disease (CHD). Mitral regurgitation with aortic regurgitation were the commonest valvular lesions (47%) in those with RHD while ventricular septal defect was the commonest (43%) in those with CHD. A younger age of onset, complicated course and high mortality were seen in these six patients with acute IE. Persistently positive blood cultures during life or at autopsy were obtained in 21%. Strep viridans was the commonest isolate and was often resistant to streptomycin. 2D echocardicgram revealed vegetations in 96% of patients, the aortic valve (39%) being more commonly affected than the mitral valve (11%). ESR of more than 20 mm drop 1st hour (Wintrobe) was seen in 96%. Thrombophlebitis was a common complication of therapy and cloxacillin the commonest drug implicated. A mortality of 21% as a result of refractory congestive heart failure (CHF) (50%), uncontrolled sepsis (33%) and embolic events (17%) was seen. A rising incidence of culture negative IE, combined aortic and mitral valve disease and CHF is noted.


Glucagon response to glucose load in offspring of conjugal type 2 diabetic parents in south India. Immunoreactive glucagon responses were measured in 21 normoglycaemic adult offspring of non-insulin dependent (Type 2) diabetic parents, in the fasting state and during an oral glucose tolerance test. In 7 of the 21 offspring, the mean fasting immunoreactive glucagon value was significantly lower than the control value (p < 0.001). In this group, glucose stimulation did not produce inhibition of immunoreactive glucagon secretion. The insulin response in this group was not significantly different from the values in the other study groups. In the other 14 offspring, the pattern of glucagon response to glucose stimulation was similar to controls. It is likely that this non-suppressive effect of glucose on immunoreactive glucagon in some of the "prediabetic" individuals is an early change in the alpha cell function during the natural history of non-insulin dependent diabetes in Asian Indian subjects.


Changing profile of enteric fever--in summer-91. The clinical presentation, complications and sensitivity pattern was studied in 30 cases of enteric fever. Fever was the main presenting feature in all. Other associated predominant presenting feature were vomiting in 15 (50%), Loose motion 9 (30%), Cough 6 (20%), headache 4 (13.33%) and altered sensorium in 2 (6.66%). The various complications observed during hospital stay were myocarditis 5 (6.16%), Paralytic ileus 2 (6.66%), Pneumonia 1 (3.33%) and Joint effusion in 2 (6.66%) cases respectively. In laboratory parameters-mild elevation of blood urea and SGOT/SGPT were detected in 1st week, which returned to normal in 2-3 weeks time. In vitro sensitivity of organism isolated (24 cases) were as follow--Chloramphenicol 7 (29.16%), Ampicillin 8 (33.33%), Gentamicin 22 (91.66%), Amikacin 24 (100%), Cefotaxime 22 (91.66%), Ciprofloxacin 24 (100%), and Ofloxacin 24 (100%). Clinical response to Ofloxacin and Ciprofloxacin was 100%, and fever subsided in 3-5 days.


Chloramphenicol resistance in Salmonella typhi. Report from Bombay. Chloramphenicol resistance to Salmonella typhi in 1989 was 16% in Hinduja Hospital. From Jan to June 1990, this resistance has increased to 81%. 74 strains of blood culture isolated of S typhi obtained from Jan to June were subjected to antibiotic sensitivity testing by disc diffusion technique of Kirby and Bauer 60 strains were found to show a block resistance tochloramphenicol, Ampicillin, Co-trimoxazole, Streptomycin, Tetracycline and Carbenicillin. All strains were sensitive to quinolones. Resistance was record and MIC done in 50 resistant strains by modified National Committee for Clinical Laboratory Standards [NCCLS] according to recommended break points and resistance to Chloramphenicol was confirmed. Of the 47 strains isolated, 34 had received treatment with either chlorampheniicol, Ampicillin or Cotrimoxazole in adequate dosages. In 39 of these 47 patients, Salmonella typhi was isolated after 14 days duration of fever. Plasmid analysis revealed presence of 100 megadalton plasmid in majority of cases. Most patients responded to fluoroquinolones but amongst the admitted patients complications such as Myoglobinuria in 2 cases, perforation in 4 cases, acute Renal failure in 2 cases and typhoid spine in 1 case were seen. Phage typing results of 19 strains were E-8, 0-6.


Retrospective treatment analysis of Salmonella infections. Twenty four culture proved and nine postmortem histopathology proved cases of enteric fever were analysed retrospectively with special interest in use of various antisalmonella agents. Chloramphenicol resistance was noted in 91.7% and yet 70% of all patients received chloramphenicol alone or in combination with another antisalmonella agent. Time required for remission of fever with chloramphenical, cotrimoxazole and ciprofloxacin was 4.5, 4.1 and 6.9 days respectively. An interesting feature noted in post-mortem histopathology proved cases was enteric carditis which was documented on postmortem examination of the heart in three out of four patients who died of peripheral circulatory failure.


Dapsone in cutaneous lesions of SLE: an open study. This short report describes a possible beneficial effect of dapsone in the treatment of chronic unresponsive muco-cutaneous lesions of systemic lupus erythematosus (SLE) without any serious side effects.


Neurological manifestations of leukemia--clinical and pathological findings. Out of 70 cases of leukemia studied, 19 had neurological manifestations. All cases were autopsied. Leukemic infiltrates and intracranial hemorrhages produced various neurological manifestations. In autopsied cases 37.2% showed infiltrative changes. Intracranial hemorrhages contributed to 20%, the cause of which were due to thrombocytopenia and leukostasis. Leukemic nodules, demyelination and astrocytosis, gliosis were also seen on histopathology.


Diltiazem as adjunctive oral therapy in patients with chronic atrial fibrillation. Digoxin frequently fails to control the heart rate in patients of chronic atrial fibrillation particularly during exertion. We have studied in 20 such patients the effect of adding diltiazem (180 mg/day) on resting and peak exercise heart rates. An attempt was also made to determine its effects on exercise tolerance by using treadmill and 6 minute walk test. Addition of diltiazem resulted in significant attenuation of heart rate both at rest and at peak exercise. The resting and exercise mean heart rates on digoxin alone were 98.9 +/- 21.5 b.p.m. and 160.2 +/- 35.68 b.p.m. respectively. After diltiazem this reduced to 78.7 +/- 12.30 b.p.m. at rest and 132.4 +/- 40.4 b.p.m. at peak exercise (p < 0.01). There was no significant effect on exercise tolerance. In conclusion, the addition of diltiazem substantially reduced the excessive heart rate response to exercise in digitalised patients of chronic atrial fibrillation.


Paraganglioma of the cauda equina.

Paraganglioma of the cauda equina. A case of paraganglioma of the cauda equina is presented. Usually reported to be benign with good prognosis, the present patient had a somewhat different course. The behaviour of the tumour was unusual, with rapid recurrence seen within first month of surgery. The need for total surgical excision and role of adjuvant radiotherapy is highlighted.


Pituitary and testicular involvement in primary haemochromatosis. A case report. A case of primary hemochromatosis with hypogonadotropic hypogonadism and decreased Leydig cell reserve is reported.


Rhythmic palatal myoclonus.

Rhythmic palatal myoclonus. We report two cases of rhythmic palatal myoclonus (RPM) first presenting with symptoms unrelated to myoclonus and a possible etiology of encephalitis and the second presenting with ear click and palatal myoclonus. The response to treatment was unsatisfactory in both.


Silicotic alveolar proteinosis with bilateral spontaneous pneumothorax. Bilateral spontaneous pneumothorax due to silicotic alveolar proteinosis is reported because of its rarity.


Non-Hodgkins lymphoma presenting as pure red cell aplasia. An interesting case of Non-Hodgkins lymphoma presenting as pure red cell aplasia is being reported. Even though acquired pure red cell aplasia is not uncommon, lymphoma presenting as pure red cell aplasia is very rare. The patient responded to COP treatment and red cell transfusion and is on regular follow up. This appears to be the first report of such an association in Indian literature.


Klebsiella pneumonia with lung abscess in a male child. An unusual presentation of Klebsiella pneumonia with lung abscess in a male child with no apparent predisposing factor is described.


[A clinicopathologic study of atrial infarction complicating left ventricular posterior myocardial infarction]. Among a series of 400 consecutive autopsy cases we performed a clinicopathologic study of atrial infarction in 46 autopsy-proven cases, which had acute or old left ventricular (LV) myocardial infarction. We used blocks taken from both atrial appendages, the region of the sinus-node, the lateral wall of the right atrium, the posterior wall of the right atrium, and the posterolateral wall of the left atrium. Atrial infarction was identified in 13 (28%) of 46 cases with LV posterior infarction which was caused by lesions of the right coronary artery; 10 cases were right atrial infarction and 3 were both right and left atrial infarction. Among 13 cases in which the acute phase of ventricular infarction could be followed, 3 cases exhibited transient atrial fibrillation. Of these 3 cases, 2 had atrial infarction. The mean stenotic index of the proximal right coronary artery was 4.3/5 in the 13 cases of atrial infarction, 3.2/5 in 17 cases of acute necrosis or scar and 3.1/5 in 16 cases without ischemic atrial lesions. Most of the atrial infarction was found in the right atrium; 10 in the right atrial appendage, 8 in the right atrial lateral wall, 3 in the region of the sinus node and the left atrial posterolateral wall, 2 in the right atrial posterior wall, and one in the left atrial appendage. In conclusion, the incidence of atrial infarction was unexpectedly high (28%) in LV posterior infarction caused by lesions of the proximal right coronary artery, particularly in severe stenosis or obstruction.


[Left ventricular diastolic function in apical hypertrophic cardiomyopathy]. To investigate left ventricular (LV) diastolic function in patients with apical hypertrophic cardiomyopathy (AHCM), we analyzed the LV cineangiograms (RAO 30 degrees) and pressures (tip manometer) in 11 patients with AHCM who had giant negative T waves on their electrocardiograms and "ace of spades" configurations on the LV angiograms. Ten patients with non-obstructive HCM (HNCM) and 10 normal subjects served as controls. LV volumes and instantaneous rates of LV volume changes were derived from frame-by-frame analyses of their LV angiograms. LV isovolumic relaxation was assessed according to the time constant (T) of LV pressure decay. LV diastolic distensibility was evaluated by plotting diastolic pressure-volume curves. There was no significant change in the LV systolic functions among these 3 groups. Compared with normals, LV end-diastolic pressure was equally elevated in AHCM and HNCM. The T of isovolumic pressure decay was significantly prolonged in AHCM and HNCM. LV early diastolic filling was maintained at the normal level in AHCM as assessed by the peak filling rate (PFR) during the rapid filling period and the time from end-systole to PFR. The LV diastolic pressure-volume relation shifted upwards in both AHCM and HNCM. In conclusion, impaired LV isovolumic relaxation and decreased diastolic distensibility, which are associated with HNCM, may also be present in AHCM.


[Characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in patients with diabetes mellitus]. To elucidate the characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in diabetic patients, we compared 51 diabetics and 73 non-diabetics who had myocardial infarction and angiographically-proven coronary artery stenosis. There was no statistical difference between these 2 groups with respect to age, sex, histories of smoking, hypertension and hypercholesterolemia, and hemodynamic parameters. Mean of the number of diseased vessels and of the jeopardy scores were higher in diabetics than in non-diabetics (2.4 vs. 1.9, p < 0.01; 7.2 vs. 5.7, p < 0.02, respectively). The absence of preinfarct angina (59 vs 32%, p < 0.01) and typical chest pain of myocardial infarction was more frequent in the diabetic group than in the non-diabetic group (43 vs 15%, p < 0.005). Congestive heart failure was more common in diabetics than in non-diabetics (45 vs 14%, p < 0.005). Though there was no difference in the frequency of postinfarct angina between the 2 groups (54 vs 52%), painless myocardial ischemia during treadmill exercise tests was more frequent in diabetics than in non-diabetics (75 vs 30%, p < 0.025). Compared to diabetic patients with typical chest pain of myocardial infarction, diabetics without typical chest pain had preinfarct angina less frequently (82 vs 41%, p < 0.01), but had diabetic neuropathy (71 vs 43%, p < 0.05) and retinopathy (67 vs 32%, p < 0.025) more frequently. We concluded that diabetic patients with myocardial infarction frequently lack 1) preinfarct angina, and 2) typical chest pain of myocardial infarction. 3) They often suffer from congestive heart failure, 4) frequently accompanied by painless myocardial ischemia during exercise stress tests. Therefore, special attention should be paid for the management of diabetic patients with specific neuropathy and retinopathy.


[Regional myocardial coronary blood flow reserve in hypertrophic cardiomyopathy assessed by digital subtraction coronary angiography]. Using digital subtraction coronary angiography (DSA), we evaluated the regional myocardial coronary blood flow reserve (rMFR) in 18 patients with hypertrophic cardiomyopathy (HCM). There were 13 patients with asymmetrical septal hypertrophy (ASH), and 5 with asymmetrical apical hypertrophy (AAH). Eight subjects without apparent cardiac abnormality served as controls. Relations between the rMFR and regional wall thickness as determined by echocardiography were also investigated. Peak contrast density (Cm) and time to Cm (Tm) were measured from digital angiograms at the middle and distal ventricular septum (VS) and at the apical and left ventricular posterior wall (PW). The rMFR of each region of interest was expressed as the ratio of Cm/Tm at the baseline and at peak hyperemic response induced by intracoronary administration of papaverine. The rMFR was significantly lower at the VS and apex in HCM than in controls: middle VS, 1.9 +/- 0.5 vs 3.9 +/- 0.5, p < 0.001; distal VS, 2.0 +/- 0.5 vs 4.4 +/- 0.9, p < 0.001; and the apex, 2.0 +/- 0.7 vs 4.5 +/- 1.6, p < 0.01. However, it did not differ at the PW; 2.6 +/- 0.9 vs 3.0 +/- 0.9 between the 3 groups. The middle VS and apex, where the wall was the thickest, had the lowest rMFR in ASH and AAH. Furthermore, at the VS and apex, a curvilinear relationship was observed between the rMFR and wall thickness (rMFR = -0.88 in WT + 2.39, r = -0.57, p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)


[Extent and degree of coronary flow reserve in hypertrophic cardiomyopathy assessed by delta Fract map unfolding coronary flow reserve index]. Patients with hypertrophic cardiomyopathy (HCM) are known to have ischemic events and decreased coronary flow reserve, but the variabilities in the site and degree of fall between patients with this disease have not been clarified. To elucidate these variabilities, we performed exercise myocardial single photon emission computed tomography (SPECT) using double dose method in 30 patients with HCM (6 with obstruction, 17 with non-obstruction, 7 with apical hypertrophy) and 10 normals. Then, the delta Fract (coronary flow reserve index) map was obtained for each subject. Exercise and then rest Tl-201 myocardial scintigraphy were performed after administration of Tl-201. The data were reconstructed, making the circumferential curves from the same level of short-axis imaging during exercise and at rest. By subtracting the values at rest from the values during exercise, which were divided by the values at rest, delta Fract in each frame was obtained, and described on the unfolded map. The extent and degree of coronary flow reserve were visually estimated by this delta Fract map. Patients were categorized into 5 groups: diffuse fall of coronary flow reserve (D-type), 6 cases; localized fall of the septum or lateral wall (L-type), 5 cases; fall of apical region (A-type), 5 cases; mild fall (M-type), 6 cases; and normal pattern (N-type), 8 cases. We concluded that delta Fract map is useful for evaluating the extent and degree of coronary flow reserve in HCM.


[Impaired cardiopulmonary baroreflex control of forearm vascular resistance in hypertrophic cardiomyopathy]. We tested the hypothesis that the cardiopulmonary baroreflex control of forearm vascular resistance is impaired in patients with hypertrophic nonobstructive cardiomyopathy (HNCM). Forearm vascular responses to lower body negative pressures (LBNP) at -20 mmHg and -40 mmHg and to lower body positive pressure (LBPP) at +20 mmHg and +40 mmHg were compared between 11 patients with HNCM and 6 normal subjects. Forearm blood flow was measured with a strain gauge plethysmograph and forearm vascular resistance was calculated by dividing mean blood pressure by forearm blood flow. The left ventricular end-diastolic dimension and the left atrial dimension changed with the increases in LBNP and LBPP in patients with HNCM and in normal subjects. The ranges of these changes were similar in the 2 groups. Mean blood pressure and heart rate did not change during LBNP and LBPP. LBNP increased but LBPP decreased forearm vascular resistance in normal subjects, but neither LBNP nor LBPP changed the resistance in patients with HNCM. Increases in the resistance to cold pressor tests did not differ between the 2 groups. In patients with HNCM, there was a negative correlation between forearm vascular resistance at LBNP -20 mmHg and the left ventricular wall thickness (r = -0.81, p < 0.01). These results suggest that the cardiopulmonary baroreflex control of forearm vascular resistance is impaired in hypertrophic cardiomyopathy and that this impairment may be associated with left ventricular wall thickness.


[Left ventricular filling disturbances in cardiac amyloidosis: a study of atrial sound and diastolic inflow velocities]. Cardiac amyloidosis is characterized by left ventricular filling disturbances in a relatively early stage. To investigate such disturbances more precisely, we studied atrial sound and left ventricular inflow velocity patterns. Twelve cases diagnosed as cardiac amyloidosis according to the clinical criteria including rectal biopsies and serum amyloid proteins or at autopsy were reviewed and analyzed. Their mean age was 60.9 +/- 12.5 years. Twelve age-matched cases with hypertrophic cardiomyopathy (HCM) served as the controls. We measured the amplitude of atrial sound by low-frequency phonocardiograms and the ratio of the heights of the A wave of apexcardiograms (ACG) to the total amplitude of the ACG. The mitral inflow velocity patterns were recorded using pulsed Doppler echocardiography. The rapid filling wave (R), atrial filling wave (A) and the ratio of A to R (A/R) were measured. In the amyloidosis group, atrial sound moderately increased in 2 cases, it was faint in 9 and not manifest in the remaining one. The A wave in the amyloidosis group was significantly smaller than that in the HCM group (p < 0.001) (12.4 +/- 3.9 vs 22.4 +/- 5.6%). In the left ventricular inflow velocity patterns, the R in amyloidosis was smaller than that in HCM (41.7 +/- 16.0 vs 56.4 +/- 12.1 cm/sec) (p < 0.02). The A in amyloidosis was also smaller than that in HCM (40.5 +/- 13.4 vs 58.1 +/- 13.0 cm/sec) (p < 0.006). The A/R was 1.0 +/- 0.34 in amyloidosis and 1.1 +/- 0.32 in HCM (N.S.). Both A and R were significantly less in amyloidosis than those in HCM.(ABSTRACT TRUNCATED AT 250 WORDS)


[Hemodynamic difference accounted for the orientation of a Björk-Shiley mitral prosthesis: a color Doppler echocardiographic study]. To determine whether the orientation of the major orifice of a mitral tilting disc prosthesis affects hemodynamics, intracavitary blood flow patterns were studied in 45 patients with well-functioning Björk-Shiley mitral prosthesis using color Doppler flow imaging. The major orifice was oriented towards the septum in 23 patients (12 men, 11 women, age 58 +/- 11 years; group S), and towards the posterior wall in 22 patients (8 men, 14 women, age 55 +/- 9 years; group P). 1) The left ventricular end-diastolic dimensions (S: 4.8 +/- 0.9 cm, P: 5.2 +/- 1.0 cm), end-systolic dimensions (S: 3.6 +/- 0.9 cm, P: 3.8 +/- 1.2 cm), and left atrial dimensions (S: 5.0 +/- 1.0 cm, P: 4.7 +/- 0.9 cm) did not differ significantly between the 2 groups. 2) The peak mitral flow velocities (S: 1.43 +/- 0.38 m/sec, P: 1.43 +/- 0.27 m/sec), pressure gradients (S: 8.5 +/- 4.0 mmHg, P: 8.4 +/- 3.1 mmHg), and pressure half-times (S: 94.0 +/- 19.0 msec, P: 86.5 +/- 21.7 msec) did not differ significantly between the 2 groups. 3) Although mitral regurgitation was detected in 8 patients (35%) in the S group and in 2 patients (9%) in the P group, hemodynamically significant regurgitation was detected in only 4 patients in the S group (3 mild, one moderate). 4) The patients in the S group had reversed intracavitary blood flow; mitral flow was first directed towards the left ventricular outflow tract during diastole, while the outflow pattern was displaced into the left ventricular inflow tract.(ABSTRACT TRUNCATED AT 250 WORDS)


A simple noninvasive measurement of stenotic mitral valve area: an alternative approach using M-mode and Doppler echocardiography. Doppler echocardiography is a widely used noninvasive technique to examine the mitral valve area (MVA) by obtaining mitral pressure half-time (PHT) and to assess the severity of the stenosis. However, several hemodynamic factors influence the PHT and may render the PHT data inaccurate in any measurement of MVA under certain conditions. Using a simple echo-Doppler (E-D) method, we assessed the MVA in a physiological equation. The mitral flow volume (MFV) is represented by MVA x transmitral mean flow velocity (mV) x diastolic filling time (DFT). Thus, the formula can be restated as MVA (cm2) = MFV (cm3)/mV (cm/sec) x DFT (sec). We measured MFV by M-mode, and mV and DFT by continuous wave Doppler echocardiography. This formula was tested in 43 patients with isolated mitral stenosis. MVA was obtained by the PHT and E-D methods, and the data obtained were validated against the results of cardiac catheterization. The results obtained using the E-D method showed much better correlation (r = 0.82) with those of catheterization than those with the PHT method (r = 0.52). The inter- and intraobserver variabilities were checked. The results obtained with the E-D method were found to be reproducible. To further validate the accuracy of the E-D method, MVA was measured by both methods at different R-R intervals after exercise and the results were compared. The MVA obtained by the PHT method showed marked variations; whereas, that obtained by the E-D method remained nearly constant. Similarly, in a patient with atrial fibrillation, the MVA assessed by the PHT method varied from beat to beat; whereas, the fluctuations in MVA were minimal using the E-D method. We concluded that the E-D method can be reliable and clinically easily applicable for the accurate assessment of MVA.


[Blood flow dynamics and dimensions of the descending thoracic aorta in patients with intra-aortic swirling echoes: assessment by biplane transesophageal echocardiography]. To examine the blood flow dynamics in the descending thoracic aorta (DAo) where intra-aortic swirling echo contrast was observed, we analyzed the flow velocity patterns (FVP) in DAo and the DAo dimensions by biplane transesophageal echocardiography (TEE) in 9 patients with intraortic swirling echo contrast and in 25 control subjects (N). We recorded sampling volumes with pulsed Doppler echocardiograms at 3 sites: median, central, and lateral sites on longitudinal scan images and on the DAo at the level of the mitral valve. We measured systolic peak flow velocity (Vp), time from the onset of the systolic flow to Vp (acceleration time: AT), deceleration time (DT) of the systolic flow, and AT/(AT + DT) for each sampling volume in the DAo. From the M-mode echogram of DAo, we measured the maximum dimension of the aorta, which usually coincided with the mid to late systolic phase. In the normal controls, the systolic forward flow was followed by a small reversal flow in early diastole and then by a small forward flow during holodiastole. Vp was highest at the center (64 +/- 10 cm/sec), then at the median (60 +/- 11 cm/sec) and lowest in the lateral (56 +/- 9 cm/sec; p < 0.01 vs center) sites in the DAo. AT was 70 +/- 13 msec and DT 215 +/- 26 msec. This flow velocity profile in the DAo was observed in both the control and patient groups. In patients with intra-aortic swirling echoes, Vp was markedly low (33 +/- 7 cm/sec; p < 0.001 vs N) and dimension of the DAo (13 +/- 2 mm/m2 in N) was significantly enlarged (21 +/- 7 mm/m2; p < 0.001 vs N), which might be related to swirling echoes and mural thrombi at the lateral portion in the DAo. Thus, we concluded that intra-aortic swirling echoes closely related to the production of mural thrombi observed mainly at the lateral site of the significantly dilated DAo.


[Three-dimensional radiologic device as a new diagnostic aid in angiocardiography]. Angiography with 180 degrees arc was performed using a rapidly rotating stereoradiographic device and a single injection of contrast medium. Duration of rotation of the X-ray tube through 180 degrees was 2.25 sec. The angiograms displayed in a rotating manner were three-dimensional with depth information. Every adjacent angiograms were obtained by the rapidly rotating X-ray tube at slightly different angles and positions, resulting in paired stereo images. The angiograms can be displayed on side-by-side monitors and viewed stereoscopically with a stereoviewer. Rotating images were displayed at 30 frames/sec (60 fields/sec) and were viewed in a fluorographic manner. To apply the data to angiocardiography the following procedures were required: 1) the start of rotation of the X-ray tube was synchronized with the R wave of the EKG, 2) suspension of respiration, and 3) the subject's upper extremities were immobilized at his head. To obtain left atrial angiograms the following steps were taken: 1) the circulation time from the pulmonary artery to the left atrium was estimated by injecting 15 ml contrast medium into the pulmonary artery under the fixed X-ray tube, then, 2) X-ray exposures of 20 fields/sec were obtained during 15 sec, and 3) left atrial arteriograms were taken by using the rotating X-ray tube referring to the circulation time. With this method, stenotic lesions of the coronary arteries and collateral pathways were easily observed simultaneously with morphological changes in a 180 degrees arc.(ABSTRACT TRUNCATED AT 250 WORDS)


[Left atrial ejection performance in heart failure as assessed by transesophageal Doppler echocardiography]. To investigate the left atrial ejection performance in heart failure, we observed both the transmitral (TMF) and pulmonary venous flow waves (PVF) by transesophageal Doppler echocardiography in 20 patients with heart failure (16 males, 4 females, 56 +/- 13 years old). In 7 of 20 patients, pulmonary capillary wedge pressures (PC) were also obtained within 72 hours after the transesophageal Doppler echocardiographic examinations. A reversal flow on PVF during atrial systole (atrial backward ejection flow) was observed in all of the 20 patients. Corrected atrial pre-ejection period correlated significantly with PC (r = -0.76, p < 0.05), indicating that the period was shortened in accordance with left atrial Starling's law. This period correlated significantly with both the duration and the time velocity integral of atrial backward flow (r = -0.72, p < 0.005; r = -0.55, p < 0.05, respectively), but not with the atrial ejection time nor with the time velocity integral of atrial systole. These results suggest that in some cases of heart failure, left atrial contractile function is preserved despite the marked augmentation of left atrial afterload, resulting in a decrease of the left atrial forward ejection and an increase of the left atrial backward ejection. Thus, the observations of TMF and PVF by transesophageal Doppler echocardiography are useful for assessing the left atrial ejection performance in patients with heart failure.


[Anthracycline cardiotoxicity evaluated by digitized M-mode echocardiography]. Ten patients with malignant diseases whose mean age was 20.0 +/- 13.2 years received anthracycline derivatives therapy and were evaluated for their left ventricular systolic and diastolic functions by computer-assisted digitized M-mode echocardiography. Fractional shortening (%FS), a parameter of systolic function, was measured. The first derivative of left ventricular dimension change (peak LV dD/dt), posterior wall thinning (peak LVPW thinning rate) and interventricular septum thinning (peak IVS thinning rate) were used as indices of diastolic function. Blood pressure (BP) was measured noninvasively at the end of the echocardiographic examination and hemoglobin concentration (Hb) was measured on the same day. These examinations were performed immediately before administration of anthracycline and one week and one month after the last administration. Statistical analyses were performed using the Student's t-test. The mean BP, HR, LVDd, LVDs, LVPW and IVS remained unchanged following the drug administration. %FS did not change significantly; 36.8 +/- 6.3%, before the administration, 35.3 +/- 6.5%, one week after the administration, and 36.5 +/- 5.1%, one month after the administration. Peak LVdD/dt and the peak LVPW thinning rate decreased appreciably from 4.46 +/- 1.10 to 3.76 +/- 1.08, and from 7.99 +/- 1.55 to 6.41 +/- 1.04, respectively, one week after the administration. The peak IVS thinning rate decreased from 3.54 +/- 0.81 to 2.99 +/- 0.79 after one week (p < 0.01). All of these values returned to the control levels in one month after the drug administration. We concluded that the indices of left ventricular diastolic function were more sensitive for detecting cardiac impairment than those of systolic function during the course of anthracycline therapy.


[Ischemic myocardial injury evaluated using positron emission tomography in children with coronary artery disease: comparison with thallium-201 SPECT]. Regional myocardial perfusion and glucose metabolism were evaluated by positron emission tomography (PET) in children with coronary artery disease. Also, PET findings were compared with those of thallium-201 myocardial single photon computed tomography (SPECT). The study patients consisted of 11 children ranging in age from 3 to 14 years. Ten patients had significantly stenotic coronary arterial lesions due to Kawasaki disease, and one patient had a left coronary artery with an anomalous origin from the pulmonary artery. Evaluation was made before and after surgical revascularization in 3 patients. Regional myocardial perfusion was assessed at rest using 13N-ammonia, and regional myocardial glucose metabolism was assessed at rest under fasting conditions using 18F-fluorodeoxyglucose (18FDG). SPECT was performed after dipyridamole infusion. Initial and delayed images were obtained 7 min and 3 hrs after dipyridamole infusion, respectively. Left ventricular myocardial images were categorized as the septal, anterior, lateral, apical, and inferior segments, and evaluation was made for each segment. A total of 70 myocardial segments in 11 patients were classified into 4 groups according to the PET findings: 1) segments with normal perfusion and without enhanced 18FDG uptake (normal segments; n = 55), 2) normal perfusion with enhanced 18FDG uptake (metabolically abnormal segments; n = 3), 3) hypoperfusion with enhanced 18FDG uptake (ischemic but viable segments; n = 9), and 4) hypoperfusion without enhanced 18FDG uptake (non-viable segments; n = 3). On SPECT, the numbers of myocardial segments showing no perfusion defects, complete redistribution, incomplete redistribution, and persistent perfusion defects were 38, 12, 14, and 6, respectively. Comparisons were made between PET findings and SPECT findings.(ABSTRACT TRUNCATED AT 250 WORDS)


[The effect of propranolol on the myocardial force-length relationship in the in situ canine left ventricle]. The effect of beta-adrenoceptor blockade on the wall performance of the in situ canine left ventricle (LV) was evaluated based on the LV end-systolic force-diameter (Fes-Des) relation in 10 healthy mongrel dogs. LV diameter was measured with ultrasonic crystals, and LV pressure was measured with a micromanometer. Preload was altered by inferior vena caval (IVC) occlusion. In the control contractility state, the IVC was occluded for 7 sec. Blockade of the cardiac beta-adrenergic nerves was induced with 2 mg/kg propranolol i.v.. Slopes (Ec) and extrapolated diameter intercepts (D(o)) of the LV Fes-Des relation were obtained from end-systolic data of the control contractility state and after the infusion of propranolol. Ec was used as an index for the inotropic state of the myocardium of the LV wall. IVC occlusion during 7 sec under the control contractility state produced little change in the heart rate. Thus, IVC occlusion for 7 sec avoided the major reflex change of autonomic tone. After the infusion of propranolol, the heart rate and Ec both decreased by 24 and 43% of the control value, respectively; whereas, D(o) was not significantly altered. Therefore, it was suspected that the cardiac beta-adrenergic nerve played an important role in maintaining myocardial contractility state of the in situ canine LV wall.


[Cardiac and plasma catecholamine response to dynamic exercise in hyperthyroidism]. To investigate cardiac and sympathoadrenal responses to dynamic exercise, heart rate, systolic blood pressure, serial plasma norepinephrine (NE) and epinephrine (E) concentrations during multistage treadmill exercise were measured in 24 hyperthyroid patients (mean age; 42 +/- 16) and 24 age-sex matched control subjects. Eleven patients were re-examined in the euthyroid state after antithyroid therapy. Exercise duration was shorter in patient with hyperthyroidism. Also, the heart rates and systolic blood pressures at rest and in the early stage of exercise were significantly higher in hyperthyroidism. NE at rest (normal vs hyperthyroid: 124 +/- 10 vs 80 +/- 7 pg/ml, p < 0.01) and NE at peak exercise (475 +/- 38 vs 310 +/- 38 pg/ml, p < 0.01) were lower in hyperthyroidism. E at rest (22 +/- 2 vs 29 +/- 4 pg/ml, n.s.) did not differ, however, E during the first stage of exercise (30 +/- 3 vs 69 +/- 12 pg/ml, p < 0.01) was higher in hyperthyroidism. Re-examination for the euthyroid state revealed the decreases in the heart rates and systolic blood pressures at rest and in the early stage of exercise, and the normalization of the NE and E response. Thus, patients with hyperthyroidism was in the hyperdynamic cardiac state at rest and during dynamic exercise, which was accounted for by decreased sympathetic nervous activity and increased adrenomedullary responses. These modifications of sympathoadrenal response seemed reversible when patients were controlled by antithyroid therapy.


[Left ventricular behavior following acute right ventricular pressure overload: an experimental study]. Relationships between biventricular pressures, left ventricular shape and paradoxical septal motion in patients with right ventricular pressure overload (RVPO) are unknown. To clarify these relationships, we measured left and right ventricular short-axis dimensions and ventricular pressures using anesthetized open-chest dogs with pulmonary embolizations. With repeated microembolization, right ventricular systolic pressure (RVSP) increased stepwise from a level of 27 mmHg to the maximum value of 72 mmHg. This elevation caused gradual leftward shift of the interventricular septum (IVS) both at end-diastole and end-systole. Further embolization caused collapse (shock: left ventricular systolic pressure: LVSP < 70 mmHg) with a fall in RVSP. In the state of shock, the rise in right ventricular end-diastolic pressure (RVEDP) and fall in left ventricular end-diastolic pressure (LVEDP) were prominent, and the degree of shift of the IVS became significantly greater at end-diastole than at end-systole, resulting in paradoxical motion of the IVS. There were significant linear relationships between the degree of end-diastolic IVS displacement and end-diastolic transseptal pressure (LVEDP-RVEDP), and between the degree of end-systolic IVS displacement and end-systolic transseptal pressure (LVESP-RVESP) throughout the course of repeated pulmonary microembolization even in the state of shock. In conclusion, abnormal movements of the IVS in RVPO patients indicate the presence of a marked decrease in end-diastolic transseptal pressure due to right ventricular failure.


[Left ventricular function assessed by multigated blood pool single photon emission computed tomography with 99mTc]. To evaluate the usefulness of gated blood pool single photon emission computed tomography with 99mTc (gated SPECT) for assessing left ventricular function, we performed gated SPECT in 2 normal subjects and 18 patients including 13 with ischemic heart disease, 3 with hypertrophic cardiomyopathy and 2 with dilated cardiomyopathy. Left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF) and regional wall motion obtained by gated SPECT were compared with the results of contrast left ventriculography (contrast LVG), echocardiography and planar multigated blood pool imaging (planar blood pool). After the patients' red blood cells were labelled with 30 mCi (1,110 MBq) 99mTc in vivo, gated SPECT was performed in each of 32 projections through a 360 degree arc for each of the cardiac cycle divided into 16. From these images, the left ventricular vertical long-axis image, the horizontal long-axis and short-axis images were reconstructed. To calculate LVEDV, we used serial short-axis images which were composed of the left ventricle. To define left ventricular and left atrial borders, we used amplitude images and cinematic displays of the vertical long-axis image. The level of the optimal cut for delineating the left ventricular border was determined from the volume-cut-level-graph at each background activity, which was constructed by a phantom study. Left ventricular wall motion by gated SPECT was compared with the results of contrast LVG according to segmental analysis. LVEDV obtained by gated SPECT showed an excellent linear correlation with LVEDV calculated by echocardiography (r = 0.98, p < 0.01) and by contrast LVG (r = 0.89, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


[Trial assessment of pain threshold].

[Trial assessment of pain threshold]. To elucidate the pathological aspects of silent myocardial ischemia, we studied 24 patients with ischemic heart disease who had culprit lesions in the left anterior descending artery (LAD). We determined the presence of myocardial ischemia and measured coronary wedge pressures (CWP; mmHg) and collateral circulation and ST deviation on the ECG (intracoronary ECG: ic-ECG, and surface ECG; mm) after balloon inflation during PTCA intervention. The study subjects included 9 with exertional angina, 10 with post-infarction angina, and 5 with Cohn type II angina. During 78 balloon inflations, the group of ischemic symptoms (Group S) occurred in 40% of all cases, the group without ischemic symptoms (Group A) constituted 45%, and the Cohn type II specific for ischemic symptoms accounted for 15%. The relationship between CWP (X-axis) and ST deviation (Y-axis) of ic-ECG was: Y = -0.46X + 20.19 (r = -0.59; p < 0.01), and the relationship between CWP and ST deviation of the surface ECG was: Y = -0.12X + 6.58 (r = -0.42; p < 0.01). Thus, a negative correlation was confirmed between them. Furthermore, similar results were obtained for Groups S and A. Based on this relationship, the pain threshold was estimated. In Group S, CWP exceeded 34 mmHg, i.e., ischemia was expected to be mild because of good collateral circulation, but an average ST deviation accompanying ischemic symptoms was observed. However, in Group A, CWP was less than 24 mmHg, i.e., ischemia was expected to be severe due to poor collateral circulation, but an average ST deviation lacking ischemic symptoms was observed. Comparison of these results showed that the pain threshold observed from the ST deviation of ic-ECG was 6.0-6.5 mm and that of the surface ECG was 2.6-2.8 mm. From these threshold values, the ST deviations during 12 balloon inflations in the Cohn type II were evaluated. Because 100% of ic-ECG and 75% of surface ECG exhibited values exceeding the threshold values, it was concluded that the cause of the Cohn type II was an increase of the pain threshold. ST deviations of the ic-ECG for Group S and the Cohn type II were 12.0 +/- 6.7 and 9.8 +/- 2.7 mm, respectively, and ST deviations of the surface ECG were 4.7 +/- 2.4 and 3.5 +/- 1.7 mm, respectively. Since there were no significant differences between Group S and the Cohn type II, it was concluded that the ischemic degree of the Cohn type II was approximately the same as that of Group S.


[Secretion of atrial natriuretic peptide during artificial pacing: assessments including the influence of ventriculoatrial conduction]. Secretion of atrial natriuretic peptide (ANP) depends on the atrial wall distension which may be caused by ventricular pacing. This study was designed to assess the differences in plasma ANP level between DDD and VVI pacing. We measured ANP from venous blood samples using radio-immunoassay in patients with the sick sinus syndrome (n = 8) and atrioventricular block (n = 2) following DDD implantation. Measurement was made under control conditions during DDD and 15-180 min after the pacing mode was changed to VVI and 60 min after returning to DDD. Serum epinephrine (E), norepinephrine (NE), renin (R) and aldosterone (A) levels were also measured prior to and every 30 min after pacing mode changes. The plasma ANP concentration changed from 71.3 pg/ml (normal value) with DDD to 126.8 (15 min), 180.6 (30 min), 221.8 (60 min), 219.2 (90 min), 270.1 (120 min), 145.4 (150 min) and 115.1 pg/ml (180 min) with VVI. It increased markedly, then gradually decreased. It returned to the control value (66.6 pg/ml) in 60 min with DDD, and it reached the peak level with VVI within 60-120 min, and the peak was significantly higher than that for DDD. The increase related to the retrograde ventriculoatrial conduction during VVI pacing. There was no significant change in the NE, E, R and A concentrations. Systolic blood pressure decreased 15 mmHg in VVI and returned to normal by DDD. These results indicated that plasma ANP levels is elevated by VVI pacing, though it was not explained by ventricular pacing alone.


[Complications of emergency coronary angioplasty for acute myocardial infarction]. To assess the incidence and consequences of complications occurring during emergency percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI), we studied 347 patients who underwent PTCA within 24 hours after the onset of AMI. Acute occlusion occurred in 29 patients (8.4%), of whom 16 patients underwent successful repeat PTCA. All of them survived until hospital discharge. The in-hospital reocclusion rates of these 16 patients were comparable to those of patients who had not experienced acute occlusion (18.8 vs 12.8%, ns). In the remaining 13 patients, reperfusion were not successful after acute occlusion, and 6 died. Side branch occlusion occurred in 21 patients (6.1%). Left circumflex artery occlusion occurring during PTCA for the proximal left anterior descending artery was fatal in 3 patients. Right ventricular branch occlusion during PTCA for the middle of the right coronary artery resulted in intractable right ventricular infarction in one patient, and he died. Among 14 patients who underwent repeat angiography, 13 had a patent side branch which had been occluded during PTCA. One patient had coronary rupture and died. During PTCA of the proximal left anterior descending artery, acute occlusion of the artery without reperfusion or occlusion of the left circumflex artery was often fatal. However, the prognosis of acute occlusion was relatively good, if repeat PTCA was successful and most of the occluded side branches remained patent in the chronic state.


[Possible pathogenesis of giant negative T and negative U waves in hypertrophic cardiomyopathy: a report of two cases]. Giant negative T (GNT) and negative U (NU) waves are electrocardiographic findings which have been frequently observed in hypertrophic cardiomyopathy (HCM). Here we report 2 cases. For the first patient, electrocardiographic and left ventriculographic studies before and after the development of GNT and NU waves and left ventricular high voltage during the follow-up period were performed. For the second patient, electrocardiographic and echocardiographic findings were obtained before and after onset of posterior myocardial infarction. In the first patient, posterior papillary muscle hypertrophy was evident on left ventriculography after appearance of GNT and NU waves. In the second patient, both GNT and NU waves disappeared after posterior myocardial infarction. Two-dimensional echocardiograms demonstrated akinesis in the posterior wall, including the posterior papillary muscle, after 8 weeks of posterior infarction. Therefore, we suggest that apical hypertrophy, especially of the posterior papillary muscle, may play an important role in the pathogenesis of GNT and NU waves in HCM.


[Myocardial perfusion and left ventricular function during exercise evaluated by 201Tl myocardial scintigraphy and 99mTc radionuclide ventriculography in patients treated with PTCA]. To evaluate the effects of percutaneous transluminal coronary angioplasty (PTCA), we investigated myocardial ischemia and left ventricular function during exercise before and after successful PTCA in 30 patients. We used extent and severity scores of 201thallium (201Tl) exercise myocardial scintigraphy to assess myocardial ischemia and determined global and regional left ventricular ejection fraction (EF and REF) of 99mTc-RBC exercise radionuclide ventriculography to assess left ventricular function. The extent and severity scores of stress images were significantly less after PTCA than before PTCA. The scores of the redistribution images were unchanged before and after PTCA. Global EF during exercise was significantly higher after PTCA than before PTCA. There was no difference in resting global EF between before and after PTCA. Myocardial ischemia induced by exercise was semi-quantitatively analyzed as transient perfusion defect with severity score. Severity score was significantly less after PTCA than before PTCA. delta EF, which was obtained by subtraction of resting global EF from exercise one, was significantly higher after PTCA than before PTCA. However, the degree of improvement in myocardial ischemia and left ventricular function varied from patient to patient. In 17 patients with one-vessel left anterior descending artery disease, delta REF, which was determined by subtracting resting regional EF from exercise one, was significantly higher in septal and apical segments after PTCA than before PTCA. Myocardial ischemia and left ventricular function under exercise were alleviated by PTCA. However, the degree of improvement varied from patient to patient and it might have been affected by various factors including coronary dissection, edema, thrombus, restenosis, spasm, side branch stenosis or occlusion, distal thrombus, and myocardial hibernation.


[Continuous monitoring of coronary venous oxygen saturation during PTCA and its relation to electrocardiographic ST changes]. The purpose of this study was to investigate change in coronary venous oxygen saturation (CSO2-Sat) during percutaneous transluminal coronary angioplasty (PTCA) and to compare the results with those of standard 12-lead ECGs (s-ECG) and epicardial ECG induced using an intracoronary guidewire (ic-ECG). CSO2-Sat was measured continuously in 10 patients undergoing PTCA; 5 patients with lesions in the left anterior descending coronary artery (LAD), one with lesions in the left circumflex artery (LCX), and 4 with right coronary artery (RCA) lesions. The results were as follows: 1. In all 6 patients with stenotic lesions in the left coronary artery, CSO2-Sat decreased by 5 to 22% immediately after balloon inflation. Significant changes in ic-ECG (ST deviation > or = 0.1 mV) were observed in 5 of the 6 patients, while significant changes in s-ECG (ST deviation > or = 0.1 mV) were observed in only 3 of the 6 patients. The s-ECG did not seem to be sensitive enough to represent myocardial ischemia in the LCX. 2. The interval from the balloon inflation to the significant change was shorter for CSO2-Sat than for the ECGs in 4 of the 5 patients with LAD lesions, except Case 4. The recovery time of CSO2-Sat to the basal level on balloon deflation was longer than the recovery times of ic-ECG and s-ECG. 3. There was no significant change in the CSO2-Sat in 3 of the 4 patients undergoing PTCA for RCA lesions, while significant changes were observed in the ic-ECG and s-ECG in all 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)


[Assessment of prognosis of old myocardial infarction]. In an attempt to predict high risk myocardial infarction, we studied 201 patients with Q wave infarction with dipyridamole-loading thallium-201 myocardial perfusion scintigraphy (D-MPS), left ventriculography, coronary angiography and treadmill exercise testing. The results of these tests were related to the use of initial PTCA or CABG, and the occurrence of cardiac deaths and nonfatal cardiac events during a mean follow-up period of 39 months. Three high risk parameters were identified by D-MPS; partial redistribution, diffuse slow washout, and extensive fixed defects. The patients were categorized into 3 groups according to the numbers of high risk parameters: group A (n = 50), patients with 2 or more high risk parameters; group B (n = 95), patients with one high risk parameter; group C (n = 56), patients without a high risk parameter. The prevalence of 3-, 2-, and one- or insignificant vessel disease was 72, 20 and 8% in group A, 15, 16, and 69% in group B, and 5, 13 and 82% in group C, respectively. Initial PTCA or CABG was performed in 42% of the patients in group A, 5% of the patients in group B, and 2% of the patients in group C. Among medically-treated patients, cardiac deaths occurred in 31% in group A, 4% in group B, and in none in group C. Nonfatal cardiac events occurred in 24, 12, and 4%, respectively. Coronary angiography revealed 3-vessel disease in 53 patients, 2-vessel disease in 32, and one-vessel disease or insignificant lesions in 116 patients. Initial PTCA or CABG was performed in 45% of the patients with 3-vessel disease, 6% of those with 2-vessel disease and 1% of those with one-vessel disease. Among medically-treated patients, cardiac deaths occurred in 31% with 3-vessel disease, 7% with 2-vessel disease, and in 2% with one-vessel disease. Nonfatal cardiac events occurred in 17, 10, and 3%, respectively.


[Clinical features of latent dilated cardiomyopathy]. To identify the evidence of presymptomatic manifestations of dilated cardiomyopathy (DCM), we studied 30 patients with latent DCM (mean 37 +/- 14 years) who satisfied the following criteria: 1) left ventricular (LV) systolic function was slightly reduced; 2) LV end-diastolic dimension (< 54 mm) and coronary arteries were normal. The incidence of ECG abnormalities was relatively high; nonspecific ST-T changes were the most common (90%). The incidence of grade 3 or 4 ventricular premature contractions according to Lown's classification on 24 hour ambulatory ECGs was 50%. Perfusion defects were observed in 83% on the thallium-201 images. Right ventricular biopsy showed that the interstitial fibrosis was milder (9 +/- 9%) in the study subjects than in 32 patients with DCM (17 +/- 8%) who were treated in our hospital, but there were no significant differences in the diameters of the myofibers (15 +/- 4 vs 17 +/- 4 microns) between the 2 groups. During the follow-up study, deterioration of LV dysfunction was observed in 3 patients. One patient died suddenly. These findings proved the importance of the early detection and characterization of latent state of DCM.


[Clinical and echocardiographic evaluation of the effects of atrial defibrillation in patients with idiopathic cardiomyopathy]. To elucidate the effects of atrial defibrillation in patients with idiopathic cardiomyopathy, we clinically and echocardiographically assessed 6 patients with hypertrophic cardiomyopathy (HCM) and 7 patients with dilated cardiomyopathy (DCM). Their mean age was 57 +/- 14 years and the mean duration of their atrial fibrillation (Af) was 47 +/- 29 days. There were no differences in age and the duration of Af between the HCM and DCM groups. We assessed the effects of defibrillation on the NYHA functional classification, heart rate (HR), systolic blood pressure (S-BP), M-mode echocardiographic data (LVDd, LVDs, %FS, LAD) and transmitral pulsed Doppler echocardiographic findings (peak velocity, time-velocity integral of rapid and atrial filling waves). These indices were obtained before and 52 +/- 22 days after defibrillation, and were compared with each other. 1. HR decreased (HCM: 87 +/- 16-->58 +/- 7/min, DCM: 93 +/- 19-->70 +/- 14/min) and total left ventricular filling increased (HCM: 6 +/- 1-->11 +/- 4 cm, DCM: 6 +/- 1-->10 +/- 2 cm) after defibrillation, and the increment of %FS (HCM: 36 +/- 6-->41 +/- 6%, DCM: 16 +/- 6-->25 +/- 11%) was observed. Four of 6 HCM patients and 5 of 7 DCM patients also improved with regard to the NYHA classification. 2. After defibrillation, LVDd increased in HCM (42 +/- 4-->47 +/- 4 mm), but not in DCM. However, LVDs decreased in DCM (52 +/- 9-->44 +/- 12 mm), but not in HCM. We concluded that atrial defibrillation had a beneficial effect on the recovery of the left ventricular function both in HCM and DCM due to the reduction in HR and increase in left ventricular filling. The mode of LV functional improvement after defibrillation varied depending on the state of patient's basal pathophysiology .


[Left ventricular trabeculae evaluated with MRI in dilated cardiomyopathy and old myocardial infarction]. The morphological examination of the left ventricular trabeculae was performed using MRI (0.5T) in 14 normal volunteers, 12 patients with dilated cardiomyopathy (DCM), and 9 patients with old myocardial infarction (OMI). Left ventricular trabeculae were observed at the free walls of the left ventricle in all subjects, but not at the septal wall. Left ventricular trabeculae were larger in DCM than in the normals. The trabeculae were scarce in OMI and inner sides of the infarcted myocardium were very smooth. The development of the left ventricular trabeculae was graded as diminished, ordinary, and marked. Ordinary trabeculae were seen in 86% of the normals, whereas; marked trabeculae in 75% of DCM, and diminished trabeculae in 78% of OMI. In patients with DCM, the mean area of the left ventricle with marked trabeculae was greater than that with ordinary trabeculae. The more dilated left ventricle, the thinner the anterior wall was and the lower the ejection fraction was in DCM and OMI, though there were no significant differences in values of these 3 items between DCM and OMI. The MRI findings on the development of the trabeculae were confirmed in patients with DCM at autopsy. Thus, the MRI findings were very useful in the differential diagnosis between DCM and OMI.


[Late potentials in dilated cardiomyopathy in relation to ventricular tachycardia and cardiac function: their significance]. We assessed the usefulness of ventricular late potentials (VLP) for detecting ventricular tachycardia (VT), and of the relationship between VLP and left ventricular dysfunction. The subjects consisted of 21 patients with dilated cardiomyopathy (DCM) not accompanied with ventricular conduction disturbances. Signal-averaged electrocardiograms were recorded by using VCM-3000. The signals of 200 or more beats were averaged through the 40-300 Hz band-pass filter until the noise level was reduced to less than one microvolt (microV). The duration (fQRSd) and the root mean square voltage (LP40) for the last 40 msec of the filtered QRS complex were calculated. The left ventricular diastolic dimension (LVDd), systolic dimension (LVDs) and the ejection fraction (EF) were obtained by echocardiography. Five of 21 patients had VT. fQRSd was significantly longer in patients with VT than in those without VT (158.8 +/- 8.6 vs 126.5 +/- 10.4 msec, p < 0.01). LP40 was significantly less in patients with VT than in those without VT (8.7 +/- 2.7 vs 24.1 +/- 12.3 microV, p < 0.01). If the presence of "fQRSd > or = 120 msec" or "LP40 < or = 20 microV" was defined as VLP positive, as in patients with old myocardial infarction, the criteria sensitivity was 100% and their specificity was 25% for detecting VT. If the presence of both "fQRSd > or = 135 msec" and "LP40 < or = 20 microV" was defined as VLP positive, the criteria sensitivity was 100%, and their specificity, 88%.(ABSTRACT TRUNCATED AT 250 WORDS)