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A determination method of nosiheptide in formula feeds by HPLC-FL was developed and validated, including an inter-laboratory study. Formula feeds were extracted with acetone after adding acetic acid. Liquid chromatographic separation was performed using a ZORBAX Eclipse XDB-C18 column, with acetonitrile and water containing acetic acid as the mobile phase. Detection of NH was carried out with a fluorescence detector. Recovery tests and an inter-laboratory study were conducted using chicken and swine formula feeds fortified with nosiheptide at 0.5-27 mg-potency/kg. Mean recoveries in recovery tests ranged from 91.4 to 103%, and the repeatability in terms of relative standard deviation was within 7.8%. Mean recoveries of the inter-laboratory study ranged from 98.4 to 108%, the repeatability and reproducibility in terms of the relative standard deviations were within 8.1% and 13% respectively, and the HorRat values ranged from 0.21 to 0.75.

The broth microdilution (BMD) method is an antimicrobial susceptibility testing method defined as a guideline by the Clinical and Laboratory Standards Institute (CLSI). To date, the Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM), has adopted the agar dilution (AD) method for monitoring antimicrobial resistances targeting isolates of Enterococcus spp., found in the fecal flora of food-producing animals, as indicator bacteria. However, the AD method is tedious, and time-consuming. In order to examine whether it could be replaced with the BMD method, the two methods were compared in terms of the correlation of MICs. In this study, the BMD results agreed with the AD results within ±1 log(2) dilutions in 72.3% of cases, except for the antimicrobial feed additive, Nosiheptide (NHT). Similarly, except for NHT, the MIC(50) and MIC(90) values obtained by the two methods were well correlated. In conclusion, our results indicate that the BMD method might be suitable for antimicrobial susceptibility testing targeting Enterococcus spp..

The appearance of a new coronary artery lesion is important in patients with acute myocardial infarction or late coronary artery bypass grafting surgery, which sometimes lead to cardiac death. We studied coronary angiograms of 1,098 patients with coronary artery disease (from 1985 to 1996) and found new lesions in 94 patients (male 74, female 20; mean age 61.6 years). Mean observation period of all 1,098 patients was 50.1 +/- 30.4 months, and that of patients with new lesions was 73.2 +/- 31.2 months. Clinical findings of the 94 patients were acute myocardial infarction (n = 28), recurrent angina (n = 56), and silent ischemia (n = 10). The appearance of a new coronary lesion was found in 2.4% (1992), 1.9% (1993), 2.3% (1994), 1.7% (1995) of all patients with ischemic heart disease per year. The new lesions were found more often in patients with non-significant stenotic lesions (n = 74) than in patients with lesions of > or = 50% stenosis (n = 20). Complex lesions were found in 56% of the recurrent angina group, and in 22% of the silent ischemia group. In our study, the rate of appearance of new coronary artery lesions was much lower than in Europe or the United States of America. These results require careful consideration for coronary revascularization procedures in Japanese patients.

Four patients with postoperative mediastinitis who were treated by omentopexy at the Fukuoka University Hospital between 1989 and 1990. Three of the 4 patients healed successfully, another one died of multiple organ failure 83 days after surgery. All patients were received coronary artery bypass surgery harvesting a left internal thoracic artery for ischemic heart disease. Three patients had diabetes mellitus, one patient had renal failure preoperatively. Recognition of mediastinitis was made by sternal wound purulent discharge and sternal dehiscence. Culture of the discharge fluid yielded methicillin-resistant Staphylococcus aureus in three, and Enterococcus cloacae in one. Irrigation with popidone-iodine or blonopol were ineffective. Thus, the wound was treated with debridement and omentopexy with an omental pedicle flap, respectively. Postoperative course after omentopexy were excellent, had no complications. We conclude that the omentopexy is useful in the treatment of postoperative refractory anterior mediastinitis.

Konno's aortoventriculoplasty was performed in two children aged 6 years and 10 years old with congenital aortic valvular stenosis. One had previous aortic valvotomy at 21 days of age. Preoperative peak systolic pressure gradients between the left ventricle and the aorta were 120 and 140 mmHg, respectively. The original diameter of the aortic valve ring were 12 mm and 16 mm and one had supra-annular aortic stenosis whose diameter was 7 mm. The 19 mm and 23 mm SJM prosthetic valves were inserted in the subcoronary position. The postoperative course was uneventful. Their ECG showed sinus rhythm with complete right bundle branch block. Both two patients made good recovery regarding clinical data and symptoms.

To evaluate the effects of intracoronary injection of nitroglycerin (NTG) on the coronary circulation, we measured the flow velocity of the coronary artery using a Doppler catheter. The Doppler catheter was introduced into the region proximal to the left anterior descending artery (LAD) via an 8F guide catheter positioned at the orifice of the left coronary artery. We measured the flow velocity at a point of 3 mm distal to the catheter tip. One mg (2 ml) of NTG was injected via the 8F guide catheter for 10 sec, followed by injection of 3 ml of normal saline. Then the increasing rate of the diastolic coronary flow velocity in the LAD was calculated. Five ml of iopamidol (dye) was also injected for comparison. The subjects consisted of 14 normal persons (G-N), and 12 patients with angina pectoris accompanying critical stenoses of the LAD, who had no ECG changes or no abnormalities by left ventriculography. The subjects with angina pectoris were subclassified as 90% stenoses (G-A: 5 patients), and 99% stenoses (G-B: 7 patients) in the LAD. 1. After intracoronary injection of NTG, the aortic pressure dropped to various degrees in G-N. In 7 of the normal subjects, who had less than a 20% aortic pressure drop, the increased diastolic flow velocity was more rapid than the control diastolic flow velocity 30 sec after the peak velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary artery bypass surgery was performed on a 58-year-old female under cold cardioplegia with topical ice slush cooling. Bilateral phrenic paralysis was observed postoperatively, in spite of prevention with a mat during aortic cross clamp, cold injury owing to ice slush was thought to be causative. Mechanical ventilatory support continued for more than two months until her complete recovery of diaphragmatic function. She complained of sleeplessness besides respiratory symptoms, and felt uneasy. Although cold injury is mostly reversible, it is stressed that we must deliberately wean from mechanical ventilatory support, turning our attention to symptoms and blood gas analysis with as much mental assistance as possible.

Two cases of postoperative erythroderma, considered the Graft-Versus-Host disease like syndrome following blood transfusion during open heart surgery, were reported. In one, a 74-year-old female underwent the patch closure of ventricular septal perforation complicated with acute myocardial infarction, and in the other, a 67-year-old female underwent coronary artery bypass surgery. They had sudden fever, general eruption, liver dysfunction, leucopenia and thrombocytopenia, and died on the 15th and the 21st days after operation. In both, pathologically, eosinophilic necrosis was seen in agreement with basal cells and prickle cells on the epidermis. T-cells and monocytes widely infiltrated on the upper dermis, particularly around blood vessels. Furthermore, similar to on the skin, cellular infiltration and eosinophilic necrosis were seen on the esophageal mucosa. Various immunoglobulin-positive cells were seen on the dermis and the esophageal mucosa, but it is not clear that this is characteristic or not, because secondary infection possibly existed on them.

Sixty-six patients were operated on by our high degree constriction technique using DeVega tricuspid annuloplasty from 1985 to 1989. They were 20 men and 46 women, age distributed from 28 to 71 (mean 54.5). Preoperative tricuspid annular diameter ranged from 29 mm to 45 mm, average 36.3 mm. Those were constricted to 27 mm in 38 patients, and to 25 mm in 28 patients. Postoperative residual tricuspid regurgitation was observed in only 8.5% of total cases followed up 14 to 55 months. This results were comparable with other reports. We concluded that our tight constriction DeVega method is considered better to prevent postoperative tricuspid regurgitation than ordinary methods.

Vasodilators expedite the rewarming process and facilitate weaning from cardiopulmonary bypass (CPB). We continuously infused prostaglandin E1 (PG-E1) at 0.02-0.05 microgram.kg-1.min-1 (n = 11) or phentolamine (PHENT) at 5-10 micrograms.kg-1.min-1 (n = 13) during rewarming from mild hypothermic CPB. Rectal temperature was 33.3 +/- 1.7 degrees C in PG-E1 group vs. 31.3 +/- 1.3 degrees C in PHENT group at 30 minutes, and 34.0 +/- 1.2 degrees C vs. 32.7 +/- 1.1 degrees C at 40 minutes from the start of rewarming. There were significant differences (P less than 0.01 at 30 min, P less than 0.05 at 40 min) in rectal temperature between the two groups. There were no differences in perfusion index of CPB, arterial perfusion temperature, mean arterial pressure, systemic vascular resistance as well as esophageal, forehead or palm skin temperatures at any point between the two groups. The required time for weaning from CPB was significantly shorter in PG-E1 than in PHENT group (P less than 0.01, 36 +/- 8 min vs. 46 +/- 11 min). Our results also strongly suggest that PG-E1 preferentially improves splanchnic blood flow.

A 30-year-old man with chronic sustained ventricular tachycardia (VT) lasting more than seven years was treated with propranolol, 30 mg/day. This resulted in controlled cardiac rates of 90 to 130/min during sleep, and 100 to 195/min while awake. However, he experienced Adams-Stokes attacks twice, in September and December, 1986. During the second attack, ambulatory heart monitoring showed his VT rate of 212/min. An electrophysiological study revealed that the VT focal point was in the lower-mid region of the interventricular septum in the right ventricle. The VT was characterized by abnormal enhanced automaticity. This VT could not be interrupted either by single or multiple combinations of antiarrhythmic drugs. Cardiac catheterization revealed a diffusely enlarged hypokinetic left ventricle, even at the rate of 120/min VT (EF 27%, C.I. 2.3 l/min/m2). Because of his severe hemodynamic state, we performed electrical catheter ablation successfully. After the ablation, his left ventricular wall motion gradually improved. Nine months after the ablation, his left ventricular diastolic dimension decreased from 64 to 48 mm and the left ventricular systolic dimension decreased from 57 to 28 mm on M-mode echocardiography, while ejection fraction increased from 27 to 73% on the left ventriculography. Bi-ventricular myocardial biopsy specimens obtained prior to the ablation revealed only cellular hypertrophy of varying degrees, and vacuole degeneration consistent with non-specific cardiomyopathy. However, nine months after the ablation, these findings were no longer present. Thus, this case was considered tachycardia-induced cardiomyopathy initiated by VT, lasting many years.

The role of left ventricular (LV) relaxation in the determination of transmitral flow dynamics was studied with pulsed Doppler flowmetry and high fidelity tip manometry in various cardiac diseases. Study population consisted of 14 cardiac patients (pts) with sinus rhythm, including 4 pts with chest pain syndrome, 4 with myocardial infarction, 3 with effort angina and 3 with hypertrophic cardiomyopathy. The acceleration of early diastolic inflow velocity (AC), the peak of early diastolic inflow velocity (peak EFV ) and the deceleration after the peak (DC) were determined from the phasic transmitral flow pattern. Hemodynamic parameters, i.e., cardiac index, mean pulmonary wedge pressure (PWP), peak positive dP/dt and the time constant of isovolumic LV pressure decay (T) were measured during cardiac catheterization. Decreases in AC, peak EFV and DC were accompanied by prolongation of T with correlation coefficient of -.851 (p less than .001), -.808 (p less than .001) and -.697 (p less than .01), respectively, indicating that impaired LV relaxation slows down the early diastolic LV filling irrespective of underlying cardiac disease. LV filling pressure did not appear as a predominant factor affecting the early diastolic filling in the pts studied, as indicated by an insignificant correlation between any of these flow indices and PWP. Also, no significant relations were found between the flow indices and other hemodynamic parameters. These results indicate that LV relaxation plays a primary role in determining the extent of the early diastolic filling. Pulsed Doppler flowmetry provides a new approach to evaluate the impairment of LV relaxation noninvasively and sensitively in cardiac disease.

We attempted to estimate transmitral pressure gradient and mitral valve area (MVA) noninvasively in mitral stenosis (MS) by a bi-directional pulsed Doppler flowmeter combined with an electronic two-dimensional echocardiograph. Eleven patients with MS in sinus rhythm were studied by cardiac catheterization. Fifteen healthy subjects (H) served as normal control. The pulsed Doppler flowmeter operated with a carrier frequency of 2.5 MHz, a pulse repetition rate of either 5 KHz or 10 KHz and a sample volume of 1 X 3 X 3 mm. The velocity of transmitral central flow was measured by this system, monitoring audible Doppler sounds and cardiac images which depict the anatomic location of the sampling site. The Doppler signal was analyzed by a sound spectrograph. In estimating the transmitral pressure gradient and MVA, we employed a Doppler parameter (half time) defined as the time for instantaneous maximal blood flow velocity to reduce to one-half from its rapid inflow peak, which is independent of the angle between the ultrasonic beam and blood flow. Transmitral pressure gradient (delta P100) was measured as the pressure gradient between either left atrial or pulmonary capillary pressure and left ventricular pressure at the point after 100 msec from the nadir of left ventricular early diastolic pressure [( LA or PC--LVDP]100). MVA was obtained using a Gorlin's formula. The transmitral blood flow velocity in both MS and healthy groups revealed a narrow frequency band pattern with two peaks, R and A, in diastole. The former peak occurred during rapid inflow phase and the latter following atrial contraction. In the healthy group, the descent rate of R wave was increased than that in the MS group. The square root of the pressure gradient also reduced linearly with transmitral flow velocity in the MS group. Thus in the MS group, the transmitral velocity was directly proportional to the square root of the pressure gradient as described by a Bernoulli theorem, and the half time was proportional to the transmitral velocity. The square of the half time (delta t2) was highly correlated with delta P100 (r = 0.97), and the inverse of the half time (delta t-1) was correlated with MVA (r = 0.76). There was no significant correlation between delta P100 and diastolic descent rate of anterior mitral leaflet (DDR). The present study indicates that the half time is useful in estimating transmitral pressure gradient and MVA in mitral stenosis.

Vertebral arteriovenous fistulas caused by insertion of percutaneous monitoring catheter through internal jugular vein are rare complications. This is a case report of a successful treatment by transcatheter embolization using spring occluder for the fistulas. Particular attention should be paid to the following: Normal basilar and contralateral vertebral arteriograms are prerequisites to this procedure in order to avoid its potential neurological hazards. For the complete elimination of the fistulas with retrograde filling, embolic material should be placed in the artery not only proximal but also distal to the fistulas opening.

Intracardiac flow dynamic alterations in patients (pts) with prosthetic mitral valve (PMV) were studied to assess prosthetic valve functions using pulsed Doppler technique and two-dimensional echocardiography. The study population consisted of 23 pts who underwent mitral valve replacement (11 with the Starr-Edwards disc valve, nine with the Björk-Shiley tilting disc valve, two with the Hancock porcine valve, and one with the homograft valve), 20 pts with mitral stenosis, and 17 control subjects (15 healthy persons and two with lone atrial fibrillation). All pts had a normal functioning PMV by clinical evaluation except for one patient with a dysfunctioning homograft valve, which was angiographically documented. Flow velocity patterns were obtained at various sites in the left ventricle (LV) and the left atrium (LA). Flow dynamic alterations in pts with PMV were evaluated from the half time of transmitral flow velocity descent in diastole, as an index of the atrioventricular pressure gradient, the extent of dispersion of Doppler frequency spectrum of intraventricular flow as an index of the degree of flow disturbances and the Doppler signals with broadening spectra indicating transvalvular regurgitant flow into the LA. The results were as follows: In pts with PMV, the velocity of transmitral flow decreased slowly and linearly throughout diastole. The half time was significantly prolonged for pts with PMV as compared with that for control subjects (272 + 94 ms [mean + SD] vs 79 + 15 ms, p less than .001), though it was shorter than that in pts with mitral stenosis (457 + 145 ms, p less than .001). In pts with PMV, the half time for pts with the Björk-Shiley valve was relatively short as compared with that for pts with other valve. Marked prolongation of the half time (483 ms) was observed in a patient with a dysfunctioning homograft valve. These findings indicate that any PMV is obstructive, even with normal valve function, as compared with healthy mitral valves and that the Björk-Shiley valve is superior to the other PMVs studied in regard to the pressure gradient across PMV. Diastolic flow velocity patterns in the LV were highly dependent on the type of PMV. Apparently, the flow characteristics in the LV were disturbed in every patient with PMV regardless of the type of PMV. The high pressure gradient across the PMV suggested by the prolonged half time in pts with PMV, may be partially caused by flow disturbances produced by PMV.(ABSTRACT TRUNCATED AT 400 WORDS)