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The cardiovascular effects of (2RS,3SR)-2-aminomethyl-2,3,7,8- tetrahydro-2,3,5,8,8-pentamethyl-6H-furo[2,3-e]indol-7-one hydrochloride (CAS 170684-14-7, UK-1745), a novel cardiotonic agent, were investigated using in vitro and in vivo preparations. In paced left atria isolated from guinea pigs, both UK-1745 and vesnarinone (CAS 81840-15-5) showed a concentration-dependent positive inotropic effect. In spontaneously beating guinea pig right atria, both agents caused only a minimal chronotropic effect. In isolated, blood-perfused canine papillary muscle preparations, UK-1745 and vesnarinone injected intra-arterially into the anterior septal artery (ASA) increased the developed tension in a dose-dependent manner. In isolated, blood-perfused canine sinoatrial node preparations, both agents injected into the right coronary artery (RCA) did not cause any appreciable changes in the sinus rate. UK-1745 increased the blood flow through the ASA and the RCA in a dose-dependent manner, whereas vesnarinone did not. In anesthetized open-chest dogs, UK-1745 injected intravenously increased cardiac contractility and cardiac output, and decreased left ventricular end-diastolic pressure, systemic vascular resistance and heart rate. In experimentally induced acute heart failure in anesthetized open-chest dogs, intravenously injected UK-1745 effectively improved hemodynamic functions. In conscious instrumented dogs, orally administered UK-1745 increased LV dP/dtmax with insignificant changes in systemic blood pressure and heart rate. In mice, orally administered UK-1745 protected the development of ventricular fibrillation induced by chloroform inhalation, whereas vesnarinone did not. Thus, in respect of inotropic and chronotropic effects, UK-1745 closely resembled vesnarinone, but differed from vesnarinone in respect of coronary vasodilating and antiarrhythmic effects. The results suggest that UK-1745 is a novel positive inotropic agent with vasodilatory and antiarrhythmic properties, without significant chronotropic action, and may be beneficial for the treatment of congestive heart failure.

Horner syndrome due to mediastinal neurinoma has been reported rare cases so far. We experienced a 55-year-old woman who developed Hornor syndrome due to mediastinal neurinoma and the patient received operation with no major complication. She was admitted to our hospital because of the left shoulder pain and the dilatation of the mediastinum on chest X-ray. She was found to have the left mild ptosis and CT scan showed left upper mediastinal tumor (12 cm in diameter) with tracheal compression. Aortography showed a 8.6 cm tumor stein and lower deviation of aortic arch. The feeding artery was branch of thyrocervical artery. Mediastinal neurinema was found by biopsy. During the operation, we found the origin was the left sympathetic nerve. The post operative course was uneventful however horner syndrome was progressed due to radical resection of the tumor.

We retrospectively studied clinical problems for 55 patients with primary hyperparathyroidism who were operated on at our hospital. The chance to discovery of primary hyperparathyroidism and its accompanied symptoms were various. Other than classical symptoms, hypertension was noted in 12 patients and malignant tumors in 9. Forty-four percent of patients who had no bone related symptoms were found to have decreased bone mineral density (BMD). Even the patients with normal BMD were seen to increase the BMD, postoperatively. We thought that the parathyroidectomy was indicated for the asymptomatic patients with normal BMD. Biochemical investigation showed that positive rate were 50% for PTH-C, 94% for PTH-HS, 78% for intact PTH, 87% for serum total calcium and 98% for serum ionized calcium. Serum ionized calcium and intact PTH were useful for the diagnosis of patients who had normocalcemia or slight elevation of serum calcium. The sensitivity was 61% for ultrasound sonography (US) and 49% for computer tomography (CT) and scintigram, respectively. The detection rate of US and CT was positively related to the size of the parathyroid glands, but scintigram was not. The rate with which the parathyroid glands can be recognized during operation increased from 30% in the former group to 52% in the later group. As a result, 11% of the patients with adenoma had too much surgery and 29% of the patients with hyperplasia had too little surgery.

The authors describe a case of xanthofibroma of the skull. A 53-year-old female was admitted to our hospital in September, 1991, with subarachnoid hemorrhage due to a ruptured aneurysm of the anterior communicating artery. The roentgenogram of her skull incidentally revealed the presence of a radiolucent (a punched out) lesion of about 20 x 25 mm in the right occipital bone. On computed tomography (CT), the mass was seen to be mainly localized in the diploe, and the outer table of the skull was thinned. On both T1 and T2 weighted magnetic resonance image (MRI), the mass showed a high intensity signal equivalent to that found in adipose tissue. The bony tumor was totally removed. Histology revealed a collection of foamy cells, benign fibrous tissues and so on which led to a diagnosis of xanthofibroma of the skull without hyperlipidemia. Xanthofibroma of the skull is extremely rare. To our knowledge, including our case, only three cases have been reported.

A severe outbreak of hemorrhagic colitis occurred at a kindergarten in Saitama, Japan in October, 1990. Children who were affected by enterohemorrhagic E. coli O157: H7 infection showed apparent bradycardia as well as severe bloody diarrhea, generalized convulsion, or hemolytic uremic syndrome. Cardiac involvement such as bradycardia observed in the patients of this outbreak has not been described in previous reports about EHEC infection, while bradycardia has been well known in typhoid fever due to salmonella typhosa infection. Electrocardiographic examination was performed to evaluate bardicardia, utilizing electrocardiography at rest and Holter's twenty-four hour electrocardiography. In the report, we demonstrate that the bradicardia was due to reduced frequency of sinus node. Both average heart rate and average minimum heart rate of the patients at night (74.0 +/- 5.6 BPM and 57.0 +/- 5.1 BPM, respectively) decreased significantly, as compared with controls (84.6 +/- 9.3 BPM and 66.3 +/- 8.0 BPM respectively) (p0.01). CVRR of the patients (0.120 +/- 0.019, respectively) increased significantly as compared with controls (0.090 +/- 0.010, respectively). These results indicate that an activated parasympathetic nervous system, that is, activation of the vagal nerve, might have induced the sinus bradycardia observed in the patients with EHEC infection.

Cerebrolysin (FPF1070) is an extract from pig brain obtained after enzymic digestion, containing free amino acids (85%) and low-molecular weight amino acid sequences (15%). We studied FPF 1070 to determine its ability to protect against delayed neuronal death in the gerbil when administered before and after ischemia. Transient forebrain ischemia was produced by occluding both common carotid arteries. Morphological changes in the CA1 sector of the hippocampus were evaluated 4 days after 5 min. occlusion. The formation of hydroxyl radicals in the postischemic (15 min. occlusion) reperfused (2 min.) brain was measured with HPLC using salicylate (SA). SA reacts with hydroxyl radicals and yields 2,3- and 2,5-dihydroxybenzoic acid (2,3- and 2,5-DHBA), which can be detected by HPLC-ECD. Gerbils treated with FPF 1070 revealed significant protection of CA1 neurons when it was applied 2 hrs before the occlusion. In contrast, no clear beneficial effects were observed when FPF 1070 was administered immediately after the recirculation. Concentrations of 2,3- and 2,5-DHBA after reperfusion increased significantly compared to the basal levels both in the hippocampus and cerebral cortex. The 2,5-DHBA contents in the postischemic reperfused brain was significantly reduced when FPF 1070 was administered 2 hr. before the occlusion. The administration of dimethylsulfoxide (DMSO), a hydroxyl radical scavenger, prevented ischemia-reperfusion-induced delayed neuronal death, and significantly reduced the 2,5-DHBA content after reperfusion. The results indicated that hydroxyl radicals are produced in the postischemic-reperfused brain and that hydroxyl radical scavenging action of FPF 1070 played an important role in preventing delayed neuronal death.

A 72-years-old woman was admitted to our hospital for evaluation of giant negative T waves, which appeared for only two days. Chest X-p revealed a cardiomegaly of slight degree and UCG showed ASH (IVS = 21 mm). Coronary arteriography presented no significant stenosis and the left ventricle was spade-shaped. There was a pressure gradient of 65 mmHg between the aorta and the left ventricle during isoproterenol infusion. Furthermore, endomyocardial biopsy showed disarray and fibrosis to a slight degree and fatty degeneration of myocytes with contraction bands. Based on these findings, calcium blocker was administrated under the diagnosis of HOCM. One month after the initiation of this drug, negative T waves gradually became shallow and finally upright with thinning of IVS (12 mm) four month later. We swimise that this T-wave change is primarily based on myocardial hypertrophy as well as being due to the abnormality of myocardial depolarization. We presented a case of HOCM with negative T-wave change of very short duration, which was improved by calcium-blocker and beta-blocker.

The operative mortality following valvular surgery remains substantial for specific high risk groups despite recent improvement in surgical techniques, anesthetic managements, and postoperative care. To test the contention that the results of valvular surgery are better in recent years, we examined patients undergoing isolated or combined mitral valve replacement in an earlier era (1980-1984; n = 68) and a later era (1985-1989; n = 106). There were no significant differences concerning the clinical characteristics between an earlier era and a later era, although patients in an earlier era were more seriously in hemodynamics, and in a later era were older, a higher prevalence of reoperations and a combined tricuspid valve surgery. The operative mortality was 10.3% in an earlier era, 6.6% in a later era, and so it is not significantly improved in a recent 5 years, however the incidence of premature death (death within 30 days) except valve re-replacement was significantly improved. Using univariate multiple logistic model, the predictors for operative death after mitral valve replacement in an earlier era were advanced NYHA functional class, larger CTR, higher systolic pulmonary pressure and pulmonary capillary wedge pressure, associated preoperative organ dysfunction and heart lung machine time. In a later era, these were advanced NYHA functional class, higher right atrial mean pressure, associated preoperative organ dysfunction, valve re-replacement, heart lung machine time and aortic cross clamp time. Multivariate analysis including these significant factors could not demonstrated the most independent predictors of operative mortality after mitral valve replacement in both an earlier era and a later era.(ABSTRACT TRUNCATED AT 250 WORDS)

A unified state space approach using bilinear transformation is proposed for continuous/discrete time H/sub infinity / optimal control problems. It is shown that Riccati equations and related factorizations of continuous time and discrete time systems can be formulated by the same Hamiltonian matrices. All H/sub infinity / sub-optimal compensators for continuous and discrete time systems are parametrized in a completely parallel way. >

Using an optically pumped far-infrared laser, we measured the temperature dependence of the surface impedance of single crystals of La 1.85 Sr 0.15 CuO 4 in the 180–5300 GHz frequency region between 10 and 300 K. The properties of electronic states are discussed.

This is a case of a 18 year-old female with capillary hemangioma of the left kidney. This tumor forms a well-demarcated solid mass showing a low grade contrast enhancement on CT, an echogenic pattern on sonogram, and hypovascularity on angiography. The radiologic findings on this tumor have wide variations in the previously reported cases.

Three cases of ongoing intracerebral hematoma are reported. In all cases, a very small hematoma on the initial CT taken within 2 hours after onset increased in size to such an extent that surgical intervention was necessary. A round radiolucent zone in high density clots was seen on the initial CT of all cases. The attenuation values of each pixels in hematoma formed V-figure in profile display, vfrying from minimum density (40-60) in the center of radiolucent zone to the maximum density (80-90) in peripheral clots. Experimental data have established that the density of blood in circulation and, therefore, one immediately after extravasation is directly related to the patient's hemoglobin and hematocrit levels. Hemoconcentration following clot formation and serum absorption in the brain tissue results in further increase of hematoma density. The radiolucent zone in a intracerebral hematoma suggests extravasated fresh blood. Therefore, we conclud that this is an evidence of active bleeding which calls for immediate surgery.

A 59-year-old woman was admitted to the hospital with a complaint of right visual disturbance. At admission, she had proteinuria and microscopic hematuria. The pulmonary X-ray showed bilateral hilar lymphadenopathy (BHL) but tuberculin test were negative. Also, bronchoalveolar lavage (BAL) and renal biopsy were performed. Bronchoalveolar lavage fluid (BALF) contained a high percentage of OKT 4 positive cells. In renal biopsy, light microscopic study showed thickening glomerular basement membrane (GBM) with tubulo-interstitial legion. Immuno-fluorescent study revealed granular deposits of IgG along glomerular capillary wall. Electron microscopic study showed subepithelial electron dense deposits of GBM, which are characteristic for membranous nephropathy (MN). It is well known that both sarcoidosis and MN are associated with immunological abnormality. This case might be significant for the study of pathogenesis of sarcoidosis.

Thirty-four rabies virus (RV) isolates from foxes (8), insectivore bats (9), cattle (14), sheep (1), a goat (1) and a donkey (1) from Paraiba state, northeastern Brazil, were genetically characterized. Sequences of 890 nts of nucleoprotein (N) genes of these isolates were analyzed and compared with those of other Brazilian isolates characterized earlier. Phylogenetic analysis revealed three genetical lineages of RV co-existing in this region. Each lineage was found to be associated with particular host species and to circulate independently of each other. The first lineage was found in foxes (Dusicyon sp.) and could be discriminated from domestic carnivore isolates from Sao Paulo, Goias and Minas Gerais in the southern and central Brazil. The second lineage was associated with insectivorous bats (Molossus spp.) and differed from vampire bat-associated RV isolates. The third lineage was found in livestock and clustered with vampire bat-associated RV isolates from Sao Paulo, Tocantins, Goias and Matto Grosso. These results indicate that RV of these genetic lineages are cocirculating in the Paraiba state and that livestock in this region are infected with vampire bat-associated RV, suggesting that the vampire bat is the main reservoir of livestock rabies in this region.