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In 57 adult patients undergoing valve replacement surgery or valve plastic surgery, pressure gradient between the femoral and radial artery was evaluated after cardiopulmonary bypass (CPB). During CPB, the rectal temperature was kept at mild or moderate hypothermia. Nitrates and prostaglandin E1 were administered in all patients during operation. Patients were divided into two groups; Group A of 31 patients who had history of hypertension and received some vasodilators up to the operation, and Group B of 27 patients who had no history of such medication. There was no difference in patient's characteristics, anesthetic time, CPB time and aortic cross clamping time between the two groups. There was a significant difference between the pre-CPB and post-CPB in hematocrit data. Systemic vascular resistance (SVR) decreased significantly from the pre-CPB level to the post-CPB level. There was no significant difference between Group A and Group B in SVR, but a higher femoral-to-radial artery pressure gradient was observed in Group A until the end of operation. Hypertension and the use of vasodilator change the tone of peripheral blood vessels and intensify femoral-to-radial artery pressure gradient after CPB.

GD3 immunocytochemical analysis was performed in 25 human specimens obtained by autopsy and biopsy from patients with astrocytomas, anaplastic astrocytomas, cerebellar astrocytomas and glioblastoma multiforme (GM), using the ABC method. Extraction of the ganglioside fraction from GM was used for thin-layer chromatography (TLC) analysis to confirm the specificity of anti-GD3 monoclonal antibody (DSG-1). Normal astrocytes were not immunoreactive for GD3. Neoplastic astrocytes of low- to high-grade tumours were GD3 immunoreactive. In GM, the multinucleated giant cells were also immunoreactive. All immunoreactivity present was within the cytoplasm. In TLC analysis, enzyme immunostaining of gangliosides from GM with DSG-1 showed only one positive band, which had the same TLC migration rate as GD3, indicating that GD3 of the ganglioside fraction from GM is the antigen detected by DSG-1. The presence of GD3 within the cytoplasm of neoplastic astrocytes showing invasive and proliferative properties, is of considerable interest. The implications and possible significance of the presence of GD3 in the cytoplasm in glioma cells are discussed.

The analysis of genetic relationships between numerous breeds and populations of domestic dogs of Asian and European origin was performed by studying their polymorphism for 14 loci of biochemical markers. Phylogenetic positions of different breed groups, related to one another and to ancestral forms from the center of domestication, were elucidated. Directions of gene flow in the formation of breed as well as dynamics and vectors of the forming genetic structure in microevolution of this extremely polytypic species, were established.

Mean cerebral blood flow (CBF) of the whole brain was measured in 48 patients who underwent cerebrospinal fluid shunt surgery for normal pressure hydrocephalus (NPH) by performing first-pass radionuclide angiography using 99Tcm-hexamethylpropylene amine oxime. Patients were divided according to outcome into an 'excellent' improvement group, a 'good' improvement group, a 'fair' improvement group and a 'poor' improvement group. Patients with excellent and good improvement had a preoperative mean CBF of 40.4 +/- 3.9 ml.100 g-1.min-1 and 37.1 +/- 5.5 ml.100 g-1.min-1, respectively, both of which were significantly (P < 0.005) higher than that in 11 patients who showed fair improvement (30.8 +/- 3.2 ml.100 g-1.min-1) and six patients who showed poor improvement (31.8 +/- 2.5 ml.100 g-1.min-1). Patients with a clinical improvement after shunting had an increased postoperative mean CBF. We conclude that patients with a preoperative mean CBF of over 35 ml.100 g-1.min-1 can show favourable improvement after a shunting procedure, and that the preoperative mean CBF of 32 ml.100 g-1.min-1 can be considered the critical level for treatment.

To evaluate the diagnostic accuracy of computed tomography (CT)-guided aspiration biopsy in combination with rapid cytology for benign pulmonary lesions.We performed percutaneous aspiration biopsy under CT guidance in combination with a rapid cytologic examination in 91 patients with pulmonary lesions. A 21-gauge modified Menghini needle coaxially placed through an 18-gauge needle was used in this procedure. Thirty-one lesions that were confirmed as a benign pulmonary lesion histologically, serologically, bacteriologically and/or clinically were evaluated in this study.In 28(90.3%) of 31 lesions, sufficient material for cytologic diagnosis was obtained from the aspiration biopsy. Specific benign diagnosis for benign disease was obtained in 13 lesions (41.9%), while nonspecific diagnosis for benign disease was obtained in 15 lesions (48.4%). The overall accuracy of the rapid cytological examination was 90.3%. Pneumothorax developed in 17 patients (54.8%), with 7 patients (22.6%) requiring chest tube drainage. Only one patient complained of mild hemoptysis, which subsided with hemostatic agents.Percutaneous aspiration biopsy combined with a rapid cytologic diagnosis provides a high degree of accuracy in the diagnosis of benign pulmonary lesions.

The psychiatric and cognitive condition of a patient with lupus psychosis was evaluated. Using a device that detects the corneal reflection of infrared light, the patterns of eye tracking movements were recorded before the onset of lupus psychosis, after remission, and again 1 year later. Electroencephalographic findings and cerebrospinal fluid levels of both interferon alpha and interleukin-6 were also obtained longitudinally. Electroencephalographic findings and clinical signs were correlated to the levels of interferon alpha in cerebrospinal fluid. Analysis of exploratory eye movements revealed marked decreases in the number of eye fixation, mean eye-scanning length and total eye-scanning length. Even though the lupus psychosis resolved and the electroencephalographic findings became normal, the eye movement patterns showed remaining deterioration. It was concluded that analysis of exploratory eye movements in patients with systemic lupus erythematosus may be useful in diagnosing lupus psychosis, and may also present a diagnostic clue to subclinical lupus psychosis.

It is known that only listeriolysin O (LLO)-producing Listeria monocytogenes strains are able to induce protective immunity, but the underlining relationship between LLO produced by virulent strains and generation of protective immunity in the infected host remains poorly understood. In the present study, it was found that LLO gene expression was only detected in the mice infected with virulent strain which was able to induce protective immunity, while non-virulent strains or killed bacteria were not able to generate protective immunity. When mice were immunized with LLO plus killed bacteria in the presence of incomplete Freund's adjuvant, the protective immunity was partially generated, and adoptive transfer experiment confirmed that this protection was antigen specific. Reverse-transcription polymerase chain reaction revealed that LLO plus killed bacteria induced the expression of interferon-gamma (IFN-gamma) and interleukin-12 (IL-12). Our results also showed CD4+ T cells were the principal cells constituting protective immunity. Taken together, it may be concluded that LLO produced from virulent strains of L. monocytogenes was essential for the generation of protective immunity, and that LLO plus killed bacteria induced IFN-gamma and IL-12 expression which resulted in the generation of protective immunity.

Monomorphic sustained ventricular tachycardia (MSVT) was revisited in relation to the electrophysiologic findings and their relation to the drug efficacy. Old myocardial infarction is less common cause of MSVT in Japan, and the majority (about 2/3) of MSVT is unrelated to coronary artery disease but, the mechanism shared a common mechanism: reentry with an excitable gap as others. The reentrant mechanism was supported from the inducibility, the terminability of VT by electrical stimulation, and by the ability to entrain with rapid pacing. In MSVT associated with underlying heart diseases, diseased myocardium showed low amplitude and fragmented electrograms and the area was considered to participate as the central common pathway of reentrant circuit. The area of slow pathway showed a decremental conduction or all-or-nothing conductive property. The width of the excitable gap seemed to be determined by the maximal conductive frequency but not by the duration of action potential: effective refractory period. As to the drug efficacy, there was no baseline characteristics in predicting the efficacy. However, the significant narrowing of the width of the excitable gap was associated with the drug efficacy and VT became non-inducible after addition of the same drug. The response pattern of the excitable gap to specific drug including class III, was not predictable. Further electropharmacological studies will be warranted.

Progression to moderate or severe mitral regurgitation (MR) was studied after Inoue balloon percutaneous transvenous mitral commissurotomy (PTMC) using the stepwise inflation technique, performed at increments of 1 mm of balloon diameter, in 49 consecutive patients with rheumatic mitral stenosis (aged from 32-73 years; 8 males, 41 females). The patients were classified on the basis of the degree of MR after PTMC, compared with that before PTMC, into either Group A, development of moderate or more severe (or = grade 2) MR (n = 8) or Group B, no increase in MR or development of mild (grade 1) MR (n = 41). Progression to moderate or severe MR was significantly associated only with advanced age (60 +/- 8 vs 52 +/- 10 years, p0.05) and narrower mitral valve area (0.87 +/- 0.35 vs 1.11 +/- 0.29 cm2, p0.05), but other characteristics before PTMC were similar in both groups. There was no difference between the two groups in the total number and degree of balloon inflation. Immediately before the final inflation, the left atrial mean pressure and v wave pressure were decreased in smaller degrees in Group A compared with Group B (-2 +/- 2 vs -5 +/- 4 mmHg, p0.05; -2 +/- 2 vs -6 +/- 6 mmHg, p0.05, respectively). Thus, the stepwise inflations require careful monitoring of changes in the left atrial pressure and waveform to recognize the aggravation of MR, especially in older patients with severe stenosis. Patients who do not have a significant drop in left atrial mean pressure and v wave pressure during stepwise inflations of the balloon might be at risk of development of moderate or severe MR after further dilations.

A 7-year-old boy presented with recurrent meningitis after head trauma. Coronal computed tomography (CT) revealed prolapse of the intracranial soft tissue into the right ethmoidal sinus, leading to the diagnosis of right frontal skull base fracture. Three-dimensional CT with bone windows provided a lifelike image of the fracture lateral to the right olfactory groove. This image was most useful in the preoperative planning of the repair surgery.

In order to prove the possible phase separation in the overdoped high‐Tc superconductors, suggested from the muon‐spin‐relaxation measurements, the superconducting (SC) volume fraction has been investigated in detail in the overdoped regime of La2−xSrxCuO4. From measurements of the magnetic susceptibility, χ, using a single crystal in which the Sr concentration, x, continuously changes in the overdoped regime, both the absolute value of χ at 2 K, |χ2K|, on field cooling reflecting the SC volume fraction and Tc have been found to decrease with increasing x. Moreover, it appears that |χ2K| has a roughly linear relation to Tc. It has been concluded that phase separation into SC and normal‐state regions takes place in the overdoped regime of La2−xSrxCuO4.

We performed a mapping observation of the Sunyaev-Zel'dovich effect toward a galaxy cluster, CL0016+16, at 43 GHz using a newly developed 6-beam receiver installed in the Nobeyama 45-m telescope. The temperature decrement of the CMB was measured to be δT*A = −0.49 ± 0.06 mK at the center of the cluster. Fitting the isothermal, spherical-symmetrical β -model to the observed temperature decrement distribution, the S-Z effect at the center is inferred to be δTRJ(0) = −1.0 ± 0.1 mK at the Rayleigh-Jeans limit. This suggests that the Hubble constant is H0{q0 = 0.5} = 67+16−11 km s−1 Mpc−1.

To evaluate the usefulness of 123I-15-(p-iodophenyl)-3 (R, S)-methyl-pentadecanoic acid (123I-BMIPP) as a radiopharmaceutical for tumor imaging, six patients with liposarcomas and one patient with malignant fibrous histiocytoma were studied with 123I-BMIPP. 123I-BMIPP accumulated in the myxoid components of liposarcoma, while the well-differentiated components showed no increased uptake of 123I-BMIPP. 123I-BMIPP accumulated in viable parts of the tumor, while there was no uptake in the necrotic parts in one patient with malignant fibrous histiocytoma. This study indicated that 123I-BMIPP may be a special radiopharmaceutical for tumor imaging.

More than 30% of the end stage liver cirrhosis was complicated by the impared glucose tolerance, in some of which insulin supplements may be required to control the blood glucose level. However, there are many unsolved issues on the cause and cares of hyperglycemia in cirrhotic men. Here, we presented a case of liver cirrhosis and hepatocellular caricnoma complicated by the severe glucose intolerance, and summarized our recent insulin therapy on the glucose intolerance of the decompensated liver cirrhosis in Fukuoka City Hospital, Department of Internal Medicine.

The mechanism of ethanol action at serotonergic neuronal systems in the brain was investigated by examining the effects of alcohols on the activity of tryptophan hydroxylase (TPH) in vitro using natural type of biopterin as cofactor. Alcohols inhibited the activity of TPH prepared from rat brain in a noncompetitive manner with respect to both the biopterin cofactor and the l-tryptophan substrate. The rank order of inhibitory potency of the tested alcohols was n -propanol> iso -propanol>ethanol>methanol. The kinetic study indicated that alcohols more potently affected the enzyme interaction with cofactor than substrate. Ethanol, at concentrations that can be reasonably attained in vivo (i.e., 25–100 mM) significantly decreased TPH activity in the presence of a physiological concentration of cofactor. However, the reduction was only ∼5% of control activity, because K i values of ethanol for the enzyme were very high (800–1000 mM). From the present results, it was concluded that the direct inhibition of the synthetic enzyme itself by ethanol would contribute little to in vivo effects of ethanol on serotonergic neuronal systems.

Single photon emission tomography (SPECT), MRI and EEG were studied in two infants with lissencephaly. One infant had generalized tonic convulsions at 7 month of age and continuous high voltage fast activities on EEG. The other infant developed infantile spasms at the age of 2.5 months, and showed low voltage disorganized background with pseudorhythmic high voltage sharp waves on EEG. Cranial CT and MRI in both infants revealed abnormally thick cortex, dilatation of the lateral ventricles, and smooth or relatively smooth cerebral surface. In SPECT studies, a diffuse increase of tracer uptake was shown at the cerebral cortex compared with the basal ganglia or cerebellum in both infants. The SPECT finding might reflect the abnormal cortical architectures in this cerebral malformation.

A 62-year-old man was admitted to our hospital for treatment of HCC with a thrombus growing from the right branch to the trunk of the portal vein. His hepatic functional reserve was fairly good. Serum levels of AFP and PIVKA-II were elevated to 1,780 ng/ml and 27 AU-ml, respectively. The hepatic arteriogram showed a hypervascular tumor approximately 4 cm in diameter in the right anterior segment and many ill-defined small tumor stains around the main tumor. Portal phase of superior mesenteric arteriogram revealed filling defect in the portal trunk, and no visualization of the right branch of portal vein. SMANCS-Lipiodol was infused via right hepatic artery, and Spongel was infused via right anterior branch of hepatic artery. Three months after the first therapy, the tumor markers normalized. A computed tomography scan showed that the main tumor and the tumor thrombus were markedly decreased in size, whereas the hepatic angiogram revealed tumor stains around the main tumor. SMANCS-Lipiodol was again infused via proper hepatic artery. He has remained well for 16 months after the first treatment. The combination of the arterial infusion of SMANCS-Lipiodol with the selective TAE was very effective for this case, probably because his hepatic functional reserve was fairly good and the left branch of portal vein was patent. It was suggested that SMANCS-Lipiodol with the selective TAE could be one therapy to be considered for a patient like this case.

Findings for focal accumulation of 123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid ([123I]BMIPP) in a patient with liposarcoma of the thigh are presented. Iodine-123-BMIPP accumulated heterogeneously in the liposarcoma. The region with marked accumulation of [123I]BMIPP was diagnosed as mixoid liposarcoma. The region with little accumulation of [123I]BMIPP was diagnosed as well-differentiated liposarcoma. Differences in the accumulation of [123I]BMIPP may reflect differences in fatty acid metabolism between histopathological types of liposarcoma.

We report on a 21-month-old girl with a haemorrhagic shock and encephalopathy who survived. Rotavirus genoinic ribonucleic acid was detected by reverse transcription polymerase chain reaction in stool, blood and cerebrospinal fluid. Serum antibody titres of the rotavirus were also high. Plasnia-pheresis had a stabilizing effect on the course of the disease. This case indicates that rotavirus infection may play an important role in the devastating cascade that occurs in some patients with this syndrome. The findings suggest that extensive investigation for rotavirus infection, particularly infection of the central nervous system, should be carried out in patients with haemorrhagic shock and encephalopathy.

Silicon-based polymers with σconjugated electrons have specific properties; photoreactivity for microlithography and photoconductivity for hole transport materials. To explore the possibility of combining these two properties to develop photoresists with electronic transport capability, photoconductivity of polysilanes is investigated in connection with their photoinduced chemical modification. Increase in photocurrent is observed accompanying photoreaction of poly(dimethylsilane) vacuum deposited films. This increase is found to be greatly enhanced in oxygen atmosphere. Such changes of photocurrent can be explained by charge transfer to electron acceptors from Si dangling bonds postulated to be formed during photoreaction.

The signal intensity of hematopoietic regions in the marrow of aplastic anemia were investigated on opposed phase T1-weighted images (op-T1WI) with a 0.5-Tesla MR unit. Hematopoietic regions were classified into two groups : 1) low intensity hematopoietic areas (LH) isointense to normal marrow and 2) high intensity hematopoietic regions (HH) with higher intensity than normal marrow on op-T1WI. a) The signal intensity of LH was significantly lower than that of HH on STIR. b) LH converted in to HH with improvement of laboratory data after therapy, whereas HH decreased with impairment of data. c) In addition, HH were hyperintense to cerebrospinal fluid on op-T1WI. These results indicated that the signal intensity of hematopoietic regions on op-T1WI reflected the cellularity in these regions and that aplastic anemia included hypercellular regions relative to normal marrow.

A single diesel spray of n — tridecane which was miscible with small dopants was injected from a hole nozzle into a quiescent high — temperature and high — pressure atmosphere, and was impinged upon a flat surface with high temperature. It is able to generate fluorescent emissions from vapor and liquid phases in this evaporating spray, when a laser light sheet from Nd: YAG laser is passing through the cross section of this spray. Then, clear 2 — dimensional images for vapor and liquid phases were obtained simultaneously, applying an exciplex fluorescence method. In particular, vapor concentration was assessed quantitatively by applying Lambert — Beer’s law into measured fluorescence intensity in vapor phase and by considering the quenching process of the fluorescent emission due to the mixture temperature.

The biological activity of 26-kD membrane-bound tumor necrosis factor (TNF)-a in embryonal development was examined in an in vitro system using embryonic stem (ES) cells. ES cells were seeded on NIH3T3 feeder cells transformed with mouse precursor TNF-a gene to express membrane-bound TNF-a on their cell surface. The proliferation of the ES cells was reduced and differentiation was accelerated. The same effects were also observed when 17-kD free TNF-a was added to the culture medium of the ES cells. Since free TNF-a is not present during embryogenesis, these results suggest that membrane-bound TNF-a may play an important role in embryonal development through cell-cell contact.

To relieve tracheal stenosis due to esophageal carcinoma, we have inserted Dumon-type endotracheal stent tube to 2 patients with stenosis of the left main bronchus and a patient with tracheal stenosis. Severe dyspnea and stridor found in these patients was much improved in all three cases. After insertion of the stent tube to 2 patients with stenosis of the left main bronchus, radiation therapy with the dose of 65 Gy to main esophageal lesion was undergone, which resulted in the partial remission. These management allowed the patients to discharge. The last case with tracheal stenosis was due to recurrence of the esophageal carcinoma, which required additional insertion of the stent tube at the proximal site after initial insertion in a short period. We conclude that the quality of life and prognosis of patients with tracheal stenosis due to advanced esophageal carcinoma may be improved by the insertion of Dumon-type endotracheal stent tube.

Left ventricular volume and ejection fraction obtained by cineangiography are useful to evaluate global left ventricular function in humans. Left ventriculography provides evidence of the effect of coronary artery stenosis on regional wall motion in patients with coronary artery disease. Changes in left ventricular shape are also found in various heart diseases. The left ventricular cavity is normally ellipsoid in shape, but becomes flat in hypertrophic cardiomyopathy, globular in dilated cardiomyopathy, and aneurysmal in some patients with myocardial infarction. This study developed a new method to quantify regional and global left ventricular shape. Regional circularity index (RCI) was defined as GD divided by r (GD = distance from each 5-degree endocardial margin to the center of gravity, r = radius of the circle equal to left ventricular area). The global circularity index (GCI) was derived from the sum of magnitude of RCI-1. The end-systolic GCI was related to end-systolic left ventricular wall stress (r = 0.71, p0.001). The change in GCI during systole was related to left ventricular ejection fraction (r = 0.79, p0.001). In severe cases of dilated cardiomyopathy, the left ventricle became more spherical during ejection. End-systolic left ventricular moment around the minor axis had a good correlation with left ventricular ejection fraction (r = 0.81, p0.001). Quantification of regional and global left ventricular shape can be used to estimate left ventricular wall stress from left ventricular shape. Left ventricular shape change during systole and the moment around the left ventricular short axis contributes to left ventricular ejection.

Preoperative chemotherapy for esophageal cancer was performed and the toxic effects, post-operative complications, histological effects and survival time were evaluated. Toxic effects and post-operative complications were rare. The histological effect was evaluated according to the Guidelines for Clinical and pathologic studies on carcinoma of the esophagus by the Japanese Society for Esophageal Disease. A histological effect of more than Grade II was seen from 25 to 42.1%. A significant difference was seen in the Kaplan-Meier survival curves between the response group and the no response group (p0.05). If we perform preoperative chemotherapy for esophageal cancer only to responsive cases determined by chemosensitivity tests, the prognosis of advanced esophageal cancer may be improved.

Based on the hypothesis that 26 kD membrane-bound rumor necrosis factor precursor (proTNF) may act as a principle regulator to maintain homeostasis in an adult, we tried to examine whether proTNF shows bidirectional regulation in specific cellular response. We focused on production of 17 kD mature TNF by acute monocytic leukemia cells THP-1 after stimulation by lipopolysaccharide. ProTNF of primed THP-1 cells had been shown to act as a positive regulator for production of mature TNF by homologous cells (primed THP-1) after LPS stimulation, whereas when THP-1 cells were co-cultivated with NIH3T3 which expressed pro-TNF, production of mature TNF by THP-1 by LPS was significantly suppressed. These results suggested that pro-TNF was really involved in bidirectional feedback regulation for TNF production by THP-1 cells themselves through cell to cell contact.

With the aim at investigating the relationship between the anomalous decrease in Tc, the development of the Cu-spin correlation and the inhomogeneity of superconductivity at x ~ 0.21 in the overdoped regime of La2-xSrxCuO4, we have performed the in-plane electrical-resistivity, ρab and magnetization measurements. Measurements of the temperature dependence of ρab in magnetic fields have revealed that the superconducting (SC) transition curve shifts to the low-temperature side almost in parallel with increasing field above ~ 9 T at x ~ 0.21, which is similar to that observed for stripe-ordered La-214 systems with the hole concentration of ~ 1/8 per Cu. On the other hand, it has been found that the magnetization curve shows the so-called second peak in the SC state at x ~ 0.21, which is due to the strong vortex pinning in normal-state regions in the nano-scale inhomogeneous SC state. Accordingly, it is likely that the stripe correlations are developed in the nano-scale inhomogeneous SC state at x ~ 0.21.

For physicians facing patients with organ-limited metastases from colorectal cancer, tumor shrinkage and sterilization of micro-metastatic disease is the main goal, giving the opportunity for secondary surgical resection. At the same time, for the majority of patients who will not achieve a sufficient tumor response, disease control remains the predominant objective. Since FOLFOX or FOLFIRI have similar efficacies, the challenge is to define which could be the most effective targeted agent to achieve these goals. The a priori molecular identification of patients who could benefit from anti-EGFR or anti-VEGF monoclonal antibodies (i.e. the targeted therapies up to now available for mCRC) is of critical importance. In this setting, the KRAS mutational status is the first identified predictive marker of response to anti-EGFR therapy and is required prior treatment with anti-EGFR therapy. For KRAS wild-type patients, the choice is in between anti-VEGF and anti-EGFR. In the future, in addition to clinical considerations, molecular markers may provide critical information for selecting patients who might benefit preferentially from one of these drugs. Indeed, the tumor's pathology and patient's metabolism is driven by genetic make-up, influencing the individual response and toxicity. A great amount of exploratory data has been delivered. The challenge of treatments' optimization through specific biomarkers gain special value for a potentially curable disease as mCRC with metastases confined to the liver, and it is even more important if we consider that we do really have the opportunity of mutually exclusive therapeutic choices in this setting. The high degree of complexity of the biological systems we are dealing with makes the discovery of determinant biomarkers a demanding endeavor per se. On the other hand, researchers have to face with all the difficulties of prospective verification and clinical validation of the most promising factors. In the future, to make translational research productive, affordable and more concrete, it will be necessary to have a worldwide effort from the scientific community (from medical oncologists to surgeons and basic researchers, but also of national health systems, industries, regulatory agencies and academies).

Several prognostic factors have been identified in patients with vasospastic angina; however, factors that would predict potentially fatal cardiac arrest during the period between the onset of angina and its definitive diagnosis remain unknown. We investigated the predictive value of the clinical findings that are available when a patient is hospitalized after a cardiac arrest but before a definitive diagnosis of vasospastic angina is made.We compared the clinical findings in 11 patients who experienced cardiac arrest before vasospastic angina was definitively diagnosed (group I) with 81 patients with vasospastic angina without cardiac arrest (group II). The definitive diagnosis of vasospastic angina was made on the basis of results of coronary spasm provocation test or ECGs during spontaneous attacks, or both.The incidence of angina-linked syncope was significantly higher in group I than in group II (six out of 11 versus nine out of 81, P0.005). Significantly fewer group I patients were receiving calcium antagonists than group II patients (three out of 11 versus 63 out of 81, P0.005). Serious arrhythmias were significantly more common in group 1 than in group II (seven out of 11 versus 12 out of 81, P0.005). Logistic regression analysis of the eight clinical variables available when first seen in the hospital indicated that angina-linked syncope and the lack of calcium antagonist therapy were independently related to risk of cardiac arrest.From the clinical findings available, a history of angina-linked syncope and lack of calcium antagonist therapy were found to be independent predictors of cardiac arrest before a definitive diagnosis had been made. Patients who have suspected vasospastic angina may benefit from early treatment with calcium antagonists if they have a history of angina-linked syncope.

The purpose of this study was to investigate the incidence of multivessel coronary spasm and compare the clinical characteristics between patients with and without multivessel coronary spasm. In variant angina, it is controversial whether coronary hyperreactivity to vasoconstrictor stimuli is localized to a segmental lesion in only one coronary artery. Moreover, the clinical characteristics of patients with multivessel coronary spasm have never been investigated. Sixty-three patients (51 men and 12 women; mean age, 56 years; range 35-72 years) with variant angina and documented ST-segment elevation during a spontaneous attack underwent spasm provocation testing with selective intracoronary injection of ergonovine. All but 4 patients who experienced spontaneous attacks during cardiac catheterization had induced coronary spasm associated with ST-segment elevation and chest pain. Multivessel coronary spasm was found in 27 (43%) of 63 patients. By univariate analysis, a high frequency of angina (or = 3 times/week), occurrence of a spontaneous attack within 24 hours after withdrawal of medication, a long history of angina and a progressive course of angina were significantly associated with multivessel coronary spasm. Multivariate analysis indicated a positive correlation between multivessel coronary spasm and progressive angina. Multivessel coronary spasm was found in 43% of patients with variant angina. Patients with multivessel coronary spasm have some unique clinical features. These results may increase the understanding of the pathophysiology and natural course of variant angina.

We report unique features of computed tomography (CT) and magnetic resonance (MR) imaging in the metastatic lesion of the liver in a case of gastric leiomyosarcoma. A CT scan and MR image demonstrated presence of a huge multilocular cystic lesion in the liver, of which finding were unlike to those of usual smooth muscle tumors, but mimicked to those of cystadenomatous tumors. In addition, this case had an extremely long elapsing time over ten years from the radical operation for the primary site.

We examined the serum levels of testosterone (T), androstenedione (delta 4-A), estrone (E1), estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S) in the non-alcoholic cirrhotic male patients when divided into compensated or decompensated state. Serum level of T was significantly elevated in compensated cirrhotic patients (9.63 +/- 1.00 ng/ml, mean +/- SE) compared to that in decompensated cirrhotic patients (5.63 +/- 0.69 ng/ml, p0.01) and in aged-matched normal controls (4.95 +/- 0.38 ng/ml, p0.01). Serum levels of E1, E2 and delta 4-A tended to be increased in decompensated cirrhotic patients, while there was not a significant difference decompensated cirrhosis compared to those of normal controls. Serum concentration of cholinesterase, indicative one of the representative residual liver function, showed a good positive correlation to T (r = 0.53, p0.01), and a negative correlations to E1 (r = -0.67, p0.01), E2 (r = -0.77, p0.01), delta 4-A (r = -0.57, r = p0.01). Also, we examined the relationship of the serum levels to gynecomastia or esophageal varices. The cirrhotics with gynecomastia showed significantly higher serum levels of E1, E2, and delta 4-A, and lower level of T than those without gynecomastia. And the cirrhotics with esophageal varices showed the greater level of T than those without esophageal varices. Our study suggests that low serum testosterone level of men with nonalcoholic cirrhotic is not a common finding, especially in compensated state.(ABSTRACT TRUNCATED AT 250 WORDS)

In a 2 x 2 factorial experiment, 110 Holstein cows (55 first-breeding and 55 repeat-breeding), free of genital abnormalities, were injected i.m. at the time of insemination with either saline solution or 100 micrograms of GnRH. Blood samples were drawn from the tail vein or artery of 22 cows (10 first- and 12 repeat-breeding) immediately before GnRH injection and again 1 and 2 h later to determine whether the GnRH induced the release of LH. The GnRH caused LH release in 18 of 22 cows, with a greater (P.05) mean concentration of LH than that in saline-treated cows at 1 h (2.3 vs 7.0 ng/mL) and 2 h (2.5 vs 6.0 ng/mL) after injection. Length of estrus and time of ovulation were calculated from estrus checks and ovarian palpations per rectum at 8-h intervals. The GnRH injections produced no change in duration of estrus (19.2 h) or time of ovulation postestrus (9.5 h). The cows were slaughtered 41 to 90 (mean = 60) h after ovulation to determine the ovum cleavage rate and the number of accessory sperm in the zona pellucida. The GnRH treatment increased the incidence of twin ovulations but did not increase the number of accessory sperm or improve the proportion of ova that cleaved in either first-service or repeat-breeding cows.

To aggregate separate information into a national database and to enhance quality improvement activities, JNUHICC Sectional Meeting of Surveillance has created a data collection system for device-associated infection rates.

Expandable metallic stents (Gianturco zig-zag wire stents) of various sizes were placed in the trachea of eight dogs to establish conditions suitable for endotracheal wire stent placement. Stents of 3.0 cm in diameter and 2, 3, or 4 cm in length were constructed with 0.018, 0.016, or 0.013 inch stainless steel wire. Optimal dilatation of the trachea was attained with stents 2 cm long made of 0.013 and 0.016 inch wire, and their surface became covered with ciliated columnar epithelium. In contrast, stents with stronger expansive force, such as those 2 cm long made of 0.018 inch wire, became deeply embedded in the membranous portion of the trachea. With stents of little expansive force, such as those 3 or 4 cm long, dilatation of the trachea was inadequate regardless of the caliber of the wire, and consequently these stents were not completely covered with epithelium. The results of the study suggest the therapeutic potential of expandable metallic stents for clinical treatment of patients with tracheobronchial stenosis.

PURPOSE: To clarify whether there were any differences in MR appearance between the childhood and the adult moyamoya syndromes. METHOD: We compared the cranial MR findings in four children under the age of 6 who had moyamoya syndrome with previously documented adult cases. RESULTS: Moyamoya syndrome in younger children exhibited a significant increase in cortical and subcortical infarction, and a decreased incidence of deep white matter infarction in the centrum semiovale and basal ganglia, in contrast to adult cases. There were no remarkable differences between these two groups of moyamoya cases with regard to the occlusive changes of the internal carotid and middle cerebral arteries, or to the flow void sign on MR. CONCLUSION: These differences in the sites and frequencies of infarctions between the childhood and the adult moyamoya syndromes observed on MR might reflect differences in the cerebral circulation.

A huge hepatomegaly was seen in a 30-yr-old female diabetic who was treated with high dose of insulin for her uncontrollable food ingestion. The liver function at the peak of the hepatic enlargement showed a moderate increase of transaminases, alkaline phosphatase, and gamma-glutamyl transpeptidase. The histology of the enlarged liver revealed PAS-positive granules in enlarged hepatocytes, indicating the presence of massive glycogen storage. On admission, she was maintained under a calorie-restricted diet and received approximately 15 to 20 units per day of insulin supplement. At one month after admission, a marked shrinkage of her enlarged liver and restoration of normal liver function were observed concomitantly with the return of fair control of her blood sugar levels. One year later, she had an episode of diabetic ketoacidosis which subsequently was treated with a continuous low-dose infusion of insulin; however, she showed neither hepatomegaly nor liver dysfunction during this episode. There have been 20 cases reported of Japanese diabetics with marked hepatomegaly, in whom the vigorous treatment of diabetic ketoacidosis with insulin seemed to be a trigger of the enlarged liver. This has occurred mostly in patients with insulin-dependent diabetes mellitus. We present a case of non-insulin-dependent diabetes mellitus with glycogen storage hepatomegaly, presumably due to excessive insulin supplements. This suggests that glycogen storage hepatomegaly in diabetics may not be only due to an acute restoration from diabetic ketoacidosis, but may also be due to an overinsulinization in an attempt to maintain a euglycemic condition in spite of excess food intake.

We reported a girl of Down syndrome with both moyamoya disease and spinal cord compression due to atlanto-axial instability. At the age of 3 years, she presented with muscle weakness of gradual onset, and could not walk without support. On admission, at the age of 6, she presented with spastic paraparesis with predominance on the right side. To explain her neurological manifestations, we performed cranial MRI first, and found multiple infarctions with predominance on the right hemisphere, the occlusive changes of internal carotid and middle cerebral arteries, and signal void flow signs in basal ganglia, which suggested moyamoya disease. Although diagnosis of moyamoya disease was confirmed by cranial angiography, discrepancy between clinical manifestations (right-side dominant spasticity) and MRI findings (right-side dominant infarctions) could not be explained. Thereafter, we performed cervical MRI, which showed severely compressed lesions with predominance on the right side, corresponding to her clinical manifestations. It is essential to perform not only cranial but also cervical MRI for a patient with Down syndrome presenting neurological complications.

We evaluated the preoperative and intraoperative general condition of 33 pediatric kidney recipients. Eighteen patients were anaesthetized with lumbar epidural anaesthesia. Ten patients were with nitrous oxide-oxygen-halothane, 5 cases were with NLA. Preoperatively many children had cardiovascular and metabolic complications. For example 39% of patients had history of hypertension. Sixty-seven percent of patients were found to have cardiomegaly (cardio-thoracic ratio50%) with chest X-ray film. Seven of 9 patients undergoing echocardiogram had abnormality of cardiac wall motion, valvular impairment, pericardial effusion. In forty-eight percent of patients, hyperlipidemia was found. During operation we could not maintain the cardiovascular stability following intratracheal intubation and manipulation of vena cava or abdominal aorta under NLA or nitrous oxide-oxygen-halothane anesthesia. Epidural analgesia inhibited the cardiovascular fluctuation following these surgical stresses. We concluded that epidural analgesia is the best anaesthesia for pediatric renal transplantation and phentolamine or PGE1 are useful to maintain cardiovascular stability and transplanted kidney function.

The plasma levels of endothelin-like immunoreactivities (ET-IR) of patients with hepatocellular carcinoma (HCC) were compared with those of patients with liver cirrhosis (LC), using a specific radioimmunoassay for endothelin-1. The mean concentration of plasma ET-IR of 21 HCC patients (30.3 +/- 8.5 pg/ml, n = 21) (means +/- SD) was markedly higher than those in LC (22.1 +/- 4.7 pg/ml, n = 16) (p0.01), which were also elevated compared with those in normal subjects (9.4 +/- 1.6 pg/ml, n = 91). Moreover, the level of plasma ET-IR reflected the tumor size of HCC patients, which was estimated by the ultrasonic and computed tomographic examinations. Although there was no relation to other biochemical parameters indicating liver function or tumor markers such as alpha-fetoprotein, a good positive correlation was obtained between plasma ET-IR and C-reactive protein (CRP) concentrations of HCC patients (r = 0.805, p0.01). We measured the tissue contents of ET-IR in HCC and its adjacent LC tissue, but failed to find any significant difference between the mean content of HCC (0.50 +/- 0.38 ng/g) and LC (0.44 +/- 0.28 ng/g). The endothelial cell damage due to cancer growth may not be responsible for the high concentrations of plasma ET-IR of HCC, because plasma thrombomodulin concentrations were not correlated with plasma ET-IR levels in HCC patients. Our study implies that the high plasma concentration of ET-IR is pathogenomonic to HCC, although the site of production is still debatable.

The effects of thromboxane A2 synthetase inhibitor and hyperdynamic therapy on delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage were evaluated in a series of twenty eight patients, who underwent aneurysmal clipping with 72 hours after subarachnoid haemorrhage. Postoperatively, 13 patients were treated with thromboxane A2 synthetase inhibitor, Xanbon [sodium (E)-3-[p-(1H-imidazol-1-ylmethyl)phenyl]-2-propenoate]. Hyperdynamic therapy with dobutamine was given to the remaining 15 patients. Of the 13 patients treated with Xanbon, nine patients (69%) developed delayed cerebral ischaemia and cerebral infarcts occurred in eight patients (62%). On the other hand, of the 15 patients treated with hyperdynamic therapy, only three patients (20%) manifested delayed cerebral ischaemia and two patients (13%) developed cerebral infarcts. In the present study, the patients treated with hyperdynamic therapy met an expected incidence of ischaemic events after subarachnoid haemorrhage by today's standards, while those treated with thromboxane A2 synthetase inhibitor did not.

We performed serial magnetic resonance imaging (MRI) toward 4 male children with possible Pelizaeus-Merzbacher disease (PMD). They were clinically suspected as PMD on the basis of typical neurological, electrophysiological and MRI examinations. MRI revealed that myelinated fibers were localized in brainstem, cerebellum, internal capsule, optic radiation and proximal corona radiata in case 1, while myelinated fibers were almost absent in case 2-4. On repeated MRI investigation, we found no further extension of myelination in case 1 and the absence of myelination in case 2-4. This study demonstrated that myelination in the brain is arrested immediately after birth in case 1, while no myelination developed before birth in case 2-4. It was speculated that MRI in case 1 and case 2-4 might correspond to neuropathologic findings of classical and connatal form as reported in the literature.