Search

Chronic nonbacterial osteomyelitis is a rare bone disorder that can be found in the jaw. It is often associated with systemic conditions, including autoimmune deficiencies. However, little is known about how the genetic and immunologic background of patients influences the disease. Here, we focus on human leukocyte antigen (HLA), killer cell immunoglobulin-like receptors (KIRs), and their specific combinations that have been difficult to analyze owing to their high diversity. We employed a recently developed technology of simultaneous typing of HLA alleles and KIR haplotype and investigated alleles of the 35 HLA loci and KIR haplotypes composed of centromeric and telomeric motifs in 18 cases and 18 controls for discovery and 472 independent controls for validation. We identified an amino acid substitution of threonine at position 94 of HLA-C in combination with the telomeric KIR genotype of haplotype tA01/tB01 that had significantly higher frequency (>20%) in the case population than in both control populations. Multiple logistic regression analysis based on a dominant model with adjustments for age and sex revealed and validated its statistical significance and high predictive accuracy (C-statistic ≥0.85). Structure-based analysis revealed that the combination of the amino acid change in HLA-C and the telomeric genotype tA01/tB01 could be associated with lower stability of HLA-C. This is the first case-control study of a rare disease that employed the latest sequencing technology enabling simultaneous typing and investigated amino acid polymorphisms at HLA loci in combination with KIR haplotype.

Supplemental material, DS_10.1177_0022034520901519 for A Targeted Genetic Association Study of the Rare Type of Osteomyelitis by H. Yahara, S. Horita, S. Yanamoto, Y. Kitagawa, T. Asaka, T. Yoda, K. Morita, Y. Michi, M. Takechi, H. Shimasue, Y. Maruoka, E. Kondo, J. Kusukawa, H. Tsujiguchi, T. Sato, T. Kannon, H. Nakamura, A. Tajima, K. Hosomichi and K. Yahara in Journal of Dental Research

In this study, flat sheet asymmetric MMMs were prepared from polyethersulfone (PES) containing 1 (PES/C15A1) and 5wt% (PES/C15A5) loading of Cloisite15A® via phase inversion to investigate the effect of dispersion of silicate layers on the properties and performance of the MMMs for CO2/CH4 separation. The MMMs were characterized by means of WAXD, TEM, tensile test and pure gas permeation measurement. Partial intercalated and exfoliated silicate layers for MMM with 1wt% loading contributed to the enhancement of the membrane morphological and mechanical properties. The increase tortuosity in PES/C15A1 reduced the CH4 permeance with a significant enhancement for the CO2/CH4 selectivity from 22.57 to 46.89. In addition, high degree of intercalation and exfoliation of silicate layers was also corroborated by particle size measurement (PSM), particle density measurement (PDM) and free-path spacing measurement (FPSM) with the increase in aspect ratio, dispersed single silicate layers, density and formation of several tactoid classes for PES/C15A1. The properties and performance of the MMMs, determined by qualitative and quantitative measurements for PES/C15A1 was higher compared to PES/C15A5; therefore, the extent of the silicate layers dispersion has a significant role in the fabrication of asymmetric MMMs. © 2015 Elsevier B.V.

Tumour hypoxia can be detected by

International audience

We investigate a scheme for making leptogenesis by means of the CP violating decays of the seesaw Majorana neutrinos proposed by Fukugita and Yanagida. However, in order to avoid the wash-out of the produced lepton number we propose the production of the Majorana neutrinos to occur non-thermally and sufficiently late. After this time, in consequence, the B-L (baryon minus lepton) quantum number becomes a good ``accidental symmetry'' protecting the asymmetry produced. This non-thermal leptogenesis at late time is realized by a boson decaying into the Majorana neutrinos with a long lifetime. Suggestively this boson could correspond to a scalar field which causes the cosmic inflation, the inflaton, and thus its decay means really the reheating of the Universe. We find that this mechanism works well even if the lightest Majorana neutrinos are not produced sufficiently or not present, and the decays of the heavier seesaw Majorana neutrinos can be responsible to the baryon asymmetry in the present Universe, as we illustrate by the example of the family replicated gauge group model., Comment: 25 pages, 1 figure, Latex2e; section 5 modified, refs. added

YBa 2 Cu 3 O 7−x (123) high-T c oxide superconductor was successfully prepared through a citric acid salt process. The effects of Ag addition as well as Zr substitution for Y on the structures and the superconducting properties of the specimens were studied. The addition of 10-30wt% Ag decreases the optimum sintering temperature to achieve highest T c by ca. 50°C. Furthermore, the effect of fine Ag precipitates on J c was studied. The 5at% Zr substitution for Y produces much smaller 123 grains with uniform grain size. Both the Ag addition and the Zr substitution enhance the J c (77K, 0T) of 123 specimen by a factor of several. The simultaneous addition of Ag and Zr suppresses the decreasing of J c by the prolonged sintering

We showed the new test sequence to solve the at-speed test escapes of SRAM boundary addresses when shared BIST tests the SRAMs of different address sizes in parallel. This test sequence accesses only an address boundary continuously. By using our method, shared BIST can test the SRAMs at-speed in parallel with slight extra area overhead and test time.

We investigated postural sway in young subjects during eye-head movements. Subjects stood on the force plate wearing a helmet on which a laser spot was attached. Visual targets were presented stepwise at 60 degrees to right and left or 50 degrees to upward and downward of the straight-ahead position. Subjects were asked to look at the targets quickly by directing the laser spot to the target. The anterior-posterior component of centre of pressures (COPs) exhibited the largest changes and shortest latencies during downward movements. Most of the subjects showed COP changes preceding the onset of downward head movements, and these changes were associated with EMG activity of biceps femoris and gastrocnemius. When subjects were asked to look at the target only by eyes, no consistent change was detected in ground reaction forces. These results indicate that the eye-head movements elicited the COP changes that preceded the onset of head movements.

In P2P content distribution systems, there are many cases in which the content can be classified into hierarchically organized categories. In this paper, we propose a hybrid overlay network design suitable for such content called Pastry/NSHCC (Pastry for non- strictly hierarchically categorized content). The semantic information of classification hierarchies of the content can be utilized regardless of whether they are in a strict tree structure or not. By doing so, the search scope can be restrained to any granularity, and the number of query messages also decreases while maintaining keyword searching available. Through simulation, we showed that the proposed method provides better performance and lower overhead than unstructured overlays exploiting the same semantic information.

We performed electron acceleration experiment with PW‐class laser and a plasma tube, which was created by imploding a hollow polystyrene cylinder. In this experiment, electron energies in excess of 600 MeV have been observed. Moreover, the spectra of a comparatively high‐density plasma ∼1019 cm−3 had a bump around 10 MeV. Additionally, we performed the absolute sensitivity calibration of imaging plate for 1 GeV electrons from the injector Linac of Spring‐8 in order to evaluate absolute number of GeV‐class electrons in the laser acceleration experiment.

Technology roadmaps for electronic packaging and 3D integration show the continuing trend of increasing input/output connection density between the semiconductor chip and the package or between two different IC's. For FlipChip packaging applications, 150 mum pitch full grid solder bump arrays have already entered production. Bump pitch requirements for 3D applications such as the integration of memory and logic are even tighter. These fine pitch applications exceed the capabilities of traditional wafer bumping processes such as solder screening or ball placement. Controlled Collapse Chip Connection - New Process (C4NP) technology has the ability to produce these very fine pitch connections in a cost effective manner. This paper reviews the latest C4NP data for a 50 mum pitch application. Glass molds were fabricated, filled with solder, inspected, and the solder transferred to a fine pitch wafer. Four molds have been fabricated with cavity top diameters ranging from ~33 to 40 mum., The molds were filled with binary SnAg solder using the mold fill tool, automatically inspected with the mold inspect tool, and wafers were bumped with the solder transfer tool. Characterization of the filled molds and bumped wafers is presented. In addition, the paper also reviews production cost analysis for various UBM stackups and solder bump processes, based on a specifically developed cost model. The Electroless Ni Immersion Au (ENIG) UBM structures in combination with C4NP solder bumping provide a significant cost reduction over alternative structures. C4NP is a unique solder bumping technology developed by IBM which addresses the limitations of existing bumping technologies by enabling low-cost, fine pitch bumping using a variety of lead-free solder alloys. It is a solder transfer technology where molten solder is injected into pre-fabricated and reusable glass molds. The glass mold contains etched cavities which mirror the bump pattern on the wafer. The filled mold is inspected prior to solder transfer to the wafer to ensure high final yields. Filled mold and wafer are brought into close proximity/soft contact at reflow temperature and solder bumps are transferred onto the entire 300 mm (or smaller) wafer in a single process step without the complexities associated with liquid flux. C4NP technology is capable of fine pitch bumping while offering the same alloy selection flexibility as solder paste printing. The simplicity of the process makes it a low cost, high yield and fast cycle time solution for both, fine-pitch as well as chip scale package bumping applications. Fine pitch C4NP molds were fabricated by ULCOAT, Japan. Mold fill, inspect and solder transfer was done using the C4NP process at the IBM Hudson Valley Research Park, Hopewell Junction, New York, United States.

This paper reports an overload control method for intelligent networks (INs). INs will facilitate the rapid and efficient introduction of new services that meet various customer needs; they will also allow easy modification of existing services. The introduction of INs may cause various patterns of overload traffic conditions. With the introduction of these diverse services, it is becoming more and more important to satisfy quality of service (QoS) requirements. We propose an overload control method that makes it possible to maintain high throughput while satisfying the QoS requirements under any overload traffic conditions. This paper begins by first showing the characteristics of the IN. Next, it is shown that the IN architecture and its traffic characteristics lead to new problems in overload control. To overcome these problems, we consider the requirements for overload control, and an overload control method is proposed. Then, we evaluate this method's performance by simulation.

An improved hardware architecture for high-speed data processing with a high-speed update rate of 60 displays/s is described. This technique is applied to a general purpose digital oscilloscope, the DL 1200. An overview is provided of the technique and the new product. >

H-SCAN (1996) was presented as a low overhead design-for-testability strategy which is applicable to RT-level controller-data path circuits. However, from the view-point of practical use, there is a possibility that the area overhead of H-SCAN is larger than that of full-scan. Moreover, H-SCAN is unable to handle many features present in actual designs. In this paper, we propose a modified H-SCAN scheme, called "H-SCAN+", as an improved solution for actual designs. H-SCAN+ consists of several enhancements, including techniques to minimize scan design area overhead, handling of features present in actual designs, and techniques to significantly minimize the running time. We provide comprehensive results of applying H-SCAN+ to several actual RT-level designs.

Magnetic domain structures of Nd(1/2)Sr(1/2)MnO3 were investigated by means of low-temperature Lorentz electron microscopy. On cooling, magnetic domain walls started to appear at 250 K, and they were oriented straight along the [100] and [110] directions. With a further decrease in temperature, the volume of each magnetic domain increased with discontinuous domain-wall jumps. A characteristic granular image was observed at around 140 K, near the charge-ordering transition temperature. We consider that this originated from ferromagnetic nanoclusters that appeared in the antiferromagnetic matrix.

In electron accelerator facilities, radio frequencies for a linac accelerator and a circular accelerator including a booster synchrotron ring and a storage ring are completely different. In order to improve the beam transmission efficiency from a linac to a circular accelerator, and to make the beam intensity constant, both rf's are generally synchronized. This method is well known and uses a common subharmonic frequency of around 10 MHz. The rf's used are generated by using a frequency multiplier from the common frequency, and they are continuously generated. We paid attention to the fact that the electron beam from a linac accelerator is always pulsed, and the rf of the linac requires only a moment during beam emission and acceleration. Taking this fact into account, we invented a new synchronization method for the rf's of both the linac and the circular accelerators. The new method is explained by describing a concrete example at the synchrotron radiation facility, SPring-8 (Super Photon ring 8 GeV). A 2856 MHz rf for the linac is generated by 508.58 MHz rf of the storage ring for a short duration of about 290 μs. Thus, the phase difference between the two rf's is automatically fixed. This method can be applied to any combination of arbitrary different rf's.

The structural phase transition of Pr(1-x)Ca(x)MnO(3)(x = 3/8) was investigated by means of low-temperature transmission electron microscopy. Superlattice reflection spots with a modulation wave vector q(1) = (0,1/2,0) appeared below 230 K, indicating formation of the d(3x(2-r(2))/d(3y(2)-r(2)) type of charge/orbital ordering. Below 150 K, a new series of superlattice reflection spots with a modulation wave vector q(2) = (1/4,1/4,1/2) appeared, suggesting an additional ordering of excess 1/8 Mn(3+), necessary due to the deviation of x from 1/2, with the occupation of the d(3z(2-r(2)) type of e(g) orbital.

Background Tools for supporting design of consumer products that is safe for children is strongly needed. Conventionally, toy companies and other child related consumer product manufacturers developed such tools by themselves. However medium and small companies whose main products are not for children have difficulty in developing such tools by themselves. Purpose This study develops commonly usable tools for childsafe consumer products design even if main users of the products are not children. Methods The authors developed some tools for supporting childsafe consumer product design using the measure data of 2228 children9s aged 6 months old to 13-years-old by cooperating human engineering researchers with product designers. These data have been accumulated by Research Institute of Human Engineering for Quality Life (HQL) and National Institute of Advanced Industrial Science and Technology (AIST) since 2005 in Japan. The data includes over 50 kinds of body measurements. Results The authors developed a data book on the measure of Japanese child (Fig. 1), a portable measure of child (Fig. 2), and portable absolute scale models of child (Fig. 3). For example, the portable measure of child draws the thickness of the index finger of 1-year-old child as well as it can be used as an ordinary scale. At this moment, 1 to 6-year-old measures are available. Significance This study developed commonly usable tools for childsafe consumer products design. The authors plan to disseminate the developed tools through seminar, publication, and lecture at colleges and professional schools.

A 22-year-old male college student had a syndactyly between the second and third fingers of his left hand, which was congenitally small in size. His left pectoralis muscles were absent. He first walked at the age of 12 months, but soon developed difficulties in walking due to weakness of the legs. Atrophy and weakness of the legs aggravated gradually. He was diagnosed as having peroneal muscular atrophy and Poland syndrome, an association of which has not been reported before. A small number of similar cases of peroneal muscular atrophy with various skeletal abnormalities in the literature suggest that the association is not incidental, but of clinical significance.

Y‐base and Bi‐base high‐Tc oxide superconductors have been successfully synthesized by the citric acid salt decomposition process. Tc’s of 92 K and 109 K have been obtained after a relatively short sintering in the Y‐system and Bi‐system, respectively. The fine dispersion of particles Ag in the Y‐base oxide appreciably decreases the sintering temperature and enhances the transport Jc. The intermediate press increases both Tc and Jc in bi‐base oxide. A Jc (77 K) of 1500 A/cm2 has been obtained in the sintered Bi‐base specimen.

Fetal mouse calvarias were cultured in a medium containing fetal calf serum, 1,25(OH)2D3 and parathyroid hormone in 5% CO2 incubator at 37 degrees C for 5 days. The calvarias were then fixed in a buffered paraformaldehyde solution and the periostea were removed. A polyclonal antibody against transforming growth factor-beta (TFG-beta) and a second antibody labeled with fluorescein isothiocyanate were used to detect TGF-beta. As a result, a specific staining was observed only in the shielding zone covered by osteoclasts in the bone resorption lacunae and in the extracellular matrix adjacent to the osteoclasts. These findings suggested the local delivery and possible activation of TGF-beta by osteoclasts in tissue.

Synthesis of various serum proteins, such as albumin, prealbumin, α1-antitrypsin, transferrin and α-fetoprotein, by human and rat yolk sac tumors was studied by indirect immunofluorescence and immunoperoxidase techniques. These serum proteins were found to be present in the cytoplasm of tumor cells forming the lining of vitelline cysts, as well as Schiller-Duval bodies and vacuolated meshwork on histological sections. Two of these tumors were cultured. Immunopathological studies revealed that albumin, prealbumin, α1-antitrypsin, transferrin and α-fetoprotein were found in the cytoplasm of these cultured tumor cells. The immunofluorescence of these proteins was also found on the PAS-positive granules, which existed intra- and extra-cellularly. The ability to synthesize these serum proteins of these tumor cells was not affected by tissue culture and was maintained during subcloning. It was demonstrated by electron microscope ferritin antibody technique that α-fetoprotein was mainly synthesized on the ribosomes of the rough endoplasmic reticula of rat yolk sac tumor cells.

During the years 1952 through June, 1977, 64 children with tumor of germ cell origin were seen at the Department of Pediatric Surgery, the University of Tokyo Hospital. There were 39 mature, 7 immature and 18 frankly malignant teratomas. Sixteen cases had histological features of endodermal sinus tumor in pure or mixed form, and all of the last eight patients showed elevated serum AFP concentrations ranging from 92,000 ng/ml to 952 ng/ml. Serum AFP concentration declined almost to zero ng/ml with a half life of about 4 days when surgical removal was complete, whereas AFP decreased only to 100–200 ng/ml with radiation therapy and chemotherapy alone. Serum concentrations of prealbumin, albumin, alpha-1-antitrypsin and transferrin were almost within normal ranges. Two endodermal sinus tumors were studied by tissue culture, which demonstrated secretion of diastaseresistant PAS-positive hyaline globules. PAS-positive granule is one of the characteristic histologic features of endodermal sinus tumor with demonstrable AFP specific immunofluorescence.

It has been shown by a series of experiments on 5-alkyl, 5-halo-, and other 5-substituted 1-naphthol derivatives that the product ratio of the ortho - and para -naphthoquinones formed on oxidation with Fremy's salt is controlled by the bulkiness of the C 5 -substituent.

The characteristics of two very common targets (TbFeCo and TbCo alloys) were evaluated and it was learned that sputtering such alloy targets varies the sample composition, but target oxygen content has no effect on the magnetic characteristics.

We have evaluated the basic performances of TbFeCo and TbCo alloy targets for the sputter deposition of magneto‐optical recording media. The composition of the sputtered film shifts from the original one of the target, and the Tb concentration in the sputtered film is always reduced by about 6 at. % in both alloy targets. Sputtered films were all perpendicular magnetic film with a squareness ratio (ratio of residual magnetization to saturation magnetization) of 1, and the residual Kerr rotation angle was about 20’ min. The measurements indicate no change in the sputtering characteristics of the targets after more than 100 h of use.

The Kerr rotation of the Co-O films which is a newly developed perpendicular magnetic films was investigated. Saturation magnetization decreases as the oxygen content of the film increases, however the Kerr rotation angle does not decrease and the same value of 15 min to 25 min as the pure cobalt film was obtained. This can be accounted for by the high transmittance of the Co-O films. Co-O film on the cobalt film significantly increased Kerr rotation by the new enhancement effect.

A patient with a double-chambered right ventricle and cor triatriatum dexter was presented. The non-invasive diagnosis of cor triatriatum dexter was stressed. A plate-like echo was imaged in the right atrium using two-dimensional echocardiography. It divided the atrium into two chambers. Contrast echocardiography revealed delayed filling of the lower portion of the atrium. Pulsed Doppler echocardiography demonstrated systolic turbulence in the lower portion of the atrium, indicating that the plate-like structure produced a stenosis in the right atrium. We conclude that non-invasive methods including contrast echocardiography and pulsed Doppler echocardiography, are effective in identifying stenoses in the right atrium.

The detection of regional myocardial dysfunction due to acute ischemic event has been limited almost entirely to experimental animal models. In human subjects, it has been limited to the observations during spontaneously-occurring or exercise-induced ischemic events. Recently, percutaneous transluminal coronary angioplasty (PTCA) provides an opportunity to study such dysfunction as the result of repeated interruptions of coronary blood flow. Echocardiograms and electrocardiograms were simultaneously recorded immediately before, during, and after 21 episodes of complete interruptions of coronary blood flow by PTCA in 11 patients. No patient had asynergy of the left ventricle either by two-dimensional echocardiography (2DE) or angiography. All patients had isolated single coronary artery stenosis including the left anterior descending artery in nine, left circumflex artery in one and right coronary artery in one. Recordings of M-mode and 2DE were successfully obtained in 10 patients. After balloon inflation, regional asynergy in the distribution of the instrumented coronary artery appeared in all 10 patients. Hypokinesis developed 9 +/- 3 (means +/- SD) sec after balloon inflation and progressed rapidly to akinesis or dyskinesis. At the same time, decreased systolic thickening of the left ventricular wall appeared in some patients in relation to the development of regional asynergy. However, systolic thinning of the left ventricular wall was not noted in all. The regional asynergy preceded ischemic electrocardiographic changes and had no relation to chest pain. Left ventricular wall motion began to normalize 12 +/- 3 sec after balloon deflation. Thereafter, transient hyperkinesis of the left ventricle developed. The first ischemic electrocardiographic change was a negative U wave which appeared 13 +/- 7 sec after coronary occlusion and remained 3 to 4 sec. Tall T waves were recorded at 28 +/- 12 sec and significant ST elevations developed 31 +/- 11 sec, after balloon inflation. These electrocardiographic changes invariably occurred only after the onset of wall motion abnormalities. Normalization of T waves was recognized at 17 +/- 16 sec and ST segment deviation were no longer present at 18 +/- 10 sec, after reperfusion. These electrocardiographic changes also preceded normalization of regional myocardial dysfunction. In conclusion, left ventricular wall motion abnormalities after coronary occlusion invariably precede the electrocardiographic changes, and begin to normalize after reperfusion prior to the electrocardiographic recovery.

Our criteria for the diagnosis of prolapsed mitral valve were proposed in this paper. With this abnormality, the principal alterations in the mitral valve consist of an abnormal systolic leaflet motion and mitral regurgitation with or without systolic clicks. Our criteria include: (1) auscultatory or phonocardiographic findings suggestive of mitral regurgitation or mitral complex abnormality, (2) a posterior displacement of the mitral valve throughout the latter half of systole by M-mode echocardiography, and (3) a systolic bulging or an apparent systolic ballooning of the mitral valve by two-dimensional echocardiography. A diagnosis of prolapsed mitral valve is justified in a given case if (1) plus one or two other findings are present. Several confusing M-mode and two-dimensional echocardiographic findings for the diagnosis of this condition are neglected in this criteria. We believe that the diagnosis of prolapsed mitral valve, as a rule, should depend on the presence of significant auscultatory or phonocardiographic finding which is a major manifestation of our criteria. However, our criteria seem to be inadequate for the diagnosis of a systolic ballooning of the mitral valve toward the left atrium which is frequently associated with atrial septal defect, since an apical systolic murmur is often absent. The mitral valve ballooning in atrial septal defect, however, is of functional origin, and should be differentiated from an organic prolapsed mitral valve. Thus, to be significant of prolapsed mitral valve, an apical auscultatory or phonocardiographic findings should be unequivocal.

It is well known that right ventriculography has unavoidable disadvantages as a method for diagnosing tricuspid regurgitation. In this study, inferior vena caval angiography (IVC angiography) was tested as a new method for quantitatively diagnosing tricuspid regurgitation. With this method, no catheter passes through the tricuspid valve, and only a small amount (10 ml) of contrast material injected into the upper portion of the inferior vena cava visualizes the entire right atrium, and tricuspid regurgitation is manifested by turbulence or a negative jet in the right atrium. With respect to the degree, tricuspid regurgitation was graded as absent (0), mild (1+), moderate (2+) and severe (3+) using the criteria shown in Fig. 1. Mild tricuspid regurgitation was diagnosed when systolic turbulence was observed in the right atrium and did not reach the right atrial wall. Moderate tricuspid regurgitation was diagnosed when systolic turbulence reached the right atrial wall. Severe tricuspid regurgitation was diagnosed when systolic turbulence entered the inferior vena cava. Sixty-four patients with valvular heart disease and four having coronary heart disease were studied using IVC angiography and pulsed Doppler echocardiography. Using Doppler, the severity of tricuspid regurgitation was determined according to the distribution of the regurgitant signal in the right atrium. The degree of tricuspid regurgitation by IVC angiography correlated well with that by Doppler. All patients with severe (3+) regurgitation and 15 of 22 patients with moderate (2+) regurgitation required surgery, but all with no (0) regurgitation and 12 of 14 with only mild (1+) regurgitation required no surgical correction of the tricuspid valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-seven patients in cardiogenic shock or medically refractory left ventricular failure due to acute myocardial infarction were treated with intraaortic balloon counterpulsation. Twenty-one of them were treated with counterpulsation alone; the remaining six underwent surgery. Thirteen patients were benefited by counterpulsation alone. Three of the patients treated with counterpulsation and surgery survived and were discharged from the hospital. Thus, 16 of the 27 patients (59%) survived. Four patients in medically refractory left ventricular failure or shock due to acute myocarditis were treated with counterpulsation. All patients were weaned easily from circulatory assist and were discharged from the hospital. This study shows that intraaortic balloon counterpulsation is a very useful adjunct to currently existing medical measures for the treatment of cardiogenic shock or for medically refractory left ventricular failure in both myocardial infarction and myocarditis.

To assess the incidence of valvular regurgitation, 180 patients more than 40 years of age without cardiac symptoms were studied by pulsed Doppler echocardiography. The 180 patients were categorized by age as group 1, 40 to 49 years; group 2, 50 to 59 years; group 3, 60 to 69 years; group 4, 70 to 79 years; and group 5, more than 80 years of age. The incidence of valvular regurgitant flow signals increased significantly with age. Multivalvular regurgitation were often detected in groups 4 and 5. Furthermore, acoustically silent regurgitation at each valve was frequently noted (71 of 85 cases with valvular regurgitant flow signal: 84%). Mitral valve prolapse was diagnosed by two-dimensional echocardiography in 27 patients, but a mid-systolic click or pansystolic murmur with late-systolic accentuation was not noted. In conclusion, valvular regurgitations were common in the aged who lacked auscultatory findings.

Collapse of the right ventricle and right and left atria is observed in cardiac tamponade. To assess the diagnostic value of each collapse component in identifying cardiac tamponade, two-dimensional and M-mode echocardiograms were recorded simultaneously with the measurement of intrapericardial pressure in five patients as they underwent pericardiocentesis. Before pericardiocentesis, each patient had evidence of right ventricular and right atrial collapse. In addition, left atrial collapse was observed in four patients. During pericardiocentesis, left atrial collapse initially resolved accompanied by a drop in pressure in the pericardial sac. Continuous drainage of pericardial effusion resulted in significant symptomatic improvement and the cessation of paradoxical pulse at the point of resolution of right ventricular collapse. However, right atrial collapse persisted after resolution of right ventricular collapse, but it was absent when pericardiocentesis was completed. Injection of saline solution with heparin into the pericardial sac for cleansing initially caused right atrial collapse, while right ventricular collapse developed with the appearance of cardiac tamponade. In one patient, the simultaneous recording of right ventricular and intrapericardial pressures and two-dimensional echocardiograms demonstrated that right ventricular collapse occurred early in diastole, when intrapericardial pressure exceeded right ventricular pressure. In conclusion, right ventricular collapse is the most reliable sign of cardiac tamponade. Right atrial collapse occurs in the early stage of cardiac tamponade. Left atrial collapse appears very late in the course of hemodynamic deterioration due to cardiac tamponade.

To assess the diagnostic performance of two-dimensional echocardiography in the diagnosis of dissecting aneurysm, 12 patients (7 women and 5 men with a mean age of 51 years) with clinically suspected dissecting aneurysm were investigated. The diagnosis was confirmed by angiography or operation or autopsy in all patients. Eight had a dissecting aneurysm and the remaining 4 had a saccular aneurysm. The intimal flap echo was observed in 7 of the 8 patients with dissecting aneurysm. The intimal flap motion in these patients showed a fluctuating motion. The site or spread of this echo corresponded well with the anatomical lesion. On the other hand, an intra-aortic abnormal linear echo was observed in three of the 4 patients with saccular aneurysm. However, this linear echo showed little motion. The sensitivity, specificity and predictive value of the intimal flap echo in association with its fluctuating motion in the diagnosis of dissecting aneurysm were all 100%, although the efficiency remained at 69%. It was concluded that the real-time two-dimensional echogram is useful in the diagnosis of acute dissecting aneurysm.

To assess a possible mechanism of abnormal interventricular septal motion following cardiac surgery, 16 patients were studied during cardiac surgery by M-mode and two-dimensional echocardiography. All 16 patients underwent open heart surgery using cardiopulmonary bypass. M-mode echocardiogram and short-axis views of the left ventricle by two-dimensional echocardiography were obtained before and after pericardiotomy, and before and after the closure of the pericardium. Interventricular septal motion did not change after pericardiotomy. Interventricular septal motion just after cardiac surgery was variable and dependent on each underlying condition. In all the 16 patients, interventricular septal motion became abnormal after the closure of pericardium. The abnormal septal motion persisted following the chest closure. We conclude that pericardial closure is responsible for post-operative abnormal septal motion.