Transvaginal pulsed and color Doppler sonography for the evaluation of adenomyosis

In an earlier paper, we reported our scoring system for the diagnosis of adenomyosis by gray scale transvaginal sonography. In this study we evaluated 44 benign uterine masses (adenomyosis and myomas) and seven uterine malignancies. We used transvaginal color and pulsed Doppler imaging to determine whether this technique is useful to differentiate adenomyosis from uterine malignancies. The peak systolic velocity and the resistive index of intratumoral vessels were studied. The differences in these parameters for adenomyosis and uterine malignancies were statistically significant. Our results suggest that this technique is useful to differentiate adenomyosis from uterine malignancies.

[A case report of bentall type operation for annuloaortic ectasia with anomalous origin of the right coronary artery complicated by aortic dissection]

A 49-year-old woman of Marfan's syndrome, who had undergone replacement of the thoracoabdominal aorta for Stanford B type aortic dissection at 47 years of age, developed Stanford A type aortic dissection with annulo-aortic ectasia and aortic regurgitation. At the time of operation, anomalous origin of the right coronary artery from the left sinus of Valsalva and near site of the left coronary orifice were found. Then, composite graft replacement of the ascending aorta and aortic valve, in which a single graft of 16 mm in diameter was interposed between the coronary ostia and composite graft, was performed. Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital abnormality. It is a matter how to reconstruct the coronary circulation for this type of operation. This technique was useful to reconstruct the aortic root even when an anomalous origin of the coronary artery existed.

Lansoprazole treatment of Helicobacter pylori-positive peptic ulcers

Forty-nine patients with Helicobacter pylori (Hp)-positive gastric ulcer (GU) and 39 patients with Hp-positive duodenal ulcer (DU) were studied. Before the trial and every 3 or 4 weeks, phenol red dye spraying endoscopy, the rapid urease test, biopsy specimen histology, and culture were performed to assess the ulcer stage and to detect Hp. Patients were divided into three groups: group I received lansoprazole 30 mg/d; Group II received dual therapy of lansoprazole 30 mg/day and amoxicillin (AMPC) 1 g/day or clarithromycin (CAM) 400 mg/day; and Group III received combination therapy of lansoprazole 30 mg/day, AMPC 1 g/day, or CAM 400 mg/day, and metronidazole 500 mg/day. Patients with GU received lansoprazole for 8 weeks and patients with DU received lansoprazole for 6 weeks. The other agents were administered for 2 weeks at the beginning of the trial. There were no differences in ulcer healing among the three treatment groups in patients with GU or DU, but there were significant differences in the eradication of Hp. No side effects were observed in any of the patients. We conclude that combination therapy is likely to be most effective and is harmless for Hp-persistent patients with peptic ulcer.

QRST time integral values in 12-lead electrocardiograms before and after radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome

OBJECTIVES

We investigated the usefulness of QRST values obtained from 12-lead electrocardiograms (ECGs) for identification of repolarization abnormalities before and after radiofrequency ablation in patients with Wolff-Parkinson-White syndrome.

BACKGROUND

Marked T wave abnormalities often appear after ablation and have been attributed to a continuation of repolarization abnormalities present before ablation (cardiac memory). However, to our knowledge repolarization properties before and after ablation have not been assessed quantitatively.

METHODS

We calculated the ECG QRST values from 53 patients with Wolff-Parkinson-White syndrome and compared these values before, immediately after and 1 day and 1 week after successful ablation in 25 patients.

RESULTS

QRST values were abnormally high in lead V1 in 7 of 28 patients with a left-sided accessory pathway and abnormally low in leads III and aVF and high in lead aVL in 12, 9 and 10 of 20 patients, respectively, with a right-sided accessory pathway. Preexisting QRST abnormalities were still present immediately and 1 day after ablation but were usually absent by 1 week after ablation. QRST values before, immediately after and 1 day after ablation were not significantly different in any lead. In 14 patients with ablation of a left-sided accessory pathway, QRST values before, immediately after and 1 day after ablation in lead V1 and immediately after ablation in leads I, aVR and V2 were significantly different from QRST values in those leads 1 week after ablation. In six patients with ablation of a right-sided accessory pathway, QRST values before, immediately after and 1 day after ablation in leads III, aVL and aVF and immediately after ablation in lead II were significantly different from QRST values in those leads 1 week after ablation.

CONCLUSIONS

Electrocardiographic QRST values may provide useful quantitative information with respect to repolarization properties before and after ablation in patients with Wolff-Parkinson-White syndrome that is otherwise difficult to obtain by conventional ECG analysis.

[Bypass grafting of left subclavian artery to descending thoracic aorta for relative stenosis of bypass graft after total correction for type A IAA with VSD]

A 4-year-old child underwent one-stage total correction for type A IAA with VSD in 1975 as the first successful case in Japan. At age 21, a gradual rise in her upper limb pressure to 190 mmHg prompted repeat catheterization, which showed a pressure gradient across the EPTFE graft of 58 mmHg. Under general anesthesia in the right lateral position, the patient's left thorax was reopened. The EPTFE graft had undergone patchy calcific degeneration and was significantly hardened. An 18-mm Toray graft preclotted with fibrin glue was anastomosed to the left subclavian artery in side-to-end fashion. Its distal end was anastomosed to the descending aorta distal to the EPTFE bypass during a 20-minute aortic occlusion. The postoperative recovery was uneventful and the pressure gradient between the upper and lower limbs fell to 0 at discharge. We chose this method for reoperation of type A IAA and CoA because of the reduced need for dissection and better effectiveness.

Establishment and characterization of IRTA17 and IRTA21, two novel acute non-lymphocytic leukaemia cell lines with t(16;21) translocation

The t(16;21)(p11;q22) translocation is an infrequent chromosomal abnormality, but seems specific to acute non-lymphocytic leukaemia (ANLL). We established two cell lines with t(16;21)(p11;q22) from the bone marrow of a patient with ANL in relapse. Their morphological, karyotypic, immunohistochemical and genetic features are examined. Although both cell lines show monocytoid features morphologically, they express only CD13 (My7) and CD34, and neither expressed monocytoid or lymphoid markers. Reverse transcription-polymerase chain reaction showed that both cell lines expressed a similar TLS-ERG chimaeric mRNA as a result of the t(16;21)(p11;q22) translocation. As far as we know, there is no report of a leukaemia cell line with t(16;21). These cell lines represent a useful tool for leukaemia research.

Cloning and characterization of MST, a novel (putative) serine/threonine kinase with SH3 domain

Protein kinases play a key role in cell growth regulation. We have isolated a cDNA fragment of the MST gene from the MKN28 gastric cancer cell line cDNA pool by degenerate polymerase chain reaction. MST-cDNAs were cloned from the human brain cDNA library. Nucleotide sequence analysis indicated that the MST gene encodes a novel putative non-receptor type of serine/threonine kinase with Src homology 3 (SH3) domain, two leucine zipper domains and proline rich domain. The deduced amino acid sequence corresponding to a part of kinase domain and leucine zipper domains of MST (amino acid codons 244-461) is almost identical to the published partial amino acid sequence of MLK2. MST is the first non-receptor type of serine/threonine kinase containing SH3 domain, leucine zipper domain and proline rich domain other than PTK1/Sprk. The MST gene was moderately expressed in brain, skeletal muscle and testis as a 3.8 kb mRNA, and the MST gene has been mapped to human chromosome 19q13.1-q13.2.

[Stanford type A acute aortic dissection involving an aberrant right subclavian artery--a successful operative case]

A 64-year-old woman was admitted with chest (pain) and back pain. We found aortic dissecting area from ascending aorta to aortic arch and thoracic descending aorta by enhanced computed tomography. She was diagnosed Stanford type A acute aortic dissection. Emergent operation was performed on Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from descending aorta. Using non-clamping selective cerebral perfusion, we could succeed this operation. As far as we know, this is the first report in Japanese literatures.

[Plasma concentration of cytosine arabinoside (Ara-C) in the elderly patients with hematological malignancy treated by Ara-C or cytarabine ocfosfate (SPAC)]

Plasma concentration of cytosine arabinoside (Ara-C) was determined in elderly patients with myelodysplastic syndromes or acute myelocytic leukemia who were treated with subcutaneous injection of Ara-C (Ara-C s.c.; 10 mg/m2/12 hr, 14-21 days), continuous drip infusion of Ara-C (Ara-C d.i.v.; 20 mg/m2/day, 24 hr 14 days) and/or oral administration of cytarabine ocfosfate (SPAC) (SPAC p.o.; 100 mg-300 mg/body/day, 14 days) by radioimmunoassay. In the Ara-C s.c. patients, the peak plasma level (Cmax) of Ara-C was 103 ng/ml and the time to reach Cmax was 15 min. The elimination half-like (t1/2) was 25 min and no accumulation was detected after 14 days of consecutive Ara-C s.c. administrations. In the SPAC p.o. patients, Cmax of Ara-C was 3-8 ng/ml and it took 3-5 days to reach Cmax. The plasma concentration level of Ara-C remains almost at the Cmax level during the SPAC p.o. administration and it remained higher than 0.32 ng/ml for as long as 15 days after the end of administration. In a Ara-C d.i.v. patient, plasma level of Ara-C was detected 4-7 ng/ml during the administration (day 7 through day 14). In all patients bone marrow suppression was observed after chemotherapy regardless of regimen, and there was no significant difference between nadir peripheral cell blood counts of Ara-C s.c. patients and SPAC p.o. patients.

[A case of acute dissecting aortic aneurysm associated with congenital bicuspid aortic valve]

The congenital bicuspid aortic valve is recognized as a cause of aortic dissection. But in Japan, the case of aortic dissection associated with bicuspid aortic valve is rare. A 66-year-old man was referred to our hospital with a diagnosis of acute Stanford A type dissecting aneurysm associated with stenotic bicuspid aortic valve. The chest computed tomography showed thrombosis of the pseudo lumen. An operation consisting of aortic valve replacement and graft replacement of the aneurysm was performed on emergency basis because of remarkable dilation of the ascending aorta. He has been doing well after the operation and discharged from the hospital on the 46th postoperative day. It is though to be important to follow up with special concern about possible dilation of sinus of Valsalva due to intrinsic weakness of the aortic wall.

Evaluation of QRST isointegral maps in detecting posterior myocardial infarction with and without conduction disturbance

We investigated the usefulness of QRST isointegral maps (I-maps) for detecting posterior myocardial infarction (MI) with and without conduction disturbance. The I-maps were recorded during sinus rhythm and right ventricular (RV) pacing, which simulated left bundle-branch block (LBBB) in 19 patients with and in 20 patients without MI. Data on 608 normal subjects were used as controls. The "-2 SD area," where the QRST integral value was less than the lower limit of the normal range, was assessed by sigma DM (sum of QRST integral values below the normal range). Posterior MI was diagnosed with a sensitivity of 84%, a specificity of 90%, and a diagnostic accuracy of 87%, assuming that MI was present if sigma DM exceeded 50 mVms. During simulated LBBB, when the criterion sigma DM more than 250 mVms was used, the sensitivity, specificity, and diagnostic accuracy were 79, 75, and 77%, respectively. Thus, I-maps may be useful in detecting posterior MI in patients with and without an intraventricular conduction disturbance.

[Detected Epstein-Barr virus genome using polymerase chain reaction in peripheral mononuclear cells--subacute necrotizing lymphadenitis]

A 23-year old woman was admitted to our hospital because of fever, leukocytopenia, thrombocytopenia and cervical lymphadenopathy. From pathological findings of the cervical lymphnode she was diagnosed as subacute necrotizing lymphadenitis (SNL). Bone marrow aspiration was hypocellular with proliferation of mature histiocytes with hemophagocytosis. Lactate dehydrogenase was elevated to 1863 IU/l and mild liver dysfunction was observed. Hepatosplenomegaly, lymphnode swelling in abdominal cavity, pleural effusion and pericardial effusion were detected. After glucocorticoid therapy all such disorders were normalized. In this course, Epstein-Barr (EB) virus genome was detected by a polymerase chain reaction method from peripheral mononuclear cells. After normalization, EB virus genome became not to be detected. From present case we concluded that EB virus was expanded in clinical course and was associated with pathogenesis of SNL.

A high-resolution cytogenetic map of human chromosome 2: localization of 434 cosmid markers by direct R-banding fluorescence in situ hybridization

We have constructed a high-resolution cytogenetic map of human chromosome 2 with 434 newly isolated cosmid markers by means of direct R-banding fluorescence in situ hybridization. Two markers were mapped to the centromeric region, 173 to the short arm, and 259 to the long arm. The clones were evenly distributed along the entire chromosome, although a tendency toward clustering in R-positive bands was observed. The mapped cosmids provide useful landmarks for construction of a contig map and for positional cloning of cancer-associated genes, as well as genes responsible for hereditary diseases.

[Evaluation of repolarization abnormalities in patients with WPW syndrome by QRST isointegral maps]

The presence of repolarization abnormalities and the effects of radiofrequency (RF) catheter ablation of the accessory pathway on QRST isointegral maps in patients with WPW syndrome were studied. Locations of the minimum in Rosenbaum types A and B differed significantly from normals. Before ablation, abnormally low QRST area (-2SD area) was located over the back and right mid-chest in types A and B WPW syndrome, respectively. Following ablation, the minimum gradually normalized and the -2SD area gradually disappeared over a week. Conclusions. 1) WPW syndrome is often associated with repolarization abnormalities; 2) RF ablation gradually normalizes the abnormalities; 3) ST-T abnormalities in 12-lead ECGs after ablation may be attributable to "cardiac memory."; and 4) QRST isointegral maps may provide useful information about repolarization properties before and after ablation in patients with WPW syndrome.

[Body surface mapping in diagnosing the severity of left ventricular hypertrophy]

Body surface mapping is constructed from numerous electrocardiographic data, obtained from many lead points distributed over the entire thorax. It is generally accepted that the electrocardiographic features of ventricular hypertrophy consists of increase of voltage and prolongation of conduction time. In this report, the usefulness of body surface mapping in diagnosing the quantitative evaluation of left ventricular hypertrophy is reviewed. Finally, we attempted to diagnosis the severity of repolarization abnormalities from QRST isointegral map of patients with left ventricular hypertrophy.

Vacuolating cytotoxin production by Helicobacter pylori isolates from peptic ulcer, atrophic gastritis and gastric carcinoma patients

OBJECTIVE

We investigated the production of vacuolating cytotoxin by Helicobacter pylori isolates from patients with peptic ulcer, atrophic gastritis or gastric carcinoma in order to examine the pathophysiological significance of vacuolating cytotoxin in these diseases.

METHODS

H. pylori was isolated from 18 patients (five with peptic ulcers, seven with atrophic gastritis and six with gastric carcinoma). Culture supernatants of H. pylori isolates, concentrated 20-fold, were serially diluted and then analyzed for cytotoxin activity semi-quantitatively using A431 cells as indicator cells. The relative activity of vacuolating cytotoxin was defined according to the maximum dilution.

RESULTS

Cytotoxin production was observed in two out of five, six out of seven and six out of six isolates from peptic ulcer, atrophic gastritis and gastric carcinoma patients, respectively. The mean relative activity was calculated as 0.80, 2.71 and 2.50 in

CONCLUSION

These results suggest that vacuolating cytotoxin-producing H. pylori is strongly associated with both atrophic gastritis and gastric carcinoma.

[Exertional hypoxemia evaluated by pulse oximetry in patients with interstitial lung diseases]

The pattern of change in arterial oxyhemoglobin saturation (SpO2) measured by pulse oximetry (PO) during exercise, including daily activities, was studied in 23 patients with interstitial lung disease (ILD), 19 of whom had idiopathic pulmonary fibrosis, 3 collagen vascular disease, and 1 BOOP. Hypoxemia, as detected by PO appeared without dyspnea at the beginning of exertion or at a mild workload. Exercise usually induced significant changes in the same fashion first in heart rate, then in SpO2, and then in dyspnea, but stair climbing had a different pattern. Workload at the lactate threshold (LT) and symptom-limited maximal exercise (SL) in a bicyclergometer incremental exercise test correlated well with distance walked in a 10-minute walking test (10-eMD) (p < 0.01). Similarly, the degree in desaturation in each exercise test was closely correlated (p < 0.01). Exertional hypoxemia was more prominent in patients with ILD than in those with chronic pulmonary emphysema. Nevertheless, dyspne changed less per change in SpO2 in ILD patients. We conclude that prolonged monitoring of SpO2 by PO will disclose the presence of exertional desaturation in ILD patients.

[The predictive factor of postpartum impaired glucose tolerance in pregnant women with abnormal glucose tolerance]

To determine factors predictive of impaired glucose tolerance (IGT) in the postpartum period, we examined the maternal and perinatal characteristics of fifty-eight women with abnormal glucose tolerance during pregnancy. A 75g oral glucose tolerance test (OGTT) was performed on the women again around 4 weeks after delivery. Forty women who had a 2-hour plasma glucose level of 140mg/dl or more were defined as IGT in postpartum (group IGT), and the other eighteen women with a 2-hour plasma glucose level lower than 140mg/dl were defined as having normalized glucose tolerance (group N). The women in group IGT weighed more during pregnancy than those in group N (p < 0.05). Insulin secretion during the antepartum OGTT was lower in group IGT than in group N. On the basis of the prepregnant body mass index (BMI) for the obese group (BMI > or = 24), the women in group IGT weighed much more during pregnancy than those in group N (p < 0.03). In the non-obese group, the women in group IGT had higher glucose levels and lower insulin responses than those in group N. We concluded that, in obese women, excessive weight gain during pregnancy is predictive of postpartum IGT, while in non-obese women, the severity of glucose intolerance during pregnancy is related to poor postpartum prognosis.

Urinary chiro-inositol excretion is an index marker of insulin sensitivity in Japanese type II diabetes

OBJECTIVE

To determine the relationship between urinary chiro-inositol excretion and insulin sensitivity in Japanese type II diabetic patients.

RESEARCH DESIGN AND METHODS

Eighteen subjects were age-matched, nonobese, type II diabetic patients. Eight subjects had impaired glucose tolerance (IGT), and 10 had normal glucose tolerance (NGT). We quantified urinary chiro-inositol excretion using gas chromatography-mass spectrometry and the insulin sensitivity index (SI), and glucose effectiveness (SG) using Bergman's modified minimal model method.

RESULTS

The urinary excretion of chiro-inositol was much lower in the diabetic patients (32.3 +/- 16.0 mumol/day, means +/- SD) than in the NGT subjects (96.0 +/- 17.6; P < 0.0001) and IGT subjects (58.9 +/- 11.6; P < 0.0001). SI was much lower in the diabetic patients (3.81 +/- 1.49) than in the NGT subjects 6.30 +/- 1.59, P < 0.0005). SG was much lower in the diabetic patients (2.14 +/- 0.56) than in the NGT subjects (3.07 +/- 0.38, P < 0.0001). There was a significant correlation between urinary chiro-inositol excretion and SI (r = 0.766), as well as a significant correlation between urinary chiro-inositol excretion and SG (r = 0.747).

[Transcranial Doppler measurement of middle cerebral artery blood flow during continuous retrograde cerebral perfusion]

This is the first report of cerebral blood flow measurement with transcranial Doppler (TCD) during aortic arch reconstruction using continuous retrograde cerebral perfusion (CRCP) with deep hypothermia. Cerebral blood flow velocity was measured in 6 patients. CRCP was performed via the superior vena cava (SVC) at 30 cmH2O of internal juglar vein pressure and at 18 degrees C or lower of minimum bladder temperature. During the operation, the flow velocity of the middle cerebral artery (MCA) was continuously measured with TCD fixed on the temple. The cerebral blood flow during CRCP was different in each of the 6 patient. The retrograde MCA flow could be measured during CRCP in 3 patients, and the flow velocity was 11-60% of the MCA flow velocity before cardiopulmonary bypass. In the other 3 patients, retrograde MCA flow could not be detected during CRCP, but antegrade MCA flow could be found after antegrade perfusion was resumed. The antegrade flow velocity right after CRCP became more than the MCA flow before CRCP, which was regarded as a reaction due to cerebral ischemia. All the patients awoke within several (2-9) hours after operations and had no permanent neurological complications. But 2 patients developed drowsiness for several days after the operations; their CRCP times were 127 and 131 minutes. It is concluded that CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is different in each patient.(ABSTRACT TRUNCATED AT 250 WORDS)