Asymptomatic congenital coronary artery aneurysm in adulthood

Congenital coronary aneurysm is a rare disorder and most of the previously reported cases were necropsy findings, usually in association with other coronary artery abnormalities. Although rupture and thrombosis were the most common causes of death, the management of this condition has not been well defined. A patient with a right coronary artery aneurysm which remained stable over 8 years is described. It is suggested that the disease might be compatible with long-term survival.

A comparative evaluation of a minute ventilation sensing and activity sensing adaptive-rate pacemakers during daily activities

Most studies evaluating the rate response of adaptive-rate pacemakers have been based on treadmill or bicycle exercise. These studies disregard the fact that few pacemaker recipients voluntarily undertake such activities. The rate responses of nine patients (mean age 62 years, range 33-79 years) with implanted minute ventilation sensing (Meta) pacemakers were studied. The indications for pacing were complete heart block (seven patients), sick sinus syndrome (one patient), and five nodal disease (one patient). Significant improvement in maximum distance covered during a 12-minute walking test was observed in the rate adaptive compared to the VVI pacing mode (989 +/- 104 vs 921 +/- 90 m, P less than 0.02). The rate responses of this pacemaker during daily activities were recorded with telemetry during a variety of structured daily activities. The rate responses were also compared to those of an externally attached Activitrax pacemaker in each patient and to a group of ten age and sex matched volunteers. For less strenuous activities such as walking, descending stairs, washing, and bed making, both pacemakers achieved adequate rate responses compared to normal subjects. For more strenuous activities, the Activitrax pacemaker failed to achieve an adequate rate response. For example, the pacing rate achieved on ascending stairs was lower than that achieved on descending stairs (92 +/- 3 vs 102 +/- 3 bpm, P less than 0.02). The direction of rate responses was more appropriate for the Meta pacemaker. Similar to the normal subjects, the maximum rate was reached before the end of an activity with the Activitrax pacemaker.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated atrial natriuretic peptide level in giant right atrium complicating Marfan's syndrome

We report a rare case of giant right atrial dilatation in a patient with Marfan's syndrome complicated by severe tricuspid regurgitation. Interestingly, the right atrial pressure was normal, but the atrial natriuretic peptide level was markedly elevated. We suggest that the underlying connective tissue abnormality had allowed extensive atrial distension which by causing an increased intramural tension according to Laplace's law stimulated atrial natriuretic peptide secretion.

Interrupted aortic arch in an asymptomatic adult

Isolated interrupted aortic arch is a rare congenital cardiac disorder believed at one time to be incompatible with life once the ductus arteriosus closed. To our knowledge, only 12 cases have been reported in the literature and mostly in children. The diagnosis was made in all of them by catheterization. We report the first adult patient with an asymptomatic interrupted aortic arch diagnosed by computed tomography.

Cor triatriatum masked by coexisting COPD in an adult

Cor triatriatum presenting in adulthood is extremely rare. We describe a case of adult cor triatriatum in which the diagnosis was initially masked by the concomitant existence of COPD. Cardiac catheterization revealed only slightly elevated pulmonary wedge pressure despite severe pulmonary arterial hypertension. Both the primary lung disease and cor triatriatum greatly accentuated the pulmonary vascular disease which led to a reduction of pulmonary blood flow. Consequently, pulmonary venous obstruction was masked and was not reflected by measuring pulmonary wedge pressure. The diagnosis was made by two-dimensional echocardiography and left ventriculography.

Ultrasonic assisted permanent pacing in a patient with severe pulmonary tuberculosis

A 67-year-old male patient with previous history of pulmonary tuberculosis presented with syncope due to complete heart block. Collapse of the right lung and deviation of the heart to the right chest had prevented visualization of the cardiac silhouette by fluoroscopy. Successful endocardial permanent pacing using a passive fixation electrode was achieved with the help of ultrasonic visualization of the cardiac chambers.

Myocardial involvement in Churg-Strauss syndrome: the role of endomyocardial biopsy

A Chinese adult with Churg-Strauss syndrome with prominent cardiac involvement is described. The myocardial impairment initially showed good response to corticosteroid and cyclophosphamide. However, the cardiac status deteriorated later despite the absence of disease activity elsewhere. Endomyocardial biopsy was performed to determine the possibility of isolated myocardial relapse in case additional immunosuppression would be beneficial. Histology of the endomyocardial biopsy revealed myocardial fibrosis. Since cardiac involvement is the major cause of mortality in this condition and delayed treatment can lead to intractable cardiac failure, we advocate that endomyocardial biopsy should be performed more liberally and possibly serially to assess the disease activity in the myocardium. Immunosuppression may then be adjusted. To our knowledge, the occurrence of Churg-Strauss syndrome in Chinese has not been reported in the English literature.

Cutaneous chylous reflux

Two cases of cutaneous chylous reflux are described. Both patients had many translucent white vesicles from which milk-like fluid wept intermittently. Lymphangiogram revealed dilated, tortuous lymphatic vessels and dermal backflow. Electron microscopic studies showed an abnormal ultrastructure of the dilated lymphatics.

A new approach to chromosome doubling for haploid rice plants

Rice nodal segments from three flowering haploids were excised and treated for different lengths of time with 0.3% or 0.4% colchicine (dissolved in 2% DMSO) in an attempt to induce fertile seeds. A combination of higher colchicine concentration and longer hours of treatment reduced the survival rate of treated segments, but more fertile plants were transformed. Pooled data showed that of the 842 segments used, 42.2% survived the treatment and sprouted, but only 31.9% were successfully established and grown to maturity. Among the 269 mature plants, 29,4% produced fertile seeds (panicles) with an average of 146.2 seeds per diploidized plant.

Myxomatous mitral valve degeneration complicating asymptomatic cor triatriatum

Cor triatriatum presenting in adulthood is extremely rare. This paper reports a case of cor triatriatum initially masquerading as mitral stenosis, which was later complicated by myxomatous mitral valve degeneration with severe regurgitation, which necessitated mitral valvular replacement. To the authors' knowledge, such a combination has not been reported in the literature.

The unseen tears of children: a Chinese boy who vomited for 14 months

A Chinese boy in Hong Kong who vomited for 14 months after his father had gone abroad to work is reported. Despite the very obvious predicament and sadness, more than 30 doctors had failed to understand the patient. In their search for a disease to explain the symptom, they trapped both themselves and the patient in the symptom of vomiting. It is argued that this patient should have been understood not from the angle of the traditional medical model. Neither was the psychoanalytical model useful. Rather the communication model of hysteria is much more practical; the vomiting can be construed as the unseen tears of a boy entrenched helplessly in his predicament. These unseen and unrecognized tears had cost the patient 14 months of precious life.

Remarkable response of lipoid proteinosis to oral dimethyl sulphoxide

We report the successful treatment of lipoid proteinosis in a 41-year-old man using oral dimethyl sulphoxide. The initial dosage was 40 mg/kg/day, which was then increased progressively to 60 mg/kg/day. After 3 years of treatment, the patient's skin lesions, hoarseness of voice and abnormal oesophageal function improved remarkably. No side-effects were noted except for a garlic-like smell on the patient's breath.

The Rutter Parent Scale A2 and Teacher Scale B2 in Chinese. II. Clinical validity among Chinese children

This is the second of two papers about the Rutter Scales A2 and B2 among Chinese children in Hong Kong. A consecutive series of patients (n = 124) suffering from emotional and conduct disorders is compared with two control groups. Similarities and differences were found when compared with Rutter's original work. In particular, not all the items could differentiate between patients and controls. But with total scores constructed according to local standards the combined sensitivity of both Scales was highly satisfactory (96% for boys and 93% for girls). No combined specificity was available owing to the design of the study, but the respective value for individual Scales was satisfactory (using optimal cut-off points the lowest specificity was 74% for Scale A2 in boys). Their discriminative power for conduct and emotional disorders was good except in the case of A2 with emotionally disordered girls where only 13% of the cases were correctly identified. Again except A2 in girls the compositions of the anti-social and neurotic subscores of both Scales among Chinese children were similar to that for English children. It appears that these two simple Scales do have important potentials among Chinese children.

The Rutter Parent Scale A2 and Teacher Scale B2 in Chinese. I. Translation study

The well established child psychiatric epidemiological instruments Rutter Scale A2 and Scale B2 were translated by the author into Chinese. The Chinese and the English versions of both Scales were administered to bilingual Chinese subjects in Hong Kong. The statistics of Cohen's kappa was used to test the item agreement between the two language versions. It was found that most kappas fell within good or excellent ranges. The overall kappa for Scale A2 was 0.81 and for Scale B2 0.71. The correlation between the total scores of both versions for both Scales was very high; for Scale A2 it was 0.94 and for Scale B2 it was 0.93. It was concluded that the Chinese versions were accurate translation of the English versions.

Friction amyloidosis

Three patients developed a peculiar pigmentation arising from prolonged mechanical friction with the skin due to the use of rough nylon towel or back scratcher for many years. Histochemical stains could not show the existence of amyloid in one of the cases, but amyloid deposition was identified in successive electron microscopic investigations in all three cases. Although "friction melanosis" was originally used by others to describe a close relationship between friction and skin pigmentation in a similar disorder, we consider the term "friction amyloidosis" more appropriate for specifying the important role of friction in causing the early stage of macular amyloidosis. Electron microscopic examination is of importance in establishing a firm diagnosis of this disorder.

Complete amino acid sequence of human serum cholinesterase

The complete amino acid sequence of human serum cholinesterase (choline esterase II (unspecific), EC 3.1.1.8) was determined by Edman degradation of purified peptides. The protein contains 574 amino acids per subunit and nine carbohydrate chains attached to 9 asparagines. The four subunits of cholinesterase appear to be identical. The active site serine is the 198th residue from the amino terminus. The sequence of human serum cholinesterase is 53.8% identical with the sequence of acetylcholinesterase from Torpedo californica and 28% identical with the carboxyl-terminal portion of bovine thyroglobulin.

Cutaneous leishmaniasis. Clinical, histopathologic, and electron microscopic studies

One Chinese construction worker and a Chinese cook experienced unknown insect bites during their stay in Abha of Saudi Arabia and then developed skin ulcers. After returning to Taiwan, Republic of China, they were diagnosed in our hospital as having cutaneous leishmaniasis on clinical and dermatopathologic grounds. We were successful in culturing the Leishmania organism with Tobie medium and liquid metacyclic stage culture medium from the skin ulcers of these two patients. The electron microscopic findings of the parasites, Leishmania tropica, both in the tissue (amastigote) and in the cultured medium (promastigote), were also reported.