[Chiromegaly in syringomyelia--radiologic studies of hand bones]

Chiromegaly, localized hypertrophy of a hand, is known to be a rare but pathognomonic trophic disturbance in syringomyelia. We recently reported that the sympathetic hyperfunction was associated with chiromegaly. This time we carried out radiological studies of hand bones in 4 patients with syringomyelic chiromegaly. In simple roentogenography, enlargement and enhanced shadows of hand bones were recognized in the chiromegalic side. Radiographic measurements showed metacarpophalangeal length and width were increased by 1.7% and 8.8% respectively compared to the normal side, and metacarpal index was decreased significantly in the chiromegalic side. In X-ray photodensitometry (MD/MS method) of the second metacarpal bones, bone density was increased by 10.6% compared to the normal side. These results suggested that bone hypertrophy was associated with chiromegaly in patient with syringomyelia. Trophic disturbance may exert some influence on the bone tissue.

The role of tumor necrosis factor-alpha in the induction of experimental autoimmune uveoretinitis in mice

PURPOSE

To examine the role of tumor necrosis factor-alpha (TNF) in the induction of experimental autoimmune uveoretinitis (EAU), the authors compared in vivo TNF production in EAU-susceptible and EAU-resistant strains of congenic mice and attempted to determine whether TNF can enhance the inflammation in EAU by injection of TNF at the time of immunization.

METHODS

The production of TNF after stimulation with lipopolysaccharide (LPS) in B10.A and B10.D2 mice was measured by bioassay with L929 cells. The incidence and severity of EAU was compared between the group immunized with conventional methods and the group that alternatively received additional subcutaneous injection of recombinant human TNF (rhTNF) at the time of immunization in both B10.A and B10.D2 mice.

RESULTS

Serum concentration of TNF after stimulation with 50 micrograms of LPS was significantly higher in B10.A mice than in B10.D2 mice. The incidence of EAU in B10.A mice was 60%, but it was only 10% in B10.D2 mice using the conventional method. Extremely severe chorioretinitis and iridocyclitis occurred in B10.A mice with the injection of rhTNF at the time of immunization for EAU. The incidence of EAU in B10.A and B10.D2 rose to 100% and 40%, respectively. When administered alone, rhTNF did not cause any inflammatory change in the uvea.

CONCLUSIONS

The rhTNF was found to enhance the immune response to interphotoreceptor retinoid-binding protein in mice. These results suggest that susceptibility to EAU is in some part mediated by the ability of mice to produce TNF.

Virulence region of plasmid pNL2001 of Salmonella enteritidis

The virulence region of the Salmonella enteritidis 55 kb plasmid pNL2001 was identified by Tn1-insertion mutagenesis, DNA hybridization studies, and Western blot analysis of proteins encoded in the virulence region of the plasmid. DNA hybridization studies showed that the pNL2001 plasmid contained a 6.4 kb SalI-EcoRI fragment homologous to the 6.4 kb SalI-EcoRI Salmonella plasmid virulence (spv) region of the S. choleraesuis 50 kb plasmid (pKDSC50). One of the 247 Tn1-insertion mutants of S. enteritidis, designated strain TA19, showed a reduced mouse lethality, and the Tn1-insertion of strain TA19 was located within this homologous 6.4 kb region, suggesting that the 6.4 kb SalI-EcoRI fragment of pNL2001 contained the spv region. Two contiguous SalI-EcoRI fragment were cloned into the expression vectors. By the 6.4 kb SalI-EcoRI fragment were cloned into the expression vectors. By Western blot analysis using four Spv peptide antisera, each specific for individual proteins encoded in the spvR, spvA, spvB and spvC genes of pKDSC50, four proteins encoded in the 6.4 kb SalI-EcoRI fragment of pNL2001 were identified. Protein SpvR with an apparent molecular mass of 32 kDa was produced from the 2.3 kb SalI-EcoRI fragment, and protein SpvA, SpvB and SpvC with apparent molecular masses of 32, 70 and 29 kDa, respectively, were produced from the 4.1 kb EcoRI-EcoRI fragment. From the 4.1 kb EcoRI::Tn1 fragment of the TA19 plasmid, proteins SpvA and SpvB were expressed, but not SpvC. It was therefore suggested that the spvC gene may contribute to the expression of virulence of S. enteritidis. Furthermore, the nucleotide sequence of the 6.4 kb SalI-EcoRI fragment encoding these four proteins was determined. Four open reading frames which encoded the four proteins with deduced molecular masses of 33,906, 28,200, 65,349 and 27,646 Da were detected. Deduced amino acid sequences of each protein showed a high degree of identity to corresponding sequences in the virulence region of S. choleraesuis, S. dublin and S. typhimurium virulence plasmids. Therefore, we confirmed that the virulence plasmids of Salmonellae including S. enteritidis share the highly conserved region responsible for virulence.

Suppression of experimental uveitis with monoclonal antibodies to ICAM-1 and LFA-1

PURPOSE

Intercellular adhesion molecule-1 (ICAM-1), which is one of the ligands for lymphocyte function associated antigen-1 (LFA-1), plays an important role in immune responses. To examine whether ICAM-1 and LFA-1 are involved in the pathogenesis of experimental autoimmune uveoretinitis (EAU), the authors investigated the therapeutic effect of anti-ICAM-1 monoclonal antibody (mAb) 1A29 and anti-LFA-1 alpha chain mAb WT.1 on retinal soluble antigen (S-Ag) and Freund's complete adjuvant (FCA)-induced EAU in rats.

METHODS

After immunization with S-Ag and FCA, rats were intraperitoneally injected with a monoclonal antibody, anti-ICAM-1 mAb 1A29 or anti-LFA-1 alpha chain mAb or control Ab, at 1.0 mg/kg body weight, according to the treatment schedule. Inflammation was examined clinically and histologically. Proliferative responses of splenocytes to S-Ag were also examined.

RESULTS

The development of EAU could be completely prevented by the administration of 1A29, 1.0 mg/kg, twice a week from day 0 to day 14, but was only partially suppressed by WT.1. However, semiweekly administration of 1A29 from day 0 to day 7, or from day 10 to day 17, did not suppress EAU.

CONCLUSIONS

These findings indicate that ICAM-1, LFA-1-dependent pathways are involved in the pathogenesis of EAU. In addition, these pathways seem to be required for both the induction and the development of this disease.

Horizontal transmission of Salmonella enteritidis and effect of stress on shedding in laying hens

Horizontal transmission of Salmonella enteritidis in laying hens and the short-term effect of stress on shedding were examined in 32 seven-month-old laying hens. Half were inoculated with 10(5) colony-forming units of S. enteritidis phage type 4, and the remaining half were left uninoculated to study horizontal transmission. Isolation of S. enteritidis from cecal droppings of all hens was attempted every morning. Uninoculated hens rapidly became infected through contaminated drinking water. Introduction of young chickens to the same rearing room and withdrawal of water and feed for 2 days coincided with a rapid increase in the shedding rate of S. enteritidis for a short period of time. The results showed that a short-term increase in the shedding rate of S. enteritidis is associated with short-term exposure to environmental stress.

Trapoxin, an antitumor cyclic tetrapeptide, is an irreversible inhibitor of mammalian histone deacetylase

Trapoxin (cyclo-(L-phenylalanyl-L-phenylalanyl-D-pipecolinyl-L-2-amino-8- oxo-9,10-epoxy-decanoyl)) is a fungal product that induces morphological reversion from transformed to normal in sis-transformed NIH3T3 fibroblasts. Trapoxin was found to cause accumulation of highly acetylated core histones in a variety of mammalian cell lines. In vitro experiments using partially purified mouse histone deacetylase showed that a low concentration of trapoxin irreversibly inhibited deacetylation of acetylated histone molecules. Chemical reduction of an epoxide group in trapoxin completely abolished the inhibitory activity, suggesting that trapoxin binds covalently to the histone deacetylase via the epoxide. In contrast, inhibition by trichostatin A, a known potent inhibitor of histone deacetylase, was reversible. Despite the different mode of inhibition, trapoxin and trichostatin A induced almost the same biological effects on the cell cycle and differentiation. These results strongly suggest that the in vivo effects commonly induced by these agents can be attributed to histone hyperacetylation resulting from the inhibition of histone deacetylase.

[An experimental and clinical study of chorioretinal photocoagulation using a frequency-doubled Nd: YAG laser]

We developed a new frequency-doubled Nd: YAG laser system which works on 100 volts AC and emits continuous wave green laser light of 532 nm. Histological observation of rabbit eyes revealed no difference in chorioretinal lesions produced with the frequency-doubled Nd: YAG laser or with an argon green laser. This device was then clinically applied to 69 eyes of 59 patients with several disorders such as diabetic retinopathy, retinal vein occlusion, Eales' disease, Coats' disease, age-related macular degeneration, lattice degeneration in the peripheral retina, macular hole, and retinal tear. The ophthalmoscopic findings showed no visible differences in the lesions made with this device or with the argon laser. No complications were observed in these patients except for one case of central retinal vein occlusion, which developed vitreous hemorrhage after the treatment. This solid-state laser system has some mechanical advantages over the gas laser, i.e. reduced cooling requirements, easy maintenance, and long life, and it is considered to be usable clinically.

Long-term shedding of Salmonella enteritidis in chickens which received a contact exposure within 24 hrs of hatching

Rifampicin-resistant mutant of Salmonella Enteritidis was used for the experiment of long-term excretion in chickens. Thirty-five specific pathogen free chicks within 24 hrs of hatching were placed in contact with 18 chicks inoculated orally with 4 x 10(2) CFU of S. Enteritidis HY-1 Rif within 12 hrs of hatching. After 7 weeks of the contact exposure, samples of cecal droppings were examined for the isolation of S. Enteritidis weekly or biweekly. Twenty-five out of 35 chicks (71%) survived. S. Enteritidis was isolated intermittently at least until 28 weeks after the contact exposure for male chickens and 21 weeks for female chickens although this strain could be isolated only for one or two months from cecal droppings or internal organs of young chickens and laying hens. In order to prevent S. Enteritidis infection in poultry, it was concluded that (1) the contact exposure within 24 hrs of hatching or transovarian infection should be avoided because infection of chicks within 24 hrs of hatching with S. Enteritidis causes the prolonged cecal shedding, and that (2) the isolation of S. Enteritidis from cecal droppings should be repeated because of its intermittent shedding.

Coronary artery spasm after aortic valve replacement

We report a patient who received aortic valve replacement and experienced early postoperative coronary artery spasm, which led to inferolateral myocardial infarction. The spasm was unresponsive to conventional medication. However, after systemic circulatory and respiratory control, a good prognosis was obtained.

Comparison of the IgG subclass distribution of anti-thyroid peroxidase antibodies in healthy subjects with that in patients with chronic thyroiditis

The IgG subclass distribution of anti-thyroid peroxidase (TPO) antibodies in patients with chronic thyroiditis and in healthy subjects has been investigated. Anti-TPO antibodies in sera of patients with chronic thyroiditis were predominantly associated with IgG1, with a lesser contribution by IgG4 and IgG3. In contrast, anti-TPO antibodies of healthy subjects were exclusively associated with IgG4. Since structural differences in IgG subclasses reflect differences in their biological roles, these findings suggest that the role of anti-TPO antibodies in patients may differ from that in healthy subjects.

[A case report of successful removal of entrapped IABP by Lambert's method]

A 68-year-old man who necessitated IABP support for acute myocardial infarction suffered from IABP entrapment after its perforation. We washed intra-balloon space several times with heparinized normal saline, and finally could successfully remove it without surgery. It appears that the washing method (Lambert's method) for IABP entrapment could be done with lower risk especially for severe cases.

Erysipelothrix tonsillarum isolated from dogs with endocarditis in Belgium

Five strains of Erysipelothrix tonsillarum were isolated from dogs with endocarditis in Belgium. The identity and validity of the species was proved by serotyping, and biochemical and pathogenicity tests. All the isolates belonged to serovar 7 (E tonsillarum serovars); they produced acid from saccharose but did not induce any clinical sign of erysipelas in swine. These results suggest that some strains of E tonsillarum are a canine pathogen.

Accumulation of multiacetylated forms of histones by trichostatin A and its developmental consequences in early starfish embryos

External application of 10 rig/ml (R)-trichostatin A (TSA), a potent and specific inhibitor of mammalian histone deacetylase, to the embryo of the starfish Asterina pectinifera inhibited development during the early gastrula stage before formation of mesenchyme cells. The TSA-sensitive period was limited to the mid-blastula stage before hatching. The pulse-chase experiment clearly demonstrated that TSA induced an accumulation of acetylated histone species in blastulae through inhibition of historic deacetylation. Similar blockage of development at the early gastrula stage was observed with n-butyrate, which has been known as a weak inhibitor of historic deacetylase. These results suggest an intimate role for historic acetylation-deacetylation equilibria in starfish development.

The ability of Salmonella enteritidis isolated from chicks imported from England to cause transovarian infection

S. Enteritidis HY-1 isolated during quarantine from chicks imported from England was used. Laying hens at the age of 34 weeks were inoculated orally with 10(10) organisms (10 birds), intramuscularly with 10(9) (5 birds), and intravenously with 10(9) (5 birds). Egg production did not change in hens infected orally, although it was reduced in hens infected intramuscularly for 2-3 weeks post inoculation. For one month, internally infected eggs of which the shells were not contaminated were found: one out of 65 eggs in hens infected orally and three out of 36 eggs in hens infected intramuscularly. This experiment demonstrated the ability of S. Enteritidis isolated from chicks imported from England to cause transovarian infection.

Molecular mechanism of the regulation of expression of plasmid-encoded mouse bacteremia (mba) genes in Salmonella serovar Choleraesuis

The regulation of mouse bacteremia genes (mba genes) encoded by a 6.4 kb region on the 50 kb virulence plasmid (pKDSC50) of Salmonella serovar Choleraesuis was analyzed. The genes mba1, mba2, mba3, and mba4, are arranged in this order, and form a cluster located in the 6.4 kb mba region. We prepared four antibodies, each specific for an individual Mba protein, using synthetic peptides as antigens. Their amino acid sequences were deduced from the DNA sequence of the corresponding mba genes. Each Mba peptide antiserum was able to recognize the corresponding Mba protein produced by Escherichia coli carrying a recombinant plasmid containing individual mba genes. When the recombinant plasmid contained all four mba genes (pMKD601), three Mba proteins (Mba2, Mba3, and Mba4) were identified by Western blotting analysis using Mba antisera. These proteins could not be detected when the recombinant plasmid lacked mba1 (pMKD201). Three species of mRNA for mba2, mba3, and mba4 with different chain length were detected from pMKD601 by Northern blot hybridization, and two start sites were identified by primer extension assay. Gel mobility shift assays demonstrated that Mba1 specifically bound to a fragment containing the start sites of mRNAs. The amino acid sequence of Mba1 had significant homology to the LysR family of DNA binding proteins, possessing a characteristic helix-turn-helix DNA binding motif. The present study provides clear evidence to show that the Mba1 protein binds to the promoter region of mba2, and positively regulates the expression of mba2, mba3, and mba4 genes.

Effect of 50 kilobase-plasmid, pKDSC50, of Salmonella choleraesuis RF-1 strain on pig septicemia

Salmonella choleraesuis strains with and without 50-kilobase plasmid (pKDSC50) were intravenously inoculated into Yorkshire pigs. By the inoculation of 7.2 x 10(5) - 3.5 x 10(7) cells, RF-1 strain with pKDSC50, but not 31N-1 strain without the plasmid, caused a septicemia. The inoculation of 8.7 x 10(9) RF-1 cells killed pigs at 2-4 day postinfection with severe hemorrhage on the whole body. Pigs with a similar number of 31N-1 cells (8.3 x 10(9) cells), showed milder hemorrhage, and they died at 6 day postinfection. These results indicated that pKDSC50 is required for RF-1 strain to express the full virulence causing a heavy cutaneous pig septicemia.

Effect of cobra venom factor on experimental infection of mice against Clostridium chauvoei

The effect of cobra venom factor (CoVF) treatment was examined to clarify the mechanism of resistance of mice to Clostridium chauvoei infection. In CoVF-treated mice inoculated with spores of C. chauvoei, no death occurred and the organisms in the infected muscle progressively decreased, similar to that of non-treated control mice. These results indicated that C3 did not play a significant role in the resistance of mice against C. chauvoei infection.

Antigenic analysis of Clostridium chauvoei flagella with protective and non-protective monoclonal antibodies

Five monoclonal antibodies (mAbs) directed against the flagellin of Clostridium chauvoei were used to analyse the structural and antigenic characteristics on the bacterial flagellar surface. Immune electron microscopy showed that three protective mAbs recognized the surfaced-exposed epitopes on the flagellar filament of this bacteria. In contrast, two non-protective mAbs recognized internal epitopes of the flagellar filament. These findings have been confirmed by ELISA using mAbs absorbed with whole cells of C. chauvoei possessing flagella. Competitive binding assays showed that protective mAbs indicated reciprocal competition, while each of the non-protective mAbs had topographically distinct epitopes. Moreover, immunoblotting analysis with cyanogen-bromide-cleaved flagellin showed that protective mAbs may preferentially recognize conformational epitopes, whilst one of the non-protective mAbs may recognize a linear and conformation-independent epitope in the flagellin of C. chauvoei.

[Motor impairment in amyloid-associated muscle pseudohypertrophy]

Muscle involvement, usually associated with pseudohypertrophy, has been described very rarely in patients with AL-(primary or myeloma-associated) amyloidosis. Although precise mechanisms for the motor impairment in amyloid-associated muscle pseudohypertrophy are unknown, amyloid accumulation in the muscle has been thought to be a main cause of muscle weakness. We here describe a patient of amyloid-associated muscle pseudohypertrophy with IgA lambda plasma cell dyscrasia, and discuss possible mechanisms for the physical disability. The patient, a 65-year-old man, was admitted because of progressive stiffness of limb and bulbar muscles for approximately three years. On physical examination he appeared muscular and athletic. The muscles were firm with wooden or rock-like hardness. Superficial veins were engorged in all extremities. Macroglossia was marked. Resistance to passive movement was noted in all extremities with decreased range of motion; proximal joints were more severely affected. The patient walking for a short distance, his legs became heavy, tired and firm, which forced him to stop. Immunoelectrophoresis revealed the monoclonal secretion of IgA lambda in the serum and free lambda light chain in the urine. Bone marrow examination disclosed 30% plasma cells with a large prevalence of IgA lambda-containing cells. A bone scan showed an increased uptake of 99mTc-methylene diphosphate in the shoulder and pelvic joints. Tissue pressures of the quadriceps femoris at the supine and standing positions, and after walking were as high as 47, 89, and 112 mmHg, respectively. Venography of the left leg showed narrowing of the femoral vein and visualization of saphena magna vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamic analysis of the Harrington system using a spinal simulator

The authors constructed a spinal simulator for the thoracolumbar spine with mechanical properties similar to those of cadaver specimens, and studied the effectiveness of the Harrington system in unstable fractures of the thoracolumbar spine. Distraction and compression rods were applied under various conditions. External bending moment was applied to the model to measure the internal bending moment on the vertebral body and ligaments. Optimal spinal stability was obtained when the distraction system was combined with the compression system with hooks at laminas three levels above and below the fracture.

Potent and specific inhibition of mammalian histone deacetylase both in vivo and in vitro by trichostatin A

(R)-Trichostatin A (TSA) is a Streptomyces product which causes the induction of Friend cell differentiation and specific inhibition of the cell cycle of normal rat fibroblasts in the G1 and G2 phases at the very low concentrations. We found that TSA caused an accumulation of acetylated histone species in a variety of mammalian cell lines. Pulse-labeling experiments indicated that TSA markedly prolonged the in vivo half-life of the labile acetyl groups on histones in mouse mammary gland tumor cells, FM3A. The partially purified histone deacetylase from wild-type FM3A cells was effectively inhibited by TSA in a noncompetitive manner with Ki = 3.4 nM. A newly isolated mutant cell line of FM3A resistant to TSA did not show the accumulation of the acetylated histones in the presence of a higher concentration of TSA. The histone deacetylase preparation from the mutant showed decreased sensitivity to TSA (Ki = 31 nM, noncompetitive). These results clearly indicate that TSA is a potent and specific inhibitor of the histone deacetylase and that the in vivo effect of TSA on cell proliferation and differentiation can be attributed to the inhibition of the enzyme.

[Residual coronary artery stenosis: its shapes immediately after thrombolysis and subsequent time courses]

Changes in shape and the time course of residual coronary artery stenoses following thrombolysis were studied in 36 patients with acute myocardial infarction. The following results were obtained: 1. Residual stenoses after thrombolysis were categorized morphologically in three groups; long segment type (group L, eight patients), segmental type (group S, 18 patients) and filling defect type (group FD, 10 patients). 2. Residual stenoses in group L did not change either as to morphology or severity one month later. Group S did not show morphological change, but 11 of the 18 patients showed slight regression of residual stenoses. In group FD, filling defect images on repeated angiography resolved in all cases within one month. However, characteristic irregularity at the infarct-related coronary arteries were often observed at the same time. 3. Twelve of the 36 patients underwent angiography during three consecutive days to study sequential changes in residual stenoses. Intracoronary thrombi were resolved before the second day, which was compatible with a plasminogen-plasmin system change. 4. Severe coronary artery atherosclerosis may be an important factor in the pathogenesis in group L, while thrombus formation based on ulcerative lesions without significant stenoses may be an important factor in group FD. 5. Mechanical revascularization for the groups L and S patients, and an additional thrombolytic agent for the group FD patients are recommended as further therapy after thrombolysis.

Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease

Fourteen cases of heart disease with hypereosinophilia were analyzed employing conventional cardiologic methods, including echocardiography, cardiac catheterization, and endomyocardial biopsy. The cases were divided into four types: Acute carditic (endocarditis, myocarditis, pericarditis; five cases); ventricular dilation (three cases); restrictive (three cases); electric disturbance (three cases). Biopsy revealed significant changes in all cases. In one case of the ventricular dilation type, endomyocardial fibrosis with myocardial degeneration was seen, and in another case mural thrombus formation was shown to be present. In three cases of the restrictive type, endomyocardial fibrosis (EMF) was observed. In two cases of the electric disturbance type, minor right ventricular myocardial degeneration was observed. In two of the three cases of the carditic type and in three of eight cases in other categories, postmyocarditic changes were observed. The course of the disease compared with the type of disorder revealed a short course in the carditic type and a longer course, ranging from 2 to 24 years, with one exception, in the other types. It is also confirmed that the various histopathologic changes can be related to particular clinical presentations. We have shown that the basic changes in eosinophilic heart disease are not restricted to the endomyocardium and that they occur in various parts of the heart causing more widespread manifestations. The more comprehensive term "eosinophilic heart disease" is a preferable description.

[Observation of magnetic fields from three directions, and the moving image of the heart in a normal subject]

Three components of the magnetic field generated by the heart over the anterior aspect of the chest in a normal subject were detected using a Superconducting Quantum Interference Device (SQUID) magnetometer with a single detecting coil in a magnetically shielded room. Contour maps and color density maps of the field were prepared by computer. Movies of sequential magnetic fields of the vertical component on the anterior aspect of the chest were made from these maps. In the movies, the maximum moved from the upper central portion to right lower portion in the early stage of ventricular excitation. It moved to the central portion in the middle stage, then returned to the upper central portion in the late stage. Three-dimensional maps of instantaneous magnetic fields over the anterior portion of the chest were derived from maps of three components of the field, and from presumed heart vectors and were drawn as arrows, based on the Viot-Savart theorem. Heart vectors from these field maps corresponded well with septal forces in the early stage, left ventricular free wall force in the middle stage and the basal force in the late stage, respectively. However, large circulating vectors in the form of clockwise rotation in the central portion were also presumed. These circulating heart vectors did not correspond with the sequence of cardiac excitation as reported by Durrer et al. This discrepancy may have been caused by the fact that the vertical electric current could not be expressed from our display for presuming an electric force. Therefore, new displays and interpretations may be required for the expression of heart vectors.

[Hypereosinophilic syndrome associated with extensive asynergy of the left ventricular wall: a case report]

This is a report of a case of the hypereosinophilic syndrome associated with extensive asynergy of the left ventricular wall. This 41-year-old man's hospital admission in March, 1982 was for congestive heart failure, with marked eosinophilia (34%). Slight depression of the ST segments and flatness of the T waves were observed in electrocardiographic leads I, II, III, a VF, and V 5-6. Digitalis and diuretics were ineffective, but supplementary prednisone therapy resulted in a decrease in eosinophilia and improvement of congestive heart failure. He was transferred to our hospital for further examination in May, 1982. There were no signs of congestive heart failure, but a third heart sound was detected on admission. Marked ST segment depression and inverted T waves were observed in the left precordial leads. Echocardiography cardiography showed extensive asynergy of the left ventricular wall, and progressive enlargement of the left atrium and left ventricle. High density area near the apex of the left ventricle suggested the presence of mural thrombi. A left endocardial biopsy showed organized thrombi sparsely invaded by eosinophils. There were no signs nor symptoms of peripheral emboli. Tapering of the dose of prednisone was attempted twice, but each time eosinophilia resulted. The patient is now free of symptoms, and is being maintained on 25 mg of prednisone daily.

A procedure to elongate the stomach tube in the esophageal replacement

When the stomach tube has to be lengthened in case of antethoracic esophageal replacement, a circumferential seromuscular incision is made and the lesser curvature side of the tube is cut through, in the same line of incision. The rent produced is longitudinally suture-closed, by which a definite elongation (about 2 cm by each incision) is obtained. In our department the antethoracic use of the stomach tube has been carried out since 1968, the elongation procedure was started in 1973 as a trial, then its application became more frequent since 1978 and was performed whenever the tube seemed to be deficient in length. The stomach tube was used in 40 cases, of which 17 underwent the elongation procedure. With regard to the suture leak at the site of the antethoracic esophagogastric anastomosis, the incidence was 50 per cent from 1968 to 1972, 54 per cent from 1973 to 1977 and 22 per cent in the last 5 years. Thus, a distinct improvement has occurred with time.

[Rhabdomyosarcoma of the heart involving the left ventricle and left atrium]

A case of rhabdomyosarcoma of the left atrium and left ventricle demonstrated by echocardiography was reported. A 31-year-old man was admitted to our hospital for evaluation of recently developed exertional dyspnea. A holosystolic murmur and a protodiastolic sound were audible at the apex. A chest X-ray showed pulmonary congestion without cardiomegaly. The two-dimensional echocardiogram showed a dense stratified mass of echoes occupying the medial half of the left ventricular cavity, and a part of the abnormal mass of echoes was observed to move toward the left ventricular outflow tract during systole. Another small mass attached to the anterior mitral leaflet was also observed to prolapse partly into the left atrium during systole. The interatrial septum showed a thick and hard band of echo in the short-axis view. Right cardiac catheterization revealed pulmonary hypertension and the levogram of the pulmonary angiography showed left atrial and left ventricular filing defects. The repeated echocardiographic study showed the growth of the abnormal mass. The patient underwent operation, but he died of congestive heart failure thereafter. The necropsy diagnosis was rhabdomyosarcoma of the heart, involving the left atrium and left ventricle.

Quantitative estimation of the right ventricular overloading by thallium-201 myocardial scintigraphy

Thallium-201 myocardial scintigraphy was performed on 55 patients with various types of right ventricular overloading. The right ventricular (RV) free wall was visualized in 39 out of the 55 patients (71%). The mean values of right ventricular systolic pressure (RVSP) and pulmonary artery mean pressure (PAMP) in the visualized cases (uptakers) were 54.6 +/- 24.1 and 30.5 +/- 15.3 mmHg, respectively. These values were significantly higher than those of the non-visualized cases (non-uptakers). There were 12 RVSP-"normotensive" uptakers and 15 PAMP-"normotensive" uptakers. The RV free wall images were classified into three types according to their morphological features. Type I was predominantly seen in cases of RV pressure overloading, type II in RV volume overloading and type III in combined ventricular overloading. RVSP in the type III group was significantly higher than that in other two groups. The radioactivity ratio in RV free well and interventricular septum (IVS), the RV/IVS uptake ratio was calculated using left anterior oblique (LAO) view images. The RV/IVS uptake ratio closely correlated with RVSP and PAMP (r = 0.88 and 0.82, respectively). In each group of RV free wall image, there were also close correlations between the RV/IVS uptake ratio and both RVSP and PAMP. Our results indicate that the RV/IVS uptake ratio can be used as a parameter for the semi-quantitative estimation of right ventricular overloading.

[Comparative studies on right ventricular pressure and volume overloading by thallium-201 myocardial scintigraphy]

Thallium-201 myocardial scintigraphy was performed in 44 patients with various heart diseases including mitral stenosis (MS), atrial septal defect (ASD), primary pulmonary hypertension (PPH), and left atrial myxoma. The morphological findings of right ventricular (RV) free wall on the scintigram and RV/IVS (interventricular septum) uptake ratio of the images obtained from the left anterior oblique projection were studied in the patients with RV pressure or volume overloading. The RV free wall was visualize by scintigraphy in 13 out of 22 patients (59%) with MS, and in 15 out of 17 patients (88%) with ASD. In 5 patients with PPH or left atrial myxoma, the RV free wall was visualized in all cases. The patterns of RV free wall image were classified into three types. Type I with the smaller right ventricle than left ventricle was mainly seen in cases of MS, and type II with the dilated right ventricle was seen in cases of ASD and PPH. The RV free wall was visualized in most of the patients with MS whose RV systolic pressure (RVSP) was higher than 35 mmHg and mean pulmonary artery pressure (PAMP) was 20 mmHg or more, and with ASD whose RVSP was higher than 30 mmHg and PAMP was 10 mmHg or more. The ratio of radioactivity on the RV free wall and interventricular septum (RV/IVS uptake ratio) was calculated using 45 degree left anterior oblique view images. The RV/IVS uptake ratio ranged from 0.38 to 0.73 in the cases with MS, from 0.40 to 0.77 in the cases with ASD, and from 0.64 to 0.79 in the cases with PPH. In two cases with left atrial myxoma, the ratio was 0.50 and 0.55, respectively. The RV/IVS uptake ratio was compared to various hemodynamic parameters in right ventricular overloading. In the cases with MS, the RV/IVS uptake ratio was closely correlated with RVSP (r = 0.93: p less than 0.001), PAMP (r = 0.92; p less than 0.001), pulmonary capillary wedge pressure (PCWP) (r = 0.83: p less than 0.01), RV work index (RVWI) (r = 0.82: p less than 0.001), and pulmonary vascular resistance (PVR) (r = 0.71: p less than 0.01), respectively. In the cases with ASD, the RV/IVS uptake ratio was closely correlated with RVSP (r = 0.89: p less than 0.001), PAMP (r = 0.68: p less than 0.01), PVR (r = 0.77: p less than 0.01), and a left-to-right shunt ratio (r = 0.785: p less than 0.001). It was concluded that the analysis of thallium-201 myocardial scintigraphy is valuable as a non-invasive technique for the qualitative and quantitative estimation of RV pressure or volume over-loading.U