Concealed conduction in the reentrant pathway as a mechanism of stable ventricular quadrigeminy

This is the first report on the stable occurrence of ventricular quadrigeminy as a manifestation of concealed bigeminy in a case of fixed and late coupled ventricular extrasystoles. A 46-year-old man is reported in whom the period of ventricular bigeminy alternated with the period of ventricular quadrigeminy. Coupling intervals of the extrasystoles were fixed and much longer than sinus QT intervals. When the heart rate is decreased, the period of bigeminy changed to the period of quadrigeminy without gradual decrease in coupling of the preceding extrasystoles. Once such a change occurred, stable quadrigeminy is maintained for a period. These findings suggest the possibility that concealed electrotonic conduction of blocked impulses and interference of conducted impulses may occur in the reentrant extrasystolic pathway as a mechanism of stable ventricular quadrigeminy.

[An elderly case of chronic inflammatory demyelinating polyneuropathy with acute onset in the course of diabetes mellitus]

A 77-year-old man was admitted because of muscle weakness in both upper and lower extremities. Diabetes mellitus was diagnosed in 1988 and he had been treated by oral hypoglycemic agents. He had a common cold at the end of January, 1997. Muscle weakness appeared in the upper extremities, followed by the lower extremities at the end of February. No sensory disturbance or dysuria was recognized. Nerve conduction study revealed distally dominant demyelinating polyneuropathy. Guillain-Barré's syndrome was diagnosed and he recovered completely following immunological absorption therapy (IAT). However, he had quadriplegia again at the end of April. He was treated by IAT combined with corticosteroid and has shown no relapse. In June, 1997, gastric cancer was detected by upper gastrointestinal fiberscopy and subtotal gastrectomy was performed. Judging from this clinical course, this case seems to be chronic inflammatory demyelinating polyneuropathy (CIDP) with acute onset. Many kinds of causes often contribute to the pathogenesis of neuropathy in the elderly. So in cases of progression or worsening, we should consider such possibilities and it is necessary not to exclude treatable causes of neuropathy.

Effect of bifidobacteria feeding on fecal flora and production of immunoglobulins in lactating mouse

To elucidate the effects of probiotics on the stimulation of immunoglobulin production during lactation, feeding trials of bifidobacteria in lactating mice were conducted. Bifidobacteria appeared in feces at 9.67+/-0.17 log 10 number per gram levels. All bifidobacteria found in the feces were the administered strain. Mice fed bifidobacteria for 12 days showed significantly high levels of fecal total IgA compared to that of the control group (P < 0.05). The levels of anti-beta-lactoglobulin IgA in milk as well as in fecal extracts were significantly higher in the bifidobacteria-fed group than that of the control group (P < 0.05). These results suggest that the intake of bifidobacteria can enhance local production of IgA in milk and the intestine, which may help to protect both pups and dams from exposure to food antigens.

Osteochondritis dissecans of the lateral femoral condyle of the knee joint

Differences in the features of osteochondritis dissecans (OCD) affecting the lateral and medial femoral condyles were investigated in 13 patients (14 knees) treated from 1991 to 1994. OCD affected the lateral femoral condyle in 6 knees (lateral group) and the medial condyle in 8 knees (medial group). The lateral group was younger (mean age, 14 v. 20 years). The radiological stage (Brückl) of the lateral group was stage 2 in 3 knees and stage 3 in 3. The lateral menisci were all discoid and the condylar articular surface of the lesions was normal in two knees, softened in 3 and detached in 1. The medial group comprised 1 knee in stage 2, 1 in stage 3, 1 in stage 4, and 5 in stage 5. The OCD lesion showed softening in 2 knees and detachment in 6. Repetitive abnormal stress on weaker osteochondral structures in the growing period produced by a discoid meniscus during growth may cause OCD of the lateral femoral condyle.

[Comparison of clinical pictures of mitochondrial encephalomyopathy with tRNA(Leu(UUR)) mutation in 3243 with that in 3254]

We compared clinical pictures of a case of mitochondrial encephalomyopathy with tRNA(Leu(UUR)) point mutation at nucleotide position 3254 of mitochondrial DNA with those at position 3243. The mutation 3254 was a 19-year-old male patient with cardiomyopathy accompanied with muscle atrophy. The first mutant 3243 was a 31-year-old female patient showing clinical features of MELAS and endocrinological abnormalities. The second 3243 mutant was a 27-year-old male patient who had an external ophthalmoplegia and slight mental decline. In all cases, muscle biopsy specimen showed ragged red fibers and strongly SDH-reactive blood vessels, but their limb weakness were unremarkable. These results suggest that tRNA(Leu(UUR)) point mutation 3254 exhibits similar clinical phenotypes as those observed in 3243 mutant.

Cross-sectional area measurement of the semitendinosus tendon for anterior cruciate ligament reconstruction

We measured the cross-sectional area (CSA) of the semitendinosus tendon (SMT) in 79 anterior cruciate ligament (ACL)-injured patients using magnetic resonance imaging (MRI) to scrutinize their appropriateness for ACL grafts. Measurements of the CSAs of the SMT with MRI were closely correlated with intraoperative direct measurement (y = 0.697). The mean CSAs of the SMT measured with MRI ranged from 6.3 to 15.0 mm2 with a mean of 10.1+/-2.1 mm2. The CSA of the SMT measured with MRI proved to be a useful indicator to determine preoperatively whether the SMT graft would be of adequate dimensions (7 mm or more in diameter, 60 mm or more in length) for ACL reconstruction. If the CSA of the SMT was more than 11 mm2, a sufficiently thick and long graft could be prepared with a tripled or quadrupled SMT in 89% of cases. We conclude that tissue CSA measurements using MRI could potentially be implemented as a useful tool for determining the most appropriate donor autograft tissue preoperatively, thus minimizing harvest-site morbidity.

Osteochondritis dissecans of the medial femoral condyle associated with congenital hypoplasia of the lateral meniscus and anterior cruciate ligament

We report a patient with osteochondritis dissecans of the medial femoral condyle associated with congenital hypoplasia of the lateral meniscus and anterior cruciate ligament. This is the first report of such a case.

Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children

The anti-infectious effect of probiotics has recently been reported and one mechanism may be the non-specific stimulation of immunity. This study was performed to elucidate the influence of a probiotic formula on intestinal microflora and local immunity in healthy children. A follow-up formula containing viable bifidobacteria was given to seven healthy Japanese children (15 to 31 months old) for 21 days. During intake of the formula, the administered strain was detected in feces from five subjects (71%) and total fecal bifidobacteria slightly increased. Fecal levels of total IgA and anti-poliovirus IgA during intake of the formula were significantly higher than those before intake (P < 0.05). The increase in local IgA levels resulting from ingestion of the probiotic formula may contribute to enhancement of the mucosal resistance against gastrointestinal infections.

Effect of mouse intestinal bacteria on incidence of colorectal tumors induced by 1,2-dimethylhydrazine injection in gnotobiotic transgenic mice harboring human prototype c-Ha-ras genes

We produced transgenic (Tg) gnotobiotic (GB) mice carrying human prototype c-Ha-ras genes and compared the incidence of colorectal tumors induced by 1,2-dimethylhydrazine (DMH) injection. At 7 to 11 weeks of age, germfree (GF) CB6F1-Tg Hras2 mice were inoculated with various mouse fecal suspensions or mixtures of bacteria isolated from mouse feces. Three weeks after bacterial inoculation, DMH was administered by subcutaneous injection at 20 mg per kg body weight for 20 weeks. Mice were euthanized 5 weeks after the last injection to investigate the number of colorectal tumors. The incidence of colorectal tumors was high in both Tg- and non-Tg-GF mice (100%). In Tg-specific pathogen-free (SPF) mice and Tg-GB-4 mice associated with basic mouse flora consisting of Escherichia coli, lactobacilli, Bacteroides and clostridia, the incidence of colorectal tumors was as high as that in GF mice. In Tg-SPF mice, the tumor score was higher than in Tg-GF mice (p < 0.01), but no colorectal tumors were detected in non-Tg groups of SPF, and the tumor incidence was remarkably low in non-Tg-GB-4 mice. The tumor incidence and score in Tg- and non-Tg-GB mice varied depending on the bacterial combination in their intestine. These results indicate that the presence of human c-Ha-ras genes and intestinal bacteria substantially modify colorectal tumorigenesis induced by DMH.

Effect of standing on ventricular parasystole: shortening of the parasystolic cycle length

OBJECTIVE

To investigate the effect of standing on the parasystolic cycle length in cases of "true" ventricular parasystole.

METHODS

Parasystolic cycle length and sinus cycle length were measured during lying and standing in eight men with true ventricular parasystole. These cycle lengths were also measured after exercise in the lying position.

RESULTS

In all cases, parasystolic cycle length and sinus cycle length both shortened on standing, by a mean of 6.4% and 17.8%, respectively, compared to lying. In all cases, the rate of shortening of the parasystolic cycle length was less than that of the sinus cycle length. Parasystolic cycle length was prolonged after exercise, in contrast to a shortening of the sinus cycle length.

CONCLUSIONS

Influences on the parasystolic cycle length are not always in the same direction as on the sinus cycle length. This suggests that the effect of autonomic changes on parasystolic rhythm is not always parallel to that on sinus rhythm.

Homofermentative Lactobacillus species predominantly isolated from canine feces

Lactobacillus salivarius group biovars VIa and VIb, which are homofermentative Lactobacillus, were predominantly isolated from canine feces. Identification and biotyping of L. salivarius group biovars VIa and VIb were originally done by Mitsuoka et al. (1976). These strains were tentatively identified as L. salivarius by their phenotypic characteristics. They are, however, more similar to those of some new Lactobacillus species, particularly L. animalis and L. murinus, than those of L. salivarius and have now been identified as L. animalis by DNA-DNA homology.

Factors influencing the development of sigmoid colon cancer. Bacteriologic and biochemical studies

BACKGROUND

Cancer of the sigmoid colon is especially sensitive to environmental factors such as food. The authors have conducted a series of studies with food as the external environmental factor and intestinal microflora as the internal environment factor in relation to sigmoid colon carcinogenesis.

METHODS

Thirteen males who had previously undergone surgery for sigmoid colon cancer, and who later developed new epithelial neoplasia of the colon, were chosen as the high risk (HR) group. Fourteen males of similar age, whose large bowel was entirely normal by total colonoscopy, were chosen as the control (CONT) group. Food constituents were analyzed by a dietician. Fecal bile acids, cholesterol metabolites, degradation products of amino acids, pH, water content, and bacterial flora were quantitatively analyzed.

RESULTS

Although the HR group consumed slightly more carbon hydrate, fiber, and calcium, as a whole, there was no significant difference in food constituents, especially animal fat, between the two groups. Concentrations of bile acids and cholesterol metabolites were not different between the groups, with the exception of a higher level of cholestanol in the HR group. Succinic, lactic, propionic, and isovaleric acids were abundant in the HR group. Fecal pH and amounts of hydrogen sulfide and cresol also were higher in the HR group. The total amount of bacteria, lecithinase-negative Clostridia, and Lactobacillus, were also more abundant in the HR group.

CONCLUSIONS

The feces of the HR group was abundant in such substances as sigmoid colon cancer promoters, and appeared unrelated to food constituents. Resident flora of the HR group were abundant in enzymatically active anaerobes. Because agents carcinogenic to the colon and rectum exist ubiquitously, microflora play a key role in sigmoid colon carcinogens by producing promoters.

Reverse effects of exercise on the sinus and parasystolic cycle lengths

Ventricular arrhythmias are the primary concern in the exercise laboratory. It has recently been suggested that in not a few cases, ventricular premature complexes are governed by modulated parasystole and not by ordinary extrasystolic rhythm. In many cases, however, it is difficult to differentiate between parasystole and ordinary extrasystoles. Few reports are available on the effect of exercise in cases of "true" parasystole. This study investigated the effect of exercise on the parasystolic cycle length 11 cases of true ventricular parasystole, in which one or more "pure" parasystolic cycles containing no intervening nonectopic QRS complexes were found. In all cases, in contrast to an acceleration of the sinus rate, a definite decrease in the parasystolic rate was found. In no case did complete suppression occur. These findings suggest that the effects of exercise on ordinary ventricular extrasystolic rhythm and on ventricular parasystole may be considerably different from each other.

Intestinal flora and human health

There is a growing interest in intestinal flora and human health and disease. The intestines of humans contain 100 trillion viable bacteria. These live bacteria, which make up 30% of the faecal mass, are known as the intestinal flora. There are two kinds of bacteria in the intestinal flora, beneficial and harmful. In healthy subjects, they are well balanced and beneficial bacteria dominate. Beneficial bacteria play useful roles in the aspects of nutrition and prevention of disease. They produce essential nutrients such as vitamins and organic acids, which are absorbed from the intestines and utilised by the gut epithelium and by vital organs such as the liver. Organic acids also suppress the growth of pathogens in the intestines.Other intestinal bacteria produce substances that are harmful to the host, such as putrefactive products, toxins and carcinogenic substances. When harmful bacteria dominate in the intestines, essential nutrients are not produced and the level of harmful substances rises. These substances may not have an immediate detrimental effect on the host but they are thought to be contributing factors to ageing, promoting cancer, liver and kidney disease, hypertension and arteriosclerosis, and reduced immunity. Little is known regarding which intestinal bacteria are responsible for these effects. A number of factors can change the balance of intestinal flora in favour of harmful bacteria. These include peristalsis disorders, surgical operations of stomach or small intestine, liver or kidney diseases, pernicious anaemia, cancer, radiation or antibiotic therapies, immune disorders, emotional stress, poor diet and ageing. However, more importantly, the normal balance of intestinal flora may be maintained, or restored to a normal from an unbalanced state, by oral bacterio-therapy or by a well balanced diet. Oral bacterio-therapy using intestinal strains of lactic acid bacteria, such as lactobacillus and bifidobacteria, can restore normal intestinal balance and produce beneficial effects. Benefits include suppression of intestinal putrification so as to reduce constipation and other geriatric diseases; prevention and treatment of diarrhoea including antibiotic-associated diarrhoea; stimulation of the immune system; and increased resistance to infection.

Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion

A flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion combined with acute rupture of the anterior cruciate ligament was successfully repaired arthroscopically by a combination of advancement of the tip of the flap into a drill hole created in the tibia and an inside-out stacked suture technique using Henning instrumentation in two cases. However, the long-term function of the repaired menisci, which was reduced several millimeters in circumferential length, is still unknown.

Development of intestinal flora of human-flora-associated (HFA) mice in the intestine of their offspring

Development of intestinal flora in newborn human-flora-associated (HFA) mice was compared with that in newborn conventional (CV) mice. Facultative anaerobes were detected from the first day after birth in both CV and HFA mice but anaerobes were not detected in the first week. Anaerobes rapidly increased from the 2nd week after birth and became predominant in newborn intestine. Most of the intestinal bacteria in adult CV and HFA mice were colonized in the intestine of CV and HFA mice, respectively, within 3 weeks after birth. The human intestinal flora established in the intestine of HFA mice finally reproduced without any remarkable change in composition in the intestine of newborn HFA mice. The development of intestinal flora in HFA mice was similar to that in CV mice but not that in human infants. These results indicated that human flora associated in HFA mice could be transferred from mothers to their offspring although HFA mice could not simulate the development of intestinal flora of the human infant.

New selective media for isolation of clostridia from faecal specimens

Two selective media, novobiocin-colistin agar (NCA) and colistin-crystal violet agar (CCA), were developed for isolating clostridia from human and animal faeces. The basal medium was modified Eggerth-Gagnon agar. The NCA medium contains novobiocin (8 micrograms ml-1) and colistin (8 micrograms ml-1) and the CCA medium contains colistin (10 micrograms ml-1) and crystal violet (10 micrograms ml-1). Nine faecal specimens were cultured. Clostridia isolated on these media were similar to those on non-selective media, and higher than those isolated after heat treatment. However, more clostridial species were isolated on the new selective media compared with the non-selective medium. These selective agars were particularly useful for enumerating and isolating clostridia from human faeces.

Effect of tea polyphenols on fecal flora and fecal metabolic products of pigs

The effects of tea polyphenols on fecal flora and fecal metabolic activities were studied in eight 30-day-old pigs fed a basal diet (control) or the diet supplemented with 0.2% of tea polyphenols for 2 weeks. During tea polyphenol administration compared to before administration, the levels of lactobacilli were increased significantly (P < 0.05 and P < 0.01 on days 7 and 14 of administration, respectively), whereas the levels of total bacteria (P < 0.01) and bacteroidaceae (P < 0.01 and P < 0.001 on days 7 and 14 of administration, respectively) were decreased significantly. The detection rate of lecithinase positive clostridia including Clostridium perfrigens showed a tendency to decrease during administration. No detectable change occurred in the levels of other organisms throughout the experimental period. Fecal concentrations of ammonia were decreased significantly (P < 0.05 and P < 0.01 on days 7 and 14 of administration, respectively). Fecal phenol (P < 0.001), p-cresol (P < 0.05), and skatol (P < 0.01) were reduced significantly on day 14 of administration compared to before administration. The amounts of fecal short chain fatty acids, acetic acid (P < 0.05) and lactic acid (P < 0.05) were increased significantly on day 14 of administration. The pH values were decreased slightly during administration. The odour of the feces was reduced remarkably during tea polyphenol administration.

Effects of dietary supplementation with lactosucrose (4G-beta-D-galactosylsucrose) on cecal flora, cecal metabolites, and performance in broiler chickens

The effects of dietary lactosucrose on cecal flora, cecal metabolites, and performance were studied in eight 20-d-old and eight 62-d-old broiler chickens fed a basal diet (control) or a diet with .15% lactosucrose added. On Day 20 of age, the frequency of occurrence of lecithinase-negative clostridia were decreased (P < .05) by lactosucrose consumption. On Day 62 of age, the numbers of bifidobacteria were increased (P < .05) by lactosucrose consumption, but the counts of lecithinase-positive clostridia, including Clostridium perfringens, bacteriodaceae, and staphylococci, total anaerobic bacteria, and the frequency of occurrence of pseudomonads were decreased (P < .05). No detectable change was observed in counts of other organisms throughout the experimental period. Cecal concentration of ammonia (P < .01), phenol (P < .05), and cresol (P < .05) were decreased on Day 62 of lactosucrose consumption. Acetic acid and butyric acid were increased (P < .01 and P < .05, respectively) on Day 62 of lactosucrose consumption. Environmental ammonia and odor of chicken ceca were greatly reduced by lactosucrose consumption.