[Ultrasonic tissue characterization in hypertrophic cardiomyopathy: analysis of three-layered appearance of the ventricular septum by apical approach]

In normal hearts, two-dimensional echocardiography from the apical window displays the left ventricular wall as a three-layered appearance (TLA): central bright layer and bilateral sonolucent zones. The TLA is considered to reflect the normal myocardial architecture: the predominant latitudinal fiber bundles of the midwall layer, and longitudinal or oblique ones on both sides. We analysed the TLA of the ventricular septum in 20 normal subjects, 20 patients with left ventricular hypertrophy due to pressure load (LVH), and 81 patients with hypertrophic cardiomyopathy (HCM). Of the 81 HCM patients, the layering was often obscure or absent in 53 (65%), whereas LVH patients showed clear TLA as well as normal hearts. In patients with severe layering disorder (n = 30), the age at diagnosis was lower (40 +/- 15 vs 50 +/- 12, p less than 0.05), and familial occurrence (53 vs 11%, p less than 0.01) and severe functional limitation (NYHA greater than or equal to III) were more common (27 vs 4%) than in those with clear TLA (n = 28). The disturbed layering detectable by echocardiography may reflect the disorder of basic myocardial fiber architecture in the ventricular septum, and is likely to become a useful marker of the pathologic severity of the disease.

Spatial and temporal analysis of solid-state imaging systems

Temporal and spatial properties of the image that is stored in the digital memory of a frame grabber through a solid-state image sensor, which employs the X-Y addressing method for scanning the image, are analyzed in the space-time domain by using the mathematical expression that we have obtained. This expression includes not only the static effects of the finite picture-cell size of the sensor and the image sampling in both the sensor and the grabber but also the dynamic effects of the temporal response of photoelectric conversion in the sensor, a one-dimensional electrical filter of the camera controller, and the asynchronous sampling with regard to time in both the sensor and the grabber. Results of the experiment and the numerical simulations based on the mathematical expression are presented for a time-varying one-dimensional object with good agreement.

Neuronal ganglioside increases dependent on the neuron--glia interaction in primary culture

Dissociated neuronal cells from rat embryonic hemispheres were cultivated on astroglial layers. The increase in ganglioside content of the cocultures was more rapid than that of neuronal cultures seeded on polylysine surfaces for the first 24 h, and the extent of the increase was greater 7 days after inoculation, probably because of interaction between the preformed astroglial layers and the neuronal cells in vitro. The promoted expression of the a-pathway gangliosides, GM1 and GD1a, was recognized by TLC and the increase in GM1 was immunologically ascertained. The incorporation of 3H-labeled N-acetyl-D-mannosamine into GD3 and b-series gangliosides was elevated for the first 24 h. However, cocultures in which there was no contact between neuronal cells and the astroglial sheet showed no appreciable increase in incorporation. Thus, cell surface changes were induced at the membrane glycolipid level in the neuronal cells by contact with astroglial layers. The synthesis and expression of neuronal gangliosides are discussed in relation to the onset of neuron--glia interaction.

[Surgery versus detachable balloon embolization of pulmonary arteriovenous fistula: clinical experience]

We experienced 4 pulmonary arteriovenous fistula cases 2 of which were treated surgically and 2 were subjected to detachable balloon embolization therapy. Favorable results were obtained in the detachable balloon embolization therapy. In treating pulmonary arteriovenous fistula, if the lesion is in the position where the catheter can be reached easily and is composed of a single afferent-efferent vessel unit, it would be advisable to perform the embolization therapy first, and then to apply an operative procedure preserving lung tissue as much as possible.

Comparison of flow cytometric DNA content in primary gastric carcinoma and metastases

Nuclear DNA contents were comparatively determined by flow cytometry in primary and metastatic lesions from 112 cases with stomach cancer. Aneuploidy frequency and mean DNA index were higher in lymph node metastatic lesions than in primary lesions, both resected synchronously. In these lymph node metastatic lesions, DNA ploidy patterns did not change in 79% (89/112 cases), and did change in 21% (23/112 cases). Concordance of the DNA index between primary lesions and synchronous liver metastatic lesions was seen in 63% (5/8 cases), but the concordance rate was only 25% (4/16 cases) for primary lesions and metachronous liver metastatic lesions and 0% (0/8) for primary lesions and lung metastases. DNA ploidy changes in metastatic lesions were marked in distal metastatic lesions, or more marked in metachronous metastases than in synchronous ones. The results of the present study suggested the possibility of detecting changes in biological characteristics of metastatic lesions by flow cytometric DNA analysis.

Transient myoclonic state with asterixis in elderly patients: a new syndrome?

We report 7 patients who developed acute co-occurrences of fragmentary generalized myoclonus and asterixis. All patients were elderly and had other chronic diseases. This condition appeared acutely, progressed over several hours and then disappeared in 2-3 days with diazepam administration. No sequelae were noted, although most cases developed recurrences. The myoclonus occurred spontaneously and was slightly enhanced by action. The myoclonus was widely distributed but predominated in the neck, shoulder girdle, and upper extremities. Opsoclonus was not noted. Clinically apparent myoclonus was not evoked by sensory stimuli. Asterixis was observed in the upper extremities in all cases. Asterixis-like movements of the protruded tongue were also observed. Neurological findings other than the myoclonus and asterixis were unremarkable. Neither metabolic nor organic abnormalities clearly responsible for this condition were identified. Cerebral potentials preceding the myoclonic jerks recorded in one case suggested that the myoclonus may have been a spontaneous cortical myoclonus. We named this condition a transient myoclonic state with asterixis (TMA). Awareness of this syndrome is clinically important because of its benign nature, although it can recur.

[Surgical techniques of ventricular assist device]

Since October 1982 to April 1990, we had 16 ventricular assist device (VAD) cases in our institute. Using this VAD system that was produced by Nippon Zeon company, surgical techniques for cannulation and de-cannulation could be made very easily, and connection between cannulae and pump also could be performed quickly. In this article, the actual surgical techniques and the know-how were illustrated in detail. If this techniques can be more accustomed, the clinical results of VAD cases will be improved.

[Right-sided patent ductus arteriosus with a right aortic arch and right descending aorta]

We experienced an extremely rare anomaly, i.e. right-sided persistent ductus arteriosus with a right aortic arch and right descending aorta. Reviewing the literature, we found only two cases clinically reported in Japan as far as we know. The diagnosis was established by angiography and MRI. We treated the patient successfully through right thoracotomy.

Efficacy of oral administration of live herpes simplex virus type 1 as a vaccine

Mice given herpes simplex virus type 1 (HSV-1) (Miyama +GC strain) intragastrically via a stainless-steel cannula were rendered immune to subsequent lethal intraperitoneal (i.p.) challenge with HSV-1. The orally administered HSV-1 was completely inactivated in the stomach within a few minutes of inoculation. However, systemic immunity was established 14 days after oral inoculation with the virus and retained for up to 6 months. The mechanisms of establishing systemic immunity were investigated by means of adoptive transfer comparisons. When splenic cells from HSV-1-immunized mice were transplanted into nonimmunized mice, all of the recipient mice survived after a lethal i.p. challenge with the virus. Immunity was not established in antithymocyte serum-treated mice or by transfer of serum from immunized to nonimmunized mice. In addition, all HSV-1-immunized mice died after lethal challenge with HSV-2 and influenza virus A. These findings suggest that the immunity was virus specific, with T lymphocytes playing a major role in its establishment. The present study therefore supports the possibility of oral immunization with live HSV-1 as a vaccine.

[Ulnar nerve palsy in a RA patient after total knee replacement: a case report]

A 49-year-old housewife had suffered from classical seropositive rheumatoid arthritis for 24 years. The shoulders and hands were involved but the most severs pain and deformity were in both elbows and knees. Consequently, she was unable to sit on wheel chair and was confined to a bed. And then, she was admitted to the Chiba Rehabilitation Center in September, 1986 for bilateral total knee replacement. In April 1987, she had an operation upon the right knee and in June, she had an operation upon the left knee. About 6 weeks after surgery, she felt numbness in bilateral hands. The diagnosis was cubital tunnel syndrome. This was confirmed by electromyographic studies. Surgical release was undertaken without delay. The day following operation the patient remarked on the absence of numbness in bilateral hands.

Mother-to-infant transmission of hepatitis C virus

Prospective studies of an infant of a mother infected with hepatitis C virus indicated that an HCV infection developed in the infant in early life. Perinatal transmission appeared to be the most likely explanation.

Heart rate and body temperature sensitive diaphragm pacing

Two ways of rate control for diaphragm pacing are proposed. One is rate control using only the patients' body temperature (method I). The other is rate control by both the patients' heart rate and body temperature (method II). To test the effectiveness of these methods, a diaphragm pacemaker which can be controlled by both heart rate and body temperature has been developed. It was applied to nine mongrel dogs. The pacing rate is controlled by atrial blood temperature (method I) or by both heart rate and temperature (method II). The animal's metabolism was elevated by the administration of a pyrogenic drug. It was found that method I is not suited to rapid changes in metabolism; however, it is useful in extreme metabolic elevation. An animal's metabolism was supported by using method II in all ranges of metabolism. This method proved more effective than method I for rate-responsive diaphragm pacing.

[Clinical evaluation of 123I-BMIPP myocardial scintigraphy in patients with hypertrophic cardiomyopathy]

123I-BMIPP myocardial scintigraphy was performed in 13 patients with hypertrophic cardiomyopathy and compared with 201Tl myocardial scintigraphy performed within 3 months for evaluating the clinical significance of 123I-BMIPP myocardial scintigraphy. SPECT images were divided into 13 segments and segmental images were visually scored on a 4 (increased tracer uptake) to 0 (severely decreased tracer uptake) scale according to the tracer uptake. In comparison of 123I-BMIPP early images and 201Tl perfusion images, mismatches were seen in about 70% of all segments. The number of segments demonstrating lower myocardial uptake of 123I-BMIPP was larger than that of 201Tl. In hypertrophic regions, the tracer uptake of 123I-BMIPP early images was significantly lower than that of 201Tl images and the lower uptake of 123I-BMIPP delayed images was more marked. In non-hypertrophic regions, no significant difference was seen between the tracer uptakes of 123I-BMIPP early images and 201Tl images but the tracer uptake of 123I-BMIPP delayed images was significantly lower than that of 201Tl images. The mismatch between the tracer uptakes of 123I-BMIPP images and 201Tl images was thought to be a reflection of disordered myocardial fatty acid metabolism. "Washout", the difference between the tracer uptakes of 123I-BMIPP early images and delayed images was also thought to be a reflection of disordered myocardial fatty acid metabolism. These results suggest that 123I-BMIPP is a promising radiopharmaceutical for evaluating disordered myocardial fatty acid metabolism in patients with HCM.

The effect of endolymphatic sac obliteration on vestibular sensory hair bundles. A high-resolution scanning electron microscopic investigation

A tannic acid-osmium staining technique and high-resolution scanning electron microscopy were used to demonstrate changes in the glycocalyx and ciliary interconnections of the vestibular sensory cells of guinea pigs after extradural obliteration of the endolymphatic sac and duct. Three months after the obliteration, it was possible to observe degeneration in the glycocalyx and the ciliary interconnections as well as the tip links. These findings suggest that the endolymphatic hydrops causes an endolymphatic ionic imbalance which affects the glycocalyx and ciliary interconnections resulting in further morphological changes of the cilia. The tip links, which are believed to be involved in sensory cell transduction, also seem to be affected.

[Long-term patency of aorto-coronary saphenous vein grafts]

One hundred eighty-two cases with 814 aorto-coronary saphenous vein grafts were studied according to coronary risk factors (smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity and family history). The patency rates of all cases were as follows, early-term (within one year after operation): 92.3%, mid-term (within 5 years after operation) 80.7%, long-term (more than 5 years after operation): 66.0%. Coronary risk factors have great influence upon the mid- and long-term patency, especially upon the latter. The long-term patency rate of the grafts complicated with hyperlipidemia was 57.4% and that without hyperlipidemia was 81.8% (p less than 0.01). Hyperlipidemia, complicating 55.5% of all cases, was one of the most influential factors on the patency and also the most difficult one to be controlled. In the United States and Europe, many cases were complicated with hyperlipidemia, and it was considered that the poor patency of the saphenous vein grafts in those countries was due to this fact. Pathological studies revealed that hyperplasia of intima and media, characteristics of venosclerosis, appeared frequently in the saphenous vein grafts having more than three risk factors, and that the factors had effect not only upon arteries but also upon veins. So we conclude that saphenous vein grafts are the materials of good long-term patency, and that the control of the risk factors, particularly hyperlipidemia, is the key to improve the patency.

Factors influencing serum concentration of zonisamide in epileptic patients

The relationship between daily dose and serum concentration of zonisamide (ZNS) and the effects of patient age on the serum level/dose (L/D) ratio for ZNS were studied in epileptic patients (mean age +/- S.D. = 10.6 +/- 6.2 years) who chronically received ZNS. The influence of phenytoin (PHT), phenobarbital (PB), carbamazepine (CBZ) and valproic acid (VPA) on the serum protein binding of ZNS in vitro and the correlation between total and unbound serum levels of ZNS in patients were also examined. Significant correlations were obtained between daily dose per body weight or per body surface area and serum level of ZNS. The correlation coefficient of the latter was higher than that of the former. There was no effect of age on the L/D ratio on the basis of body surface area, whereas that on the basis of body weight increased significantly with age. No significant increase in the free fraction of ZNS was observed in the presence of PHT, PB and CBZ except VPA in vitro. There were significant correlations between total and unbound serum levels of ZNS in the two patient groups coadministered with and without VPA. Although the free fraction of ZNS in the former was significantly higher than that of the latter, the increase was small. These results suggest that dosage regimens on the basis of body surface area would be more accurate than those on a body weight basis and that there is little effect of other antiepileptics on the serum protein binding of ZNS.

Lack of cell density-dependent changes in gangliosides of rat primary culture neurons

Cell density-dependent changes in neuronal gangliosides, primarily relating to neurite outgrowth under dense to sparse conditions, were examined at cell seeding densities over an 8-fold range. During the first 24 h of incubation, the dissociated fetal rat neurons showed characteristic protrusion of neurites as a function of cell density. Ganglioside and protein contents per the same cell numbers were higher in dense cultures than sparse ones. However, the ganglioside pattern was essentially unchanged from dense to sparse culture, showing a predominance of GD3 and GT1b. The biosynthetic activity of gangliosides, as estimated by the incorporation of 3H-labeled N-acetyl-D-mannosamine, a precursor of sialic acid, was similar at various cell densities, with the labeling of b-series gangliosides predominating. The expression of neuronal gangliosides was monitored by indirect immunofluorescence using anti-GM1 antibody, but was found to be poor. A2B5 antigen, which was mainly identified as GT1b, appeared to be readily expressed on cell surfaces in sparse cultures. In contrast, the highly polysialylated form of the neural cell adhesion molecule (NCAM-H) was fully expressed on both the neurites and cell soma at various cell densities. The results suggest that the polysialic acids in NCAM have more important roles in neurite outgrowth than gangliosides, since the composition and synthesis of gangliosides are not affected by cell seeding density.

Metastatic mode of gastric carcinoma by flow cytometric and clinicopathologic parameters

We used flow cytometric and conventional clinicopathologic parameters to analyse the metastatic mode of cancer in 113 stomach cancer patients. Liver metastasis was frequent in cases with intestinal-type cancer, cancer located in the distal stomach, positive venous invasion and aneuploid cancer. Lung and pleural metastasis (excluding nodular lung metastasis), however, were frequent in cases with serosal invasion and diploid cancer. Peritoneal metastasis was frequently seen with tumors located in the proximal or whole stomach, diffuse-type cancer and cancer with serosal invasion. All cases developing bone metastasis were positive for lymph node metastasis. DNA ploidy was partially related to the metastatic mode of stomach cancer, but this was not the sole parameter for predicting metastasis. However, prediction may be possible if based on both DNA ploidy and clinicopathologic parameters, suggesting the possibility of the prophylaxis of recurrence by appropriate postoperative adjuvant therapy.

[Clinico-immunological study of the patients infected with Mycobacterium avium complex (MAC)]

Lymphocyte functions of the peripheral blood in the patients infected with MAC (MAC-pts) were evaluated comparatively with age-matched normal controls by using flow cytometry. The results obtained were as follows: 1) In normal controls, the number of total lymphocytes and the proportion and number of T lymphocyte subsets significantly decreased with age. The proportion of natural killer lymphocytes significantly increased in elder controls. 2) In MAC-pts, the number of total lymphocytes and T lymphocyte subsets were significantly lower and the proportion of natural killer lymphocytes were higher respectively than normal controls. 3) The lymphocyte proliferation induced by PPD-S stimulation in vitro in MAC-pts was significantly lower than the normal controls in both age groups of 50-69 and 70-89 years old. 4) The lymphocyte proliferation induced by PPD-S stimulation in MAC-pts was increased slightly by adding recombinant IL-2 and significantly higher by depletion of monocytes. By combination of both treatments, it recovered to the level of normal controls. From these results, we suggested that the decline of lymphocyte proliferation induced by PPD-S stimulation in MAC-pts was due to the decrease of IL-2 production by antigen committed lymphocytes and suppression by monocytes. 5) Lymphocyte proliferation induced by PHA stimulation in vitro was also significantly depressed in MAC-pts as compared with normal controls.

Effect of colchicine on ganglioside composition of rat primary culture neurons

Developmental changes in gangliosides in the course of neurite outgrowth were examined in dissociated fetal rat cerebral neurons in culture. About a 2-fold increase in ganglioside levels was seen with the progression of neurite formation for up to 24 h in predominantly neuronal cultures. Ganglioside patterns appeared to be unchanged during the first 24 h, subsequently consisted of higher amounts of GD3 and b-series gangliosides (such as GD1b, GT1b, and GQ1b), and lower amounts of a-series gangliosides (GM1 and GD1a). Although the addition of colchicine to the cell growth medium inhibited neurite outgrowth in developing neurons, little if any differences in ganglioside patterns were found between control and colchicine-treated cells. Ganglioside levels decreased slightly in colchicine-treated cells in agreement with the decrease in cell attachment to culture dishes. Although colchicine treatment 8 h after plating caused complete retraction of formed neurites, the ganglioside level of the cells continued to increase during the following 16-hour incubation. Thus, the data suggest that ganglioside synthesis in differentiating neurons does not primarily accompany the expansion in cell surfaces due to neurite formation, and raises the possibility that a large proportion of gangliosides is retained in intracellular compartments.

[Diffuse subendocardial ischemia in a patient with aortic valve stenosis without coronary artery disease by exercise 201Tl SPECT]

A case of aortic valve stenosis without coronary artery disease was confirmed to have diffuse subendocardial ischemia by exercise Thallium-201 myocardial single photon emission computed tomography. A 72-year-old woman, who had been diagnosed as aortic valve stenosis, was admitted because of chest pain during exercise. In cardiac catheterization findings, the patient angiographically had normal coronary arteries and no asynergy of left ventricular wall motion. The peak flow velocity in continuous wave Doppler echocardiography was about 5.0 m/sec at aortic valve level, providing a pressure drop of 100 mmHg across a stenotic valve with calculating on a modified Bernoulli equation (PG = 4V2). Thallium-201 myocardial SPECT images during exercise showed a transient "dilation and a widespread wall thinning" of left ventricle with apical perfusion defect. Simultaneous electrocardiogram showed further ST depression and the patient had chest pain. In 6 months after aortic valve replacement the patient no longer demonstrated both apical perfusion defect and "wall thinning" in postoperative thallium-201 myocardial SPECT images and also had neither ST depression nor chest pain. Thus; a transient "dilation and wall thinning" of left ventricle in this patient is suspected to be a sign of diffuse subendocardial ischemia.

[Establishment of a congenic strain with complement regulatory protein of factor H allotype derived from Mus. musculus molossinus]

Factor H is a plasma glycoprotein with M. W of 160 KDa which serves as one of the regulatory proteins for C 3 convertases. We have previously reported three serologically defined mouse factor H allotypes by surveying many laboratory and wild mice. In the present work, we established a congenic strain with factor H allotype, H. 2. on BALB/c (H. 1 allotype) background and named this strain BALB-H.2. Alloantiserum against each allotype has been easily prepared using two congenic strains by immunization with a small amount of whole mouse serum. BALB-H.2 is valuable for the genetic studies on the genes in the vicinity of factor H gene (cfh) derived from Mus. m. molossinus.

A case report of intraoperative ultrasonic exploration for an inferior vena cava thrombectomy of the right Wilms' tumor

The intraoperative ultrasonic explorations for a case of right Wilms' tumor with inferior vena cava thrombosis are reported. This method of assessment is most appropriate for cases of inferior vena cava thrombectomy of malignant tumors either with or without an inferior vena cava resection.

Metastatic mode and DNA ploidy in gastric carcinoma

We studied the amounts of nuclear DNA in gastric cancer metastases histologically and cytochemically by flow cytometry, which was performed retrospectively on paraffin-embedded specimens from 95 patients. At surgery, all cases of aneuploid cancer were positive for lymph node metastases. Liver metastases were frequently seen in aneuploid cancer (63%, P < 0.01), while lung metastases were the most common in diploid cancer (50%, P < 0.05). The incidence of peritoneal metastasis was high in undifferentiated diploid cancer (72%, P < 0.01). Local lymph node recurrence after surgery was more common in aneuploid than in diploid cancer (P < 0.01). The incidence of bone and distant lymph node metastasis was found to be strongly dependent on tissue differentiation. The DNA ploidy pattern is thus considered to be closely linked to lymph node, liver, and lung metastases in gastric cancer.