[Successful rituximab treatment for acquired amegakaryocytic thrombocytopenic purpura complicated with Coombs-negative autoimmune hemolytic anemia]

Acquired amegakaryocytic thrombocytopenic purpura (AATP) is a rare disorder characterized by severe thrombocytopenia associated with total absence or a selective decrease in bone marrow megakaryocytes. A 67-year-old male presented with a 2-month bleeding tendency. He was referred to our hospital because of severe thrombocytopenia. Bone marrow biopsy showed complete absence of megakaryocytes without dysplasia in cells of the myeloid and erythroid lineages. AATP was diagnosed. In addition, mild normocytic normochromic anemia and reticulocytosis were also observed and haptoglobin was below the detectable level. Coombs-negative autoimmune hemolytic anemia (AIHA) was diagnosed based on the high titer of RBC-bound IgG and negative direct and indirect coombs test results. He was first treated with cyclosporine 200 mg per day and subsequently with prednisolone but only slight temporary improvement was achieved. Administration of eight doses of rituximab 375 mg/m(2) per week ameliorated both thrombocytopenia and anemia. AATP should be considered in the differential diagnosis of thrombocytopenia, and immunosuppressive therapy is a potential first-line treatment. This is the first case report of AATP accompanied by AIHA successfully treated with rituximab.

[Loss of CD23 expression after bortezomib plus dexamethasone therapy in CCND1/IGH-positive multiple myeloma]

A 69-year-old male was referred to our hospital because of anemia, renal insufficiency, and a positive urine test for Bence-Jones protein. A bone marrow examination showed 73.7% of myeloma cells with lymphoplasmacytic morphology, the strong expressions of CD20 and CD23 by flow cytometry, and the chromosomal aberration of CCND1/IGH by FISH analysis. He was diagnosed with multiple myeloma, IgG-λ type. The initial treatment with bortezomib plus dexamethasone (BD) provided a rapid decrease in the level of IgG; however, he developed bortezomib-induced recurrent paralytic ileus accompanied by aspiration pneumonia during the second course. Interestingly, CD23 expression on myeloma cells decreased from 87.7% to 2.2% after 2 courses of BD. Negative CD23 expression was maintained following lenalidomide plus dexamethasone therapy. There are extremely few reports on CD23 expression on myeloma cells, and this is the first case report of multiple myeloma in which CD23 expression was lost after BD therapy.

Threshold levels for wettability in nano- and micro-meter periodic structures

The purposes of this study are to clarify the relationship between surface wettability and the pitch and size of periodic structures on the surface and to determine the thresholds at which the wettability switches from being hydrophobic to hydrophilic. To this various nano- and micro-meter scale periodic structures were fabricated. By applying a fine periodic structure to the surface, the wettability can be controlled between + 50° (hydrophobic) and -55° (hydrophilic). The pitch of the periodic structure at which the wettability switches from hydrophilic to hydrophobic was found to between 500 and 1,000 nm. Additionally, the height of the periodic structure at which the wettability switches from hydrophobic to hydrophilic was found to between 300 and 700 nm.

Mutations of p53, E-cadherin, alpha- and beta-catenin genes and tyrosine phosphorylation of beta-catenin in human gastric carcinomas

We investigated whether dysfunction of p53 and E-cadherin participate in invasiveness and metastasis of human gastric carcinoma. We examined twenty-five human gastric carcinomas for p53, E-cadherin, alpha- and beta-catenin gene alteration by the reverse transcription-polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP) method and sequencing analysis. Three samples (13%) showed p53 gene mutation (two missense mutations and 6 bp deletion). 25% (3/12) of the carcinomas with lymph node metastasis had p53 gene mutations. One sample (4%) showed E-cadherin silent mutation. We were not able to detect alpha- or beta-catenin gene alteration. Therefore we investigated tyrosine-phosphorylation of E-cadherin, a and beta-catenin. Tyrosine-phosphorylated beta-catenin was detected in 13% (2/15) of poorly differentiated carcinomas. These results suggest that the p53 gene mutations have some correlation with lymph node metastasis, and tyrosine phosphorylation of beta-catenin rather than cadherin/catenin gene mutation is at least partly responsible for the loosening of cell-cell contact and invasiveness of poorly differentiated carcinomas.

Activation of the 20S Proteasome of Xenopus Oocytes by SDS: Evidence for the Substrate-Induced Conformational Change Characteristic of Trypsin-Like Peptidase

The 20S proteasome of eukaryotic cells has at least three distinct peptidase activities (trypsin-like, chymotrypsin-like and peptidylglutamylpeptide (PGP) hydrolase activities). These peptidases are latent and require appropriate activators. SDS has been widely used as an activator of these peptidases, but the mechanism of its activation remains unresolved. In this study, we investigated the kinetics of the SDS-activated hydrolysis of the above three types of peptidase of the 20S proteasome purified from Xenopus oocytes. When the reaction was started by simultaneous adding both SDS and substrate, maximal rates of hydrolysis were reached after appreciable lag phases with the trypsin-type substrate [t-butyloxycarbonylLeu-Arg-Arg-4-methylcoumaryl-7-amide (Boc-LRR-MCA)], but no such lag phases were observed with the chymotrypsin-type and PGP hydrolase-type substrates [succinyl-Leu-Leu-Val-Tyr-4-methylcoumaryl-7-amide (Suc-LLVY-MCA), and benzyloxycarbonyl-Leu-Leu-Glu-2-naphthylamide (Cbz-LLE-2NA), respectively]. Similarly, changes in the hydrolysis rate to a reduced level upon dilution of SDS occurred after an appreciable lag phase again in the trypsin-like peptidase, but not in the other types. The lag phase characteristic of the trypsin-like peptidase was dependent on the substrate concentration. Thus, the lag phase was less discernible at very low concentrations of the substrate (e.g. at concentrations in the order of 1/100 of the Km value), but became more conspicuous with the increases in the substrate concentration. This lag phase also vanished upon preincubation of the activator (SDS) for a short period of 5 sec. These results suggest that the formation of the enzyme-substrate complex in the trypsin-like reaction induces a conformational change in the enzyme which makes the SDS activator site(s) in an occluded form, reducing the rates of SDS binding and dissociation.

Combination therapy with cisplatin, 5'-deoxy-5-fluorouridine (5'-DFUR) and mitomycin (MMC) in patients with inoperable, advanced gastric cancer

The optimal dose of cisplatin (CDDP) for combination chemotherapy for the treatment of inoperable, advanced gastric cancer has yet to be established. We therefore performed a randomized study to compare the therapeutic usefulness of two dose levels of cisplatin. 5'-deoxy-5-fluorouridine (5'-DFUR 1,400 mg/m(2)/d) was given orally on days 1 to 4 and 15 to 18. Mitomycin C (MMC, 5.75 mg/m(2)/d) was injected intravenously on day 5. In addition, 80 mg/m2/d of CDDP (regimen A) or 60 mg/m(2)/d of CDDP (regimen B) was given by 2-h intravenous drip infusion on day 5. This treatment cycle was repeated every four weeks. Fifty-six patients were enrolled. Clinical response was evaluated in 32 patients (regimen A, 16 patients; regimen B? 16 patients) with measurable lesions. The response rate was significantly higher with regimen A (9 PR/16, 56.3%) than with regimen B (3 PR/16, 18.9%) (p=0.028, chi(2) test). Median survival was slightly but not significantly longer with regimen A (7.4 months) than with regimen B (6.3 months). Drug toxicity included myelosuppression and gastrointestinal symptoms, but there were no serious adverse reactions or differences in safety between the treatment regimens. Regimen A was associated with a high response rate and low toxicity. The optimal dose of CDDP in combination with 5'-DFUR and MMC for the treatment of advanced gastric cancer is regarded to be 80 mg/m(2).

[Chronic hepatitis C presenting with hepatic involvement by chronic lymphocytic leukemia responding to polyethylene glycol interferon-α-2b]

Hepatic involvement by chronic lymphocytic leukemia(CLL)is common, but rarely presents with liver injury. We report a case of chronic hepatitis C(CH-C)in a patient who had suffered from liver injury as a result of hepatic involvement by CLL. A 74-year-old man was hospitalized because of an examination confirming him positive for leukocytosis. Computer tomography scan showed mild hepatosplenomegaly, lymph node swelling of the neck and axilla, and abdominal lymphadenopathy. He was diagnosed as CLL by bone marrow examination. His laboratory data revealed hepatis C virus(HCV)antibody-positive, and elevated levels of both aminotransferase and HCV-RNA. Liver biopsy demonstrated significant CLL involvement of portal areas and a mild T lymphocyte invasion of centrilobular and portal areas. After treatment with polyethylene glycol interferon (PEG-IFN)-α-2b for CH-C, the CLL count was decreased in both peripheral blood and the liver. The hematological response was significantly correlated with the disappearance of HCV-RNA. The patient has maintained a sustained virological response(SVR)status for the past 9 months after PEG-IFN-α-2b administration. Thus, PEG-IFN-α-2b therapy could be effective not only for CH-C but also for hepatic involvement of CLL as seen in our patient.

[Complete response by rituximab monotherapy in a patient with leukemic mantle cell lymphoma diagnosed by fluorescence in situ hybridization analysis]

An 85-year-old male was admitted to a hospital with abdominal discomfort in October, 2010. Severe splenomegaly and mild para-aortic lymphoadenopathy were detected. In addition, an increase in atypical lymphocytes was noticed by bone marrow analyses with weak positive staining of cyclin D1. Subsequently, the fluorescence in situ hybridization(FISH)method confirmed cyclin D1 reconstruction, and the fusion signals of the BCL1 and IgH genes were detected, thus providing a definitive diagnosis of leukemic mantle cell lymphoma. After treatment with rituximab monotherapy, the Ki-67 index was stabilized to within 10%, and complete response was obtained.

Cardiac gene therapy in large animals: bridge from bench to bedside

Several clinical trials are evaluating gene transfer as a therapeutic approach to treat cardiac diseases. Although it has just started on the path to clinical application, recent advances in gene delivery technologies with increasing knowledge of underlying mechanisms raise great expectations for the cardiac gene therapy. Although in vivo experiments using small animals provide the therapeutic potential of gene transfer, there exist many fundamental differences between the small animal and the human hearts. Before applying the therapy to clinical patients, large animal studies are a prerequisite to validate the efficacy in an animal model more relevant to the human heart. Several key factors including vector type, injected dose, delivery method and targeted cardiac disease are all important factors that determine the therapeutic efficacy. Selecting the most optimal combination of these factors is essential for successful gene therapy. In addition to the efficacy, safety profiles need to be addressed as well. In this regard, large animal studies are best suited for comprehensive evaluation at the preclinical stages of therapeutic development to ensure safe and effective gene transfer. As the cardiac gene therapy expands its potential, large animal studies will become more important to bridge the bench side knowledge to the clinical arena.

Improvement in organic solvent tolerance by double disruptions of proV and marR genes in Escherichia coli

AIMS

To investigate the involvement of osmoprotectant transporters in organic solvent tolerance in Escherichia coli and to construct an E. coli strain with high organic solvent tolerance.

METHODS AND RESULTS

The organic solvent tolerance of ΔbetT, ΔproV, ΔproP or ΔputP single-gene knockout mutants of E. coli K-12 strain was examined. Among these mutants, the organic solvent tolerance of the ΔproV mutant remarkably increased compared with that of the parent strain. It has been known that a marR mutation confers tolerance on E. coli to organic solvents. A ΔproV and ΔmarR double-gene mutant was more tolerant to organic solvents than the ΔproV or ΔmarR single-gene mutant. The n-hexane amount accumulated in E. coli cells was examined after incubation in an n-hexane-aqueous medium two-phase system. The intracellular n-hexane level in the ΔproV and ΔmarR double-gene mutant was kept lower than those of the parent strain, ΔproV mutant and ΔmarR mutant.

CONCLUSIONS

The organic solvent tolerance level in E. coli highly increased by dual disruption of proV and marR.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study suggests a new strategy for increasing the organic solvent tolerance level in E. coli to improve the usability of the whole-cell biocatalysts in two-phase systems employing organic solvents.

Visual function 5 years or more after macular translocation surgery for myopic choroidal neovascularisation and age-related macular degeneration

PURPOSE

To evaluate the changes in the best-corrected visual acuity (BCVA) after 1 year and after ≥ 5 years after macular translocation for age-related macular degeneration (AMD) or myopic choroidal neovascularisation (mCNV).

METHODS

The medical records of 61 consecutive patients who underwent macular translocation with 360° retinotomy for AMD (35 eyes) or mCNV (26 eyes) were reviewed. Overall, 40 patients, 17 mCNV and 23 AMD, were followed for at least 5 years. BCVA and area of the Goldmann visual field (VF) measured before, 12 months after surgery, and at the final visit.

RESULTS

In the 23 AMD eyes followed for ≥ 5 years, the mean preoperative BCVA was 1.149 ± 0.105 logMAR units, which significantly improved to 0.69 ± 0.06 logMAR units at 1 year (P<0.001). This BCVA was maintained at 0.633 ± 0.083 logMAR units on their final examination. In the 17 eyes with mCNV followed for ≥ 5 years, the mean preoperative BCVA was 1.083 ± 0.119 logMAR units, which was significantly improved to 0.689 ± 0.121 logMAR units at 1 year (P = 0.001). This BCVA was maintained at 0.678 ± 0.142 logMAR units on their final examination. The area of the VF was significantly decreased at 12 months and did not change significantly thereafter.

CONCLUSIONS

Our results show that macular translocation surgery significantly improves the BCVA and significantly decreases the VF area of eyes with mCNV or AMD after first 1 year. The BCVA and VF area do not change significantly from the values at 1 year for at least 5 years.

Hospital and health information systems - Current perspectives. Contribution of the IMIA Health Information Systems Working Group

OBJECTIVE

To celebrate over 30 years of health information systems' (HIS) evolution by bringing together pioneers in the field, members of the next generation of leaders, and government officials from several developing nations in Africa to discuss the past, present, and future of HISs.

METHODS

Participants gathered in Le Franschhoek, South Africa for a 2 1/2 day working conference consisting of scientific presentations followed by several concurrent breakout sessions. A small writing group prepared draft statements representing their positions on various topics of discussion which were circulated and revised by the entire group.

RESULTS

Many new tools, techniques and technologies were described and discussed in great detail. Interestingly, all of the key themes identified in the first HIS meeting held over 30 years ago are still of vital importance today: Patient Centered design, Clinical User Support, Real-time Education, Human-computer Factors and Measuring Clinical User Performance, Meaningful use.

CONCLUSIONS

As we continue to work to develop next-generation HISs, we must remember the lessons of the past as we strive to develop the solutions for tomorrow.

Effect of co-doping of donor and acceptor impurities in the ferromagnetic semiconductor Zn(1-x)Cr(x)Te studied by soft x-ray magnetic circular dichroism

We have performed x-ray absorption spectroscopy (XAS) and x-ray magnetic circular dichroism (XMCD) studies of the diluted ferromagnetic semiconductor Zn(1-x)Cr(x)Te doped with iodine (I) or nitrogen (N), corresponding to electron or hole doping, respectively. From the shape of the Cr 2p absorption peak in the XAS spectra, it was concluded that the Cr ions in the undoped, I-doped and lightly N-doped samples are divalent (Cr(2+)), while Cr(2+) and trivalent (Cr(3+)) coexist in the heavily N-doped sample. This result indicates that the doped nitrogen atoms act as acceptors but that doped holes are located on the Cr ions. In the magnetic field dependence of the XMCD signal at the Cr 2p absorption edge, ferromagnetic behaviors were observed in the undoped, I-doped, and lightly N-doped samples, while ferromagnetism was considerably suppressed in the heavily N-doped sample, which is consistent with the results of magnetization measurements.

Small vestibular schwannomas can cause gait instability

PURPOSE

To confirm whether detailed gait analysis can detect gait instability in patients with small vestibular schwannoma (VS) with an apparently normal gait.

METHODS

Twenty-two patients (7 males, 15 females; 40-64 years old) with small VS and nine healthy age- and weight-matched controls were enrolled. Small VS was defined as the longest diameter less than 20mm from the porus acusticus internus on MRI with no brainstem compression. Each subject was asked to walk straight for a distance of 8m with tactile sensors attached to both feet, and repeat two trials with eyes open and closed. Gait variables of stance, swing, double support, stability, and average length of the trajectories of the center of force (TCOF) during stance were recorded and analyzed.

RESULTS

No significant differences in the stability of the TCOF were found during gaits with eyes open and closed between the two groups. No obvious changes in gait variables were recognized with eyes open between the two groups. However, under gait with eyes closed, the values of the coefficient of variation (CV) of the gait phase were significantly greater in stance and swing in the VS group than in the normal group. In addition, patients with canal paresis (CP) showed greater CV values in gait phase related parameters than those who without CP during gait with eyes closed.

CONCLUSIONS

Patients with small VS may have an apparently normal gait, but their vestibular deficit could be detected by proper use of gait analysis, especially with visual deprivation.

Evaluation of the role of second TUR for transurethral resection of bladder tumor in one piece (TURBO)

298

Background: Since transurethral resection of bladder tumor in one piece (TURBO) was reported in the Journal of Urology in 2000 by Ukai, some urologists carried out TURBO. We analyzed treatment results of TURBO in our hospital and examined the value of this procedure, especially for the pathological findings, recurrence and necessity of second TUR for TURBO.

Methods: A total of 14 patients with bladder tumors carried out TURBO under spinal anesthesia, in some cases blocking the obtulater nerve, from April 2006 to June 2009 in our hospital. All cases were followed for over 1 year. The procedure is 1. point marking; 2. circular incision; 3. level incision; and 4. specimen retrieval using a needle electrode in accordance with the Ukai's method. We investigated pathological findings (margin situation), operation time, complications and recurrence.

Results: It is possible to diagnose the precise pathlogical findings by TURBO. We judged the width and depth ew in sequential section. There were no complications during and after the operation. Operation time of TURBO (35–170 min) was longer than TUR-BT. Urethral catheter holding period and hospitalization period after TURBO was the same as TUR-BT. TURBO is a relatively safe procedure even for beginners. 5 cases had a recurrence in 13 cases. 2 cases had a recurrence in under 1 year, but the locations were other places. One case had a same place recurrence after 13 months. There were no cases of same place recurrence in under 1 year among margin-negative cases. Therfore we judged that ew-negative cases had no residual cancers.

Conclusions: TURBO is a safe and useful procedure that provides precise pathological findings with minimal complications. Second TUR is not necessary for TURBO. TURBO has a possibility to be gold standard of the treatment for non-muscle invasive bladder cancer.

No significant financial relationships to disclose.

Direct Observation of Microstructure Change During Densification of Silicon Nitride Ceramics with A Novel Characterization Method

A novel characterization method is applied to study the evolution of microstructures during densification of silicon nitride ceramics. This characterization method involves an immersion liquid for making green and sintered bodies transparent, and a subsequent direct optical microscopic examination. Granules were prepared with the spray drying processand formed into green bodies by CIP. After sintering at various temperatures, the specimens were examined for microstructural evolution. Large pores were located at the center and boundary regions of granules left in the green bodies; they were not removed by densification and resulted in large pores in the sintered body, possibly forming fracture origin in ceramics.

Vitrification-based cryopreservation of Grammatophyllum speciosum protocorm

Three vitrification-based methods for the cryopreservation of Grammatophyllum speciosum protocorms were invesigated: droplet-vitrification, encapsulation-dehydration and encapsulation-vitrification. Protocorms, 0.1 cm in diameter, developed from 2-month-old germinating seeds were used. For droplet-vitrification, protocorms were precultured on filter paper soaked in half strength Murashige and Skoog medium (half strength MS) containing 0.4 M sucrose at 25 2 degree C for 2 d, followed by soaking in loading solution (2 M glycerol and 0.4 M sucrose in half strength MS liquid medium) for 20 min and then dehydrated with PVS2 solution [30 percent (w/v) glycerol, 15 percent (w/v) ethylene glycol and 15 percent (w/v) dimethyl sulfoxide in half strength MS liquid medium containing 0.4 M sucrose at pH 5.7] for 30 min. For encapsulation-dehydration, encapsulated protocorms were precultured in half strength MS liquid medium containing 0.4 M sucrose on a shaker (110 rpm) at 25 f 2 degree C for 2 d, followed by soaking in the same loading solution for 20 min and then exposed to a sterile air-flow at 2.5 inches/water column from the laminar air-flow cabinet for 8 h. For encapsulation-vitrification, encapsulated protocorms were precultured in half strength MS liquid medium containing 0.4 M sucrose for 1 or 2 d, followed by soaking in the same loading solution for 20 min and then dehydrated with PVS2 solution for 60 min. For all three methods, preculturing with 0.4 M sucrose for 2 d resulted in a significant induction of dehydration and freezing tolerance. The cryopreservation results showed highest protocorm regrowth after droplet-vitrification (38 percent), followed by encapsulation-dehydration (24 percent) and encapsulation-vitrification (14 percent). Plantlets developed from these three methods did not show any abnormal characteristics or ploidy level change when investigated by flow cytometry.

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction

BACKGROUND

Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI.

HYPOTHESIS

The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI.

METHODS

Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death.

RESULTS

In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1.

CONCLUSION

Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.

Periodic rotation of magnetization in a non-centrosymmetric soft magnet induced by an electric field

The control of magnetism with an electric field is a challenging area with the potential to affect fields related to magnetic data storage, sensors and magnetic random access memory. Although there are some successful examples of such control based on the use of magnetic metals and semiconductors, energy loss caused by current flow is a problem that needs to be addressed. In particular, the repeatable control of magnetization with an electric field can be disturbed by joule heat loss. In this regard, non-centrosymmetric insulating magnets are good candidates for controlling magnetization without energy loss, in which the linear magnetoelectric effect has an essential role. Moreover, such magnets exhibit an unconventional magneto-optical effect, which allows the time-resolved detection of the magnetization direction. Here, we show a periodic oscillation of the magnetization direction by +/-20 degrees in a non-centrosymmetric soft magnet (Cu,Ni)B(2)O(4), which is induced by an a.c. electric field of 2 kHz. The present study provides a strategy for identifying materials in which the magnetization direction can be modulated at high speed with an electric field.

Phase I/II study of twenty-four-hour infusion of irinotecan in combination with oral UFT plus leucovorin for metastatic colorectal cancer

OBJECTIVE

Irinotecan has, in general, been administered as a 90-min infusion. However, several studies have demonstrated that continuous infusion seems to be a promising method of delivering irinotecan. This phase I/II trial was performed to evaluate the efficacy and safety of continuous infusion of irinotecan combined with UFT plus leucovorin (LV) for metastatic colorectal cancer.

METHODS

Escalating doses of irinotecan (90-110 mg/m(2)) were administered by 24-hour infusion on day 1. UFT 300 mg/m(2)/day and LV 75 mg/day were administered orally, in 3 divided daily doses, on days 3-7 and 10-14. The treatment cycles were repeated every 2 weeks.

RESULTS

In the phase I study, the maximum tolerated dose of irinotecan was 110 mg/m(2) and the recommended dose for the phase II study was determined to be 100 mg/m(2). Thirty-six patients, including 3 patients at the recommended dose in the phase I study, were evaluated in the phase II study. The common grade 3/4 toxicities were leucopenia, neutropenia, diarrhea and anorexia. The response rate was 63.9%, and the median progression-free and overall survival times were 8.3 and 24.6 months, respectively.

CONCLUSION

A 24-hour infusion of irinotecan combined with UFT/LV is feasible and active for metastatic colorectal cancer.

Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction

BACKGROUND

We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct-related lesion (IRL).

HYPOTHESIS

The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock.

METHODS

The study group consisted of 53 patients with single-vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non-shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI.

RESULTS

Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phosphokinase (CPK-MB). the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non-shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK-MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI.

CONCLUSION

This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.

Emergent angioplasty prevents left ventricular dilation in patients with acute anterior wall myocardial infarction and cardiogenic shock

BACKGROUND

Percutaneous transluminal coronary angioplasty (PTCA) reduces in-hospital mortality and improves long-term outcome in patients with acute myocardial infarction (MI) complicated by cardiogenic shock. However, no study has evaluated the effects of different reperfusion therapies on left ventricular (LV) dimension and cardiac function in long-term survivors of MI with cardiogenic shock.

HYPOTHESIS

We investigated the effects of PTCA on the development of LV dilation in patients who survived MI complicated by cardiogenic shock.

METHODS

We studied 34 patients with a first MI and cardiogenic shock in whom two-dimensional echocardiography was performed immediately after admission and 1 month after infarction. Group A consisted of 17 patients who underwent emergent PTCA during the acute phase of MI, and Group B consisted of 17 patients who did not undergo PTCA. We also studied 119 patients with a first uncomplicated acute anterior MI, including 53 who underwent PTCA (Group C) and 66 who did not (Group D). The length and wall thickness of the infarcted and noninfarcted endocardial segments were determined immediately after MI and 1 month later, and LV ejection fraction (LVEF) was measured during the chronic phase.

RESULTS

The lengths of the infarcted and noninfarcted endocardial segments were significantly greater in Group B than in the other three groups (p < 0.05). The LVEF was significantly lower in Group B than in the other three groups (p < 0.05).

CONCLUSIONS

We conclude that PTCA performed in patients during the acute phase of MI complicated by cardiogenic shock lowers in-hospital mortality and prevents both LV dilation and a decrease in LVEF.