STAZ: interactive software for undergraduate statistics

STAZ is an interactive computer program that demonstrates statistical concepts, many of which cannot be readily demonstrated using conventional methods. Use of dynamic graphics encourages active engagement with challenging statistical concepts. The program consists of 13 graphical demonstrations, most of which allow for interactive participation by students. A detailed Help file with guided explanations accompanies each demonstration. STAZ is a multiple document interface program that makes full use of Windows features, such as tiling, links, and multitasking. Designed to be used as a supplement for any undergraduate statistics course, STAZ may be used by either instructors in class-room settings or students working independently.

The clinical efficacy of low-dose step-up follicle stimulating hormone administration for treatment of unexplained infertility

The present study was designed to compare the clinical efficacy of low-dose step-up follicle stimulating hormone (FSH) administration with conventional FSH protocol (FSH was injected daily starting with a dose of 150 IU), both combined with intrauterine insemination (IUI), for the treatment of unexplained infertility. A total of 97 unexplained infertility couples was randomly assigned to one or other of the two treatment groups, either conventional FSH with IUI (48 patients) or low-dose step-up FSH with IUI (49 patients), and only the first treatment cycle was evaluated in each protocol. The difference in pregnancy rates per cycle was not statistically significant between the low-dose FSH group and the conventional group [seven of 49 (14.3%) and seven of 48 (14.6%) respectively]. A significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) was observed in the low-dose group (8.3% versus 27.1%, P < 0.05). The incidence of moderate OHSS requiring hospitalization was reduced significantly in the low-dose group (low-dose 0% versus conventional 16.7%, P < 0.01). However, the low-dose protocol did not completely prevent multiple pregnancies. Our results suggest that the low-dose step-up FSH treatment appeared to be useful for the treatment of unexplained infertility because of the high pregnancy rates and the significant decrease in the incidence of OHSS.

Requirement of sperm-oocyte plasma membrane fusion for establishment of the plasma membrane block to polyspermy in human pronuclear oocytes

We investigated whether the incorporation of the sperm membrane into the oolemma contributes to the human plasma membrane block to polyspermy. We used zona pellucida-free oocytes fertilized by intracytoplasmic sperm injection (ICSI) or activated by parthenogenetic activation. Only two of the 35 pronuclear oocytes fertilized by spermatozoa (control) demonstrated one single penetrating spermatozoa. In contrast, the majority of ICSI and parthenogenetically activated pronuclear oocytes were penetrated with an average of three spermatozoa per oocyte. The number of fused and binding spermatozoa of ICSI and parthenogenetically activated oocytes were significantly higher than in control oocytes (3.5+/-0.6 and 4.3+/-0.6 for ICSI; 3.0+/-0.3 and 3.8+/-0.4 for activated and 0.2+/-0.1 and 0.6+/-0.2 for controls, respectively, P < 0.01). Furthermore, the cortical granules were released from the cortex of ICSI and calcium ionophore-puromycin-activated pronuclear oocytes to the same extent as that of pronuclear oocytes fertilized by spermatozoa. These results suggest that the establishment of the plasma membrane block to sperm penetration in the human oocyte may require a fusion process between sperm and oocyte plasma membranes.

Histological evaluation of coronary plaque in patients with variant angina: relationship between vasospasm and neointimal hyperplasia in primary coronary lesions

OBJECTIVES

This study was designed to determine whether coronary vasospasm in patients with variant angina pectoris (VAP) may produce focal organic lesions at the site of vasospasm that would contribute to disease progression.

BACKGROUND

Recent clinical angiographic and experimental studies have demonstrated the potential role of vasospasm in the worsening of organic coronary stenosis.

METHODS

We studied histologically the coronary plaques obtained at atherectomy in 202 patients with moderate to severe coronary stenosis. This population included 22 patients with VAP, 100 patients with chronic stable angina and 80 patients with restenosis following angioplasty or atherectomy. Diagnosis of VAP was based on both the clinical feature of angina at rest associated with ST elevation and a positive response to acetylcholine provocation test.

RESULTS

The most common histological appearance in 92% of patients with stable angina was hypocellular fibroatheromatous plaques, whereas neointimal hyperplasia was the characteristic feature of the plaque observed in 90% of patients with restenosis. The coronary specimens at the site of spasm in 15 of the 22 patients (68%) with VAP demonstrated intimal injuries such as neointimal hyperplasia (15), thrombus formation (2), and intimal hemorrhage (3). Neointimal hyperplasia was significantly more common in the patients with VAP as compared with those with stable angina (68% vs. 8%; p < 0.0001). A rapid progression of organic stenosis within three years was angiographically found in 5 of the 22 patients with variant angina. In all five cases, neointimal hyperplasia was the main contributor to the worsening of the organic lesion at the site of spasm. These histological findings in patients with VAP extremely resembled those in restenosis. Except for vasospasm, no factors significantly predicted the presence of neointimal formations in primary coronary lesions.

CONCLUSIONS

Coronary vasospasm may provoke vascular injury that leads to the formation of neointima in VAP patients similar to that seen with restenosis. Coronary spasm may thus play a key role in the rapid coronary stenosis progression in certain patients with VAP.

Mushroom bodies of the cockroach: activity and identities of neurons recorded in freely moving animals

This article describes novel attributes of the mushroom bodies of cockroaches revealed by recording from neurons in freely moving insects. The results suggest several hitherto unrecognized functions of the mushroom bodies: extrinsic neurons that discriminate between imposed and self-generated sensory stimulation, extrinsic neurons that monitor motor actions, and a third class of extrinsic neurons that predict episodes of locomotion and modulate their activity depending on the turning direction. Electrophysiological units have been correlated with neurons that were partially stained by uptake of copper ions and silver intensification. Neurons so revealed correspond to Golgi-impregnated or Lucifer yellow-filled neurons and demonstrate that their processes generally ascend to other areas of the protocerebrum. The present results support the idea of multiple roles for the mushroom bodies. These include sensory discrimination, the integration of sensory perception with motor actions, and, as described in the companion article, a role in place memory.

Topography of modular subunits in the mushroom bodies of the cockroach

The mushroom body (MB), a conspicuous neuropil structure in the insect brain, is implicated in associative memory and in some aspects of motor control. Intrinsic neurons of the MB (Kenyon cells) extend dendrites into the calyx, and their axons run through the pedunculus and then bifurcate to form the alpha and the beta lobes. At the pedunculus and the lobes, Kenyon cells make synaptic connections with dendrites of extrinsic (output) neurons. Previously, we reported that the alpha lobe of the cockroach MB consists of repetitive modular subunits (Mizunami et al. [1997] Neurosci. Lett. 229:153-156). Each subunit is composed of a dark layer and a light layer, and the layers are refereed to as slabs. Each slab is composed of axons of a specific subset of Kenyon cells. In the present study, we examined serial sections of reduced silver preparations and found that each dark and light slab continues throughout the length of the pedunculus and the alpha and beta lobes. We also found that Golgi-impregnated Kenyon cells often exhibit a characteristic grouping, forming a thin sheet interlaced by dozens or hundreds of axons. The sheet is much thinner than the slab, and each sheet remains within a particular slab throughout the length of the pedunculus and the lobes. Thus, the sheet is a component forming the slab. In the pedunculus and the beta lobe, a class of Golgi-impregnated extrinsic neurons exhibit segmented dendritelike arbors that interact with every other slab, i.e., either with only dark or light slabs. Because each neuron of this class interacts with each particular set of dark or light slabs, we conclude that the slabs are units for transmitting output signals from the MB.

Topography of four classes of Kenyon cells in the mushroom bodies of the cockroach

Mushroom bodies (MBs), which are higher centers in the insect brain, are implicated in associative memory and in the control of some behaviors. Intrinsic neurons of the MB, called Kenyon cells, receive synaptic inputs from axon terminals of input neurons in the calyx. Axons of Kenyon cells project into the pedunculus and to the alpha and beta lobes, where they make synaptic connections with dendrites of extrinsic (output) neurons. In this study, we examined the morphology of Kenyon cells in the cockroach by using Golgi stains and found that they can be classified into four classes (K1, K2, K3, and K4), according to the diameter, location, and morphology of the cell bodies, dendrites, and axons. The somata of Kenyon cells of different classes occupy different concentric zones; K1 cells occupy the most central zone, and K4 cells occupy the most peripheral zone. The main processes of Kenyon cells of different classes also occupy different concentric zones in the calyx. Dendrites of K2 and K3 cells are distributed throughout the calycal neuropil, whereas those of K1 and K4 cells cover the outer and inner halves of the depth of the neuropil, respectively. In the pedunculus and the alpha and beta lobes, axons of Kenyon cells of different classes occupy different zones, although the separation is not complete. A class of extrinsic neurons in the a lobe has dendrite-like arbors that cover the zones where either K1, K2, or K3 are located. These neurons probably transmit signals of each class of Kenyon cells. We conclude that, in the cockroach, four classes of Kenyon cells subdivide the cell body region, pedunculus, and lobes of the MBs, whereas subdivision is less prominent in the calycal neuropil.

Mitral valve aneurysm as a sequela of infective endocarditis: review of pathologic findings in Japanese cases

Mitral valve aneurysm is defined as a localized protrusion of the valve with a different radius from that of the remaining portion of the valve. The medical records and pathological findings of seven patients with mitral valve aneurysm [aged 48-69 years (mean 64), 4 males] and the pathological findings of other 29 Japanese cases were reviewed. All seven patients were diagnosed pathologically as infective endocarditis, but two patients had no documentation of clinical symptoms suggestive of infective endocarditis (latent infective endocarditis). The underlying lesion of the heart was aortic valve disease and/or fibrosal degeneration of the mitral valve. Only 29 of 36 Japanese case reports stated a precise description of the valve pathology. Of these 29 cases, 23 were associated with infective endocarditis, two with rheumatic valvular disease with fusion and/or shrinkage of the chordae tendineae, three with mitral valve prolapse or myxomatous degeneration of the mitral valve, and one with aortitis syndrome. Neovascularization was described in eight cases. Neovascularization with thick wall should be considered as post-inflammatory vascularization. This review indicates that patients with latent infective endocarditis and mitral valve aneurysm should be considered as potential candidates for valve surgery.

Effect of probucol on smooth muscle cell proliferation and dedifferentiation after vascular injury in rabbits: possible role of PDGF

We previously reported a clinical study in which probucol reduced the restenosis rate. The mechanism of this effect is unclear. Restenosis is characterized by neointimal hyperplasia caused by proliferation of smooth muscle cells (SMCs), which increases the expression of Platelet-derived growth factor (PDGF)-A and SMemb. SMemb, a non-muscle-type myosin heavy chain most predominantly expressed in embryonic smooth muscle, can be used as a good molecular marker for dedifferentiated SMC. The aim of this study was to analyze the effect of probucol on neointimal proliferation and the level of expression of PDGF-A and SMemb after balloon injury in rabbits. Probucol was given orally 1.3 g/d from 2 weeks prior to carotid balloon injury to the time of killing (2 or 4 weeks after balloon injury). Intimal area was determined histologically using a computerized morphometry program. For quantification of SMC proliferation, alpha-actin-positive cells and proliferating cell nuclear antigen (PCNA)-labeled cells were counted. The expression of PDGF-A and SMemb mRNA was analyzed by the RNase protection assay. SMemb expression was also examined by immunohistochemistry. Probucol remarkably decreased intimal area by 70% and the number of SMC and PCNA-labeled cells in the intima. The expression of PDGF-A mRNA was significantly increased after balloon injury in untreated rabbits, whereas it was markedly suppressed with probucol treatment. The expression of SMemb was significantly increased in injured arteries at mRNA and protein levels. However, probucol did not suppress SMemb expression. Probucol is effective in preventing SMC proliferation, which is possibly due to a decrease in the expression of PDGF.

Suppressive effect of simvastatin on intramural small coronary arterial lesions in cholesterol-fed rabbits

The aim of this study was to examine the suppressive effect of simvastatin on intramural coronary arterial lesions in cholesterol-fed rabbits. In one experiment, six groups of rabbits were fed laboratory chow alone or with added 0.1%, 0.2%, 0.3%, 0.5% or 1.0% cholesterol for 16 weeks. In another experiment, four groups of rabbits were fed a 0.5% cholesterol diet and treated with simvastatin at 1, 3, or 5 mg/kg/day or placebo. In each rabbit, the levels of serum total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 microm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. In the two experiments, there were positive correlations between the lesion induction ratio and integrated TC (r=0.785, P<0.0001 and r=0.763, P<0.0001, respectively). The slopes of the regression lines for integrated TC obtained in the two experiments were similar, but the lesion induction ratio in the simvastatin-treated group was always lower, by about 14%, in comparison with that in the non-simvastatin-treated group. These findings suggest that simvastatin induces lesion reduction not only by reducing the levels of circulating cholesterol but also by directly suppressing the development of lipoidosis.

Eosinophilic myocarditis associated with toxicodermia caused by phenobarbital

We report on a 37-year-old man with congestive heart failure caused by eosinophilic myocarditis associated with toxicodermia. He developed many annular skin eruptions and peripheral eosinophilia due to reactions against phenobarbital. Right ventricular endomyocardial biopsy revealed extensive infiltration of eosinophils in the myocardium. A drug lymphocyte-stimulating test (DLST) for phenobarbital was positive. His symptoms, cardiomegaly, and cardiac function were improved by discontinuing phenobarbital followed by oral administration of prednisolone. We conclude that this eosinophilic myocarditis must have been induced by an allergic reaction to phenobarbital and that long-term eosinophilia contributed to the myocardial injury.

[Unclassified cardiomyopathies: subspecies and their transformation]

Some cases with hypertrophic cardiomyopathy (HCM) progress to dilated cardiomyopathy (DCM), therefore, we hypothesized that a transforming-type phase between HCM and DCM could exist. This study was made based on a retrospective analysis of 471 of 1,388 patients with cardiomyopathy who underwent diagnostic myocardial biopsy in several hospitals between 1977 to 1995, and who were not diagnosed with restrictive cardiomyopathy, arrhythmogenic right ventricular dysplasia, specific heart muscle diseases, or electrical disturbance type of heart muscle diseases. Based on echocardiographic measurements, the 471 patients were classified into eight subgroups according to the presence or absence of three parameters. A: left ventricular hypertrophy (septal or posterior wall thickness > 12 mm), B: left ventricular dilation (left ventricular end-diastolic dimension > 55 mm), C: systolic dysfunction (left ventricular ejection fraction < 50%), is signified by plus or minus ([ABC]). HCM, DCM and normal heart are defined as [+(-)-], [-(+2)] and [-(-)-], respectively. Unclassified cardiomyopathy (UCM) was indicated as cardiomyopathy not diagnosed as HCM or DCM. Therefore, unclassified cardiomyopathies are signified as either [+2-], [+(-)+], [+3], [-(+)-] or [-(-)+]. Patients in each subgroup of UCM were followed up for 6.4 +/- 6.0 years and their clinical courses compared with the histological findings. Of the 471 patients, 111 (24%) were classified as UCM, 240 as HCM, and 120 as DCM. Severe myocardial disarray was noted more frequently in UCM [17 of 111 cases (15%)] than in DCM [7 of 120 cases (6%)] (p < 0.05), and not significantly higher than in HCM [34 of 240 cases (14%)]. Patients with UCM whose conditions deteriorated had positive pathological findings (15 of 26 cases) more often than those without deterioration (8 of 29 cases; p < 0.05). UCM could be a transforming type of cardiomyopathy for some patients with HCM who progress to DCM. In addition, there may be a positive correlation between the histopathologic findings and the clinical course.

Limitations of angiotensin-converting enzyme inhibitor in restenosis of a deep arterial injury model

Cilazapril (CLZ) has been reported to reduce intimal hyperplasia in a rat carotid model of restenosis. The purpose of this study was to determine whether CLZ inhibits restenosis after deep arterial injury in lathyritic rats. The lathyritic rat was used as a model of deep arterial injury; in this model the internal elastic lamina is easily broken by balloon injury because of the fragility of the connective tissue. Deep arterial injury is defined as rupture of the internal elastic lamina with damage to both the intima and the media. The rats were divided into 4 groups (n = 40): mild injury (intimal damage with intact internal elastic lamina), mild injury +CLZ, deep injury, and deep injury +CLZ. In the CLZ-treated groups, the drug was administered orally (10 mg/day) from 7 days before balloon injury until the time of sacrifice 21 days after balloon injury. The intimal hyperplasia was determined histologically using a computerized morphometry program. At sacrifice, blood pressure was lower in the CLZ-treated groups than in the untreated (control) rats (p < 0.05). In the mild injury model, CLZ decreased intimal hyperplasia markedly. In contrast, CLZ failed to reduce intimal hyperplasia in the rats with deep injury. CLZ markedly decreased neointimal hyperplasia in mild injury. In contrast, CLZ failed to reduce intimal area in deep injury. The type of arterial injury seems to determine the effectiveness of CLZ.

The antiatherogenic effect of nifedipine on intramural small coronary arterial lesions in cholesterol-fed rabbits

The objective of this study was to examine the suppressive effect of nifedipine on intramural coronary arterial lesions in cholesterol-fed rabbits. Each rabbit in Groups A (n=6) and B (n=5) was fed a 0.3% cholesterol diet and was orally administered nifedipine (40 mg/day) or placebo. Each rabbit in Groups C (n=5) and D (n=6) was fed a 0.5% cholesterol diet and was orally administered nifedipine (40 mg/day) or placebo. The serum concentrations of total cholesterol (TC) were determined at 1-week intervals to calculate the integrated values. The lesion induction ratio was defined as the ratio of intramural coronary arteries 50-150 microm in diameter with arterial lipoidosis to the total number of arteries of the same diameter. There were no significant differences between the nifedipine-treated and placebo groups in either the integrated TC or lesion induction ratio in either the 0.3% and 0.5% cholesterol-fed rabbits. This study demonstrates that nifedipine does not suppress atherogenesis in the intramural small coronary arteries of cholesterol-fed rabbits.

[Home infusion therapy for cancer patients at a near-terminal stage--analysis of cases who died at home]

To improve the quality of life in cancer patients at a near-terminal stage, we assisted patients to stay home using a system for home infusion therapy (HIT) established at Osaka Prefectural Habikino Hospital in 1994. From April in 1995 to April in 1996, 25 patients were treated at home using the HIT system for longer than 7 days. Thirteen out of 25 patients still stayed at home even at a terminal stage and died in their residences. There was no difference either in the mean age or in the HIT duration between 13 patients who died at home and the remaining 12 patients who were readmitted to their hospitals before death. However, 47% of the patients who died at home had been told their diagnoses by doctors and realized their own prognoses, while only 17% of the patients who died in the hospital knew their diagnoses and prognoses. Seventy-seven percent of the patients who died at home were given home oxygen therapy (HOT), against 33% of the patients who died in the hospital. Furthermore, the patients who died at home were given more intensive care than the patients who died in the hospital, because the former had a larger family than the latter. In conclusion, HIT at a near-terminal stage and death at home may be more readily accepted by patients who know their diagnoses and prognoses and have a large family.

Modular structures in the mushroom body of the cockroach

The mushroom body (MB) is a higher center of the insect brain and is critical to olfactory and other forms of associative memory. Here, we report that repetitive modular subunits, which we refer to as slabs, are present in the internal matrix of the alpha lobe, a major output neuropil of the MB in the cockroach. The methods employed were osmium-ethyl gallate, Bodian-reduced silver, and Golgi staining procedures. A total of 15 dark and 15 pale slabs, each consisting of specific subsets of intrinsic neurons (Kenyon cells), alternate throughout the length of the alpha lobe. One of the major classes of MB output neurons, which are postsynaptic to Kenyon cells, exhibited segmented dendritic arbors that interact with every other slabs, i.e. only either dark or pale slabs. As each output neuron interacts with each specific set of dark or pale slabs, the slab likely functions as a unit for transmitting MB output signals.

High-dose dexamethasone therapy for a 14-month-old boy with refractory idiopathic thrombocytopenic purpura

A 14-month-old boy with refractory idiopathic thrombocytopenic purpura (ITP), who was successfully treated with pulsed high-dose oral dexamethasone therapy is reported. The platelet count increased after six scheduled courses of treatment (10 mg/day x 4 days, six courses). Twenty-four months later, the platelet count remained over 10.0 x 10(4)/microL. No obvious side effects were observed during or after the therapy. This treatment could be taken into consideration not only for adults but also for young children with refractory ITP. It is effective, safe, easy to administer, patient comfort is taken into consideration, and hospitalization duration and costs are minimized.

Late persistent expressions of ICAM-1 and VCAM-1 on myocardial tissue in children with lymphocytic myocarditis

BACKGROUND

Both intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) have been implicated in cardiac allograft rejection. However, there is little information about the relationship between the expression of these adhesion molecules and myocarditis in children.

METHODS AND RESULTS

Immunoreactivities of ICAM-1 and VCAM-1 were examined by enzyme immunoassay in 31 biopsy specimens obtained from 11 pediatric patients with biopsy-proven myocarditis or cardiomyopathy. Five of the 11 patients had clear evidence of acute myocarditis. The other 6 had ECG abnormalities identified by mass screening for heart disease, and subsequently had been histologically diagnosed as having non-specific cardiomyopathy. The period between onset of myocarditis or identification of ECG abnormality and immunohistochemical studies was 23 to 60 days and 8 months to 3 years, respectively. Expression of ICAM-1 and VCAM-1 was assessed by counting ICAM-1 and VCAM-1 positive vessels and dividing by the total number of vessels. ICAM-1 was significantly present on 81% (P < 0.01) of myocardial tissue samples in the 5 patients with healing-stage acute myocarditis, and on 45% (P < 0.05) in the remaining 6 patients with non-specific cardiomyopathy, compared with 24% in control specimens obtained from right ventricular muscle resected at surgery for tetralogy of Fallot. VCAM-1 was also present on 50% (P < 0.05) of the samples from the 5 patients with acute myocarditis, but was not present in those with non-specific cardiomyopathy.

CONCLUSION

This persistent expression of ICAM-1 suggests that myocardial cell damage may persist immunologically for a long period in myocarditis. In addition, immunostaining for these adhesion molecules may be diagnostic value in clinically silent lymphocytic myocarditis and chronic cardiomyopathy.

Apoptosis as a possible cause of wall thinning in end-stage hypertrophic cardiomyopathy

A 15-year-old boy with hypertrophic cardiomyopathy died of congestive heart failure with progressive left ventricular wall thinning with poor systolic function. Microscopic examination revealed patchy fibrosis in the ventricular myocardium with wall thinning, and immunohistochemical evaluation of apoptosis showed apoptotic cells and bodies in the destroyed myocytes along the border between the fibrotic area and myofibril.

Idiopathic restrictive cardiomyopathy with diffuse perimyocytic fibrosis--a rare observation

Idiopathic restrictive cardiomyopathy (RCM) is rare. Even today little is understood of its etiology or underlying mechanisms, and definitive diagnostic criteria are lacking. In this report, we describe a case of idiopathic RCM in a young Japanese woman who died while awaiting cardiac transplantation during the 5-year course of the disease. Rare pathologic findings of diffuse perimyocytic fibrosis were revealed at autopsy.

[Variations in mesenchymal cell activity between rheumatic and non-rheumatic valve disease]

Deoxyribonucleic acid (DNA) synthesis of mesenchymal cells in the diseased valve tissue of patients with rheumatic and non-rheumatic valve diseases were compared. Surgically resected mitral valves from eight rheumatic and eight non-rheumatic patients in their 40s were examined immunohistochemically to estimate the activity of the various mesenchymal cells by cell cycle analysis, using monoclonal antibodies to cyclin E, A, B1, p53, and b cl-2 after routine tissue fixation, paraffin embedding and sectioning. Cyclin B1-positive fibrocytes and fibroblasts of the spongiosa and fibrosa were observed in all non-rheumatic cases, whereas some lymphocytes in the perivascular area were cyclin B1-, p53- and b cl-2-positive in rheumatic cases. The distinct qualitative difference in the mesenchymal cells of valve tissue between rheumatic and non-rheumatic etiologies suggests a different mode of valve pathology.

[Concealed infective endocarditis]

The occurrence of concealed infection or "natural remission" in infective endocarditis was investigated microscopically in 35 consecutive patients (36 valves) with infective endocarditis (between April 1987 and May 1995). Four patients were considered as having concealed or silent infective endocarditis. Preoperative diagnosis of these patients was mitral valve prolapse, rheumatic aortic valve stenosis with insufficiency, aortic valve prolapse and hypertrophic cardiomyopathy, respectively. These patients did not present with any clinical signs of infective endocarditis such as cardiac murmur and ventricular dysfunction. Histological examination of the excised valves revealed valvular perforation, small round cell infiltration, neovascularization, remnants of vascular smooth muscle cells, and organizing vegetations. These findings are consistent with the histological findings of infective endocarditis. Latent infective endocarditis may be present without inflammatory manifestation.

Differentiation induction therapy with all-trans retinoic acid (ATRA) in a patient with secondary 11q23 leukemia

PURPOSE

Frequently recurrent leukemia is encountered in childhood and is usually resistant to multidrug therapy. We evaluated the efficacy of differentiation induction therapy in a child with leukemia.

PATIENT AND METHODS

We administered all-trans retinoic acid (ATRA) alone, and then a combination of low-dose 1-beta-D-arabinofuranosylcytosine (Ara-C), to a 7-year-old boy who had leukemia secondary to etoposide with chromosomal abnormality 11q23.

RESULTS

The patient exhibited a good response to ATRA and had a complete remission after combination therapy of ATRA and low-dose Ara-C.

CONCLUSION

Differentiation induction therapy with ATRA was effective in treating a patient with recurrence of leukemia without t(15;17) translocation, and which is resistant to conventional cytotoxic treatment.

Characteristics of patients with right bundle branch block and ST-segment elevation in right precordial leads. Idiopathic Ventricular Fibrillation Investigators

To elucidate the clinical characteristics of patients with right bundle branch block and ST elevation in the right precordial leads, a prospective follow-up study was made in 63 registered patients, including 17 with a history of ventricular fibrillation (VF) and 14 with a history of syncope. The prevalence of coved type ST elevation was significantly higher in patients who had had cardiac events, and during the initial 15-month follow-up, 2 patients in the VF group died suddenly.

Clinicopathologic characteristics of hypertrophic cardiomyopathy detected during mass screening for heart disease

Between 1981 and 1992 a total of 10 patients with hypertrophic cardiomyopathy (HCM) were detected by mass screening for heart disease in Tokyo's Adachi Ward. Four were first grade elementary school children and six were first grade junior high school adolescents. Two-dimensional echocardiography at the initial evaluation revealed asymmetric septal hypertrophy in four patients, diffuse hypertrophy of the left ventricle in five, and poor left ventricular contractility with wall thinning in one (dilated phase). Three of the five patients with diffuse hypertrophy progressed to asymmetric septal hypertrophy during the average 4-year follow-up period. The degree of septal thickness and the left ventricular wall thickness index were significantly less than in those of young adult controls (12 +/- 3 versus 21 +/- 9 mm, p < 0.05; and 22 +/- 4 versus 28 +/- 16 mm, p < 0.05, respectively). Right ventricular endomyocardial biopsy specimens obtained from 9 of the 10 patients showed features typical of HCM (e.g., myocyte hypertrophy with myofibril disarray) in five patients and atypical features (mainly interstitial fibrosis with perivascular cell infiltration) in another four. One patient with dilated phase disease died of congestive heart failure 6 months after the initial evaluation. These results indicate that HCM detected during mass screening is a mild form of the disease and may have atypical pathologic features, such as interstitial fibrosis and perivascular cell infiltration, mimicking the sequela of chronic myocarditis.