A new polyvinylchloride blood bag plasticized with less-leachable phthalate ester analogue, di-n-decyl phthalate, for storage of platelets

To compare changes in platelets stored in the new di-n-decyl phthalate (DnDP)-plasticized polyvinyl chloride (PVC) bag with those in a di-(2-ethylhexyl) phthalate (DEHP)-plasticized PVC bag, single-donor apheresis platelet concentrates (PCs), 133 +/- 11 x 10(7) platelets per ml (n = 7), were stored with 94 +/- 3 ml of plasma in a new 1-liter bag with a surface area of 44 +/- 7.1 cm2 per 10(10) platelets. Oxygen and carbon dioxide gas diffusion properties of PVC-DnDP films were respectively, 1.6 and 2 times those of standard PVC-DEHP films. The amounts of DnDP leaked into the plasma of PCs were low at 0.58 +/- 0.06 mg per bag after 5-day storage, which is about one-eightieth the amount of DEHP leaked. The pH of PCs in PVC-DnDP bags amounted to 6.99 +/- 0.03 after 5-day storage, with glycolysis accelerated somewhat in the new bags. However, the platelet oxygen consumption was no different from that in the PVC-DEHP bags. Platelet aggregation and responses to hypotonic shock were significantly better in the new bags at the end of storage. Shape changes of platelets into spherical forms with dendrites were more frequently observed in PVC-DnDP bags than in PVC-DEHP bags. The study indicated that platelets stored in the new DnDP-plasticized PVC bags have retained aggregation and responses to hypotonic shock more than platelets in the PVC-DEHP bags, but spherical forms and anaerobic metabolism increased in the new bags.

Relationship between mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy

To clarify the relationship between mitral regurgitation and left ventricular outflow obstruction, Doppler and two-dimensional echocardiographic studies were performed in 62 patients with hypertrophic cardiomyopathy (22 with and 40 without obstruction caused by mitral systolic anterior motion with septal contact). Pulsed Doppler echocardiography with color Doppler flow imaging demostrated that in 20 of the 22 patients with obstruction, mitral regurgitation occurred mainly during midsystole from the onset to the end of mitral-septal contact. Such midsystolic mitral regurgitation was not observed in patients without obstruction, except in three of 25 patients with mild mitral systolic anterior motion without septal contact. Furthermore, that regurgitation developed or disappeared together with the obstruction during follow-up periods or pharmacologic interventions. Two-dimensional echocardiography showed that in 21 of the 22 patients with obstruction, a distal residual portion of the "anterior" mitral leaflet moved anteriorly in early systole and protruded into the outflow tract during midsystole to cause the obstruction. In the other patient with obstruction, who had only early systolic mitral regurgitation, a distal residual "posterior" leaflet moved similary. These results may indicate that the midsystolic mitral regurgitation is hydrodynamically induced by the midsystolic pressure gradient across the protruding distal residual anterior mitral leaflet.

Is immunotherapy for habitual aborters an immunologically hazardous procedure for infants?

Physical development and tests of immunologic function are reported from the first year of life for 13 infants born to mothers who were habitual aborters and who had undergone subcutaneous vaccination with their husband's lymphocytes. The mean weight of the infants at birth was 2,975 +/- 540 g, including one infant who was small for dates. Physical development parameters for the first year were all within normal range. Immunologic studies were performed at ages 0, 1, 3, 6, 9, and 12 months. The studies included the following: (1) serum levels of immunoglobulins and complement components; (2) the number of peripheral blood lymphocytes (PBL) and their subpopulations; and (3) proliferative responses by PBL against unrelated lymphocytes and some mitogens (pokeweed, phytohemagglutinin, and concanavalin A). All were normal when compared with studies of infants of nonimmunized mothers. These observations suggested that subcutaneous vaccination of women with their husband's lymphocytes did not result in any adverse effects on their infants' physical or immunologic development.

A long-term follow-up study of total hip replacement with bone graft. Correlations between roentgenographic measurement and hip mobility

Fifty total hip replacement treating the acetabular deficiency with autologous bone graft from the femoral head were performed on 44 patients with congenital dislocation of the hip. The average age was 55 years. The average follow-up period was 5 years and 2 months, ranging from 3 years, 8 months to 6 years, 11 months. Solid union was demonstrated in all acetabular grafting. No loosening of either acetabular or femoral components occurred. Roentgenological measurements used as a parameter of good results showed that better results were obtained using the true acetabulum (ideal position) with appropriate bony coverage.

Assessment of the thickness of the right ventricular free wall by magnetic resonance imaging in patients with hypertrophic cardiomyopathy

Electrocardiogram gated magnetic resonance imaging was performed in nine healthy volunteers, in four patients with pulmonary hypertension, and in 16 patients with hypertrophic cardiomyopathy. Fifty two short axis images in diastole were examined to assess the usefulness of magnetic resonance imaging for the measurement of the thickness of the free wall of the right ventricle and the degree of hypertrophy of the right ventricular free wall in hypertrophic cardiomyopathy and pulmonary hypertension. Magnetic resonance imaging gave a clear image of 68% of the length of the right ventricular free wall, showing both the endocardial and epicardial margins. The mean (1 SD) thickness of the right ventricular free wall measured at a total of 512 points was 0.44 (0.12) cm in patients with hypertrophic cardiomyopathy, 0.29 (0.08) cm in healthy individuals, and 0.73 (0.27) cm in patients with pulmonary hypertension.

Screening of blood donors for antibody to human immunodeficiency virus type I by sensitive particle agglutination assay

A particle agglutination (PA) assay for antibody to human immunodeficiency virus type I (anti-HIV) was used to screen blood donors and to test leukemia and hemophilia patients. Results by PA showed complete agreement with the results of two kinds of enzyme immunoassay (EIA), and the false-positive rate was the same as or lower than with the EIAs. The sensitivity of PA was 10- to 100-fold higher than that of the EIAs. This simple sensitive assay takes less time and fewer personnel than the EIAs, and has been used for massive screening of blood donors in our blood center.

[Distribution patterns of hypertrophy at the apical level in patients with giant negative T waves: identification by magnetic resonance imaging]

To clarify the distribution patterns of hypertrophy at the apical level in patients with giant negative T waves (GNT), ECG-gated magnetic resonance imaging (MRI) was performed in 10 patients with GNT and in five normal controls. End-diastolic left ventricular short-axis images at the basal and apical levels were obtained in all subjects. Thicknesses of the septal, anterior, lateral and posterior walls at these two levels were measured and distribution of hypertrophied myocardium (more than or equal to 15 mm) at the apical level was examined. The ratio (R) of the maximal thickness at the apical level over that at the basal level was calculated. In normal subjects, the mean apical wall thickness was 8.7 +/- 1.9 mm. In the GNT group, the wall thickness was always greater than the mean value +3 SD of the normal control, and there were no differences among the four segmental walls. The hypertrophic portions at the apex were circumferential in three, septal-anterior-lateral in two, septal-anterior in two, septal in one, anterior in one and lateral in one. In patients with GNT, the average maximal thickness at the apical level was 19.3 +/- 3.2 mm; by location, four cases in the septum, four in the anterior wall and two in the lateral wall, and the average minimum thickness was 11.7 +/- 3.7 mm; all in the posterior wall. The R was more than 1.3 in nine patients with GNT and less than 1.0 in all normal subjects. In conclusion, there was a variety of patterns of apical hypertrophy, and the R greater than or equal to 1.3 was characteristic in patients with GNT.

New closed system using a sterile connection device and preconnected PRP pack for extended storage of apheresis platelet products

In order to prevent bacterial contamination during the procedure of plateletapheresis, preconnected platelet-rich plasma (PRP) packs were prepared which include the apheresis bowl of a plasma collecting system (Haemonetics) with a 16G needle and a 0.6- and 1-liter double-bag system. The anticoagulant line of the PRP pack and that from the bag containing acid-citrate-dextrose formula A solution were welded by a sterile connection device (SCD model 312, DuPont). No additional care was needed to perform plateletapheresis with the present closed system. Platelet concentrates (PCs) stored in 1-liter bags made of polyvinyl chloride plastics with a plasticizer of either di (2-ethylhexyl) phthalate or tri (2-ethylhexyl) trimellitate were demonstrated to be sterile. The pH of PCs was maintained over 6.8 after 5-day storage. Preliminary studies suggest that the present closed system using the preconnected PRP pack and sterile connection device will be useful for reducing the risk of bacterial contamination in platelet products during single-donor plateletapheresis.

[Phonocardiographic and two-dimensional and pulsed Doppler echocardiographic studies of Still's murmurs]

The prevalence of Still's murmur was examined by phonocardiographic study, and the clinical significance of this murmur was investigated using pharmacodynamic phonocardiography and echocardiography. Still's murmur was present in 224 of 9,478 cases (2.4%) in school children. Its prevalence was 143 in 4,524 (3.2%) in elementary school children and this was significantly greater than that in middle school youngsters who numbered 81 among 4,954 (1.6%) (p less than 0.001). There were neither abnormal findings on two-dimensional echocardiography, nor pathological regurgitant signals on pulsed Doppler examination. After the inhalation of amyl nitrite, Still's murmur was accentuated by 5.3 +/- 3.0 dB, and was louder in the expiratory than in the inspiratory phase by 4.7 +/- 3.5 dB.

[Correlation of left ventricular outflow obstruction with mitral regurgitation]

Our previous study of mitral regurgitation in obstructive hypertrophic cardiomyopathy suggested that left ventricular outflow obstruction due to systolic anterior motion of the distal residual anterior mitral leaflet may hydrodynamically induce mid-systolic mitral regurgitation. To test this hypothesis, we examined whether drug-induced left ventricular outflow obstruction in dogs might cause mitral regurgitation. Dobutamine, 20-60 micrograms/kg/min, induced the obstruction due to mitral systolic anterior motion with mitral-septal contact in 11 of 18 dogs. Pulsed Doppler and contrast echocardiography demonstrated that mitral regurgitation was concomitantly induced in the 11 dogs. The regurgitation was prominent during mid-systole from the onset to the end of mitral-septal contact. Two-dimensional echocardiography showed reduction of the mitral annular dimension and anterior shifts of the mitral valve coaptation during drug infusion in the 11 dogs. Accordingly, the distal portion of the mitral valve, especially of its anterior leaflet, became residual, and moved anteriorly in early systole and protruded into the outflow tract during mid-systole. Catheter-tip pressure recordings simultaneous with two-dimensional echocardiographic observation revealed that the outflow pressure gradient occurred across the protruding distal residual mitral valve. The onset and the end of the pressure gradient were nearly simultaneous with those of the mitral-septal contact. After cessation of the infusion, the mid-systolic mitral regurgitation disappeared together with the obstruction. These results indicate a close relationship between left ventricular outflow obstruction and mid-systolic mitral regurgitation, and strongly support the hypothesis that the obstruction due to systolic anterior motion of the distal residual anterior mitral leaflet is responsible for mitral regurgitation.

Results of transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head

From 1976 to 1985, transtrochanteric rotational osteotomy was applied to 58 hips of nontraumatic necrosis of the femoral head. Of these, 52 hips were available for the present study. The follow-up periods ranged from one to ten years (average, 5.1 years). Satisfactory results were obtained in 69%, as there was no evidence of progressive collapse of the head. Hips that had had no collapse or slight collapse before osteotomy had a significantly better prognosis, compared with those that had marked collapse of the head. The extent of the lesion as depicted on the preoperative lateral roentgenogram also influenced the eventual function. Patient satisfaction was significantly greater when these lesions were less than 70% (31/37), compared with greater than 70% (5/15).

[Aortic regurgitation in hypertrophic cardiomyopathy as detected by color Doppler echocardiography]

Aortic regurgitation (AR) in patients with hypertrophic cardiomyopathy (HCM) has rarely been reported. Using color Doppler echocardiography, we assessed the incidence and the cause of AR in patients with HCM. There were 86 patients with HCM (M:F = 66: 20, 57 +/- 12 years, mean +/- SD) and 43 control subjects (M: F = 33: 10, 57 +/- 8 years). HCM was diagnosed by echocardiography; the thickness of the interventricular septum (IVS) was more than 15 mm and the ratio to the thickness of the left ventricular free wall (LVPW) was more than 1.3. The rate and degree of aortic regurgitation were observed by color Doppler echocardiography, and aortic regurgitant murmurs were recorded by phonocardiography. Echocardiographic measurements were made using standard techniques. In the M-mode echocardiograms, the aortic diameter, the thicknesses of the IVS and LVPW were measured. In the 2DE, calcification of the aortic valve and systolic anterior movement of the mitral valve (SAM) were evaluated. In the early systolic 2DE image, the distance from the point of the greatest bulging of the upper IVS to the aortic root (D1) and the distance from the point of the greatest bulging to the line which is parallel to the long axis of the aorta (D2) were measured. Results were as follows: 1. Color Doppler echocardiography revealed aortic regurgitation in 17 (21%) patients with HCM; whereas it was observed in only three (7%) of the control subjects. 2. The aortic regurgitant signals were limited to the left ventricular outflow tract both in patients with HCM and in the control subjects. 3. Aortic regurgitant murmurs were recorded in only two patients with HCM and in none of the control subjects. 4. There was no difference between the patients with and without AR as to age (59 vs 56 years), blood pressure (141/84 vs 136/80 mmHg), aortic diameter (34 vs 33 mm), aortic valve calcification (12% vs 9%) and SAM (53% vs 52%). 5. In the patients with HCM, D1 was shorter (9.9 vs 14 mm, p less than 0.001) and D2 was longer (16 vs 10 mm, p less than 0.001) in the patients with AR than in those without AR. That is, the basal septum of the patients with AR protruded more deeply into the outflow tract, and the distance to the aortic valve was significantly shorter than in those without AR.(ABSTRACT TRUNCATED AT 400 WORDS)

[Left ventricular short-axis plane for magnetic resonance imaging: its clinical importance and applications]

Left ventricular short-axis images were obtained by ECG-gated magnetic resonance imaging (MRI) in nine patients with hypertrophic cardiomyopathy and seven patients with chest pain, all of whom had diagnostic cardiac catheterization including angiography. The accuracy and usefulness of the short-axis image in MRI for measuring wall thickness and dimension and for calculating ejection fraction were evaluated. All patients were examined on an examination couch in the right anterior oblique position in optimal positions to obtain the left ventricular long-axis images in the Z-X plane (conventional coronal plane). Next, the paraxial mode was used to obtain the short-axis images by rotating the Y-Z plane (conventional sagittal plane) around the Y axis. The intervals between the trigger on the middle point of the upstroke of the R wave and the 90 degree pulse of saturation recovery spin echo sequence were 40 msec and 340 msec with a 34 msec echo delay time for the end-diastolic and end-systolic images, respectively. Short-axis images in MRI in end-diastole were utilized to measure wall thickness and dimension in patients with hypertrophic cardiomyopathy and the measurements obtained were compared with those of echocardiography. As for calculating ejection fraction in patients with chest pain, the length of the left ventricular long axis (L) was measured using the MRI long-axis image. The intraventricular sectional area at four levels (S1, S2, S3, S4) were measured using the MRI short-axis image in end-diastole and in end-systole. Left ventricular end-diastolic and end-systolic volumes were calculated using the following formula: V = 1/2 X (L -4.5) X S1 + 1.5 X (S1 + S2 + S3) + 1/3 X 1/2 X (L -4.5) X S4. Ejection fraction by MRI was compared with that by cardiac catheterization (single plane, area-length method). The measurements of wall thickness and dimension by MRI correlated well with those by echocardiography (r = 0.97, p less than 0.01). Ejection fraction calculated by MRI correlated significantly with that by cardiac catheterization (r = 0.82, p less than 0.05). We concluded that the left ventricular short-axis image in MRI is satisfactorily accurate for measuring wall thickness and dimension, and useful for evaluating the left ventricular ejection fraction.

Chondroblastoma arising in the triradiate cartilage. Report of two cases with review of the literature

Chondroblastoma is a relatively rare benign bone tumor of cartilage origin. Roentgenologically it presents usually as a region of lytic destruction of bone with a thin sclerotic rim in the epiphysis of long tubular bone. Less than 9% occur in the pelvic bones but show a tendency to arise from the triradiate cartilage. We present two cases of chondroblastoma originating in the triradiate cartilage, each showing extensive lytic bony destruction and an intrapelvic soft tissue mass. A review of the literature suggests that chondroblastoma of the triradiate cartilage shows an aggressive radiological appearance.

Deficiency of AMP deaminase in erythrocytes

Six individuals with complete deficiency of erythrocyte AMP deaminase have been discovered. They are all healthy and have no hematological disorders. The deficiency is only in isozyme E, which is the erythrocyte type isozyme, and is inherited as an autosomal recessive trait. The frequency of the mutant gene is surprisingly high, one heterozygote in about 30 of the population in Japan, Seoul, and Taipei. The ATP level is approximately 50% higher in AMP-deficient erythrocytes compared to that of control cells. Degradation of adenine nucleotide is slower in the deficient erythrocytes than in the control erythrocytes.

[Musical murmurs: phonocardiographic, echocardiographic and Doppler echocardiographic study]

Musical murmurs are probably related to the vibrations of some structures in the cardiovascular system, and this may be reflected in the characteristic stripes which are recorded by the fast Fourier transformation (FFT) of the pulsed Doppler echocardiography (so-called FFT stripe). In the present study, we demonstrated new stripes by color Doppler echocardiography, which were composed of multiple warm and cold color bands which we termed color Doppler stripes (CD stripe). An experiment was performed to obtain Doppler signals from the surface of a vibrating tonometer at a frequency of 128 Hz. When the CD stripe was obtained, a similar FFT stripe was also recorded from the same sampling site. Fourteen patients with musical murmurs were selected from 2,000 consecutive phonocardiographic records made during the last one and a half years. The CD stripe was obtained in three and the FFT stripe in six. When both stripes were obtained, the FFT stripe was always obtained if we set carefully the sample site in the CD stripe, and these two were consistent in timing. We concluded that, in view of the close correlation between the CD stripe and the FFT stripe, the newly observed CD stripe is also a characteristic finding reflecting a regularly vibrating structure. The technical feasibility of color Doppler echocardiography to detect fine movements of structures may be helpful in the study of musical murmurs.

Asymmetric apical hypertrophy: ten years experience

This paper reports 10 years experience of 31 patients with asymmetric apical hypertrophy, in whom left ventricular hypertrophy involved the apex exclusively and giant T wave inversion in the left precordial leads was the characteristic finding. This type of hypertrophic cardiomyopathy was observed predominantly in men over 40 years of age. Family history was negative and patients usually had no complaints. Left ventricular hypertrophy was evident by physical examination as in other forms of hypertrophic cardiomyopathy, but a systolic murmur was faint or absent and the second heart sound was frequently split. Electrocardiographic signs may fluctuate, and occasionally progression or regression occurs. Echocardiography including the two-dimensional method was essential for the diagnosis and left ventriculography was helpful for confirmation. To date complications have been infrequent and the prognosis seems good. The relation of asymmetric apical hypertrophy to other forms of hypertrophic cardiomyopathy is under investigation.

Clinical significance of early or mid-systolic apical murmurs: analysis by phonocardiography, two-dimensional echocardiography and pulsed Doppler echocardiography

The records of 2,000 consecutive patients who had been examined by auscultation, phonocardiography (PCG), two-dimensional echocardiography and pulsed Doppler echocardiography (PDE) were reviewed to assess the clinical significance of apical systolic murmurs which cease well before the aortic closure sound. Fifty-five patients were verified to have early or mid-systolic apical murmurs. Mitral regurgitation (MR) was detected in 32 patients by PDE (29/32) and/or PCG with methoxamine test (27/32). The degree of MR was judged to be mild by PDE in all cases. Apical systolic murmurs due to MR began mainly with the first heart sound (27/32), were confined to the apex (27/32), and high-pitched (25/32). Their intensity was grade III/VI or less in all cases. Mitral valve prolapse (12 patients) was the most common cause of MR. Other causes were rheumatic mitral involvement in seven patients, dilated or ischemic cardiomyopathy in five, mitral annular calcification in three, and hypertrophic cardiomyopathy in two. The causes of the MR in the remaining three patients could not be identified. Thus, early or mid-systolic apical murmurs are mainly attributable to mild MR which can be diagnosed by careful auscultation, PDE and/or PCG with the methoxamine test.

Method for processing leukocyte- and platelet-poor red cells in closed bags

If leukocyte- and platelet-poor red cells have been processed and stored in closed bags, their delivery, especially on holidays, will be easy. The modified warm-centrifuge method was applied to a quadruple bag prepared for such purpose. Red cells were processed in the first bag by the centrifugation of whole blood. The supernatant plasma was transferred to the second bag. A phosphate buffer in the third bag was introduced into red cells and diluted red cells were then incubated at 37 degrees C for 1 h in an inverted position. After centrifugation, the red cell phase below the buffy coat layer was isolated using a Biotest separation apparatus and stored in the fourth bag (containing a preservative with adenine, phosphate, glucose and 0.9% NaCl solution) for 28 days at 4 degrees C. Ninety-eight percent of the leukocyte and 97% of platelets in whole blood unit were removed with a red cell recovery of 86%. Biochemical changes in stored red cells were similar to those of conventional buffy coat-removed red cells suspended in the same preservative, except for rapid decreases in 2,3-diphosphoglycerate levels. Since processing buffy coat-removed red cells containing few leukocytes and platelets with the present method was simple and these units might be stored for over 14 days with minimum cell damage, we suggest that the present method is useful way of processing leukocyte- and platelet-poor red cells in blood centers.

Improved hemagglutination and hemagglutination-inhibition tests for Akabane virus using formalinized goose erythrocytes

When formalinized instead of fresh goose erythrocytes were used in the hemagglutination (HA) test system of the Akabane virus, the agglutinability of the erythrocytes increased and became less salt-dependent. The improved method based on these findings should facilitate the hemagglutination-inhibition (HI) test and may be useful for epidemiological studies of the Akabane virus.

Transtrochanteric anterior rotational osteotomy for slipped capital femoral epiphysis: a report of five cases

We have performed a transtrochanteric anterior rotational osteotomy on five patients with severe chronic slipped capital femoral epiphysis. Four patients were free from clinical symptoms, whereas one patient continued to feel a dull pain in the hip. Radiographic evaluation indicated that the osteotomy was able to correct even a severe slip without any deformity around the trochanteric region. There were complications in two cases: a posteromedial tilt at the osteotomy site and a focal avascular necrosis in the anterolateral epiphysis.

Noninvasive study of the presystolic component of the first heart sound in mitral stenosis

Echophonocardiography and pulsed Doppler echocardiography were performed in 30 patients with mitral stenosis (19 with atrial fibrillation and 11 with sinus rhythm) to investigate the genesis of the presystolic component or small apical vibrations preceding the first heart sound in mitral stenosis. In 27 patients, mitral valve closure preceded or coincided with tricuspid valve closure regardless of the preceding RR interval. Of three patients whose tricuspid valve closed prematurely, two had a prolonged PR interval. The soft apical vibrations, which were recorded during the final rapid closing motion of the mitral valve echogram (B-C slope), began with the upstroke of the apexcardiogram. During this event the pulsed Doppler echocardiogram revealed a deceleration in the velocity of mitral inflow. In two exceptional patients with a prolonged PR interval, this apical sound was separated from a presystolic rumble that occurred during an accelerated phase of mitral inflow or at the A wave of mitral valve echograms. In conclusion, the tricuspid valve is not a factor contributing to the genesis of the small apical vibrations preceding the first heart sound in mitral stenosis. These vibrations are caused by acceleration of left ventricular contraction and deceleration of mitral inflow in the presence of a stenotic valve.

[Echocardiographic features of small heart]

To clarify the clinical significance of a small heart; i.e., a small cardiac silhouette on chest radiography, an echocardiographic study was performed. Sixty persons with small heart according to cardiothoracic ratios less than or equal to 40%, and 23 age- and sex-matched normal controls (42% less than cardiothoracic ratio less than or equal to 50%) received two-dimensional and M-mode echocardiography. The body weights and body surface areas (BSA) in the small heart group were significantly less than those in the control group. On the lateral chest radiographs, numerous cases with small heart had straight spines and chests with decreased anteroposterior diameters. More than half of the small heart group had a variety of cardiovascular complaints, including chest pain, palpitation, dyspnea, and dizziness. Echocardiographic measurements were performed and hemodynamic indices were calculated. The results were as follows: Left ventricular dimension at end-diastole (LVDd), left ventricular dimension at end-systole (LVDs), left atrial dimension (LAD), and left ventricular mass (LV mass) of the small heart group were significantly less than those of the control group. There were, however, no differences in the values corrected by BSA (LVDd/BSA, LVDs/BSA, LAD/BSA and LV mass/BSA) between the two groups. We found no differences in hemodynamic indices (heart rate, stroke volume, ejection fraction, and cardiac output) at rest between the small heart and control groups. Nineteen cases (32%) had mitral valve prolapse (MVP) on echocardiography in the small heart group. Characteristic phonocardiographic findings were found in 11 cases with MVP (systolic click in four, mitral regurgitant murmur in three, and both in four).(ABSTRACT TRUNCATED AT 250 WORDS)

[Mechanism of systolic anterior motion and left ventricular outflow obstruction in hypertrophic obstructive cardiomyopathy]

Two-dimensional echocardiographic studies were performed for 22 patients with asymmetric septal hypertrophy and systolic anterior motion (SAM) of the mitral valve to clarify the mechanism of SAM and left ventricular outflow obstruction. The long-axis view of the left ventricle showed that a distal portion of the anterior mitral leaflet became surplus when the mitral valve was closed in 15 of 16 patients with SAM-septal contact and in four of six patients without it. In these patients, the mitral leaflet coaptation was displaced anteriorly, and/or the anterior leaflet was elongated, showing an anterior motion. In an unusual patient with SAM-septal contact, a distal portion of the long posterior mitral leaflet was surplus. The remaining two patients without SAM-septal contact had a rather widely coapted portion of the mitral leaflets. The distal surplus portion and the coapted portion of the mitral valve were displaced anteriorly prior to the onset of ejection, and moved forward and protruded into the outflow tract more rapidly and more excessively than the papillary muscles during early to mid systole in all patients. Then, the distal mitral valve and the chordae tendineae adopted the configuration of an inverted V in mid systole. The tip of the surplus leaflet contacted the interventricular septum in patients with SAM-septal contacts. In the short-axis view of the left ventricle, the central portion of the distal mitral valve moved forward excessively and bent like an inverted U during early to mid systole. Therefore, SAM of the distal mitral valve is thought to be caused by the hydrodynamic force generated by the ejection flow. This force is supposed to be not only due to the Venturi effect, but is more properly understood as a "pushing force". Left ventricular outflow obstruction is considered to be formed by the protruding distal mitral valve and the hypertrophied septum.

[Pulsed Doppler echocardiography and pharmacodynamic phonocardiography in the diagnosis of silent aortic regurgitation: a correlative study]

To determine the usefulness of pulsed Doppler echocardiography (PDE) in diagnosing aortic regurgitation (AR), the following two studies were performed. PDE and phonocardiography (PCG) were evaluated for the diagnosis of AR in 36 patients for whom angiography was performed. In 24 patients with grade 2 to 4 by Sellers' classification, all PDE studies were positive for AR (sensitivity of 100%) and PCG studies were positive in 21 patients (sensitivity of 88%). Among 10 patients of grade 1, PDE studies were positive for eight (sensitivity of 80%) and PCG studies were positive for seven (sensitivity of 70%). Angiography was negative for AR in two PCG-proven cases, and PDE also proved AR in one of these. Thus, in all patients, the sensitivity of PDE and PCG were 94 and 82%, respectively. These results indicate that AR may be missed during auscultation, or even when using the latest type PCG. The ability of detecting silent AR was studied in 160 consecutive patients with AR. PDE was positive for AR in 156 of 160 consecutive patients who were diagnosed as having AR by PDE or PCG. In the remaining four patients, three were diagnosed by PCG alone and one by pharmacodynamic phonocardiography using methoxamine (ME-PCG). On the other hand, in 137 of 160, Ar was proven by PCG, and the remaining 23 were so-called "silent AR". ME-PCG was performed for 11 cases of silent AR, but an unequivocal AR murmur was detected in only five. Therefore, the sensitivity of PDE in diagnosing silent AR was 96 percent, while that of ME-PCG was only 45 percent. Thus, compared to PCG and even pharmacodynamic PCG, PDE is a much more sensitive method of diagnosing AR. However, in mild AR cases, angiography, PDE and PCG, all have some limitations in diagnosing AR.

High yield of platelet-rich plasma from CPD blood compared to ACD blood

The yields of platelet-rich plasma (PRP) obtained by centrifugation of CPD (citrate-phosphate-dextrose) blood and ACD (acid-citrate-phosphate) blood were compared. The volumes of PRP from 5 ml blood in test tubes and 200 ml blood in bags were larger by 4% and 4.5%, respectively, when CPD was used as an anticoagulant. In addition, the number of platelets in PRP from CPD blood was higher than that from ACD blood. These data suggest that the optimal centrifugal condition for CPD blood should be different from that for ACD blood.

Complete deficiency of AMP deaminase in human erythrocytes

Four individuals with complete absence of erythrocyte AMP deaminase have been discovered. The subjects appear to be perfectly healthy and there was no evidence of hemolysis. The deficiency was found only in erythrocytes and as expected, mononuclear cells and platelets showed normal level of activity. The activities of all the other purine metabolizing enzymes that were tested were normal. The deficiency is inherited as an autosomal recessive trait.

High yield of platelet-rich plasma from CPD blood compared to ACD blood

The yields of platelet-rich plasma (PRP) obtained by centrifugation of CPD (citrate-phosphate-dextrose) blood and ACD (acid-citrate-phosphate) blood were compared. The volumes of PRP from 5 ml blood in test tubes and 200 ml blood in bags were larger by 4% and 4.5%, respectively, when CPD was used as an anticoagulant. In addition, the number of platelets in PRP from CPD blood was higher than that from ACD blood. These data suggest that the optimal centrifugal condition for CPD blood should be different from that for ACD blood.

The importance of warming at 37 degrees C for removal of leukocytes and platelets from reconstituted red cells

Red cells suspended in sodium phosphate buffer (R-RBC) were incubated at 37 degrees C, and the distribution of the leukocytes and platelets in the suspension was compared to a similar suspension incubated at 22 degrees C. Following centrifugation, a more dense packing of the red cells was observed in warm R-RBC, and less leukocytes and platelets remained in the red cells below the buffy coat, than was observed in R-RBC packed at room temperature. These experiments indicate that incubation at 37 degrees C prior to separation improves the quality of leukocyte- and platelet-depleted red cells.

Sensitive enzyme immunoassay for the measurement of platelet factor 4 in blood plasma

A sandwich enzyme immunoassay method for the measurement of platelet factor 4 (PF4) was developed with the use of polystyrene balls with immobilized antibody F(ab')2 fragments and the same antibody Fab' fragments labeled with beta-D-galactosidase from E. coli. The measurable range was 30 pg to 3 ng of PF4 per tube. Within-run and between-run coefficients of variation were less than 10%. The results obtained with the enzyme immunoassay correlated well with those of a radioimmunoassay (r = 0.952, slope = 0.954, gamma-intercept = 2.43 ng/ml). Platelets contained large amounts of PF4 (7.21 +/- 1.97 ng/10(6) cells or 2.51 +/- 1.13 ng/mg protein), whereas the PF4 levels in red blood cells and lymphocytes were negligible, confirming the specific localization of PF4 in platelets. The applicability of the immunoassay method was tested to determine the in vitro release of PF4 during preparation and storage of platelet concentrates.

Determination of low affinity platelet factor 4 in frozen and thawed human platelets by the newly developed enzyme immunoassay system

By the use of a newly developed sandwich enzyme immunoassay method for low affinity platelet factor 4 (LA-PF4), the effects of repeated freeze-thawing on the contents of this protein in platelets were determined and compared with those of Triton-X 100 lysed platelets. The assay system consisted of polystyrene balls covered with immobilized antibody fragments F(ab')2 and the same antibody Fab' labeled with beta-D-galactosidase from E. coli. The assay was specific to LA-PF4 with no significant cross-reactivity with platelet factor 4. Coefficients of variation within-run and between-run for the assay of LA-PF4 were less than 12%. The results obtained with this enzyme immunoassay correlated well with those of a radioimmunoassay of beta-thromboglobulin which is immunologically identical with LA-PF4 (r = 0.961, slope = 1.056, y-intercept = -3.739 ng/ml; n = 22). The contents of LA-PF4 per 10(9) Triton-X 100 lysed platelets in platelet-rich plasma were 23.65 +/- 3.14 micrograms (mean +/- S.D.). The contents of LA-PF4 in platelets were increased from 46% to 95% of Triton-X 100 values by repeated freezing and thawing 1 to 7 times. The present data indicate that the freeze-thawing technique should be done carefully to obtain the reliable determination of LA-PF4 in platelets.

[Hepatic glycolytic intermediates and glucoregulatory enzymes in septic shock due to peritonitis: experimental study in rats]

The hypoglycemia in septic shock due to peritonitis indicates deranged carbohydrate metabolism. To determine if this metabolic failure could be attributed to changes of glucoregulatory enzymes and glycolytic intermediates, activities and changes of these substances in septic shock have been studied in rats. Liver tissue was sampled 5 hours after induction of peritonitis by cecal incision in fasted male rats. Hepatic glycolytic intermediates were assayed by UV-spectrophotometry. Peritonitis caused 33% decrease in glucose-6-phosphate (G6P), a 2.5 fold increase in fructose-1,6-diphosphate (FDP) and a 3.5 fold increase in lactate. Phosphoenolpyruvate (PEP) levels did not show a significant increase in peritonitis. We investigated activities of glucose-6-phosphatase (G6Pase), fructose-1,6-diphosphatase (FDPase), phosphofructokinase ( PFKase ) and pyruvate kinase ( PKase ) in mitochondria-free supernatants from rat liver homogenates. Tissue was sampled 5 hours after induction of peritonitis by cecal incision. Assays were conducted at optimal substrate levels at pH 7.4; NADH charges produced by coupled reactions were determined by UV-spectrophotometry. A significant increase of PFKase and PKase specific activity was observed. These changes were consistent with stimulated glycolysis. For gluconeogenesis to achieve maximum efficiency it would be necessary to inhibit PFKase and PKase completely.

[Generalized lentigo in a case of hypertrophic cardiomyopathy with right ventricular outflow tract obstruction]

A case was reported in which generalized lentigo was associated with hypertrophic cardiomyopathy and right ventricular outflow tract obstruction. A 34-year-old man was admitted to our hospital for cardiac evaluation. He had been noted to have a heart murmur since his childhood and had had a diagnosis of pulmonary stenosis in his high school age. Physical examination revealed precordial murmurs and numerous lentigines over his whole body surface including palms and soles. Two-dimensional and M-mode echocardiography disclosed asymmetric septal hypertrophy, systolic anterior motion of the mitral valve (SAM) and systolic semiclosure of both semilunar valves. A systolic turbulent flow was recorded at the outflow tracts of both ventricles by pulsed Doppler technique. Cardiac catheterization demonstrated a pressure gradient of 13 mmHg across the right ventricular outflow tract. We considered that the present case was an atypical LEOPARD syndrome with predominant right ventricular outflow tract obstruction which was precisely evaluated by noninvasive techniques.