[Successful operation for isolated cardiac rhabdomyoma of the right atrium]

A 12-year-old girl has experienced palpitation and dizziness, and presented atrial flutter with maximal heart rate of 220/min. Two-dimensional echocardiogram and chest MRI revealed a mass attached to the inter-atrial septum. Complete excision of the tumor including the atrial septum was performed without damage to tricuspid valve. The interatrial septal defect was closed primarily. Histology of the tumor was compatible with cardiac rhabdomyoma. Sinus rhythm was present and no tachycardia occurred in the postoperative period. On the literature, only one case of isolated cardiac rhabdomyoma developing in the atrium was reported and this is considered as the oldest operative case in Japan.

Efficient preparation of monospecific anti-canine C-reactive protein serum and purification of canine C-reactive protein by affinity chromatography

The canine C-reactive protein (CRP) fraction isolated from canine acute-phase serum on a phosphorylcholine-Sepharose 4B column was further subjected to Sephacryl S-300 gel filtration. A canine CRP fraction not containing IgM was then obtained. The antisera, obtained after several immunizations with this canine CRP fraction, contained nonspecific antibodies that reacted with albumin, transferrin and IgG in addition to CRP. This antiserum could be easily changed to monospecific canine CRP serum, when it was subjected to absorption for only 15 min using glutaraldehyde-insolubilized normal canine serum protein containing 3.5 micrograms ml-1 of CRP. Pure canine CRP was isolated with a recovery rate of 95% from canine acute-phase serum by affinity chromatography using specific anti-canine CRP antibody.

Cerebral myxopapillary ependymoma

A rare case of myxopapillary ependymoma is reported. The tumor occurred in the cerebral hemisphere of an 8-year-old girl and had no relationship to the lateral ventricles. Microscopically, it showed abundant mucin production around papillary or reticular structures. Immunohistochemically, these tumor cells were weakly positive, with glial fibrillary acidic protein demonstrated in part of the tumor and vimentin strongly demonstrated throughout the tumor. The results may indicate the poorly differentiated nature of this tumor. This is the second reported case of intracranial myxopapillary ependymoma.

Leber congenital amaurosis in an infant with Down syndrome

A male infant had defects of atrial and ventricular septa and trisomy 21. At 2 months of age, the patient had markedly sluggish pupillary reactions to light OU. Searching nystagmus, multiple chorioretinal atrophic spots in mottled retinas, and unrecordable electroretinograms also were found in the patient when he was 6 months of age. We believe that this infant represents a rare case of Leber congenital amaurosis in association with Down syndrome.

Effect of radiation therapy against intracranial hemangiopericytoma

Seven cases of intracranial hemangiopericytoma were studied retrospectively to investigate the efficacy of radiation therapy. Tumor response evaluated by computed tomography and magnetic resonance imaging was obvious after 20-30 Gy irradiation. The total reduction rate was 80-90% and continued as long as 5-7 months after treatment. In five patients receiving radiation therapy before radical removal, the tumors were easily removed without massive hemorrhage. Histological inspection of specimens after irradiation showed a significant disappearance of tumor cells. Pyknosis frequently occurred in endothelial cells, and proliferating vessels with hyalinoid degeneration were also seen. Reticulin fibers between tumor cells were fewer, split, or absent. Preoperative radiation therapy is useful in the treatment of hemangiopericytoma involving considerable surgical risk. Postoperative radiation therapy should be given even if removal is complete.

Lysinuric protein intolerance presenting deficiency of argininosuccinate synthetase

A 35-yr-old woman, who suffered from relapsing coma with hyperammonemia for 17 yr, was diagnosed to have lysinuric protein intolerance (LPI). Increased urinary dibasic amino acids (lysine, arginine and ornithine) and impaired absorption of orally administered lysine and arginine proved the defects of renal tubular and intestinal transport of dibasic amino acids. These defects are the primary cause of impaired urea cycle metabolism in LPI. Further, the level of argininosuccinate synthetase (ASS), a urea cycle enzyme, was analyzed and it was found to be below the normal level. This is the second reported case of LPI presenting ASS deficiency.

Waardenburg syndrome in Japanese patients. Case reports and literature review

A 3-year-old girl (case 1) had a blue iris and albinotic fundus in the right eye and bilateral deafness. Her 6-month-old sister (case 2) had hypopigmented irides and fundi in both eyes and bilateral deafness. We found that the ratios of interinner canthal distance to interpupillary distance were less than 0.65 in normal Japanese controls. In our patients, these ratios were within the normal range, indicating the absence of dystopia canthorum. After reviewing the recent Japanese literature, we found that the hypopigmented iris and deafness seen in our patients are common in Japanese patients with Waardenburg syndrome.

Immunological study of childhood acute ITP at onset

We attempted to search for any specific change in the immune system during the onset of childhood acute immune thrombocytopenic purpura (ITP) in order to clarify the pathophysiology of acute ITP by examining the lymphocyte subset, lymphocyte blastogenic response, serum complements, and immunoglobulins in 18 patients with childhood acute ITP and 18 controls (control values after normalization). At the onset of acute ITP, the levels of serum complements and IgG and IgA were found to be within the normal ranges, but serum IgM levels were greater than 200 mg/dL in six cases among 18 patients. Lymphocyte blastogenic response to phytohemagglutinin (PHA) and concanavalin A (ConA) was depressed in patients relative to controls (PHA: p less than 0.05, ConA: p less than 0.01). Lymphocyte blastogenic response to pokewood mitogen (PWM) was lower than that of the control, but no statistical significance was observed. There was no difference in the proportion of CD3, CD4, CD8, SmIg, SmIgG, SmIgM, SmIgA, and SmIgD. The CD4/CD8 ratio was not different from that of controls. The proportion of CD38 was higher than that of control, but no significant difference from the control was observed. Increase in the serum IgM level and proportion of CD38 and depressed lymphocyte blastogenic response may be the influence of preceding infection. It has been reported that the CD4/CD8 ratio is depressed due to an increase in the CD8 level in acute and convalescent phases of viral infection. However, the proportion of CD8 was not necessarily increased in our patient in whom preceding infection was obvious. The immunological status of the patients with acute ITP at onset differs from that after infection.

[Study of satellite tumor nodules in renal cell carcinoma]

Topography and histological types of main tumor and satellite tumor nodules (STN) were investigated on 60 cases of renal cell carcinoma by gross and microscopic study by making whole area histological sections. 30-100 histological slides were made from the median sagittal section and multiple horizontal sections of renal cell carcinoma. STN were observed in 28 cases of the 60 cases (46.7%) and could be classified into 3 types according to their location relative to the main tumor. STN could not be observed in some cases despite the large main tumor of 10 cm or more, while STN were observed in some cases with the main tumor of only 2.5 cm or less. High grade and high stage cases showed a high incidence of STN. It is considered that, only in cases, with the tumors of low grade, low stage and has only 1 STN or less, conservative surgery on renal parenchyma is possible. When the case is of low grade and low stage and has a possibility of preserving normal renal parenchyma, conservative surgery on renal parenchyma may be justified even if the tumor is large.

[Two cases of pure agraphia developed after thalamic hemorrhage]

We have observed two cases suffered from left thalamic hemorrhage, that showed pure agraphia. The first case was a 49 year-old, right handed male, who was educated through 11th grade. The CT scan revealed left thalamic hemorrhage with ventricular casting. The second case was a 48 year- old, right handed male, who was educated through 9th grade. The CT scan revealed left thalamic hemorrhage which is smaller than that of the first case, without intraventricular rupture. With a standard neuropsychological evaluation performed at chronic stage, neither cases showed oral language disorder, apraxia and agnosia. On the Wechsler Adult Intelligence Scale, total IQ of the first and second case were 71 and 80 respectively. Each case developed severe writing disorder. The first case showed severe neographism and scrawl, mild literal paragraphia, which were frequently accompanied with perseveration. The second case showed literal paragraphia and no response, but neographism was not detected. The common characteristics of both cases were; 1) intact copy writing. 2) discrepancy between difficulty in writing "Kana" and that in "Kanji". 3) anosognosia of agraphia. The cerebral blood flow study by 123I-IMP Single photon emission computed tomography revealed low perfusion of the left cerebral hemisphere in both cases. From these findings, we concluded that dysfunction of the left cerebral cortex is responsible for producing agraphia in these cases.

Chronic alpha 1 blockade in a patient with Eisenmenger syndrome

In an 18-year-old male with Eisenmenger syndrome cyanosis and erythrocytosis were increasing. The erythrocytosis diminished following oral bunazosin and phlebotomy was not needed during the treatment. When bunazosin was stopped, the erythrocytosis increased, but when it was resumed, the erythrocytosis and general fatigue diminished.

[The evaluation of the effect of Estracyt on prostatic cancer]

The clinical effect of Estracyt on untreated prostatic carcinoma was evaluated. The subjects consisted of 51 of 71 patients with prostatic carcinoma who were observed for 6 months or more after oral administration of 560 mg of estramustine phosphate. This drug was effective in all patients: markedly effective in 34 (66.6%), moderately effective in 13 (25.5%), and slightly effective in 4 (7.8%). During the observation period varying from 6 months to 2 years and 6 months, 7 patients had recurrence of progression. The interval between the drug administration and recurrence of progression varied from 6 months to 1 year and 10 months (mean, 15.8 months). Prostate acid phosphatase and gamma-seminoprotein remained normal between 3 and 15 months after the administration but became elevated due to recurrence of progression after 18 months or more in some patients. Blood testosterone, luteinizing hormone, and follicle stimulating hormone decreased while blood cortisol increased. Therefore, estrogen was acting effectively. Side effects were observed in 56.9% of the patients, the most frequent being mazoplasia in 33 patients (45.8%), and cardiovascular complications and apoplexy in 11 patients (15.3%). Estracyt was effective for untreated prostatic carcinoma but the problems such as recurrence of progression and side effects require further examination.

Effect of experimental ocular hypertension on macrovacuolation in Schlemm's canal endothelial cells of monkey eyes

The severance of all the extraocular muscles (tenotomy) caused temporary ocular hypertension, lasting a few days, in Japanese monkey (Macaca fuscata) eyes. We studied the morphology of Schlemm's canal endothelium of the eyes under a light microscope after quick fixation through continuous irrigation of the anterior chamber with a 10% acrolein solution, with precise control of the hydrostatic pressure on the eyes during fixation. A statistically significant increase in macrovacuolation in endothelial cells of Schlemm's canal of normal eyes was observed when additional hydrostatic pressure was applied. However, such an increase was not observed in the case of tenotomized temporary hypertensive eyes.

Left ventricular diastolic function of children in high blood pressure tracking group

The purpose of this study was to determine whether left ventricular (LV) diastolic function in children with high blood pressure (BP) is abnormal. We measured the corrected LV isovolumic relaxation time (IRT), peak velocity of increase in LV dimension (dD/dt) and the LV muscle volume in a high systolic BP tracking group (10 boys and 22 girls) and a low BP tracking group (22 boys and 11 girls) at 3-year intervals from the ages of 6 to 15. The corrected IRT of the high BP tracking group was significantly longer than the low BP tracking group. Left ventricular dD/dt/D of the high BP tracking group was significantly lower than the low BP tracking group from the ages of 12 in boys and 9 in girls. The left ventricular muscle volume index of both groups, however, was not significantly different. Both corrected IRT and dD/dt/D were well correlated with diastolic BP. These data suggest that children in the high BP tracking group might have LV diastolic abnormalities from age 12 or 15, in contrast to children of the low BP tracking group, without increased LV muscle volume. Therefore, it might be useful to examine BP and LV function of children from ages 12 or 15 for prevention of hypertension.

Glutathione conjugation of methazolamide and subsequent reactions in the ciliary body in vitro

Conjugation reaction of methazolamide with glutathione and its subsequent reactions were studied in vitro. Glutathione, cysteinylglycine, and cysteine conjugates of methazolamide were chemically synthesized. All of the three compounds showed absorbance below 330 nm, with maximal absorbance at approximately 300 nm. At the wavelengths below 220 nm, absorbance was proportional to the number of the amino acids each compound had. Amino acid analysis of the glutathione conjugate showed that the conjugation reaction involved the cysteine residue of glutathione. In order to identify the chemical structure of the reaction product, cysteine conjugate was subjected to infrared, proton nuclear magnetic resonance, and mass spectral analyses. These studies indicated that the cysteine conjugate was S-(5-acetylimino-4-methyl-delta 2-1,3,4-thiadiazolinyl)cysteine. The reaction with glutathione was not catalyzed by glutathione S-transferases, but proceeded in the absence of the enzyme. The glutathione conjugate was degraded by bovine ciliary body homogenate to the cysteinylglycine conjugate and then to the cysteine conjugate.

Relation between blood pressure, left ventricular mass and pulsed Doppler parameters in healthy school children

We analyzed the relations between blood pressure in sitting and supine positions, left ventricular mass (LVM) and Doppler aortic, pulmonary and mitral flow velocity measurements in 163 healthy school children. Systolic blood pressure in a supine position correlated significantly with aortic acceleration (ATc) and ejection time (ETc), corrected by the square of R-R interval, pulmonary AT and peak flow velocities. Moreover, the systolic blood pressure in a sitting position correlated with pulmonary AT and LVM. LVM correlated with pulmonary ATc, the ratio of AT to ET and average acceleration, and aortic ETc and peak flow velocity. These data suggest the following: (1) the posture influences the relation between blood pressure and flow velocity, (2) pulmonary hemodynamics are influenced by systemic blood pressure in healthy children and (3) the development of LVM may be dependent not only on blood pressure but also on cardiac work in childhood.

Changes of left ventricular isovolumic relaxation time with growth in children

We investigated the changes of left ventricular isovolumic relaxation time (LVIRT) with growth and the factors influencing them during childhood, in a 10-year follow-up study. We measured the body height (BH), body weight (BW), lean body weight (LBW), heart rate (HR), blood pressure (BP), left ventricular muscle volume index (LVMVI), and LVIRT corrected by the preceding R-R interval (IRT/R-R), of 187 healthy children at 3-year intervals (6, 9, 12, 15 years old). IRT/R-R were prolonged with growth in boys and girls. At the ages of 12 and 15, the IRT/R-R of girls were longer than those of boys. Significant correlation coefficients for IRT/R-R on systolic and diastolic, BW, and LVMVI were 0.28, 0.31, 0.20, 0.28, respectively. These data suggest that (1) IRT/R-R is mainly determined by the diastolic BP, (2) left ventricular diastolic function of children develops with growth of body size, especially BW, and (3) left ventricular early diastolic function in adolescents is related to sexual maturation.

Prenatal diagnosis of valvar aortic stenosis by Doppler echocardiography and magnetic resonance imaging

We present herein a case of valvar aortic stenosis diagnosed antenatally, using color and pulsed Doppler echocardiography and magnetic resonance imaging. The benefit and advantages of the use of magnetic resonance imaging, complementary to the Doppler echocardiography, are discussed.

Quantitative analysis of systolic blood pressure tracking during childhood and adolescence using a tracking index: the Shimane Heart Study

We used a tracking index to carry out a quantitative analysis of blood pressure tracking in children and adolescents. The index was calculated according to changes in blood pressure quintiles for the whole population during the observation period. The study population consisted of 463 Japanese children living in Izumo, who were examined every 3 years from 6 to 12 years of age in cohort 1, and from 9 to 15 years of age in cohort 2. In both sexes, the tracking index decreased transiently during the period from 9 to 12 years of age and increased again thereafter. The index was higher in girls than in boys except for the period from 12 to 15 years. Correlation coefficients between blood pressure at the first and that at the second examination increased with age in both sexes. We conclude that the tracking index could quantify the degree of tracking. Systolic blood pressure tracked well during childhood and adolescence, and the degree of tracking increased after the age of 12 years in both sexes.

Diastolic left ventricular function in normal children: the maximal positive dD/dt compared with the E/A ratio of mitral flow pattern

The normal values for left ventricular diastolic function in children are influenced by numerous factors. As an index of this function, the maximum velocity of left ventricular internal dimension expansion (+ max dD/dt) was calculated from M-mode echocardiography for 33 normal persons who ranged in age from seven days to 18 years. This index showed a linear correlation with left ventricular end-diastolic dimension in the resting state. This index was compared with the E/A ratio which is ordinarily used as the diastolic functional index for children. Considering changes in physical development during childhood, both indices showed similar trends in relation to body surface area. The E/A ratio was strongly influenced by heart rate, but + max dD/dt was not. This was the major difference between two indices.

Prevalence of human immunodeficiency virus (HIV) infection among hemophiliacs in Fukuoka, Japan

To determine when the hemophiliacs in Fukuoka prefecture, Japan, first became positive for antibodies, we tested human immunodeficiency virus (HIV) antibodies on serum samples obtained from 1976-1987 stored at -30 C. Fifteen out of 64 hemophilia A patients (23.4%), five out of 11 hemophilia B patients (45.5%), but none of 17 patients with von Willebrand's disease (0%) were positive for HIV antibodies. In this series, two with hemophilia A became positive for HIV antibodies for the first time in 1983, and in 1984 another four with hemophilia A and one with hemophilia B became positive.

Nature of linkage and mode of action of methotrexate conjugated with antitumor antibodies: implications for future preparation of conjugates

The binding of methotrexate (MTX) to IgG in conjugates was examined by studies on a direct MTX conjugate with a monoclonal antibody (aMM46) to mouse mammary tumor MM46 cells and corresponding irrelevant antibody and normal gamma-globulin conjugates, all prepared by the active ester method with MTX N-succinimidyl ester (MTX-OSu). The binding was examined in terms of effects on the potency and selectivity of the cytotoxic activity of the aMM46 conjugate. The results obtained supported the following conclusions: (a) MTX-OSu reacts not only with the amino group of IgG to give an amide bond, but also with another group(s) to give a less stable bond(s) such as an ester bond; (b) in contrast to the amide bond-linked MTX, which is taken up by the cells by endocytic internalization, a substantial portion of the MTX linked by an ester or other less stable bond(s) is released from the conjugates extracellularly and enters the cells by the MTX active transport system, as revealed by the inhibitory effect of thiamine pyrophosphate on the cytotoxicity; (c) this MTX linked by a less stable bond(s) that causes nonspecific cytotoxicity can be removed by treatment with hydroxylamine; (d) the overall cytotoxicity of aMM46-MTX decreased on removal of this less stably linked MTX, suggesting that the lysosomal degradation of the conjugate carrying amide bond-linked MTX to liberate MTX derivatives of low molecular weight is insufficient; (e) the liberation of low-molecular-weight substances in the lysosomes is probably more important for efficient entry of active substances into the cytosol, than for inhibition of the activity of dihydrofolate reductase, because after hydroxylamine treatment, the amide bond-linked MTX showed greater decrease in drug cytotoxicity than in inhibitory activity against dihydrofolate reductase; (f) in combination with hydroxylamine treatment, insertion between MTX and IgG of a linkage capable of ready cleavage in lysosomes deserves exploitation as a method for making potent conjugates with less nonspecific activity.