Clinical and electrophysiological characteristics of atrial standstill

To clarify the clinical and electrophysiological characteristics of atrial standstill (AS) we studied 11 patients (7 males and 4 females), whose average age was 62 years and who were followed over a period of 4-179 months. Underlying heart disease was present in nine patients and two cases were idiopathic. Major clinical symptoms in the 11 cases included Adams-Stokes attacks, and dyspnea on exertion. In the standard 12-lead ECGs obtained on admission, the P wave was absent in six cases. Atrial flutter (AF) was noted in 3, atrial fibrillation (Af) in 1, and multifocal atrial tachycardia in 1. In some cases, the ECG initially showed AF or Af, and was transformed after several years into ectopic atrial tachycardia or an ectopic atrial rhythm with a markedly decreased amplitude of the P wave. Finally, the P wave disappeared over a prolonged period. When intracardiac mapping was performed, the atrial electrograms tended to diminish at the site of high, mid-lateral right atrium (RA). Electrograms were remained present in the vicinity of the tricuspid valve (TV) annulus. A repeated mapping and pacing study conducted in two patients revealed that the "silent" area spread toward the lower site of RA. During the average follow-up period of 64 months, four patients died. The interval until death in one patient with myocarditis was 6 months, and in another with dilated cardiomyopathy (DCM) it was 8 months. It appears that the atrial muscular lesion starts in the high lateral RA and progresses toward the lower RA, then to the vicinity of the TV annulus. A diffuse and progressive disturbance may occur not only in the atrial muscle, but also in the atrioventricular conduction system in patients with AS who had progressive myocarditis or DCM.

Mortality of Candida albicans-infected mice is facilitated by superinfection of Escherichia coli or administration of its lipopolysaccharide

Pathogenesis of complex infection with Candida albicans and gram-negative bacteria was studied by determining the influence of infection with Escherichia coli or injection of E. coli lipopolysaccharide (LPS) on mortality of C. albicans-infected mice. Mice were infected intravenously with lethal doses of C. albicans, then treated intravenously at various times with viable E. coli or E. coli LPS, which individually were not lethal. Treatments 3 h after C. albicans infection clearly facilitated the death of the mice. Corresponding to this facilitated death, production of tumor necrosis factor (TNF) in sera was augmented 2 h after LPS injection into the infected mice. Similar increased production of TNF was also observed in mice treated with a nonlethal combination of heat-killed C. albicans and LPS. The number of viable C. albicans in kidneys of the infected mice was increased by LPS treatment, which was assumed to be the main cause of the greater mortality rate.

Ectodermal dysplasia syndrome in siblings with true keloids, stenosis of the esophagus after operations for congenital achalasia and renovascular hypertension due to stenosis of renal artery

Ectodermal dysplasia syndrome (EDS) is a rare hereditary disease, with symptoms brought about by dysplasia of ectodermal tissue (such as skin, teeth, nails, and hair). This report details the cases of two siblings (41 and 43 year old sisters) with autosomal recessive and hydrotic EDS complicated by esophageal achalasia, postoperative stenosis of esophagus, true keloids, renovascular hypertension, incomplete malrotation of the bowel, and demyelination of the brain.

Haemodynamic, diuretic and hormonal responses to prostaglandin E1 infusion in halothane anaesthetized dogs: comparison among epidural lidocaine, epidural fentanyl and epidural saline

Deliberate hypotension decreases blood loss and transfusion but it may be accompanied by adverse effects due either to the hypotensive agents themselves or to haemodynamic alterations. Prostaglandin E1 (PGE1) has the advantage of a diuretic effect coupled with systemic hypotension. To elucidate the mechanisms by which PGE1 induces diuresis we compared the haemodynamic, diuretic and hormonal responses to PGE1 infusion simultaneously with epidural lidocaine (EP-L n = 7), epidural fentanyl (EP-F n = 8) or epidural saline (CONT n = 7) in halothane anaesthetized mongrel dogs. All groups developed a decrease in mean arterial pressure during PGE1 infusion (from 105 +/- 24 to 77 +/- 18 mmHg in EP-L; 106 +/- 19 to 79 +/- 13 mmHg in the EP-F; and 129 +/- 14 to 106 +/- 18 mmHg in the CONT groups (mean +/- SD)) (P < 0.05). In the EP-F and CONT groups urinary output increased during PGE1 infusion (from 4.31 +/- 1.89 to 6.15 +/- 2.03 ml.min-1 and 2.71 +/- 1.23 to 4.48 +/- 1.66 ml.min-1 (P < 0.05), respectively) and was accompanied by increases in renal blood flow (from 87.0 +/- 40.7 to 111.0 +/- 42.8 ml.min-1 and from 121.6 +/- 46.6 to 158.4 +/- 64.9 ml.min-1 (P < 0.05), respectively) and in fractional excretion of sodium (FENa) (from 4.78 +/- 3.88 to 7.63 +/- 5.20% in CONT group).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of conductivity in patients with second- or third-degree atrioventricular block after pacemaker implantation

The purpose of this study was to examine the long-term course of conductivity in patients with second- or third-degree atrioventricular (AV) block after pacemaker implantation. Fifty-four patients (30 males and 24 females, mean age 59.5 years) had a 12-lead electrocardiogram (ECG) recorded prior to pacemaker implantation and again after a follow-up of more than 5 years (mean 108 months). The degree of AV block and the morphology of the QRS complex in the two ECGs were compared. Twenty-eight (85%) of the 33 patients with complete AV block and 15 (71%) of the 21 patients with second-degree AV block before implantation showed complete AV block after the follow-up period. The progression of AV block was recognized only in patients with intra-His (BH) or infra-His (H-V) block. In 29 patients, escape QRS complexes were recorded in both ECGs. A change in the QRS complex was noted in 6 patients (21%), including 2 with new bundle branch block (BBB), 2 with wider BBB, 1 with new left axis deviation, and 1 with a change to another BBB. This change was particularly notable in the H-V block group (44%).

IN CONCLUSION

(1) Most patients with complete AV block did not recover AV conductivity after the long-term follow-up. (2) Second-degree BH and H-V block tended to progress to complete AV block.

Simultaneous DNA typing of human platelet antigens 2, 3 and 4 by an allele-specific PCR method

We developed an allele-specific polymerase chain reaction (ASPCR) method using originally designed primers to determine the genotype of the human platelet antigens (HPAs) 2, 3 and 4 in parallel. The results were compared with those obtained by PCR restriction fragment length polymorphism and the mixed passive hemagglutination test. Seventy-three individuals were tested and the ASPCR results were in good agreement with those determined by the other two methods. This method enables the genotyping of HPA-2, -3 and -4 in parallel without the use of platelets, platelet-specific alloantibodies or restriction enzymes.

Effects of simvastatin on plasma lipoprotein subfractions, cholesterol esterification rate, and cholesteryl ester transfer protein in type II hyperlipoproteinemia

We investigated the effects of simvastatin on plasma levels of lipoprotein subfractions, cholesterol esterification rates and activities of cholesteryl ester transfer protein in 28 patients with type II hyperlipoproteinemia (i.e., nonfamilial hyperlipoproteinemia type IIa and type IIb, and heterozygous familial hypercholesterolemia (FH)). Plasma levels of VLDL-cholesterol (C) and VLDL-triglyceride (TG) were significantly reduced overall by 12.9 +/- 58.0% (mean +/- S.D.; P < 0.05) and 4.2 +/- 54.2% (P < 0.05) respectively, but not in FH. Plasma levels of IDL-C and IDLT-G were decreased overall by 23.2 +/- 47.5% (P < 0.001) and 12.3 +/- 49.7% (P < 0.05), respectively, again mainly due to decreases seen in nonfamilial type II hyperlipoproteinemia. Plasma levels of LDL1 (1.019 < d < 1.045)-C and LDL1-TG were significantly reduced by 33.1 +/- 12.9% (P < 0.001) and 23.3 +/- 24.7% (P < 0.001), respectively. Plasma levels of LDL2 (1.045 < d < 1.063)-C were significantly reduced by 22.9 +/- 18.1% (P < 0.001) overall but not in FH. Gradient PAGE showed no consistent changes in the distribution of LDL particles. Thus, plasma levels of all apo B-containing lipoprotein subfractions were reduced by simvastatin, but its effects varied among the three subgroups. Cholesterol esterification rates were suppressed by 9.3 +/- 19.7% (P < 0.01) and activities of cholesteryl ester transfer protein were reduced by 30.6 +/- 21.5% (P < 0.001). Changes in CETP activity and in plasma levels of cholesterol in lipoprotein subfractions were not correlated. Thus, the changes in distribution of lipoprotein subfractions were not due mainly to CETP suppression.

Morphological aspects of cell wall formation during protoplast regeneration in Candida albicans

The dynamics of cell wall regeneration in Candida albicans protoplasts was investigated by fluorescence microscopy using a new fluorescent dye, Fungiflora Y, which specifically binds to beta-linked polysaccharides, as well as by electron microscopy. When freshly prepared protoplasts were incubated in osmotically stabilized medium, multiple binding sites of Fungiflora Y were detected on their surface within 15 min of incubation. At this initial stage of reversion, protoplasts began to form microfibrils outside the cytoplasmic membrane. From 1 h onward, the whole cell surface displayed a bright fluorescence. After 3 h of incubation, the reverting protoplasts were covered by an interwoven network of microfibrils. After 5 h of incubation, although most of the revertants had become osmotically resistant, regenerated cell walls in which the constituent materials appeared highly integrated were observed to be still monolayered in profile. Cell wall regeneration was complete after 24 h of incubation, at which time the reverted cells were capable of proliferating.

Mutagenicity of bile and pancreatic juice from patients with pancreatico-biliary maljunction

We attempted to detect mutagenic activity in bile and pancreatic juice from patients with biliary tract disease using the spore rec assay and wild (H17) and mutant (M45) strains. Three bile samples out of 5 obtained from patients with pancreatico-biliary maljunction showed positive reaction in the spore rec assay, and all contained a high level of amylase activity, while 300 microliters of bile samples obtained from 10 control patients without pancreatico-biliary maljunction did not show any positive reaction. Moreover, 300 microliters of the in vitro mixture of bile with an equal volume of pancreatic juice also showed a positive reaction after treatment for 12 days at 37 degrees C or for 10 min at 100 degrees C, suggesting that they were very stable and long-acting in vivo. These data suggest that possible mutagens might be formed by the mixing of bile with pancreatic juice regurgitated into the biliary tract, and that there might be a relationship to biliary tract cancer which often accompanies pancreatico-biliary maljunction.

Exercise-induced changes in R wave amplitude and heart rate in normal subjects

An intermittent exercise protocol on a treadmill was used to examine six healthy subjects, and a steady protocol was applied to three of the subjects before and after short-term training. The peak blood velocity in the common carotid artery increased by 73.1% during the intermittent protocol and recovered to resting level within 3 minutes, while the heart rate (HR) remained high even 5 minutes after exercise. R wave amplitude (RWA) increased significantly from 1.40 +/- 0.39 mV at rest to 1.59 +/- 0.33 mV (P < .05) immediately after the start of walking, and decreased gradually to 1.46 +/- 0.36 mV (P < .05) during 3 minutes of walking. Thus, it decreased significantly to 1.31 +/- 0.40 mV (P < .01) during the interphase from exercise to rest, and increased again during recovery or rest periods in the intermittent protocol. The results suggest that an increase in the venous return per heart beat at the start of walking induces the increase in RWA, and that its abrupt decrease at the end of walking induces the decrease in RWA. Subjects with a higher HR response and recovery slopes have smaller abrupt changes in RWA at the interphases between rest and walking. The gradual decrease in RWA during walking may be related to a gradual increase in HR and a gradual decrease in systemic peripheral resistance, and the gradual increase in RWA after walking may be related to a gradual decrease in HR and a gradual increase in systemic peripheral resistance.

Plasma thrombomodulin levels in coronary sinus blood in patients with coronary artery disease

Plasma thrombomodulin (TM) levels in coronary sinus blood were measured in 15 patients with coronary artery disease who underwent elective PTCA (group A). TM was also measured in eight patients with coronary artery disease (group B) and six patients without coronary artery disease (group C), who only underwent diagnostic coronary angiography. The baseline level was 21.6 +/- 3.4 U/ml in group A, and 21.0 +/- 4.9 in group B, and both levels were slightly higher (P < 0.05) than those in group C (15.1 +/- 3.3). In group A, the level increased to 27.5 +/- 8.3 (P < 0.01) immediately after PTCA and then returned to 22.2 +/- 5.1 by 24 h. In groups B and C, levels showed no change immediately after angiography. In group A, the percentage increase in the TM level immediately after PTCA from that before the procedure correlated with the number of balloon inflations (r = 0.76, P < 0.01). In conclusion, the plasma TM level in coronary sinus blood might indicate endothelial damage due to atherosclerotic coronary artery disease and an increase in the level after PTCA might directly indicate vascular injury by balloon inflation.

Etiology of gastric remnant cancer with special reference to the effects of denervation of the gastric mucosa

BACKGROUND

Gastric mucosal blood flow, secretion of mucin, and renewal of the gastric mucosal cells are considered to be defensive factors against gastric mucosal injuries. These factors are regulated by the nervous system and neuropeptides. Gastrectomy may affect this regulation and induce gastric mucosal changes, such as atrophic gastritis and carcinoma. The effects of denervation of the gastric mucosa on tumorigenesis of the remnant stomach were investigated.

METHODS

Using male Wistar rats, four groups of Billroth I (B-I)gastrectomy, Billroth II (B-II) gastrectomy, and those with denervation were conducted. Subdiaphragmatic truncal vagotomy was performed in the denervated group. Thirty weeks after the operations, histologic examination and periodic acid-Schiff--Alcian blue (PAS-AB) staining of the gastric mucosa, analysis of cell kinetics of the gastric mucosa by immunohistochemistry of proliferating cell nuclear antigen, and measurement of intragastric pH, intragastric bile acid concentration, and serum gastrin levels were performed. No carcinogenic agents were given.

RESULTS

The B-I group showed no remarkable gastric mucosal changes, but B-I with denervation showed a significant increase in the development of tumor (67%) and carcinoma (42%). In the B-II groups, the denervation induced a significant increase in tumorigenesis, from 22% to 58%. Analysis of cell kinetics revealed a significant increase of labeling index in those groups that developed tumors. PAS-AB staining showed a decrease of PAS positive mucin but an increase of acidic mucin-producing cells in the denervated groups, suggesting an increase in the number of immature cells that are more susceptible to atrophic gastritis and carcinoma. There was no close relationship between tumorigenesis and intragastric pH, intragastric bile acid concentration, or serum gastrin levels.

CONCLUSIONS

After gastrectomy, not only duodenogastric reflux, but also the denervation of the gastric mucosa play an important role in the etiology of gastric remnant cancer.

Blood flow velocity in the common carotid artery in humans during graded exercise on a treadmill

Cerebral blood volume flow and flow velocity have been reported to increase during dynamic exercise, but whether the two increase in parallel and whether both increases occur as functions of exercise intensity remain unsettled. In this study, blood flow velocity in the common carotid artery was measured using the Doppler ultrasound method in eight healthy male students during graded treadmill exercise. The exercise consisted of stepwise progressive increases and decreases in exercise intensity. The peak intensity corresponded to approximately 85% of maximal oxygen consumption. During this exercise, the heart rate (fc), mean blood pressure (BP) in the brachial artery and mean blood flow velocity (vcc) in the common carotid artery increased as functions of exercise intensity. At the peak exercise intensity, fc, BP and vcc increased by 134.5%, 20.5% and 51.8% over the control levels before exercise (P < 0.01), respectively. The resistance index (RI) and pulsatility index (PI) were determined from the velocity profile and were expected to reflect the distal cerebral blood flow resistance. The RI and PI increased during the graded exercise, but tended to decrease at the highest levels of exercise intensity. As vcc increased with increases in exercise intensity it would be expected that cerebral blood flow would also increase at these higher intensities. It is also suggested that blood flow velocity in the cerebral artery does not proportionately reflect the cerebral blood flow during dynamic exercise, since the cerebral blood flow resistance changes.

Isoproterenol increases peripheral [Ca2+]i and decreases inner [Ca2+]i in single airway smooth muscle cells

The effects of isoproterenol (Iso) or photolysis of caged adenosine 3',5'-cyclic monophosphate (cAMP) on intracellular Ca2+ concentration ([Ca2+]i) were studied in single airway smooth muscle cells. Changes in [Ca2+]i were measured ratiometrically. In cells loaded with 10 microM fura 2-acetoxymethyl ester (AM), superfusion of Iso (10 microM) increased [Ca2+]i in 20 of 22 cells from 153.2 +/- 21.3 to 252.8 +/- 38.3 nM, and this increase depended on extracellular Ca2+ and was blocked by ryanodine (50 microM). Photolysis of intracellular caged cAMP increased [Ca2+]i by 104.0 +/- 17.3 nM in 20 cells and decreased [Ca2+]i by 49.3 +/- 9.4 nM in 10 cells. With modified confocal microscopy, peripheral [Ca2+]i was increased and inner cytosolic [Ca2+]i was decreased during stimulation with Iso. Iso-induced decreases in [Ca2+]i were also observed with conventional optics in cells loaded with 0.5 microM fura 2-AM. However, in these same cells, Iso increased [Ca2+]i in the presence of low concentrations of ryanodine (1-20 microM). We concluded that Iso decreased [Ca2+]i in the inner cytosol but increased [Ca2+]i in the peripheral cytosol by mechanisms that depended on both extracellular and sarcoplasmic reticulum Ca2+ release channels. Our study suggests that fluorescence from a peripheral cytosol with high [Ca2+]i can sometimes confound the measurement of "cytosolic" [Ca2+]i with conventional optics.

Effect of endothelin-1 on the development of hemorrhagic pancreatitis in rats

BACKGROUND

It has been hypothesized that microcirculatory disturbance plays an important role in the development of severe pancreatitis. In this study we investigated the effects of exogenous endothelin-1 on the development of severe pancreatitis in rats.

METHODS

Acute pancreatitis was induced by two intraperitoneal injections of cerulein (10 micrograms/kg body weight). Endothelin-1 was administered via an abdominal aortic catheter as a bolus of 250-750 pmol/kg BW every hour for 4 h.

RESULTS

Remarkable morphologic changes in the pancreas, including hemorrhage, and increases in serum amylase level and active elastase content in pancreatic tissue were observed in rats treated with cerulein plus endothelin-1 in a dose-dependent manner 5 h after the first cerulein injection. Local pancreatic blood flow decreased significantly, and microcirculatory disturbances in the pancreas were demonstrated.

CONCLUSIONS

These results suggest that endothelin-1 causes pancreatic microcirculatory disturbance and might be a contributing factor in the aggravation of acute pancreatitis.

Basic fibroblast growth factor as a candidate tumor marker for renal cell carcinoma

The present investigation was conducted to determine serum levels of basic fibroblast growth factor (FGF) by enzyme immunoassay in patients with various urogenital tumors. Renal cell carcinoma had a higher tendency (28 of 52, 53.8%) toward increased serum levels of basic FGF than any of the other urogenital tumors, and increased serum basic FGF was detected more frequently in patients with advanced renal cell carcinoma. Analysis of histological pattern indicated that renal cell carcinoma with a solid or tubular component is more likely to produce basic FGF. However, no significant difference was seen between the percentage of clear cell type tumor patients with increased serum basic FGF (50.0%) and the percentage of granular cell type tumor patients with increased serum basic FGF (66.7%). Five of 8 patients with renal cell carcinoma who underwent selective renal venous sampling before nephrectomy showed increased serum basic FGF in the renal vein from the affected kidney. After resection of the affected kidney to remove the cancer, serum basic FGF disappeared within 2 weeks. However, residual huge tumor or postoperative disease prolonged the increased levels of basic FGF in 2 patients, indicating that basic FGF is produced from and secreted by tumor tissue itself. These findings suggest that serum basic FGF can be useful in the diagnosis, and in evaluating the prognosis, of patients with renal cell carcinoma.

[Induction and maintenance therapy in all-trans retinoic acid with relapsed acute promyelocytic leukemia]

We reported a 17-year-old girl with relapsed acute promyelocytic leukemia (APL) who achieved complete remission and has been received maintenance therapy with all-trans retinoic acid (ATRA). The patient was diagnosed as APL in 1986. The ANLL 861 protocol of the Children's Cancer and Leukemia Study Group induced complete remission, and the chemotherapy was discontinued in 1989. However, she suffered a relapse with APL in 1991 and begun receiving ATRA (30 mg/m2/day) therapy because of disseminated intravascular coagulation. Bleeding tendency was discontinued by day 5. During the treatment, the white blood cell count increased markedly to 35,510 per microliters on 15th day, however she achieved complete remission morphologically on day 18. After informed consent was obtained from the family, she has been given ATRA orally for more than three years at the time of this report. The pharmacokinetics examination (ATRA 20 mg/m2 single per os) was performed 12 and 22 months after the induction therapy. The each peak plasma level of ATRA was 89 and 149 ng/ml. The concentration of ATRA has yet reached a level despite the continuous ATRA therapy. We considered that it may be useful to monitor plasma levels of ATRA during the treatment.

Relation of saphenous vein graft obstruction to serum cholesterol levels

OBJECTIVES

To determine the potential of lipid-lowering therapy to reduce saphenous vein graft obstruction, we retrospectively studied the association between graft obstruction and serum cholesterol levels.

BACKGROUND

Atherosclerosis is the major cause of vein graft obstruction. Approximately 50% of grafts are occluded by 10 years after operation. It remains to be established whether lipid control affects long-term graft survival.

METHODS

We carried out a retrospective review of all 284 patients who had undergone coronary artery bypass graft surgery at Juntendo University Hospital between 1976 and 1991 and met the following additional criteria: at least one saphenous vein graft, repeat coronary arteriography at some point after coronary artery bypass graft surgery and a serum cholesterol level > or = 200 mg/dl before operation. Saphenous vein graft obstruction rates were compared among three groups classified by serum cholesterol levels at follow-up arteriography: group I < 200 mg/dl; group II 200 to 239 mg/dl; group III > or = 240 mg/dl. A vein graft was considered obstructed if it was narrowed by > or = 70%.

RESULTS

In group I, 88% of grafts were not obstructed 7 years after operation. The respective rates were 61% in group II and 57% in group III (p < 0.005). This relation was true for vein grafts to the left anterior descending and other coronary arteries.

CONCLUSIONS

Lower serum cholesterol levels are associated with lower rates of vein graft obstruction for up to 7 years. This suggests that cholesterol-lowering therapy may improve long-term saphenous vein graft survival after coronary artery bypass surgery.