Insecurity of the ECG interpretation data as a health mass screening--the serial reliability evaluation study

To evaluate the reliability of the interpretations of ECG data which have been stored yearly as health mass screening data between 1982 and 1991 in an industry, we recently analyzed the data variation of 10,546 samples. So as not to ignore the longitudinal health management, we are going to reevaluate the clinical significance of the ECG interpretation data, which were stored as an item of health mass screening.

[Support techniques in the surgical treatment of aneurysms of the aortic arch]

During the last 15 years, we operated 25 patients of aneurysm of the aortic arch. From 1977 to 1990, various support techniques combined with extracorporeal circulation and carotid bypass were used but from 1990 extracorporeal circulation with selective cerebral perfusion was employed, and so postoperative brain damage was decreased from 47% to 10% (p = 0.05) and operative mortality from 53% to 10% (p = 0.03). We now consider that extracorporeal circulation with selective cerebral perfusion is the best method for cerebral protection in the operation of aneurysms of the aortic arch.

[Coronary reoperation--report of 16 cases]

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients. The mean number of bypass grafts was 2.31 per patient in the first operation and 1.75 in the reoperation. The main reasons for the reoperation were an occlusion of the graft in 12 cases and both graft occlusion and new coronary artery disease in 3 cases. In one other case, an emergency right coronary bypass graft done for an acute occlusion during PTCA to an area of right coronary artery stenosis 13 months after two bypass graftings to the LAD and circumflex coronary artery. Fourteen cases had vein graft disease bypassed to the LAD or new coronary artery disease in the LAD and required reoperations of the LAD. In the case with a recurrence of myocardial ischemia after coronary bypass surgery and with bypass grafts to the LAD that were patent, there were no cases requiring reoperation. These findings demonstrate that patency of the grafts to the LAD is an important factor for reoperation after myocardial revascularization surgery.

Two-layer membrane model for iontophoretic drug transport through excised rat skin

Iontophoretic and passive transport of an ionized drug (sulfisoxazole) across excised rat skin was studied using a two-chamber cell with four electrodes under successive experimental conditions: without electrical current (stage-I) and with electrical current (stage-II). Two iontophoretic/diffusion models, i.e. a one-layer membrane model and a two-layer membrane model, in which a difference in the electrical potential gradient was taken into account between the stratum corneum and epidermis/dermis layer, were constructed to describe the non-steady-state drug permeation process during ionotrophoresis. The observed iontophoretic lag-time was two times greater than the calculated value based on the one-layer membrane model. According to the two-layer membrane model, the calculated ionotophoretic lag-time agreed with the observed value. It was revealed by model adaptation to the observed data that the stratum corneum fraction of the electro-chemical potential difference across the whole skin caused by the iontophoresis was around 90%. This result was consistent with the observation that the direct current resistance of whole skin was seven times greater than that of stripped skin.

Aplastic anemia and idiopathic thrombocytopenic purpura with antibody to platelet glycoprotein IIb/IIIa following resection of malignant thymoma

A case of a 64-year-old Japanese woman who developed aplastic anemia and idiopathic thrombocytopenic purpura with antibody to platelet glycoprotein IIb/IIIa 4 years following a resection of malignant thymoma is reported. Bone marrow was hypocellular and ferrokinetics revealed the prolongation of the half-time of plasma iron disappearance and a decrease in red cell utilization, findings compatible with a diagnosis of aplastic anemia. The life span of platelets was markedly decreased to 3.07 h, and the test for antiplatelet glycoprotein IIb/IIIa antibody was positive. The patient's serum had a suppressive effect on the formation of colonies of burst-forming unit-erythroid and colony-forming unit-granulocyte using normal bone marrow cells. These results suggest that the aplastic anemia in this patient may have been induced by some suppressive activity in the serum. Splenectomy followed by an administration of cyclosporine effectively restored the peripheral blood count.

[Choice of conduit in coronary bypass surgery]

Since 1987, arterial conduits have been used in 78 of 130 cases receiving coronary bypass surgery, including 25 treated by arterial conduits alone. The use of arterial conduits was mainly indicated to the anterior descending coronary artery (LAD), but the saphenous vein had to be used in 39 percent, 47 of 120 cases receiving bypass grafting to the LAD for various reasons including a combination of multiple obstructive arteriosclerosis, multiple bypass graftings in the aged, unstable angina, emergency operation and no suitable artery for a conduit as indicated by preoperative angiography. Hereafter, arterial conduits for coronary bypass grafting to LAD should be used in many more cases to the best possible advantage.

[A fifty two-week oral repeated dose toxicity study of suplatast tosilate (IPD-1151T) in dogs]

A 52-week oral repeated dose toxicity study of suplatast tosilate (IPD-1151T), a newly developed anti-allergic agent, was carried out in beagles by oral administration of 30, 90, 270 and 810 mg/kg/day for 52 weeks. The recovery study was carried out by the withdrawal for 5 weeks using control and the 810 mg/kg groups. The results are as follows: 1. Observation of general conditions revealed soft feces, mucous feces, and diarrhea in both sexes of the 270 and 810 mg/kg groups during the administration period, and these findings disappeared during the withdrawal period. One female of the 810 mg/kg group exhibited tremors in the legs and neck, staggering, a decrease of spontaneous motor activity, and clonic convulsions in Week 17 of administration and died on Day 118. One male of the same group exhibited whole body tremors and staggering from Week 32 to Week 52. 2. Body weight gain tended to be inhibited in males of the 810 mg/kg group during the administration period. The body weight of the female that died decreased rapidly after the appearance of neurological symptoms. The body weight of the male that exhibited neurological symptoms decreased after their appearance but later increased. 3. There were no abnormal changes in food consumption in all of the sacrificed dogs. The female that died did not eat at all after the appearance of neurological symptoms. The male that exhibited neurological symptoms did not eat at all for 1 week after their appearance, but the food consumption returned to normal thereafter. 4. Prothrombin times were prolonged in males of the 270 and 810 mg/kg groups at Week 26, and activated partial thromboplastin times were prolonged in males of the 810 mg/kg group at Week 52. 5. Plasma levels of alkaline phosphatase, GPT and LDH were elevated in some males and females of the 810 mg/kg groups. 6. No abnormalities due to IPD-1151T administration were found in urinalysis, opthalmological examination, electrocardiography, and fecal occult blood examination, or organ weights. 7. Autopsies including histopathological and electron microscopic examinations on the sacrificed dogs revealed no abnormalities. Subserosal hemorrhage in the base of the heart, congestion in the lungs, congestion and vacuolation in the liver and slight cell infiltration around vessels of the brain were found in the female that died.(ABSTRACT TRUNCATED AT 400 WORDS)

[Four cases of aortic valve replacement in aortitis syndrome]

Four surgically treated cases of aortic valve regurgitation associated with the aortitis syndrome were reported. All patients were female and ranged in age from 38 to 51 years. In two cases, obstructive lesions of the aortic arch branch were seen in aortograms. Three patients had no inflammatory findings at the operation and one was operated on after improvement of inflammatory findings by steroid therapy. Aortic regurgitation was caused by annuloaortic ectasia, and aortic valve replacement was performed by the everting mattress suture method in all cases. One patient with stenosis of the left carotid artery, occlusion of the left subclavian artery, and hypertension died of extended cerebral damage due to suspected low flow cerebral perfusion during cardiopulmonary bypass. The other three patients are doing well 4 months to 11 years after surgery without paravalvular leakage. In cardiac surgery for the aortitis syndrome with an obstructive lesion of the aortic arch branch, deep hypothermic and high flow cardiopulmonary perfusion is required to prevent ischemic brain complications during surgery.

Hypothermia enhances contractile responses of the guinea pig taenia caeci to acetylcholine, 5-hydroxytryptamine, caffeine and calcium

Isometric contraction of isolated guinea-pig taenia caeci was induced with acetylcholine (ACh) and 5-hydroxytryptamine (5-HT) at 37 and 30 degrees C to investigate the effect of hypothermia on the response of smooth muscle to neurotransmitters. Lowering the temperature increased the amplitude of contraction in response to 10(-6) M ACh. Contraction in response to 10(-6) M 5-HT was also greater at 30 degrees C. 5-HT-contraction was not inhibited by atropine, but was inhibited by ketanserin. Calcium-contraction was also induced in an isosmotic high potassium solution. The amplitude of the contraction elicited by 5 x 10(-3) M Ca was significantly greater at 30 degrees C, and was inhibited by verapamil. The amplitude of the contractile response to 5 x 10(-3) M caffeine was also greater at 30 degrees C than at 37 degrees C. The finding that both calcium- and caffeine-contraction were enhanced at low temperature raises the possibility that intracellular calcium participate in cold-induced enhancement of contraction.

[Coronary artery bypass surgery in dialysis patient]

In patients with chronic renal failure undergoing hemodialysis for a long period, arteriosclerosis progresses rapidly, and the incidence of ischemic heart diseases is high. We performed coronary artery revascularization in a patient with chronic renal failure complicated by angina pectoris in whom discontinuation of dialysis was sometimes needed for hypotension during dialysis. Her postoperative course was uneventful. Problems in intra and postoperative management of dialysis patients are reported.

[Replacement of the ascending aorta and aortic valve with a composite graft using a reversed St. Jude medical mitral valve prosthesis]

Between 1981 and 1989, ten patients underwent replacement of the ascending aorta and aortic valve by a composite graft for an aneurysm of the ascending aorta with aortic regurgitation. The first two cases using an SJM aortic valve prosthesis and Teflon felt-pledgeted mattress sutures for the proximal anastomoses required a coronary bypass graft from the tube graft to the anterior descending coronary artery because of difficulty in completing the graft-left coronary ostial anastomoses. In the subsequent seven cases, an SJM mitral valve prosthesis with a large, soft cuff for a valved conduit was sewn in reverse and a thin wall Teflon roll was used for the Teflon felt of the pledgeted mattress suture in the proximal anastomoses. As a result, anastomoses between the tube graft and coronary ostia were performed easily and successfully in eight patients. One case with Marfan syndrome required reoperation nine years after the first operation for recurrence of the aneurysm of the aortic arch. Thus, the need for careful and continued follow-up is important in the Marfan syndrome.

Interactions between steroid hormones and insulin-like growth factor-I in rabbit chondrocytes

The mechanism of action of steroid hormones on skeletal growth is not understood in detail. We examined the interactions of steroid hormones and insulin-like growth factor-I (IGF-I) during DNA and sulfated proteoglycan synthesis in rabbit costal chondrocytes. Progesterone at 0.05 nM stimulated the incorporation of [3H]thymidine into DNA by 30% above the control level in confluent cultures, but neither testosterone nor 17 beta-estradiol stimulated DNA synthesis. None of the hormones affected [3H]thymidine incorporation stimulated by IGF-I when chondrocytes were incubated with one of the hormones and IGF-I simultaneously. In contrast, when confluent cultures were incubated with one of the sex steroids for 24 h before the addition of IGF-I, stimulation of DNA synthesis by the growth factor was enhanced about 45% above the control value by 0.5 nM progesterone, 50% by 0.5 nM testosterone, and 80% by 50 nM 17 beta-estradiol. The effects of IGF-I on proteoglycan synthesis, as judged by the incorporation of [35S]sulfate, were stimulated by treatment with progesterone or testosterone. Dexamethasone at physiological concentrations inhibited chondrocyte DNA synthesis in confluent cultures to 10% of the control level. At 50 nM, dexamethasone suppressed IGF-I induction of DNA synthesis by 60%. This suppression was greater when dexamethasone was added before IGF-I than when the additions were simultaneous. When chondrocytes were treated with hydrocortisone or dexamethasone for 24 h before the addition of IGF-I, the glucocorticoids synergistically accelerated proteoglycan synthesis mediated by IGF-I. These findings suggest that steroid hormones have priming effects on the biological action of IGF-I in cartilage metabolism.

[A case of acute pericarditis secondary to mediastinitis]

A 45-year-old man who complained of swallowing disturbance and chest pain in inspiration phase was admitted for evaluation of "pericarditis". A chest X-ray film on admission disclosed a wide mediastinal shadow and pleural effusion on the right side. Bilateral tonsils were swollen, and covered with pus. A Computed tomogram of the chest showed a shadow of exudate contained with air in the mediastinum. Mediastinal drainage, tonsillectomy and drainage of fistula from pre-tracheal space to upper mediastinum were immediately performed. Staphylococcus aureus was confirmed from the sputum and mediastinal effusion. Thus, acute mediastinitis was confirmed as an etiological diagnosis of "pericarditis" in this patient.

Transfer of diclofenac sodium across excised guinea pig skin on high-frequency pulse iontophoresis. I. Equivalent circuit model

High frequency pulse iontophoresis of diclofenac sodium across excised guinea-pig skin was carried out in vitro. An equivalent circuit model was constructed to simulate the time courses of voltage drop across the donor solution and the skin. Parameter values obtained by the least-squares adaptation of the model to observed data were consistent with expectation and validated the proposed model.

Transfer of diclofenac sodium across excised guinea pig skin on high-frequency pulse iontophoresis. II. Factors affecting steady-state transport rate

Some of the factors affecting the steady-state transport rate of diclofenac sodium across excised guinea-pig skin during high-frequency pulse iontophoresis were examined. The same mathematical expression was employed for enhancement ratio as a function of applied voltage as the one derived for direct-current iontophoresis. The effective voltage drop across the skin was only 1.1% of the applied voltage. The steady-state flux value increased with increase of the donor concentration.

Activities of newly synthesized dihydropyridines in overcoming of vincristine resistance, calcium antagonism, and inhibition of photoaffinity labeling of P-glycoprotein in rodents

Newly synthesized 1,4-dihydropyridine derivatives (NK-compounds) were screened to determine whether they could overcome vincristine (VCR) resistance in VCR-resistant (P388/VCR) leukemia-bearing mice. Among the 57 NK-compounds examined, six compounds had strong reversing ability (Grade A), 18 partially overcame the resistance (Grade B), and 33 did not reverse the resistance (Grade C). The ability to overcome resistance varied considerably with the nature of substituents at positions 3.5 of the 1,4-dihydropyridine, and the most suitable substituents were the pyridylalkyl-including esters. Calcium antagonistic activity of NK-compounds having pyridylalkyl-including esters at positions 3.5 and dithiene ring at position 4 of the 1,4-dihydropyridine was greater than in those compounds having the dioxene ring at position 4. NK-242, which was assessed at Grade A and had no calcium antagonistic activity, improved therapeutic effects in both VCR-sensitive (P388/S) leukemia- and P388/VCR leukemia-bearing mice when combined with VCR. Fourteen NK-compounds were screened to determine whether they could inhibit photoaffinity labeling of the P-glycoprotein (Mr 170,000 glycoprotein) in a multidrug-resistant cell line by [3H]azidopine. All six compounds of Grade A and two of the three compounds of Grade B almost completely inhibited the labeling of Mr 170,000 glycoprotein at 1 to 10 microM. Thus there was a good correlation between the ability to reverse VCR resistance in vivo and the inhibition of photoaffinity labeling of Mr 170,000 glycoprotein.

[Enhanced percutaneous absorption of formoterol furmarate via pulsed iontophoresis. I. Effect of constant current and constant voltage]

The effect of iontophoresis on percutaneous absorption of formoterol fumarate (FF) was investigated in vitro with abdominal skin excised from guinea pig. By passive diffusion, the flux at steady state for stripped skin was about 230 times greater than that for intact skin. Therefore, it is suggested that stratum corneum is a barrier for the percutaneous absorption of FF. Penetrated amount of FF increased significantly with an increase in donor concentration from 0.035% to 0.07%. Under the constant current iontophoresis the large flux accompanied with the high applied voltage was shown at the beginning of iontophoresis. Thereafter the flux decreased with a decrease in applied voltage. Under the constant voltage iontophoresis a linear relationship between penetrated amount of FF and time was observed.

[Enhanced percutaneous absorption of formoterol fumarate via pulsed iontophoresis. II. Effect of polarity, pulse frequency and duty]

To clarify the effect of polarity, pulse frequency and duty on the iontophoretic transport of formoterol fumarate (FF), in vitro and in vivo studies were performed with guinea pigs. In the in vitro studies, the flux at steady state was enhanced by the factor 7.61 with anodal iontophoresis in comparison with control, whereas, with cathodal iontophoresis it was restrained by the factor 0.79. When pulse frequency was varied from 0 to 40 kHz, the flux at steady state was enhanced with an increase in pulse frequency. In the in vivo studies with varying the duty of pulse potential from 10 to 100%, the maximum plasma concentration of FF was obtained at a 30% duty. In contrast, the plasma concentration of FF achieved at 100% duty was not high. With stripped skin, no significant difference in the plasma concentration of FF was shown between iontophoresis and control. Consequently, it is suggested that iontophoresis contributes to FF penetration across stratum corneum.

Factors affecting sulfisoxazole transport through excised rat skin during iontophoresis

Permeation of sulfisoxazole (SIX) across the excised rat skin were studied using two chamber cell with four electrodes, under three successive experimental conditions: without current for 3 h (treatment I), with current for 4 h (treatment II) and without current for 3 h (treatment III). Transport of SIX was significantly increased by iontophoresis. The enhancement ratio of SIX flux were reasonably predicted by Goldman's equation. There was no significant difference (p less than 0.05) between the flux in treatment I and treatment III. On the basis of the flux reversibility, it was concluded that skin alteration did not occur when the applied electric potential was below 5.025 V. Although a prominent current-induced volume flow (from the anodal side to the cathodal side) was observed during current exposure, SIX flux was not influenced by the volume flow. The flux enhancement of SIX was mainly dependent on transdermal potential difference.

[Two cases of miliary tuberculosis following prosthetic valve replacement]

Pyrexia which occurs at late stage after prosthetic heart valve replacement must be suspected to be caused by prosthetic valve endocarditis (PVE). However, since confirmatory diagnosis is difficult, we are concerned about the treatment for so many cases. We encountered two cases who were suspected PVE at late stage after prosthetic aortic valve replacement and diagnosed miliary tuberculosis at autopsy. Here, we present a report of the two cases.

Trends for coronary heart disease and stroke and their risk factors in Japan

Disease surveillance and population surveys of risk characteristics in a northeast rural community of Japan (1965 census population, 7,030) are combined in an attempt to relate morbidity and risk factor trends for coronary heart disease and stroke during the last 2 decades. Between 1964 and 1983, the incidence of coronary heart disease (i.e., combined myocardial infarction, angina pectoris, and sudden death) did not change significantly among men and women ages 40-69, and was lower than that for stroke. The incidence of all stroke declined about 60% for both men and women, ages 40-69, with a significant decrease in cerebral hemorrhage for both sexes and in cerebral infarction for men. Between 1963-1966 and 1980-1983, significant upward shifts occurred in the means and distributions of serum total cholesterol and serum total protein in every age and sex group, primarily during the 1st decade. Age-adjusted mean cholesterol levels rose 22 mg/dl to the 1980-1983 mean of 179 mg/dl in men ages 40-69. In women ages 40-69, the mean rose 29 mg/dl to 192 mg/dl. Among nutrients, animal fat intake doubled in men ages 40-59 from 4.5% of daily calories in 1969 to 9.6% in 1980-1983. Animal protein intake also increased, from 5.8% to 7.1%. Most of this increase occurred between 1969 and 1972-1975 and may be attributable to an increased intake of meat, eggs and dairy products. From 1963-1966 to 1980-1983, mean relative weight index rose significantly for all age-sex groups except men ages 50-69. Mean systolic and diastolic blood pressure levels declined for every age-sex group, with a 15-mm Hg age-adjusted decrease in systolic, 4-mm Hg decrease in diastolic pressure among men ages 40-69, and a 11-mm Hg systolic and 4-mm Hg diastolic decrease for women. Two cohorts of men and women ages 40-69 at baseline were followed for disease incidence: an early cohort (2,257 persons) followed from 1963-1966 to 1973 and a later cohort (2,711 persons) followed from 1972-1975 to 1983. In these cohorts, significant risk prediction for cerebral hemorrhage and infarction was obtained with blood pressure level and end organ effects in the electrocardiogram and fundus photographs. Serum cholesterol was inversely associated with cerebral hemorrhage in the early cohort but not in the later.(ABSTRACT TRUNCATED AT 400 WORDS)

[Present status of aortitis syndrome surgery in Japan]

It is well known in patients with aortitis syndrome that the clinical features and prognosis vary with location, spread, and degree of the lesion in the affected artery. Therefore, both an indication for surgery and suitable surgical procedures are very manifold in each case. The indication of surgical management for aortitis syndrome is mainly to prevent the cerebral ischemia, cardiac failure and for aneurysm. We reviewed the current status of surgical treatment for aortitis syndrome on the cases reported in Japan and some cases surgically treated in our institute.