Prognosis following acute myocardial infarction in patients with ECG evidence of left ventricular hypertrophy prior to infarction

This study was designed to determine the relationship between prognosis after myocardial infarction (MI) and left ventricular hypertrophy (LVH). Left ventricular hypertrophy diagnosed by electrocardiography according to the criteria of Sokolow and Lyon was noted in 57 of 223 patients (25.6%) on the pre-MI electrocardiogram (ECG), in 11.2% on an early post-MI ECG, and in 11.3% on the discharge ECG. In-hospital and 1-year postdischarge mortalities were significantly greater in patients with LVH noted on pre-MI ECG than in patients without prior LVH. There was no relationship between the presence of LVH on early post-MI ECGs and in-hospital or postdischarge 1-year mortality. Multivariate analysis revealed that evidence of LVH on a pre-MI ECG and acute congestive heart failure were independent predictors of cardiac death within 1 year of MI in patients over 70 years old. It is concluded that in patients over 70 years of age, the presence of LVH on a pre-MI ECG is a reliable predictor of post-MI prognosis.

Catechol-O-methyltransferase genotype and susceptibility to Parkinson's disease in Japan. Short communication

We report -108Met/Val polymorphism of the COMT gene in Japanese patients with Parkinson's disease (PD). The allele frequency for -108Val was higher in PD patients compared with controls, although the differences did not reach the statistical significance. However, the frequency of -108Val homozygotes was significantly higher in PD patients (56.8%) than in control subjects (44.2%), and heterozygotes of -108Met/Val were less in PD. COMT gene polymorphism may constitute a genetic risk factor for PD among Japanese.

[Acute transverse myelitis presenting with syrinx formation associated with anti-sulfated glucuronyl lactosaminyl paragloboside antibody and anticardiolipin antibody]

A 37-year-old woman was admitted because of rapidly progressive unsteady gait, back pain and ascending dysesthesia below the lower chest level. On admission, she showed ataxic gait, positive Romberg's sign, severely impaired deep sensation of lower extremities, and vesico-rectal disturbance. Deep tendon reflexes in both lower extremities were brisk, while normal in the upper extremities. Babinski's sign was positive on both sides. On laboratory data, antinuclear antibody, immune complex and the low titer of IgG anticardiolipin antibody as well as IgM anti-sulfated glucuronyl lactosaminyl paragloboside (SGLPG) antibody were positive in her serum. Cerebrospinal fluid showed pleocytosis and increased protein level, but no oligoclonal IgG bands. The posterior tibial nerve SEP showed no P39 peak with normal latency of N20. Spinal MRI revealed mild cord swelling and syrinx formation at T7 to T9 level. Steroid therapy including pulse therapy with methylprednisolone was effective. The present case was diagnosed as acute transverse myelitis (ATM) similar to lupoid sclerosis, and to the best of knowledge, the first case of ATM with anti-SGLPG antibody. It is speculated that the autoimmune mechanism with anti-SGLPG antibody and anticardiolipin antibody by reacting with the endothelial cells in the central nervous system might contribute to causing ATM in our case.

Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction

The clinical significance of the time of onset of atrial fibrillation (AF) was investigated in patients with acute myocardial infarction (AMI). Among 1,039 patients with AMI, 100 (9.6%) had AF. These patients were divided into 3 groups: AF group 1 (n = 45), who developed AF within 24 hours of the onset of AMI; AF group 2 (n = 41), who developed AF >24 hours after the onset of AMI; and AF group 3 (n = 14), who developed AF before the onset of AMI. The infarct-related lesion was most frequent (67%) in the proximal right coronary artery in AF group 1 (p <0.01). Right atrial pressure was most significantly increased in AF group 1. The left atrial dimension and pulmonary arterial wedge pressure were most significantly increased, and left ventricular ejection fraction was most significantly decreased in AF group 2. In the acute phase, the frequencies of heart failure, cardiogenic shock, and in-hospital mortality were higher for all 3 AF groups than the sinus group (p <0.01). The long-term survival rate was significantly lower in AF group 1 and AF group 2 than in the sinus group. AF was an independent predictor of cardiac death in both AF group 1 (odds ratio 2.5; 95% confidence interval 1.2 to 5.0; p = 0.0012) and AF group 2 (odds ratio 3.7; 95% confidence interval 1.8 to 7.5; p = 0.0005), but not in AF group 3. The onset time of AF appears to be a useful parameter for evaluating the cardiac status and prognosis of patients with AMI.

A 192Arg variant of the human paraoxonase (HUMPONA) gene polymorphism is associated with an increased risk for coronary artery disease in the Japanese

Recent reports have suggested that polymorphisms in the human paraoxonase (HUMPONA) gene may be a genetic risk factor for coronary artery disease (CAD) in white populations. However, this association has not yet been confirmed in other ethnic populations. We studied 75 Japanese patients with CAD, whose coronary lesions were confirmed by angiography, and 115 Japanese control subjects with no history of CAD and a normal resting electrocardiogram. The assays for genotyping the two polymorphisms in the HUMPONA gene (192Arg/Gln and 55Leu/Met) were based on changes in restriction enzyme digestion patterns. For codon 192, the frequencies of the Arg-coding allele (B allele) in both patients and control subjects were much higher than those from published results of whites (.26 to .31), and the difference between patients (.74) and control subjects (.59) was statistically significant (P = .002). The patient group had a higher proportion of Arg/Arg (B/B) homozygotes (52.0% vs 32.2%, P = .006). For codon 55, the frequencies of the Leu-coding allele in control subjects and patients were much higher (.91 and .93, respectively) than those published results for whites, but there was no difference between Japanese control subjects and Japanese patients. When subjects with the 55Leu/Leu genotype only were analyzed, 192Arg/Arg homozygotes were still significantly more frequent in the patients than in the control subjects (55.4% vs 37.2%, P = .024), and the frequency of the 192Arg allele was also higher in patients than control subjects (P = .013). Logistic regression analysis including conventional coronary risk factors revealed that 192Arg is an independent risk factor for CAD. Thus, in the Japanese, the association of CAD with the 192Arg variant of HUMPONA (B-type enzyme) is similar to that reported for whites, although the allele frequencies for 192Arg and 55Leu are much higher in the former than the latter population.

[Therapeutic strategy and clinical outcome in congenital diaphragmatic hernia]

Congenital diaphragmatic hernia (CDH) continues to carry a high mortality rate 40%-60% mainly due to severe pulmonary hypoplasia. At our institute, thirty-seven neonates were treated for CDH diagnosed within the first 24 hours of life. Eleven of thirty-seven patients died and the mortality rate was 30%. Deaths in ten patients were due to severe pulmonary hypoplasia. The other one patient died from barotrauma at three months of age. All twenty-six patients who responded to ventilatory management and pharmacological therapies underwent surgical repair of CDH and all except one survived. Eight of eleven patients who did not respond to treatment also underwent surgery, but all died. These cases were all treated fufore ECMO introduction. Two of the other three in whom ECMO support was instituted died postoperatively. Among the parameters PH < 7, PaO2 < 60, PaCO2 > 60, AaDO2 > or = 600 and OI > or = 40 recorded on admission and examined retrospectively, OI > or = 40 was the most reliable as a predictor for poor outcome (sensitivity: 100%, specificity: 81%) and probably entry criteria for ECMO. The mean lung/body weight ratio of nonsurviving neonatal cases was as low as 0.49 +/- 0.18% while at least 1% is the critical value for survival. To salvage the CDH patient with severe pulmonary hypoplasia, surgical intervention before birth is inevitably necessary based on accurate prenatal diagnosis and established surgical techniques.

Coronary artery disease and polymorphisms in a receptor mediating shear stress-dependent platelet activation

BACKGROUND

Platelets play pivotal roles in coronary thrombosis, and antiplatelet therapies are widely used for coronary artery disease (CAD). However, the effects of genetic variation in platelets on CAD are poorly understood. We have assessed the association between CAD and polymorphisms in a platelet receptor for von Willebrand factor, the glycoprotein (GP) Ib/IX complex, which mediates shear stress-dependent platelet activation.

METHODS AND RESULTS

Genotypes of the alpha-chain of the receptor (GP Ib alpha, 145Thr/Met) were determined in 91 patients with myocardial infarction (MI) or angina pectoris whose lesions were confirmed by coronary angiography as well as in 105 individuals from the general population with no history of angina or other heart diseases and normal resting ECGs. There was no homozygote for Met/Met in either the control or patient groups. The prevalence of the Thr/Met genotype (T/M) in all patients was not significantly different from that in the control group. However, the frequency of T/M was significantly higher in patients aged < or = 60 years (31.8%) than in control subjects aged < or = 60 years (16.0%; P<.05, odds ratio=2.5). An association was also demonstrated between CAD and the other polymorphism of GP Ib alpha, a variable number of tandem repeats of a 13-amino acid sequence, which is known to be linked to the 145Thr/Met polymorphism. There was an association between the frequency of the T/M genotype and the angiographic severity of CAD: 11.1% for Gensini score < 40 versus 50.0% for Gensini score > or = 40 (P=.0015). There was no difference in the distribution of GP Ib alpha genotypes between patients with MI and those with angina pectoris.

CONCLUSIONS

This study suggests that the presence of the Met allele in GP Ib alpha is a risk factor for the prevalence and severity of CAD in individuals aged < or = 60 years. The results need to be confirmed in a large-scale study of incident case subjects and matching control subjects.

Accuracy of treadmill exercise electrocardiography in detecting restenosis following single-vessel percutaneous transluminal coronary angioplasty

To develop an improved method for diagnosing restenosis using treadmill exercise electrocardiography (ECG) following percutaneous transluminal coronary angioplasty (PTCA), we prospectively evaluated 46 patients who underwent PTCA for the treatment of single-vessel coronary artery disease and who did not have a history of myocardial infarction. Treadmill exercise ECG and coronary angiography were performed 3 months after PTCA to determine their accuracy in diagnosing restenosis based on standard ST-segment depression criteria, the difference between the maximum ST-segment depression before and 3 months after PTCA (< or =0.5 mm: positive; >0.5 mm: negative), and the difference between sigmaST-segment depression before PTCA and 3 months after PTCA (< or = 1.5 mm: positive; > 1.5 mm: negative). The sensitivity, specificity, and diagnostic accuracy of standard ST-segment depression criteria were 65%, 66%, and 65%, respectively. The sensitivity, specificity, and accuracy for the difference in maximum ST-segment depression were 77%, 76%, and 76%, respectively, whereas the values for the difference in sigmaST-segment depression were 77%, 83%, and 80%, respectively. Based on these results, we conclude that using the difference between ST-segment depression before and after PTCA improves the accuracy of treadmill exercise ECG for diagnosing restenosis.

Genotype distribution of estrogen receptor polymorphisms in men and postmenopausal women from healthy and coronary populations and its relation to serum lipid levels

The cardiovascular protective effects of estrogen are known to be mediated by its beneficial effects on lipid metabolism and its direct actions on the vessel wall. The latter can be mediated by a specific receptor for estrogen present on smooth muscle cells and endothelial cells. The gene for the receptor (the classic estrogen receptor [ER]) has three known polymorphisms, Pvu II, Xba I, and B-variant polymorphisms, which are reportedly associated with receptor expression and altered receptor function and with some disorders including breast cancer, hypertension, and spontaneous abortion. However, the significance of genetic variations of the ER in vascular diseases has not been reported. We have examined the association between coronary artery disease (CAD) and the three polymorphisms in ER. Genotypes (P1/P2, X1/X2, and B-wild type/B-variant type) were determined in 87 men and postmenopausal women with myocardial infarction or angina pectoris whose lesions were confirmed by coronary angiography, as well as from 94 control individuals from the general population with no coronary heart disease and normal resting ECG. For B-variant polymorphism, all individuals examined had B-wild type, which contrasts with the reported allele frequency for B-variant type (0.1) in the white population. Genotype distributions and allele frequencies of Pvu II or Xba I polymorphisms were not significantly different between control subjects and patients (P > .05 for Pvu II or Xba I genotypes; P > .05 for Pvu II or Xba I allele frequencies). When the allele frequencies were analyzed separately by sex, there was still no statistically significant difference for both polymorphisms (P > .05 for men; P > .05 for women). No association was found between the polymorphisms and the angiographic severity of CAD. Total cholesterol, triglyceride, or HDL-cholesterol levels were not significantly different among ER genotypes. These findings suggest that the three polymorphisms in ER are not associated with the prevalence and severity of CAD and that the polymorphisms are unrelated to the serum lipid levels in control subjects and patients.

Postischemic accumulation of lipid peroxidation products in the rat brain: immunohistochemical detection of 4-hydroxy-2-nonenal modified proteins

We report an immunohistochemical study on the distribution and alterations of 4-hydroxy-2-nonenal (HNE)-modified proteins, an indicator of lipid peroxidation, in the rat brain after 3 h of middle cerebral artery (MCA) occlusion followed by reperfusion. HNE immunoreactivity was not observed in intact neurons, but it appeared in some shrunken neurons within the infarcted zone at 3 h after reperfusion. The number of HNE-positive neurons increased with the spread of the infarcted area. The pyramidal neurons in the third layer of the frontoparietal cortex were HNE-positive and the intensity of their HNE immunoreactivity was highest at 24 h after reperfusion. At 48 h, HNE-positive neurons were observed in the medial part of the striatum, the lateral side of the frontoparietal cortex, and at the boundary between the infarcted and noninfarcted zones. In addition, strong HNE immunoreactivity was seen in microglia (identified by OX-42 immunostaining). This method seems to be useful to follow the progress of lipid peroxidation at the cellular level after ischemic injury.

Directed proximal magnetic resonance coronary angiography compared with conventional contrast coronary angiography

Magnetic resonance coronary angiography in 36 patients with proximal 1-vessel disease within 1 week of contrast coronary angiography was performed and the time required to complete the study was 13.4 +/- 4.2 min 13.2 +/- 8.1 minutes for the right and left coronary arteries, respectively. The sensitivity, specificity, positive and negative predictive values, and accuracy of magnetic resonance coronary angiography were 100% for right cronary artery disease, and 83%, 98%, 94%, 94%, and 94%, respectively, for left coronary artery disease.

The effect of arginine supplementation on growth hormone release and intestinal mucosal growth after massive small bowel resection in growing rats

Four-week-old male Sprague-Dawley rats underwent a 90% small bowel resection. From the fourth day after surgery, they were divided into group 1 and 2, and pair-fed by elemental diets (0.8 kcal/mL, 50 mL/day) with L-arginine (n = 10) or L-glycine (n = 11) as an isonitrogenous and isoenergetic supplement for 3 weeks. They were compared with each other 3 weeks after surgery. A statistical analysis was performed using the unpaired Student's t test and the one-way factorial analysis of variance (ANOVA) using Bonferroni/Dunn multiple comparison test. A Pvalue of < .05 was considered significant. There were no significant differences between the two groups in food intake, body weight, tail length, residual ileal length, and plasma IGF-I level. However, the mean height of ileal villi in group 1 showed higher than that in group 2 (P < .01). Growth hormone-releasing hormone (GHRH) provocative tests (1 microg per rat, intravenously) showed the more significant elevation of growth hormone IGH) secretion in the arginine supplement group than that of glycine supplement group at 5 minutes (P < .05). There were no significant differences between basal levels of plasma rat GH in both groups. It is suggested that arginine has a possible significant role of GH secretion and intestinal mucosal growth after massive small bowel resection.

Mechanism of action of E7010, an orally active sulfonamide antitumor agent: inhibition of mitosis by binding to the colchicine site of tubulin

E7010 (N-[2-[(4-hydroxyphenyl)amino]-3-pyridinyl]-4-methoxybenzenesulfonami de), an orally active sulfonamide antitumor agent that is currently in a Phase I clinical trial, showed rather consistent growth-inhibitory activities against a panel of 26 human tumor cell lines (IC50 = 0.06-0.8 microg/ml), in contrast to vincristine (VCR; IC50 = 0.0002-0.04 microg/ml), 5-fluorouracil (IC50 = 0.2-30 microg/ml), Adriamycin (IC50 = 0.002-0.7 microg/ml), mitomycin C (IC50 = 0.007-3 microg/ml), 1-beta-D-arabinofuranoxylcytosine (IC50 = 0.005 to >30 microg/ml), camptothecin (IC50 = 0.002-0.4 microg/ml), and cisplatin (IC50 = 0.5-20 microg/ml). It caused a dose-dependent increase in the percentage of mitotic cells in parallel with a decrease in cell proliferation, like VCR. It also showed a dose-dependent inhibition of tubulin polymerization, which correlated well with the cell growth-inhibitory activity. 14C-labeled E7010 bound to purified tubulin, and this binding was inhibited by colchicine but not by VCR. However, its binding properties were different from those of colchicine, as well as those of VCR. E7010 was active against two kinds of VCR-resistant P388 cell lines, one of which showed multidrug resistance due to the overexpression of P-glycoprotein (resistant to Taxol), and the other did not show multidrug resistance (sensitive to Taxol). Furthermore, four E7010-resistant P388 cell lines showed no cross-resistance to VCR, a different pattern of resistance to podophyllotoxin, and collateral sensitivity to Taxol. Therefore, E7010 is a novel tubulin-binding agent that has a wider antitumor spectrum than VCR and has different properties from those of VCR or Taxol.

Glycosyltransferase activities in cultured endothelial cells of bovine brain microvascular origin

Bovine brain microvascular endothelial cells (BMECs) express GM3 (NeuAc) and GM3 (NeuGc) as the major gangliosides, and GM1, GD1a, GD1b, GT1b as well as sialosylparagloboside and sialosyllactosaminylparagloboside as the minor species. To investigate the metabolic basis of this ganglioside pattern, the activities of eight glycosyltransferases (GM3-, GD1a-, GD3-, LM1-, GM2 (NeuAc)-, GM2 (NeuGc)-, LacCer-, and GM1-synthases) in cultured BMECs were studied. It was found that BMECs possessed high activities of GM3- and GD1a-synthases, and low activities of GM2-, GM1-, and GD3-synthases. Thus, the present study provides evidence that endothelial cells are capable of synthesizing gangliosides in situ and that the high content of GM3 in BMEC is closely associated with high activities of GM3-synthase and low activities of GM2-, GM1-, and GD3-synthases.

Cellular immuno-competence of infected root canal contents in pathogenesis of periapical lesions

The soluble fractions of infected root canal contents (IRCC) were collected from about 300 human extracted teeth and examined for the presence of mononuclear cell (MNC) chemotaxis and cellular immunocompetence. IRCC showed remarkable chemotactic activity for polymorphonuclear leukocytes but a weak activity for MNC. However, generation of intrinsic MNC chemotaxis and induction of cellular immunity were confirmed in rats given repeated injections of IRCC.

[A case of Guillain-Barré syndrome with bulbar palsy and a high titer of anti-GT1a antibody]

We report a rare case of Guillain-Barré syndrome (GBS) in a patient with anti-GT1a antibody. A 42-year-old man was admitted with dysphagia, dysarthria and weakness in his neck and both upper limbs. Serial electrophysiological studies suggested that the predominant process was demyelination of the motor nerves. Thin-layer chromatography with immunostaining revealed that his serum IgG reacted strongly with GT1a and weakly with GQ1b. He recovered rapidly with plasmapheresis. These findings suggest that anti-GT1a IgG antibody might play an important role in the pathogenesis of bulbar palsy in GBS.

[Axonal motor neuropathy associated with anti-SGPG antibody]

We report a case of axonal motor neuropathy associated with anti-sulfated glucuronic paragloboside (SGPG) antibody which has not been reported yet. A 49-year-old man was admitted with asymmetrical patchy weakness which started in his upper extremities. The deep tendon reflexes were absent in the upper extremities, but normal in the lower extremities. There was a slight decrease in the vibratory sensation in the distal portions of the lower extremities. The general laboratory tests including the protein level of the cerebrospinal fluid revealed no abnormalities. Motor conduction studies showed the low amplitudes of CMAP and no demonstrable conduction block in the limbs. Sensory conduction studies showed no abnormalities except for slightly decreased amplitude of SNAP in the limbs. Electromyography showed active denervation in the upper extremities. Serial electrophysiological studies suggested that the predominant process was axonal degeneration of the motor nerves. Thin-layer chromatography with immunostaining showed that his serum IgM reacted with SGPG. Treatment with cyclophosphamide and corticosteroids was unsuccessful. In this case, this anti-SGPG antibody may be involved in the pathogenesis of chronic axonal degeneration of the motor nerves.

Experience with treatment of three pairs of conjoined twins

Three pairs of female conjoined twins--a xiphoomphalopagus, a pygopagus, and a thoracopagus--were encountered during the past 10 years. Surgical separation was successful in the xiphopagus, and both twins survived. Separation was also successful in the pygopagus, but only one of the twins survived; the twin that died had sustained cerebral hemorrhage before the operation. Both of the twins in the thoracopagus died before surgery could be performed, due to sepsis and heart failure, 44 days after birth. Separation surgery of conjoined twins is often successful with a high survival rate of both twins unless vital organs such as the brain or the heart are fused. However, unlike other operations, separation surgery entails ethical considerations pertaining to matters such as the distribution of organs in addition to surgical considerations. Furthermore, separation of conjoined twins is certain to cause various degrees of anatomical as well as functional disorders associated with the surgical procedure, and provision for the postoperative care for these disorders is indispensable.

Cases of Sprague-Dawley rats which did not respond to an 'alarm substance' in the forced swimming test

The fact found by Abel and his group that rats produce an 'alarm substance' while swimming was examined by employing a single-subject approach. Sprague-Dawley rats were tested in the forced swimming test situation in fresh water and in water soiled by another rat. In Exp. 1, Sprague-Dawley rats from Japan SLC, Inc. were used. No evidence of responding to the 'alarm substance' was found. Then, further experiments were conducted employing methods similar to those of Abel and his group. In Exp. 2, Sprague-Dawley rats from Charles River, Japan, were used. In Exp. 3, the water depth and inner diameter in a cylinder used were the same as those used by Abel and his group, and the water was soiled more thoroughly. In Exp. 4, the level of water contamination was raised to four times that employed in Exps. 1 and 2. However, the series of experiments yielded no evidence of the 'alarm substance.' Breeder differences among subjects might explain the discrepancy in results.

Histometry and three-dimensional image reconstruction of the lung in congenital diaphragmatic hernia

A small lung capacity, hypoplasia of the airway system, and abnormalities of the pulmonary artery system have been demonstrated as pathologic characteristics of congenital diaphragmatic hernia, but opinions have differed on the degree of hypoplasia of the acinus and terminal airspace. In this study, acinar size, mean wall thickness of the terminal airspace, an surface area of the terminal airspace were histometrically evaluated in four clinical cases. In addition, the pulmonary artery system was investigated by computerized three dimensional image reconstruction. Hypoplasia of the lung acinus and terminal airspace was observed in all four cases, and hypoplasia was more marked as lung capacity decreased. Thickening of the walls of pulmonary arterioles was confirmed, and previously undescribed abnormal branching of the pulmonary artery was recorded.

Angiographic and coronary risk factor analyses of Japanese patients with ischemic heart disease before age 40--a multicenter cooperative study

Coronary angiographic and risk factor (RF) characteristics were analyzed in 133 Japanese patients with ischemic heart disease (IHD) who were less than 40 years old and who had undergone coronary angiography (CAG) during the past 10 years at six university hospitals in the Tokyo area. We compared the coronary angiographic characteristics of the subject group with those of 216 controls with coronary sclerosis detected by CAG who were more than 40 years old (older control group) and the RF characteristics with those of 133 sex- and age-matched volunteers (younger control group). Sixty seven percent of the subjects (89 cases) were diagnosed as having myocardial infarction (MI) and 33% (44 cases) had angina pectoris (AP). Coronary artery disorders in this group consisted of 103 (77%) cases of coronary sclerosis, 20 (15%) cases of coronary spasm and 10 (8%) cases of miscellaneous diseases, eg, possible vasculitis with connective tissue disease, congenital anomalies, etc. The incidences of significant (> or = 75%) sclerotic narrowing in 0 vessels (31%) and 1 vessel (49%) in the subject group were significantly (p < 0.01) higher than those in the older control group, while the incidence of multivessel disease was significantly (p < 0.05) less in the subject group than in the older control group. The incidences of the following coronary risk factors were significantly (p < 0.05) higher in the subjects than in the younger controls: smoking (83% vs 35%), hypercholesteremia (44% vs 10%), obesity (31% vs 9%), hypertension (29% vs 3%), familial IHD (28% vs 7%) and diabetes mellitus (19% vs 2%). Thus, zero- or single-vessel disease predominated in the younger subject group and the prevalence of coronary risk factors was significantly higher in the subject.