Clinical significance of exercise-induced ST changes in patients with prior myocardial infarction: comparison of electrocardiographic and angiographic findings

In order to investigate the clinical significance of exercise-induced ST changes in patients with prior myocardial infarction, we performed an exercise tolerance test using bicycle ergometer, coronary arteriography and left ventriculography in 77 patients with prior myocardial infarction and compared exercise-induced ST changes with coronary arteriographic and left ventriculographic findings. At end-point time in the exercise test, we observed abnormal ST elevation in 36 patients (46.7%), ST depression in 11 (14.3%) and no significant ST changes in the remaining 30 (39.0%). After exercise, 29 out of 48 patients (60.4%) with prior anterior myocardial infarction had significant ST elevation, 9 (18.8%) had ST depression, and 10 patients (20.8%) had no significant ST changes. Of the 29 patients with exercise-induced ST elevation, 26 (89.6%) had no significant coronary lesion or simply had single vessel disease, and 6 of 9 patients with ST depression (66.7%) had multiple vessel disease. Furthermore, 18 of 29 patients with exercise-induced ST elevation (62.1%) had dyskinesis, 8 (27.6%) had akinesis and only 3 (10.3%) had hypokinesis. ON the other hand, only 2 of 9 patients with exercise-induced ST depression (22.2%) had dyskinesis, 5 had akinesis, and 2 had hypokinesis. Only 7 out of 29 patients (24.1%) with prior inferior myocardial infarction had ST elevation, 2 (6.9%) had ST depression, and no significant ST changes were observed in the remaining 20 (69.0%). No significant correlation was obtained between exercise-induced ST changes and coronary arteriographic and left ventriculographic findings. These findings strongly suggest that exercise-induced ST elevation is commonly observed in patients with anterior myocardial infarction and correlated with the severity of abnormal left ventricular wall movement, and ST depression is related with the extent of coronary artery lesion.

The therapeutic use of games with mentally retarded adults

This article provides conceptualizations of play as a learning and survival behavior and presents findings of a study of the use of games with mentally retarded adults. In this study the aim was to describe both how therapists can use games as therapeutic media and how changes can be observed in the subjects. Along with increases in play, improvement in motor behavior, cognitive abilities, affect, attention, self-confidence, and social interaction was observed.

Effect of calcium antagonists on the electrical alternans of the ST segment during acute coronary occlusion in dogs

Effects of antagonists on the ST alternans during acute coronary occlusion were examined in dogs. The intravenous administration of verapamil at doses of 0.1 mg/Kg and 0.2 mg/Kg prominently attenuated the degree of alternans. Diltiazem at dose of 0.2 mg/Kg also attenuated the degree of alternans. Dipyridamole at dose of 0.5 mg/Kg did not significantly attenuate the degree of alternans. Verapamil significantly inhibited the ST-segment elevation. After verapamil, ST alternans did not occur even after a longer period of occlusion when changes in QRS complex and the ST-segment elevation were remarkable. It is possible that verapamil inhibits ST alternans by both the protecting effect against ischemic injury and a direct effect on the electrical activity of the myocardial cell membrane.

Aniseikonia in patients with a unilateral artificial lens, measured with Aulhorn's phase difference haploscope

Aniseikonia was measured in unilaterally pseudophakic patients using Aulhorn's phase difference haploscope. Mean values of aniseikonia were 1.5% horizontally and 2.0% vertically without correction, and 2.1% horizontally and 2.3% vertically with correction. With spectacle correction, the greater the dioptric difference between two eyes, the greater the amount of aniseikonia. In either case, patients tolerated these amounts of aniseikonia according to our criteria of aniseikonia tolerance.

Cathodic isozyme of serum creatine kinase in a case of stomach cancer complicated by disseminated intravascular coagulation

A rare isozyme of serum creatine kinase (CK) migrating cathodic to CK-MM on electrophoresis was found in a 30-year-old male with stomach cancer complicated by disseminated intravascular coagulation leading to massive upper gastrointestinal bleeding and marked anemia. Serum CK activity rose to a maximum of 374 U/l without detectable CK-MB isoenzyme. The patient was also characterized by a marked increase in serum lactate dehydrogenase (all isozymes elevated) and by preferential leakage of mitochondrial aspartate aminotransferase and glutamate dehydrogenase, indicating the presence of extensive tissue damage involving mitochondria. Skeletal muscle mitochondria were considered the most likely source of the additional CK isozyme.

The mechanism of release of hepatic enzymes in various liver diseases. II. Altered activity ratios of GOT to GPT in serum and liver of patients with liver diseases

The activities of glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT) and glutamate dehydrogenase (GLD) were determined in liver biopsy specimens and sera of patients with various liver diseases. Mitochondrial and cytosol isozymes of GOT were also separated for their assay. The activity ratio of GOT/GPT in serum was found to reflect the ratio in liver cytosol. The increased ratio in advanced or severe liver diseases, such as liver cirrhosis, was due to the greater decrease in liver cytosol GPT activity, this being pronounced in primary hepatoma. The activity of GLD decreased similarly but less markedly. The relatively greater decrease in GPT compared with GOT in advanced liver diseases was not mainly due to leakage of the enzyme from the liver, but to a specific mechanism associated with hepatic injury or its progression. Other pathological conditions of the liver such as those in obstructive jaundice and alcoholic liver injury also appeared to result in reduced liver GPT activity, which was reflected in the serum as an increased GOT/GPT ratio.

The mechanism of the release of hepatic enzymes in various liver diseases. 1. Alterations in cytoplasmic and mitochondrial enzyme activities in serum

Serum glutamic oxaloacetic transaminase (GOT), mitochondrial GOT (GOTm), glutamic-pyruvic transaminase (GPT) and glutamate dehydrogenase activities were determined in 43 healthy controls and in 280 cases of liver diseases. A simplified column chromatographic method coupled with UV assay was employed for separation of GOTm. The activity was measured by following decrease in abosrbance of NADH at 340 nm. The lowest activity of GOTm determined with a coefficient of variation below 10% was 6 mIU/ml. High GOTm activities were found in acute hepatitis (acute stage), subacute hepatitis and primary biliary cirrhosis and were generally associated with high total GOT (GOTt) activities. The activity ratio of GOTm/GOTt varied depending on the stage and severity of liver diseases. The GOTm/GOTt ratio was decreased in acute, fulminant and subacute hepatitides. No significant reduction in the ratio was found in bile duct obstruction, alcoholic liver injury or metastatic liver cancer. Although relatively high GOTm/GOTt ratios were found in some patients with severe hepatic injury, they had no definite association with poor prognosis. These results indicate that the marked elevation in GOTt over GPT in advanced chronic hepatitis, liver cirrhosis and primary hepatoma was mainly due to preferential leakage of cytoplasmic GOT (GOTs).

Effect of beta-phenylethylamine on intraocular pressure

Upon injection of beta-phenylethylamine (PEA) into the subconjunctival space of rabbit, intraocular pressure increased. This effect went parallel with the amount of PEA transferred into the anterior chamber, which indicates that intraocular pressure was elevated by direct action of PEA.

Treatment of the Lennox syndrome with ACTH: a clinical and electroencephalographic study

In 45 cases of Lennox syndrome treated with ACTH, the immediate and long-term effects and the various factors affecting them were investigated by a follow-up study. 1) Regarding the immediate effect, 23 (51.1%) of the 45 cases became "seizure free" for over 10 days. 2) As to the long-term prognosis of these 23 cases, 10 cases relapsed into Lennox syndrome within 6 months and in the remaining 13 cases, seizures were suppressed for over 6 months; out of these 13, seizure relapse was observed in eight cases from 9 months to 7 years later, and the other five cases followed a very favorable course without relapse. 3) The favorable factors related to the effect of ACTH for Lennox syndrome are: a) age at ACTH treatment: up to 4 years old, b) time lag between onset of Lennox syndrome and initiation of ACTH treatment: the shorter the better; at least within 1 year, preferably within 3 months, c) presumptive causes and underlying diseases: idiopathic cases are best, d) mental defects before treatment: the slighter the better, e) seizure patterns: without tonic seizures, and f) EEG findings: disorganized diffuse slow spike-waves without asymmetry. 4) It is desirable to continue the ACTH treatment as long as possible, with the goal of the disappearance of seizure discharges, or at least the disappearance of diffuse seizure discharges.

Sodium valproate and thrombocytopenia

Thrombocytopenia has been occasionally reported in patients on sodium valproate. Here is reported a 6-year-old boy on this drug who was found to have thrombocytopenia 6 months after initiation of administration and it was progressive up to 16 months. Though the medication was continued because of its efficacy, platelet count gradually recovered to the normal level spontaneously. Throughout the course, no hemorrhagic tendency was observed clinically. It was suggested that platelet count should be monitored periodically, but that the presence of thrombocytopenia itself does not serve as an absolute indication for discontinuing the drug.

Low responsiveness of synovial and peripheral blood lymphocytes stimulated by either PHA-P or CON-A in patients with chronic rheumatoid arthritis

Lymphocytes were highly purified from synovial fluid and peripheral blood of 10 rheumatoid arthritis patients and assessed for responsiveness to PHA-P and Con-A. In all cases, both synovial and blood lymphocytes showed a marked reduction in response to these mitogens compared with normal blood lymphocytes. The factors responsible for this low T cell responsiveness are discussed.

Herpes simplex encephalitis: an autopsy case with isolation of type 1 herpes simplex virus

An adult case of herpes simplex encephalitis was studied after autopsy. Postmortem examination revealed necrotizing encephalitis associated with Cowdry type A intranuclear inclusion bodies in glial cells. Herper simplex virus type 1 was isolated from the removed brain. Herpes simplex virus antigens were detected diffusely in wide areas of the brain by immunofluorescent test and viral particles characteristic to herpes simplex virus were demonstrated by electron microscopy. There was an apparent discrepancy between severity of histological changes and distribution of virus antigen.

[Morphological differentiation in vitro of human continuous and functional neuroblastoma cell line, NB-I under treatment of (But)2cAMP (author's transl)]

Human neuroblastoma cell line (NB-I), obtained from metastatic neck lymph node of 2.3 y-o, boy, is established and maintained in vitro for more than 3 years in our department. The cells have been proliferated in 10% calf serum in EAGLE's medium, in closed stational culture system. The cell line has characteristic activities of rather rapid growth (Tg = 40 or 50h, 1974) catecholamine metabolism and chromosomal abnormality, bearing two marker chromosomes. NB-I cells are uncloned because of co-adhesiveness but biochemically identified as adrenergic line. Morphologically, they are round or tear-drop like in shape with delicate short protoplasmic processes. NB-I cells exhibit remarkable morphological differentiation and maturation under treatment of (But)2cAMP (final concentration, 1mM/ml). A longer time (1-2 weeks) for differentiation, however, is needed in comparison with that of mouse neuroblastoma cell lines. The NB-I cells exhibit hypertrophy of cytoplasma and nuclei in size, elongation of cytoplasmic processes, as well as the tendency of flattness and multipolarity of cells. Electronmicroscopically, the cells that showed scant organella but plentiful polysomes in the specimen, obtained during autopsy, reveal an increase of cell organellae after implantation in vitro: Golgi apparatus, neurotubules and neural dense bodies appeared in cytoplasma. These organellae characteristic of sympathetic neuron are much more increased under treatment of (But)2cAMP in 3 weeks. Core-vesicle like dense bodies are extremely rich in periphery of perikaryon and elongated processes (100 - 150 mu in diameter). Microtubules are also increased, running in bundles in processes. The NB-I cells are considered to differentiate and approach to matured neurons in vitro.