Roles of GABAA, NMDA and muscarinic receptors in induction of long-term potentiation in the medial and lateral amygdala in vitro

We have studied mechanisms underlying long-term potentiation (LTP) in the medial and lateral amygdala using in vitro slice preparations. In normal bathing medium, LTP was not induced by tetanic stimulation (100 pulses at 100 Hz). However, in the presence of a GABAA blocker, picrotoxin or bicuculline, LTP was reproducibly induced in both medial and lateral amygdala. In the medial amygdala, the LTP induced in the presence of picrotoxin was blocked by 2-amino-5-phosphonovalerate (APV), an NMDA receptor antagonist, and was significantly reduced by scopolamine, a muscarinic receptor antagonist. On the other hand, the LTP in the lateral amygdala was not affected by APV, but was significantly reduced by scopolamine. These results suggest that both NMDA receptors and muscarinic receptors are involved in the induction of medial amygdala LTP, while muscarinic receptors, but not NMDA receptors, are involved in the induction of lateral amygdala LTP.

Coronary artery bypass grafting in familial hypercholesterolemia

Familial hypercholesterolemia is an autosomal dominant disorder caused by a mutation of the gene for the low-density lipoprotein receptor and is characterized by rapidly progressing coronary atherosclerosis. We assessed the long-term results of coronary artery bypass grafting performed during the past 13 years in 62 patients with heterozygous familial hypercholesterolemia, whose mean plasma total and low-density lipoprotein cholesterol level was 327 mg/dl, respectively. The patients had severe coronary atherosclerosis, with coronary stenosis index of 19.7, and the prevalence of extracoronary atherosclerotic lesions was 27%. Sixty-one patients underwent successful coronary artery bypass operation, with an average of 2.5 grafts, and the coronary stenosis index decreased to 7.1. After operation, all patients consumed a cholesterol-lowering diet and received drug therapy with pravastatin, probucol, or cholestyramine. Seven patients who were resistant to drug therapy were treated with plasma low-density lipoprotein apheresis. The cholesterol-lowering therapy reduced plasma total cholesterol level by 37%, low-density lipoprotein cholesterol level by 42%, and low-density lipoprotein/high-density lipoprotein cholesterol ratio by 37% (p < 0.001). During the follow-up period (mean, 52 months; range, 10 to 157 months), there was no cardiac death, but three patients died of malignant disease. The actuarial survival rate was 95% at 5 years and 89% at 12 years after operation. The actuarial freedom from recurrent angina was 90% at 5 years and 53% at 11 years after operation. Four patients underwent reoperation, an average of 8 years postoperatively, because of vein graft atherosclerosis. In spite of severe coronary atherosclerosis, these patients with familial hypercholesterolemia showed good long-term outcome after coronary artery bypass operation. The present findings suggest that aggressive use of arterial grafts, intensive cholesterol-lowering drug therapy, and low-density lipoprotein apheresis may be useful in patients with familial hypercholesterolemia.

Mer-A2026A and B, novel piericidins with vasodilating effect. II. Physico-chemical properties and chemical structures

The structure of vasodilating active substances, Mer-A2026A and B, produced by Streptomyces pactum Me2108 were determined on the basis of their spectral and chemical properties.

Efficacy of a skeletal muscle-powered dynamic patch: Part 2. Right ventricular assistance

The purpose of this study was to assess the feasibility of using a skeletal muscle-powered dynamic patch to assist the failing right ventricle. Seven adult mongrel dogs were used in the study. The proximal portion of the left latissimus dorsi muscle was harvested and reattached to the actuator to serve as a skeletal muscle energy convertor. The right ventricular free wall was fully excised and the dynamic patch was implanted under cardiopulmonary bypass. After weaning from cardiopulmonary bypass, the latissimus dorsi muscle was stimulated using a burst frequency of 33 Hz, a burst duration of 200 ms, and 1:2 synchronous mode stimulation with the native R wave. Latissimus dorsi muscle stimulation increased systolic aortic pressure (78 versus 91 mm Hg; p < 0.01), mean aortic pressure (56 versus 62 mm Hg; p < 0.05), aortic blood flow (0.73 versus 0.97 mL; p < 0.01), and systolic right ventricular pressure (41 versus 56 mm Hg; p < 0.01). The mean right atrial pressure decreased from 14 to 9.6 mm Hg (p < 0.01). Our results demonstrate that the use of a right ventricular dynamic patch powered by a skeletal muscle linear-type actuator can not only function as a right ventricular free wall substitute but also lead to the augmentation of right ventricular and global cardiac function.

Cloning and sequencing of the genes encoding the light-harvesting B806-866 polypeptides and initial studies on the transcriptional organization of puf2B, puf2A and puf2C in Chloroflexus aurantiacus

The genes encoding the alpha- and beta-polypeptide subunits of the B806-866 membrane-bound light-harvesting complex of Chloroflexus aurantiacus have been cloned and the nucleotide sequences determined. The gene puf2A, which encodes the B806-866 alpha-polypeptide, began 28 bases downstream of the stop codon of puf2B, which encodes the B806-866 beta gene. The gene-encoding cytochrome c-554, puf2C, was found about 250 bp downstream of puf2A. puf2A encoded a 13 amino acid extension at the C-terminus of the B806-866 alpha-polypeptide that was not present in the mature protein. These genes, unlike those of purple nonsulfur bacteria, did not form a contiguous operon with puf1L or puf1M, the genes encoding the L and M subunits of the photochemical reaction center. The occurrence of the two latter genes and of puf2B and puf2A in two separate operons has not been observed in purple bacteria. Under photoheterotrophic growth conditions, puf2B and puf2A were encoded on an abundant mRNA that was 0.5 kb long. Two monocistronic transcripts for puf2C were observed that had different 5'-ends. One transcript encoding all three genes was also detected. Nucleotide sequences very similar to the consensus promoter sequence of the Escherichia coli RNA polymerase sigma 70 subunit were found seven and eight bases upstream of the 5'-end of mRNA encoding puf2B and for one of the monocistronic mRNA encoding puf2C, respectively.

Interleukin-1 beta stimulates phospholipase A2 activity in rat C6 glioma cells

Phospholipase A2 activities could be detected in both cytosolic and membrane fractions prepared from rat C6 glioma cells. The activities in both fractions were significantly increased by human recombinant interleukin-1 beta in a dose-dependent manner. Such a stimulation required a long-time exposure over 72 h and was partially inhibited by cycloheximide, a potent protein synthesis inhibitor. These results suggested that interleukin-1 beta may stimulate phospholipase A2 activity through its gene activation.

Mer-A2026A and B, novel piericidins with vasodilating effect. I. Producing organism, fermentation, isolation and biological properties

A strain of Streptomyces was found to produce new piericidins. The compounds were purified and separated into two substances named Mer-A2026A and B. These new piericidins exhibited vasodilating and depressor activities.

[Two cases of chondrosacoma of rib]

Chondrosarcoma of rib origin is rare in Japan. We treated two cases of chondrosarcoma of rib origin. Case 1: A 68-year-old man with anterior chest wall mass and chest pain was underwent aspiration biopsy in Inami General Hospital. The histological examination showed Class V. Operation was done in our department and the histological diagnosis was chondrosarcoma. The tumor was 30 x 20 x 20 mm in size arising from the left fourth rib. The defect of bony chest wall was repaired with a double layer of Marlex mesh. His postoperative course was uneventful. Case 2: 66-year-old man noticed a tumor in left anterior part of the chest 7 months ago. He was underwent incisional biopsy and the histological diagnosis was chondrosarcoma. Radical resection was performed. The tumor was 70 x 50 x 50 mm in size arising from the left rib. His postoperative course was uneventful.

[Left ventricular systolic and diastolic function after mitral valve replacement with preservation of posterior chordae tendineae]

Left ventricular function was compared in 14 patients who underwent mitral valve replacement with preservation of the posterior leaflet, chordae tendineae and papillary muscle (preserved group) and 14 patients who underwent conventional mitral valve replacement (non-preserved group). 99mTc radionuclide ventriculography was performed before surgery and one month after surgery. The early diastolic filling rate, an indicator of the efficiency of diastolic function, was measured. The patients in the non-preserved group showed an anteroseptal ejection fraction of 28 +/- 10% before surgery and 32 +/- 10% after surgery, an apical ejection fraction (71 +/- 10% vs 73 +/- 16%), and an inferolateral ejection fraction (56 +/- 16% vs 53 +/- 16%). The global ejection fraction tended to decrease from 56 +/- 9% to 52 +/- 10%. The patients in the preserved group showed an anteroseptal ejection fraction of 37 +/- 13% before surgery and 43 +/- 19% after surgery, an apical ejection fraction (74 +/- 20% vs 77 +/- 17%) and an inferolateral ejection fraction (53 +/- 11% vs 68 +/- 16%). The global ejection fraction, reflecting improvement in the inferolateral ejection fraction, tended to increase from 53 +/- 11% to 58 +/- 11%. The early diastolic filling rate for the preserved group was 1.73 +/- 0.43 before surgery and 1.05 +/- 0.61 after surgery, while that for the nonpreserved group was 1.59 +/- 0.24 vs 0.97 +/- 0.48. Although the early diastolic filling rate normalized in both groups, there was no significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of a skeletal muscle-powered dynamic patch: Part 1. Left ventricular assistance

In this study, we examined the capability of a skeletal muscle-powered, dynamic patch to provide left ventricular assistance. An actuator was developed that used linear traction power furnished by the latissimus dorsi muscle and liquid as the medium for power transfer. The proximal portion of the muscle was dissected and was reattached to the actuator. The left ventricular apex was excised, and the dynamic patch lined with autologous pericardium was implanted during cardiopulmonary bypass. Hemodynamic studies were performed in 8 dogs after weaning from cardiopulmonary bypass. Muscle stimulation was found to significantly increase the systolic aortic pressure (91.6 versus 112.1 mm Hg; p < 0.01), the mean aortic pressure (65.2 versus 73.0 mm Hg; p < 0.01), and aortic blood flow (0.77 versus 0.92 L/min; p < 0.01). The left atrial pressure decreased from 17.9 to 16.6 mm Hg (p < 0.01). This "hybrid" left ventricular assist device possesses notable clinical advantages because of its remarkable efficacy in assisting circulation. Further experimental studies using preconditioned skeletal muscle are necessary to assess the long-term effects of this technique.

Role of macrophage colony-stimulating factor in the initial process of atherosclerosis

The early atherosclerotic lesion is characterized by the presence of macrophage-derived foam cells. Macrophage colony-stimulating factor (M-CSF) specifically stimulates the functions of the monocyte-macrophages. To elucidate the role of M-CSF in the atherogenic process in vitro and in vivo, we studied the effects of M-CSF on enzyme activities of acidic cholesteryl ester (CE) hydrolase, neutral CE hydrolase, and acyl-coenzyme A:cholesterol acyltransferase (ACAT), and 300 micrograms of M-CSF was intravenously injected into WHHL rabbits aged 2.5 months for 8.5 months. M-CSF (100 ng/ml) enhanced acidic and neutral CE hydrolase, and ACAT activities by 3.2-fold, 4-fold, and 2.3-fold, respectively, in the presence of acetyl LDL, and M-CSF increased ratios of both acidic and neutral CE hydrolase activities to ACAT activity. After M-CSF injection into WHHL rabbits, we found very retarded progression of atherosclerosis. The accumulation of cholesterol ester was remarkably decreased in the aortae of M-CSF-treated animals (0.60 +/- 0.32 mg/g tissue), as compared to those of controls (4.21 +/- 0.65 mg/g tissue). The results suggest that M-CSF prevents the progression of atherosclerosis in WHHL rabbits by increasing net hydrolysis of cholesteryl ester in macrophages.

Identification in the calcineurin A subunit of the domain that binds the regulatory B subunit

Calcineurin (CaN) is the serine/threonine protein phosphatase (phosphatase 2B) that is activated by binding of Ca2+ to its B subunit and to calmodulin (CaM). This paper identifies residues between the catalytic region and the CaM-binding domain of the A subunit as the domain that binds the regulatory B subunit. A purified fusion protein containing residues 328-390 of the A subunit 1) binds CaN B subunit, and 2) inhibits (IC50 = 0.1 microM) the in vitro stimulation of CaN A phosphatase activity by purified CaN B subunit. A synthetic peptide corresponding to residues 341-360 blocked the binding of CaN B to residues 328-390 in the fusion protein, so 4 hydrophobic residues within this region (Val349-Phe350 and Phe356-Val357) were mutated to either Glu (E mutant) or Gln (Q mutant). The wild-type and mutant A subunits were expressed individually or coexpressed with B subunit in Sf9 cells, purified and characterized. The mutant A subunits were similar to wild-type A subunit in terms of basal phosphatase activity (1-3 nmol/min/mg) and activation by Mn2+/CaM. Addition of purified B subunit to purified wild-type A subunit at a 1:1 molar ratio gave a 40-fold increase in phosphatase activity whereas addition of B subunit to either of the mutant A subunits had no effect on phosphatase activity, even at a 3:1 molar excess of B subunit. Furthermore, when wild-type or mutant A subunits were coexpressed with B subunit and purified on CaM-Sepharose, the B subunit co-eluted with the wild-type A subunit but not with either mutant A subunit. These results demonstrate that residues 328-390 in the A subunit bind B subunit and that the mutated hydrophobic residues are essential.

[Extraction and purification of the three major vitamin D metabolites using C18 and NH2 cartridges and measurement of 25-hydroxyvitamin D]

In this study, the three major vitamin D metabolites: 25-hydroxyvitamin D [25(OH)D], 24,25-dihydroxy-vitamin D [24,25(OH)2D], 1,25-dihydroxyvitamin D [1,25(OH)2D] were clearly separated using a NH2 cartridge after acetonitrile and C18 cartridge extraction. In the NH2 cartridge purification procedure, 25(OH)D was eluted with hexane/dichloromethane (50:50), 24,25(OH)2D was eluted with hexane/dichloromethane (20:80) and 1,25(OH)2D was eluted with hexane/isopropanol (75:25). Contamination of each fraction with two other metabolites were less than 1.4%. Recoveries of added 3H-25(OH)D, 3H-24,25-(OH)2D and 3H-1,25(OH)2D were 73.2 +/- 2.45%, 60.0 +/- 2.98% and 63.5 +/- 3.37%, respectively. Using the 25(OH)D fraction after the NH2 cartridge procedure, we measured 25(OH)D using a competitive protein binding assay. The intra- (n = 10) and interassay (n = 8) coefficients of variation were 4.60-8.41% and 6.62-16.4%, respectively. Analytical recovery of added 25(OH)D was in the range of 81.2-130%. The 25(OH)D values were 17.4 +/- 6.02 ng/ml (mean +/- SD) in serum from 110 healthy volunteer collected in May. The correlation of 25(OH)D values was good between cartridge purification and high performance liquid chromatography (HPLC) purification. (gamma = -0.38 + 1.03x, r = 0.953, n = 36). This purification using a simple cartridge procedure was suitable for the measurement of 25(OH)D, and preferable to the time-consuming HPLC purification.

PACAP stimulates glucose output from the perfused rat liver

The effects of PACAP on hepatic glucose metabolism were examined using the flow-through perfusion method for fed rat livers, because some of the glucagon superfamily peptides stimulate hepatic glucose output. Glucose output was significantly stimulated in a dose-dependent manner by more than 1 nM PACAP-27. The potency of its stimulation was equal to that of PACAP-38, greater than that of VIP, and clearly lower than that of glucagon. The cAMP output was also increased significantly by more than 1 nM PACAP-27; however, the degree and profile of cAMP output were not in parallel with those of glucose. Theophylline did not affect these stimulatory effects. On the other hand, in the perfusion experiment with Ca2+ free perfusate, the degrees of increase in glucose output induced by 15 and 40 nM PACAP-27 were significantly reduced. In conclusion, PACAP stimulates glucose output from the perfused rat liver, and Ca2+ rather than cAMP plays an important role in this action as a second messenger.

Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet, and Japan

It has been reported that both chorangiosis and chorangioma are increased in placentas at high altitudes. In this study, 1.14% of 2448 Japanese placentas obtained at 30-300 m had chorangiosis or chorangioma, compared with 3.24% of the Nepalese placentas (1300-3000 m) and 9.09% of the Tibetan samples (3800-4200 m). The incidence of both pathologies was significantly higher in the Himalayan groups than those of the Japanese group (P < 0.05). Obstetric complications of the 28 Japanese placentas with chorangiosis and chorangioma included Caesarean section 16 (57.1%), abruptio placentae 2 (7.14%), intrauterine growth retardation 3 (10.7%), intrauterine fetal death 4 (14.2%) and placenta praevia 4 (14.2%). Four infants (14.2%) had Apgar scores ranging from 0 to 3. Among 48 Himalayan placentas with chorangiosis and chorangioma, incidence of marked subchorionic fibrin was significantly higher (25%) than in the Japanese group (3.57%) (P < 0.05). The incidence of abnormal insertion of the cord was significantly higher (14.2%) in the Japanese group than in the Himalayan group (5%) (P < 0.05). There was no significant difference in the frequencies of intervillous thrombosis and infarction between the two groups. These findings suggest that the incidence of pathological change such as chorangiosis and chorangioma may be increased in placentas at Himalayan altitudes.

Inhibitory effects of intravenous lansoprazole on gastric acid hypersecretion in patients with postoperative stress

The inhibitory effects of intravenous lansoprazole on gastric acid hypersecretion caused by stress after surgical invasion were studied in patients who underwent surgery under general anesthesia for gastrointestinal diseases. Patients in this study received either 15 mg or 30 mg of lansoprazole by slow intravenous injection twice daily for 3 days (six injections). The total number of patients studied was 82, with 41 patients in each group. Intragastric pH was measured every 8 h after the start of administration, and the inhibitory effects of intravenous lansoprazole on postoperative gastric acid secretion were evaluated using four grades: excellent, good, fair, and poor. In the 15-mg group, 65.8% (25 of 38 patients) were classified as good or excellent, and in the 30-mg group, 75.7% (28 of 37 patients) were good or excellent. No adverse effects directly attributable to the administration of lansoprazole were observed.

[Body surface ST mapping in daily life using multi-lead ambulatory electrocardiograph]

To extend the usefulness of multi-lead ambulatory electrocardiography, we attempted to construct body surface isopotential maps of ST segment using our newly designed multi-lead ambulatory electrocardiograph. Material consisted of 40 patients (pts) with angiographically proven coronary arterial stenosis. By a commercially-available 4-channel recorder and a specially designed adapter, 30-lead ECGs were sequentially recorded together with body position signals for 24 hours. Compensation for ST distortion and interpolation of ST level on time scale techniques were performed before construction of ST maps. The extension of ST depression area in pts with single LAD disease were larger than in pts with single LCX or RCA disease. As time elapsed, after occurrence of ischemia the extension and location of ST depression area were changed. These results were thought to be reasonable. In conclusion, the ambulatory recording of body surface ST maps may become useful for study of myocardial ischemia in daily life.

Small giant cell carcinoma of the lung diagnosed preoperatively by transthoracic aspiration cytology. A case report

Giant cell carcinoma (GCC) of the lung is considered an aggressive form of lung cancer. Most patients with GCC have large tumors with widespread metastases on hospital admission. We describe a small GCC in the lower lobe of the right lung. Preoperative aspiration cytology showed numerous bizarre, giant epithelial cells, highly suggestive of GCC. The resected tumor measured 1.2 x 1.0 x 0.7 cm in diameter, with an ill-defined margin. Histologically the tumor was composed of pleomorphic mononucleate or multinucleate giant cells without adenocarcinoma or squamous cell differentiation. The tumor cells were loosely organized and noncohesive or free in the alveolar space. The histology was interpreted as GCC of the lung. The clinicopathologic features of giant cell carcinoma are discussed.

[Mechanism on formation of new ipsilateral corticospinal tract following neonatal unilateral cortical ablation in rats]

The corticospinal tract in the rat after neonatal ablation of the unilateral cerebral cortex was studied morphologically using the antegrade horse-radish peroxidase (HRP) tracing method. An aberrant ipsilateral tract was observed 7 days after the operation. Formation of the aberrant neuronal pathway has been confirmed to be contributed mainly by new axons, which ramified at the level of the pyramidal decussation from healthy corticospinal fibers. This ramified axon ran toward the ipsilateral dorsal funiculus. A few fibers also contributed to the aberrant pathway by changing their direction on the way of extension at the level of the pyramidal decussation. These results indicate that the ramification and change of the direction of extending axons play an important role for formation of a new ipsilateral corticospinal tract.

Mechanism of phospholipase D activation induced by prostaglandin D2 in osteoblast-like cells: function of Ca2+/calmodulin

Prostaglandin D2 (PGD2) stimulated the formation of choline in a dose-dependent manner in the range between 10 nM and 10 microM. The effect of PGD2 on the formation of inositol phosphates (EC50 was 20 nM) was more potent than that on the formation of choline (EC50 was 0.5 microM). The formation of choline stimulated by a combination of PGD2 and 12-O-tetradecanoylphorbol-13-acetate (TPA), an activator of protein kinase C, was additive. Staurosporine, an inhibitor for protein kinases, enhanced the PGD2-induced formation of choline, but H-7, another inhibitor for protein kinases, had little effect. PGD2 stimulated Ca2+ influx from extracellular space dose-dependently. The depletion of extracellular Ca2+ by EGTA reduced the PGD2-induced formation of choline. W-7 and trifluoperazine dihydrochloride, antagonists of calmodulin, dose-dependently inhibited the PGD2-induced choline formation. These results strongly suggest that PGD2 activates phospholipase D in a Ca2+/calmodulin dependent manner in osteoblast-like cells, and that protein kinase C is not essential for the PGD2-induced activation of phospholipase D.

Purification and characterization of rat adrenodoxin

Adrenodoxin was purified from the rat adrenal gland. The A414/A280 value of the purified rat adrenodoxin was 0.90 and the oxidized spectrum showed absorption maxima at 320, 414 and 455 nm, similar to those of bovine adrenodoxin. On SDS-PAGE, the rat adrenodoxin showed a single band with a molecular mass of 11.2 kDa, while the apparent molecular mass by gel filtration through Sephadex G-75 equilibrated with 10 mM K-phosphate (pH 7.5) was 27 kDa. In the reconstituted system, Vmax of NADPH-cytochrome c reduction activity and the Km for the rat adrenodoxin were much the same as those for recombinant bovine adrenodoxin. In the case of cholesterol side-chain cleavage activity, however, these values of the rat adrenodoxin were about half of those of the bovine adrenodoxin. The CD spectrum of the rat adrenodoxin was similar to that of the bovine adrenodoxin but showed a significantly lower ellipticity value in the 195-205 nm region than that of the bovine adrenodoxin. The structural differences may possibly explain differences in the enzymic properties between rat and bovine adrenodoxins.

Inhibitory action of nebracetam on various stimuli-evoked increases in intracellular Ca2+ concentrations in cultured rat cerebellar granule cells

Nebracetam (10-100 microM) dose-dependently inhibited increases in intracellular Ca2+ concentrations evoked by various stimuli in cultured rat cerebellar granule cells. The magnitude of the nebracetam (100 microM)-induced inhibition of L-glutamate- and N-methyl-D-aspartate-evoked Ca2+ responses was 1.5-fold and 1.7-fold greater, respectively, than the inhibition of the high K(+)-evoked response. These findings suggest that in cultured cerebellar granule cells, nebracetam attenuates the external Ca2+ influx derived from the activation of N-methyl-D-aspartate receptor-gated rather than voltage-gated Ca2+ channels.

Long-term results of hepatic resection for hepatolithiasis

Long-term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic biliary strictures were studied. The left lateral and the right posterior segmental ducts were commonly and often simultaneously involved. Fourteen patients had multiple segmental involvement. Hepatic resection included left sided resection (n = 27), right sided resection (n = 6), and repeated bilateral resection (n = 1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, 1 cystadenocarcinoma, and 1 dysplasia of intrahepatic ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent stones developed in 3 and 4 patients, respectively. Twenty-six patients had no remaining symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms caused by retained stones (n = 2), recurrent stones (n = 2), bile stasis (n = 1), or neuralgia (n = 1). In 4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean follow-up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients with right lobar or bilobar type, intra- and extrahepatic type, and confluence strictures, bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis, however, meticulous management of biliary tract abnormalities, particularly the posterior duct stricture, is mandatory.

The state of body surface mapping in Japan

In Japan, body surface mapping (BSM) started in 1974. A huge amount of data has been accumulated regarding basic researches and clinical applications. Recent work on BSM in Japan is summarized here, with the goals of establishing a normal database and diagnostic criteria by using the standardized mapping system. The standard systems used in Japan are the HPM-7100 and the VCM-3000, manufactured by Fukuda-Denshi (Tokyo, Japan) under the supervision of a committee of the Japanese Circulation Society. The number of leads in this system is 87 (59 on front, 28 on back). As a basic study, a computer simulation was carried out on bundle branch block with myocardial infarction (MI), on late potentials in MI, and finally, on the solution of the inverse problem. The database of 606 normal subjects was established regarding age and sex, and a "departure index" (the grade of deviation from normal: the difference between a patient's data the normal mean divided by the normal SD) was proposed. Using the departure index, diagnostic criteria were proposed for the ischemic site, MI site, hypertrophic site of the ventricle, etc. The origin of the ventricular premature contractions was determined by the site of minima and maxima of the QRS and QRST isointegral maps. The site of accessory pathways was determined by the site of minimum less than -0.15 mV on the BSM. For the prediction of patients prone to ventricular tachycardia (VT), several approaches were tried such as multipolar patterns of QRST isointegral maps, Wigner distribution, late potentials with relation to endo- or epicardial delayed potentials, body surface distribution of specific frequency band (25-50 Hz) obtained from fast Fourier transform analysis, and nondipolarity of the QRST isointegral map. To improve the ablation procedure of VT, the author developed a technique to determine the precise location of the VT focus in pace mapping using a correlation matrix between VT and pace maps. To ensure the longevity of the BSM, a reduction of the number of leads has been proposed. The usefulness of BSM has been confirmed and the technique accepted in Japan for daily clinical diagnosis.