Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement

BACKGROUND AND STUDY AIMS

In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access--pancreatic duct wire placement.

PATIENTS AND METHODS

During a six-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 10 min in 53 of the patients, who were randomly assigned to either pre-insertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups.

RESULTS

In the pancreatic duct-guide wire group (n=27), the success rate was significantly greater than in the conventional group (93% vs 58%). No pancreatitis complications occurred within either group.

CONCLUSIONS

Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the bile duct.

Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer

BACKGROUND AND STUDY AIMS

Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood.

PATIENTS AND METHODS

In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan.

RESULTS

In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6% at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure.

CONCLUSIONS

Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.

Endoscopic surveillance for gastric remnant cancer after early cancer surgery

BACKGROUND AND STUDY AIMS

The aims of this article were to clarify the incidence of gastric remnant cancer after surgery for early gastric cancer, and to develop surveillance programs for patients who have undergone partial gastrectomy in order to detect such lesions at an early stage.

PATIENTS AND METHODS

A total of 642 patients with partial gastrectomy for early gastric cancer were enrolled in a surveillance program for gastric remnant cancer between 1985 and 1996. In 509 patients, the interval between endoscopic examinations was no more than 2 years.

RESULTS

Among the 509 patients examined periodically, 15 patients were diagnosed as having gastric remnant cancer; in 12 patients, the cancers were detected at an early stage. All gastric remnant cancers were found distant from the site of the anastomosis, and in eight patients the cancers were located on the lesser curvature. The cumulative 5-year prevalence rate was estimated as 2.4 % and the 10-year prevalence rate as 6.1 %. The initial tumors in the patients with gastric remnant cancer were of the microscopically intestinal type, without exception. The interval between the preceding examination and diagnosis was shorter in the patients with early cancer than in those with advanced cancer ( P < 0.01).

CONCLUSIONS

Periodical surveillance endoscopy for gastric remnant cancer is recommended after surgery for early gastric cancer, particularly in patients whose cancers are of the intestinal type. The examinations can be repeated at 2 - 3-year intervals, and special attention should be given to the lesser curvature away from the anastomotic site.

Detection of gastric cancer by repeat endoscopy within a short time after negative examination

BACKGROUND AND STUDY AIMS

Although a large number of patients are examined using endoscopy in order to identify gastric cancer, it is unclear how individuals should be managed after they are not diagnosed as having gastric cancer at the time of their initial examinations. This study was conducted to identify the group at high risk for gastric cancer who should be examined by repeat endoscopy within a short time after obtaining negative results.

PATIENTS AND METHODS

The study involved 3672 patients who were not diagnosed as having gastric cancer by endoscopy in 1993, but underwent re-examination by gastroscopy between January 1994 and December 1996.

RESULTS

Among these participants, 32 patients (0.9%) were diagnosed as having gastric cancer. The incidence of gastric cancer was 2.0% in participants aged 60 to 69 and 2.7% in those with marked atrophy of the gastric mucosa. Multivariate analysis showed that the odds ratios (OR) for patients aged 60 to 69 and those with marked atrophy of the gastric mucosa were 3.092 and 3.255 (P < 0.01), respectively. Gastric cancer was detected in 17.2 % of patients who were previously diagnosed as having gastric adenoma and in 2.2% of those who were previously diagnosed as having gastric ulcer. The ORs for participants with these gastric lesions detected by the initial examination were 49.417 and 5.259 (P < 0.01), respectively.

CONCLUSIONS

Groups at high risk for gastric cancer were identified by the initial endoscopy, when two findings (gastric lesions, atrophy) and age were combined. We emphasize the importance of repeat endoscopic examination for patients who are aged 60 to 69 or have marked atrophy of gastric mucosa, even if no lesions are detected on initial endoscopy. If gastric adenoma or ulcer are detected, endoscopic examination should be likewise repeated or these lesions should be treated by endoscopy or by other means.

Protective role of metallothionein on DNA damage in rat kidney caused by cis-diamminedichloroplatinum

Cis-diamminedichloroplatinum (cis-DDP) has been used as an anticancer agent but it also causes nephrotoxicity. To study the cis-DDP metabolism and its effects, the induction of metallothioneins and DNA damage caused by cis-DDP were observed. Cis-DDP or trans-DDP was administered to seven-week-old Wistar male rats as three daily injections of 8.0 mg/kg body wt., intraperitoneally. Using the obtained kidneys, gel filtration assay, metal analysis, immunohistochemistry and terminal deoxy transferase-mediated deoxy uracil triphosphate nick end labeling (TUNEL) method were carried out to examine localization of metallothioneins and DNA damage caused by cis-DDP. Platinum (Pt) contents, 26.05+/-12.01 microg/g body wt. and 51.29+/-4.59 microg/g body wt. (average+/-S.E.) were detected in the kidney of rats injected with both cis- and trans-DDP, respectively. Metallothionein was detected in the cortex of the kidney in rats administrated cis-DDP or trans-DDP. The mRNA was also detected in the same region. On the other hand cis-DDP showed induction of DNA damage on the cells in the outer stripe of the outer medulla but trans-DDP did not show any damage. The region-induced DNA damage differed from that induced by metallothioneins. Cis-DDP is suggested to be mainly trapped at the proximal tubules by metallothioneins, and the rest of cis-DDP induces DNA damage at the outer stripe of the outer medulla. Metallothioneins are considered to contribute to the protection against cis-DDP in the rat cortex.

Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy

BACKGROUND AND STUDY AIMS

The degree of accuracy of gastroscopy for the detection of gastric cancer is poorly understood. The aim of this retrospective study was to determine the accuracy of gastroscopy by using cancer registry records.

PATIENTS AND METHODS

Gastroscopic examinations (n = 37094) conducted between 1984 and 1989 were studied by linking them with hospital-based and population-based (Fukui Prefecture, Japan) cancer registry records between 1984 and 1992. False-negative gastroscopies that had been carried out within the three years preceding the diagnosis of gastric cancer were identified.

RESULTS

The numbers of true-positive, false-positive, and false-negative examinations carried out were 659, six and 155, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 81.0%, 100.0%, 99.1%, and 99.6%, respectively. The overall diagnostic accuracy of gastroscopy was 99.6%. There was little difference in sensitivity results between the patient groups with regard to reason for referral, type of endoscope used, experience of endoscopist, or location of gastric cancer. The percentage of tumours representing early gastric cancer, identified after false-negative gastroscopy, was lower for those situated in the cardia or gastric body than for those in the angular notch or the antrum.

CONCLUSIONS

The accuracy of gastroscopy in the detection of gastric cancer is satisfactory, but false-negative results are sometimes obtained. We emphasize the importance of repeated endoscopic examination for the detection of gastric cancer.

[Clinicopathological analysis of leiomyosarcomas of the small intestine and a review of the Japanese literature]

An analysis has been made of 9 cases of a leiomyosarcoma of the small intestine that were treated from 1974 through 1989. In two patients (22.2%), a perforation was seen, and a case report of a 59-year-old woman is presented. Further, case reports of leiomyosarcomas in the Japanese literature from 1980 through 1989 were clinico-pathologically analyzed. The frequency of a perforation was found to be 8.6%, and the distribution of the perforated leiomyosarcomas was the same as for the non-perforated cases. The five-year postoperative survival rate was 41.2%. Of note is that 3 out of 10 patients that had survived for 5 years subsequently died of sarcomatosis.

[Study of early gastric carcinomas with a pyloric stenosis]

From 1969 to 1989, 1106 cases of early gastric carcinomas were treated in our hospital, and 9 cases (0.8%) of an early gastric carcinoma with a pyloric stenosis were found among them. Five of these cases involved males and 4 cases females. The average age of these patients was 57.1 years. An accurate preoperative diagnosis was very difficult and 7 cases had been considered to be advanced gastric carcinoma preoperatively. In all these cases the lesions were found located on the pyloric ring or in the antral region. Further, all cases evidenced a submucosal infiltration and/or ulceration in the lesion. Most of the stenotic cases had lesions greater than 3.1 cm in diameter, with diameters of over 1.1 cm in the ulceration and the submucosal infiltration. Some early gastric carcinomas in the antral region with no pyloric stenosis also had lesions that were over this size.

[A clinicopathological study of early mucinous adenocarcinoma of the stomach]

From 1963 to 1986, 1126 cases (1300 lesions) of early gastric carcinoma were treated at Fukui Prefectural Hospital. Mucinous adenocarcinomas comprised 16 lesions in this series. These cases of mucinous adenocarcinoma were younger than all the other early carcinomas of the stomach and they often were locted in the lower third of the stomach. Macroscopically, most were types "Iia + IIc". Dividing them into 3 grouping: papillary, tubular, and signet ring cell types, depending on the microscopic appearance of the intramucosal carcinoma, the signet ring cell group differed from the other two as to age, macroscopic appearance, and region it occupied. An immunochemical study showed that CA19-9 stained positively in a mucous lake, much like a carcinoma cell, but that CEA stained little.

[Early carcinoma of the gastric remnant: pathological features relating to the interval between the initial and second surgery]

Twenty cases of early carcinoma of the gastric remnant have been treated at our hospital and examined clinico-pathologically. In 11 cases, the interval after the initial gastrectomy, due to the gastric carcinoma, was done was short compared with length of the interval of 9 cases after a gastrectomy for a benign gastric disease. There were two types of gastric remnant carcinomas in cases in which the interval extended 10 years. The first type developed at the site of the gastro-intestinal anastomosis, especially when the anastomosis was found to be joined by the Billroth II method, and the carcinoma was associated with a gastritis cystica polyposa (GCP). The other type showed a polypoid appearance except for the stomal site.

[The efficacy of combined use of 1 alpha-hydroxyvitamin D3 with calcium supplements in the treatment of osteoporosis]

Synthetic analogue of active vitamin D metabolite, 1 alpha (OH) D3, has been widely used in the treatment of osteoporosis. However, the most effective method of treatment is yet to be established. Importance of calcium supplement to improve the calcium metabolism in osteoporosis is also reported by many authors. We have studied the combined effects of 1 alpha (OH)D3 with calcium supplement in preventing progressive decrease of bone mass in patients with osteoporosis. Sixty-six cases of postmenopausal and senile osteoporosis were divided into two groups: one treated with calcium alone 1,000 mg a day and the other treated with calcium 1,000 mg and 1 alpha (OH)D3 0.5 microgram a day, and both groups were followed for 24 months. Bone mass was evaluated by microdensitometry of the roentgenograms of the second metacarpal bone. The results revealed that the combined use of 1 alpha (OH)D3 with calcium has a significantly more favorable effect than the use of calcium alone in preventing bone loss. Therefore, 1 alpha (OH)D3 with calcium is useful in the treatment of osteoporosis. The conclusion would be further confirmed with longer term study and a more accurate method of measuring bone mass.

[The annual change in cases of early gastric cancer]

From 1963 to 1985, 1038 cases of early gastric cancer were treated at Fukui Prefecture Hospital. From a study that was undertaken, the incidence of early gastric cancer in cases of a resected gastric cancer was found to have increased. The age distribution and the sex ratio of early gastric cancer patients had not changed annually, though early gastric cancers that were detected by a mass survey or comprehensive physical examinations had increased. Macroscopically, early gastric cancers of the elevated type decreased while those of the depressed type increased. With regard to size, lesions smaller than 1.0 cm have increased during the past 5 years. Histologically, well-differentiated tubular adenocarcinomas have increased annually. The grade of intestinal metaplasia in the stomach has not changed.

[Calcinosis universalis with hyperphosphataemia--successful treatment with phosphorus deprivation]

Seven year old boy with calcinosis universalis associated with high serum phosphorus was reported. Over one year's treatment with aluminum hydroxide up to 18 grams per day have reduced calcified mass remarkably, while serum phosphorus levels were remaining still above the normal range. Concomitant use of probenecid seemed to be effective in reducing serum phosphorus levels as well as decreasing the calcified mass. Pathogenetic mechanisms of soft tissue calcification in calcinosis universalis is not clear, but in this case hyperphosphataemia is considered to be one important factor accelerating soft tissue calcification. Although hyperphosphataemia associated with tumoral calcinosis has been frequently observed, no report is yet available on calcinosis universalis associated with hyperphosphataemia. This case might represent one unique type of calcinosis.

[Regression of adenomas in Gardner's syndrome induced by systemic chemotherapy]

A 31-year-old male was admitted to our hospital with Gardner's syndrome and sigmoid colon cancer. Palliative resection (sigmoid colectomy) was performed due to hepatic and lymph node metastasis. Systemic chemotherapy with MMC, 5-FU and PSK was started postoperatively. Barium enema study on the 23rd successive post-operative day and fiberscopic study on the 134th post-operative day showed regression of the size and number of the polyps in the remaining colon and rectum. We suggest that the administration of anticancer drugs may be useful in the treatment of familial polyposis or Gardner's syndrome which have been treated with only surgical therapy.

The causative mechanisms of mitral valve prolapse in progressive muscular dystrophy in reference to thorax and thoracic spine deformities and left ventricular dysfunction

The causative mechanisms of mitral valve prolapse (MVP) were evaluated in 58 patients with progressive muscular dystrophy (PMD). Two possible causes, 1) left ventricular (LV) dysfunction and 2) thoracic spine and thorax deformities were assessed. Patients were classified into three groups by echocardiographic findings. Group 1: 31 patients without MVP, group 2: 11 patients with MVP confirmed only by M-mode echocardiogram, group 3: 16 patients with MVP confirmed by both two-dimensional and M-mode echocardiograms. LV functions evaluated by systolic time intervals and fractional shortening showed no significant differences among the three groups. Scoliosis of the thoracic spine was not related to the incidence of MVP. Lordotic or straight spines were found in 32.3%, 100%, 93.8% of cases in group 1, group 2 and group 3, respectively, and the incidences of MVP in cases with kyphosis, straight spine and lordosis were 4.8%, 66.7% and 77.8%, respectively. The shape of the thorax as evaluated by the ratio of anteroposterior internal diameter to transverse diameter was more flattened in groups 2 and 3 than in group 1. From these results, we concluded that LV dysfunction was not related to the incidence of MVP and that the lordotic or straight spine and the flattened thorax were supposed to be the major factors in the occurrence of MVP in PMD.

[Left ventricular regional wall motion after correction of tetralogy of Fallot]

Cardiac function and left ventricular regional wall motion were examined using two-dimensional echocardiography in 40 post-operative patients of tetralogy of Fallot (TOF) of an average of 13 years after the correction. From the data of treadmill exercise test and cardiac catheterization, patients were classified into two groups; cases with complete ability for treadmill test (Group A, n = 22), and disabled for the test and the right ventricular systolic pressure above 50 mmHg (Group B, n = 18). Compared with the control group (n = 10), the patient groups had greater cardiothoracic ratios (CTR) and right/left ventricular dimensions (RVd/LVd) (p less than 0.001), and Group B had a greater CTR and RVd/LVd than Group A (respectively p less than 0.001). Compared with the control group, the patient groups had no significant differences in corrected ejection time, fractional shortening and mean velocity of circumferential fiber shortening, and no difference was noted between Group A and Group B. Left ventricular regional wall was divided into 12 segments around the left ventricular circumference on the two-dimensional short-axis view and the regional wall motion was evaluated on the basis of [(diastolic-systolic)/diastolic left hemiaxial length X 100%] values. In Group B, akinetic or dyskinetic wall motion was visualized at the interventricular septum and left ventricular posterior wall, but there was no abnormal motion in the control group and Group A. We concluded that even in postoperative patients with preserved cardiac function at rest, some of them had abnormal left ventricular regional wall motion due to the persistent right ventricular overload or corrective patch, resulting in low exercise capacity.

[Mitral valve prolapse in the heart with pressure overload of the right ventricle]

The prevalence of mitral valve prolapse (MVP) was examined in 16 patients with right ventricular pressure overload with a peak systolic pressure ranged from 60 to 204 mmHg (Group 1; 9 cases of primary pulmonary hypertension and 7 cases of pulmonary valve stenosis), and the clinical and echocardiographic data were compared to those of 12 patients with idiopathic MVP (Group 2) and 10 healthy persons (Group 3). MVP was defined when either or both of the mitral valve leaflets protruded into the left atrium beyond the plane of the mitral ring, and "gap" was defined as positive when one of the leaflets of the mitral valve slipped 3 mm or more without prolapse toward the left atrium than the other leaflet. Eccentricity of the left ventricle was obtained from the cross-sectional view of the left ventricle at the mid-ventricular level: the ratio of the internal diameter (S) passing through the mid-point of the interventricular septum (IVS) and perpendicular to the IVS divided by the longest internal diameter (L) parallel to the IVS, at end-diastole (S/L(d] and at end-systole (S/L(s], respectively. The following results were obtained. MVP was found in seven cases of 16 patients (43.8%) of Group 1. Two cases had positive "gap" (12.5%). Eccentricity of the left ventricle in Group 1 (S/L(d) 0.81 +/- 0.12, S/L(s) 0.78 +/- 0.15) was more marked than that of Group 2 (S/L(d) 0.98 +/- 0.09, S/L(s) 1.02 +/- 0.06) or of Group 3 (S/L(d) 1.03 +/- 0.08, S/L(s) 1.00 +/- 0.04) (p less than 0.001 in each).(ABSTRACT TRUNCATED AT 250 WORDS)

A possible autonomic modulation of sinus node recovery time in overdrive suppression test

The effect of blood pressure fall on sinus node recovery time (SNRT) was studied in 17 patients during the overdrive suppression test. Their maximal SNRT was less than 150% of the mean P-P interval of the control state (=SCL) and CSNRT (=SNRT-SCL) was less than 550msec. Blood pressure was found to fall in about a half of the patients at a high pacing rate. Concomitantly, SNRT was found to shorten in those who showed such a fall in blood pressure. The subjects were then divided into two groups; one with a shorter SNRT at 150bpm than at 90bpm of pacing rate and the other without such shortening. The changes in SNRT and CSNRT were both significant in the first group (p less than 0.02 and p less than 0.001, respectively). The fall in blood pressure at 150 bpm was significant in the group with shortened SNRT and CSNRT and it was larger than in the other group: 23 +/- 14mmHg vs. 1 +/- 5mmHg (p less than 0.001). This result suggests a possible modulation of SNRT by a fall of blood pressure via baroreflex.

[Effect of regional phase delay on left ventricular performance studied by radionuclide angiography]

When cardiac hypokinesis in myocardial infarction is analyzed by means of phase analysis of radionuclide (RI) angiography, there are some cases in which the amount of regional wall movement of the left ventricle does not so decline, but the phase delay of regional wall movement is great. Hence, a simulation experiment was performed with a computer to evaluate the influences of regional phase delay on cardiac work. It was assumed that the radius of the model of the left ventricle varies from 3 cm in the late diastolic phase to 2 cm in the late systolic phase, and that in the initial 1/3 time of diastole, the radius alters by 90% of the change. One cardiac cycle (360 degrees) was divided into 60 fractions (1 fraction = 6 degrees), 0 degree being the end of diastole and 180 degrees the end of systole. An ischemic area was supposed to cover S% of the whole volume of the left ventricle, its amount of regional wall movement being P% of the normal area, and the phase delay being R degrees. By varying S, P and R, and taking weighted means of volume curves and normal ones, their assumed volume curves of the left ventricle were computed. Stroke volume (SV) and ejection fraction (EF) obtained from these curves were compared to those obtained from the normal curves, and were expressed in percentage (%SV, %EF). The influences of the changes of S, P and R on the volume curve and on the cardiac work were examined. Then the count curves of the left ventricle (LV) were obtained by gated RI angiography in 22 cases of myocardial infarction and 8 healthy controls, and LV regional wall movements were examined by means of the Fourier analysis. The circular volume was partitioned from the center into eight sections on the LV image of LAO 45 degrees, and the amount of wall movement and the phase delay of each section were evaluated from the count curves of each section. The following results were obtained. %SV and %EF declined with sole occurrence of regional phase delay. Occurrence of the regional phase delay flattened the slope of the volume curve of the initial diastolic phase and formed shoulders on this curve. This was observed also on the count curves actually determined from cases with myocardial infarction. When regional wall movement was markedly decreased, the influence of the regional phase delay on the pattern of the volume curve was slight even if the phase delay was extensive.(ABSTRACT TRUNCATED AT 400 WORDS)

[Characteristic findings of mitral valve and mechanism of mitral valve prolapse in Marfan syndrome]

To elucidate the mechanism of generation of mitral valve prolapse (MVP) in Marfan syndrome, we studied the relations of the length of the anterior mitral leaflet to the diameter of the mitral ring. In 13 cases of Marfan syndrome associated with MVP (Group I), 21 of isolated MVP (Group II), and 24 controls free from valvular disease (Group C), the maximal length of the anterior mitral leaflet (L) and the end-diastolic and end-systolic diameters of the mitral ring (Rd and Rs) were measured in the long-axis views on two-dimensional echocardiograms. In addition, the measurements were corrected with the body surface area; designated as L(c), Rd(c) and Rs(c), respectively. Furthermore, L/Rd and L/Rs, and the percentage of shortening of the mitral ring in systole, (Rd-Rs)/Rd X 100, were obtained. The body surface area in Group I was greater than that in Group II (p less than 0.05), but there was no significant difference between Groups II and C. The L was obviously different between Groups I and II or C (p less than 0.001, respectively). Similarly, there was a significant difference in L(c) between Groups I and II (p less than 0.02) or C (p less than 0.001), indicating the remarkably long anterior mitral leaflet in Group I. The Rd in Group I and II was greater than that in Group C (p less than 0.01 and p less than 0.02, respectively), while there was no significant difference in the Rd(c) among the 3 groups. There was also no statistical difference in either Rs or Rs(c) among the 3 groups. Both L/Rd and L/Rs in Group I were remarkably higher than those in Groups II and C (p less than 0.001, respectively), whereas these parameter did not differentiate Group II from Group C. (Rd-Rs)/Rd X 100 was higher in Group I than that in Groups II and C (p less than 0.05 and p less than 0.01, respectively), but it was not significantly different between Groups II and C. These results suggested that one of the probable mechanisms of generation of MVP in Marfan's syndrome is the redundant mitral valve resulting from a remarkably long leaflet and increased systolic shortening of the enlarged mitral ring.

His-bundle electrogram in the convalescent stage of inferior myocardial infarction complicated with complete A-V block

Twelve patients with inferior wall myocardial infarction complicated with complete atrioventricular block during the acute stage were studied. The His-bundle electrogram was studied in the convalescent stage at an average of 6 months after the acute attack. The age of the patients was 62 +/- 16 years. The width of the QRS complex was within the normal range and the PR interval was less than 200 msec. AH time was 74 +/- 18 msec (mean +/- SD). No split H activity was observed. HV time however, was significantly prolonged in the 12 patients; 54 +/- 12 msec vs. 42 +/- 9 msec in the control group (p less than 0.02). Five patients had HV time equal to or more than 60 msec. Intra-His block was suggested to exist in a high frequency in the patients who had previous complete AV block during the acute stage of myocardial infarction of the inferior wall.

[Regional wall motion of the left ventricle in congestive cardiomyopathy: in comparison with progressive muscular dystrophy of Duchenne type (author's transl)]

The features of regional wall motion abnormalities of the left ventricle were analysed in 11 patients of congestive cardiomyopathy (CCM) in comparison with 22 patients of progressive muscular dystrophy (DMD) of Duchenne type who showed an abnormal motion of the left ventricle by echocardiography. Real time two-dimensional echocardiographic study demonstrated the following results: I) In CCM, (1) only 2 or less of 11 cases preserved a normal motion in each left ventricular segment, and the depression of wall motion of the left ventricle were thought to be generalized; (2) there were 9 cases with segmental wall motion abnormalities and 3 of them demonstrated ventricular aneurysms, and (3) the localizations of the segmental abnormalities varied in each case, and there was no apparent accumulation to any segments. II) In DMD, (1) all the cases showed depressed motions and 8 of them demonstrated a ventricular aneurysm in the posterior wall of the left ventricle (LVPW), (2) while, there was no case showing ventricular aneurysm in the segments other than LVPW, and about one third of all cases showed normal motion in those segments. From these results, we concluded as follows: 1) Although the depression of a wall motion of the left ventricle was generalized in CCM, this was not always uniform and the segmental abnormalities of a wall motion were frequently observed. The localization of the most severely disturbed segment varied in each case. 2) On the other hand, in DMD, the wall motion was disturbed more frequently and more severely in LVPW than in other ventricular segments.

Stroke volume estimated at aortic root in M-mode echocardiography

A noninvasive method for the determination of stroke volume which can be applicable even to a heart contracting asymmetrically is desired. The momentum of blood ejected from heart will be divided into 2 forms; the one is that of blood running away distally and the other is the momentum of the aortic root. SV is estimated by an equation; SVa0 = kXD2XVao1/2XAOT, where D is the diameter of the aortic root, Vao is the mean velocity of the systolic movement of anterior wall, and AOT is the duration of the valve opening of the aortic leaflets. A good correlation was found between SVao and SV measured by the thermodilution method (r = 0.85, p less than 0.001). Since the parameters used in the present method are not affected directly by the mode of cardiac contraction; symmetrical or asymmetrical, it may be useful to determine SV in man.