Visual field deficit: a rare initial symptom of autoimmune pancreatitis

An autoimmune pancreatitis (AIP) patient with metachronous and multiple extrapancreatic lesions is reported. Initial symptoms were proptosis, oculomotor deficits, and a visual field deficit of the left eye, and swelling of bilateral lacrimal glands. Swelling of the right salivary gland and elevated serum levels of hepatobiliary enzymes were detected. AIP associated with IgG4-related orbital pseudotumor, IgG4-related sclerosing dacryoadenitis and sialadenitis, and IgG4-related sclerosing cholangitis was diagnosed. All symptoms and lesions improved with steroid therapy. Although an orbital pseudotumor is a rare extrapancreatic lesion of AIP, we should know that AIP patients may describe unusual symptoms such as abnormal visual field.

Study on the usefulness of precise and simple dynamic balance tests for the evaluation of recovery from intravenous sedation with midazolam and propofol

BACKGROUND AND OBJECTIVE

Dynamic balance involving movement of the centre of gravity is important for the evaluation of street fitness after sedation. The purpose of this study was to compare the recovery of dynamic balance after intravenous sedation with propofol or midazolam, and to investigate the usefulness of simple dynamic balance tests in evaluating the recovery.

METHODS

Fourteen young male volunteers underwent intravenous sedation with propofol and midazolam for 1 h each at an interval of more than 1 week. Computerized dynamic posturography using a multi-axial tilting platform, the 10-m maximum-speed walking test and the timed 'up & go' test (subjects stand up from a chair, walk 5 m and back with maximum speed and sit down again) were performed before and after sedation. The increase in each variable of the tests described above represents a reduction of function.

RESULTS

The score of the computerized dynamic posturography was significantly lower in propofol sedation than that in midazolam sedation until 40 min after the end of sedation (P = 0.006). The scores of maximum-speed walking test and timed 'up & go' test were significantly lower in propofol sedation than those in midazolam sedation till 60 min after the end of sedation, respectively (P = 0.035 and 0.042). The timed 'up & go' and maximum-speed walking tests were well and significantly correlated with computerized dynamic posturography in midazolam sedation (timed 'up & go' test vs. computerized dynamic posturography: r = 0.66, P < 0.01; and maximum-speed walking test vs. computerized dynamic posturography: r = 0.53, P < 0.01).

CONCLUSION

The timed 'up & go' and maximum-speed walking tests are useful simple dynamic balance tests well correlated with precise computerized dynamic posturography for the evaluation of the recovery of dynamic balance from midazolam sedation in younger adults.

Recovery of intentional dynamic balance function after intravenous sedation with midazolam in young and elderly subjects

BACKGROUND AND OBJECTIVE

Computerized dynamic posturography using an intentional postural-sway task can be used to assess body-leaning ability and postural-control ability to prevent falls. Falls are the leading cause of morbidity and mortality for the elderly. The purpose of the present study was to evaluate the recovery of intentional dynamic balance function after intravenous sedation with midazolam in elderly subjects in comparison with that in young subjects.

METHODS

Midazolam was administered in small, divided doses over 4-5 min until the Wilson sedation score reached three in 20 young and 18 elderly male volunteers. The dynamic limits of the stability test, in which subjects leaned their body intentionally as indicated by a cursor moving on a computer screen, was determined before (baseline) and 50, 70, 90, 110, and 130 min after administration of midazolam.

RESULTS

The changes from baseline values of path sway and movement time 50 min after the administration of midazolam in elderly subjects (106.8 +/- 101.0%, 4.6 +/- 3.0 s; mean +/- SD) were significantly greater than those (32.9 +/- 87.2%, 1.9 +/- 2.8 s) in young subjects (P = 0.024, P = 0.008), respectively.

CONCLUSIONS

The elderly show slower recovery of the intentional dynamic balance function than do young adults after intravenous sedation with midazolam.

Assessment of left ventricular systolic function using contrast two-dimensional echocardiography with a high-frequency transducer in the awake murine model of myocardial infarction

The estimation of global left ventricular function using M-mode echocardiography has technical limitations in the murine model of myocardial infarction (MI), but the recent improvements in 2-dimensional (2-D) echocardiography using a high-frequency transducer provide more accessible images. Furthermore, intravenous injection of contrast agent has the additional benefit of enhancing the endocardial border in the murine heart. The present study was designed to evaluate the value of 2-D echocardiography with intravenous injection of contrast agent in the assessment of global systolic function of the murine heart with MI. Two-dimensional and M-mode echocardiography without and with intravenous injection of contrast agent (Optison, 0.1-0.15 ml) were performed in 76 awake mice 2 days before and 2 days after left coronary artery ligation. Fractional shortening (FS) was calculated from the end-diastolic and end-systolic diameters on M-mode echocardiography, and fractional area change (FAC) from the end-diastolic and end-systolic areas on 2-D echocardiography. Both FS and FAC were compared with the areas of hypoperfusion observed in the pathological samples. The use of contrast agent improved the number of hearts that could be evaluated by both the M-mode and 2-D method (M-mode: non-contrast 87% vs contrast 99%, p<0.01; 2-D: non-contrast 26% vs contrast 89%, p<0.001). FAC from the 2-D method correlated better with the region of hypoperfusion in the pathological samples than did FS from the M-mode method (FAC: r=0.84 vs FS: r=0.51). In conclusion, FAC obtained from 2-D contrast echocardiography is useful for noninvasive assessment of global systolic function in infarcted murine hearts and can be used to serially assess systolic function in various models of the murine heart.

Effect of neonatal capsaicin treatment on neural activity in the medullary dorsal horn of neonatal rats evoked by electrical stimulation to the trigeminal afferents: an optical, electrophysiological, and quantitative study

To elucidate which glutamate receptors, NMDA or non-NMDA, have the main role in synaptic transmission via unmyelinated afferents in the trigeminal subnucleus caudalis (the medullary dorsal horn), and to examine the early functional effects of neonatal capsaicin treatment to the subnucleus caudalis, optical recording, field potential recording, and quantitative study using electron micrographs were employed. A medulla oblongata isolated from a rat 5--7 days old was sectioned horizontally 400-microm thick or parasagittally and stained with a voltage-sensitive dye, RH482 or RH795. Single-pulse stimulation with high intensity to the trigeminal afferents evoked optical responses mainly in the subnucleus caudalis. The optical signals were composed of two phases, a fast component followed by a long-lasting component. The spatiotemporal properties of the optical signals were well correlated to those of the field potentials recorded simultaneously. The fast component was eliminated by 6-cyano-7-nitro-quinoxaline-2,3-dione (CNQX; 10 microM), while the long-lasting component was not. The latter increased in amplitude under a condition of low Mg(2+) but was significantly reduced by DL-2-amino-5-phosphonovaleric acid (AP5; 30 microM). Neonatal capsaicin treatment also reduced the long-lasting component markedly. In addition, the decreases in the ratio of unmyelinated axons to myelinated axons and in the ratio of unmyelinated axons to Schwann cell subunits of trigeminal nerve roots both showed significant differences (P<0.05, Student's t-test) between the control group and the neonatal capsaicin treatment group. This line of evidence indirectly suggests that synaptic transmission via unmyelinated afferents in the subnucleus caudalis is mediated substantially by NMDA glutamate receptors and documented that neonatal capsaicin treatment induced a functional alteration of the neural transmission in the subnucleus caudalis as well as a morphological alteration of primary afferents within several days after the treatment.

LV volume quantification via spatiotemporal analysis of real-time 3-D echocardiography

This paper presents a method of four-dimensional (4-D) (3-D + Time) space-frequency analysis for directional denoising and enhancement of real-time three-dimensional (RT3D) ultrasound and quantitative measures in diagnostic cardiac ultrasound. Expansion of echocardiographic volumes is performed with complex exponential wavelet-like basis functions called brushlets. These functions offer good localization in time and frequency and decompose a signal into distinct patterns of oriented harmonics, which are invariant to intensity and contrast range. Deformable-model segmentation is carried out on denoised data after thresholding of transform coefficients. This process attenuates speckle noise while preserving cardiac structure location. The superiority of 4-D over 3-D analysis for decorrelating additive white noise and multiplicative speckle noise on a 4-D phantom volume expanding in time is demonstrated. Quantitative validation, computed for contours and volumes, is performed on in vitro balloon phantoms. Clinical applications of this spaciotemporal analysis tool are reported for six patient cases providing measures of left ventricular volumes and ejection fraction.

Anesthetic inhibition in ischemic and nonischemic murine heart: comparison with conscious echocardiographic approach

It is well known that the level of anesthesia obtained by intraperitoneal injection is variable and may alter cardiac function. In this study, we compared the effects of different anesthetics on cardiac function with the conscious state using high-resolution two-dimensional echocardiography in nonischemic and ischemic mice. Eighty-four mice were tested before and after surgery with ligation of the coronary artery. All 84 mice were studied in the conscious state and under high-dose intraperitoneal anesthesia. Twenty-two of 84 mice were studied under low-dose intraperitoneal anesthesia. Another 22 mice were also studied under gas anesthesia and spontaneous breathing. Experiments in the conscious state were performed by two investigators before the administration of anesthesia: one investigator held the animal and the transducer and the other operated the ultrasound equipment. Left ventricular systolic function was measured, and measurements obtained after surgery were compared with infarcted areas assessed by histological staining. Results showed that both high- and low-dose intraperitoneal anesthesia significantly reduced heart rates and left ventricular contractility in both pre- and postsurgical mice as opposed to conscious mice (P < 0.01). There were significantly higher correlation coefficients between mean fractional area change (FAC) and infarcted area in conscious state compared with high-dose intraperitoneal anesthesia (P < 0.05). The correlation coefficient between FAC and infarcted area during gas anesthesia was also significantly higher compared with high-dose intraperitoneal anesthesia (P < 0.05). In conclusion, conscious experiments or the use of gas anesthesia is preferred for echocardiographic assessment of cardiac function in mice because intraperitoneal injection significantly induces a significant reduction in heart rate and left ventricular systolic function.

Assessment of left ventricular function by real-time 3-dimensional echocardiography compared with conventional noninvasive methods

Quantitative assessment of left ventricular ejection fraction is an essential component of cardiac evaluation. We performed real-time 3-dimensional echocardiography in 56 consecutive patients who underwent multigated radionuclide angiography. Thirteen patients were excluded for the following reasons: 5 for large size of left ventricle required for image acquisition, 5 for suboptimal image quality in real-time 3-dimensional echocardiography, and 3 for atrial fibrillation. Finally, we compared left ventricular ejection fraction assessed by real-time 3-dimensional echocardiography and conventional 2-dimensional echocardiography with that obtained by multigated radionuclide angiography in 43 patients. Left ventricular ejection fraction was determined by real-time 3-dimensional echocardiography with the use of parallel plane-disks and sector plane-disks summation methods. A good correlation was obtained between both real-time 3-dimensional echocardiography methods and multigated radionuclide angiography (r = 0.87 and 0.90, standard error of estimate = 3.7% and 4.2%), whereas the relation between the 2-dimensional echocardiography method and radionuclide angiography demonstrated a significant departure from the line of identity (P <.001). In addition, interobserver variability was significantly lower (P <.05) for the real-time 3-dimensional echocardiography methods than that by the 2-dimensional echocardiography method. Real-time 3-dimensional echocardiography may be used for quantification of left ventricular function as an alternative to conventional methods in patients with adequate image quality.

Neovascularization of ischemic myocardium by human bone-marrow-derived angioblasts prevents cardiomyocyte apoptosis, reduces remodeling and improves cardiac function

Left ventricular remodeling is a major cause of progressive heart failure and death after myocardial infarction. Although neoangiogenesis within the infarcted tissue is an integral component of the remodeling process, the capillary network is unable to support the greater demands of the hypertrophied myocardium, resulting in progressive loss of viable tissue, infarct extension and fibrous replacement. Here we show that bone marrow from adult humans contains endothelial precursors with phenotypic and functional characteristics of embryonic hemangioblasts, and that these can be used to directly induce new blood vessel formation in the infarct-bed (vasculogenesis) and proliferation of preexisting vasculature (angiogenesis) after experimental myocardial infarction. The neoangiogenesis resulted in decreased apoptosis of hypertrophied myocytes in the peri-infarct region, long-term salvage and survival of viable myocardium, reduction in collagen deposition and sustained improvement in cardiac function. The use of cytokine-mobilized autologous human bone-marrow-derived angioblasts for revascularization of infarcted myocardium (alone or in conjunction with currently used therapies) has the potential to significantly reduce morbidity and mortality associated with left ventricular remodeling.

Assessment of segmental wall motion abnormalities using contrast two-dimensional echocardiography in awake mice

Murine models of cardiac disease are becoming an important tool for studying pathophysiological processes. Development of methods to accurately assess ventricular function are therefore important. The purpose of this study was to evaluate the feasibility of echocardiographic assessment of segmental wall motion abnormalities in a murine model of myocardial infarction. Two-dimensional contrast (C+) and noncontrast (C-) echocardiography were performed in 76 awake mice 2 days before and 2 days after left coronary ligation. The short-axis images obtained with two-dimensional echocardiography and corresponding postmortem cross-sectional histological samples stained with Evans blue dye were each divided into 16 segments, and all matched segments were examined for correlation between wall motion abnormalities and myocardial hypoperfusion. With the use of contrast enhancement, the number of visualized segments was significantly increased (base: C- 86%, C+ 98%; midpapillary: C- 57%, C+ 89%; apex: C- 30%, C+ 74%). Agreement between echocardiographically assessed regional wall motion abnormalities and pathologically determined hypoperfusion in basal, midpapillary, and apical levels were 90%, 93%, and 93%, respectively. Agreement between echocardiographically normal wall motion and pathologically normal findings in basal, midpapillary, and apical levels were 99%, 88%, and 71%, respectively. Thus echocardiographic assessment of segmental wall motion in awake mice was feasible and the accuracy was improved with the use of a contrast agent.

Real-time three-dimensional stress echocardiography: a Review of current applications

Cardiovascular stress testing plays a crucial role in the initial detection of coronary artery disease. In exercise stress echocardiography, the rapid acquisition of echocardiographic images is critical for accuracy. Real-time three-dimensional echocardiography permits the rapid acquisition of a volumetric data set that includes the entire left ventricle and allows the review of multiple, standard two-dimensional images from a single volumetric data set. Volumetric data can be obtained using both apical and parasternal windows. Often, satisfactory images are obtained in the majority of both prestress and poststress imaging using only an apical volume set. The following is a review of the current applications of real-time three-dimensional echocardiography in stress testing.

Determination of left ventricular mass by real-time three-dimensional echocardiography: in vitro validation

Twenty-one explanted fixed hearts (14 dogs and 7 pigs) were examined to validate newly developed real-time three-dimensional (RT3D) echocardiography for measurement of left ventricular (LV) mass in vitro and to compare its accuracy and variability with those of conventional echocardiographic measurements. There was an excellent correlation and high degree of agreement for the determination of LV mass between RT3D echocardiography and true mass measurement (r = 0.98; standard error of the estimate [SEE] = 7.3 g; absolute difference [AD] = 2.8 g; y = 1.00 x -4.0, interobserver variability; 5.0%). The conventional echocardiographic methods yielded weaker correlations, larger standard errors, and interobserver variability (area-length method: r = 0.90; SEE = 13.3 g; AD = 13.2 g; 13.3 % / truncated ellipsoid method: r = 0.91; SEE = 14.7 g; AD = 10.5 g; 7. 9% / M-mode: r = 0.91; SEE = 16.2 g; AD = 9.4 g; 15.3%). Determination of LV mass by RT3D echocardiography has a high degree of accuracy and is superior to conventional one- and two-dimensional echocardiographic methods.

[Jichi Medical School Social Support Scale (JMS-SSS) revision and tests for validity and reliability]

OBJECTIVE

To develop a perceived social support scale for the Japanese.

METHODS

Participants consisted of a total of 2,150 residents who responded to a perceived social support scale questionnaire in four communities involved in the Jichi Medical School Cohort Study at the study baseline in 1992-1994 (Analysis I) and 380 residents of Akaike town who responded to a questionnaire survey with the revised scale in 1999 (Analysis II). The first analysis was performed to confirm cross validity of the perceived social support scale measuring the availability of functional support from the spouse, family, and friends. The factor structures estimated for each district were compared with each other. The second analysis was set to revise the scale, modified in terms of a 4-point scoring format. The correlation between each item and a social desirability scale score, Cronbach alpha, and correlation coefficients between the revised scale scores and the original scale scores were calculated.

RESULTS

Cross validity was confirmed based on the similarity of the factor structures of the responses obtained from the four different communities. Four selected indices supported the constancy of the factor structures across the communities. For the revised scale, two items were removed from the original scale-items measuring spousal support because of their statistically significant correlations with the social desirability scale score. The first principal component accounted for 57.0% of variance for spousal support, 68.2% for family support, and 67.0% for friends support and uni-dimensionality of the scales was confirmed. Alpha coefficients of the scales were .89, .95, and .94, respectively. Social support levels were stable over a mean period of 6.2 years.

CONCLUSIONS

On an empirical basis, we have been able to develop a perceived social support scale. Homogeneous data from three different sources were obtained which were free from social desirability response bias and thus applicable for Japanese adults.

Noninvasive assessment and necropsy validation of changes in left ventricular mass in ascending aortic banded mice

Although left ventricular (LV) hypertrophy can be induced by aortic banding, noninvasive assessment of changes in LV mass in mice with a banded ascending aorta by using 2-dimensional (2D) images has not been previously performed. In this study we serially assessed changes in LV mass by 2D echocardiography with a newly available 12-MHz transducer in mice with a banded ascending aorta and validated measurements at necropsy. Estimated by echocardiography, LV mass increased from 74+/- 17 mg before banding to 191.08+/-54 mg at 8 weeks after banding (P <.0001), and excellent correlation was shown with postmortem measurements (r = 0.97). Furthermore, with the use of pulsed Doppler 2-dimensionally guided echocardiography, noninvasive measurement of flow velocities in the ascending aorta before and after the band at the various time points was possible. We propose that 2D echocardiography with a 12-MHz transducer is a powerful tool for serial noninvasive evaluations as an adjunct to the study of cardiac hypertrophy in the murine model.

cAMP pulse during preservation inhibits the late development of cardiac isograft and allograft vasculopathy

The causes of transplant-associated coronary artery disease remain obscure, and there is no known treatment. Preservation injury of murine heterotopic vascularized cardiac isografts caused a small, albeit significant, increase in neointimal formation; preservation injury of allografts markedly increased both the incidence and severity of transplant-associated coronary artery disease. As cAMP is an important vascular homeostatic mediator the levels of which decline during organ preservation, buttressing cAMP levels solely during initial preservation both improved acute allograft function and reduced the severity of transplant-associated coronary artery disease in grafts examined 2 months later. Inhibiting the cAMP-dependent protein kinase abrogated these beneficial effects. cAMP treatment was associated with an early reduction in leukocyte infiltration and a reciprocal decrease in superoxide and increase in NO levels. These data indicate that alloantigen-independent injury to the graft, which occurs at the time of cardiac preservation, can set in motion pathological vascular events that are manifest months later. Furthermore, a cAMP pulse during cardiac preservation reduces the incidence and severity of transplant-associated coronary artery disease.

Histological analysis of murine colitis induced by dextran sulfate sodium of different molecular weights

In this study, we examined the relationship between the molecular weight of dextran sulfate sodium (DSS) and the features of colitis in a DSS-induced mouse model of human ulcerative colitis. DSS at three different molecular weights, 5 kD, 40 kD and 500 kD, was used in this study. DSS was administered in drinking water at 5% (w/v) to 6-7-week-old female BALB/c mice. After 7 days of treatment with DSS, the large intestine was examined histopathologically. Colitis was characterized by a loss of crypts, infiltration of inflammatory cells into the mucosa and submucosa, edema of the submucosa, erosion and ulceration and was observed in mice given the 5 kD and 40 kD forms but not the 500 kD. In the 5 kD group, colitis was observed predominantly in the cecum and upper colon. Colitis in the 40 kD group was more severe than that in the 5 kD group, and in the 40 kD group it was more severe in the lower colon than in the upper colon. These findings suggest the molecular weight of DSS to be an important factor in the murine model of colitis.

Changes in colonic mucosal permeability in mouse colitis induced with dextran sulfate sodium

In this study we examined changes in colonic mucosal permeability induced by dextran sulfate sodium (DSS) during the acute phase of mouse colitis. To induce colitis, the mice were given drinking water containing 5% (w/v) DSS (MW = 40,000) ad libitum. Colonic mucosal permeability was evaluated by the permeation of Evans blue (EB) from the lumen into the wall of the colon on 1, 2, 3 and 7 days postadministration of DSS. Mucosal changes were also histologically examined daily for 7 days postadministration. The permeation of EB increased significantly by days 3 and 7 postadministration. Histological analysis showed that crypt loss was the initial change, with no inflammatory process and the surface mucosal epithelial cells remained morphologically intact. These histological changes developed on 2 to 3 days postadministration. Erosion was first recognized at 5 days postadministration. These findings indicated that the increase in colonic mucosal permeability may have occurred in 3 days postadministration, and the increase in mucosal permeability occurred before the appearance of the inflammatory process. This suggests that an increase in colonic mucosal permeability, leading to the destruction of mucosal barrier function, may play an important role in the induction of DSS-induced murine colitis.

Feasibility of real-time 3-dimensional treadmill stress echocardiography

Rapid acquisition of echocardiographic images is critical for the predictive accuracy of stress echocardiography. Real-time 3-dimensional echocardiography (RT3D) allows review of several standard 2-dimensional images from a single volumetric data set. To assess the feasibility of RT3D for treadmill stress echocardiography, we performed treadmill stress RT3D on 20 volunteers (10 men and 10 women; mean age 32 +/- 6 years) with a device that uses a matrix phased-array transducer in a 60-degree pyramidal volume. Images are displayed as 2 steerable, intersecting B-scan sectors with adjustable C-scan planes parallel to the transducer face. At pre-exercise and immediate postexercise assessment, the volumetric data were obtained from apical and parasternal windows, respectively. Left ventricular segments were divided into 16 standard segments according to criteria defined by the American Society of Echocardiography. The use of both volume sets resulted in visualization of 98% of the segments at peak exercise. Even with only an apical volume set, 89% of the segments were adequately visualized. Image optimization and acquisition time at peak exercise was 35 +/- 18 seconds from the apical window and 50 +/- 28 seconds from the parasternal window. This preliminary study indicates that RT3D treadmill stress echocardiography is feasible and may be an important application of this new 3-dimensional device.

Lipoprotein(a) levels and apolipoprotein(a) isoforms related to life style risk factors

Lipoprotein(a) [Lp(a)] has been considered to be a predictor of premature coronary heart disease and other cardiovascular diseases. Lp(a) levels are largely genetically determined, but the detailed mechanism of Lp(a) elevation is uncertain. We examined the association between Lp(a) levels and apolipoprotein(a) [apo(a)] phenotypes as well as that of Lp(a) level and other various conditions. The subjects were 280 healthy Japanese (102 males and 178 females) aged 39 to 70 years who were living in a rural community in 1992. We obtained apo(a) phenotypes determined by SDS-PAGE as well as Lp(a) levels and other cardiovascular risk factors. We combined apo(a) phenotypes form 4 groups according to molecular weights (from high apo(a) molecular weight to low: I, II, III and IV). Lp(a) levels were associated with apo(a) phenotype-groups, that is, they were inversely associated with apo(a) molecular weight. Small apo(a) phenotypes were less frequent than large ones. The median Lp(a) level was higher in smoking (29.2 mg/dL) than in non-smoking subjects (18.5 mg/dL) in phenotype-group III. Adjusted means of total cholesterol and fibrinogen levels in apo(a) phenotype-group IV were the highest of all phenotype-groups. Age, apo(a) phenotype, smoking status, total cholesterol and fibrinogen were positively correlated with Lp(a) levels by multiple regression analysis. Lp(a) levels were found to be mainly associated with apo(a) phenotype, but varied broadly within the same apo(a) phenotype at various conditions, such as smoking status and high total cholesterol.

Real-time, 3-dimensional echocardiography acquires all standard 2-dimensional images from 2 volume sets: a clinical demonstration in 45 patients

To test the hypothesis that real-time, 3-dimensional (3-D) echocardiography can obtain all standard 2-dimensional (2-D) views from acquisition of 2 volume sets, we scanned 45 patients (24 men, 21 women; mean age 49 +/- 17 years). This real-time 3-D device (VOLUMETRICS Medical Imaging, Durham, NC) uses a matrix phased array transducer in a 60 degree pyramidal volume. Images are displayed as 2 steerable, intersecting, conventional 2-D image sectors that can be oriented throughout 3-D space. By using this equipment, we were able to obtain 93.3% of standard views from a parasternal volume set and 85.2% of standard views from an apical volume set. The mean scanning time was 91 +/- 19 seconds for the parasternal volume set and 86 +/- 22 seconds for the apical volume set. We conclude that standard 2-D views can be obtained in the majority of patients by using this method. This equipment has the potential to substantially decrease the imaging time compared with the standard 2-D echocardiography.

Tissue distribution of dextran sulfate sodium (DSS) in the acute phase of murine DSS-induced colitis

In the present study, we examined histochemically the tissue distribution of dextran sulfate sodium (DSS) in the acute phase of murine colitis induced by administering DSS in the drinking water. DSS was mainly observed in the Kupffer cells of the liver, in the macrophages of the mesenteric lymph node (MLN) and in the lamina propria of the large intestine after administration of DSS. We followed the time course of DSS distribution and found that DSS, which was considered as a large and negatively charged molecule that can not easily cross membranes, was distributed in the liver, the MLN, and the large intestine 1 day after the start of administration of DSS.

Evaluation of mitral valve disease using transesophageal echocardiography

In the past 10 years, clinical application of transesophageal echocardiography (TE) has grown explosively. Intraoperative TE offers a powerful diagnostic and monitoring tool for the physicians in the cardiac operating room. The use of TE revolutionizes the assessment of patients with mitral valve disease. Surgical decisions are often altered based on the information obtained from TE. This review describes the basic features of TE as well as its uses in the intraoperative setting for evaluation of the mitral valve.

[New surgical procedure for patients with dilated heart and end-stage cardiac failure (Batista procedure)]

A 53-year-old man with dilated cardiomyopathy underwent left ventriculoplasty (Batista procedure), a new surgical procedure, which reduces ventricular volume to improve left ventricular function. Left ventricular ejection fraction increased from 19.7% to 43.7%. Unfortunately, he died of pneumonia 12 days after surgery. This is the first such procedure in a human in Japan.

[Surgical treatment of acute Stanford Type-A aortic dissection]

Twelve cases of Stanford Type-A aortic dissection were operated in an acute phase. The male vs female ratio was 3:9, and their ages ranged from 47 to 79 (mean 61.3) years old. Most of them complained of chest and/or back pain, and four of them complained of syncope. Eight patients had the history of hypertension. As to the complications of aortic dissection, cardiac tamponade was seen in two cases, myocardial infarction in one, and transient hemiplegia and paraplegia in one case each. In five cases, moderate to severe aortic regurgitation was also noted. All but one case were operated within twenty-four hours after admission. The replacement of the ascending aorta with a tube graft was performed in all cases including the two cases whose entries were located in the aortic arch. CABG was done concomitantly in three cases, and aortic valve replacement and CABG in one case. The open distal anastomosis was carried out under the systemic circulatory arrest combined with the retrograde cerebral perfusion. The systemic perfusion was reinstituted after the distal anastomosis was completed. In cases whose dissecting pseudo-lumen of the distal aorta was not thrombosed, the arterial cannulation site was shifted from the femoral artery to the tube graft. All but two cases were discharged from the hospital in good condition. One case, who had been transferred to the operating room under cardiac massage due to myocardial infarction, was lost by severe LOS three weeks postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of a perceived social support scale: for a Japanese population]

Social support is increasingly attracting interest in as a factor in epidemiological research of disease risks. However, at present, few methods for measuring social support that can be credited as having reliability and validity exist in Japan. Therefore a perceived social support scale was developed in relation to a population study of a town in Fukuoka prefecture. A method for measuring functional support from several external sources was designed consisting of a self-administered test provided with only two available response options--yes & no. Pretests were conducted twice in order to evaluate content validity and adjust the number of determinants and resulted in spouse, family members, and friends being selected to be primary sources of support. A factor analysis was applied to select 10 conditions with high internal consistency for each of the sources. Responses were scored 0 or 1, for 'no' or 'yes,' respectively. Subsequently each set of 10 variables was summed into an index ranking social support conditions for each of the three sources. The three highest ranking indicators from each of the respective sources were then integrated into a single comprehensive total social support score of the individuals. The inquiry method was applied on 277 adults, aged from 40 to 69 years, in the town. Intercorrelation between the indicators of support derived from the three sources was low and coefficients of reliability ranged from 0.892 to 0.978. The score of each set of the 10 variables were incorporated into a principal components analysis in order to determine factorial validity. All of the first factor loadings of the items measuring support from both spouse and family were greater than 0.7 and high eigenvalues were obtained. Therefore the methods applied to spouse and family were considered adequate to measure a given construct. The items measuring support from friends were divided into two factors, emotional support and tangible support.

[A case of acute aortic dissection associated with myxedema]

A 53-year-old female, who had been severe hypothyroidism for about ten years, was admitted Stanford type A acute aortic dissection. The replacement of ascending aorta with a composite graft and coronary artery bypass grafting were performed immediately. During the post operative period, many complications occurred including delayed awakening from anesthesia, paralytic ileus, colon perforation, hyperbilirubinemia, pulmonary edema, cerebral hemorrhage and bacterial endocarditis. In this case, intravenous administration of steroid and thyroid hormone was effective to keep hormone level in the normal range although enteral administration was ineffective. It was suggested that early active supplement therapy is mandatory to prevent postoperative complications.

[A case of bronchial rupture and pulmonary laceration caused by blunt chest trauma]

A 37-year-old female was crushed by a traffic accident. She was in severe respiratory distress. A chest X-ray revealed right pneumothorax and multiple rib fractures. Shortly after the initiation of the positive pressure ventilation, severe subcutaneous emphysema developed and she became shock. The bronchoscopy showed the rupture of the right main bronchus which was repaired through a right posterolateral thoracotomy using interrupted monofilament PPP sutures. Pulmonary lacerations were also repaired by the same sutures. Postoperative bronchoscopic examination showed good healing without any stricture. It cannot be overemphasized that accurate diagnosis and urgent surgical management is mandatory in patients with bronchial rupture.

Presence of multinucleate cells in the papillary layer of the Macaca fuscata enamel organ

The enamel organ of Macaca fuscata from post-secretory transition to the early maturation stage of was investigated by means of light and electron microscopy. Unusual, large multinucleated cells were observed in the papillary layer. These cells contained organelles characteristic of the maturation stage ameloblast and often extended to the enamel surface, suggesting a possible origin from the ameloblast layer.

Isolation of xylose reductase gene of Pichia stipitis and its expression in Saccharomyces cerevisiae

A NADPH/NADH-dependent xylose reductase gene was isolated from the xylose-assimilating yeast, Pichia stipitis. DNA sequence analysis showed that the gene consists of 951 bp. The gene introduced in Saccharomyces cerevisiae was transcribed to mRNA, and a considerable amount of enzyme activity was observed constitutively, whereas transcription and translation in P stipitis were inducible. S. cerevisiae carrying the xylose reductase gene could not, however, grow on xylose medium, and could not produce ethanol from xylose. Since xylose uptake and accumulation of xylitol by S. cerevisiae were observed, the conversion of xylitol to xylulose seemed to be limited.

Electron-immunocytochemistry of laminin and type-IV collagen in the junctional epithelium of rat molar gingiva

The present study was carried out to examine the ultrastructural localization of laminin and type-IV collagen in the junctional epithelium of rat molar gingiva by means of the indirect immunoperoxidase method. Intense laminin reaction occurred in both the internal and the external basal laminae. Laminin reaction products were observed within the cisternae of the rough endoplasmic reticulum of junctional epithelium cells and in concavities formed at the distal plasma membranes adjacent to the basal lamina. Small spherical bodies occurring in the concavities also reacted positively to laminin. Type-IV collagen reaction was intense in the external basal lamina. The internal basal lamina, however, showed no reaction for type-IV collagen. These results indicate that the internal basal lamina contains laminin but no type-IV collagen and that junctional epithelium cells seem very likely to be involved in the production of laminin.

Evidence for uptake of basement membrane by differentiating ameloblasts in the rat incisor enamel organ

Demonstration of type-IV collagen and acid phosphatase (ACPase) was carried out in the rat incisor enamel organ after the animals were fixed by perfusion with periodate-lysine-paraformaldehyde. Their incisors were dissected out, demineralized with EDTA, and prepared into 6-microns-thick frozen sections. The sections, which had been treated by means of antibody incubation for type-IV collagen, were washed with a Trismaleate buffer, incubated in Novikoff's medium for acid phosphatase (ACPase), and then incubated in a 3, 3'-diaminobenzidine solution. After osmification, the sections were embedded in epoxy resin for electron microscopy. The plasma membranes of the distal ends of the inner-enamel-epithelial cells were relatively even and were lined with a basement membrane. Type-IV collagen was localized both in the lamina densa and in the filaments attached to the lamina densa. In differentiating ameloblasts, the remarkably undulating distal plasma membranes formed irregular shallow and deep invaginations, and small cytoplasmic processes that penetrated the basement membrane. Coated pits occurred in various parts of these undulating plasma membranes. Positive reaction to type-IV collagen was observed in the invaginations and coated pits. ACPase-positive granules, present in inner-enamel-epithelial cells, increased in number and sometimes appeared close to both shallow and deep invaginations of differentiating ameloblasts. These results indicate that type-IV collagen in the basement membrane of the enamel organ is removed and degraded by differentiating ameloblasts by means of their engulfing system.

Ultrastructural changes in rat-molar cementoblasts after administration of puromycin

Ultrastructural changes in rat-molar cementoblasts after administration of puromycin were observed. Young Wistar male rats were injected with 200 mg/kg of puromycin dihydrochloride. At 10, 30, 60, and 180 minutes after the injection, the animals were fixed by perfusion with 2.5% glutaraldehyde-2.0% paraformaldehyde. After perfusion, the lower first molars were dissected out of the mandibles, and their cementoblast were observed in an electron microscope. Striking changes were seen in the Golgi apparatus and the rough endoplasmic reticulum after puromycin administration. The Golgi saccules were dilated and devoid of content. Golgi vacuoles and secretion granules were reduced in number. Numerous small, smooth-walled vesicles, 45-70 nm in diameter and a large number of coated vesicles were present in the Golgi area. The rough endoplasmic reticulum showed unusual shapes and arrangement. Ribosomes attached to the reticulum lost polysomal arrangement. These changes progressed following the time elapsed after experiment, and a great number of large vacuoles which contain fine flocculent material came to predominate the supranuclear areas of the cementoblasts.

Ultrastructure and composition of enamel in human dental fluorosis

Materials used in this work were 13 permanent molars exhibiting dental fluorosis (between 5 and 9 on the Thylstrup-Fejerskov scale, 1978) obtained from adults (aged 20-40 years) living in regions with 3.5 ppm fluoride in the water supplies. Small but deep occlusal caries lesions necessitated extraction. Light and polarized microscopic, microradiographic, electron microscopic, and electron-probe- and ion-micro-analytical studies were made. Enamel surfaces were generally cloudy to opaque, with several pits or defects of various sizes and degrees of brown-staining. An extensively hypomineralized area extended from the inner enamel to the surface layer, which was mineralized to a high degree. The hypomineralized area contained sparsely arranged, flattened, hexagonal crystals with either perforated centers or defects extending from the perimeter and indicating either no or low fluoride content. The highly mineralized surface layer, however, was composed of many large, flattened, hexagonal crystals and extremely small, irregularly shaped crystals. Both types were free of central perforations and defects. A high fluoride concentration was determined in the highly mineralized surface layer. These findings suggest that the hypomineralized area undergoes caries-like changes in terms of crystal dissolution and that the highly mineralized surface layer contains hydroxyapatite and fluoridated-hydroxyapatite, or fluorapatite, or both.

Epithelial-mesenchymal junctional area in an early stage of odontogenesis in Macaca fuscata

The epithelial-mesenchymal junctional area in tooth germs of one- and three-year-old Japanese monkeys was studied with electron microscopy.

The plasma membranes at the distal ends of inner enamel epithelium cells were relatively even, and were associated with basement membrane. A large number of filaments, which were 15 nm in diameter and up to 2 μm in length, were present, extending perpendicularly from the basement membrane toward the dental papilla, forming an unique fibrillar layer. The distal cytoplasm of the cell contained rather few vesicles and granules which were positive for the acid phosphatase reaction. The distal ends of differentiating ameloblasts showed irregular undulations and numerous small processes which penetrated through the basement membrane and fibrillar layer. Following an increase of the undulations, the fibrillar layer and the basement membrane were engulfed by the cells and removed from the surface of pre-dentin. Large irregular bodies, which were filled with the filaments of the disintegrating fibrillar layer, were observed frequently. The distal cytoplasm contained a large number of coated pits, coated vesicles, and acid-phosphatase-positive granules. The fibrillar layer then disappeared, being replaced by collagen fibrils in the pre-dentin, which was in the stage of early mineralization.

These results indicate that the fibrillar layer is removed by the differentiating ameloblasts and degraded through an engulfing system which is formed by the cell surfaces.

Intracrystalline structure of enamel crystals affected by caries

Enamel crystals in the demineralized zones in early caries lesions of human teeth were observed by high-resolution electron microscopy. The enamel crystals frequently exhibited perforations in their centers and defects of various sizes on their lateral surfaces. There were a number of small electron-lucent spots, suggesting that the dissolution of crystals had taken place there. These spots were in especially large numbers near the central dark line. The central perforations, the lateral defects, and the small spots had a common habit which formed regularly along the crystalline a- and b-axes. In many cases, when the central dark line was seen, the perforations were located a few unit cells away from the line. The perforations seem to result from a fusion of small spots, which enlarge by involving other small spots. The lateral defect seemed to enlarge by removal of unit cells and progression along the a- and b-axes. In the regions where the small spots were present, however, the enlargement of the defects also progressed involving the spots. The central dark line seems to be rather resistant to dissolution. One of the main factors for the central perforation of the crystals is thought to be the presence there of especially large numbers of defective sites.

Lack of tuberculin activity of synthetic peptides

We synthesized an octapeptide, H-Asp-Gly-Gly-Ser-Glu-Ser-Glu-Gly-OH, and a hexadecapeptide, H-Asp-Gly-Gly-Ser-Glu-Ser-Glu-Gly-Lys-Asn-Gly-Ser-Gln-Met-Arg-Leu-OH, which corresponded to amino acids 61 to 68 and 61 to 76, respectively, of the amino acid sequence of a crystalline protein reported to be tuberculin active. Authenticity and purity of the synthesized peptides were confirmed by high-pressure liquid chromatography, amino acid analysis, mass spectrometry, and protein sequencer analysis. Tuberculin activity of the synthesized peptides was examined in guinea pigs sensitized with Mycobacterium tuberculosis or Mycobacterium bovis BCG and in tuberculin-positive healthy humans. Neither the octa- nor the hexadecapeptide was as active as tuberculin skin-test antigen.

Unusual collagen aggregates induced in rat incisor dentin after vinblastine administration

Young male Wistar rats weighing 100 g were injected intravenously with 0.2 mg of vinblastine sulfate (VBL). At 24, 27, and 36 hours and 2, 4, and 6 days after introduction of the drug, the rats were fixed by means of perfusion and the upper incisors were removed for electron microscopy. Many secretion granules had accumulated in the young odontoblasts 24 hours after VBL administration. Newly formed predentin located between odontoblasts contained small amounts of an unusual collagen aggregate characterized by a fine, symmetrically striated structure, and paired, dense bands, which were present at both ends. After 27 hours, following the disappearance of the secretion granules in the odontoblasts, unusual collagen aggregates had increased in amount. Two days after administration, the predentin layer, which was close to the odontoblasts, was composed largely of unusual collagen aggregates. During dentinogenesis, the layer of unusual collagen aggregates gradually shifted into the dentin, where, 4 days after VBL administration, it was, to a large degree, located. Mineralization of the unusual collagen aggregates began with the deposition of fine, filamentous crystals that later grew into needle-shaped crystals 40 A thick. These findings suggest that unusual collagen aggregates are produced as a result of the secreting function of odontoblasts and are mineralized, as are normal collagen fibrils in dentin.

Ultrastructural changes in the cementoblasts of rat molars after injection of vincristine

Cytological changes in the cementoblasts of rats treated with vincristine were investigated. Accumulation of secretion granules indicated a disturbed secretory mechanism in the cells. Conspicuous dilation of the endoplasmic reticulum suggested disturbance in the transport of substances from the rough endoplasmic reticulum to the Golgi elements. These disturbances were interpreted to be a result of disruption of microtubules.

Ultrastructural changes of secreting rat-incisor ameloblasts following administration of vincristine and vinblastine

Ultrastructural changes of secreting rat-incisor ameloblasts after administration of vincristine and vinblastine were observed. Polarity of nuclei and cytoplasmic organellae was remarkably disturbed; consequently, the regular secreting orientation of cellular products was altered greatly, leading to heterotopic deposition of large amounts of enamel matrix.

Electron microscopic study on the effects of vinblastine on young odontoblasts in rat incisor

Young Wistar male rats were injected intravenously with 2 mg/kg of vinblastine sulfate. After three, six, 12, 24 and 48 hours, the upper incisors were dissected out of the animals, and their young odontoblasts were observed in an electron microscope. Three to six hours after the injection, the regular polarity of the nuclei and the cytoplasmic organelles were dramatically changed following a decrease in the number of microtubules. Disturbance in protein synthesis was suggested at this stage by unusual shapes and the arrangement of the rough endoplasmic reticulum and loss of the polysomal arrangement of the ribosomes attached to the reticulum. After more than 12 hours, accumulation of secretion granules and the occurrence of bodies, containing a few strands of collagen-like fibrils, were frequently seen in various portions of the cells, indicating retarded export of the secretion substance. Occurrence of a number of unusually short fibrils in predentin was another prominent feature noticed in later stages. The fibrils were about 3000A long by 2000A or 600A wide, and many of the 2000A wide fibrils were characterized by a banded structure which resembled the previously reported SLS collagen. The 600A wide fibrils were usually banded with about 600A periodicity.