"Ischemia at a distance" during intermittent coronary artery occlusion: a coronary anatomic explanation

The mechanism of electrocardiographic ST segment changes during acute coronary occlusion was evaluated in 28 consecutive patients with single vessel coronary artery disease undergoing coronary angioplasty. Patients were continuously monitored with a six lead electrocardiogram. Twenty-three patients showed ST changes in the primary zone of occlusion, and 13 of these had additional ST changes in a remote zone. Ten of these 13 had unusually extensive arteries supplying the remote zone. The balloon occluded two adjacent normal arteries in two patients, and no coronary anatomic explanation was evident in one patient. Ten patients with striking primary zone ST changes showed no remote change. Seven had nonextensive primary zone arteries, and three others had abundant collateral vessels. Five patients showed no electrocardiographic changes in primary or remote zones. Four had collateral vessels, and one had left ventricular hypertrophy on the baseline electrocardiogram. It was concluded that remote electrocardiographic changes are probably due to occlusion of unusually extensive coronary arteries and are not simply reciprocal.     

Nail involvement in leprosy: a study of 300 patients

Three hundred leprosy patients were recruited to study the pattern and frequency of nail changes. Nail changes, like longitudinal ridging in finger nails, transverse striations involving both finger and toe nails etc. which occurred with similar frequency in the PB and MB patients in comparison with the control group, were excluded from the analysis. Out of a total number of 150 PB patients, 84 (56%) showed nail changes. Fifty-eight (38.6%) patients showed changes in the finger nails, with an average of 3.2 involved nails per patient. Fifty-three (35.3%) patients showed changes in the toe nails, with an average of 3.0 nails per patient. The most common change observed was longitudinal melanonychia (32.4%) in the finger nails and longitudinal ridging (46.3%) in the toe nails.In comparison, 131/150 (87.3%) MB patients showed nail changes. Finger nail changes were seen in 102 (68%) patients with an average of 5.5 nails affected per patient. Changes in toe nails were seen in 116 (77.3%) patients, with an average of 6.0 nails involved per patient. The most common nail change observed was longitudinal melanonychia in 89/523, (17%) of the total involved finger nails and subungual hyperkeratosis in 164/702, (23.4%) of the total toe nails involvement. Out of a total of 32 colony patients, 31 (96.9%) showed nail changes both in finger and toe nails with an average of 7.9 and 8.4 affected nails per patient, respectively. The most common nail change observed was rudimentary nail(s) on fingers (29%) and toes (21.1%). Among MB patients, a significantly higher number had finger nail involvement in LL group. The frequency of nail involvement for both fingers and toes was significantly greater in LL as compared to BL group of patients. The frequency of nail involvement was significantly more in patients having disease for more than 5 years and in those having trophic changes secondary to loss of sensations and impaired circulation.     

Non-invasive evaluation of the haemodynamic effects of amiodarone

Sixteen patients were examined hemodynamically with echocardiography, calibrated apexcardiography, and systolic time intervals before treatment, after 1 week treatment with amiodarone 600 mg daily and after 2-4 months treatment with 300 mg daily. During the treatment thyroid function was controlled. The echocardiogram showed a small increase in shortening fraction, while left ventricular dimensions did not change significantly. The apexcardiogram revealed minor changes, which could not be interpreted as being due to changes in contractility. The systolic time intervals showed marked decreases in preejection period index and preejection period/left ventricular ejection time. These changes could not be correlated to changes in serum thyroxine, which was the only thyroid parameter to change significantly. The hemodynamic changes during amiodarone treatment were interpreted as mainly being due to a decrease in afterload while possible changes in preload and myocardial contractility were of minor importance.     

Progression of radiological changes in relapsing and chronic pancreatitis

Progression of radiological changes was noted in 19 (22.1%) of 86 cases of relapsing or chronic pancreatitis followed by serial pancreatograms. The initial feature of chronic pancreatitis was focal minimal pancreatitis, characterized by an irregular dilatation of several side branches on the pancreatogram. Some patients with focal minimal pancreatitis demonstrated progression of the extent and severity of changes only in side branches while others progressed further to moderate or advanced chronic pancreatitis showing changes in the main pancreatic duct. Most of the progressive cases were alcoholic, and some showed progression to advanced pancreatitis within 4 years. Rapid progression of radiological changes was associated with relapses of acute pancreatitis. No remarkable changes were observed in many non-alcoholic patients, whereas some cases complicated with gallstones showed progression of disease in the side branches during a follow-up period of 3-7 years.     

风湿性心脏病心房颤动患者心房肌超微结构改变的研究

探讨风湿性心脏病(简称风心病)心房颤动(简称房颤)患者心房肌超微结构改变与房颤维持的相关关系。选取进行人工瓣膜置换术的风心病房颤患者24例为房颤组,风心病窦性心律(简称窦律)患者12例为窦律组。上述患者于手术时取左心耳心肌标本,进行电镜的定性研究。结果:与窦律组相比,房颤组心房肌的超微结构特点有:心肌细胞肌原纤维溶解、断裂,线粒体占据了肌原纤维的位置;在肌原纤维溶解区糖原积聚,形成“糖原湖”;线粒体数量明显增多,且大小不一;细胞核异型明显;闰盘扭曲,盘旋重叠,模糊、不连续;心肌间质纤维增生明显。结论:风心病房颤组患者心房肌超微结构改变可能是导致风心病患者房颤持续的重要病理基础。     

Biliary adenofibroma with ominous features of imminent malignant changes

Biliary adenofibroma (BAF) is a rare, benign liver tumor. Herein, we report a case of BAF with histological features of imminent malignant changes. Ultrasound and CT revealed a solid 2.5-cm mass in the right liver lobe. The patient was asymptomatic and had no past medical history including liver disease. A general examination that included the abdomen and the laboratory data were normal. Because of the increase of its size, this tumor was surgically resected. Grossly, a 3.5-cm nodular mass abutted on the hepatic capsule was found, and its cut surface showed a well-circumscribed, whitish, and firm lesion that showed microcystic changes in the periphery and solid changes in the central parts. Histologically, the tumor showed a proliferation of tubulocystic structures embedded in a fibrous stroma. Microcysts were prevalent in the periphery, while tubular components with abundant fibrous stroma were in the central parts. The tubules were variably dilated and branched. This case closely resembled the previously reported cases of BAF, except that there were complicated papillary projections with fine fibrovascular cores in some of the microcysts and that the epithelial component in papillary projections showed dysplastic changes and increased cellular proliferative activities, implicating ominous features of imminent malignant changes. These dysplastic and papillary changes may be an intermediate lesion leading to malignancy, which have occasionally been reported in BAF.     

Binswanger病与Alzheimer病脑电地形图对比研究

本文对照观察了Ｂｉｎｓｗａｎｇｅｒ病（ＢＤ）和Ａｌｚｈｅｉｍｅｒ病（ＡＤ）各３０例患者脑电地形图的变化。结果发现，ＢＤ患者局灶性和阵发性脑电改变的阳性率明显高于ＡＤ患者，并且双侧脑电功率谱不对称，以额、中央、枕区θ波多见，而ＡＤ患者双侧功率谙基本对称，以额、颞、顶区δ波多见。ＢＤ患者智能障碍程度与脑电异常改变有显著相关性，提示脑电地形图检查对ＢＤ和ＡＤ的鉴别诊断有参考价值。     

Palm temperature monitoring during exercise in patients with heart disease

The quantitative use of palm temperature changes during a fixed-load treadmill exercise was evaluated in normal subjects and patients with various degrees of cardiac disability. Treadmill exercise revealed different temperature patterns between subject groups. Normal subjects showed an initial transient decrease to a plateau phase, followed by a prompt return to the control level after cessation of exercise. Cardiac patients with severe disabilities showed a progressive decrease during and even after exercise, and the return to the control level was delayed. Patients with less severe cardiac disabilities showed an intermediate pattern. A significant correlation was observed between the temperature pattern and the plasma catecholamine concentration. The simultaneous measurement of forearm and hand blood flow, and palm temperature during a supine ergometer exercise showed that the temperature change reflected the blood flow changes. In conclusion, palm temperature monitoring during treadmill exercise is a simple and useful method for assessment of the vasoconstrictor response to exercise and, therefore, the pattern of temperature changes indicates indirectly the exercise capacity in heart disease.     

Histoclinical Long-standing Follow-up Study of Hyperplastic Polyps of the Stomach

In a series of 2,013 gastric polyps in 1,201 patients, morphological and histopathological studies have been performed. Ninety-three hyperplastic polyps in 56 patients have been followed-up endoscopically and histopathologically for five to 12 years. The incidence of detection of gastric polyps has increased: 1.4% in 1967 to 8.7% in 1979 year by year. Thirty patients (54%) among the 56 showed changes in number, size or shape of polyps during follow-up. Twenty patients (37%) revealed numerical changes (increase in 16 patients, reversion in three patients and vanishing in two patients).
Twenty-eight polyps (30%) showed morphological changes, six of them showed continuous enlargement, 18 lesions repeated enlargement, stationary or reduction stages, three lesions were reversed and two polyps disappeared.
Histopathologically, three lesions showed transformation from the hyperplastic type to adenoma while demonstrating morphological enlargement. Two of these showed increase in cellular atypia, from the hyperplastic type through adenoma with severe atypia and finally to carcinoma in the polypectomy specimens. From this study, it was concluded that although hyperplastic polyps show changes in size, shape or number with passage of time, malignant changes occur in only a few cases.     

Postextrasystolic T wave changes and angiographic coronary disease.

The significance of postextrasystolic T wave changes in beats following induced extrasystoles was assessed by angiography in 55 patients. These T wave changes were found in 81 per cent of coronary artery disease patients but also in 68 per cent of patients with normal coronary arteries (PNS). All patients with normal baseline electrocardiograms and normal coronary arteries showed postextrasystolic T wave changes. In electrocardiographic leads corresponding to the distribution of major coronary arteries, T wave changes occurred just as frequently when the artery was normal (54%) as when the artery was stenosed (55%). Left ventricular asynergy was not associated with an increased frequency of postextrasystolic T wave changes and in fact ejection fraction was greater end-diastolic pressure lower in patients with T wave changes. Thus, postextrasystolic T wave changes appear not to be useful in diagnosing or localising coronary artery disease.     

Role of myocardial scintigraphy with thallium-201 in the characterization of episodes of transient ischemia at rest. Clinical and electrocardiographic correlates

In the past ten years we studied 80 patients with angina at rest by 201-Thallium perfusion scintigraphy. According to ECG changes during episodes of transient ischemia at rest, the patients were divided into three groups. Thirty six patients showed transient ST segment elevation (Group 1); 33 ST segment depression (Group 2) and 11 normalization of negative T waves (Group 3). 201-TI scintigraphy was performed during spontaneous or ergonovine induced episodes of ischemia and at redistribution. Group 1 showed localized and severe perfusion defects, well correlated to the site of ECG changes. Group 2 showed more diffuse and less severe perfusion defects, less correlated to the site of ECG changes. Group 3 showed perfusion defects similar to those observed in Group 1 and associated in 54% with basal perfusion defects due to previous myocardial infarction. In conclusion: A) three main perfusion patterns are associated with the three types of ECG changes; B) relative to ECG, myocardial scintigraphy provides a more accurate definition of the site and extension of ischemia, particularly in Group 2 patients.     

Changes in airflow obstruction and oxygen saturation in response to exercise and bronchodilators in cystic fibrosis

The airway response to exercise and inhaled terbutaline was assessed in 25 patients with cystic fibrosis (CF), seeking evidence for the possible deleterious effects of bronchial muscle relaxation. We postulated that "early" and "late" flows, taken from the full maximum expiratory flow volume curve, might move paradoxically in patients with unstable airways. Oxygen saturation was measured continuously; desaturation occurred early in exercise with partial recovery thereafter. This was unrelated to changes in expiratory airflow measurements. Both during and after exercise, and after inhaled bronchodilator, changes in expiratory airflow measurements were strikingly variable. Changes in individual measurements should be interpreted in relationship to the within-subject variability of the test in patients with CF. During exercise, there was a significant increase in mean FEV1; this was most marked in patients with worst lung function. Two patients (both with severe lung disease) showed paradoxical changes in early and late flows. After exercise, only two patients showed the asthmatic pattern of postexercise bronchoconstriction. After inhaled bronchodilator, the group as a whole showed small but statistically significant increases in expiratory airflow measurements. Those with highest baseline FEV1 had the greatest bronchodilator response; this is the opposite of the pattern observed in asthma. Paradox did not occur after bronchodilators and only one patient showed a significant fall in late expiratory airflow. This pattern of expiratory airflow changes is compatible with the concept of airway instability in which any beneficial effects of bronchial tone reduction are canceled out by the effects of compression of damaged airways rendered more compliant by loss of bronchial wall tone. We did not observe any clinically important deleterious effects from this mechanism.     

Immunohistochemical investigation of pericytes in chronic venous insufficiency.

Patients with chronic venous insufficiency show typical glomerulum like alterations of cutaneous capillaries. Objective of this study was to determine any changes of the alignment of pericytes around cutaneous capillaries in CVI patients. Skin biopsies from the area of the medial malleolus were taken from 42 patients with CVI, 5 healthy individuals and 11 cadavers without history of CVI. Sections were stained with HHF35, anti alpha and gamma muscle actin with the avidin-biotin-peroxidase method (ABC) and anti vimentin with the alkaline phosphatase anti-alkaline phosphatase technique (APAAP). The stage of stasis dermatosis was assessed and sections were examined for pericyte changes. Among the collective of 42 patients with CVI, 31 patients showed slight or severe pericyte changes, 11 patients were without changes. None of the sections from cadavers or healthy patients showed any pericyte changes. Pericytes are among other functions possibly involved in microvasculature regulation and wound healing. Thus destruction of the pericyte envelope might lead to microcirculatory dysfunction. This could be one of the causes that lead to leg ulcers in CVI.     

Postextrasystolic T wave changes and angiographic coronary disease.

The significance of postextrasystolic T wave changes in beats following induced extrasystoles was assessed by angiography in 55 patients. These T wave changes were found in 81 per cent of coronary artery disease patients but also in 68 per cent of patients with normal coronary arteries (PNS). All patients with normal baseline electrocardiograms and normal coronary arteries showed postextrasystolic T wave changes. In electrocardiographic leads corresponding to the distribution of major coronary arteries, T wave changes occurred just as frequently when the artery was normal (54%) as when the artery was stenosed (55%). Left ventricular asynergy was not associated with an increased frequency of postextrasystolic T wave changes and in fact ejection fraction was greater end-diastolic pressure lower in patients with T wave changes. Thus, postextrasystolic T wave changes appear not to be useful in diagnosing or localising coronary artery disease.     

The respiratory function in children with collagen disease]

Respiratory function tests were performed on 60 children with collagen disease. Twenty-seven cases (45%) showed abnormalities in the respiratory function. These abnormalities were restrictive in 14 cases (52%), obstructive in 6 cases (22%), and mixed type in 7 cases (26%). Eight out of 14 SLE patients (57%) showed abnormalities of various types. Abnormalities were seen in 9 out of 25 JRA patients (36%) including 6 cases (67%) with restrictive type changes. Four out of 6 MCTD (67%) and 3 out of 9 DM (33%) patient showed functional abnormalities. Most of patients with these two types of collagen disease showed restrictive changes. Investigations performed by a research group of the Ministry of Health and Welfare showed the incidence of restrictive type changes (% VC less than 80) in adult patients of collagen disease to be in the following descending order: PM/DM greater than PSS greater than MCTD greater than SLE. Though small in number, our investigation revealed that a considerable proportion of MCTD and SLE patients showed restrictive changes in respiratory function. In evaluating the clinical course of the disease, it was thus considered to be important to follow up the progress of respiratory functions in children with collagen disease.     

Pathology of Kawasaki disease: II. Distribution and incidence of the vascular lesions.

Histopathology, distribution and incidence of vascular changes were studied in tissues obtained at autopsy on thirty-seven children. Elastic and musculoelastic arteries showed a high incidence of arteritic changes, however the degree of the lesions was in general mild to moderate with the exception of the iliac artery, which revealed severe changes and a necrotizing panarteritis which was often accompanied with an aneurysm formation. A high incidence of arteritic changes, of which main histological feature was necrotizing panarteritis, was seen in extravisceral middle sized arteries. The coronary artery in particular was involved in each case and most had an accompanying aneurysm, some of which had ruptured. Intravisceral small sized arteries showed a relatively low incidence of arteritic changes and the degree of inflamation was in general mild. Phlebitis was present in over half the number of patients. The degree of lesions was mild in the small veins and mild to moderate in the large veins. Vascular lesions in Kawasaki disease should be termed systemic vasculitis rather than a systemic arteritis. There was a correlation between the caliber of involved vessels and the degree of vascular lesions. According to the histopathology, distribution and incidence of angitis, Kawasaki disease does resemble infantile periarteritis nodosa with the exception of the different manner of the coronary and iliac involvement.     

Repolarization analysis in children with the long QT syndrome

QT duration changes were analysed in 26 children with long QT syndrome (median age 9 years). With 12-lead Holter recordings, we found that macroscopically QT adaptation to heart rate changes was slow and only 3 of 26 patients showed abrupt changes in QT interval duration. These changes in the time domain were always accompanied by changes of STT morphology in the 3 of 26 patients. Application of Bazett′s heart rate correction algorithm was inappropriate to show true QT changes in this young patient group due to temporary typical large cycle length variations, where moreover an overcorrection of the heart rate impact resulted in reflection of RR interval changes rather than true QT duration changes.     

Haematological profiles after Intensive phase of Anti Koch Treatment with special emphasis on bone marrow changes

BackgroundTuberculosis remains a major public health problem in various parts of the world. It leads to various haematological changes. Study of these haematological changes will help better patient management.Objective & methodsIt is to evaluate haematological changes in tuberculosis patients and compare the result with special emphasis to bone marrow changes as active case search is sharply decreasing the miliary tuberculosis. It is also to evaluate the patients with before and after the Intensive Phase of Anti Koch Treatment. Sputum positive and sputum negative tuberculosis patients confirmed by other ancillary techniques were included into this study. It is conducted at a tertiary level hospital in rural area.ResultIn this study bone marrow hypercellularity was of erythroid series with only 1.92% patients showed granuloma in bone marrow aspiration. In addition to bone marrow changes, significant changes were evident in haemoglobin level, Erythrocyte Sedimentation Rate (ESR) Total White Blood Cell count and RBC count.DiscussionIn majority cases this study showed Erythroid Hyperplasia. It is sharp contrast with other study where myeloid hyperplasia was evident. This study also differs from other study where high number of bone marrow granuloma was reported. In this study only 1.92% cases showed bone marrow granuloma. This study also documented higher number of anaemic cases mostly because of the institute serves poor and tribal population.ConclusionIn our study the cases showing granuloma and hyperplasia of myeloid series were limited. With introduction of Directly Observed Treatment and house to house active case search helped to sharply decrease bone marrow granuloma by limiting multi-organ spread. This study showed, ESR level may be considered as prognostic parameters of tuberculosis.     

原白头翁素衍生物对人乳腺癌MCF-7细胞的抗增殖与诱导凋亡作用

目的探讨原白头翁素衍生物（溴甲基呋喃酮）体外对乳腺癌MCF-7细胞株的抗增殖及诱导凋亡作用。方法应用MTT法、倒置显微镜、HE染色、扫描电镜技术、吖啶橙/溴化乙锭荧光染色方法以及流式细胞技术检测原白头翁素衍生物对体外培养的人乳腺癌MCF-7细胞的诱导凋亡及细胞形态学改变。结果MTT法示不同浓度原白头翁素衍生物对MCF-7细胞株均有抗增殖作用,并呈时间—浓度依赖性。倒置显微镜、HE染色、扫描电镜观察示核固缩、碎裂、凋亡小体形成等典型形态学改变。AO/EB双染色结果显示细胞死亡主要以凋亡为主。流式细胞示随着药物浓度的增加细胞凋亡率亦逐渐升高,S期细胞所占比例增大。结论原白头翁素衍生物在体外对人MCF-7乳腺癌细胞株有抗增殖及诱导凋亡作用。