An Acute Myocardial Infarction Case that Survived An Out‐of‐Hospital Cardiac Arrest in Which Prominent Ischemic J Waves Were Documented

We describe a case of a myocardial infarction, in which prominent ischemic J waves were documented during recurrent ventricular fibrillation attacks. The patient was referred to our hospital to treat an out‐of hospital cardiac arrest. Although the 12‐lead electrocardiogram obtained just after the first cardioversion did not show any apparent J waves, a J wave‐like steep downsloping type ST‐segment elevation associated with q waves in the inferior leads was documented during multiple episodes of ventricular fibrillation. Our report revealed the appearance of J waves as an important marker for lethal arrhythmias in acute ischemia. (PACE 2012; 35:e27–e30)     

Detection of invasive protein profile of Streptococcus pyogenes M1 isolates from pharyngitis patients

Hasegawa T, Okamoto A, Kamimura T, Tatsuno I, Hashikawa S‐N, Yabutani M, Matsumoto M, Yamada K, Isaka M, Minami M, Ohta M. Detection of invasive protein profile of Streptococcus pyogenes M1 isolates from pharyngitis patients. APMIS 2010; 118: 167–78. Streptococcal toxic shock syndrome (STSS) is a re‐emerging infectious disease in Japan and many other developed countries. Epidemiological studies have revealed that the M1 serotype of Streptococcus pyogenes is the most dominant causative isolate of STSS. Recent characterization of M1 isolates revealed that the mutation of covS, one of the two‐component regulatory systems, plays an important role in STSS by altering protein expression. We analyzed the M1 S. pyogenes clinical isolates before or after 1990 in Japan, using two‐dimensional gel electrophoresis (2‐DE) and pulsed‐field gel electrophoresis (PFGE). PFGE profiles were different between the isolates before and after 1990. Markedly different profiles among isolates after 1990 from STSS and pharyngitis patients were detected. Sequence analysis of two‐component regulatory systems showed that covS mutations were detected not only in STSS but also in three pharyngitis isolates, in which proteins from the culture supernatant displayed the invasive type. The mutated CovS detected in the pharyngitis isolates had impaired function on the production of streptococcal pyrogenic exotoxin B (SpeB) analyzed by 2‐DE. These results suggest that several covS mutations that lead to the malfunction of the CovS protein occurred even in pharyngeal infection.     

Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation

Two infants with biliary atresia who exhibited three-fold increased trough levels of tacrolimus and required reduced doses during episodes of acute infantile diarrhea within 5 months of liver transplantation are described. The cause of the increase was not explained simply by hemoconcentration as a result of significant loss of extracellular fluid during these episodes. It does highlight an important issue: that of the continuing need to carefully monitor the trough levels of tacrolimus in such infants.     

Herpes simplex on nipples inoculated from herpetic gingivostomatitis of a baby

Herpes simplex on the nipples of a 31-year-old woman inoculated from herpetic gingivostomatitis of her baby is described. It is proposed that this condition is another special form of cutaneous inoculation herpes simplex.     

Expression of β‐Adrenoceptor Subtypes in Urothelium,Interstitial Cells and Detrusor of the Human Urinary Bladder

Objective: We examined whether interstitial cells (ICs) of the human urinary bladder expressed β‐adrenoceptor (AR) subtypes, and semiquantitatively compared the staining intensity among urothelium, ICs and detrusor muscles. Methods: Paraffin sections of the human urinary bladder were obtained from histologically normal areas of formalin‐fixed specimens removed for bladder carcinoma. Double‐labeling immunohistochemical methods using antibodies against each β‐AR subtype and vimentin were performed to identify ICs of the human urinary bladder. The staining intensity of β‐ARs was semiquantitatively compared among urothelium, ICs and detrusor muscles. Further, gender‐related difference or age‐related correlation in the staining intensity of β‐ARs was compared in the same cell types. Results: The expression of β₁‐, β₂‐, and β₃‐AR was observed in vimentin‐positive ICs localized in suburothelium, between detrusor muscle bundles, and within these bundles of the human urinary bladder. The rank order of the staining intensity was urothelium > ICs = detrusor muscles in β₁‐AR, urothelium > ICs > detrusor muscles in β₂‐AR, whereas its order was ICs = detrusor muscles > urothelium in β₃‐AR. Except for urothelial β₁‐AR, there was no gender‐related difference in the signal intensity of β‐ARs in the urothelium, ICs or detrusor muscles. Age negatively correlated with the signal intensity of all β‐AR subtypes. Conclusion: β‐ARs were expressed in vimentin‐positive ICs of the human urinary bladder. As for β₂‐ and β₃‐AR, there was no gender‐related difference or age‐related correlation in urothelium, ICs and detrusor muscles. In the human urinary bladder, β‐ARs expressed in ICs may play a role in bladder physiology.     

Two cases of sleep-disordered breathing in climacteric

Abstract Two cases of sleep disordered-breathing in climacteric were reported. Polysomnography including esophageal pressure (Pes) measurement was performed. Case 1 was diagnosed as upper airway resistance syndrome. Case 2 was diagnosed as obstructive sleep apnea syndrome, while many episodes of upper airway resistance also existed. Hormone replacement therapy improved clinical symptoms, and in case 1, Pes nadir was improved but incidence of arousals which was induced by breathing disturbances was not significantly changed. Sleep disordered-breathing should be suspected as a cause of sleep disorder even in females, especially in climacteric age. Pes measurement and evaluation of arousals is required. Hormone replacement therapy may release the upper airway resistance.     

Value of B-Scan Ultrasonography in the Diagnosis of Liver Cancer

Seventy-one patients with liver cancer were examined by B-scan ultrasonography. The presence of liver cancer was assumed through the irregularity and increased intensity of echos. The accuracy of ultrasonography in the diagnosis of liver cancer was 72%, while the diagnostic accuracy of scintigraphy was 85% and angiography 93%. No obvious correlation could be demonstrated between the ultrasonographic patterns and serum alpha-fetoprotein (AFP) levels. Ultrasonography is a useful method of detecting liver cancer.