Arbutamine stimulation detects viable myocardium 4 weeks after coronary occlusion.

At low doses, dobutamine has potent inotropic, but limited chronotropic, effects-properties that may be necessary for detection of hibernating myocardium. The efficacy of other catecholamines, which have more closely coupled inotropic and chronotropic effects, for the detection of viable myocardium is unknown. This study evaluated the efficacy of arbutamine, a catecholamine with potent chrono-tropic effects, for the detection of viable myocardium in a canine model of hibernating myocardium. Contractile reserve was assessed during stepwise arbutamine infusion (dosages of 2.5, 5, 10, 50, and 100 ng/kg/min) at 3 days (early) and 4 weeks (late) after coronary ligation. Segment shortening, wall thickening, and segmental wall motion were assessed by sonomicrometry and echocardiography. After 4 weeks of occlusion, functional recovery was assessed after revascularization. During the early arbutamine study, the sensitivity for predicting functional recovery was highest at a dosage of 50 ng/kg/min, which also produced tachycardia. The sensitivity was 50% for segment shortening, 20% for wall thickening, and 75% for wall motion score. The late arbutamine study had improved sensitivity. The sensitivity was 100% for segment shortening, 80% for wall thickening, and 90% for wall motion score at a dosage of 50 ng/kg/min. At the late arbutamine study, myocardial perfusion reserve in the ischemic zone of dogs with functional recovery was only mildly reduced (2.0 versus 2.6 in nonischemic zones, P =.53). After coronary occlusion, viable myocardium can be detected with high doses of arbutamine that produce tachycardia. However, the sensitivity of arbutamine stimulation for predicting functional recovery is low early after occlusion, but it is improved by 4 weeks after occlusion with adequate perfusion reserve.     

Recanalization of saphenous vein graft occlusion after CABG using a newly designed coronary wire]

A 57-year-old male underwent coronary bypass grafting, consisting of sequentially grafting of saphenous vein grafts to the diagonal and left descending arteries and the right coronary artery. On the 12th postoperative day, he had chest pain and ECG showed significant ST elevation on the V1-5 leads. Subsequently, PTCR was performed, however, the occlusion of the graft between the diagonal artery and the left descending artery remained. Then, a coronary boring wire we designed was inserted into the left descending artery and coronary recanalization was successfully achieved.     

A Case of Intraluminal Duodenal Diverticulum Associated with Congenital Biliary Dilatation: A Review of the Literature in Japan

A case of intraluminal duodenal diverticulum (IDD) associated with congenital biliary dilatation is reported. Patients with intraluminal duodenal diverticulum often have congenital anatomical abnormalities or acquired diseases. The treatment of the intraluminal duodenal diverticulum itself is easy, but it is important to detect and treat other disorders also present.     

Primary cutaneous carcinosarcoma: review and presentation of a case with emphasis on clinical characteristics and management

Carcinosarcomas are rare malignant biphasic tumours that contain intermingled carcinomatous and sarcomatous elements. Primary cutaneous carcinosarcomas (PCCS) are extremely rare. We present the 20th reported case and review the literature especially regarding histogenesis and clinical features such as diagnosis and management. PCCS resembles other non-melanocytic neoplasms of the skin. Diagnosis is obtained by primary excision with subsequent histologic and immunohistochemical examination. PCCS is a potentially lethal neoplasm, but radical surgery is successful in most cases.     

Incidence of tricuspid regurgitation in normal subjects according to a new Doppler echographic criterion

To develop a Doppler echocardiographic criterion for tricuspid regurgitation (TR) and to determine the incidence of TR in normal subjects, we examined 357 apparently normal subjects ranging in age from five to 95 years using pulsed and continuous wave Doppler echocardiography. A Doppler transducer was placed over the right ventricular apex, with the Doppler beam directed parallel with TR flow. TR was judged to be present when a holosystolic abnormal flow pattern with the peak velocity greater than 1.5 m/sec was recorded at the tricuspid valve orifice. This was based on the theory that in TR systolic pressure gradient across the tricuspid valve should be 10 mmHg or greater in normal subjects. TR was detected in 87 (24%) of 357 subjects and the mean peak velocity of the TR was 2.1 +/- 0.2 m/sec (mean +/- SD). It was more frequent in women (28%) than in men (19%) and differed significantly among the young, middle and old age groups. It was 79% in the first decade, 30% in the second, 10% in the third, 21% in the fourth, 5% in the fifth, 19% in the sixth, 14% in the seventh, 23% in the eight, 37% in the ninth and 40% in the tenth. The minimum dimension of the tricuspid annulus was significantly enlarged (p less than 0.001) in subjects with TR (2.2 +/- 0.3 cm/m2) compared to that of subjects without TR (1.8 +/- 0.3 cm/m2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Abscessed leiomyosarcoma of the ileum.

A-49-year-old man was admitted because of a lower abdominal mass. During the five days prior to admission, he had noted fever and lower abdominal pain. Palpation of the abdomen revealed a tender mass, 10 cm in diameter, in the suprapubic region. An x-ray revealed an irregular collection of gas, 9 cm in diameter, in the pelvic cavity, which appeared as a mirror image when the patient was upright. Based on the physical finding and the results of a barium enema, abdominal CT, MRI, and small intestine imaging, a diagnosis of leiomyosarcoma of the ileum was made. Excision of the tumor and part of the small intestine was performed. A saccular tumor, 11 x 6 x 5 cm, was found 1.0 m from the cecum and growing out of the wall of the ileum. A large amount of pus was found inside the cavity. The pathological diagnosis was leiomyosarcoma.     

A new treatment: thermal therapy for chronic fatigue syndrome

Thermal therapy using far-infrared ray dry sauna was performed for patients with chronic fatigue syndrome (CFS). Symptoms such as fatigue, pain, and low-grade fever were dramatically improved on two patients. And prednisolone administration was discontinued and became socially rehabilitated 6 months after discharge. On other 11 patients with CFS, physical symptoms such as fatigue and pain improved, too. Furthermore, we reported that repeated thermal therapy had relaxation effect and diminishes appetite loss and subjective complaints in mildly depressed patients. These results suggest that repeated thermal therapy may be a promising method for the treatment of CFS.     

Noninvasive estimation of impaired hemodynamics for patients with acute myocardial infarction by Tei index.

BACKGROUND: Tei index, defined as the sum of isovolumic contraction and relaxation times divided by ejection time, has been proposed to express global left ventricular function. For patients with acute myocardial infarction (AMI), left ventricular function can potentially be a major determinant of hemodynamics with limited time for compensation, such as increased brain natriuretic peptide to attenuate congestion, and usually without any intervention to modify cardiac loading on arrival at the hospital during the acute phase. We, therefore, hypothesized that left ventricular function, expressed by the Tei index, allows noninvasive estimation of impaired hemodynamics for patients with AMI. METHODS: We studied 86 consecutive patients with first AMI (34 inferoposterior and 52 anteroseptal). Tei index was obtained as: (a - b)/b, where a is the interval between the cessation and onset of mitral flow and b is the ejection time by aortic flow by pulsed Doppler echocardiography. By using pulmonary capillary wedge pressure (PCWP) > or = 18 mm Hg or <18 mm Hg and cardiac index (CI) < or = 2.2 L/min/m(2) or > 2.2 L/min/m(2) by consecutive catheterization, patients were classified into 4 subsets: subset I with normal hemodynamics; subset II with elevated PCWP; subset III with reduced CI; and subset IV with both elevated PCWP and reduced CI. RESULTS: For patients with inferoposterior AMI, there was no significant correlation between the Tei index and PCWP or CI. For patients with anteroseptal AMI, however, the Tei index showed significant correlation both with PCWP (r = 0.59, P <.0001) and CI (r = -0.42, P <.01). Diagnosis of impaired hemodynamics (subset II-IV) by a Tei index > or = 0.60 showed a sensitivity, specificity, and accuracy of 86%, 82%, and 83%, respectively. CONCLUSIONS: Although the Tei index has limitations to evaluate hemodynamics in patients with inferoposterior AMI, the index allows approximate but quick and practical noninvasive estimation of impaired hemodynamics in patients with anteroseptal AMI.