Cardiovascular disorders in patients with diabetes mellitus

Diabetes mellitus is a disease with multiorgan involvement. Besides retinopathy, nephropathy and peripheral neuropathy induced by microangiopathy, both cardiovascular and cerebrovascular complications are significant. Both cardiomyopathy and coronary artery disease are observed in patients with diabetes, and the latter is clinically more important because of its high incidence and seriousness.     

Objective assessment of autophony in patients with patulous Eustachian tube

The objective of the present study is to evaluate the Eustachian tube (ET) acoustic patency during phonation. The sound level in the EAC during phonation of the “A” and ”N” sounds was measured by microphones in the bilateral EACs of nine normal subjects and 31 patients with patulous ET. The measured sound pressure differences between the right and left ears were correlated with the differences in severity of autophony between the bilateral ears assessed by a visual analogue scale (VAS). The patulous condition was often remarkable when the “N” sound was phonated. In some patients with patulous ET, the patulous condition was indicated only by the present method, and not by conventional ET function tests such as tubo-tympano-aerodynamic-graphy or sonotubometry.     

An anatomical study of the partial anomalous pulmonary venous return with special references to the bronchial vein

Two examples of partial anomalous drainage of the pulmonary vein were detected at dissection. The first case was found in a 70-year-old female Japanese. An aberrant vein, approximately 6 mm in diameter, that derived from the upper lobe of the right lung was observed to drain into the superior vena cava at a point just below the entrance of the azygos vein. The other veins from the right lung gathered into two pulmonary veins and returned into the left atrium as usual. In the second case, which was found in an 80-year-old female Japanese, a connecting vein, approximately 8 mm in diameter, was found between the left superior pulmonary vein and the left brachiocephalic vein. In this case, although the direction of the blood flow within the connecting vein was not certain, it is probable that the blood passed from the pulmonary vein into the brachiocephalic vein, judging from the increase in the width of the latter vein. No other anomalies were found in the cardiovascular systems. At the occurrence of the anomalous drainage of the pulmonary veins in both cases, we suspected the role of the bronchial vein to be a communicating and boundary vein between the pulmonary and systemic circulations. The developmental background of these anomalies is also considered.     

Mechanisms regulating the expression of indoleamine 2,3-dioxygenase during decidualization of human endometrium

BACKGROUND: Expression of the tryptophan catabolizing enzyme, indoleamine 2,3-dioxygenase, in the mouse placenta has been shown to be critical in preventing immunological rejection of the fetal allograft. To clarify the physiological importance of indoleamine 2,3-dioxygenase in human pregnancy, we have studied how the expression of this enzyme changes during decidualization of human endometrium at both the cell and tissue level. METHODS AND RESULTS: The level of indoleamine 2,3-dioxygenase mRNA expression (determined by RT-PCR) was higher in decidual than in endometrial tissue. Uterine decidual tissue in ectopic pregnancy similarly showed increased mRNA expression. Immunohistochemistry demonstrated that indoleamine 2,3-dioxygenase protein immunoreactivity was found in glandular epithelium and in stromal cells. The intensity of this immunoreactivity was increased in decidualized tissue. In a cell culture model, the level of indoleamine 2,3-dioxygenase mRNA was suppressed specifically by progesterone-induced decidualization of isolated endometrial stromal cells. Indoleamine 2,3-dioxygenase protein abundance (determined by Western blot) was also decreased by progesterone-induced decidualization. However interferon-gamma, a potent stimulator of indoleamine 2,3-dioxygenase gene expression, increased the level of indoleamine 2,3-dioxygenase mRNA and protein in both non-decidualized and in decidualized cells. Indoleamine 2,3-dioxygenase activity (determined by measuring the concentration of tryptophan and its indoleamine 2,3-dioxygenase catabolite, kynurenine) was also decreased by progesterone-induced decidualization but enhanced following interferon-gamma treatment. Expression of other interferon-gamma inducible genes (STAT1 and tryptophanyl-tRNA synthetase) showed the same pattern as that of indoleamine 2,3-dioxygenase in tissue samples, but was not changed by decidualization in the cell culture model. CONCLUSIONS: These data suggest that despite suppression by progesterone, indoleamine 2,3-dioxygenase expression in endometrial stromal cells may increase during decidualization due to stimulation by interferon-gamma secreted by infiltrating leukocytes.     

Modified binaural pitch-matching test for the assessment of diplacusis

Diplacusis is defined as the phenomenon of hearing the same tone at different pitches in the two ears. Although binaural pitch-matching using method-of-adjustment has been employed in most studies, it is sometimes hard for subjects with impaired hearing to judge 'equal pitch' as one frequency. To resolve this problem. a modified pitch-matching test, in which the relation of pitch sensation between the two ears was assessed as a matched frequency 'range' using the randomized maximum likelihood sequential procedure, was developed. Eight subjects with unilaterally impaired hearing, as well as eight normal subjects, were examined to evaluate this new test procedure. In the present method, matched frequency is assessed as a frequency range, in which subjects cannot judge whether the pitch of the signal in one ear is higher or lower than that in the opposite ear. This method appeared to be useful for assessing the characteristics of diplacusis in subjects with impaired hearing as well as in normal subjects.     

Middle ear dynamic characteristics in patients with otosclerosis

OBJECTIVE: To investigate the middle ear dynamic characteristics in patients with otosclerosis using the sweep frequency impedance meter (SFI test) and conventional tympanometry, and also to evaluate the diagnostic efficiency of the SFI test for otosclerosis. DESIGN: The study was designed to collect a total of 25 (36 ears) consecutive patients with otosclerosis. All subjects followed a clinical protocol, which consisted of a hearing problem questionnaire, otoscopic examination, and audiometric measurements. These included pure tone audiometry, conventional tympanometry, and SFI test. RESULTS: In the SFI test, the middle ear dynamic characteristics were measured in terms of the resonance frequency and middle ear mobility. Three distinct categories of middle ear dynamic characteristics were found in patients with otosclerosis, i.e., high stiffness, normal stiffness, and low stiffness middle ear status. On comparison of the results of SFI with conventional tympanometry, a significantly higher percentage of abnormal stiffness was found when using the SFI test than that when using conventional tympanometry. CONCLUSIONS: The present findings confirm the advantage of the SFI test over conventional tympanometry in detecting middle ear status and mechanics in patients with otosclerosis. Moreover, different middle ear dynamic characteristics in patients with otosclerosis are most likely to be related to the different stages of the pathological changes.     

Serum KL-6 Levels in Patients With Pulmonary Complications After Allogeneic Bone Marrow Transplantation

KL-6, a mucinous high—molecular weight glycoprotein expressed on type 2 pneumocytes, has been shown to be elevated in the serum and bronchoalveolar lavage fluid of patients with interstitial pneumonitis (IP). We measured the serum levels of KL-6 in patients after they had undergone allogeneic bone marrow transplantation (BMT) to determine whether KL-6 could be a clinically useful indicator for the development of IP. The serum concentrations of KL-6 were determined by a sandwichtype enzyme-linked immunosorbent assay using an anti—KL-6 monoclonal antibody. A total of 1028 samples were tested from 76 patients (78 transplantations) who received BMTs. The KL-6 values were markedly elevated in patients with pulmonary complications, but not in those with acute and chronic graft-versus-host disease, hemorrhagic cystitis, herpes encephalitis, sepsis, and veno-occlusive disease.The serum levels of KL-6 from patients with pulmonary complications were significantly higher than from those without pulmonary complications (P < .001) and those with other complications (P < .001). Of the 12 patients with pulmonary complications, 6 had idiopathic IP (IIP). The levels were not high at the onset of IIP. Four of 6 IIP patients showed marked elevations of KL-6 levels in parallel with the severity of IP and died of respiratory failure without response to treatment.Assessment of serum KL-6 levels might not be useful for the early diagnosis of IP, but may be a useful indicator for monitoring the severity of IP after BMT.     

The nerves to the plantaris muscle and a bipennate part of the soleus muscle

We performed nerve fiber analysis of the nerve to the plantaris muscle in ten cases. Macroscopically, the nerve to the plantaris muscle has a tendency to branch off from the tibial nerve itself independent of the nerves to the gastrocnemius and soleus muscles (the triceps surae muscle). After removing the epineurium of the tibial nerve, it was revealed that, in all ten cases, the nerve to the plantaris muscle formed a common funicular trunk with the nerve to a bipennate part of the soleus. This trunk is akin to the nerves to the deep muscles of the calf. In addition, in five of the ten cases, the nerve to the plantaris muscle had another component, which arose from the branch to the popliteus muscle. By removing the perineurium of the nerves concerned, it became clear that the elements of the nerve to the plantaris muscle, and of the nerve to the bipennate part of the soleus, had an intimate relation (inseparable). On the other hand, the elements of the nerve to the plantaris muscle and those to the popliteus were separable and they showed different routes proximally. Based on the present findings derived from nerve fiber analysis, we postulate that the plantaris muscle and bipennate part of the soleus muscle were probably derived from the deep muscle anlage of the calf in spite of their topographical closeness to the superficial muscles of the calf.