Subcutaneous pedicle hypothenar island flap.

The status of the blood supply to the hypothenar skin was investigated by anatomical and radiological studies. The investigation revealed that the hypothenar skin receives a rich blood supply from the arterial network by branches from the palmar ulnar artery of the little finger and the hypothenar branches. By making use of this abundance of vascular networking, a subcutaneous pedicle flap was obtained from this site. This method was clinically applied to 7 patients, and the procedures and advantages of the method are described.     

Dietary restriction of choline reduces hippocampal acetylcholine release in rats: In vivo microdialysis study

We fed rats with a diet deficient in choline for 12 weeks and studied how dietary choline deficiency affected their behavior and their ability to release acetylcholine in discrete regions of rat brain using step-through passive avoidance task and in vivo microdialysis. In comparison with the control, rats fed the choline-deficient diet showed poorer retention of nociceptive memory in the passive avoidance task. Average choline level in cerebrospinal fluid in the choline-deficient group was significantly less (33.1%) than that of control rats. In vivo microdialysis showed no difference in the pattern of acetylcholine release enhanced by intraperitoneal administration of scopolamine hydrochloride (2 mg/kg) in the striatum between the two groups, whereas in the hippocampus, the maximum and subsequent increase of acetylcholine from the baseline by scopolamine injection was significantly lower in the choline-deficient group than in the control. From the results of our study, we speculate that long-term dietary restriction of choline can affect extra- and intracellular sources of substrates required for acetylcholine synthesis, and eventually limit the ability to release acetylcholine in the hippocampus. Reduced capacity to release acetylcholine in the hippocampus implies that the mechanism, maintaining acetylcholine synthesis on increased neuronal demand, may vary in discrete regions of the brain in response to dietary manipulation. The vulnerability of the mechanism in the hippocampus to dietary choline restriction is indicated by impaired mnemonic performance we observed.     

A case of recurrent bacterial meningitis by delayed cerebrospinal fluid (CSF) leakage due to a head trauma]

A 42-year-old man was admitted due to recurrent bacterial meningitis, as he had been treated here for bacterial meningitis three years prior to the current event. He had a remote history of head injury that he had almost forgotten, and his laboratory data showed no immunodeficiency state. 111In-DTPA cisternography showed an abnormal radioactive accumulation in the frontal lobe adjacent to the left frontal sinus at 23 hours after intrathecal injection, and MPR CT images revealed the left frontal sinus bone fracture. These findings indicated that he had a head injury by which a delayed CSF fistula has been formed. He was surgically treated for a CSF leakage. Although a combination therapy of ABPC and CTRX was efficacious for this patient, this regimen may not be ideal, as meningitis by PRSP has been increasing in incidence. Pneumococcal meningitis, once not a difficult infection to treat, could be a difficult one, as resistant strains to ABPC and CTRX have been more common.     

Clinical trial of 111In-antimyosin antibody imaging: (1). Assessment of tracer kinetics and imaging time

The human clinical trial of 111In-antimyosin antibody was performed in 20 patients with various cardiac disorders to assess its safety and tracer kinetics and to determine the optimal imaging time. There were no side effects derived from this tracer after its administration. The skin test and the antimurine antibody were both negative in any patient. The radiation dose to the kidney (3.6 rad) and to the whole body (0.36 rad) was acceptable. The half life of the blood clearance was 6.3 hours (fast component) and 25.8 hours (slow component) with the relatively high retention of blood activity at 24 hours (21%) and at 48 hours (11%). The planar images at 24 hours after the tracer administration in 4 patients showed high residual blood-pool activity without delineating significant myocardial uptake, while the images at 48 hours clearly demonstrated the presence or absence of discrete myocardial uptake. However, 2 patients showed significant residual blood-pool activity at 48 hours after the injection which needed 72 hour delayed scan in order to identify the myocardial uptake. In one patient, the single-photon tomography (SPECT) was useful to delineate the myocardial uptake from the residual blood-pool activity at 48 hours after the injection. Although this tracer provides an elegant technique for identifying myocardial necrosis, it needs 48 hours delayed scan and/or SPECT imaging because of relatively slow blood clearance.     

Selection of candidates for a ventricular assist device as a bridge to heart transplantation

This study was undertaken to see how many people could receive the ventricular assist device (VAD) as a bridge to heart transplantation and to get selection criteria of the recipient. From January 1984 to December 1987, 9916 patients were admitted to our institute and 399 cases of them were dead. All dead cases were examined in terms of age, heart disease, other organ function, infection, and so on. There were 42 possible candidates for VAD, 31 men and 11 women. The average age was 50 years with a range from 22 to 63 years. Ten cases (23.8%) of them had the indication for VAD bridge to transplantation. The criteria for transplantable patients included the following three categories: I) Cardiogenic shock: Irreversible left or double ventricular failure with or without life-threatening dysrhythmia during IABP therapy--4 cases. II) End-stage valvular heart disease; Operation under VAD stand-by--2 cases. III) Postoperative refractory ventricular pump failure: Failure to wean from assist circulation after IABP trial or sustained ventricular failure under IABP support--4 cases. It was indicated that continuous precise evaluation of the deteriorating hemodynamics and the intensive care for major organ functions (renal, pulmonary, neurologic, hepatic, coagulation, etc.) were important to select the candidate for VAD bridge to heart transplantation.     

111In-antimyosin Fab scintigraphy in cardiovascular diseases: (multicenter clinical trial)

In a multicenter study, a total of 380 patients with myocardial infarction, myocarditis and cardiomyopathy underwent 111In-Antimyosin Fab myocardial imaging. 111In-Antimyosin Fab was administered intravenously and myocardial images were obtained 48 hours later. Only 3 patients developed mild adverse effects. Human antimouse antibodies were detected in 7 patients. Positive scans in patients with myocardial infarction were seen in 92/119 (77%) within 2 weeks after the onset of myocardial infarction, in 58/71 (82%) at 3-4 weeks, in 20/22 (91%) at 4-8 weeks and 17/31 (55%) thereafter. The location of myocardial damage delineated by 111In-Antimyosin Fab imaging was concordant with the infarct location by ECG and coronary angiography. In patients with myocarditis, 111In-Antimyosin Fab uptake was positive in 7/12 (58%) within 8 weeks and 6/17 (35%) thereafter. Positive 111In-Antimyosin Fab scans were seen in 12/36 (33%) in dilated cardiomyopathy and in 17/19 (89%) in hypertrophic cardiomyopathy. Although the mechanism of persistently positive 111In-Antimyosin Fab images in the subacute to chronic stage of myocardial infarction and myocarditis remains to be clarified, 111In-Antimyosin Fab may be useful for the detection of the diseases and in evaluating the prognosis of patients with cardiomyopathy.     

Biotin deficiency per se is teratogenic in mice

We examined whether maternal biotin deficiency would potentiate the latent teratogenicity of relatively low doses of vitamin A in mice. The incidence and the type of gross congenital malformations (cleft palate, micrognathia, and micromelia) induced by biotin deficiency were similar among the groups given three different concentrations of vitamin A (4000, 12,000 and 60,000 IU) in the diet. Also, the type of these malformations was different from those (exencephaly, cleft palate and macroglossia) induced by a known teratogenic dose of vitamin A (1,200,000 IU). We conclude that in mice concentrations of vitamin A in the range of 4-10 times the level recommended by the National Research Council and biotin deficiency do not interfere with one another; also, biotin deficiency per se is teratogenic in mice.