Diastolic mitral annular motion in normal subjects and patients with coronary artery disease

The purpose of this study was to evaluate the characteristicsof mitral annular motion during diastole in 28 normal subjects,40 patients with prior myocardial infarction (MI), and 23 patientswith coronary artery disease but without prior MI. Mitral annularmotion during diastole was obtained from the apex by M-modeechocardiography at the posterior wall of the left ventricle.Determinants of mitral annular excursion during early (MAE-E)and late diastole (MAE-L) were investigated in all subjects.Differences in the MAE-E, MAE-L, and the MAE-L.MAE-E ratio werecompared among the three patient groups. The Doppler-derivedtransmitral flow velocity-time integral during early (El) andlate (AI) diastole and mitral annular excursions during diastolewere obtained in 55 other patients with a prior MI and in 29healthy volunteers. The relationships between the MAE-L: MAE-Eratio and AI: EI ratio in these two groups were studied. The MAE-E was determined mainly by heart rate and left ventricularejection fraction (LVEF). The MAE-L was determined only by age.The magnitude of MAE-E was significantly less in patients witha prior MI than in normal subjects (P<0.01). However, theMAE-L did not differ among the three groups. The MAE-L.MAE-Ewas higher in patients with a prior MI than in normal subjects(P<0.05), and was significantly correlated with AI: EI inhealthy volunteers (r=0.65, P<0.001) and in patients witha prior MI (r=0.50, P<0.001). The MAE-E in patients with a prior MI decreases in proportionto the deterioration in LVEF. The relative at rial contributionto left ventricular longitudinal distension is increased inpatients with a prior MI and diastolic mitral annular motionhas a significant relationship to the transmitral flow. Thesefindings suggest that mitral annular motion during late diastoleplays an important role in maintaining left ventricular fillingin patients whose left ventricular systolic function has deteriorated.     

Lennox-Gastaut syndrome: A new vista

Abstract Lennox-Gastaut syndrome (LGS) is regarded as a model of the epileptic syndrome because of its specific clinicoelectrical manifestation. However, a close investigation reveals that its outline is somewhat vague, having the borderland around it. Precise diagnosis in an individual case is not always easy. In this paper, the diagnostic criteria of LGS are described. According to these criteria, cases with LGS were subclassified into the typical and the atypical cases, and also cases in the borderland of LGS were reviewed. On the other hand, our prospective long-term follow-up study revealed that cortical mechanisms played an important role in the pathophysiology, clinical features and refractoriness of LGS. Secondary bilateral synchrony (SBS) is supposed to be a mode of expression of cortical mechanisms of LGS. A newly developed method with coherence and phase analysis demonstrated that the pathophysiology was based on SBS in 33% of the typical LGS cases. This finding is not only crucial for the choice of rational treatment including epilepsy surgery, such as callosotomy, but also contributes to a more refined subclassification of LGS.     

Reconstruction of Obliterated Vesicourethral Junction: Use of the Bulbar Urethra as a Continent Valve

Reconstruction of the obliterated vesicourethral junction is both complex and difficult. Here, we report an innovative method using a mobilized bulbar urethra as a continent valve. Three patients with major problems at the vesicourethral junction underwent continent valve reconstruction. In cases 1 and 2, in which there were problems at the anastomosing site after radical prostatectomy, the bladder wall was closed, wedge resection of the midline pubic bone was performed, and a fully mobilized bulbar urethra was implanted submucosally into the anterior bladder wall. In case 2, augmentation cystoplasty using an ileal segment was required due to the small capacity of the bladder. In case 3, in which there was posterior urethra disruption associated with pelvic fracture, the bulbar urethra was implanted into the bladder wall in the same manner as in cases 1 and 2 without pubectomy. The postoperative follow‐up periods were 48, 36, and 12 months, respectively. In all patients, urinary management was achieved by self‐catheterization postoperatively, and the patients were satisfied with their status. This newly devised continent valve construction using a bulbar urethra is effective for reconstruction of the obliterated vesicourethral junction, which markedly improves patients' quality of life.     

Lack of Teratogenicity of 3-Chloro-4-(Dichloromethyl)-5-Hydroxy-2 (5H)-Furanone (MX) in Embryonic Mouse Palate Culture in vitro

3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5 H )-furanone (MX) is known as a by-product of wood pulp manufacture and a contaminant of chlorinated drinking water. Since our previous studies (Teramoto et al., 1998, 1999) demonstrated in a micromass in vitro test a strong inhibitory effect of MX on rat embryo cell differentiation, the potential teratogenicity was investigated in this study by using a suspension organ culture system. Twelve-day mouse embryo palatal explants were cultivated for 72 hr in the MX-containing medium at a concentration of 0, 1, 10, 100 or 300 μg/ml and examined for closure of the palatal shelves. All control explants showed almost complete closure of the palatal shelves. Similar results were also obtained in the MX-treated explants at concentrations up to and including 100 μg/ml. Immunohistochemistry revealed no difference between the control and MX-treated explants in distribution of PCNA-and TUNEL-positive cells in the palatal mesenchyme and medial edge epithelium, respectively. When the MX concentration was raised to 300 μg/ml, palatal shelves remained wide open. However, histopathology revealed extensive pyknosis of the mesenchymal cells and loss of the epithelium. These results may indicate that MX is cytotoxic against the mouse palate at a high concentration, and that it has no cleft-palate inducing effects in mice.     

Cerebral infarction in acute promyelocytic leukemia at initial presentation

We report on a 3 year old girl with acute promyelocytic leukemia (APL) with cerebral infarction due to disseminated intravascular coagulation (DIC) at initial presentation. She was hospitalized because of unconsciousness and petechiae on the chest wall and extremities. Cerebral ischemia and infarction were found on computed tomography scan and magnetic resonance imaging. Peripheral bood content was hemoglobin 7.3 g/dL, white blood cells 1.0 × 10³cells/μL (31% blasts) and platelet count was 12 × 10³cells/μL. Fragmented erythrocytes were frequently observed on May-Giemsa stained blood smears. Bone marrow aspirates showed normal cellularity, with 60.4% blasts, containing faggot cells. The blasts were positive for peroxidase. Therapy was begun; however, the patient died 1 week after admission.     

个旧市郊室内氡、钍射气浓度和地面γ辐射水平初步调查

目的调查个旧地区居室内氡（^222Rn）、钍射气（^220Rn）及其子体水平，明确钍射气的剂量贡献。方法考虑住宅类型和地理分布因素，从个旧市郊某村选取建筑结构有代表性的50户住宅的主卧室，采用氡-钍射气鉴别探测器测量氡、钍射气浓度，用沉积率装置测量钍射气子体浓度。其中14间居室采用连续性氡测量探测器和α谱氡、钍射气鉴别探测器测量氡、钍射气浓度，空气采样滤膜结合CR-39探测器测量钍射气衰变产物浓度，碘化钠闪烁计数器测量地表γ剂量率。结果50间居室的氡浓度为32～498Bq／m^3，平均136Bq／m^3；钍射气浓度为39～7908Bq／m^3，平均3297Bq／m^3；钍射气子体浓度为2．0～23．9Bq／m^3，平均10．2Bq／m^3。钍射气子体衰变产物致居民年平均有效剂量大于氡子体衰变产物的平均年有效剂量（2．9mSv vs 1．6mSv）。结论个旧市郊部分居室室内钍射气及其子体浓度高，钍射气子体的剂量贡献要高于氡子体的剂量贡献。在个旧开展氡致肺癌危险评价研究应当考虑钍射气子体的剂量贡献。     

Jaundice and Renal Failure Following Radical Surgery for Cancer: An Analysis of Five Autopsied Cases

An analysis of postoperative jaundice and renal failure in fiveautopsied cases is presented. Two patients had total resectionof esophageal cancer, one had a subtotal gastrectomy, and theother two had radical operations for urinary bladder carcinoma.Halothane was used for anesthesia for three patients, and allfive required blood transfusions. Postoperatively, jaundiceand azotemia developed between the 1st and 7th days, with deathsix to 10 days after surgery. Total bilirubin ranged from 1.5to 13.4mg/dl despite the normal or modest rise in hepatic enzymes.BUN varied from 46 to 288 mg/dl. Pre- and postoperative ECGrevealed a prolongation of QTc in all cases. At autopsy, theliver, kidneys and heart showed a definite increase in weight.The salient hepatic pathology included diffusely dilated spaceof Disse, centrilobular bile stasis and steatosis. This, alongwith acute tubular necrosis confirmed at autopsy, was thoughtto be due to ischemia. Although the significance of prolongedQTc remains uncertain, it is worthy of attention as one of thepreoperative checks.     

Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan

Although some studies have indicated that endometriosis may increase the risk of developing ovarian cancer, there are no data from epidemiologic studies in Japan. We prospectively analyzed all cases of ovarian endometrioma enrolled in the prefecture-wide Shizuoka Cohort Study on Endometriosis and Ovarian Cancer Programme, which was initiated in 1985. To evaluate the risk of ovarian cancer by time periods subsequent to ovarian endometrioma diagnosis, a cohort of 6,398 women with a clinically documented ovarian endometrioma in Shizuoka between 1985 and 1995 was identified from the Shizuoka Cancer Registry (SCR), with follow-up through 2002. Ovarian cancer incidence among cohort members was ascertained by linkage to the SCR using a unique person-identification number. Standardized incidence ratios (SIR) and their 95% confidence intervals (CI) were computed by a use of prefecture-wide rates of ovarian cancer, adjusted for age and calendar year. During follow-up of up to 17 years of the ovarian endometrioma cohort, 46 incident ovarian cancers were identified, yielding that the ovarian cancer risk was elevated significantly among patients with ovarian endometrioma (SIR = 8.95, 95% CI = 4.12-15.3). The SIR did not increase with increasing follow-up duration. The risk increased with increasing age at ovarian endometrioma diagnosis, with a SIR equal to 13.2 (95% CI = 6.90-20.9) in women above 50 years of age. Our findings for the first time support the hypothesis that ovarian endometrioma increases the subsequent risk of developing ovarian cancer in Shizuoka, Japan.     

VACCINE-ASSOCIATED POLIOMYELITIS IN AN INFANT WITH AGAMMAGLO BULINEMIA

Abstract. Sakano, T., Kittaka, E., Tanaka, Y., Yamaoka, H., Kobayashi, Y. and Usui, T. (Department of Paediatrics, Hiroshima University Hospital and Hiroshima City Hospital, Hiroshima, Japan). Vaccine-associated poliomyelitis in an infant with agammagiobulinemia. Acta Paediatr Scand, 69:549, 1980.—We describe a female infant with agammaglobulinemia who contracted vaccine-associated poliomyelitis. Poliovirus type 2 was isolated from the initial stool specimen. In our patient, temporary changes in the cerebrospinal fluid resembled those in patients without immunodeficiencies, although gammaglobulin therapy had not yet been started. Pleocytosis was observed for a short time after viremia, but soon there was a return to normal without antibody production.