Directional Coronary Atherectomy in Takayasu's Disease

A 44-year-old woman with a history of coronary aorta bypass grafting (CABG)for stenosis of the left main trunk (LMT) due to Takayasu's disease underwent directional coronary atherectomy (DCA) to the LMT lesion under percutaneous cardiopulmonary support because she had angina pectoris and heart failure due to occlusion of the grafts. Three and a half years after the catheter intervention, her clinical condition remains good. DCA may be an alternative to CABG in limited cases with LMT disease.     

Kinetic Evidence for Facilitated Peritoneal Transport of Benzoic acid in Rats

To evaluate the dose dependency in apparent peritoneal permeability (P_d) of benzoic acid as a model compound for a monocarboxylic acid transport system, a kinetic model, which involves changes in the volume and osmolality of the dialysate as well as the diffusion and convection of drugs across the peritoneum, was applied. We compared the P_d value of benzoic acid to that of phenobarbital which is a more lipophilic drug than benzoic acid. The concentration-time courses of phenobarbital in both peritoneal cavity and serum after the intraperitoneal administration with various doses were parallel according to dose, whereas those of benzoic acid varied in a dose-dependent manner. Using the values of unbound fraction (f_u), the value of P_d for unbound drugs was estimated. The P_d values of benzoic acid at 20 μg mL^?1 was three times the value determined at 1000 μg mL^?1. We suggest that certain facilitated transport systems constitute the mechanism of enhanced peritoneal membrane permeability of benzoic acid.     

Exercise Induced Atrioventricular Block with Gap Phenomenon in Atrioventricular Conduction

A 54-year-old man with normal atrioventricuiar (AV) conduction at rest gave a 4-year history of presyncope during exercise. Treadmill testing showed exercise induced AV block. Electrophysiological study demonstrated rate dependent infranodal AV block and abnormal refractory period of the His-Purkinje system. The gap phenomenon in AV conduction occurred during the programmed stimulation. Supernormal conduction could be considered as the mechanism of the gap phenomenon in this patient.     

"Fork" Stenting for Bifurcational Lesion

Based on the experience of our in vitro examination to assess the stents for a safe and effective angioplasty through the struts, a Palmaz-Schatz stent was implanted easily and completely from the left main trunk to the left anterior descending coronary artery through the struts of a Wiktor stent implanted from the left main trunk to the circumflex artery in two cases .     

Expression of Secreted Immunoglobulin Heavy Chain Genes and Immunoglobulin-Secreting Cells in Human Lymphocytes

The numbers of immunoglobulin-secreting cells in peripheral blood mononuclear cells and the expression of mRNA for secreted type of immunoglobulin heavy chains were investigated in healthy children, compared with the percentages of surface immunoglobulin-bearing cells and the expression of mRNA for membrane-bound type of immunoglobulin heavy chains, respectively. Although a difference between expression of μs mRNA and μm mRNA was unclear, μmRNA was well transcribed. The expression of γs mRNA or αs mRNA was markedly higher than that of γm mRNA or αm mRNA. However, although the detection methods could be of different sensitivities, the percentage of IgM-, IgG-, or IgA-secreting cells was markedly low, compared with the percentage of surface IgM-, IgG-, or IgA-bearing cells, respectively. Therefore, additional regulation of the pattern of the immunoglobulin gene expression may be exerted at the translational and post-translational stages.     

A case of anomalous origin of the right coronary artery from the left sinus of Valsalva exhibiting the Wolff-Parkinson-White syndrome

A 56-year-old male with the Wolff-Parkinson-White syndrome wassuspected of having suffered a myocardial infarction followingattacks of chest pain. Serial measurements of serum creatinephosphokinase and the electrocardiographic findings after ajmalineloading virtually excluded the possibility of myocardial infarction.Paroxysmal tachycardia was not noted on 24 Holler electrocardiographicmonitoring. Both the left and right coronary arteries were foundby selective coronary angiography to originate from the leftsinus of Valsalva, but neither of the arteries showed organicstenoses. However, myocardial²⁰¹ Tl scintigraphy after exerciseindicated poor uptake in the high anterolateral wall, and atthe apex and septum near the anterior wall, which suggestedthe absence ofischaemia in the area supplied by the right coronaryartery. We speculate that a left coronary artery steal phenomenonwas the cause of the ischaemia after exercise in this patient.