Functional abnormality due to a deformation of the left ventricle: dynamic anatomy revealed using echocardiography

A deformation of the left ventricular cavity is commonly observed in myocardial infarction, which directly influences the ventricular function. Even in cases without ischemia, a deformation of the left ventricle during systole or diastole is presumed to affect its function. Inward bending of the left ventricular posterobasal wall in giant left atrium is an example of the unfavourable effects of such a deformation. Systolic flattening of the left ventricle is atrial septal defect complicated by pulmonary hypertension is an example of the favourable influences by such a deformation. A regional wall motion abnormality observed in these cases is explained by the deformation attributed to the relationship between the left ventricle and left atrium or between the left and right ventricles. The relationship between the deformation and the function of the left ventricle in ventricular aneurysm can be explained well by the mode of blood turnover within the left ventricle. Contrast studies via the left atrium revealed that blood flow into the left ventricle did not reach the cardiac apex with an aneurysm, but immediately turned upwards towards the outflow tract. These results indicate that, although the left ventricle is anatomically a single cavity, it consists of functioning and non-functioning portions for blood turnover. A morphological abnormality of the left ventricle influences its function even without myocardial ischemia. It is necessary to relate all morphological changes of the left ventricle to cardiac function, regardless of the causes of a deformation.     

Experimental Borrelia burgdorferi infection of outbred mice.

Infectivity of Borrelia burgdorferi strain 297 in normal outbred ddY mice was examined. Strain 297 was inoculated intraperitoneally in 3-week-old outbred ddY mice. B. burgdorferi was routinely cultured from the heart and urinary bladder 5 to 84 days postinoculation. The combined isolation rate from both heart and urinary bladder was significantly higher than the rate from spleen, kidney, liver, urine, and blood samples. Three- and 10-week-old mice were infected with inocula of 10(4) and 10(5) or more, respectively. Passive transfer of undiluted and 10-fold-diluted anti-297 rabbit serum and active immunization of 50 to 100 micrograms of lyophilized whole cells completely protected mice from infection with B. burgdorferi. These results suggest that the outbred mouse is a convenient model for experimental infection with B. burgdorferi.     

Human heart recovery during weaning from a left ventricular assist system: time course and outcome prediction]

To investigate the time course of recovery of a failing heart using the left ventricular assist system (LVAS) and to predict the outcome of weaning from the LVAS, 14 patients with a failing heart were studied. Among them, 5 had recovered and survived for more than 2 weeks after weaning from the LVAS (recovered group), while 9 could not be weaned or died within 2 weeks after weaning (unrecovered group). All patients were gradually weaned from the LVAS with adequate support for systemic circulation for 3 days. In the recovered group, indices of systolic time intervals (STIs) showed improvement within a week. However, improvement of STIs was slow reaching a plateau around the 10th day in the unrecovered group. On weaning from the LVAS, aortic systolic pressure and ejection time were regulated by the patients' own hearts and were nearly the same between the 2 groups. However, left atrial pressure was significantly higher in the unrecovered group than in the recovered group. These hemodynamic features were first present on the 7th day. Therefore, hemodynamic data on the 7th assistant day can be a reliable factor in predicting the possibility of successful weaning from the LVAS and recovery in patients with a failing heart.     

Eradication of esophageal varices with repeated injection sclerotherapy in inoperable patients

Esophageal varices in 50 cirrhotic patients were treated with repeated injection sclerotherapy. Eradication of varices was achieved in 27 patients (54.0%) with a mean of 4.5 injections (range 2-12) after a mean period of 3.1 months (range 1-11). There was no variceal bleeding in these 27 patients once eradication had been achieved, with a mean follow up period of 5.6 months, although bleeding occurred in 5 of the same group before eradication of the varices had been achieved, during an average of 3.1 months, and in 6 of the remaining 23 patients (10 episodes) with residual varices after a mean of 4.7 injections (range 2-12) in a mean period of 12.2 months (range 1-33). Esophageal varices can thus be eradicated with repeated injections and bleeding from recurrent esophageal varices can be prevented in many patients after eradication has been achieved.     

Role of technetium-99m pertechnetate scintigraphy in the management of extra-abdominal fibromatosis

The purpose of this study was to investigate technetium-99m pertechnetate (Tc-99m) as a tumor-scanning agent in patients with extra-abdominal fibromatosis, and to establish the sensitivity of this type of scintigraphy. Eleven patients with extra-abdominal fibromatosis were studied: all but one having postsurgical recurrences. Of the 11 patients, diagnosed histologically, 5 underwent repeated Tc-99m scintigraphic follow-up examinations. The injected 370 MBq Tc-99m gave us an early scintigram within 10 min and a delayed one 2 h later. For adequate comparison, the region of interest (ROI) of the scintigram was placed over the tumor. The tumor-to-background (T/BG) count ratio was computed. Extra-abdominal fibromatoses, even recurrences, were demonstrated scintigraphically in both the early and the delayed phase, in all 11 patients. The average T/BG ratio was 2.11 in the early scintigram and 2.15 in the delayed one. The sensitivity and the specificity were both 100%. Tc-99m scintigraphy has proved useful in detecting extra-abdominal fibromatoses and in the follow-up of patients.     

Retropharyngeal Abscess after Radiation Therapy and Cis-platinum, 5-Fluorouracil Treatment for Nasopharyngeal Carcinoma with Collagen Disease: Report of Two Patients and a Review of the Literature

Collagen disease are frequently associated with malignant tumors.Recently, radiotherapy combined with chemotherapy has been recommendedfor improving the efficacy of treatment for nasopharyngeal carcinoma.Two patients with nasopharyngeal carcinoma complicated by collagendiseases (dermatomyositis in one, and Sjögren's syndromewith mixed connective tissue disease in the other) were givenradiotherapy combined with chemotherapy consisting of cis-platinumand 5-fluorouracil. Following this combination therapy, bothpatients developed retropharyngeal abscess and ulceration ofthe mucosal membrane on the posterior wall of the oropharynx;there was no tumor cell involvement. Because these injurieswere more severe than would have been expected from radiotherapyalone, it is recommended that special attention be paid to combinationtherapy in patients with nasopharyngeal carcinoma complicatedby collagen disease.     

The prognosis of segmental type of primary sclerosing cholangitis--a prognostic study of the cases

Our review of the cases of segmental primary sclerosing cholangitis (PSC) in Japanese literature has found nineteen cases, of which our own case in 1976 has been in good health for fifteen years and three months after resection. The prognostic study was possible in sixteen cases. In twelve cases the lesions were resected. Ten of twelve are found in good health, the average length of survival being nine years and one month. There are two cases of death and the causes are unknown. The unresected cases (4 out of 16) are all dead. It is concluded that the prognosis of segmental PSC is good if the lesion is resected.