Changes in apolipoproteins during the acute phase of Kawasaki disease

To determine disturbances of lipid metabolism in patients with Kawasaki disease, we investigated changes in the serum levels of apolipoproteins and serum lipids. Results were as follows. Total serum cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) decreased during the early stage of Kawasaki disease. The apo A-I and A-II levels were low until the 2nd week of illness. Apo B decreased during the 1st week of illness, but rose slightly during the 2nd and 3rd weeks. The apo B/apo A-I ratio and the apo B/TC ratio were high in the early stages of illness. The group of patients with coronary artery lesions showed low levels of TC and HDL-C, and low levels of apo A-I, A-II and B during the early stages, compared with the group without coronary artery lesions. The apo B/TC ratio was significantly higher in the patients with coronary artery lesions during the 2nd week of illness. Our findings suggest an association between changes in serum lipids and apolipoproteins and coronary artery involvement in Kawasaki disease. These abnormalities may indicate the presence of early coronary arteriosclerosis.     

Influence of Mobile Magnetic Resonance Imaging on Implanted Pacemakers

KISHI, R., et al.: Influence of Mobile Magnetic Resonance Imaging on Implanted Pacemakers. Purpose: Mobile magnetic resonance imaging (MRI) systems will be widely used in Japan. When traveling, mobile MRI generate alternating electromagnetic waves which may cause electromagnetic interference (EMI). This study was designed to determine whether this may influence the function of implanted pacemakers (PM). Methods and Results: The influence of the static magnetic fields was tested in the first method using a PM-human model (Phantom). Magnetic force was simultaneously measured. The PM was switched to the magnet mode within 90 cm from the vehicle, where the magnetic force was = 2 mT. In the second method, six phantoms were placed on the side of the road, facing in three different directions in X-Y-Z axis orientations, at 1.3 m and 2.0 m above the ground. The mobile MRI passed by at a distance of 1 m from the phantoms at the speed of 20 or 40 km/h. In these experiments, magnet mode switch of the PM was observed for 2 seconds when the vehicle passed close to the phantoms, though no electrical noise was recorded. Conclusion: Mobile MRI vehicles can switch a PM to magnet mode when the distance between patient and vehicle is <90 cm, regardless of whether the vehicle is moving or at a stop. Patients with implanted PM should not approach within <1 m of a mobile MRI. No other EMI-induced PM dysfunction was detected. (PACE 2003; 26[Pt. II]:527–529)     

Nonuniformity of AH Intervals During Stimulation at Different Left Atrial Sites

Studies in humans have found left atrial stimulation via the coronary sinus (CS) to elicit significantly shorter atrium-His (AH) intervals as compared to right atrial stimulation, but whether pacing at dijferent left atrial sites (anterior vs posterior left atrium, i.e., far distal vs proximal CSJ affects the AH interval has not been studied. Hence, in 22 patients, we compared the effects of stimulation from various atriai sites, including anterior high right atrium (HRA), distal CS, mid-CS, and proximal CS, on; stimulus-atrium (SA), AH, and stimuIus-His intervals on the His bundle electrogram. Paced cycle length differed for each patient (range 900–350 msec, mean 532 ± 140 msec), but conduction intervals from different atrial sites were compared using identical cycle length in each patient. The mean SA intervals were 34 ± 10 msec, 57 ± 10 msec, 44 ± 11 msec, and 32 ± 8 msec with stimulation, respectively, from HRA, distal CS, mid-CS. and proximal CS (each significantly different except for HRA vs proximal CSJ. The mean AH intervals were 123 ± 23 msec, 104 ± 28 msec, 95 ± 15 msec, and 90 ± 18 msec with stimulation, respectively, from HRA, distal CS, mid-CS, and proximal CS (each significantly different except for mid-CS vs proximal CSJ. In 13 patients, the discrepancy in AH intervals during distal versus proximal CS stimulation was > 15 msec; in 9 patients this difference was only < 10 msec, considered within the range of measurement error. Thus, in a significant portion of patients, discrepant AH intervals were demonstrated during stimulation from the distal versus proximal CS. These previously undescribed observations suggest that electrophysiological studies on atrioventricular nodal conduction that involve left atrial stimulation must take into account actual location of the stimulation site (anterior or posterior) in order to properly interpret the findings.     

Morbidity and mortality of infants born at the threshold of viability: Ten years'' experience in a single neonatal intensive care unit, 1991–2000

BACKGROUND: The purpose of the present paper was to evaluate the mortality and morbidity of infants born at 22-24 weeks gestation. METHODS: A total of 78 infants born at 22-24 weeks gestation, who were admitted between January 1991 through December 2000, were retrospectively studied. RESULTS: Seventy-one of 78 infants were enrolled in the present study. One year survival rates at 22, 23 and 24 weeks were 40.0% (2/5), 61.1% (11/18), and 50.0% (24/48), respectively. Failure of response to surfactant and air leak were associated with death in infants born at 23 weeks gestation. Low Apgar score, intraventricular hemorrhage (> or =III), and sepsis were correlated with death in infants born at 24 weeks gestation. The handicap rates of survivors born at 22, 23, and 24 weeks gestation were 100, 36.4, and 26.1%, respectively. CONCLUSIONS: The present study indicates that infants born at 22 weeks gestation, in whom pulmonary structure is established, that is, a viable lung that can exchange gas with exogenous surfactant, have a chance to survive, but neurological outcome is still poor. Every possible effort should be made to extend gestation beyond 22 weeks.     

Changing pattern of mental health utilization in Hachijojima

Abstract We have reviewed retrospectively 229 patients interviewed by the mental health team in the Hachijojima since the establishment of our services in 1987. The 6 year observation period was classified into three chronological stages for the purposes of identifying any change in the utilization pattern of the mental health services of the island. The rate of schizophrenia was observed to have decreased from 48% in the first 2 years of the study period to 28% in the last 2 years; while that of other mental disorders increased yearly. Interestingly, an increasing number of patients were referred to our services by professionals in areas other than mental health (from 42 to 77%), and patients without any history of psychiatric treatment were more frequently seen (from 36 to 75%) in the later part of the study period. These changes suggest the importance of access to mental health services.     

Impact of implant number,distribution and prosthesis material on loading on implants supporting fixed prostheses

Summary  The purpose of this study is to evaluate axial forces and bending moments (BMs) on implants supporting a complete arch fixed implant supported prosthesis with respect to number and distribution of the implants and type of prosthesis material. Seven oral Brånemark implants with a diameter of 3.75 mm and a length of 13 and 7 mm (short distal implant) were placed in an edentulous composite mandible used as the experimental model. One all‐acrylic, one fibre‐reinforced acrylic, and one milled titanium framework prosthesis were made. A 50 N vertical load was applied on the extension 10 mm distal from the most posterior implant. Axial forces and BMs were measured by calculating signals from three strain gauges attached to each of the abutments. The load was measured using three different models with varying numbers of supporting implants (3, 4 and 5), three models with different implant distribution conditions (small, medium and large) and three models with different prosthesis materials (titanium, acrylic and fibre‐reinforced acrylic). Maximum BMs were highest when prostheses were supported by three implants compared to four and five implants (P < 0.001). The BMs were significantly influenced by the implant distribution, in that the smallest distribution induced the highest BMs (P < 0.001). Maximum BMs were lowest with the titanium prosthesis (P < 0.01). The resultant forces on implants were significantly associated with the implant number and distribution and the prosthesis material.     

Anatomical Reproducibility of a Head Model Molded by a Three-dimensional Printer

We prepared rapid prototyping models of heads with unruptured cerebral aneurysm based on image data of computed tomography angiography (CTA) using a three-dimensional (3D) printer. The objective of this study was to evaluate the anatomical reproducibility and accuracy of these models by comparison with the CTA images on a monitor. The subjects were 22 patients with unruptured cerebral aneurysm who underwent preoperative CTA. Reproducibility of the microsurgical anatomy of skull bone and arteries, the length and thickness of the main arteries, and the size of cerebral aneurysm were compared between the CTA image and rapid prototyping model. The microsurgical anatomy and arteries were favorably reproduced, apart from a few minute regions, in the rapid prototyping models. No significant difference was noted in the measured lengths of the main arteries between the CTA image and rapid prototyping model, but errors were noted in their thickness (p < 0.001). A significant difference was also noted in the longitudinal diameter of the cerebral aneurysm (p < 0.01). Regarding the CTA image as the gold standard, reproducibility of the microsurgical anatomy of skull bone and main arteries was favorable in the rapid prototyping models prepared using a 3D printer. It was concluded that these models are useful tools for neurosurgical simulation. The thickness of the main arteries and size of cerebral aneurysm should be comprehensively judged including other neuroimaging in consideration of errors.