Changes of QRS axis in transient myocardial ischaemia induced by percutaneous transluminal coronary angioplasty

The QRS axis of 130 consecutive patients with coronary arterydisease undergoing percutaneous transluminal coronary angioplasty(PTCA) were measured before balloon inflation and just beforeballoon deflation. Patients were divided into two groups. GroupA (103) had angina pectoris and/or non-transmural old myocardialinfarction with no abnormal Q waves; group B (27) had an oldtransmural myocardial infarction with abnormal Q waves. In groupA, the QRS axis had significantly shifted to the left in patientswith left anterior descending artery (LAD) occlusion (from 68.0± 42.7^° to 40.2 ± 44.6^°, P<0.001);however in those patients without involvement of the major septalbranch, significant axis changes were not observed (from 53.6± 34.1^° to 49.8 ± 33.1^°). When the rightcoronary artery (RCA) was occluded in group A, the QRS axisshifted to the right significantly (from 63.2 ± 40.0^°to 89.8 ± 30.1^° P<0.01); during left circumflexartery (LCX) occlusion, no significant axis shift was observed.In group B, no significant axis shift was observed either inpatients with occlusion of the LAD or the RCA. It is concludedthat transient left axis deviation reflects an obstructive lesionof the proximal portion of the LAD with involvement of the majorseptal branch, and transient right axis deviation reflects anobstructive lesion of the RCA.     

The curative role of radiotherapy in patients with isolated para-aortic node recurrence from cervical cancer and value of squamous cell carcinoma antigen for early detection

The objective of this study was to examine the clinical benefits of routine squamous cell carcinoma antigen (SCC-ag) monitoring of patients with locally advanced cervical cancer. Recurrent disease occurred in 99 uterine cervical cancer patients with elevated pretreatment SCC-ag before primary radiotherapy. Elevated SCC-ag levels persisted in 23 patients after primary radiotherapy (group 1), and SCC-ag was normalized in 76 patients after primary radiotherapy (group 2). The overall survival (OS) rate was higher for patients with SCC-ag elevation as the first sign than for patients with recurrence predicted by other modalities for group 2 patients (P = 0.033). The prediction of isolated para-aortic node recurrence significantly correlated with SCC-ag elevation as an initial sign (P = 0.001). The SCC-ag level before primary radiotherapy (> or = 10.8 ng/mL) significantly affected recurrence predicted by SCC-ag elevation as an initial sign (P = 0.002). For multivariate analysis, the presence of para-aortic node recurrence was statistically significant in OS (P < 0.0001). Routine SCC-ag monitoring of patients with carcinoma of the uterine cervix can lead to the early diagnosis of isolated para-aortic lymph node recurrence, and prolonged survival can be achieved by applying radiation therapy to the para-aortic region. To reduce the number of patients monitored for SCC-ag, we recommend monitoring group 2 patients with pretreatment SCC-ag level before primary radiotherapy > or = 10.8 ng/mL.     

Total Reconstruction of the Auricle in Unilateral Microtia*

ABSTRACT In the 10 years from 1973 to 1982, 537 microtia patients visited to our Department. the operation is usually started around the age of ten years. We have used to reconstruct the auricle consists of two stages. To transplant the cartilage framework, the subcutaneous pocket is made from the incision line for the switching of the auricular remnants. The thickness of the skin layer in this pocket was selected to correspond to a depth immediately below the subdermal plexus. The skin of the auricular area is fitted closely to the transplanted cartilage framework by several mattress sutures tied over gauze. After transplanting the framework, it is of paramount importance for achieving a well-shaped prominence for the helix and anthelix to ensure that no excessive stress is brought to bear from the outside of the article. For this purpose, we used a thick Reston Sponge (3M Co., Ltd.) with a hole provided in the middle and stuck in onto the auricle. About six months after the first stage operation, the transplanted framework is raised from the side of the head with its overlying skin, in one stage. The skin flaps A and B are prepared at the upper and lower parts of the root of the auricle. These two flaps are transferred along the auriculocephalic sulcus toward the posteromedical auricular surface and sutured with 4-0 nylon mattress sutures. The raw area left event after this, a full thickness skin graft taken from the abdominal region is transplanted.     

Response of sympathetic nervous system activity to exercise in patients with congestive heart failure

To investigate the serial sympathetic nervous system response to exercise, plasma norepinephrine (NE) and epinephrine (E) concentrations were measured at rest, during each stage of treadmill exercise, and immediately and 5 minutes after exercise in 68 congestive heart failure (CHF) patients (NYHA functional class I 24, II 25, III 19) and 30 normal subjects. Circulatory responses of NYHA class II patients increased at early stages of exercise. Systolic blood pressure and double product at peak exercise were significantly lower in NYHA class III patients. Plasma NE response of NYHA class I patients was similar to that of normal subjects. However, plasma NE at rest, and during and after exercise were significantly higher in NYHA classes II and III patients than in normal subjects and NYHA class I patients (peak NE (pg ml-1); Normals: 547 +/- 37, I: 535 +/- 53, II: 867 +/- 87, III: 1033 +/- 157). There was no significant difference in plasma E levels among the four groups. NE response to exercise was augmented according to the severity of heart failure, which suggested compensatory activation of sympathetic nervous system activity. Circulatory responses were reduced in NYHA class III patients despite the exaggerated compensatory activation of the sympathetic nervous system. Blunted circulatory responses to increased NE concentration in NYHA class III patients might relate to a decreased cardiac responsiveness to sympathetic activity in severe CHF patients.     

A case of four coronary artery fistulae originating from three vessels associated with aneurysm

A case of an aneurysm associated with four coronary artery fistulaeoriginating from three vessels is reported. The patient, a 52-year-oldwoman, had chest heaviness and palpitations. Coronary arteriographyreveaed the four fistulae originating from three coronary vesselswith an aneurysm draining into the left ventricle and the mainpulmonary artery.The patient's symptoms were relieved afterfistulectomy and the aneurysmectomy, suggesting that a coronarysteal phenomenon through the fistulae was the cause of her symptoms.This case is of interest because of its rarity, since this isthe first case report of an aneurysm associated with four coronaryartery fistulae from three vessels.     

Donepezil increases regional cerebral blood flow in a case of Korsakoff syndrome

Cholinesterase inhibitors improve cognitive functions and regional cerebral blood flow (rCBF) in mild to moderate Alzheimer's disease (AD). Recently, the possibility has been suggested that in patients with dementia other than AD cholinesterase inhibitors are useful for the treatment of their cognitive impairment and behavioral symptoms. In the present study we report the effectiveness of donepezil for a patient with Korsakoff syndrome. The patient was a 65‐year‐old man who gradually showed disturbances in memory, attention and concentration. The etiology was considered to be alcoholism. He would indulge in drinking and repeatedly asked the same questions over and over. He also developed emotional fluttering and would not settle down. On admission, he showed a severe memory deficit, disorientation and momentary confabulation. It was obvious that the patient was inactive and not spontaneous. He also manifested disinhibited behaviors. The patient's confabulation gradually diminished in hospital. He had no focal neurological deficit. Cranial magnetic resonance imaging (MRI) did not reveal any abnormality. Single photon emission computed tomography (SPECT) with 99 m‐TC‐ hexamethyl propylamenamine oxide (HMPAO) indicated hypoperfusion in the left thalamus, left basal ganglia and bilateral medial temporal lobes. In order to improve his cognitive function, the patient was treated donepezil. An evaluation of the effects of donepezil on rCBF was performed with the images showing a remarkable improvement in cerebral perfusion in the right medial temporal, the left thalamus and basal ganglia. However, the patient's memory impairment, disorientation, disinhibition, and stereotypical behavior and utterance were not improved. As an explanation, it was speculated that his neural network might be damaged so severely that there was no room for improvement by the acetylcholinesterase inhibitors.     

Clinical and Experimental Studies on Teratogenic Mechanisms of Congenital Absence of Digits in Longitudinal Deficiencies*

ABSTRACT: In order to clarify teratogenic mechanisms of congenital absence of the digits in longitudinal deficiencies, ulnar deficiency, radial deficiency, central polydactyly, osseous syndactyly and cleft hand (central deficiency) were analyzed. Then, the same anomalies induced in rat fetuses with myleran were analyzed. In ulnar and radial deficiencies, the more severe was the degree of finger deficit, the more severe was the arrest of the forearm bone. The critical periods of these anomalies were earlier than those of other anomalies. Ulnar deficiencies were induced only in Gun: Wistar rats and radial deficiencies only in WKAH/Hkm rats. A genetic factor may influence the teratogenesis of ulnar and radial deficiencies. From histological analysis of tibial deficiency, it may be suggested that the cause of absence of digits in longitudinal deficiency is closely related to a deficit of mesenchymal cells. The analysis of skeletal changes of central polydactylies, osseous syndactylies and cleft hands suggested that there seemed to be the cleft hand formation process from osseous syndactylies and central polydactylies. These anomalies were often observed in both hands in various combinations. They could be induced by the same treatment at the same developmental stage in rats. The teratogenic mechanism of cleft hand seemed to be failure of induction of digital rays in the hand plate.