Intervention for Jailed Diagonal Branch Is Not Necessary While Stenting the Left Anterior Descending Artery

Objectives: To evaluate whether or not to treat diagonal branches interventionally while implanting sirolimus-eluting stents (SES) in left anterior descending artery (LAD).
Background: Percutaneous coronary intervention (PCI) procedures are complicated, especially in the case of a bifurcation lesion. The complicated strategy of PCI may increase the quantity of contrast medium, fluoroscopy time, and the number of devices.
Methods: We retrospectively included 35 patients with stable angina who were treated with SES between July 2005 and December 2006. They had 40 LAD/diagonal branch bifurcation lesions. The diagonal branches had a diameter greater than 1.5 mm. We finished the procedure without inflating diagonal branches when their flow showed thrombolysis in myocardial infarction (TIMI) flow grade 3, even if the ostium of the branches had severe stenosis. Follow-up angiographies were performed 6 months later. The LAD and ostium of diagonal branches were evaluated according to the quantitative coronary angiography (QCA) measurements.
Results: The percent diameter stenosis (%DS) of the ostium of diagonal branches was worse post-PCI than at baseline (P = 0.0101). When comparing the follow-up values with the baseline values, there were no significant differences. Additionally, follow-up values were significantly better than the post-PCI values (P = 0.0016). There was no hospitalization for heart failure, angina, or cardiac death. There was only one restenosis in LAD at follow-up, and no diagonal branch became totally occluded or delayed.
Conclusions: In the diagonal branches, the minimal lumen diameter decreased and diameter stenosis progressed temporarily; however, both parameters recovered at the time of follow-up.     

Inhibitory effect of clarithromycin on costimulatory molecule expression and cytokine production by synovial fibroblast-like cells

This study was undertaken to investigate the immunomodulatory effect of clarithromycin against synovial fibroblast-like cells (synoviocytes). Synovial tissue obtained from rheumatoid arthritis (RA) or osteoarthritis (OA) patients was enzymatically digested to separate synoviocytes. The synoviocytes were cultured with or without cytokines in the presence of various concentrations of clarithromycin. The expression of costimulatory molecules was examined on the surface of the synoviocytes, using specific MoAbs and flow cytometry. The production of cytokines by synoviocytes was also measured using an immunoenzymatic assay. Finally, autologous T cells were stimulated by interferon-gamma (IFN-γ)-treated synoviocytes in response to purified protein derivative (PPD). In some experiments, MoAbs specific for costimulatory molecules or clarithromycin were added and ³H-thymidine incorporation was counted. Intercellular adhesion molecule-1 (ICAM-1), LFA-3 and vascular cell adhesion molecule-1 (VCAM-1) were detected on the surface of both RA and OA synoviocytes. However, ICAM-2, B7–1 and B7–2 were not detected, and cytokines failed to induce these molecules. Both spontaneous and up-regulated expression of ICAM-1, LFA-3 and VCAM-1 by IFN-γ, IL-1β or 12-o-tetradecanoyl phorbol 13-acetate (TPA) were markedly suppressed by clarithromycin in a dose-dependent manner at concentrations between 0.1 and 10 μg/ml. The production of IL-1β, IL-6, IL-8, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) but not IL-1α and tumour necrosis factor-alpha (TNF-α) by synoviocytes was detected. Clarithromycin significantly suppressed the production of these cytokines, but did not enhance IL-10 production. Finally, autologous T cells were stimulated by IFN-γ-treated synoviocytes in response to PPD. As clarithromycin suppressed HLA-DR and costimulatory molecule expression was enhanced by IFN-γ, autologous T cell proliferation was markedly inhibited by clarithromycin. Clarithromycin has a considerable immunosuppressive effect on synoviocytes by inhibiting costimulatory molecule expression, cytokine production and antigen-specific T cell proliferation induced by synoviocytes.     

Significance of monitoring plasma levels of amitriptyline, and its hydroxylated and desmethylated metabolites in prediction of the clinical outcome of depressive state

Abstract The clinical significance of monitoring the plasma levels of amitriptyline and its metabolites in prediction of the clinical outcome of depressive episode was investigated in 49 inpatients. Discriminant analysis of drug concentrations (at two weeks after initiation of drug treatment) and clinical outcome revealed that increasing the plasma levels of amitriptyline, cis-isomers of hydroxylated metabolites (Z-10-hydroxyamitriptyline and Z-10-hydroxynortriptyline) predicted a better clinical outcome, while increasing of plasma levels of nortriptyline and trans-isomers of hydroxylated metabolites (E-10-hydroxyamitriptyline and E-10-hydroxynortriptyline) were shown to predict a poor clinical outcome in the depressive episode of the subjects, and that clinical outcome of approximately 73% of the subjects could be correctly predicted.     

Urodynamic evaluation of a suspension technique for rapid recovery of continence after radical retropubic prostatectomy

BACKGROUND: We investigated urodynamic findings involved in the rapid recovery of urinary continence after radical retropubic prostatectomy with a suspension technique. METHODS: A total of 45 consecutive patients (mean age 67.6 years) who had undergone radical retropubic prostatectomy for localized prostate cancer were evaluated with multichannel urodynamics including the maximal urethral pressure (MUP), functional urethral length (FUL), maximal cystometric capacity (MCC) and abdominal leak point pressure (ALPP) at base line, 1 week, 1 month, and 3 months postoperatively. The suspension of vesicourethral anastomosis preserving anterior attachments of puboprostatic ligaments to pubic bone was performed in 33 patients. Twelve patients did not undergo the suspension technique. RESULTS: The continence rates at 1 week, 1 month, and 3 months after radical prostatectomy in the suspension group were significantly higher than those in the non-suspension group: 67% versus 0% at 1 week (P < 0.001), 82% versus 25% at 1 month (P < 0.001), and 91% versus 50% at 3 months (P < 0.01), respectively. Postoperative ALPP at all points of measurement was significantly higher in the suspension group than in the non-suspension group (P < 0.0002). There was no difference in MUP, FUL or MCC at each point following radical prostatectomy between the two groups. CONCLUSIONS: These observations suggest that preserving anterior attachments of puboprostatic ligaments to pubic bone and fixation of urethral hyper-mobility by the suspension of vesicourethral anastomosis promotes rapid recovery of urinary continence after radical retropubic prostatectomy.     

Impaired transient elevation of blood hemoglobin in response to acute hypoxia in neonates with asplenia

BACKGROUND: It has been shown that acute hypoxia induces the transient elevation of blood hemoglobin concentration ([Hb]) as a consequence of sympathetic-mediated splenic contraction to maintain the supply of oxygen, and splenectomy abolishes this phenomenon. The purpose of the present paper was to determine, retrospectively, whether the ability of transient elevation of [Hb] against acute hypoxia would be impaired in neonates with asplenia. METHOD: Eleven neonates who underwent surgery from 1998 to 2003 were enrolled in this retrospective study. They were divided into two groups: (i) five patients with asplenia syndrome with cyanotic congenital heart disease (asplenia group); and (ii) six patients with hypoplastic left heart syndrome who needed nitrogen gas inhalation therapy (HLHS group). In the asplenia group simultaneous data of arterial oxygen saturation (Sao(2)) and [Hb] were obtained before and after the temporary unexpected decrease of percutaneous arterial oxygen saturation. In the HLHS group they were obtained before and after nitrogen gas administration therapy. The arterial oxygen content (Cao(2)) changes and the ratio of Cao(2) change (Cao(2) after hypoxia divided by Cao(2) before hypoxia) were also calculated. RESULTS: In the asplenia group [Hb] was unchanged (12.9 +/- 1.6 g/dL to 12.8 +/- 1.4, n.s.) and Cao(2) was decreased (14.5 +/- 1.6 mL/dL to 11.9 +/- 1.1, P = 0.018). In the HLHS group [Hb] was increased (14.6 +/- 1.3 g/dL to 15.4 +/- 1.5, P = 0.028), but Cao(2) was changed (18.2 +/- 2.2 mL/dL to 16.7 +/- 3.0, P = 0.043). The ratio of Cao(2) change for the HLHS group was significantly different from that of the asplenia group (0.92 +/- 0.10, 0.83 +/- 0.10, respectively, P = 0.02). CONCLUSIONS: Patients with asplenia syndrome have some disadvantage regarding this protective mechanism against acute hypoxia.     

A possible association between paternal longevity and major depression among elderly men

Abstract  Ancestral longevity is sometimes thought to contribute to psychosocial well-being in late life. The resent paper aims to examine if parental longevity is associated with mental health among the elderly. The age at death of the parents was compared between 68 patients with major depression who were aged 65 or over and 40 subjects of the same age range without any history of psychiatric disorder. Cox regression revealed that the fathers of the elderly men with unipolar depression died at a significantly younger age than those of the control group. Several hypotheses are advanced to explain this unexpected and intriguing association.     

Generalized cold urticaria: detection of heat-sensitive passive transfer substance active at moderate temperature

An 11–year-old girl presented with generalized weal formation of 8 months' duration which occurred when she was cooled at rest or after physical effort. The ice cube test was only slightly positive. Injection of the patient's serum into her arm skin and into the skin of two volunteers produced immediate weals. This passive transfer reaction occurred most strongly at skin temperatures around 30 °C but not at 40 °C. The weal producing substance was provisionally identified as an unusual immunoglobulin M(IgM) by gel filtration, immunoadsorption and physicochemical treatments.     

Medically and economically appropriate follow-up schedule for prostate cancer patients after radical prostatectomy

BACKGROUND: Our goal was to determine the optimal frequency and method of follow-up after radical prostatectomy to minimize medical cost without adversely affecting patients. METHODS: Two hundred and twenty-one patients who underwent a radical prostatectomy with or without adjuvant androgen deprivation from 1989 to 1999 were selected for the study. Eighty percent of the patients received postoperative androgen deprivation. Tumor recurrence was strictly defined as detectable serum prostate specific antigen (PSA) and/or clinical findings such as local tumor detection or bone metastasis. Thirty of 221 patients experienced tumor recurrence. Risk of tumor recurrence, procedures for detection of recurrence, and PSA doubling time after biochemical failure were analyzed. RESULTS: None of the 30 patients who were examined showed definitive local recurrence or metastatic sites on the imaging study at the time of initial PSA detection, and there were no observed recurrences in the absence of detectable serum PSA. In patients who showed elevated PSA within 12 months after radical prostatectomy, PSA levels rapidly increased with doubling times ranging from 1.2 to 13.7 months. Excluding those patients, the doubling time of PSA levels ranged from 2.8 to 31.5 months. CONCLUSIONS: Prostate specific antigen screening is sufficient to detect treatment failure after radical prostatectomy, irrespective of adjuvant hormone therapy. Based on the calculated doubling time, the longest advisable interval between checks of PSA levels is estimated to be four months within the first year after radical prostatectomy, and biannually or annually thereafter. Continuously elevated PSA levels or clinical symptoms indicate surveys for local recurrences and distant metastases.     

Macrocytosis Resulting from Early Denucleation of Erythroid Precursors

In an attempt to elucidate the mechanism of production of macrocytosis inacute anemia, we studied changes in red cell volume and hemoglobin content, the RNA level of normoblasts and reticulocytes and RNA synthesis inreticulocytes of rabbits made anemic by blood loss or phenylhydrazine administration. The results were as follows:

(1) In severe phenylhydrazine anemia, red cell volume and hemoglobincontent per cell increased to twice the normal values.

(2) The RNA level of normoblasts decreases with the maturation of thecells and reaches a minimum at the orthochromatic stage. The decrease issimilar in the normal and anemic rabbits.

(3) The RNA level of reticulocytes in the bone marrow is higher in anemicthan in normal rabbits. In general, the RNA level of reticulocytes of anemicrabbits is comparable to that of the polychromatic normoblasts, while in normal rabbits this value is comparable to that of orthochromatic normoblasts.

(4) Autoradiographs of reticulocytes incubated with H³-uridine indicatethat the increased level of reticulocyte RNA of anemic rabbits is not due tonewly synthesized RNA.

From these results, we conclude that in an "emergency" situation of erythropoietic stimulation denucleation of normoblasts occurs at the polychromaticstage of red cell maturation, with skipping of the terminal cell division toorthochromatic cells and formation of macrocytic reticulocytes and red cells.

Submitted on August 28, 1963 Accepted on April 30, 1964