Mapping-guided focal cryoablation and endoaneurysmorrhaphy for a case of ischemic ventricular tachycardia with left ventricular aneurysm

A 74-year-old woman admitted with exertional dyspnea. Echocardiography revealed the giant left ventricular aneurysm. In the hospital course, she fell into sustained monomorphic ventricular tachycardia. Coronary angiogram showed complete obstruction of the LAD. Left ventricular ejection fraction was 20%. The origin of tachycardia seems to be at infero-apicallateral area of LV by electrophysiology study. Because of the failure of RF energy ablation, we planned mapping-guided cryoablation, CABG and endoaneurysmorrhaphy. To prevent air embolism and myocardial ischemic damage for long aortic cross clamp, intraoperative endocardial mapping was carried out on beating heart due to continuous normothermic coronary blood perfusion (300 ml/min) from the aortic root cannula under aortic clamping. Cold crystalloid cardioplegia changed into the root cannula after EPS, focal cryoablation (-100 degrees C) was performed 3 times on cardiac arrest. Sustained VT was not inducible in the following study. CABG and endoaneurysmorrhaphy was performed on repeated cardiac arrest during single aortic clamp. Postoperative course was uneventful, and she discharged 8 weeks after the operation.     

Molecular epidemiological study on tetracycline resistance R plasmids in enterohaemorrhagic Escherichia coli O157:H7.

Restriction patterns obtained with EcoRI and Southern hybridization were used for the differentiation of tetracycline-resistant (Tet(r)) R plasmids in enterobaemorrhagic Escherichia coli (EHEC) O157:H7 isolates from a mass outbreak at a kindergarten in Obihiro-City, Hokkaido, Japan, 1996. Two kinds of Tet(r) R plasmids of 50 and 95 kb were detected. The 50-kb plasmids were identical to each other, while the 93-kb plasmids were of three types that were very similar to each other. The tet genes of both 50- and 95-kb R plasmids were 100% identical to the tet gene of pSC101 and all plasmids hybridized to a probe for tet. Because food-origin O157 strains were sensitive to tetracycline, we concluded that such Tet(r) R-plasmids might transfer to drug-sensitive O157 strains in the infected individuals.     

Coronary heart disease risk factors in black and white patients with non‐insulin‐dependent diabetes mellitus

Objective. To determine possible racial differences in risk factors for coronary heart disease (CHD) in black and white patients with noninsulin‐dependent diabetes mellitus (NIDDM).

Methods: Study of risk factors for coronary heart disease among 308 subjects who met the WHO criteria for NIDDM.

Results. Both black and white patients were found to have a high prevalence of hypertension, obesity, low high density lipoprotein (HDL) cholesterol, low leisure‐time physical activity levels, and an atherogenic dietary profile. Black males were more likely to have hypertension, reported a greater intake of dietary cholesterol, and had lower triglycerides, higher HDL cholesterol levels, a lower CHOL/HDL ratio, and a lower waist to hip ratio (WHR) than white males. Black females had higher mean arterial and diastolic blood pressures, had lower triglycerides, higher HDL cholesterol, a lower CHOL/HDL ratio, a higher subscapular/triceps ratio and lower reported leisure‐time energy expenditure compared to white females. There were no racial differences found for obesity level.

Conclusion. Our results indicate that racial differences in CHD risk factors exist among black and white patients with NIDDM. The complex genetic, sociocultural and environmental interactions involving CHD risk factors that contribute to the development of CHD may eventually provide clues to the etiology of the disease.     

Medical students' images of the occupational health physician--on the evaluation of motivation in medical education

One of the aims of the University of Occupational and Environmental Health, Japan, is to educate students to become occupational health physicians. However, the number of students who enter the university without an understanding of this aim is large. Therefore, the course titled 'Introductory Lectures on Occupational and Environmental Health' was planned for the 2nd-year students with the purpose of giving them the motivation to become occupational health physicians. Surveys of students' images of the term "occupational health physician" before and after taking the course were accomplished using the method of 'Monju card', that is, three students, in turn, write their ideas of an occupational health physician on a card. Moreover, after the series of lectures, students were assigned a self-evaluation regarding the improvement of their images. The results of these surveys show that favorable images increased after the course, that classes offering information regarding the occupational health physician had an influence on the improvement of the images, and that students desire more such information. However, as some students indicated a strong rejection to becoming occupational health physicians throughout the course, a different type of course, and a new philosophy regarding the training of medical students may be necessary.     

Measurement of nerve dysfunction in neuropathic pain

Neuropathic pain is difficult to diagnose and treat. Both can be made easier if the nerve dysfunction can be quantified. The two basic modes of evaluation are subjective and objective. This article presents currently used methods in both arenas. Discussion is also given to some basic neurophysiology necessary to understanding the use of these testing methods.     

Papillary fibroelastoma in the left ventricular outflow tract

Summary We report a case of a papillary fibroelastoma originating from the left ventricular endocardium in the outflow tract which was discovered by echocardiography in an asymptomatic patient. Two echocardiographic features were observed: (1) the tumor surface was smooth, and characteristic papillary formation was not detected; and (2) the outline of the mass was clearly defined as a dense echo, with the central, radiolucent, portion surrounded by a highly refractive linear echo at the level of the maximum diameter of the mass. The excised tumor was covered with a gelatinous substance that masked multiple papillae on the surface, but its echolucent center could not be explained by the pathology of the tumor which was solid centrally. Our case indicates that a papillary fibroelastoma may sometimes show echocardiographic findings similar to those of a myxoma, although other investigators have not noted the smooth surface and the echolucent center makes it indistinguishable from a myxoma. Thus, in some cases, it is difficult to distinguish papillary fibroelastoma from myxoma by echocardiography.