A case of lung infection due to Mycobacterium abscessus (M. abscessus) complicated with primary macroamylasemia]

We report a case of lung infection due to Mycobacterium abscessus (M. abscessus), complicated with primary macroamylasemia. A 76-year-old man was admitted to our hospital in August 2002 because of bloody sputum and an abnormal shadow found on chest radiography. The patient had had pulmonary tuberculosis from 1998 to 2000. He was found to be antacid bacillus-positive (Gaffky 5) on examination of the sputum in August 2002, but after hospitalization was negative for tuberculosis bacillus on sputum examination by the PCR method. We had suspected the presence of non-tuberculous mycobacterial disease since the patient's admission, and had started a regime of three drugs: clarithromycin, rifampicin, and ethambutol. The bacteria were identified as M. abscessus in a later sputum culture examination. It was noticed that the blood amylase level was high, and the disease was diagnosed as primary macroamylasemia. Such a case of lung infection due to M. abscessus complicated with macroamylasemia has rarely been reported in Japan.     

Long-term prognostic value of cardiac autonomic nervous activity in postoperative patients with congenital heart disease

Background

Abnormal cardiac autonomic nervous activity (CANA) is not uncommon in postoperative patients with congenital heart disease (CHD).

Methods and results

We attempted to clarify the prognostic value of the CANA variables in postoperative CHD patients and prospectively evaluated the CANA variables in 292 consecutive biventricular and 91 Fontan repair patients. The CANA variables included the heart rate variability, arterial baroreflex sensitivity (BRS), washout ratio of the myocardial metaiodobenzylguanidine scintigraphy, and plasma norepinephrine level. With a follow-up of 10 ± 2 years, 98 total events that required hospitalization, including 13 deaths and 48 unscheduled cardiac events (UCEs), occurred. In all the CHD patients, all the CANA indices predicted the total events and UCEs. Of those, the NE level (p = 0.0004) and BRS (p = 0.0373) predicted the mortality. In a multivariate analysis, the BRS was an independent CANA-predictor for the total events (p = 0.007). In the biventricular patients, the plasma NE level, heart rate variability, and BRS predicted the total events and UCEs and the BRS was the only independent CANA-predictor for the total events (p = 0.0329). In the Fontan patients, the plasma NE level was the only predictor for the UCEs (p = 0.0242) and no other CANA variables were independent predictors of the total events or UCEs.

Conclusions

All CANA variables, especially the BRS, were useful predictors for future clinical events in biventricular CHD patients, whereas no CANA variables, except for the plasma NE level, predicted future clinical events in the Fontan patients.     

Three-year experience with alendronate treatment in postmenopausal osteoporotic Japanese women with or without type 2 diabetes

Aims

The increased risk of fractures in patients with type 2 diabetes can partly be explained by poor bone quality and extra-skeletal factors. A retrospective study was conducted to compare the outcome of alendronate (ALN) treatment for 3 years in postmenopausal osteoporotic Japanese women with or without type 2 diabetes.

Methods

One-hundred and fifty-one postmenopausal osteoporotic Japanese women (mean age at baseline: 67.8 years) who had been treated with ALN for more than 3 years in our outpatient clinic were analysed. The lumbar spine bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, and the urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX) and the serum levels of alkaline phosphatase (ALP) were monitored during the 3-year treatment period. The incidence of osteoporotic fractures was also assessed.

Results

Sixteen women had type 2 diabetes and were receiving pharmacological treatment, and 135 were non-diabetic. The urinary NTX and serum ALP levels significantly decreased and the lumbar spine BMD significantly increased, compared with the baseline values, without causing any severe adverse events including osteonecrosis of the jaw, femoral diaphysis atypical fractures, and atrial fibrillation, in a manner that was similar among women with type 2 diabetes and non-diabetics. However, the incidence of non-vertebral fractures was significantly higher among women with type 2 diabetes than among the non-diabetics.

Conclusions

ALN treatment appeared to have the similar effect on surrogate markers in postmenopausal osteoporotic Japanese women with or without type 2 diabetes. Because of lacking in statistical power for fracture incidence due to the small sample size, further studies are warranted to confirm the results of the fracture incidence.     

The effects of sex on out-of-hospital cardiac arrest outcomes

Objective

We examined the effects of sex on out-of-hospital cardiac arrest outcomes. There is evidence that women are more likely to survive cardiac arrest than men. However, few large studies have examined these sex differences in detail. It is unknown whether the female survival advantage is age-specific or whether sex affects neurologic outcomes after cardiac arrest events.

Methods

Data were analyzed from a nationwide population-based out-of-hospital cardiac arrest database (between January 2005 and December 2007) involving 318,123 patients (male: 188,357, female: 129,766) to assess the effects of sex on out-of-hospital cardiac arrest outcomes in Japan. We selected 276,590 patients aged 20 to 89 years with out-of-hospital cardiac arrest and compared the frequencies of initial cardiac rhythms, 1-month survival rates, and favorable neurologic outcome rates between sexes.

Results

The incidence of out-of-hospital cardiac arrest was higher in men than in women (men: 0.12%; women: 0.07%). Men were witnessed more often while out-of-hospital cardiac arrest was occurring (men: 42.1% and women: 36.9%), typically presented with initial ventricular fibrillation/ventricular tachycardia rhythms, and had a higher 1-month survival rate overall after out-of-hospital cardiac arrest events (men: 5.2% and women: 4.3%). However, the rate of survival with a favorable neurologic outcome for women aged 30 to 49 years was significantly higher than that for men within the same age range. Among patients initially presenting with ventricular fibrillation/ventricular tachycardia, the rate of survival with favorable neurologic outcome was higher for women than men in the group aged 40 to 59 years.

Conclusion

Our results suggest that men have a higher 1-month survival rate after out-of-hospital cardiac arrest because of a higher frequency of ventricular fibrillation/ventricular tachycardia presentation compared with women. Although patients of both sexes with out-of-hospital cardiac arrest initially presenting with ventricular fibrillation/ventricular tachycardia exhibited similar overall survival rates, the rate of survival with favorable neurologic outcome was significantly higher for women than men in the group aged 40 to 59 years.     

Effects of HMGB1 on ischemia-reperfusion injury in the rat heart

BACKGROUND: Coronary ischemia-reperfusion (I/R) injury causes cardiomyocyte necrosis in a multi-step process that includes an inflammatory reaction. A recent study has suggested that high-mobility group box 1 (HMGB1) is a late mediator of lethal sepsis and an early mediator of inflammation and necrosis following I/R injury. In the present study a neutralizing monoclonal antibody (mAb) for HMGB1 was used to clarify the role of HMGB1 in cardiac I/R injury. METHODS AND RESULTS: Rats underwent 30 min of left coronary artery occlusion followed by 60 min reperfusion. An intravenous injection of anti-HMGB1 mAb or control IgG was administered just before reperfusion. The infarct size was enlarged in the anti-HMGB1 mAb group in comparison with the control group (p<0.05). The treatment of anti-HMGB1 mAb significantly increased the plasma troponin-T and norepinephrine (NE) content in the heart in comparison with the control (p<0.05). Moreover, the production of dihydroxyphenylglycol was reduced in the anti-HMGB1-treated group (p<0.05). CONCLUSION: This study shows for the first time the effects of treatment with neutralizing anti-HMGB1 mAb on I/R injury in the rat heart. The findings support the novel view that I/R-induced HMGB1 may be an important factor in the modulation of interstitial NE.     

Transfecting Deoxyribonucleic Acid of Bacillus Bacteriophage ϕ29 That Is Protease Sensitive

The transfecting activity of Bacillus phage varphi29 DNA, extracted either by sodium lauroyl sarcosine-phenol or by 2 M perchlorate, was destroyed by treatment with proteolytic enzymes, although these enzymes did not effect transfecting DNAs of SPP1, SPO1, and SP50. These facts suggest that a protein is associated with transfective varphi29 DNA. Stabilization of protease-resistance during transfection appeared earlier than that of DNaseresistance, indicating that the protein associated with varphi29 DNA is necessary for initiation of the incorporation of DNA molecules into competent cells. The physical nature of varphi29 DNA before and after the trypsin treatment was investigated by sucrose and CsCl density gradient centrifugations. The trypsin treatment did not alter the sedimentation rate of the unit varphi29 DNA; however, it did convert the sedimentation rate of the aggregated material in the untreated DNA to that of the unit varphi29 DNA. The density of the trypsinized DNA was 0.009 g/cm(3) greater than that of the untreated DNA. The possible location of the protein on the DNA is discussed.     

Effect of Corticosteroid Therapy on Ventricular Arrhythmias in Patients with Cardiac Sarcoidosis

Background: Ventricular arrhythmias are one of the main causes of sudden death in cardiac sarcoidosis (CS). Little is known about the efficacy of corticosteroid therapy for ventricular arrhythmias in CS. Methods: Thirty‐one CS patients presenting premature ventricular contractions (PVCs, ≥300/day) were investigated. Fourteen patients had nonsustained ventricular tachycardia (NSVT). All of patients were treated with corticosteroid, and the initial dosage is 30 mg/day of prednisone, which was tapered over a period of 6 months to a maintenance dosage of 10 mg/day. Twenty‐four hour Holter monitoring, signal averaged electrocardiography (SAECG), echocardiography, gallium‐67 scintigraphy, serum angiotensin converting enzyme (ACE) and plasma B‐type natriuretic peptide (BNP) concentrations were assessed before and after corticosteroid therapy. Results: As a whole, there were no significant differences in the number of PVCs and in the prevalence of NSVT before and after steroid therapy. However, the less advanced LV dysfunction patients (EF ≥ 35%, n = 17) showed significant reduction in the number of PVCs (from 1820 ± 2969 to 742 ± 1425, P = 0.048) and in the prevalence of NSVT (from 41 to 6%, p = 0.039). Late potentials on SAECG were abolished in 3 patients. The less advanced LV dysfunction group showed a significantly higher prevalence of gallium‐67 uptake compared with the advanced LV dysfunction group (EF < 35 %, n = 14). In the advanced LV dysfunction patients, there were no significant differences in these parameters. Conclusions: Corticosteroid therapy may be effective for ventricular arrhythmias in the early stage, but less effective in the late stage. Ann Noninvasive Electrocardiol 2011;16(2):140–147     

Hyponatremia and Its Association with the Neurohormonal Activity and Adverse Clinical Events in Children and Young Adult Patients after the Fontan Operation

Background. Hyponatremia (HN) is relatively common in adults with congenital heart disease and is a powerful predictor of mortality. However, the precise relationship of HN to the Fontan pathophysiology remains unknown. Purpose. Our study aimed to clarify the association of HN to the Fontan pathophysiology. Methods and Results. We measured the plasma sodium (Na) level in 169 consecutive Fontan patients (78 children) and HN (≤137 mEq/L) was observed in 50 patients (30% of the total patients, 31% of the children). The HN patients showed a lower peak oxygen uptake (VO₂) with a greater New York Heart Association class (P < .0001). The plasma level of norepinephrine (NE), rennin activity (PRA), arginine vasopressin, central venous pressure (CVP) and medications were associated with the Na levels and the NE, PRA, and diuretic use were the independent determinants (P < .01?.0001). The plasma B‐type natriuretic peptide was not correlated with the Na levels. In the children, diuretic use and the PRA independently determined the Na levels without any association to the CVP or peak VO₂. During a median follow‐up of 2.1 years, the HN in addition to the CVP and peak VO₂ independently predicted the unscheduled hospitalizations in all patients, while the HN was the only independent predictor of the hospitalizations in the adult patients (hazard ratio: 3.1, 95% confidence interval 1.2–8.0, P= .021). Conclusions. Child and adult Fontan patients exhibited a high prevalence for HN that closely reflected some neurohumoral activation and predicted adverse clinical events, especially in adult Fontan patients.     

Acquired pseudoaneurysm of the sinus of Valsalva

Localized aneurysms of the sinus of Valsalva are uncommon. Repair is tailored to the defective anatomy of the sinus, the aortic valve, and the coronary artery. Herein, we report the successful surgical treatment of 2 patients who had unruptured pseudoaneurysms of the sinus of Valsalva. An evident fissure in the intima of the sinus of Valsalva was seen in both patients. Patient 1 was a 57-year-old man with annuloaortic ectasia who was diagnosed with pseudoaneurysm of the right sinus of Valsalva. A thrombus that had formed in the pseudoaneurysm subsequently migrated into the right coronary artery. Aortic root remodeling was performed. Patient 2 was a 23-year-old man with a history of blunt chest trauma. He developed a pseudoaneurysm in the right sinus of Valsalva and tears on the aortic cusps. He underwent aortic valve replacement and repair of the Valsalva wall.     

Clinical, molecular, and genomic changes in response to a left ventricular assist device

The use of left ventricular assist devices in treating patients with end-stage heart failure has increased significantly in recent years, both as a bridge to transplantation and as destination therapy in those who are ineligible for cardiac transplantation. This increase is based largely on the results of several recently completed clinical trials with the new second-generation continuous-flow devices that showed significant improvements in survival, functional capacity, and quality of life. Additional information on the use of the first- and second-generation left ventricular assist devices has come from a recently released report spanning the years 2006 to 2009, from the Interagency Registry for Mechanically Assisted Circulatory Support, a National Heart, Lung, and Blood Institute-sponsored collaboration between the U.S. Food and Drug Administration, the Centers for Medicare and Medicaid Services, and the scientific community. The authors review the latest clinical trials and data from the registry, with tight integration of the landmark molecular, cellular, and genomic research that accompanies the reverse remodeling of the human heart in response to a left ventricular assist device and functional recovery that has been reported in a subset of these patients.