Clinical characteristics in transient ischemic attack patients with atrial fibrillation

OBJECTIVE: The aim of this study was to clarify the characteristics of transient ischemic attack (TIA) patients with atrial fibrillation (AF) compared to those without. METHODS: We divided 67 TIA patients with left hemispheric involvement into two groups; patients with AF (AF group) and without AF (Non-AF group) and compared the clinical characteristics between the two groups. PATIENTS: AF group included 12 patients (73.0 +/- 9.7 years old) and the Non-AF group 55 patients (64.1 +/- 9.8 years old). RESULTS: Clinically, arterial disease was less frequently seen in the AF group than in the Non-AF group (17% vs 53%, p = 0.028). No significant differences were observed between the two groups in the duration (< 1 hour; AF vs Non AF group: 50% vs 32%) or number of TIAs (more than 1; 17% vs 37%), use of anticoagulation or antiplatelet at time of symptom onset (34% vs 14%), past history of stroke and TIA (58% vs 38%) and ischemic heart diseases (8% vs 13%), and risk factors for atherosclerosis including hypertension (42% vs 71%), diabetes mellitus (17% vs 31%), hyperlipidemia (17% vs 47%), smoking (50% vs 51%) and other emboligenic cardiac diseases except for AF (0% vs 4%). Aphasia was observed more frequently in the AF group than in the Non-AF group (67% vs 20%, p = 0.003), whereas, hemiparesis without aphasia was seen less frequently in the AF group than in the Non-AF group (17% vs 55%, p = 0.025). CONCLUSION: TIA patients with AF are more likely than those without AF to exhibit a major hemispheric syndrome, such as aphasia.     

Proximal Left Subclavian Artery Aneurysm Presenting Hemoptysis,Hoarseness, and Diplopia: Repair through Partial Cardiopulmonary Bypass and Perfusion of the Left Common Carotid Artery

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.     

Fascicle arrangements of vastus lateralis and gastrocnemius muscles in highly trained soccer players and swimmers of both genders

The thickness, fascicle angles of pennation, and fascicle length of the vastus lateralis (VL) and medial gastrocnemius (MG) muscles in highly trained soccer players and swimmers of both genders were determined from ulrasonograms to investigate whether the fascicle arrangements of the lower limb muscles in the athletes could be related to the requirements of the events, i. e., intensive muscular activities in the water versus on the ground. In comparisons between the two events, the soccer players tended to show shorter fascicles and greater fascicle angles, and the swimmers thicker muscles and longer fascicles, especially in VL. In both events, the males showed thicker muscles and greater fascicle angles than the females. In both VL and MG, the thickness, fascicle length and fascicle angle were related to each other in a right-angled triangle model, and so, most of the event- and/or gender-related differences observed in the fascicle angle depended on the difference in muscle thickness relative to fascicle length. The present data cannot answer the question of whether the athletes had muscles suited to their respective sports prior to beginning their sports or whether the muscles adapted specifically to the competitive and/or training styles. However, it might be assumed that the lower limb muscles for swimmers are suitable to perform rapid, powerful kick movements during competitive swims by having greater thickness and longer fascicle, i. e., priorities in both force production and shortening velocity, but those for soccer players do not show architectural profiles which can be related to intensive activity on the ground, except that the thickness values exceed the normal range.     

Pulsed Dye Laser Treatment for Linear Scars with Concave and Erythematous Appearance

Facial linear scars with concave and erythematous appearance sometimes occur after long observation even if adequate conservative treatments have been applied. Because the regenerated epithelium is thin, those scars are seen as red or pink, and are sometimes accompanied with postinflammatory hyperpigmentation. For these scars, flashlamp-pumped pulsed dye of the wavelength of 585 nm and pulse-width of 450 µs was used, and acceptable results were obtained. Three cases required one treatment and one case needed two, and any side effects were not recognized. Compared with the carbon dioxide laser, which often shows severe scarring as a side effect, the pulsed dye laser with a short down time is useful.     

Inactivation of cholinesterase induced by chlorpromazine cation radicals

To clarify the mechanism of the side effect of chlorpromazine, we examined the inactivation of cholinesterase induced by chlorpromazine. Cholinesterase was inactivated and its activity was lost in rat serum during interaction of chlorpromazine with horseradish peroxidase and H2O2. When chlorpromazine was oxidized by horseradish peroxidase and H2O2, the reaction solution colored pink and the visible absorption spectrum was consistent with the absorption spectrum of the chlorpromazine cation radical (CPZ*+). Adding cholinesterase immediately decreased the pink color of CPZ*+, indicating that CPZ*+ directly attacked cholinesterase to cause loss of the enzyme activity. Tryptophan residues in cholinesterase sharply decreased during the interaction of cholinesterase with horseradish peroxidase and H2O2. Presumably, loss of tryptophan residues changed the conformation of the cholinesterase protein and then the activity of the enzyme was lost. Other phenothiazine derivatives, including promethazine, triflupromazine, trifluoperazine, trimeprazine, thioridazine and perphenazine, also inactivated cholinesterase during the oxidation by horseradish peroxidase and H2O2. These results suggest that phenothiazine cation radicals participate in toxicological signs caused by the drugs.     

Elimination kinetics of quinaprilat and perindoprilat in hypertensive patients with renal failure on haemodialysis

Objective of the present study was to investigate the elimination kinetics of quinaprilat and perindoprilat, the active metabolites of angiotensin-converting enzyme (ACE) inhibitors quinapril and perindopril, in hypertensive patients with renal failure under haemodialysis to evaluate the appropriate duration of off-dose of these drugs before starting of low-density lipoprotein (LDL) apheresis. The informed consent was received from 12 hypertensive patients with renal failure, who were under haemodialysis (42 to 62 years). The patients received oral administration of quinapril (10 mg) or perindopril (2 mg) once a day for four weeks. First, to evaluate the dialyzability of each metabolite, blood samples were collected before and after haemodialysis one week after the repeated doses. Second, to evaluate the elimination kinetics of quinaprilat or perindoprilat, blood samples were collected at 24, 72, 120, 192 and 240 h after the final administration. Plasma concentrations of quinaprilat and perindoprilat were measured by high-performance liquid chromatography (HPLC) and radioimmunoassay, respectively. Pharmacokinetic parameters were determined by a model-dependent method. Values of haemodialysis clearance (CL(HD)) and extraction ratio (ER) were 51.5+/-30.2 ml/min and 0.35+/-0.21 for quinaprilat and 108.1+/-5.9 ml/min and 0.75+/-0.04 for perindoprilat, respectively. The terminal elimination half-lives of quinaprilat and perindoprilat were 60.7+/-2.1 and 79.9+/-14.0 h, respectively. The dialyzability of perindoprilat was much higher than that of quinaprilat probably due to low protein binding potency. The present study suggests that hypertensive patients receiving chronic therapy with quinapril or perindopril on haemodialysis should be withdrawn for at least 2 to 3 weeks before LDL apheresis.     

Helicobactor pylori infection is closely associated with telomere reduction in gastric mucosa

OBJECTIVE: To investigate differential reduction in telomere DNA in tissue components of gastric mucosa with respect to Helicobactor pylori infection. MATERIALS AND METHODS: The telomere content was examined by fluorescent in situ hybridization with the (TTAGGG)(4) probe. To compare the signal intensities from the probe (telomere volume) with telomere length, five gastric carcinoma cell lines were used. Telomere volumes were examined in 9 healthy persons, 124 non-cancer patients, and 86 gastric cancer patients. RESULTS: Telomere volume showed a linear correlation with telomere length measured by Southern blotting in gastric carcinoma cells. In healthy persons without H. pylori infection, the telomere volumes of gastric epithelial tissues were 70-79% that of intramucosal lymphocytes (internal control). In 124 patients without gastric cancer, telomere volume of H.-PYLORI-infected mucosa was significantly less than that of H.-pylori-negative mucosa in both metaplastic and non- metaplastic tissues (p < 0.0001). In 86 gastric cancer patients, telomere volumes in intestinal metaplasia adjacent to cancer were 75% that of intestinal metaplasia of non-cancer patients (p = 0.0001). hTERT expression was detected in 6 cancer-associated and 2 cancer-negative intestinal metaplasia specimens, in which telomere volume was markedly reduced. CONCLUSION: H. pylori infection is closely associated with telomere reduction in gastric epithelium.     

Cross-sectional shapes of the internal auditory canal in patients with acoustic neuromas

Cross-sectional images of the internal auditory canal (IAC) were investigated in 23 patients with acoustic neuroma in order to clarify the widening of the IAC. The area of the IAC and the ratio of areas (neuroma side:normal side) were calculated. The shape of the IAC was fitted by an ellipse to obtain the length of the axes and the direction of the long axis. The area of the IAC was 34.2+/-12.2 mm2 in the neuroma side and 18.1+/-4.8 mm2 in the normal side. The neuroma side was larger than the normal side in all patients, and the mean ratio of areas was 1.9. However, the degrees of cochlear and vestibular damage did not correlate with the ratio of areas. The mean ratio of axes of the approximated ellipse was 1.17+/-0.09 in the neuroma side and 1.14+/-0.10 in the normal side; however, no significant difference was seen between the ratio of axes. The directions of the long axes were not always consistent with the positions of the originating nerves of the tumour. Referring to hypothetical models of enlargement of the IAC, our data suggest that the widening of the IAC in the acoustic neuroma was expansive. The data also indicated that symptoms of the acoustic neuroma were caused not only by compression of the nerves but also by other mechanisms, such as vascular insufficiency to the inner ear.     

Isolation and structural determination of phepropeptins A, B, C, and D, new proteasome inhibitors, produced by Streptomyces sp

We have isolated four related compounds named phepropeptins A, B, C, and D, as inhibitors of proteasome proposed to regulate many cellular functions. From an NMR analysis, the phepropeptins appeared as cyclic hexapeptides, differing in the two residues of the constituent amino acids from one another, with four conserved amino acid moieties. Based on an amino acid analysis, we synthesized two possible cyclic peptides to phepropeptin B that differ in the configurations. A comparison of the properties between the natural and synthesized compounds revealed that the structure of phepropeptin B was cyclo(-L-Leu-D-Phe-L-Pro-L-Phe-D-Leu-L-Val-). The phepropeptins showed inhibition to the proteasomal chymotrypsin-like activity but not to alpha-chymotrypsin.     

Toxicity study of cefmatilen hydrochloride hydrate (S-1090) (4)--One- and three-month repeated oral dose toxicity studies in dogs

One- or three-month repeated oral dose toxicity studies of Cefmatilen hydrochloride hydrate (S-1090) were conducted in beagle dogs. Doses were set at 25, 100 and 400 mg potency/kg/day in both studies. In both studies, no deaths occurred, and reddish-brown feces (due to chelated products of S-1090 and its decomposition products with Fe3+ in the diet) were observed in all treated groups. A transient excretion of reddish urine was observed in the 400 mg potency/kg group and a slight increase in plasma irons was also observed in the 100 and 400 mg potency/kg groups of both studies. However, as no changes suggesting anemia or hepatic injury were noted in these groups, the change of plasma irons was considered to have no toxicological significance. Plasma S-1090 concentrations increased in a manner less than dose-proportional in both studies. In the one-month toxicity study, no toxicologically significant changes, including the above findings, were noted, so the NOAEL was assessed to be 400 mg potency/kg/day. In the three-month toxicity study, urinalysis in the 400 mg potency/kg group revealed a positive reaction to occult blood and erythrocytes in sediments. In the pathological examinations, submucosal edema, hemorrhage, inflammatory cell infiltration and occasionally focal mucosal thickening were observed in the urinary bladder of the 400 mg potency/kg group. The cystisis was considered to result from chronic stimulation with the metabolite(s) of S-1090 in urine, and the reversibility was demonstrable upon one-month drug withdrawal. From these results, the NOAEL of S-1090 in the three-month toxicity study was assessed to be 100 mg potency/kg/day.