Electrical connection between left superior and inferior pulmonary veins in a patient with paroxysmal atrial fibrillation

We report the case of a patient with paroxysmal atrial fibrillation, who underwent pulmonary vein (PV) electrical isolation from the left atrium (LA). Prior to achieving isolation of the left superior PV (LSPV) from the LA, earlier PV potentials were recorded inside the left inferior PV (LIPV) than LA activity during pacing at the distal LSPV. The LSPV finally was isolated by radiofrequency applications at the ostium of the LIPV. The patient had electrical connection between the LSPV and LIPV, and required radiofrequency ablation of the breakthroughs from the LA to LIPV for complete isolation of the LSPV.     

Psychological stress,but not physical stress,causes increase in diazepam binding inhibitor (DBI) mRNA expression in mouse brains

Effects of conditioned emotional stimuli (CES), which induce psychological stress, on the expression of cerebral diazepam binding inhibitor (DBI) mRNA in mouse were examined using a communication box. Cerebral DBI mRNA expression significantly increased in a time-dependent manner after the application of CES. The maximal enhancement of DBI mRNA expression was observed 2 days after the application of CES, and this increase faded out over 7 days after the treatment. Flunitrazepam (1 mg/kg), an agonist for central benzodiazepine (BZD) receptors, completely abolished the CES-induced elevation of cerebral DBI contents and its mRNA expressions. These results indicate that cerebral DBI is enhanced by psychological stress, which is regulated by central BZD receptors.     

Effect of low-dose isoproterenol infusion on left atrial appendage function soon after cardioversion of chronic atrial tachyarrhythmias

BACKGROUND: Cardioversion of chronic atrial fibrillation or atrial flutter to sinus rhythm is often associated with transient atrial mechanical dysfunction, i.e. 'atrial stunning', which may increase the risk of subsequent thromboembolic events. We hypothesized that, because of its positive inotropic action, a low-dose isoproterenol infusion might improve postcardioversion atrial mechanical function. METHOD: Eighteen patients (15 male, three female; 12 atrial fibrillation, six atrial flutter; mean age 65+/-10 years) exhibiting atrial postcardioversion stunning were included in the study. Isoproterenol was infused for 10 min at a dose sufficient to increase the heart rate by about 10%. Using transesophageal echocardiography, both the left atrial appendage emptying/filling flow velocity and function (fractional area change) were examined at baseline, before isoproterenol (immediately after cardioversion) and after isoproterenol. RESULTS: With infusion of 0.005-0.008 microg/kg/min isoproterenol, heart rate increased by 11.1+/-2.9%, and left atrial appendage emptying velocity, which was diminished following cardioversion, increased significantly (P<0.001) (baseline, before and after isoproterenol: 41.1+/-18.0, 20.3+/-8.5 and 27.3+/-9.6 cm/s, respectively). No major complications were associated with isoproterenol infusion. CONCLUSIONS: Short-term infusion of low-dose isoproterenol improved atrial function after cardioversion of chronic atrial fibrillation and atrial flutter.     

RadGenomics project

Human health conditions are largely determined by a complex interplay among genetic susceptibility, environmental factors, and aging. The RadGenomics project, which began in April 2001, promotes analysis of genes in response to irradiation, identification of their allelic variants in the human population, development of an effective procedure for quantitating individual radio-sensitivity, and analysis of the interrelationship between genetic heterogeneity and susceptibility to irradiation. Major groups of genes with which the project will concern itself include DNA repair genes, cell cycle genes, oncogenes, tumor suppressor genes, genes for programmed cell death, genes for signal transduction, and genes for oxidative processes. The outcome of the RadGenomics project should lead to improved protocols for personalized radiotherapy and reduce the possible side effects of treatment. The project will contribute to future research on the molecular mechanisms of radiation sensitivity in humans and stimulate the development of new high-throughput technology for a broader application of the biological and medical sciences. Identification of functionally important polymorphisms in the radiation response genes may determine individual differences in sensitivity to radiation exposure. The staff members, who are specialists in a variety of fields including genome science, radiation biology, medical science, molecular biology, and bioinformatics, have come to the RadGenomics project from various universities, companies, and research institutes.     

A fatal case of anaphylactoid shock after administration of nonionic contrast medium

We report a case of fatal anaphylactoid shock caused by a CT examination using nonionic contrast medium. A 79-year-old female patient was diagnosed with right recurrent nerve plasy. There was no known history of drug allergy or exposure to contrast medium. Approximately 50 seconds after contrast medium bolus injection began, the patient was noted to be apneic. Despite cardiopulmonary resucitation, the patient died. An autopsy demonstrated marked laryngeal edema and showed extensive mast cell infiltration.     

Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease

OBJECTIVE: The purpose of this study was to clarify the nature of Osgood-Schlatter disease (OSD) using MR images.DESIGN: Thirty boys (40 knees) with OSD diagnosed by clinical symptoms and signs were investigated with MRI. Longitudinal evaluation was undertaken in 22 patients and the mean follow-up was 1.5+/-0.9 years. MR examinations were performed at least every 6 months in most cases. When a patient's symptoms changed, MRI was repeated and in cases where the initial MR examination showed an early or progressive stage of OSD, MRI was undertaken every month where possible. All MR examinations were performed in the sagittal plane with a 0.2 T imager.RESULTS: MR images were classified into five stages as follows: normal, early, progressive, terminal and healing. The stage of 11 knees (28%) did not change during the course of the study and 21 knees (53%) showed a change of at least one stage. Eight knees (20%) did not have follow-up MR studies. The initial MR examination was normal in nine knees. Eight knees were at the early stage at presentation. MR images showed edema-like changes around the tibial tuberosity. Ten knees were classified as in the progressive stage at the initial presentation and six knees were classified in this group during progression on follow-up MRI. MR images showed partial avulsion of the secondary ossification center, which was seen to be being pulled proximally. Eleven knees were at the terminal stage on presentation, where the avulsed parts of the secondary ossification center had become completely separated. Two knees were classified as in the healing stage at presentation and 19 knees progressed to the healing stage from the normal, early and progressive stages. The MR images showed the separated part that did not create the ossicle had recovered by osseous healing. On the other hand, radiographs of the early stage appeared almost normal, and in the progressive stage could not show the avulsed parts.CONCLUSIONS: We clarified the progress of OSD with MRI. The process of OSD started from the apophyseal stage and a tear appeared in the secondary ossification center, widening to an opened shell-like shape. This damage progressed to an ossicle in some cases. In short, the ossicle was formed from an avulsed portion. It was very difficult to show the course of OSD with radiography. MR images were especially useful for revealing early and progressive lesions of OSD.     

FDG-PET after radiotherapy is a good prognostic indicator of rectal cancer

In the management of rectal cancer after the combined therapy of the radiation and surgical operation, the evaluation of the prognosis is important. Although fluoro- 18-deoxyglucose positron emission tomography (FDG-PET) is considered as a useful tool for evaluation of therapeutic effect of this cancer as well as the other cancers, however, there are few articles that clearly describe the appropriate procedure of the FDG-PET in order to obtain the best prognostic value. The purpose of the present study is to compare several variations of a semi-quantification method, the Standardized Uptake Values (SUV) and to determine the most appropriate parameter, for the prognostic prediction and to propose the quantitative guideline of the FDG-PET. Especially, the authors focused on the SUV after radiotherapy, which had not been considered as a key quantitative value, as it was rather taken as a mere indicator of the therapeutic (radiotherapeutic) effect, not a direct indicator of the prognosis for the cancer itself. METHODS: Forty patients with rectal cancer in the lower rectal region underwent two series of FDG-PET study before and after pre-operative radiotherapy. Their SUVs were calculated from FDG-PET data and compared with the results of the long-term follow-up of the patients as well as with histopathological outcomes. Results: All 40 patients had high FDG uptake before radiotherapy. The mean value of SUV before radiotherapy (SUV1) was 7.6. After radiotherapy, the mean value of SUV (SUV2) decreased to 4.2. There was a significant difference in SUV2 between the groups with and without recurrence (p < 0.05), however, SUVI or SUV ratio (SUV2/SUV1) displayed no significant difference with the incidence of recurrence. CONCLUSION: SUV2 was considered to be a good prognostic indicator for long-term prognosis of rectal cancer patients. SUV1 nor SUV ratio SUV2/SUV1 did not have the equivalent prognostic usefulness. Subsets of patients with SUV2 greater than 3.2 should be observed closely.     

MR-guided intravascular catheter manipulation: feasibility of both active and passive tracking in experimental study and initial clinical applications

PURPOSE: To evaluate clinically the feasibility and usefulness of MR-guided intravascular procedures with either active or passive tracking. METHODS: With an active MR tacking system and a 0.2 Tesla open MR imager, real-time and biplane displays of positions of a receive-only coil at the tip of catheters were obtained. For passive tracking, 4 Fr catheters with suitable susceptibility for passive tracking were used. Passive tracking with a 1.5 Tesla MR imager could be performed with parameters of TR 15-50 msec, TE 2.2-2.7 msec, and FA 30 degrees. The temperature of each tracking catheter was monitored in vitro. Clinical trials were performed on six patients (three each). The catheter was introduced to the superior mesenteric artery (SMA) under MR guidance by active or passive tracking to perform MR imaging during arterial portography. RESULTS: The temperature increased minimally. In humans, the SMA and celiac artery could be easily introduced on active tracking. MR-guided manipulation of catheters by active or passive tracking in the model and in dogs' vessels was very successful. Introduction of the catheter into the SMA was successful in two cases of active tracking and in all cases of passive tracking. CONCLUSION: The MR-guided intravascular manipulation of catheters by active or passive tracking may be a clinically feasible method.     

Efficacy of contrast-enhanced MR imaging in cardiomyopathy: an experimental study using Bio14.6 hamsters

RATIONALE AND OBJECTIVES: Myocardial fibrosis was evaluated with magnetic resonance (MR) imaging in Bio14.6 hamsters. MATERIALS AND METHODS: Gated gradient-echo T1-weighted images and spin-echo images with gadopentetate dimeglumine enhancement (0.2 mmol/kg) were obtained. RESULTS: Myocardial enhancement persisted for 13 minutes after administration of gadopentetate dimeglumine, and myocardial signal intensity peaked at 13 minutes on gradient-echo T1-weighted images. The enhanced areas were greater in Bio14.6 hamsters at 25-42 weeks than at 10 weeks. Pathologic data revealed enhancement with inflammation at 10 weeks and fibrosis with vessel proliferation at 25-42 weeks. Pathologic fibrotic change was greater at 32-42 weeks than at 10 weeks. The myocardium of 42-week-old Bio14.6 hamsters showed remarkable contrast enhancement, which continued for 13 minutes. There was no correlation between gadolinium enhancement and pathologic findings in the evaluation of myocardial degeneration and fibrosis. CONCLUSION: Gadolinium-enhanced MR imaging was useful for estimating myocardial fibrotic changes with vessel proliferation and myocardial damage.