Myocardial perfusion and function in dogs with moderate coronary stenosis

MRI studies of first-pass contrast enhancement with polylysine-Gd-DTPA and myocardial tagging using spatial modulation of magnetization (SPAMM) were performed to assess the feasibility of a combined regional myocardial blood flow and 2D deformation exam. Instrumented closed-chest dogs were imaged at a baseline control state (Cntl) followed by two interventions: moderate coronary stenosis (St) achieved by partial occlusion of the left anterior descending (LAD) and moderate coronary stenosis with dobutamine loading (StD). Hypoperfusion of the anterior region (ANT) of the myocardium (LAD distribution) relative to the posterior wall (POS) based on the upslope of the signal intensity time curve from the contrast-enhanced MR images was demonstrated only with dobutamine loading (ANT:POS Cntl=1.077 ± 0.15 versus ANT:POS StD=0.477 ± 0.11, P<0.03) and was confirmed with radio-labeled microspheres measurements (ANT:POS Cntl=1.18 ± 0.2 ml/min/g versus ANT:POS StD=0.44 ± 0.1 ml/min/g; P<0.002). Significant changes in regional myocardial shortening were only seen in the StD state (P<0.02); the anterior region showed impaired myocardial shortening with dobutamine loading (P=NS), whereas the nonaffected POS region showed a marked increase in shortening when compared with Cntl (Cntl=0.964 ± 0.02 versus StD=0.884 ± 0.03; P<0.001). These results demonstrate that an integrated quantitative assessment of regional myocardial function and semiquantitative assessment of myocardial blood flow can be performed noninvasively with ultrafast MRI.     

Abdominal zygomycotic thromboangiitis in a patient with AML and t(1;13;14)

 The case report of a 61 year-old man with AML M2 FAB, t(1; 13; 14) and zygomycotic mesenterial thromboangiitis is presented. Two induction cycles of chemotherapy were administered due to primary drug resistance. They were complicated by pneumonia, colonic pseudo-obstruction and perforation with peritonitis. The patient died on the 40th day of therapy, 4 days after undergoing palliative surgery. Zygomycotic thromboangiitis, which very probably contributed to the intestinal perforation, was confirmed morphologically at necropsy. The novel complex chromosomal translocation t(1; 13; 14) (q31; q32; q24) and the problems connected with the diagnosis of invasive fungal infections are discussed. Received: 26 January 1996 / Accepted: 12 June 1996     

Long-term follow-up study of 268 diabetic patients undergoing haemodialysis, with special attention to visual acuity and heterogeneity

We studied the long-term outcome of 268 patients suffering fromdiabetic end-stage renal disease (DM-ESRD) treated with long-termhaemodialysis between 1978 and 1991, with special emphasis onvisual acuity as well as the heterogeneity of DM-ESRD The 50%patient survival on haemodialysis was 60 months. Visual disturbanceswere found in 73.1% (392/536) of eyes at the start of haemodialysis.Chronological assess ment of visual acuity demonstrated thestabilization of visual acuity and 87.1% (364/418) of eyes werestable, 4.8% (20/418) were improved, and 8.1% (34/418) wereaggravated in the long term respectively. The change of visualacuity was frequently seen in the short term, and rapid shiftsof body fluid to correct overhydration induced abrupt changesof glycaemic control as well as retraction of macular oedema.Hence it might be one of the factors affecting rapid changeof visual acuity in the short term. Meanwhile, long-term deterioration of visual acuity resulted from either hyperten sionunresponsive to medical treatment or poor glycaemic control.Some DM-ESRD patients had only background retinopathy at thestart of haemodialysis and these were likely to have the nephroscleroticglomerular lesion. They were old, not nephrotic and had a milddegree of diabetes during the predialysis stage. Thus, DM-ESRDpatients seem to have some heterogeneity in their clinical characteristics,and old DM-ESRD patients with only background retinopathy havethe appearance of diabetic macroangiopathy rather than microangiopathy.     

Frequency and Output-Dependent Change in Conduction Over Slow Pathways in a Patient with Sustained Ventricular Tachycardia Unrelated to Coronary Artery Disease

In a patient with sustained ventricular tachycardia, we obtained two different paced QRS morphologies from a single pacing site. In one QRS morphology the stimulus to the QRS complex was long, 150 msec, and in the other it was 100 msec. At the paced cycle length of 600 msec and the stimulus output of 4 V, one QRS morphology with the stimulus to the onset of QRS activation (St-QRS) interval of 150 msec was observed. At the paced cycle length of 400 msec, the other QRS morphology with a St-QRS interval of 100 msec was observed alternatively with the former. At the paced cycle length of 353 msec or 316 msec, the latter with a shorter St-QRS interval was exclusively observed. When the stimulus output was increased from 4 to 10 V, keeping with the paced cycle length at 400 msec, the St-QRS interval was shortened from 100 to 80 msec. For the two QRS morphologies with two St-QRS intervals, two slowly conducting pathways would be responsible. The site of the block in the faster pathway must be located at the proximity of the pacing site and the conduction at a shorter paced cycle length would be explained by "supernormal conduction."     

Successful pregnancy in advanced renal failure without dialysis

We describe a successful pregnancy in a 22-year-old patient with advanced renal failure, who gave birth to a living boy in the 35th week of pregnancy. At the time of spontaneous delivery the mother had a serum creatinine of 851 mol/l. No dialysis treatment had been instituted during this successful pregnancy.     

Primary cerebral neuroblastoma (neurocytoma) in adults

Summary We report a case of a third ventricular neuroblastoma (neurocytoma) in a 66 year old man. A stereotactic needly biopsy was performed to obtain a tissue diagnosis and was followed by total resection. We elected not to give radiation or chemotherapy and to follow the patient closely with serial CT scans. Presently, 48 months postoperatively, the patient is free of tumor by head CT scan and able to live independently. We reviewed the literature of primary cerebral neuroblastomas/neurocytomas occurring in adults (15 years of age) and found 32 cases. Our patient is the oldest of this group with a mean age of 32 ± 14 years (S.D.). The location of the 33 neoplasms was intraventricular in 17 cases (52%) and intraparenchymal in 16 cases. The male to female ratio was 2: 1. Of the 17 patients having a minimal follow-up period of 5 months (mean 51 months), five developed recurrences after 5 to 144 months (mean 50 months) compared to 12 patients without recurrence after a 6- to 72-month follow-up period (mean 52 months). Recurrences occurred statistically significantly more often in parenchymal neuroblastomas/neurocytomas than in intraventricular tumor locations.     

Holt-Oram syndrome associated with the hypoplastic left heart syndrome

We present the first case of Holt-Oram syndrome associated with the lethal congenital heart defect of hypoplastic left heart syndrome. The possible pathophysiological link is explored and the need for careful genetic and cardiologic evaluation in these patients is reiterated.     

A simple cardiac contractility computer

A single-purpose analogue-computing device is described for the online assessment of the contractile state of the human myocardium from the left ventricular pressure (P_lv) data available during routine cardiac catheterisation. Due attention has been paid to the design of the computer circuits so that they will not process pressure phenomena outside the isovolumic contractile period. Either a \(\left( {\frac{1}{{P_{lv} }}\frac{{dP_{lv} }}{{dt}}} \right)_{max} \) or a plain \(\left( {\frac{{dP_{lv} }}{{dt}}} \right)_{max} \) index is presented on a digitalvoltmeter display, thus obviating the need for any graphical extrapolation or additional computation.     

慢性肾衰大鼠单个核细胞内游离钙浓度和白介素－1活性的变化

本文探讨了５／６肾切除术后慢性肾衰大鼠残肾纤维化的发生机理，发现术后１２０天，在残肾单个核炎性细胞浸润、残肾显著纤维化和肾功能损害的同时，残肾脂质过氧化物含量显著升高，抗氧化机制功能显著下降，钠钾ＡＴＰ酶活力显著下降，周围血单个核细胞内游离钙浓度显著升高，单个核细胞培养上清白介素－１活性增高。而摄入大量维生素Ｅ的大鼠，上述各指标有不同程度的改善，残肾纤维化显著减轻。提示残肾纤维化可能与单个核白细胞内游离钙浓度升高，进而产生白介素－１增多有关。