Class IC Antiarrhythmic Drugs, Flecainide and Pilsicainide, Produce ST Segment Elevation Simulating Inferior Myocardial Ischemia

ST Elevation with Flecainide and Pilsicainide . Flecainide and pilsicainide, Class IC antiarrhythmic drugs with slow kinetics, were administered to a 64-year-old man experiencing ventricular tachycardia. Both drugs suppressed the arrhythmia, but caused ST segment elevation in leads II, III, and aVF. No evidence of ischemic heart disease was detected. Withdrawal of the drugs eliminated the ST change. Because these drugs frequently are used to treat tachyarrhythmias in patients who may present with chest pain, this rare ECG manifestation of Class IC drugs should he recognized to avoid misdiagnosis of acute interior myocardial infarction.     

A Study of Reflux Esophagitis in an Apparently Healthy Population

Abstract: To study reflux esophagitis in the general population, we reviewed the records of 64,171 apparently healthy Japanese adults, 48, 706 men and 15,465 women, who had undergone automated multiphasic health testing and services (AMHTS), a comprehensive routine medical health check, that includes double-contrast upper gastrointestinal roentgenograms. All subjects suspected of having gastrointestinal disease underwent a flexible fiberscopy as indicated. Reflux esophagitis was thus confirmed in 101 subjects. The prevalence of refla esophugitis was 0.20% among men and 0.04% among women (men vs. women p<0.001) and its frequency increased with age in both men (p<0.001) and women (p<0.05). Endoscopic classification according to the Savary-Miller criteria yielded 48, 27, 23, and patients in Stage I, II, III and IV, respectively. In this series, 49/101 (48.5%) of the esophagitis patients had concurrent upper gastrointestinal abnormalities. The incidence of heavy smoking and excessive drinking of alcohol was significantly higher in the patients with reflux esophagitis (p<0.001 and p<0.005, respectively) as compared with the normal population.     

Morphological and Functional Evaluation of Gastric Ulcer Healing and Recurrence by Endoscopic Ultrasonography

Abstract: The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI-IV ulcers was significantly higher than those in UI-II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurrence.     

Association between activity level and changes in bodyweight in dementia patients

Introduction: Bodyweight is routinely used as an important health assessment measure in care facilities. Recently, the integrated circuit (IC) tag monitoring system became available for measuring the distance walked by patients with dementia (PsWD) over an extended period. The main objective of the present study was to examine an association between the distance walked and changes in bodyweight in PsWD. Methods: Monitoring was conducted in a semi‐acute dementia care unit in Japan between November 2006 and March 2007. All patients had been diagnosed with dementia and were able to walk independently. Demographic and food intake data were obtained from medical records. Bodyweight was measured weekly. The monitoring system calculated the distance walked. The study was approved by the Ethics Committees of Osaka University and Asakayama Hospital and written informed consent was obtained from authorized proxies. Results: In total, 23 patients were monitored. The median distance walked per day for all subjects was 1042.7 m (range 136–7781m) and the mean rate of weight change per month was ?0.1 kg (range ?1.5 to 2.4 kg). The mean food intake per day was 97 ± 5% (range 79–100%). There was a significant negative correlation between median distance walked per day and rate of weight change per month (r = ?0.52; P < 0.05). Distance walked per day was divided into three groups (<1 km, 1–2 km and ≥ 2 km), but there was no change in mean food intake between the three groups. However, PsWD who walked ≥ 2 km/day tended to have higher total Neuropsychiatric Inventory–Nursing Home Version (NPI‐NH) scores and a higher number of symptoms than those who walked < 2 km/day. The former tended to have aberrant motor activity compared with the latter. Conclusion: The present study shows that the distance walked per day seems to play a major role in weight change. Because the IC tag monitoring system can measure the distance walked accurately over an extended period, it could be used to estimate the calorie expenditure for each patient and to reduce the various risks related to weight loss.     

Subchronic Oral Toxicity of Glyoxal via Drinking Water in Rats

Subchronic Oral Toxicity of Glyoxal via Drinking Water in Rats.Ueno, H., Segawa, T., Hasegawa, T., Nakamuro, K., Maeda, H.,Hiramatsu, Y., Okada, S., and Sayato, Y. (1991). Fundam. Appl.Toxicol. 16, 763–772. The subchronic oral toxicity ofglyoxal via drinking water and the effect on in vivo proteinsynthesis in tissues following a single treatment with thissubstance were assessed in Sprague–Dawley male rats. Animalsreceived drinking water containing glyoxal levels of 2000, 4000,and 6000 mg/liter ad libitum for 30, 60, and 90 days in PhaseI. In Phase II, the high-dose and control-1 groups fed the dietad libitum, and a diet-limited control-2 group given the sameamount of diet as consumed by the high-dose group were maintainedfor 90 and 180 days. The study designs included observationsof clinical signs, body weights, major organ weights, grossand histopathological examinations, serum clinical chemistry,and biochemical examinations such as glyoxalase activity andglutathione content in selected tissues. Body weight gain andorgan weights significantly decreased with dosage. Althoughconsumption of food and water was also depressed in the exposedgroup, the reduction of body weight gain was greater in thehigh-dose group than in the diet-limited control 2 group. Histopathologicalexaminations revealed only a slight papillary change in thekidneys from the high-dose group at both 90 and 180 days terminationsin Phase II. The induction of both glyoxalase I and II was observedin liver and erythrocytes at 30-day termination of the exposedgroups. Serum enzyme and protein levels were significantly reducedby the mid- and/or high-dose exposures. With a single oral high-dosetreatment of glyoxal, a great decline in the incorporation ofL-[³H]leucine was shown particularly in the liver, and thisprobably led in part to a reduction in the serum protein levelsin rats following subchronic exposure to glyoxal. These dataindicated an overall low degree of systemic toxicity to ratsexposed subchronically to glyoxal via drinking water.     

Clinical and Endoscopic Study of Ischemic Colitis

The clinical signs and symptoms of ischemic colitis have been analyzed. Eighty-one cases were investigated; there were 62 cases of the transient type, 15 of the stricturing type, and 4 cases of the gangrenous type. All cases were diagnosed by colonoscopy. In addition, the healing process of the transient type, observed by colonoscopy, was analyzed. The results were noted as follows. 1. Sudden onset of abdominal pain was the initial complaint in most of the cases. The onset time of this pain was morning (8.7%), afternoon (23.2%), and night (68.1 %). 2. The average amount of time from the onset of abdominal pain to hemorrhage was 6.6 +/- 4.1 hours. Abdominal pain persisted for 1.6 +/- 0.7 days and hemorrhage continued for an average of 1.5 +/- 0.8 days. 3. The transient type was common in the young age group (under 40), and the stricturing type was common in the advanced age group (over 70). 4. In cases of the transient type, the lesions healed within 7 days in 68% of all cases, and within 14 days in 82% of them. On the other hand, in cases of the stricturing type, during these same time spans, the lesions healed in 33% and 50% of affected patients, respectively. 5. The change in the findings of longitudinal ulcers in cases of the transient type, which were typical findings of ischemic colitis, disappeared within about 6 days in most cases. It is concluded that an emergency colonoscopy is essential in the diagnosis of ischemic colitis of the transient type.     

Studies on peptides

A decapeptide corresponding to the entire amino acid sequence of neurokinin A, a porcine spinal cord peptide, was synthesized in a conventional manner using protecting groups removable by 1 M TFMSA-thioanisole in TFA. The HS-CH₂CH₂CO group was introduced onto the synthetic neurokinin A by reaction of 3-(S-acetyl-thiopropionyl)-thiazolidine-2-thione, followed by deacetylation with hydroxylamine. 2,4-Dinitrophenyl-p-(β-nitrovinyl)-benzoate trapped the above HS-CH₂CH₂CO-neurokinin A derivative in acidic media, then BSA in basic media in nearly quantitative yield. A similar decapeptide, neurokinin B, was also synthesized and conjugated onto BSA using an alternative SH-introducing reagent, 3-(S-p-methoxybenzyl-thiopropionyl)-thiazolidine-2-thione, and the above heterobifunctional conjugating reagent.     

Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Persistent primitive hypoglossal artery (PHA) originating from the external carotid artery (ECA) is a rare anomaly. Reports of carotid endarterectomy (CEA) for ECA stenosis associated with this anomaly are even rarer. A 76-year-old woman presented to a medical clinic with a major complaint of refractory dizziness. Carotid ultrasound study suggested severe stenosis of the left cervical carotid bifurcation; therefore, she was referred to our department for a possible CEA. The imaging results indicated severe stenosis of the left carotid bifurcation and that the ECA was a PHA and the origin of the dominant vertebrobasilar artery (VBA). CEA was performed with the special caution of providing VBA collateral flow during clamping and preventing microembolisms during declamping of the ECA. Postoperative head magnetic resonance imaging revealed no new findings of cerebral infarction, and her dizziness disappeared. CEA associated with stenosis of the PHA as the origin of a dominant VBA was safely performed with an appropriate understanding of possible collateral pathways during cross-clamping.     

Evaluation of the maximal excretion rate of indocyanin green as a prognostic indicator in patients undergoing biliary decompression for obstructive jaundice

To assess the postoperative outcome of jaundiced patients and to select the optimal timing for surgical intervention, indocyanin green (ICG) concentrations in the bile were measured after biliary decompression in patients with obstructive jaundice. The maximal excretion rate of ICG in the bile was calculated as a function of time (ICG B_max). Among 59 patients with positive ICG B_max values, morbidity was 15.2% and postoperative hospital mortality was 3.3%. However, the morbidity and mortality in nine patients with values between - 0.5 and 0 were 88.8 and 44.4%, respectively. The 13 patients with in ICG B_max below - 0.5 had a 76.9% morbidity and a 61.5% mortality. The patients with ICG B_max values below 0 showed a significantly higher morbidity and mortality than positive ICG B_max patients. In patients showing ICG B_max values below - 0.5, surgery is contraindicated despite intensive postoperative care. The ICG B_max value improved according to the increasing effect of biliary decompression. The index is useful not only as a prognostic index in the early phase of biliary decompression but also as an index of bile secretory capacity at a given time. By means of time course measurement of this index, the suitable time for operation can be determined. The ICG B_max is a useful and reliable indicator in the assessment of hepatobiliary functional reserve in jaundiced patients after biliary decompression and prior to further surgical intervention.