Simultaneous closure of the tricuspid and mitral valve in Ebstein's anomaly

Echocardiographic studies of a 23-year-old man with Ebstein's anomaly and type B Wolff-Parkinson-White syndrome showed almost simultaneous closure of the tricuspid and mitral valve. After administration of edrophonium chloride, the tricuspid valve closed 20 msec earlier than the mitral valve. However, the closure of the mitral valve preceded that of the tricuspid valve after administration of ajmaline and atropine sulfate by 90 msec and 60 msec, respectively, concomitant with obliteration of preexcitation. From these observations, the simultaneous closure of the tricuspid and mitral valve of this case appears to depend on the preexcitation of the right ventricle.

Correlation of early neurologic outcome and CT findings in neonatal brain hypoxia and injury

Ninety cranial computed tomography scans were analyzed in 56 high risk neonates (30 premature and 26 term). Neurologic follow-up averaging 18 months in length was obtained. Four types of intracranial hemorrhage were seen: subdural (with three subtypes), germinal matrix--intraventricular, primary subarachnoid, and cerebellar. The four types differ in age of occurrence, mechanism, and prognosis. Mild periventricular low density was present in most of the neonates and did not correlate with future neurologic deficit. Severe periventricular leukomalacia (16%) and cortical low density zones (12%) at 40 weeks did correlate with abnormal motor and mental development.

Left atrial ball thrombus diagnosed by two-dimensional echocardiography

The diagnosis of the ball thrombus in the left atrium has been very difficult by conventional clinical techniques. In the present case, two-dimensional echocardiography successfully demonstrated a spherical tumor moving in unpredictable directions in the left atrium. M-mode echocardiography did not clearly identify the tumor because of the limited visual width and spatial orientation of the technique; however, simultaneous recordings of the M-mode echocardiogram with phonocardiogram, carotid pulse wave, and electrocardiogram provided some diagnostic clues to the occlusive left atrial tumor. In the absence mitral valve occlusion by the tumor, a logarithmic correlation between the ejection time and the preceding R-R interval, and a negative lines correlation between Q to the first sound interval and the preceding R-R interval were found. In the beat following the appearance of the tumor in the mitral orifice, the sudden shortening of the ejection time and the prolongation of Q to the first sound interval were noted. Both of these findings are indirect evidence of decreased left ventricular filling associated with an elevated left atrial pressure resulting from the sudden mitral orifice obstruction by the tumor. Detailed analysis of the data obtained by the conventional noninvasive techniques could provide critical clues for the diagnosis of the occlusive left atrial tumor.

[Intracerebral germinoma developing in the right basal ganglia--report of a case followed up by CTscan and review of the literature (author's transl)]

Recently, a case of intracranial germinoma in the right basal ganglia was experienced in our department. He was a 14-years old boy with left motor hemiparesis. On repeated CT studies (7 times), developmental process of the tumor was observed for about 2 years. The tumor developed from the right putamen and invaded toward it's neighboring area (right basal ganglia, thalamus and hypothalamus). As the tumor grew larger, multiple cysts were formed in the tumor tissue and dislocation of ventricles occurred. On 21 December 1978, right temporal craniotomy was performed and a piece of the tumor was removed. It's tissue was diagnosed as germinoma by pathohistological examination. As the effect of postoperative 60Co irradiation and chemotherapy (Vicristine, CCNU), tumor stain (high density area) on CT scann disappeared and remained only as a well margined low density area. On CT scan in September 1979, recurrence sign was not noted. Clinical features of the germinoma located in the basal ganglia has not been well known, because of it's rarity. As a result of the survey of 7 cases reported in the Japanese literature and our case, it has been made clear that most of them are characterized by motor hemiparesis in the early stage, not accompanied by intracranial hypertension.

The change in the left atrial dimension during diastole. Echocardiographic assessment of mitral stenosis

The change in the left atrial dimension during diastole was examined in patients with mitral stenosis using echocardiography. The left atrial emptying fraction (LAEF), defined as the ratio of enddiastolic dimension to endsystolic dimension of the left atrium, was 0.65 +/- 0.03 (mean +/- SE) for normal subjects, 0.86 +/- 0.01 for low grade mitral stenosis, and 0.92 +/- 0.01 for high grade stenosis. The LAEF correlated well with mitral valve area index (r = -0.70), but the correlation between E-F slope of the anterior mitral leaflet and mitral valve area index was less significant (r = 0.48). In patients who received mitral valve replacement the LAEF and the left atrial dimension significantly improved. The left atrial emptying fraction is an easily obtainable and reliable index to estimate the severity of mitral stenosis, even in patients who have undergone mitral valvular surgery.

Attenuated response to insulin in very low birthweight infants

Four hyperglycemia very low birthweight (VLBW) infants were given a constant infusion of insulin with parenteral alimentation in order to improve glucose tolerance. After an initial 45% decrease in serum glucose, intolerance recurred within hours to days despite delivery of as much as 16 units/kg/hour or regular insulin. Resulting serum insulin levels were as high as 72,000 microU/ml. It is suggested that insulin "resistance", instead of insulin deficiency, may be responsible for glucose intolerance in some infants.

Detection of flail aortic valve in bacterial endocarditis with real-time two-dimensional echocardiography. A case report

This report describes a case with flail right and noncoronary cusps due to bacterial endocarditis, diagnosed with real-time two-dimensional echocardiography. Real-time two-dimensional phased array sector scanner demonstrated 2 cugdel-shaped lesions in the region of the left ventricular outflow tract through the aortic root, pendulating upward and downward floating along the blood stream. This study shows that the real-time two-dimensional echocardiography is a very useful noninvasive tool in the early diagnosis of flail aortic valve.

Electron microscopic observations of intracytoplasmic membrane systems and cell division in Mycobacterium lepraemurium

The fine structures and the interconnections between the intracytoplasmic membrane systems and cell division of murine leprosy bacilli in liver tissue from mice infected intraperitoneally with Mycobacterium lepraemurium, Hawaiian strain, were studied in ultrathin serial sections at the electron microscopic level. Intracellular membranous organelles (mesosomes) were seen as vesicular, tubular and/or lamellar structures. The formation of mesosomes appeared to be initiated by invagination and/or folding of the cytoplasmic membrane. A few dividing bacilli were observed. The lateral extension and the centripetal growth of the septal wall seemed to result from the original development of cytoplasmic membrane occurring at or near the leading edge of the nascent septum. After the septum formation was completely accomplished, the separation of two new daughter cells is assumed to occur. The mesosome was associated with the newly formed cytoplasmic membrane (septal wall). It was shown that both the cytoplasmic membrane and the mesosome played an important part in septum formation.

Echocardiographic findings of large patent ductus arteriosus in the very low birthweight infant before and after treatment with indomethacin

17 very low birthweight infants (mean birthweight 850 g) with large patent ductus arteriosus (PDA) were studied by echocardiography before and after treatment with indomethacin. Before treatment left heart dimensions were increased suggesting large left-to-right shunt. Echographic measurements of augmented left ventricular (LV) contraction could be attributed to increase in preload, and reduction in afterload in PDA. After indomethacin, in infants showing clinical response, left heart dimensions returned rapidly to normal and LV contraction became normal or reduced. Two infants had reduced LV contraction with persistent pulmonary oedema suggesting LV failure. In contrast, infants showing no clinical response to the drug also had no significant changes in echographic measurements. Right ventricular systolic time intervals (RPEP/RVET) did not alter after indomethacin treatment in either group, suggesting that the drug does not increase pulmonary vascular resistance.

PPD-induced immunoglobulin production in human peripheral blood lymphocytes. II. Separation of PPD-reactive helper T cells from PWM-reactive helper T cells in polyclonal immunoglobulin production of human peripheral blood lymphocytes

We investigated the relationship bewteen PPD-reactive helper T cells and PWM-reactive helper T cells in polyclonal Ig production of human PBL. Elimination of PPD-reactive T cells by BUdR + light treatment resulted in a loss of helper function in PPD-induced Ig production, but had no effect on helper function in PWM-induced Ig production. On the other hand, elimination of PWM-reactive T cells resulted in a loss of helper function in both PPD-induced Ig production and PWM-induced Ig production. A blast cell-enriched fraction that was generated by PPD and separated by the velocity sedimentation method contained helper function in both responses. On the other hand, blast cell-depleted fractions did not contain PPD-reactive helper function, although the PWM-reactive helper function was evident. These results strongly suggest that PPD-reactive helper T cells are included in PWM-reactive helper T cells.

Effects of concanavalin A-induced cells on the proliferative response of T cells. Concanavalin A-induced suppressor and amplifier cells to the proliferative response of human T cells to trinitrophenyl-modified autologous lymphocytes

Effects of Con A-induced human mononuclear cells on the proliferative response of peripheral T cells were examined by using TNP-modified autologous lymphocytes as stimulator cells. Cells induced by incubation with Con A contained both suppressor cells and amplifier cells. The former were induced from nylon wool-nonadherent T cells and these precursor cells were sensitive to mitomycin treatment. On the other hand, amplifier precursor cells were nylon wool-nonadherent T cells and were resistant to mitomycin treatment. Cell proliferation was required for the induction of suppressor cells but not for the induction of amplifier cells. Con A-induced suppressor effector cells were both nylon wool-adherent and nonadherent cells, on the contrary, Con A-induced amplifier effector cells were nonadherent cells. A small number of macrophages enhanced the suppressive activity of nonadherent T cells when added at the induction phase of suppressor T cells.

Early closure of the tricuspid valve in a case of Ebstein's anomaly with type B Wolff-Parkinson-White Syndrome

Echocardiographic studies of a 19-year-old female with Ebstein's anomaly and type B Wolff-Parkinson-White syndrome showed an earlier closure of the anterior tricuspid leaflet (ATL) than of the anterior mitral leaflet (AML), contrary to the previous reports. The interval between the closure of the ATL and the AML was 20 msec and 30 msec, respectively, before and after administration of edrophonium chloride. However, closure of the AML preceded that of the ATL after administration of atropine sulfate and during supraventricular tachycardia by 10 msec and 60 msec, respectively, concomitant with the shortening of the duration of the QRS complex. We conclude that early closure of the ATL may depend on preexcitation of the right ventricle.

PPD-induced immunoglobulin production in human peripheral blood lymphocytes. I. Necessary conditions for inducing the response

The ability of PPD to induce Ig production in human PBL was investigated. PPD proved to be a good B cell activator for inducing polyclonal Ig production in PBL from healthy Japanese. Comparative studies of this response with PWM-induced Ig production showed that the cellular mechanisms involved in the two responses were different. First, PBL from an atypical individual with a deficient IgM production to PWM responded normally to PPD with IgM production as well as IgG production. Secondly, in IgG production, the effects of the two mitogens (PPDand PWM) were additive. An analysis of the cellular requirements in PPD-induced Ig production clearly demonstrated that T cells played a role in this response as well as in the PWM-induced response. However, the head-to-head comparative study on the titration curves of helper T cells in the two responses showed that PWM-induced helper activity was 2 to 5 times more effective than PPD-induced helper activity. Moreover, PPD-induced helper activity was shown to be more sensitive to ionizing radiation than was PWM-induced helper activity. Thus, this system of PPD-induced Ig production may provide a useful tool for understanding the human antibody production system as well as the PWM-induced response.

Perinatal listeriosis--a review of twelve patients

From July, 1974 to February, 1978, we managed 12 infants with listeriosis. This infection presented in two distinct forms: an early-onset type (nine patients), often representing a congenital infection following maternal illness, and a late-onset type in which the patient presented with meningitis (three patients). Of our nine infants with early-onset disease, three died, three developed permanent sequelae, and only three were normal at follow-up. Appropriate early management in the perinatal period may improve the outlook in this condition. Affected infants were often premature and had pneumonia, rash, and hepatosplenomegaly at birth. Prenatal clues to the diagnosis included maternal fever, abdominal pains, and leukocytosis with meconium staining of the preterm amniotic fluid. Examination of gastric aspirate at birth showed gram-positive coccobacilli. Antibiotic therapy should be started prenatally and continue for three weeks after birth to prevent recurrences of the late-onset type. This late-onset disease presented as meningitis after the second week of life and responded well to antibiotics. Our three patients recovered without sequelae.

Electron microscopic observations of intracytoplasmic membranous structures in Mycobacterium leprae by means of serial ultrathin sectioning

The fine structures and interconnections between the cytoplasmic membrane and mesosomes of Mycobacterium leprae in human skin were studied in ultrathin sections. These intracellular membranous organelles were seen as laminated structures and as clusters of vesicles, which were trilaminar consisting of two electron-dense layers separated by an electron-transparent zone. The formation of mesosomes seems to be initiated by invagination and/or folding of the cytoplasmic membrane.

[Hemangioblastoma of the cauda equina--a case report (author's transl)]

We reported the case of a 40-year-old man who was hospitalized to our department on November 16, 1975 with a year history of neuralgia in the saddle region and vesicorectal dysfunction. Examination of CSF on lumbar puncture at L4-5 revealed xanthochromia with a protein content of 2,560 mg/dl. Myelography revealed a tortuous filling defect at the level of L2 coupled with complete blockade at L3 level. Selective spinal angiography of the left 12th intercostal artery demonstrated the enlarged Adamkiewicz's artery. This blood vessel was found to enter a diffuse uniform density, where no distinct blood vessels were visible. Within one second after the injection of contrast agent an efferent vein appeared from the right side of the density, ascended to the level of Th12 and then, upon turning, descended to the pelvic canal. These findings suggested a hemangioblastoma of the spinal cord. Laminectomy was performed at levels of L2 through L4 and a hemangioblastoma of the cauda equina was totally excised at L3 level. Although the postoperative course was complicated by a transient dysuria and hypesthesia at S1-S5 levels, complete cure was achieved in a month. In the present paper clinical features and neuroradiological examination of a hemangioblastoma of the spinal cord were described.

Electron microscopic observations of cell division in Mycobacterium leprae by means of serial ultrathin sectioning

The division of Mycobacterium leprae in human skin was studied in the ultrathin sections at the electron microscopic level. A few dividing bacilli were observed. The division seemed to be accomplished by inward extension ob both the cell wall and the cytoplasmic membrane into the cytoplasm of the bacillary cell to form a septum. The intracellular membranous organelle (mesosome) is assumed to play a role in division.

Inhibition of gastric secretion by intraduodenal hypertonic glucose in patients with duodenal ulcer

Intraduodenal instillation of hypertonic glucose significantly inhibited tetragastrin-induced gastric acid and pepsin outputs in man. The secretory volume of gastric juice was markedly decreased, whereas, acid concentration remained unchanged. Pepsin concentration, on the contrary, was reduced significantly. The degree of inhibition of pepsin output, therefore, was greater than that of acid output. No significant difference in the extent of inhibition of acid or pepsin output was observed between control subjects and patients with duodenal ulcer.

Potential CNS antitumor agents-phenothiazines II: fluphenazine analogs

Fluphenazine was found to possess moderate reproducible activity against the intraperitoneal L-1210 and P-388 leukemia murine tumor models. Seven ether derivatives of fluphenazine and eight compounds in which the terminal side-chain hydroxyl group was replaced by an amine function were prepared and evaluated in the intraperitoneal L-1210, P-388, and B16 melanoma systems as well as the intracerebral L-1210 and ependymoblastoma brain tumor models. While no substantial intracerebral activity was observed, seven derivatives possessed reproducible activity in the intraperitoneal L-1210 or P-388 system. Several gave T/C values of 150%. No B16 melanoma activity was observed. These compounds were also tested for their cytotoxic properties in culture against L-1210, P-388, and KB cells. The amine isosteres, while possessing little in vivo activity, were the most cytotoxic of the compounds prepared, with several having ED50 values less than 1 microgram/ml.

[Spontaneous regression of sinus pericranii--report of a case (author's transl)]

Spontaneous regression of sinus pericranii has not been reported in the literatures. The aurthors presented a very rare case of sinus pericranii, which was diagnosed as early as nine days after birth and completely disappeared in seven years. The patient was a nine-day-old boy from normal delivery in full term, who had a soft tumor simulating cephalhematoma in the right parietal region. The overlying scalp looked like a hemangioma bitemporally connecting with strikingly dilated scalp veins. Soft X-ray examination of the skull revealed a homogenous mass and a small bone defect beneath the mass. Venous blood was punctured from the tumor. By means of direct injection of contrast media into the tumor, the superior sagittal sinus as well as many extracranial varicositous veins were shown. No intracranial vascular anomaly. In a year the tumor spontaneously declined and in the following seven years it disappeared completely. Pathogenesis of this lesion was discussed with special reference to cephalhematoma and a possibility of spontaneous regression of sinus pericranii was stressed.

Biologically active constituents of leaves and roots of Aloe arborescens var. natalensis

Several biologically active substances, such as aloenin (1), magnesium lactate, aloe-emodin (4), barbaloin (5), and succinic acid, were found to be contained in the leaf juice of Aloe arborescens Mill. var. natalensis Berger, which has widely been used in domestic medicines. Aloenin (1) and magnesium lactate were elucidated to exhibit an inhibitory action on the gastric juice secretion of rats. Various constituents other than the above bioactive substances were found in the leaves and the roots of the plant.

Potential CNS antitumor agents--phenothiazines I: Nitrogen mustard derivatives

Four phenothiazine derivatives containing the bis(beta-chloroethyl)aminopropyl side chain were prepared and evaluated in the murine L-1210, P-388, and B-16 melanoma intraperitoneal tumor systems. Moderate P-388 activity was observed. An aminoethyl phenothiazine mustard was compared with the aminopropyl analogs and was superior in all test systems. None of the compounds tested against the murine ependymoblastoma brain tumor system was active.

Microorganism capable of decomposing N-acetylglucosaminyl ribitol teichoic acid of Staphylococcus aureus

Enzyme(s) capable of decomposing N-acetylglucosaminyl ribitol teichoic acid prepared from the cell wall of Staphylococcus aureus FDA 209 P was obtained from the culture supernatant of a gram-negative, rod-shaped, spore-forming soil bacterium. Properties of the bacterium were very similar to those of Bacillus circulans.

Echocardiographic recognition of the cardiac mural tumor

An abnormal echocardiographic signal was detected in the myocardium on the echocardiographic examination of the septum and posterior left ventricular wall in a patient found to have lymphosarcoma which was diffusely infiltrated in the myocardium. This echocardiographic abnormality was well correlated with the autopsy findings. Echocardiography appears to be one of useful methods in diagnosing cardiac mural tumor antemortemly.