Familial isolated noncompaction of the left ventricular myocardium

Noncompaction of the ventricular myocardium (sometimes referred to as 'spongy myocardium') is believed to represent an arrest in endomyocardial morphogenesis. The gross anatomical appearance is characterized by numerous excessively prominent trabeculations and deep intertrabecular recesses. Distinct morphological features can be diagnosed on two-dimensional echocardiography. We present here a family of isolated noncompaction of the left ventricular myocardium, in which 5 affected individuals suggested the presence of some genetic abnormalities in this disorder.

[Anesthesia for abdominal surgery after percutaneous transluminal coronary angioplasty (PTCA)]

From December 1989 to October 1996, 1,318 PTCAs (percutaneous transluminal coronaly angioplasty) were performed for AMI (acute myocardial infarction) or postinfarction angina in our institute. Within 7 days to 71 days after successful PTCA, five patients who had been diagnosed as cholelithiasis or gastric cancer were operated under general anesthesia. Performed operations were cholecystectomy in the first patient, subtotal gastrectomy in the second, third and fourth patients, and total gastrectomy and cholecystectomy in the fifth patient. There was no serious cardiac complication during the operations and perioperative period. PTCA is considered to have decreased cardiac complications in patients with ischemic heart disease having undergone abdominal surgery.

Measurement of maxillary sinus volume using computerized tomographic images

This study measured maxillary sinus volume as an aid in determining the volume of graft bone needed before grafting autogenous bone to the maxillary sinus floor. Maxillary sinus volumes were measured from computerized tomographic images of 38 sinuses using a 3-dimensional reconstruction system. When the sinus-lift procedure was simulated, volumes (mean +/- SD) of the inferior portion of the sinuses were 4.02 +/- 1.44 cm3 for 15-mm lifting and 6.19 +/- 1.77 cm3 for 20-mm lifting. In bone grafting of the maxillary sinus floor, taking into consideration individual differences in maxillary sinus volume and resorption of the grafted bone, 5.46 cm3 or more were required for a 15-mm lift and 7.96 cm3 or more were required for a 20-mm lift.

A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor

PURPOSE

This study measured maxillary sinus volume as an aid in determining graft bone volume before grafting of the maxillary sinus floor.

MATERIALS AND METHODS

Maxillary sinus size was measured in 32 cadavers (59 sinuses) using casts of the maxillary sinus made using dental impression material.

RESULTS

Anteroposterior length, height, width, and volume of the maxillary sinus (mean+/-SD) were 30.1+/-5.65 mm, 34.6+/-7.71 mm, 25.4+/-5.71 mm, and 11.3+/-4.60 cm3, respectively. When the sinus-lift procedure was simulated, inferior sinus volumes (mean +/- SD) were 3.51+/-1.23 cm3 for a 15-mm lift and 5.66+/-1.71 cm3 for a 20-mm lift.

CONCLUSIONS

In bone grafting of the maxillary sinus floor, taking into consideration individual differences in maxillary sinus volume and resorption of the grafted bone, 4.74 cm3 or more of the graft is required for a 15-mm lift, and 7.37 cm3 or more is required for a 20-mm lift.

Multicenter experience with maxillary prostheses supported by Brånemark implants: a clinical report

This retrospective study involved Japanese patients with prostheses supported by Brånemark implants following maxillectomy. Questionnaires were sent to 75 institutions, and data on 19 patients were collected from 8 institutions. The mean age of patients at the time of implant placement was 64.2 years (range 22 to 82 years). The mean follow-up time was 27.6 months. Of the 81 implants placed, 16 were lost for an implant survival rate of 80.2%. The effects on implant survival rate of radiotherapy, chemotherapy, hyperbaric oxygen therapy, and the support system of the prosthesis were analyzed, but no significant differences were observed.

Determinant analysis of IgE and IgG4 antibodies and T cells specific for bovine alpha(s)1-casein from the same patients allergic to cow's milk: existence of alpha(s)1-casein-specific B cells and T cells characteristic in cow's-milk allergy

In an effort to clarify the etiology of milk allergy from the standpoint of allergen-specific immune reactions, we investigated the determinants of IgE, IgG4, and T cells specific for bovine alpha(s)1-casein from the same individual patients by using its synthetic peptides and cyanogen bromide-digested fragments. Alpha(s)1-casein is a major allergen in cow's milk, and its unique conformation enabled us to investigate the determinants of antibodies without consideration about missing the reactivities because of conformational changes. Nine patients were selected as subjects from among 129 milk-sensitive infants screened by ELISA to assess the anti-alpha(s)1-casein IgE levels in their sera. By using ELISA for epitope mapping, a C-terminal region of alpha(s)1-casein was identified as a common binding site for IgE from all of these patients, whereas those for anti-alpha(s)1-casein IgG4 were located in multiple regions of alpha(s)1-casein. We determined the specificities of seven alpha(s)1-casein-specific T-cell lines established from peripheral blood mononuclear cells of two of the patients. These T cells have been shown to secrete IL-4. All of the T-cell lines had different specificities to alpha(s)1-casein. However, a common amino acid residue use was found among the determinants of various T-cell lines from each patient. The results suggest that patients allergic to cow's milk have characteristic B cells recognizing a limited region of alpha(s)1-casein and secreting alpha(s)1-casein-specific IgE. These B cells may interact particularly with T cells recognizing determinants with a common structure.

Acutely severe myocarditis successfully treated by percutaneous cardiopulmonary support applied by a newly developed heparin-binding oxygenator and circuits

The feasibility of using the heparin-bound percutaneous cardiopulmonary support system (PCPS) for prolonged extracorporeal circulation in patients with acute severe myocarditis is demonstrated. The case histories of 2 patients with cardiogenic shock caused by acute myocarditis are presented; both were successfully treated with long-term PCPS using a newly developed heparin-binding oxygenator and circuits without changing the oxygenator. The courses of both patients remain uneventful more than 12 months after discharge. We also discuss the clinical aspects of using heparin-bound PCPS in patients with acute severe myocarditis.

Immunohistochemical demonstration of bcl-2 protein in ameloblastoma

The bcl-2 gene is known through its product, bcl-2 protein, which prevents apoptosis, and also by its expression in development, especially in sites characterized by epithelial-mesenchymal interactions. In the developing tooth germ, bcl-2-protein is expressed in the epithelial component. In this study, we examined the expression of bcl-2 protein immunohistochemically in 25 ameloblastomas using a monoclonal antibody against anti-human bcl-2 oncoprotein. In all 25 cases, bcl-2 protein was found mainly in the outer layer of tumor cells, whereas the inner cells (stellate reticulum-like cells and squamoid cells) were negative. The bcl-2 protein is therefore thought to play a role in maintaining the stem-cell population in the peripheral layers of the tumor nests from which proliferating cells can be recruited.

Comparison of specificity between IgG, IgE and T cells to three casein components: implication for the role of circulating allergen-specific T cells in food allergy

In order to investigate the role of food antigen-specific T cells circulating in the blood of patients with food allergy, we compared T cell response to three casein components (alpha s-, beta- and, kappa-casein) with specificities of IgG and IgE binding to the casein components in four milk-allergic patients (P1-4) with atopic dermatitis. In all patients the binding activities of IgG antibodies to alpha s-casein were most dominant, followed by those to beta- and to kappa-casein. The major component of casein bound by IgE antibodies was alpha s-casein in P1 and P3, kappa-casein in P2, and alpha s-casein as well as kappa-casein in P4; the order of casein components bound by IgE antibodies was different from that by IgG antibodies. Proliferative responses of peripheral blood mononuclear cells (PBMC) to casein components were so low that the dominance of casein recognition could not be clearly demonstrated. However, short-term T cell lines that specifically respond to casein were successfully established from PBMC of the four patients and the proliferative responses of the T cell lines to the three components of casein were in accord with the IgE antibody specificity to casein components but not with that of IgG antibody specificity. When taken together, these results indicate that casein-specific T cells circulating in the blood are involved in or reflect an allergic reaction against casein.

[Eosinophils in stool smear in normal and milk-allergic infants]

Stool smears of newborn infants were investigated sequentially from birth through 6 months of life in order to study relation between appearance of eosinophils in stool and feeding of babies. In babies born to non-atopic parents, eosinophils appeared in stool smear soon after start of feeding, but disappeared in a short time. Eosinophils were found irrespective of types of feeding, i.e., breast feeding, powdered milk or amino acid formula. There was tendency of sustained presence of eosinophils in stool smears in babies born to severe atopic parents. These results suggest that appearance in stool of eosinophils does not necessarily mean allergic reaction to ingested foods and need attention in diagnosing milk allergy. Mechanisms of appearance and function of eosinophils in stool in normal babies may differ from those in pathological situations and need further detailed investigation.

Further ST elevation at reperfusion by direct percutaneous transluminal coronary angioplasty predicts poor recovery of left ventricular systolic function in anterior wall AMI

Some patients with acute myocardial infarction (AMI) develop further ST elevation at reperfusion by percutaneous transluminal coronary angioplasty (PTCA). This study reports the ST deviation at reperfusion by direct PTCA in relation to the clinical factors and the recovery of left ventricular (LV) systolic function. Fifty-two patients with anterior wall AMI were treated with direct PTCA. They were classified into the following 3 groups according to the change in ST elevation at reperfusion: increase of > or = 20% (ST reelevation); reduction of > or = 20% (ST resolution); and the other (ST no change). Angina pectoris preceding AMI occurred less often in the ST reelevation group (ST reelevation group, 38%; ST no change group, 81%; ST resolution group, 70%; p < 0.05). Recovery of LV ejection fraction during the first month after direct PTCA was significantly poor in the ST reelevation group in contrast to the ST resolution group (ST reelevation group, -6.3 +/- 13%; ST no change group, 18 +/- 20%; ST resolution group, 45 +/- 29%; p < 0.0001). The change in ST elevation at reperfusion was an index predicting the recovery of LV systolic function in the reperfusion by direct PTCA.

Primary antiphospholipid syndrome and pulmonary hypertension with prolonged survival. A case report

The outcome of patients with pulmonary hypertension (PHT) and antiphospholipid syndrome (APS) is usually fatal. The authors report the rare case of a patient with primary APS and nonthrombotic PHT who has survived for twenty years after the onset of PHT. In this case, the patient's PHT resembled the primary idiopathic variety with clear lung fields and normal perfusion on the lung scan, and the combination therapy with nitrate, digoxin, and diuretics had been performed. During her clinical course over twenty years, she had not experienced any critical pulmonary thrombosis that influenced the progression of nonthrombotic PHT or any other severe systemic involvement of APS.

Distribution and origins of nitric oxide-producing nerve fibers in the dog tongue: correlated NADPH-diaphorase histochemistry and immunohistochemistry for calcitonin gene-related peptide using light and electron microscopy

The distribution and origins of nitric oxide (NO)-producing nerves in the dog tongue with reference to calcitonin gene-related peptide (CGRP)-containing sensory fibers were investigated using NADPH-diaphorase (NADPH-d) histochemistry and immunohistochemistry for CGRP and NO synthase combined with retrograde axonal tracing and denervation experiments. The ultrastructural relationships between NADPH-d-positive and CGRP-immunoreactive neuronal elements were also examined electron microscopically. NADPH-d-positive and CGRP-immunoreactive varicose fibers were found within the taste buds and surrounding the epithelia of the fungiform papillae, and they disappeared completely after severance of the lingual nerve. Following injection of fast blue into the subepithelial layer of the anterior two thirds of the tongue, retrogradely labeled neurons possessing NO synthase and/or CGRP immunoreactivities were mainly detected in the trigeminal ganglion. Some of the retrogradely labeled trigeminal cells showed the coexistence of NADPH-d reactivity and CGRP immunoreactivity, but in the geniculate ganglion neither NADPH-d reactivity nor NO synthase immunoreactivity was found instead of retrogradely labeled CGRP-immunoreactive neurons. The lingual artery and its branches, including the arteriovenous anastomoses, showed dense distributions of NADPH-d-positive fibers, most of which were unaffected by the denervation experiments. There were many small ganglia in the tongue, and virtually all ganglionic neurons were NADPH-d reactive. CGRP-immuno-reactive varicose fibers were also found around the vascular walls and within the intralingual ganglia. Ultrastructural analysis revealed a close distribution of NADPH-d-positive and CGRP-immunoreactive varicose fibers within the arterial walls, and synaptic contacts between CGRP-immunoreactive terminals and NADPH-d-positive intralingual ganglionic neurons. These results indicated that the taste buds of epithelia of fungiform papillae in the anterior two thirds of the dog tongue receive NADPH-d-positive and CGRP-immunoreactive sensory fibers from the trigeminal ganglion, and that perivascular NADPH-d-positive fibers mainly originate from intrinsic ganglia in the tongue. The ultrastructural findings suggest an intrinsic peripheral nerve-reflex mechanism in the regulation of the lingual vascular function by NO-producing postganglionic parasympathetic neurons and CGRP-containing sensory fibers.

Diminished interferon-gamma (IFN-gamma) production by bacterial antigen-specific T cells in atopic patients

In this study, we established and studied cytokine production of T cell lines (TCL) specific to either a purified protein derivative of Mycobacterium tuberculosis (PPD) or Dermatophagoides farinae (Df) from atopic patients and non-atopic healthy subjects. IFN-gamma was detected in the culture supernatants of all of 36 PPD-specific TCL established from healthy controls, whereas only 24 of 38 PPD-specific TCL from patients produced IFN-gamma. Furthermore, the amounts of IFN-gamma produced by PPD-specific TCL from patients were significantly lower than those from healthy controls. No IL-4 was detected in any PPD-specific TCL from either healthy controls or atopic patients. The amounts of IL-4 production from Df-specific TCL from atopic patients were much higher than from healthy controls, while few TCL produced IFN-gamma. These results suggest that the skewing to the Th2-type T cell response in atopic patients is a response not only to allergens, but also to bacterial antigens, compared with non-atopic subjects. Activation of PPD-specific TCL from patients with calcium ionophore A23187 plus phorbol myristate acetate resulted in much higher IFN-gamma production than in TCL established from healthy controls, indicating that the low production of IFN-gamma by PPD-specific T cells from atopic patients is not due to an intrinsic T cell defect but to some regulatory mechanisms.

Establishment and characterization of alpha s1-casein-specific T-cell lines from patients allergic to cow's milk: unexpected higher frequency of CD8+ T-cell lines

To study cow's milk allergy at the cellular level, we assessed the reactivity of peripheral blood mononuclear cells from patients allergic to cow's milk to alpha s1-casein, which is one of the major allergens in cow's milk. Proliferation of the cells to alpha s1-casein activation showed a rather weak response. Therefore to understand T-cell reactivity to alpha s1-casein in more detail, we prepared alpha s1-casein-specific T-cell lines from patients allergic to cow's milk and established 26 T-cell lines. These T-cell lines could be classified into three groups by analyzing their surface marker expression: those containing predominantly CD4+ CD8- T cells, those containing both CD4+CD8- and CD4-CD8+ T cells, and those containing predominantly CD4- CD8+ T cells. The CD8+ T cells were obtained at an unexpectedly higher frequency from the patients. These T-cell lines produced interferon-gamma and IL-4. These results suggest that CD8+ T cells specific for alpha s1-casein and CD4+ T cells were primed by the stimulation with alpha s1-casein in patients allergic to milk and that both T cells may play a key role in the onset, progression of, or recovery from cow's milk allergy.

Establishment and characterization of ovalbumin-specific T cell lines from patients with egg allergy

In order to investigate T cell recognition of allergens in hen egg allergy, we have established 30 ovalbumin (OVA)-specific T cell lines (TCLs) from peripheral blood mononuclear cells of 6 patients with atopic dermatitis, who are positive for IgE antibodies to OVA and clinically allergic to hen egg, and characterized them for their cytokine production pattern. All TCLs we could study were mainly composed of CD4+ T cells. Most TCLs produced significant amounts of interleukin 4 (IL-4) and IL-5 but no or very little interferon gamma on antigen stimulation, suggesting that these TCLs belong to TH2-type T cells. Restriction elements and epitope specificities were further studied on some TCLs. Antibody blocking of the proliferative responses of the TCLs to OVA indicated that HLA-DR are acting as the dominant restriction elements for these TCLs with minor contribution of HLA-DQ. By use of 187 overlapping synthetic peptides covering the whole sequence of OVA, at least 3 different T cell epitopes were identified.

Delayed improvement in skeletal muscle metabolism and exercise capacity in patients with mitral stenosis following immediate hemodynamic amelioration by percutaneous transvenous mitral commissurotomy

The abrupt improvement in hemodynamics after successful percutaneous transvenous mitral commissurotomy (PTMC) does not immediately enhance exercise capacity. Improved exercise capacity several months after PTMC has been reported. We hypothesized that the delayed improvement in exercise capacity is due partly to the slow improvement in the metabolism of skeletal muscle. This study examined the short- and long-term effects of PTMC on exercise capacity and skeletal muscle metabolism in patients with mitral stenosis. Treadmill exercise testing with respiratory gas analysis was performed in 11 patients with symptomatic mitral stenosis before and 3, 30, and 90 days after successful PTMC. On the same schedule, forearm metabolism of high-energy phosphates was measured by magnetic resonance spectroscopy during and after handgrip exercise. Ten healthy volunteers were examined. PTMC resulted in an immediate symptomatic improvement. However, exercise capacity and skeletal muscle metabolism remained unchanged 3 days after PTMC. At 30 days after PTMC, there were significant improvements in peak oxygen consumption (p <0.05), intracellular pH at end-exercise (p <0.05), and time constant for phosphocreatine recovery (mean +/- SD 88.9 +/- 11.3 vs 106.3 +/- 11.7 seconds, p <0.01) compared with these baseline values. These improvements remained even at 90 days after PTMC. Exercise capacity improved with some time delay after immediate hemodynamic amelioration by PTMC. Long-term improvement in exercise capacity depends partly on the slowly progressing improvement in skeletal muscle metabolism after long-standing mitral stenosis.