Difference between proximal and distal right coronary flow velocity pattern in humans

The purpose of this study is to clarify the difference between proximal and distal right coronary artery flow velocity pattern in humans. Each portion of the coronary artery in thirteen patients with chest pain syndrome was measured by means of Doppler guide wire. The systolic/diastolic peak velocity ratio and velocity integral ratio at the proximal portion of the right coronary artery were significantly higher than those at distal portion of the right coronary artery (0.97 +/- 0.27, 0.61 +/- 0.20, 0.66 +/- 0.19, 0.44 +/- 0.13, respectively). In the right ventricular branch, coronary flow velocity pattern showed systolic dominancy. Systolic/diastolic peak velocity ratio and integral ratio showed 1.69 +/- 0.62 and 1.00 +/- 0.62 in the right ventricular branch, respectively. It is speculated that the less marked diastolic predominant pattern in the proximal right coronary artery flow velocity may be due to the fact that the proximal right coronary artery supplies both the right and left ventricle but that the distal right coronary artery supplies only the left ventricular inferior wall.

Effects of a high-protein diet on mineral metabolism and struvite activity product in clinically normal cats

OBJECTIVE

To examine effects of high-protein diets (> 50% crude protein of dry matter) on urinary mineral excretion and struvite activity product ([Mg2+] x [NH4+] x [PO(4)3-]).

ANIMALS

14 clinically normal cats, 4 adult female and male cats for experiments 1 and 2, respectively, and 6 female kittens aged 4 months for experiment 3.

PROCEDURE

Relations between dietary protein amount (25.9, 38.3, 51.4, and 65.4% crude protein [dry matter]) and urinary excretion of Mg, P, and Ca were examined in a 4 x 4-Latin square design (experiment 1). Struvite activity product, the index of solubility of struvite crystals, was determined when a high-protein diet (54.9%) was fed (experiment 2). Utilization of minerals in cats fed a high-protein diet long term was examined (experiment 3).

RESULTS

Water intake and urine volume increased with increasing dietary protein concentration. Urinary Mg2+ excretion was not affected (experiment 1) or was decreased (experiment 3) by higher protein intake, leading to lower urine Mg2+ concentration in groups fed higher protein amounts. Urine pH was decreased by high-protein intake. As a result, PO(4)3- concentration was decreased by high-protein intake (experiment 2), although total daily urinary excretion of P was increased. Consequently, struvite activity product tended to decrease in cats fed high-protein diets, indicating increase in struvite solubility. High-protein intake decreased Ca and P retention by increasing their fecal and urinary excretions, respectively.

CONCLUSION

As a consequence of the increase in urine volume and urine acidification, high-protein diets have potential ability to increase solubility of struvite crystals.

[Effect of histamine H2-receptor antagonists on the phosphorus-binding ability of phosphate binders in hemodialysis patients]

We examined the effects of histamine H2-receptor antagonists on the phosphorus binding ability of phosphate binders. Serum calcium, phosphorus, ALP, PTH and arterial blood pH and bicarbonate were measured during treatment with histamine H2-receptor antagonists accompanied by calcium carbonate in sixteen patients undergoing maintenance hemodialysis. Seven patients receiving histamine H2-receptor antagonists without calcium carbonate were selected as controls. In the sixteen patients receiving calcium carbonate, serum calcium, ALP, PTH and arterial blood pH and bicarbonate were not significantly altered during treatment with histamine H2-receptor antagonists, but serum phosphorus levels increased significantly after four (5.6 +/- 1.1 mg/dl) and eight weeks (5.9 +/- 0.8 mg/dl) of treatment as compared with that before treatment (4.8 +/- 1.2 mg/dl). Furthermore, serum phosphorus levels decreased significantly eight weeks after the discontinuation of treatment with histamine H2-receptor antagonists. In the seven control patients there were no statistical differences in serum calcium and phosphorus levels measured before and after treatment with histamine H2-receptor antagonists. In seven other patients receiving histamine H2-receptor antagonists with calcium carbonate, calcium carbonate was replaced with calcium lactate as the phosphate binder after four weeks of treatment with histamine H2-receptor antagonists. With the 4-week administration of histamine H2-receptor antagonists accompanied by calcium carbonate, the serum phosphorus level increased, similarly to that of the first study (from 6.3 +/- 0.9 to 7.1 +/- 0.5 mg/dl). However, with the substitution of calcium lactate, the serum phosphorus level decreased significantly (6.3 +/- 0.2 and 6.0 +/- 0.9 mg/dl after four and eight weeks, respectively, despite continued administration of histamine H2-receptor antagonists). These results suggest that histamine H2-receptor antagonists significantly affect the phosphorus binding ability of calcium carbonate, but not of calcium lactate. Although the exact mechanism remains obscure, one possible explanation may be related to the rise in pH of the gastric juice. Careful observation of changes in the serum phosphorus level is required in hemodialysis patients receiving calcium carbonate and histamine H2-receptor antagonists. Calcium lactate may be useful as a phosphate binder in such hemodialysis patients.

[A case of coronary perforation after directional coronary atherectomy]

Directional coronary atherectomy was performed on a 69-year-old female with angina pectoris. She suffered from coronary perforation as a result of cardiac tamponade and shock. Pericardial drainage and hemostasis were performed immediately using a perfusion catheter. The patient was transferred to the operating room for perforation repair and coronary artery bypass grafting to the distal portion of the left anterior descending artery. The procedure was performed successfully. Although acute coronary perforation associated with directional coronary atherectomy is rare, it can be managed temporarily by a perfusion catheter and we successfully performed coronary artery bypass grafting.

Immunohistochemical study of estradiol, epidermal growth factor, transforming growth factor alpha and epidermal growth factor receptor in endometrial neoplasia

In a total of 113 cases of endometrial neoplasm, we studied the immunohistochemical expression of estradiol (E2), epidermal growth factor (EGF), transforming growth factor alpha (TGFalpha), and epidermal growth factor receptor (EGFR). Positive immunoreactivity of E2 was found in 61% of the neoplasms. E2 immunoreactivity correlated well with high histologic grade and early clinical stage. Positive immunoreactivity for EGF or EGFR was found in 25.6% or 53.1% of the neoplasms, respectively. However, this was unrelated to histologic grade or clinical stage. On the other hand, TGFalpha immunoreactivity was found in 67% of endometrial neoplasias and was correlated with poor histologic grade and advanced stage. Contingency tables indicated a significant negative association between the status of E2 and that of TGFalpha. Simultaneous expression of E2, EGF and EGFR, or E2, TGFalpha and EGFR was found in 6.8% and 15.9% of endometrial carcinomas, respectively. These results suggest that a predominant number of endometrial carcinomas escape autocrine/paracrine growth regulation by EGF and E2 or TGFalpha and E2, and that TGFalpha may be involved in the progression of endometrial carcinoma.

Transference neurosis, transference borderline, and transference psychosis--as seen through a case of obsessive-compulsive neurosis treated successfully through regression to the state of transference psychosis

Transference manifestations are divided into the neurotic, borderline, and psychotic, and their corresponding states are termed transference neurosis, transference borderline, and transference psychosis, respectively. This paper discusses the onset of these conditions and their relationship to each other through the process of long-term psychotherapy of a case of obsessive-compulsive neurosis manifesting all three forms of transference. The transference neurosis appeared naturally soon after initiating psychotherapy, but the transference borderline and the transference psychosis appeared at the peak of transference neurosis and transference borderline, respectively, triggered by defeat in an imaginary triangular relationship. This case was not that of shifting from transference neurosis to transference borderline, and from there on to transference psychosis. Even though the newly appearing form of transference was the tangible form appearing in therapeutic situations and became more prominent, this was a case of two, or all three forms of transference existing together. Additionally, although the transference psychosis was prominent for some time, it gradually declined, leaving transference borderline and transference neurosis to coexist, until their simultaneous resolution and disappearance.

Superficial siderosis and episodic fourth nerve paresis. Report of a case with clinical and magnetic resonance imaging findings

We describe a patient with superficial siderosis who had an episodic unilateral fourth nerve paresis. The superficial siderosis was caused by small repeated intraventricular hemorrhages from a periventricular cavernous angioma. T2-weighted magnetic resonance images demonstrated a rim of low signal intensity at the brain surface, characteristic of hemosiderin deposition. These low-signal-intensity deposits included the dorsal brain stem around the anterior medullary velum. We suggest that the hemosiderin deposits affected the proximal portion of the fourth nerve where it contains central myelin and that this in some way caused unstable conduction of nerve impulses through the nerve.

Synthesis and characterization of a carbene-generating biotinylated N-acetylglucosamine for photoaffinity labeling of beta-(1-->4)-galactosyltransferase

A photoreactive N-acetylglucosamine derivative, N-[2-[2-[2-(2-biotinylaminoethoxy)-ethoxy]ethoxy]-4-[3-(trifluo rom ethyl)-3-H-diazirin-3-yl]benzoyl]-N4-[2-(acetylamino)-deoxy-beta-D -glucopyranosyl]-L-aspartamide (BDGA), was synthesized as a carbene-generating biotinylated probe for UDP-galactose:N-acetylglucosamine beta-(1-->4)-galactosyltransferase (GalT). The photoaffinity labeling experiments of bovine GalT with BDGA under various condition were examined based on the quantitative chemiluminescent detection of the biotinyl residue which was photochemically introduced into in GalT protein. A progressive decrease in the yield of specific photolabeling was observed upon lowering the incubation temperature from 37 degrees C to 20 degrees C or 4 degree C. The amount of photoincorporation was also decreased when UMP was not included in the incubation mixture. Using a crude protein mixture of recombinant human GalT, a band corresponding to the glutathione S-transferase fusion GalT protein was also specifically visualized. Furthermore, combine use of BDGA photolabeling with an immobilized avidin was found to be effective for the selective retrieval of photolabeled GalT from a reaction mixture containing a large amount of unlabeled GalT protein. The results obtained clearly demonstrate that the covalent biotinylation using the carbene-generating photoaffinity reagent BDGA would be useful for the analysis of acceptor substrate binding sites within the GalT protein.

A new HLA-DQB1*0306 allele sharing motifs from DQB1*03032 and DQB1*04 sequences

We have discovered a new HLA-DQB1 allele in a Japanese family, MAT. In the family the new allele segregates in three generations and demonstrates the positive association with DRB1*0901. We observed a novel RFLP pattern in the course of examining the modified PCR-RFLP method for HLA-DQB1 genotyping. The PCR-SSOP analysis also showed a new hybridized pattern. Sequence analysis of the allele indicates that it was generated by a gene conversion-like event between the HLADQB1*03032 and one of DQB1*04 contemporary alleles. This new allelic product did not react with all of allosera and monoclonal antibodies against DQ1, DQ2, DQ3, DQ4 and DQ7. The HLA molecule encoded by the allele is not defined by serology. This new allele was officially recognized and named DQB1*0306 by the WHO Nomenclature Committee in November 1995.

Response of conductance and resistance vessels of the coronary artery to intracoronary isosorbide dinitrate in patients with variant angina

To elucidate the response of conductance and resistance vessels of the coronary artery after intracoronary isosorbide dinitrate (ISDN), we evaluated 11 patients with variant angina and 13 controls with a Doppler guidewire. Epicardial arterial diameter increased significantly after ISDN in patients with variant angina while it did not change significantly in the controls. Coronary diastolic flow velocity increased significantly in controls (p < 0.05), but was unchanged in patients with vasospastic angina. Coronary flow volume increased from 23.8 +/- 18.6 to 46.5 +/- 28.4 ml/min in patients with vasospastic angina as well as in the controls from 32.2 +/- 24.2 to 54.7 +/- 44.4 ml/min. Coronary resistance did not differ between the two groups before or after the injection of ISDN. Conductance vessels were dilated to a greater extent in the patients with variant angina. However, the response of resistance vessels did not differ significantly between the two groups.

The role of a hydroxyl radical scavenger (nicaraven) in recovery of cardiac function following preservation and reperfusion

We investigated the efficacy in reducing myocardial preservation and reperfusion (P/R) injury of direct hydroxyl radical scavenging by nicaraven as compared with scavenging of both superoxide radicals and hydrogen peroxides by superoxide dismutase (SOD) and catalase (CAT), respectively. Isolated rat hearts were mounted on a Langendorff (L) apparatus to estimate the baseline aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), aortic mean pressure (MP), rate pressure product, and LV dp/dt. They were divided into 3 groups: group 1, 12 hr storage in HTK solution; group 2, 12 hr storage in HTK solution containing 2.5x10(5) U/L SOD and 2x10(5) U/L mg/L CAT; and Group 3, 12 hr storage in HTK solution containing 10(-3) M nicaraven. SOD, CAT, and nicaraven were administered intraperitoneally before harvesting. Hearts were stored in each preservation solution at 4, and then reperfused. Postpreservative function and concentrations of leaked enzymes were measured. The hearts were switched back to the L-mode and paced at 330 beats/min. CF following perfusion with Krebs-Henseleit bicarbonate buffer (KHB) solution containing 10(-6) M 5-hydroxytryptamine (5-HT) or 10(-5) M nitroglycerin (NTG) then evaluated. The myocardial water content also was measured. The recovery of CF, CO, SP, MP, and LV dp/dt was significantly greater in group 3 than in group 1. The recovery of CF was superior to that in group 2 (P<0.05). There were no significant differences in the recovery of cardiac function between groups 1 and 2. 5-HT caused a decrease in CF in each group, however, CF in group 3 was higher than that in group 1 (P<0.05). NTG caused no significant differences among the groups. There were no significant differences in leaked enzymes and myocardial water content among the three groups. These results suggest that nicaraven protects against myocardial P/R injury through its hydroxyl radical scavenging activity, and that therapy with oxygen-free radical scavengers should be directed toward inactivation of hydroxyl radicals rather than superoxide radicals and/or hydrogen peroxides.

Silver-stained nucleolar organizer regions in the uterine myomatous tumors

The numbers of silver-stained nucleolar organizer regions (AgNORs) were counted in uterine myomatous tumors, and compared with those in corresponding normal myometria. The mean number of AgNORs in myomatous tumors tended to increase according to the neoplastic changes. The mean number of AgNORs in leiomyosarcoma (6.4 +/- 0.9) was significantly higher than that in cellular leiomyoma (4.5 +/- 0.7, P < 0.01). or leiomyoma (3.0 +/- 0.5, P < 0.001). In the normal myometria, the mean number of AgNORs (3.3 +/- 0.4) in the premenopausal women showed a higher tendency than that in the post-menopausal women (2.4 +/- 0.5). These results therefore suggest that AgNOR counts may be useful for diagnosis of cellular activity in uterine myomatous tumors.

A case of Schmidt syndrome accompanied by a pituitary adenoma

Schmidt syndrome consists of adrenal insufficiency and Hashimoto's thyroiditis, which are probably caused by an autoimmune process. We encountered a patient who manifested severe generalized fatigue due to Schmidt syndrome recurrently. The endocrinological examination tests on the patient showed that the increase in thyroid stimulating hormone (TSH) and ACTH concentrations were not remarkable, despite hypo-function of the peripheral glands. Subsequent cranial magnetic resonance imaging (MRI) exhibited the existence of a pituitary tumor. The pathological findings on the resected tumor and endocrinological stimulation tests proved that the tumor was a FSH-producing adenoma. Although involvement of the pituitary region in Schmidt syndrome on rare occasions presents as hypophysitis, no pituitary adenoma has previously been reported in association with this syndrome. We present a patient with Schmidt syndrome and an accompanying FSH-producing pituitary adenoma. The coexistence of these disorders suggests that the functioning pituitary tumor might be considered as a pituitary lesion in Schmidt syndrome.

Manifestation of subclinical diabetes insipidus due to pituitary tumor during pregnancy

We describe a case of diabetes insipidus (DI) due to a pituitary tumor in a 33-year-old pregnant woman who developed a sudden onset of polyuria (over 8 l/day) and polydipsia at 30 weeks of gestation. Her plasma concentration of vasopressin (AVP) was low compared with high serum osmolality (298 mOsm/kg), and her urine output was well controlled by treatment with desmopressin acetate (DDAVP). Cranial magnetic resonance imaging (MRI) demonstrated a 1.8 x 1.2-cm pituitary tumor, but she did not have any disturbance in the release of anterior pituitary hormones. The serum concentration of cystine aminopeptidase (CAP) was within the normal range for a woman at 34 weeks of gestation. After an uncomplicated delivery of a healthy girl, her polyuria gradually resolved. The size of the pituitary tumor gradually decreased in parallel to a reduction in her urine output, but a silent hemorrhage was detected in her pituitary gland 4 weeks after the delivery. Although pregnancy is sometimes associated with central DI, the occurrence of DI due to pituitary tumor under pregnancy is rare. The basal AVP recovered to within the normal range, but the low response of AVP secretion to high osmolality persisted. In this case, pregnancy may affect the manifestation of subclinical DI. This case may therefore enhance our understanding of the mechanisms of DI during pregnancy.

Difference between normal and WHHL rabbits in susceptibility to the adrenal toxicity of an acyl-CoA:cholesterol acyltransferase inhibitor, FR145237

The adrenal toxicity of an acyl-CoA:cholesterol acyltransferase (ACAT) inhibitor, FR145237, was investigated using Japanese White (normal) and low density lipoprotein (LDL) receptor deficient Watanabe heritable hyperlipidemic (WHHL) rabbits. In the normal rabbits, severe necrosis of the cells in the zona fasciculata and reticularis was observed 24 hr after intravenous injection of 3.2 mg/kg of FR145237, whereas no morphological changes could be found in the adrenal cells of the WHHL rabbits in spite of a higher plasma concentration of the drug. Since most of the FR145237 (87%) in the plasma of the WHHL rabbits was recovered in the LDL fraction 1 hr after intravenous injection of the drug (3.2 mg/kg), it was hypothesized that the delivery of the drug to the adrenal cells may be limited by the LDL receptor deficiency. However, the concentration of FR145237 in the adrenal gland of the WHHL rabbits (13.3 microg/g) was identical to that in the normal rabbits (13.6 microg/g). These results suggest that the susceptibility of the adrenal cells of the WHHL rabbits to the toxicity of FR145237 truly differs from that of normal rabbits, and that the WHHL rabbit may be a useful animal model for the investigation of the mechanisms of the adrenal toxicity of ACAT inhibitors.

[Bowel injury caused by a catheter for Intraperitoneal chemotherapy--a case report]

A case of bowel perforation caused by a catheter used for intraperitoneal chemotherapy is reported. A 46-year-old woman underwent bilateral salpingo-oophorectomy, total hysterectomy and infracolic omentectomy for treatment of stage II c endometrioid carcinoma of ovary. Subsequently, the patient was treated with intraperitoneal administration of CBDCA through Port-A-Cath as well as intravenous CPA infusion every 5-6 weeks. Ten days after the 5th course of chemotherapy, she complained of low abdominal pain and fever of 37.9 degrees C, which resolved during a 6-day hospital stay, although her appetite remained poor. In the 6th course, CBDCA was administrated intravenously, because the intraperitoneal catheter became obstructed. Secondary cytoreductive laparotomy, which was performed 14 months after the primary surgery, revealed that the catheter of Port-A-Cath had penetrated the descending colon. Although intraabdominal injury by the catheter may be rare, it should be noted as one of complications when a patient is treated with intraperitoneal chemotherapy.

Radiofrequency catheter ablation for a patient with Wolf-Parkinson-White syndrome associated with sustained atrial tachycardia

Successful catheter ablation for a patient with both Wolff-Parkinson-White syndrome and sustained atrial tachycardia has not been reported. We describe a patient with Wolff-Parkinson-White syndrome associated with sustained atrial tachycardia, in whom an atrioventricular accessory pathway and an intra-atrial reentrant circuit were successfully ablated in a single session. Radiofrequency catheter ablation for the left-sided atrioventricular accessory pathway was performed via the trans-septal approach. Catheter ablation for the atrial tachycardia was achieved in the right atrium where the earliest and fractionated atrial activation was obtained. Catheter ablation for multiple lesions during a single session is feasible.

Lowering extracellular Na+ concentration causes NMDA receptor-mediated neuronal death in cultured rat hippocampal slices

Reduction of the transmembrane Na+ gradient is expected to induce neurotoxic glutamate release via reversed uptake. We describe neuronal death induced by lowering extracellular Na+ concentration in cultured rat hippocampal slices. When slices were exposed to 3.6 mM Na+ for 30 min, almost all the neurons in the CA1 region were degenerated within 20-24 h. The marginal concentration of external Na+ for induction of neurotoxicity was 6.6 mM. N-methyl-D-aspartate (NMDA) receptor antagonists, MK-801 at 1-3 microM and (+/-)-CPP at 30 microM, significantly decreased these neurotoxic effects. A non-NMDA receptor antagonist, DNQX at 30-100 microM, had no protective effect against neurotoxicity. Removal of external Ca2+ completely eliminated neuronal death, but replacing external Cl- with SO4(2-) had no protective effect against neurotoxicity. A drastic 40-fold increase in glutamate release was produced by 30 min exposure to 3.6 mM Na+, and this release was partially independent of external Ca2+. These findings suggest that the low-Na(+)-induced neurotoxicity we observed is mediated by excessive release of glutamate via reversed uptake and subsequent Ca(2+)-influx through NMDA receptors. The model reported here may be useful for investigation of the mechanism of neuronal injury mediated by endogenous glutamate.

The effects of omega-3 polyunsaturated (correction of polyunsatulated) fatty acids on the recovery of cardiac function following cold preservation and reperfusion in hyperlipidemic rats

We examined the effects of supplementation with eiosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), major components of omega-3 polyunsaturated (correction of polyunsatulated) fatty acids (PUFAs), on basal cardiac function and recovery of cardiac function of "donor hearts" from adults (30 week) rats following cold preservation and reperfusion (P/R). In groups 1, 2, 3, and 4, respectively, 30-week-old rats were fed a soybean oil diet, a high-cholesterol oil (HC) diet, an HC diet with EPA, or an HC diet with DHA for 5 weeks. After collecting blood to analyze plasma levels of fatty acids among each group, the heart was excised and perfused on a Langendorff apparatus. Following evaluation of each rat's cardiac function, each heart was stored in HTK solution for 8 hr at 4 degrees C. The heart was then reperfused and the coronary perfusate was collected to evaluate enzyme that had leaked. After cardiac functional recovery was estimated, myocardial fatty acids were measured. EPA supplementation significantly increases the plasma and cardiac levels of EPA as well as the ratio of EPA to arachidonic acid (AA). EPA supplementation also led to improved recovery of cardiac function following P/P, compared with that of rats who received soybean oil, high-cholesterol oil, and DHA. DHA supplementation significantly increased the plasma and cardiac levels of DHA as well as the ratio of DHA to AA--however, the cardiac functional recovery was almost identical to that of the rats who received high-cholesterol oil and was higher only than that of the rats who received soybean oil. There were no significant differences in enzyme that had leaked and myocardial water content among each group. These results suggest that alterations in the myocardial phospholipid composition by EPA supplementation may be profoundly responsible for attenuating myocardial I/R injuries. In contrast, DHA supplementation may not exert a cardioprotective effect following cold P/R. DHA supplementation alone may not increase the myocardial level of EPA enough to cause a protective effect against P/R injury. EPA supplementation to hyperlipidemic patients may be clinically warranted for increasing the potential number of donors.

[Use of a micturition-monitoring device in elderly inpatients]

More than 100,000 people suffer from functional urinary incontinence in Japan. To improve the quality of life of these people, we tested a device for monitoring micturition by means of a thin-layer membrane sensor in a diaper. The device was tested in elderly inpatients, and associated changes in the wordload of the nursing staff were also recorded. The device was beneficial because the precise micturition time was easily obtained and thus the daily pattern of micturition became obvious. With the use of this device, the time during which the patients wore wet diapers was shorter than with the conventional system of scheduled changes. However, the increase in the frequency of diaper changed doubled the workload of the nursing staff. In conclusion, improving the quality of life with regard to urinary incontinence entails an increase in the workload of the nursing staff; efficient distribution of that work may require some staff members to devote all their time to changing diapers.

Extraforaminal stenosis in the lumbosacral spine. Efficacy of MR imaging in the coronal plane

PURPOSE

To review experience with MR images of extraforaminal (EF) stenosis in the lumbosacral spine.

MATERIAL

MR images from 9 patients with 10 EF stenoses were reviewed. The diagnosis was confirmed in 6 patients at surgery, and in 4 on the basis of findings of nerve root injection combined with nerve block.

RESULTS AND CONCLUSION

All patients had congenital lumbosacral anomalies with various degrees of fixation between the last formed level and the pelvis. In all cases, affected roots were compressed between the transverse process of the last lumbar segment and the sacral ala. MR using coronal plane imaging demonstrated the root impingement directly in the far lateral zone in all patients. However, sagittal and axial images were unable to define the EF stenoses in all patients. The results of this study show that a transitional vertebra is a cause of EF stenosis and that MR images using coronal plane are useful in the assessment of EF stenosis.