Cardiac output measurement by thoracic electrical bioimpedance in a patient with ovarian hyperstimulation syndrome

A 31-year-old woman developed severe ovarian hyperstimulation syndrome (OHSS) after exogenous gonadotropin stimulation for an in vitro fertilization program. Because of refusal of invasive monitoring, thoracic electrical bioimpedance (TEB) was performed to evaluate cardiac function and volume status. TEB pointed out decreased cardiac output (CO: 4.23 liters/min), cardiac index (CI: 2.63) and stroke volume (SV: 57.5 ml/beat). Serial monitoring of hemodynamic variables was then performed. After the data were obtained, fluid management was performed, and the patient recovered from abnormal homeostasis in 3 days. The hemodynamic variables returned to the normal range (CO: 6.85 liters/min, CI: 4.25, SV: 100.5 ml/beat) within the first 24 h. There were no complications such as life-threatening multiple organ failure. We discuss the usefulness of TEB for the fluid management of severe OHSS, as well as its implications.

[Operative corrections of funnel chest depend on age group]

The methods of correcting funnel chest are various and many. It's necessary to select the proper method depending on the age group. For children, sternal elevation by Ravitch's procedure produces to better results without prosthesis. For adolescent patients, the elevated sternum can be maintained by Kirschner's wires. Furthermore, adult patients have severe chest wall deformities with calcificated costal cartilage. The methods sternal elevation methods cause an unsatisfactory by postoperative appearance for adult patients with funnel chest. Two adult patients, 20 and 48-year-old men, underwent the sternal turnover methods with complete sternal blood supplies. The procedures of the new method turn over the sternal body crossing bilateral internal thoracic vessels and abdominal rectal muscles. No chest wall deformities were seen and the patency of internal thoracic arteries and superior epigastric arteries was revealed by postoperative arteriography.

[Usefulness of PCR-SSCP using non-RI coloration method as a routine genetic analysis]

The polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis is considered as one of useful routine genetic analyses. However, that PCR-SSCP has been analyzed using radioisotope (RI) such as [32P] labeled compounds. So that, it was difficult to use this method routinely at clinical laboratories. In this paper, we compared with an RI mediated and a non-RI coloration mediated PCR-SSCP analysis regarding to those of sensitivity, time and money cost, respectively. The coloration method had enough sensitivity to detect one of cholesteryl ester transfer protein gene mutations. The time and money cost of non-RI coloration mediated method were more advantageous than the RI mediated one. Therefore, it is shown that the non-RI coloration mediated PCR-SSCP analysis is very useful for the routine genetic analysis at clinical laboratories.

[Urgent allogeneic bone marrow transplantation using a preparative regimen of cyclophosphamide anti-human thymocytes rabbit globulin in a patient with severe aplastic anemia with pneumonia]

A 16-year-old girl was diagnosed as having severe aplastic anemia (SAA) had received emergency complicated by sever pneumonia. She had an HLA-identical younger brother and been urgently transplantation with her brother's marrow following a preparative regimen of CY+rabbit antithymocyte globulin (ATG). Granulocyte transfusions carried out before and after the transplant prevented exacerbation of the pneumonia. The pneumonia was cured in association with the hematopoietic recovery after BMT. No signs or symptoms of acute or chronic graft-versus-host disease were recognized and her hematological data are normal. The rabbit ATG was thought to be effective in preventing rejection and could be used in the preparative regimen instead of total body irradiation.

A formal study on summary table handling with application to health care statistical databases

There is an ever-increasing demand for statistics in the health care field. Various surveys are conducted every year, and a huge number of summary tables are created. To share information and to make the most of the summary tables, we present a method for storing and transforming summary tables with special application to the health care field. A database management system being developed is also presented.

Lower-limb speed and foot preference in children

Foot preference and performance characteristics of gross-motor lower-limb speed of tapping were examined in 606 4- to 6-yr.-olds. Analysis indicated no effect for gender; however, speed of foot tapping increased significantly across the three ages, suggesting an association with selected developmental (neuromuscular) processes. Contrary to earlier reports on handedness, there was no statistical evidence that mixed- or left-footers were at a performance disadvantage compared to right-footers. All groups performed best with the right foot, limb differentiation (right versus left) being significant for the right- and mixed-footed groups. Speculation about maturational and environmental influences is given.

Successful 24-hour rabbit heart preservation by hypothermic continuous coronary microperfusion with oxygenated University of Wisconsin Solution

BACKGROUND

This study assessed whether a combination of hypothermic continuous coronary microperfusion and oxygenated University of Wisconsin Solution (UWS) improves postischemic functional recovery and minimizes myocardial tissue edema.

METHODS

Isolated rabbit hearts were divided into four groups (n = 6 each): group I (immediate reperfusion), group II (simple cold storage in UWS), group III (hypothermic continuous coronary microperfusion with UWS), and group IV (hypothermic continuous coronary microperfusion with oxygenated UWS). Hearts in groups II, III, and IV were preserved for 24 hours. Preischemic and postischemic cardiac function was measured using a Langendorff apparatus.

RESULTS

Hearts in group I showed complete functional recovery, whereas cardiac output in group II was inadequate. In groups III and IV, the percentage recovery rate (post/pre) of cardiac output was 57.0% +/- 3.1% and 82.2% +/- 9.1%, respectively (p < 0.05). In groups III and IV, perfusion pressures at the end of 24-hour preservation increased from the initial 5 mm Hg to 12.3 +/- 2.7 and 8.3 +/- 1.4 mm Hg (p < 0.05), respectively. In groups I, III, and IV, the percentage tissue water content was 82.8 +/- 1.0, 86.7 +/- 1.7, and 83.8 +/- 1.6, respectively (p < 0.05 for group III versus groups I and IV). There was a significant correlation between the percentage tissue water content and coronary perfusion pressure at the end of the 24-hour preservation (r = 0.60, p = 0.040) and a significant inverse correlation between percentage tissue water content and percentage recovery rate of cardiac output (r = -0.69, p = 0.014). In ultrastructural examination, myocardial tissue edema was limited and mitochondria were well preserved in group IV.

CONCLUSION

We conclude that the combination of a hypothermic continuous coronary microperfusion technique and oxygenation of UWS was the procedure of choice for reducing tissue edema and improving both the coronary microcirculation and functional recovery during 24-hour heart preservation.

Expression of alpha 2,8-sialyltransferase (GD3 synthase) gene in human cancer cell lines: high level expression in melanomas and up-regulation in activated T lymphocytes

GD3 Synthase (alpha 2,8sialyltransferase) (EC 2.4.99.8) cDNA has been cloned by eukaryotic cell expression cloning. Using this cDNA as a probe, the expression level of the gene in human cancer cell lines was analysed by Northern blotting and RT-PCR, then correlated with the ganglioside expression and enzyme activity. Melanoma cell lines showed extremely strong bands in Northern blot and RT-PCR/Southern analysis. The enzyme activity was also very high in melanomas as expected. Neuroblastoma and astrocytoma lines showed relatively low levels of the gene expression, whereas they expressed high levels of GD2. Although the mRNA level of the GD3 synthase gene and enzyme activity in individual cell lines correlated positively, some cell lines showed much higher activity than expected from the mRNA level. Among leukaemia lines, adult T cell leukaemia-associated (HTLV-I+) lines showed fairly high levels of the mRNA. On the other hand, T-ALL lines showed very low levels. In addition, GD3 and GD2 expression and mRNA level of the gene during T lymphocyte activation were analysed. Only GD3 expression was induced by any of the stimulatory reagents used, and corresponding up-regulation of the GD3 synthase gene was shown in RT-PCR/Southern analysis.

Increased frequency of apolipoprotein epsilon 2 allele in non-insulin dependent diabetic (NIDDM) patients with nephropathy

The genetic polymorphism of apolipoprotein E (epsilon 2, epsilon 3 and epsilon 4) is associated with lipid abnormalities. It has been suggested that lipid abnormalities may contribute to the development and progression of kidney diseases, including diabetic nephropathy. Thus, in this study we compared the apo E allele frequencies among 146 non-insulin-dependent diabetic (NIDDM) patients with nephropathy, 135 NIDDM patients without nephropathy and 576 of the general Japanese population. The epsilon 2 allele frequency was significantly higher in diabetic patients with nephropathy (7.2%) and with renal failure (9.7%) than in diabetic patients without nephropathy (2.6%) and in the general Japanese population (3.7%). It is concluded that there is a possibility that the epsilon 2 allele is associated with nephropathy in NIDDM.

Contribution of endothelin-1 to warm ischemia/reperfusion injury of the rat lung

The purpose of the present study was to clarify the role of endothelin-1 (ET-1) in the pathogenesis of ischemia/reperfusion lung injury and to determine whether pretreatment with an ET receptor antagonist prevents such injury. The left lung of Sprague-Dawley rats was subjected to 60 min of no-flow warm ischemia followed by 90 min of reperfusion. The plasma ET-1 concentration increased significantly after reperfusion compared with before and after ischemia (p < 0.05). Arterial oxygen tension was reduced, and the lung tissue wet/dry weight ratio increased in post-reperfusion lungs compared with both pre-ischemia and post-ischemia lungs. Histologic study showed pulmonary edema, hemorrhage, hyaline membrane formation, and a significant increase in lung tissue neutrophils after reperfusion. In addition, the expression of ET-1 mRNA was determined by Northern blot analysis. Although ischemia did not significantly alter ET-1 expression, reperfusion increased expression in the left lung markedly and in the right lung moderately. Pre-infusion of FR139317, an ETA receptor antagonist, prevented post-reperfusion damage to the lung. These results suggest that ET-1 contributes to the ischemia/reperfusion injury of the rat lung, mediated by an ETA receptor, and that an ETA receptor antagonist may inhibit ischemia/reperfusion lung injury.

Prognostic determinants of hypertrophic cardiomyopathy--the results of the Shiga Cardiomyopathy Study

Previous studies have reported that patients with hypertrophic cardiomyopathy (HCM) are prone to sudden death. In this study, we retrospectively assessed the prognosis and any influencing factors in 83 patients (66 male, 17 female) with HCM. Twenty-two patients were obstructive, 40 were non-obstructive, 18 were apical HCM and 3 were unclassified. Four of the 83 cases progressed to left ventricular dilatation and dysfunction during the follow-up period. The mean age was 51.2 years (range 16 to 73) and the mean duration of follow-up was 6.7 years (range 0.3 to 15.1). The 5- and 10-year survival rates were 98% and 89%, respectively. Five patients dies; 3 from cardiac events (two sudden deaths and one due to congestive heart failure) and 2 from malignant diseases. The lack of a family history of sudden death and the amplitude of the S wave in lead V1 (less than 2.0 mV) were associated with a favorable prognosis. None of the patients who were diagnosed before age 50 died, but this observation was not statistically significant. None of the patients with apical HCM died, but the classification of HCM was not significantly associated with the prognosis. None of the patients without medication died and medical treatment did not influence the prognosis. Sex, family history of HCM, the patient's symptoms and physical signs, NYHA classification of cardiovascular disability, thickness of the septum and the posterior wall of the left ventricle, dimension of the left atrium, and the left and right ventricles in echocardiogram, amplitude of the R wave in lead V5, the depth of the negative T wave and atrial fibrillation did not influence the prognosis.

Primary hypoparathyroidism in Turner's syndrome

A case of hypoparathyroidism accompanied with Turner's syndrome is reported. On admission, a 44-year-old woman had facial dystonia, deafness, and primary amenorrhea. Laboratory examinations showed a decrease in serum PTH and mosaicism of 45,X and 46,XX(6:34). A brain CT revealed marked calcification in the basal ganglia, cerebellum and periventricular area. Antiparkinsonian drugs were found to be effective for the dystonia. This case therefore suggests that some relationship may exist between intracranial calcification and Turner's syndrome.

Effects of zonisamide on dopaminergic system

Effects of zonisamide (ZNS) on extracellular dopamine (DA), its precursor 3,4-dihydroxyphenylalanine (DOPA), its metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels in the striatum as well as hippocampus of freely moving rats were studied. Intracellular DA, DOPA, DOPAC and HVA levels, as well as DOPA accumulation as an index of tyrosine hydroxylase activity in the rat brain in vivo, DA re-uptake in the striatum and hippocampus, and monoamine oxidase (MAO) activities were also determined. Acute administrations of therapeutic ZNS doses (20 and 50 mg/kg) increased striatal extracellular DOPA levels, intracellular striatal and hippocampal DOPA levels, and stimulated DOPA accumulation in both brain regions. ZNS also increased striatal and hippocampal intracellular as well as extracellular DA and HVA levels, but decreased those of DOPAC levels. Chronic (3 weeks) administrations of therapeutic ZNS doses (20 and 50 mg/kg/day) increased intracellular DA, DOPA, DOPAC and HVA levels in striatum and hippocampus. ZNS-induced changes were greater in intracellular levels than in extracellular levels. Acute and chronic supratherapeutic ZNS dose (100 mg/kg) administration decreased intracellular levels of all substances detectable in both brain regions, and inhibited DOPA accumulation. Both subtypes of MAO (type A and type B) activities were weakly inhibited by ZNS. ZNS showed no effect on DA re-uptake in striatum nor in hippocampus. These results suggest that therapeutic ZNS doses increase DOPA accumulation as well as both intracellular and extracellular DA, DOPA and HVA levels. However, such doses also decrease extracellular and intracellular DOPAC levels by enhancing DA synthesis and/or by selectively inhibiting MAO-B activities. In addition, chronic therapeutic ZNS dose administration enhances DA synthesis, which results in increased intracellular DA, its precursor and its metabolites levels. On the other hand, both acute and chronic supratherapeutic ZNS dose administrations inhibit DA turnover. These ZNS effects on DA metabolism are at least partly involved in the mechanisms of action of ZNS.

Dental health indicator based on a questionnaire

Dentistry has lacked an effective indicator of the impact of dental problems on a person's daily life. Subjective factors in dental health need to be included in order to improve current indicators. The purpose of this research was to develop a new type of indicator recorded from a questionnaire which takes account of subjective factors in dental health. The indicator we constructed has the following advantages. 1. Calculation process is simple in practice. 2. The indicator values range from 0 to 100, with values closer to 100 indicating a more favorable condition for the individual. 3. The distribution of indicator values is similar to the normal distribution. 4. The score of each item is reflected on the indicator, suggesting the individual's characteristics in terms of dental health. 5. Although it is principally an indicator for individuals, it can also be applied to groups. This study will also provide a model for the preparation of a dental health indicator.

[Effect of reimplantation response on recipient pulmonary hemodynamics in single lung transplantation]

Until now, reimplantation response (RR) has been thought to be a transient dysfunction of the transplanted lung in single lung transplantation. How does RR influence on the native lung in single lung transplantation? We studied the influence of RR to the native lung with 20 dogs which were divided separated into 3 groups. In group I (6 dogs) and II (6), left lung allotransplantation without immunosuppression was performed. In group II, PGI2 was administered to the donors at 1 microgram/kg/min for 60 minutes iv drip infusion during lung extraction and super oxide dismutase (SOD) was administered to the recipients at 20 mg/kg just before reperfusion of the transplanted lung. In group III (8), allotransplantation with immunosuppression (CYA 20 mg/kg, AZ 4 mg/kg) was done using PGI2 and SOD in the same way as group II. In all groups doppler flow probes were attached to the ascending aorta and left pulmonary artery. For over 1 week, pulmonary hemodynamics was evaluated. In group I pulmonary arterial pressure increased up to 38.7 +/- 19.7 mmHg on 3 postoperative day, which showed significant difference (p < 0.05) from group II. An increase in vascular resistance of the transplanted lung was recognized right after transplantation in the both groups (0.212 +/- 0.058 mmHg/ml/kg to 0.487 +/- 0.114 in group I, 0.207 +/- 0.072 to 0.407 +/- 0.172 in group II). However, vascular resistance of the right lung increased in group I against group II right after transplantation (0.182 +/- 0.116 to 0.367 +/- 0.195 in group I, 0.183 +/- 0.116 to 0.214 +/- 0.149 in group II), which showed significant difference (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)