[A 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years]

We report the case of a 66-year-old woman with a patent ductus arteriosus and no significant progression of pulmonary arterial pressure over 17 years. She was admitted to our hospital in 1978 because of palpitations on exertion and chest discomfort. Cardiac catheterization was done, and she was given a diagnosis of patent ductus arteriosus. Because the left-to-right shunt was small (15%) and because there was no evidence of pulmonary hypertension (38/18 mmHg), she was treated medically. In 1995 she was admitted again, to determine the cause of a cerebral infarction. The cerebral infarction was believed to have been caused by an embolism due to atrial fibrillation. She underwent cardiac catheterization again. The left-to-right shunt had increased to 41%, but the pulmonary artery pressure had not changed (27/14 mmHg). Intravascular ultrasound imaging was used to evaluate the ductus arteriosus. The diameter of the ductus was 4.4 mm and calcification was not observed. During the 17 years of follow-up, heart size increased slightly, but pulmonary artery pressure did not change. In addition, intravascular ultrasound was very useful for evaluating the condition of the ductus arteriosus.

Ossifying fibromyxoid tumor of soft parts of the back

We report a first case of ossifying fibromyxoid tumor of soft parts of the back, a 10 x 9.5 x 6 cm well-circumscribed elevated subcutaneous tumor demarcated by an incomplete fibrous capsule with bone formation at its base. The tumor was composed of both myxomatous areas with spindle tumor cells and pseudoalveolar structures with oval tumor cells. The tumor cells had evenly sized, oval nuclei without atypia and slightly eosinophilic cytoplasm with intracellular vacuoles. Immunohistochemical studies revealed positivity for vimentin and focal positivity for S-100 protein. Ultrastructural examination revealed a few filopodia-like processes, discontinuous basal lamina and a few primitive cell junctions. Based on these immunohistochemical and ultrastructural results, this tumor may be related to Schwann's cells. There has been no recurrence 5 years after wide local excision.

Effect of continuous passive motion on the results of TMJ meniscectomy. Part I: Comparison of chewing movement

In order to evaluate the therapeutic effect of continuous passive motion (CPM) on the outcome of TMJ meniscectomy, chewing movement was analyzed before surgery and six months after surgery in 31 patients receiving CPM (CPM group), 26 patients without CPM (non-CPM group), and in ten normal subjects. The surgical procedure consisted of either total meniscectomy or partial meniscectomy with disk repair. It was found that chewing in patients receiving CPM was closer to the normal range than for patients in the non-CPM group. The results from the CPM group demonstrated chewing parameters for patients with partial meniscectomy returning to the normal range. However, for the patients with total meniscectomy, some parameters remained out of the normal range. From these results, we conclude that CPM has a positive influence on the outcome of TMJ surgery.

Experimental infusion phlebitis: importance of titratableacidity on phlebitic potential of infusion solution

The titratable acidity of infusion solutions has never been taken into account in infusion phlebitis. This study aims to clarify the importance of titratable acidity on the phlebitic potential of infusion solutions. Solutions with different titratable acidity (from 0.16 to 12 mEq/L) were infused into the ear veins of 6 rabbits for 6 h at 10 mL/kg/h, and the veins were later examined histopathologically. Even at pH 4.0, a commercial 10% glucose solution scarcely caused any changes because of its very low titratable acidity (0.16 mEq/L). A 10% glucose solution with its titratable acidity adjusted to 3 mEq/L (pH 4.3) with citrate and NaOH, however, caused phlebitic changes in all 6 rabbits, and adjusting the titratable acidity to 12 mEq/L (pH 4.4) increased the degree of phlebitis. On the other hand, a 10% glucose solution with a pH of 5.4 and a titratable acidity of 6 mEq/L caused slight phlebitic changes in half the rabbits. These results suggest that 1) the titratable acidity of infusion solutions is important to the phlebitic potential when the pH is low, 2) when the pHs are similar, the phlebitic potential of infusion solutions depend on the titratable acidity, and 3) the phlebitic potential of infusion solutions can not be estimated by pH or titratable acidity alone.

Detection of Bacteroides fragilis by PCR assay targeting the neuraminidase-encoding gene

Oligonucleotide primers were designed on the basis of the sequence of the neuraminidase-encoding gene (nanH) of Bacteroides fragilis and used for the specific detection of this anaerobe by the nested PCR assay. Fifty-nine of 60 representative strains of Bact. fragilis were detected, while none of 45 strains of other species generated visible PCR products. The detection limits of Bact. fragilis cells and DNA by the nested PCR were 10 colony-forming units and 10 fg of chromosomal DNA, respectively. The PCR assay targeting the nanH gene has the potential for the detection of Bact. fragilis.

[A case of selective IgM deficiency associated with systemic lupus erythematosus]

We report a case of selective IgM deficiency associated with systemic lupus erythematosus (SLE). A 34-year-old female suffering from SLE was admitted with proteinuria and general fatigue. Laboratory findings revealed a very low serum IgM level, almost lower than 12 mg/dl. Renal biopsy findings showed diffuse proliferative lupus nephritis (DPLN). In immunofluorescent microscopy, IgG was the most strongly stained followed by IgA, but IgM staining was only faint. As for the immunophenotype of the T cells, the OKT4/OKT8 ratio was normal. Response to both phytohemagglutinin (PHA) and concanavalin A (ConA) was normal. However, responses of B cells to both pokeweed mitogen (PWM) and Staphylococcus aureus Cowan strain I (SAC) were significantly reduced. Surface IgM-positive B cells were decreased. These results indicate that the patient had B cell dysfunction, involving impairment of B cell differentiation. In this report, we discuss selective IgM deficiency and SLE documented in the literature.

[Familial hypertrophic cardiomyopathy generating a marked left ventricular pressure gradient in an 82-year-old woman]

Familial nonobstructive hypertrophic cardiomyopathy in 78-year-old woman was diagnosed in 1988. Since then she has been treated with a beta-blocking drug and a calcium antagonist. Her clinical condition was NYHA I or II for several years. Echocardiography revealed asymmetric septal hypertrophy in 1988 (interventricular septal thickness = 21 mm, posterior wall thickness = 10 mm). Systolic anterior motion of the mitral valve was first observed at the end of 1992. The left ventricular pressure gradient also gradually increased; it was about 138 mmHg in 1993 (age 82 yrs). The left ventricular ejection time index increased from 376 msec in May, 1992 to 459 msec in May, 1994. In September, 1994, the patient's condition gradually deteriorated (NYHA IV), and she was admitted to our hospital. To attenuate the left ventricular pressure gradient, 150 mg of disopyramide was administered. Her condition markedly improved: the left ventricular pressure gradient decreased from 180 mmHg to 76 mmHg, and the left ventricular ejection time index decreased from 485 msec to 419 msec. These results indicate that a left ventricular pressure gradient can be generated rapidly even in a very old patient, and that disopyramide may be useful to attenuate the left ventricular pressure gradient.

The influence of postoperative treatment on the results of TMJ meniscectomy. Part II: comparison of chewing movement

In order to evaluate the influence of different types of postoperative treatments on the results of TMJ surgery, chewing movement recorded postoperatively was compared in 32 patients with unilateral total meniscectomy, 42 patients with partial meniscectomy with disk repair, and 10 normal subjects. Postoperative treatment was of three different types depending on its strategy. It was found that postoperative treatment had a significant positive effect on the results of both total and partial meniscectomy. Postoperative treatment which included both physical medicine modalities and dental treatment demonstrated better results than only dental treatment or no postoperative treatment. However, none of these studied techniques could recover chewing movement to the normal range.

Characteristic chewing parameters for specific types of temporomandibular joint internal derangements

In order to determine if there are characteristic chewing patterns for specific types of TMJ internal derangements, chewing was analyzed in 210 TMD patients with unilateral internal derangement (MDR early, 40; MDR late, 41; MD, 80; MDP, 49), and in 94 TMD patients without internal derangement, and 10 asymptomatic subjects with normal TMJ imaging. Each internal derangement subgroup demonstrated a significantly restricted envelope of motion and a reduced chewing velocity especially when they chewed on their normal TMJ side. Comparing different types of internal derangement, the MDR early group demonstrated relatively normal chewing, while the MDR late, MD and MDP groups showed severely impaired chewing movements. Among these three groups, the MD group demonstrated the most impairment, followed by the MDP and the MDR late groups. These results demonstrate that different types of internal derangement have specific impairments upon chewing, suggesting use of this analysis as a diagnostic tool.

Intraglomerular deposition of intact cross-linked fibrin in IgA nephropathy and Henoch-Schönlein purpura nephritis

To investigate the significance of intraglomerular coagulation and fibrinolysis in IgA nephropathy (IgA-N) and Henoch-Schönlein purpura nephritis (HSPN), the distribution of intact cross-linked fibrin (XFb) modulated by plasmin activity was examined in 25 patients with IgA-N and in 12 with HSPN. In addition to the conventional method detecting fibrin-related antigen (FRA) with an antibody against fibrinogen, the enhanced intensity of immunoreactivity of cross-linked FRA (KL-FRA) using the monoclonal antibody DD3B6/22 after plasmin exposure was evaluated to assess intraglomerular deposition of intact XFb. Also, intraglomerular invasion of macrophages was detected using the monoclonal antibody KP1 against CD68. Sixteen of a total of 37 specimens (43%) showed increased intensity of XL-FRA staining after plasmin treatment which is considered to reflect the distribution of intact XFb. Increases in the intensity of XL-FRA staining were observed mainly in mesangium and partially along glomerular capillary loops and also in a few cases in the crescents. The incidence (67%) of increases in XL-FRA staining after plasmin exposure in HSPN specimens was significantly higher than that in IgA-N specimens (32%; p < 0.05). In the group positive for XL-FRA after plasmin exposure, the numbers of macrophages per glomerulus were significantly higher (n = 15; mean +/- SD = 1.6 +/- 0.9) than in the negative group (n = 6; 0.5 +/- 0.6; p < 0.01). In HSPN, the number of macrophages per glomerulus (n = 8; 1.9 +/- 1.0) was higher than that in IgA-N (n = 13; 0.9 +/- 0.9; p < 0.05). Based on these results, we conclude that XFb is often produced and distributed in intact form in the glomeruli both in IgA-N and HSPN, associated with a relatively low intraglomerular plasmin activity, and that intraglomerular coagulation may progress in accordance with macrophage infiltration, especially in HSPN.

[Bladder cancer in spinal cord injury patient. A case report]

A case of bladder cancer following spinal cord injury is reported. A 57-year-old male with L1 incomplete paraplegia was referred to our hospital under the diagnosis of bladder tumor with gross hematuria in November, 1994. Radical cystectomy, rt nephroureterectomy (nonfunctioning kidney) and lt ureterocutaneostomy were carried. Histopathological study revealed squamous cell carcinoma (well differentiation) and transitional cell carcinoma (G3), stage pT3b. He has been doing well without recurrence for 4 months after operation.

Ionotropic mechanisms involved in postsynaptic inhibition by the endothelins of ganglionic transmission in dog cardiac sympathetic ganglia

We investigated the effects of endothelin-1 and endothelin-3 (ET-1, ET-3) on the ganglionic transmission of cardiac sympathetic ganglia in vivo by the direct administration of agents to the ganglia through the right subclavian artery while monitoring the heart rate (HR) as an indicator of the ganglionic function in spinal dogs. The positive chronotropic responses to dimethylphenylpiperazinium (DMPP) and McN-A-343 administered to the ganglia were similarly inhibited by ET-1 (0.05-0.2 microg) and ET-3 (0.5-2 microg), but ET-1 was approximately 10 times more potent than ET-3. The inhibition induced by ETs was antagonized by endothelin ETA receptor antagonist BQ-123 (20 microg). This inhibition was unaffected by pretreatment with indomethacin given intravenously (i.v.), ruling out the possible involvement of endogenous prostaglandins production. The voltage-sensitive Ca2+ channel antagonist nifedipine had no effect on inhibition. However, the inhibition was antagonized by pretreatment with the low conductance Ca2+-activated potassium channel antagonists, such as apamin (20 microg intraarterially, i.a.), scyllatoxin (10 mug i.a.) and D-tubocurarine (0.6 mg i.a.). On the other hand, the voltage-sensitive K+ channel antagonist 4-aminopyridine (4-AP), ATP-dependent K+ channel antagonist, glibenclamide, and high-conductance Ca2+-activated K+ channel antagonists iberiotoxin and charybdotoxin failed to affect the inhibition by ETs. The results suggest that ETs inhibit the nicotinic and muscarinic ganglionic transmission through the ETA receptor-operated low-conductance Ca2+-activated potassium channel at postganglionic sites.

Young borderline hypertensives are hyperreactive to mental arithmetic stress: spectral analysis of R-R intervals

To investigate whether sympathetic tone and its reactivity to stress are increased in borderline hypertension, we compared pressor and autonomic nervous responses to mental arithmetic stress in male borderline hypertensives (BH) and normotensive volunteers (NT). Three age groups, 30, 40 and 50-year-old groups, which included 30 to 39, 40 to 49 and 50 to 59-year-old subjects, were studied. Fractional LF (%LF), fractional HF (%HF) and L/H, obtained from the power spectrum of R-R intervals, were used as indices of autonomic nervous function. Baseline autonomic nervous indices did not differ between NT and BH of any age group. Blood pressure rose higher during mental arithmetic stress in 50 than in 30-year-old NT but not in comparable age groups of BH. Pressor responses were augmented in BH compared to NT only in the 30-year-old group. However, the differences were not significant when pressor responses were expressed as percent increases in blood pressure. Both %L and L/H increased during arithmetic stress. The increase in %L did not differ between NT and BH but that in L/H (% delta L/H) was larger in 50 than in 30-year-old NT. % delta L/H was larger in BH than in NT only in the 30-year-old group. These findings suggest that both pressor and autonomic nervous responses to metal arithmetic stress were altered by aging and augmented in BH compared to NT in the 30-year-old group.

Warfarin-induced eosinophilic pleurisy

A 51-year-old man was admitted to our hospital because of dry cough and low grade fever with right-sided pleural fluid and blood eosinophilia. Warfarin had been prescribed following coronary artery bypass grafting. After the discontinuation of warfarin the clinical and chest X-ray findings improved; readministration of the drug caused recurrent blood eosinophilia and pleural effusion in the other lung. Since no other specific etiologies for eosinophilia and pleural effusion were determined by extensive evaluation, warfarin seemed to be associated with his illness. This is the first report of warfarin-induced eosinophilic pleurisy.

[A case of systemic arterial supply to the normal left basal segments with anomalous return of the left inferior pulmonary vein]

A 38-year-old man was admitted to Yatsushiro General Hospital because of an abnormal shadow on chest X-ray film. Chest X-ray film showed a tumorous shadow in the left posterior basal segment (S10). Chest CT scan showed that this shadow was consisted of torutuous vessels and was connected to the descending thoracic aorta. Angiographic examinations showed that there was no normal left basal trunk of the pulmonary artery, and revealed an anomalous arterial supply to the basal segments from the descending thoracic aorta, with an anomalous left inferior pulmonary vein. The left bronchial tree appeared normal during fibroptic bronchoscopy (confirmed by post-operative bronchography). From these findings, we determined that this patient had an systemic arterial supply to the normal basal segments. Furthermore, this patient had an anomalous left inferior pulmonary vein, which took a peculiar route to the left atrium. The left lower lobe and the anomalous systemic artery were resected. In the resected specimen, the bronchi of the left lower lobe had a normal structure and showed a normal pattern of distribution. This anomalous systemic artery had an elastic component.

Chewing pattern analysis in TMD patients with unilateral and bilateral internal derangement

In order to evaluate chewing in temporomandibular disorder (TMD) patients with unilateral and bilateral internal derangement of the temporomandibular joint (TMJ), the envelope of motion and velocity of chewing were analyzed in 103 TMD patients with unilateral internal derangement, 42 patients with bilateral internal derangement and 10 normal subjects. It was found that patients with bilateral internal derangement demonstrated a significantly restricted range of motion and reduced velocity than patients with unilateral internal derangement or normal subjects. The analysis of chewing patterns in the frontal and sagittal planes revealed that patients with bilateral internal derangement had no specific pattern while patients with unilateral internal derangement demonstrated a specific pattern. The analysis of chewing velocity pattern suggested that opening and closing patterns without any obvious peak velocity was significantly more frequent in patients with bilateral internal derangement than patients with unilateral internal derangement or normal subjects.

Nucleotide sequence of the gene encoding beta-isopropylmalate dehydrogenase (leuB) from Bacteroides fragilis

The complete nucleotide sequence of the gene (leuB) coding for beta-isopropylmalate dehydrogenase of Bacteroides fragilis was determined. An open reading frame of 1,061 nucleotides was detected that could encode a polypeptide of 353 amino acid residues with a calculated molecular mass of 39,179 Da. The deduced amino acid sequence of the beta-isopropylmalate dehydrogenase from B. fragilis showed substantial sequence similarity with the beta-isopropylmalate dehydrogenases from other bacteria.

Chewing pattern analysis in TMD patients with and without internal derangement: Part II

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), the velocity of chewing movement was analyzed in 103 TMD patients with unilateral internal derangement (D group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The ID group showed a significantly reduced maximum opening velocity, a significantly smaller standard deviation for the velocity and a significantly frequent opening velocity pattern with a deceleration in the middle of opening compared to the NID or the normal groups. The NID group demonstrated significantly frequent opening velocity patterns without any velocity peak compared to the ID or normal groups.

Activation of endogenous thromboxane A2 biosynthesis mediates presynaptic inhibition by endothelin-3 of dog stellate ganglionic transmission

Effects of endothelin-3 on ganglionic transmission were investigated in dog cardiac sympathetic ganglia. Positive chronotropic responses to preganglionic stellate stimulation were inhibited by endothelin-3 (0.5-2 micrograms) given directly to the ganglia through the artery. To find possible inhibitory effects of the peptide at presynaptic sites, acetylcholine released from the isolated stellate ganglia was determined. The amount of acetylcholine released during preganglionic stimulation was reduced by exposure to endothelin-3 (10(-9) to 10(-6) M). A similar reduction of acetylcholine release was observed after application of a stable thromboxane A2, a thromboxane A2/prostaglandin H2 receptor agonist, U-46619, and prostaglandin E2 at concentrations from 10(-8) to 10(-4) M, but not by the same concentrations of prostaglandins F2 alpha and I2. The reduction elicited by endothelin-3 was unaffected by a phospholipase C inhibitor, neomycin, or a protein kinase C inhibitor, H-7, but was antagonized by pretreatment with phospholipase A2 inhibitors, dexamethasone or methylprednisolone, and by cyclooxygenase inhibitors, aspirin and indomethacin. In addition, the reduction also was antagonized by pretreatment with a thromboxane A2 synthetase inhibitor, OKY-046, and a specific thromboxane A2 receptor antagonist, S-145, but not by a specific prostaglandin E2 receptor antagonist, SC-19220. Furthermore, endothelin-3 (10(-7) M) stimulated the OKY-046- and indomethacin-sensitive formation of thromboxane A2 in the ganglia. These results indicate that endothelin-3 inhibits the sympathetic ganglionic transmission by reducing acetylcholine release at preganglionic terminals and that this inhibition seems to involve activation of endogenous thromboxane A2 production.

Chewing pattern analysis in TMD patients with and without internal derangement: Part I

In order to investigate the chewing movement of temporomandibular disorders (TMD) patients with and without internal derangement of the temporomandibular joint (TMJ), analysis of the envelope of motion during chewing was performed in 103 TMD patients with unilateral internal derangement (ID group), 94 TMD patients without internal derangement (NID group) and 10 normal subjects (normal group). The analysis of numeric parameters revealed that the ID group demonstrated a significantly restricted range of motion compared to the NID or normal groups, and the NID group demonstrated significant irregularity of chewing compared to the ID or normal groups. The analysis of chewing also demonstrated that the chewing pattern for the ID group demonstrated more frequent deviation of the turning point to the nonchewing side in the frontal plane and a narrow anteroposterior pattern in the sagittal plane compared to the other groups. No characteristic chewing patterns were identified for the NID group.

The influence of postoperative treatment on the results of temporomandibular joint menisectomy. Part I: Comparison of mandibular opening and closing movements

In order to evaluate the influence of postoperative treatment on the results of temporomandibular joint (TMJ) menisectomy, the maximum voluntary opening and closing movements of 67 patients who underwent either total menisectomy or partial menisectomy with disk repair were analyzed and compared to those of 10 normal subjects. The postoperative treatment was classified into three different types depending on its strategy. It was observed that postoperative treatment which emphasized physical medicine modalities could produce opening and closing movements of the mandible closer to the normal range. The effect of the postoperative treatment on the results of total menisectomy was more significant than that on the results of partial menisectomy with disk repair. Partial menisectomy with disk repair resulted in better opening and closing movement than total menisectomy.