229 From head to tail: A red wolf sperm project

Development of assisted reproductive technologies for the critically endangered red wolf (Canis rufus) is crucial to the maintenance of genetic diversity to support species recovery. Towards this goal, a cryopreservation protocol has previously been developed for red wolf sperm; however, the ability of the gametes to undergo capacitation has not been assessed in this species. Previously, we have shown that oviductal extracellular vesicles (oEVs) improve cat sperm motility and fertilizing ability. The objectives were to (1) compare the effects of culture media on motility and acrosomal integrity of fresh sperm, and select the best medium that can be used in a capacitation protocol; (2) identify potential biomarkers for sperm cryo-tolerance; and (3) determine the influence of canine oEVs on sperm survival and motility post-thaw. In Study 1, sperm were collected by electro-ejaculation from adult red wolves (n=8) and immediately cryopreserved in TRIS-egg yolk buffer with 8% glycerol or incubated for 18h in 5% CO2 and 38.5°C in one of the following media: canine capacitation medium (CCM), FERT-TALP (FERT), NCSU, synthetic oviductal fluid (SOF) and TRIS. At 0, 1, 2, 3, 4, and 18h, sperm were evaluated for total motility and acrosome integrity (FITC-PNA). In Study 2, sperm with high (>80%, HM, n=2 wolves) and low (<15%, LM, n=2 wolves) motility post-incubation at 4°C in the cryopreservation medium for 18h were subjected to proteomic analysis. In Study 3, oviducts were collected from domestic dogs (1-9 years, n=12) after elective spaying, and oEVs from various stages of the oestrous cycle [early follicular (EF), late follicular (LF), early luteal (EL), and late luteal (LL)] were isolated using the Total Exosome Isolation kit (Invitrogen). Frozen-thawed red wolf sperm (n=4 males) were incubated with 30×106 oEVs in non-capacitating CCM, and assessed as in study 1 at 0, 0.5, 1, 2, 3, 4, 6, 8, and 10h. Data were analysed using a paired samples t-test with 95% CI (Prism8, GraphPad Inc.). Sperm incubated in CCM and NCSU had higher motility than those in FERT, SOF, and TRIS after 2h of incubation and onward (2 h: 65±6, 68±6, 42±10, 57±8, and 43±5; 3 h: 60±9, 63±8, 36±11, 46±9, and 34±6; 4 h: 60±9, 60±10, 30±10, 43±8, and 20±5; 18 h: 12±7, 15±7, 9±5, 3±2, and 0, respectively; P<0.05). After 1h of incubation, samples incubated in CCM, NCSU, and SOF had a higher number of sperm with intact acrosomal membranes (P>0.05) than other treatments. A total of 179 proteins were identified, of which 129, including those regulating energy metabolism and mitochondrial mediated apoptosis, were differentially expressed between HM and LM. Preliminary data from Study 3 suggested that thawing and incubating sperm in the presence of LF, EL, and LL oEVs improved sperm motility. In conclusion, CCM and NCSU sustained sperm survival after invitro incubation and could be candidates for invitro fertilization studies in the red wolf. Data generated from sperm proteomic analysis provided insights into cellular pathways regulating sperm cryo-sensitivity. Finally, we demonstrated the potential of oEVs in improving wolf sperm survival post-thawing.

230 Cryopreservation for Canis lupus conservation: Evaluating protocols to freeze grey wolf testicular tissue

Because of the severe decline in grey wolf (Canis lupus) abundance, preservation of genetic diversity within the species is essential to prevent inbreeding depression. Cryopreservation is a valuable tool in endangered species conservation, because it allows genetic material to be rescued from rare individuals for future use. The ability to preserve gonadal tissue is particularly useful in seasonal breeders, such as grey wolves, when mature gametes are not available during the non-breeding season. Optimization of species-specific cryopreservation protocols is necessary due to the toxicity of cryoprotectants. Here, we aimed to investigate three protocols to cryopreserve grey wolf testicular tissue, as a model for endangered canid species. Testicular tissue samples from four adult grey wolves were obtained and cryopreserved using slow-freezing (SF) and needle vitrification (nVT) techniques. Slow-frozen samples were exposed to 15% dimethylsulfoxide (DMSO) or 7.5% DMSO + 7.5% ethylene glycol (EG) in minimum essential medium (MEM) at room temperature, placed in a Mr. Frosty Freezing Container (Thermo Fisher Scientific) and cooled to −80°C overnight, before storage in liquid nitrogen. Needle-vitrified samples were equilibrated in a 7.5% DMSO + 7.5% EG solution in MEM for 10min at 4°C, then treated with 15% DMSO + 15% EG + 0.5M sucrose for 10min at 4°C before plunging into liquid nitrogen. Each sample was thawed using serial dilutions of sucrose (1, 0.5, and 0.25) into MEM at 37°C for 5min each, fixed in 4% paraformaldehyde, and embedded in paraffin wax. Five-micron-thick cross-sections of tissue samples were stained using haematoxylin and eosin. Tubule areas and quantity of each cell type (Sertoli cells, spermatogonia, spermatocytes, spermatids, and abnormal cells) were recorded and compared with a fresh control group for each wolf. Cell populations and tubule areas were analysed using a nonparametric Wilcoxon test through JMP statistical software (SAS Institute Inc.), and are presented as means±standard deviations. There was no difference in tubule areas between the treatment groups (fresh=5200±2870, nVT=5655±2370, SF DMSO=3607±814, SF DMSO+EG=3905±1450µm2; P>0.05). Although there was an increase in abnormal cells/tubule area (µm2) for nVT, SF DMSO, and SF DMSO+EG compared with the fresh samples (0.0015±0.0014, 0.0014±0.0013, 0.0016±0.0011, and 0.0007±0.0004, respectively; P>0.05), differences were not statistically significant. Moreover, the number of Sertoli cells, spermatogonia, and spermatocytes were reduced in the cryopreserved groups compared with fresh tissues, but the differences were not statistically different (P>0.05). The data suggest that the three tested protocols preserved testicular structure and cell populations of cryopreserved testicular tissue and could be useful in the genetic preservation of grey wolves.

The domestic dog and cat as models for understanding the regulation of ovarian follicle development in vitro

The culture of ovarian follicles is an important tool for understanding the mechanisms controlling follicle development and differentiation of the oocyte. The benefit of recovering meiotically and developmentally competent oocytes from early stage follicles (primordial, primary, pre-antral and early antral) also would be significant, ranging from rescue of genomes from endangered species to preserving fertility in women facing cancer treatments. This research field is at an early stage of scientific discovery. To-date, live offspring from cultured primordial follicles that produced fertilizable oocytes has occurred only in the mouse. Progress in other more complex species has been limited because larger animals have longer durations of natural folliculogenesis, thereby requiring more culture time to generate fully grown follicles and oocytes. We believe the dog and cat are excellent models for understanding more about folliculogenesis in vitro. This review highlights what is known about this topic for these two species as well as future priorities. We have discovered that it is more challenging to maintain viability of primordial follicles within ovarian tissues in vitro in the dog than the cat. Nonetheless, it is possible to grow both isolated cat and dog pre-antral follicles in culture. Although the follicles of both species have the capacity to increase in size and produce steroids, only cat oocytes appear morphologically normal. The reason for this striking difference between these two species is an area of high research priority. While much more fundamental data are required, we envision advanced technology that will allow harvesting oocytes from the vast, unused follicle stores sequestered within carnivore ovaries. These gametes have utility for reproducing genetically valuable dogs and cats that are 'companions' or biomedical models for investigating human disorders as well as for salvaging the genomes of rare canid and felid species that die before contributing to genetic management programs.

The unusual canangafruticosides A-E: five monoterpene glucosides, two monoterpenes and a monoterpene glucoside diester of the aryldihydronaphthalene lignan dicarboxylic acid from leaves of Cananga odorata var. fruticosa

From the leaves of Cananga odorata var. fruticosa, five unusual monoterpene glucosides, named canangafruticosides A-E (1-5), along with two unusual non-glucosidic monoterpenes (6, 7) were isolated. An aryldihydronaphthalene-type lignan dicarboxylate (8) was also isolated, with two moles of canangafruticoside A (1) on its ester moiety. This lignan also showed strong blue fluorescence emission under basic conditions. The structures of these compounds were elucidated by means of spectroscopic methods, with their absolute configurations determined by application of the modified Mosher's method to a compound chemically derived from canangafruticoside E.

Megastigmane glucosides and an unusual monoterpene from the leaves of Cananga odorata var. odorata, and absolute structures of megastigmane glucosides isolated from C. odorata var. odorata and Breynia officinalis

From a 1-BuOH-soluble fraction of a MeOH extract of Cananga odorata var. odorata, collected at the Botanical Garden of Chiang Mai University, a new megastigmane glucoside, named canangaionoside, and an irregular monoterpene were isolated. A known compound, breyniaionoside A, which has been obtained from the leaves of Breynia officinalis, was also isolated, and its absolute structure was substantiated for the first time in this study. On this occasion, the absolute stereochemistries of structurally related megastigmane glucosides, breyniaionosides B and C, isolated from B. officinalis were examined.

Effect of angiotensin-converting enzyme gene polymorphism on left ventricular remodeling after anteroseptal infarction

BACKGROUND AND HYPOTHESIS

Genetic influence on cardiac remodeling is uncertain. The purpose of this study is to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on cardiac remodeling after myocardial infarction.

METHODS

The subjects were 43 patients with old anteroseptal myocardial infarction. Based on the polymorphism of the ACE gene, they were classified into a deletion group of 25 patients (D/D genotype in 4 and D/I genotype in 21) and an insertion group of 18 patients (all I/I genotype). Echocardiograms were used to determine left ventricular end-diastolic and end-systolic diameters, interventricular septal and posterior wall thicknesses, left ventricular mass, left atrial diameter, and left ventricular ejection fraction. Blood concentrations of atrial and brain natriuretic peptide were also measured.

RESULTS

Left ventricular end-systolic and end-diastolic dimensions, left ventricular mass, and levels of both atrial and brain natriuretic peptide were significantly higher in the deletion group. In contrast, septal thickness, posterior wall thickness, and ejection fraction showed no differences between the two groups.

CONCLUSIONS

In patients with old anteroseptal infarction, ACE gene polymorphism of the D/D and D/I genotypes has a stronger influence on left ventricular remodeling than polymorphism of the I/I genotype.

Influence of angiotensin-converting enzyme gene polymorphism on development of athlete's heart

BACKGROUND AND HYPOTHESIS

Genetic influence on development of athlete's heart is uncertain. This study investigated whether angiotensin-converting enzyme (ACE) gene polymorphism influenced development of athlete's heart.

METHODS

Forty-three participants in a 100-km ultramarathon were classified on the basis of ACE gene polymorphism into a deletion group (n = 26) and an insertion group (n = 17). Echocardiograms were recorded to determine left ventricular end-diastolic and end-systolic diameters, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass, and ejection fraction.

RESULTS

Left ventricular end-diastolic diameter (65.5 +/- 4.0 mm) and left ventricular mass (369.5 +/- 73.9 g) were significantly larger in the subjects with deletion than in those with insertion (57.4 +/- 4.2 mm, 306.5 +/- 93.7 g). However, no significant differences in the other parameters were noted.

CONCLUSIONS

In long-distance runners, ACE gene polymorphism of the D/D and D/I genotypes has a stronger influence on left ventricular hypertrophy than polymorphism of the I/I genotype.

Permanent, lowered HLA class I expression using lentivirus vectors with shRNA constructs: Averting cytotoxicity by alloreactive T lymphocytes

Transplantation of many tissues requires histocompatibility matching of human leukocyte antigens (HLA) to prevent graft rejection, to reduce the level of immunosuppression needed to maintain graft survival, and to minimize the risk of graft-versus-host disease, particularly in the case of bone marrow transplantation. However, recent advances in fields of gene delivery and genetic regulation technologies have opened the possibility of engineering grafts that display reduced levels of HLA expression. Suppression of HLA expression could help to overcome the limitations imposed by extensive HLA polymorphisms that restrict the availability of suitable donors, necessitate the maintenance of large donor registries, and complicate the logistics of procuring and delivering matched tissues and organs to the recipient. Accordingly, we investigated whether knockdown of HLA by RNA interference (RNAi), a ubiquitous regulatory system that can efficiently and selectively inhibit the expression of specific gene products, would enable allogeneic cells to evade immune recognition. For efficient and stable delivery of short hairpin-type RNAi constructs (shRNA), we employed lentivirus-based gene transfer vectors, which provide a delivery system that can achieve integration into genomic DNA, thereby permanently modifying transduced graft cells. Our results show that lentivirus-mediated delivery of shRNA targeting pan-Class I and allele-specific HLA can achieve efficient and dose-dependent reduction in surface expression of HLA in human cells, associated with enhanced resistance to alloreactive T lymphocyte-mediated cytotoxicity, while avoiding MHC-non-restricted killing. We hypothesize that RNAi-induced silencing of HLA expression has the potential to create histocompatibility-enhanced, and, eventually, perhaps "universally" compatible cellular grafts.

Left ventricular chamber size predicts the race time of Japanese participants in a 100 km ultramarathon

OBJECTIVE

As a subanalysis of an echocardiographic study performed on 291 Japanese participants in a 100 km ultramarathon, to estimate predictors of race time.

METHODS

A total of 247 male participants in a 100 km ultramarathon (age 20-73 years) were examined by echocardiography. Correlations between age, body surface area, monthly running distance, or echocardiographic variables and the race time were examined.

RESULTS

According to simple regression analysis, age (r = 0.299, p < 0.0001), monthly running distance (r = -0.388, p < 0.0001), left ventricular end diastolic diameter (r = -0.300, p < 0.0001), and left ventricular end systolic diameter (r = -0.325, p < 0.0001) correlated significantly with the race time. When multiple regression analysis was performed, age (f = 2.364), monthly running distance (f = -0.113), and left ventricular end systolic diameter (f = -2.361) remained significant predictors of the race time.

CONCLUSION

Left ventricular diameter predicts the race time for a 100 km ultramarathon, in addition to age and amount of training.

Reliability of MIBG myocardial scintigraphy in the diagnosis of Parkinson's disease

AIM

To evaluate the reliability of [(123)I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for diagnosing Parkinson's disease (PD).

PATIENTS/METHODS

A series of 391 outpatients showing one or more parkinsonian-like symptoms was longitudinally followed up for accurate clinical diagnosis. MIBG scintigraphy was performed in the patients and 10 normal controls of similar age. The heart to mediastinum uptake ratio was calculated in each person, and the values were considered abnormal if they were greater than two standard deviations below the control mean.

RESULTS

MIBG uptake was decreased in most patients with PD (87.7%), and was seen in all advanced cases with Hohen-Yahr stage III or more; the sensitivity and specificity of scintigraphy for detecting PD were 87.7% and 37.4%, respectively. Surprisingly, over half of the patients without PD (66.5%) also exhibited low uptake, resulting in considerable overlap in the ratios between PD and the other disorders.

CONCLUSION

MIBG scintigraphy is a sensitive, but not specific, test for PD. Low MIBG uptake does not necessarily indicate PD, but is essential for diagnosing advanced PD.

Cerebral blood flow index image as a simple indicator for the fate of acute ischemic lesion

BACKGROUND AND PURPOSE

To evaluate the feasibility of utilizing cerebral blood flow (CBF) index images, we attempted to investigate 1) whether CBF index images can reveal the resulting infracted area, 2) whether the CBF index can correlate other modality (SPECT).

METHODS

DWI and DPI were obtained in 17 patients within 12 hours of stroke onset and follow up MRI. On three DPI delivered images, namely relative regional cerebral blood volume (rrCBV), uncorrected mean transit time (MTTu) and CBF index images, correlations between initial lesion volume of and follow up infarction volume of three images and rCBF images delivered with singular value decomposition (SVD) methods were assessed. Then 99mTc-ECD SPECT was taken immediately after MRI to correlate to MRI data.

RESULTS

Among the three images, lesion volume of CBF index images against follow up infarct volume had the highest correlation (r = 0.995) to a linear fit and the slope was closest to 1.0 (0.91) and had identical accuracy to the regression coefficient of rCBF images. CBF index well correlated to SPECT delivered CBF.

CONCLUSION

CBF index images can accurately predict final infarct volume. Evaluating CBF index images together with DWI can guide the initial assessment in the acute stage of cerebral ischemia.

Treatments of non-parasitic giant hepatic cysts

This retrospective study presents the results of surgical treatments for large cyst of the liver over 10 cm in diameter in 9 patients diagnosed and treated at Kurume University Hospital. There were 8 women and 1 man, with an average age of 71.6 years. Although the chief complaints were abdominal pain or fullness, 1 had obstructive jaundice due to biliary compression by a large cyst. Cyst size ranged from 10 cm to 27 cm. There are several treatment modalities for giant hepatic cyst, such as cyst resection, unroofing, and sclerotherapy after cyst drainage. Operative procedures in the patients reported here were surgical resection of the liver cyst in 3 patients, unroofing with ethanol sclerotherapy in 1 patient and laparoscopic treatment in 2 patients. Sclerotherapy after percutaneous transhepatic cyst drainage was performed in 3 patients because their general condition was poor. There were no postoperative complications among these patients. Costs varied among the patients and depended mainly on the method of treatment and period of hospital stay. We discuss operative procedures and costs of treatment of each patient and review the literature.

Xanthogranulomatous cholecystitis

Seven cases of xanthogranulomatous cholecystitis are presented, and their clinicopathological appearance is described. Three men and 4 women with xanthogranulomatous cholecystitis, aged 53-72 years old, were reviewed. Five patients had had previous attacks of acute cholecystitis lasting from 3 weeks to 6 months. Abdominal ultrasonography was performed in all patients, and computed tomography in 5 patients. Cholelithiasis and sludge were present in all patients. The gallbladder wall was thickened in all patients. On computed tomography, one patient showed no abnormal finding, and 4 patients had abnormal findings such as increased wall thickness and irregularity, and pericholecystic abnormalities. A diagnosis of gallbladder carcinoma was made preoperatively in 1 patient. During laparotomy, the gallbladders in all patients showed signs of chronic cholecystitis, and cholecystectomies were performed. Histological findings showed xanthogranulomatous cholecystitis, and 4 patients had stones in the gallbladder wall. Despite the characteristic histologic appearance of xanthogranulomatous cholecystitis, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm. We report here 7 cases of xanthogranulomatous cholecystitis and review the literature.

A case of hepatocellular carcinoma rupturing after angiography

We report a case of primary hepatocellular carcinoma (referred to as hepatocellular carcinoma below) apparently rupturing after angiography. The patient was a 62-year-old male who was admitted for the treatment of hepatocellular carcinoma. Ultrasonography (US) and computed tomography (CT) on admission showed a tumor occupying the entire left lobe of the liver and partly protruding outside the liver and a tumor embolus in the portal vein. We performed preoperative angiography, after which fever and abdominal discomfort appeared. Two days after the angiography, abdominal pain and a rapid increase in the size of the abdominal tumor were noted. US also revealed an unquestionable increase in the size of the tumor, leading to a diagnosis of intratumoral hemorrhage due to the rupture of hepatocellular carcinoma. Since child classification A, clinical stage I and ICG 11.7% indicated an adequate functional reserve of the liver, we performed an emergency operation. Laparotomy revealed that the tumor occupied almost the entire left lobe of the liver, partly protruded outside it, and was bleeding from part of its anterior surface. The volume of intra-abdominal hemorrhage was about 100 ml. A portal tumor embolus was present in the portal vein from the horizontal part to the trunk. We performed resection of the left and caudate lobes of the liver with removal of the portal tumor embolus. The resected specimens showed a hemorrhage in and around the tumor. We speculated that in a hepatocellular carcinoma that involves the surface of the liver and is complicated by tumor embolism of the portal vein, angiography could trigger the rupture of the carcinoma.

Assessment of reflection pulse wave in patients with cardiomyopathy: evaluation of noninvasive measurement of wave intensity

OBJECTIVE

We assessed the reflection pressure wave using noninvasive measurement of wave intensity (WI) in patients with cardiomyopathy.

METHODS AND RESULTS

Subjects included 8 patients with hypertrophic cardiomyopathy (HCM group) and 10 patients with dilated cardiomyopathy (DCM group). Twelve healthy subjects were used as a control group. By using a combined Doppler and echo-tracking system, changes in vascular diameter (dD) and blood flow velocity (dV) were recorded simultaneously at the common carotid artery and dD x dV was measured as WI. In the components of WI, the positive component of early systolic phase (FE) and the negative component following FE (B) were significantly reduced in the DCM group. There was a significant positive correlation between FE and B in all 3 groups. The appearance time of B was significantly shorter in the HCM group and significantly longer in the DCM group compared with the control group.

CONCLUSIONS

It was suggested that the value of the reflection pressure wave was influenced by the left ventricular contractility, and that the effect of the reflection pressure wave appeared earlier in patients with HCM and later in patients with DCM compared with the control subjects.

Spatial and temporal analysis of left ventricular filling flow propagation in hypertensive patients before and after regression of myocardial hypertrophy with alacepril therapy

The purpose of this study was to assess the clinical significance of spatial and temporal analysis of left ventricular (LV) filling-flow propagation using color M-mode Doppler echocardiography before and after regression of LV hypertrophy in patients with hypertension. Seven patients with hypertensive LV hypertrophy were studied. Echocardiographic and Doppler examinations were performed both before and after 6 months administration of alacepril. LV mass index (LVMI), LV flow propagation velocity (FPV), and the maximal early transmitral flow velocity (E) were measured. LVMI, FPV, and FPV/E ratio were compared to before and after administration of alacepril. In addition, the correlation between LVMI and FPV/E ratio was evaluated. Results showed that LVMI was significantly decreased (P < 0.05) and the FPV/E ratio was significantly increased (P < 0.05) after treatment with alacepril. There was no significant change in FPV. In addition, there was a significant negative correlation between LVMI and the FPV/E ratio (r = -0.662, P < 0.001). The present study indicates that the FPV/E ratio could be a useful noninvasive parameter to assess the diastolic dysfunction associated with LV hypertrophy in patients with hypertension.

[A case of sepsis by Neisseria meningitidis beginning with pneumonia during a trip abroad]

A 62-year-male presented a high fever and a dry cough during a trip to Australia. He was admitted to a hospital as soon as be returned to Japan. The next day after returning to Japan, he was transferred to our hospital with septic shock and loss of consciousness. Neisseria meningitidis was cultured from his blood. N. meningitidis is rare in Japan. However its seems common, in some foreign countries. With these findings, it can be postulated that N. meningitidis might be one of the etiological agents of the imported infectious disease.

Evaluation of simultaneous excision of pancreatic cancer and the surrounding blood vessels

Of the 139 patients who underwent excision for invasive cancer in the pancreatic duct at Kurume University Hospital between January 1965 and December 1998, the subjects were 38 patients in whom blood vessels around the cancer were simultaneously excised. The surgical methods were pancreatoduodenectomy (PD) in 31 patients, distal pancreatectomy (DP) in 5, and total pancreatectomy (TP) in 2. The excised blood vessels were the portal vein alone in 32 patients, the artery alone in 1, and both portal vein and artery in 5. Excision of the portal vein was performed by circumcision in 25 patients and by segmentectomy in 12. The range of circumcision was 1.0-7.0 cm (mean, 3.5 +/- 1.4 cm), and the blocking time of the portal vein was 8-36 min (mean, 19.5 +/- 8.8 min). Of the 25 patients who underwent circumcision, reconstruction was performed by end-to-end anastomosis in 23 and by transplantation of the autologous vein between the ends in 2. Of the 12 patients who underwent segmentectomy, direct suture was performed in 10, and transplantation of an autologous vein patch was performed in 2. Postoperative complications occurred in 14 of the 32 patients. In 5 of the 6 patients who underwent excision of the artery, reconstruction was performed by end-to-end anastomosis in 3 and by transplantation of the autologous vein between the ends in 2. Postoperative complications did not occur in the patient who had undergone excision of the artery alone, but 4 of the 5 patients who had undergone simultaneous excision of the portal vein and artery had postoperative complications, of whom 2 died during the period of hospitalization. Three patients with pv0, pv1 or pv2 survived for more than 3 years. Because some of the patients who had undergone excision of the portal vein alone survived for a long time and this method is relatively safe, this surgery can be generally applied, but simultaneous excision of the portal vein and artery should be carefully applied because the incidences of postoperative complications and death during the period of hospitalization are high. With the development of surgical techniques and postoperative control, simultaneous excision of pancreatic cancer and the surrounding blood vessels has become safe, but this method should only be applied to patients who have the potential to recover completely.

Effects of prolonged strenuous exercise on plasma levels of atrial natriuretic peptide and brain natriuretic peptide in healthy men

BACKGROUND

Now that marathon racing is growing in popularity, many thousands of enthusiastic athletes are participating in various ultramarathons all over the world each year. However, it remains controversial whether such a sport contributes to the promotion of health. The occurrence of transient cardiac dysfunction and irreversible myocardial injury has been reported in association with such exercise in healthy individuals. Brain natriuretic peptide (BNP) is a cardiac hormone, as is atrial natriuretic peptide (ANP), and its measurement has been widely used for clinical evaluation of cardiac dysfunction. However, little is known about the response of plasma BNP to prolonged strenuous exercise. We hypothesized that confirmation of minimal cardiac dysfunction or myocardial injury may be made by measurements of plasma BNP.

METHODS

Levels of plasma ANP, BNP, catecholamines, blood lactate, and serum cardiac troponin T (cTnT) were determined before and after a 100-km ultramarathon in 10 healthy men to examine the effects of the exercise on levels of ANP and BNP and correlations between the natriuretic peptides and cTnT as a marker for myocardial damage.

RESULTS

Whereas all variables significantly increased after the race, increased levels of ANP and BNP were most strongly correlated with increases in cTnT levels. The cTnT level after the race was greater than the upper reference limit in 9 of 10 men.

CONCLUSIONS

Such exercise significantly increased ANP and BNP levels in healthy men, and the increases could be partially attributed to myocardial damage during the race.

Clinicopathological evaluation of surgical treatment for early gallbladder cancer

We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mp-cancers). The gross patterns were lp (pedunculated) in 16 patients, ls (sessile) in 3 patients, IIa (flat elevated) in 4 patients, and IIb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 had the IIb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the IIb pattern. The 5-year survival rates for the m- and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m- and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.

Congenital giant aneurysm of the left atrial appendage mimicking pericardial absence case report

A 25-year-old man was found to have an abnormal cardiac contour on a chest radiograph, and was referred. Transesophageal echocardiography suggested herniation of the left atrial appendage (LAA) through a gap in the pericardium, and magnetic resonance imaging indicated congenital partial absence of the pericardium. Cardiac dysfunction was caused by compression from the enlarged left atrium and thrombi were thought to be present in the appendage, so surgery was performed. The intraoperative diagnosis was congenital LAA aneurysm. Although distinguishing between congenital LAA aneurysm and congenital absence of the pericardium is reported to be possible with magnetic resonance imaging, we were unable to so in this case.

[A case of an advanced aged Eisenmenger's syndrome]

We report a 70-year-old women with Eisenmenger's syndrome. Eisenmenger's syndrome with ventricular septal defect was diagnosed at another hospital when she was 32 years old. Then, she was referred to our hospital at age 60 old and she now is according to the out patient in over clinic. She have mild cardiac function, NYHA classification, was II-M, polycythemia cell blood count 535 x 10(4) and 17.2 g/dl in hemoglobin. Echocardiography suggested serious Eisenmenger's syndrome. The left ventricle was compressed, the blood pressure of the right ventricle exceeded 105 mmHg, and the onset of the right to left shunt flow was thought to be 250 msec bored on the electrocardiogram Q wave. The reason why the progression of complicated obstructive pulmonary artery disease was slow may have been become of the mildness of her polycythemia, and this is presumed to be the reason for her long survival to age 70.

Acute myocardial infarction induced by alternating exposure to heat in a sauna and rapid cooling in cold water

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the alpha-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.

Differential diagnosis between tumor-forming pancreatitis and pancreatic cancer by percutaneous transhepatic portography and selective direct pancreatic venography

In 32 patients with tumor-forming pancreatitis and 109 patients with pancreatic cancer, the usefulness of percutaneous transhepatic portography (PTP) and selective pancreatic venography (SPV) for differential diagnosis of the two diseases was evaluated. The PTP images were type I in 53.1%, type II in 21.9%, type III in 12.5%, and type IV in 12.5% of the patients with tumor-forming pancreatitis and type I in 20.2%, type II in 23.9%, type III in 37.6%, and type IV in 18.3% of the patients with pancreatic cancer. Advanced images (type III or type IV) were observed in more than half the patients with pancreatic cancer. Mild images classified as type II were observed slightly more frequently in the patients with pancreatic cancer, but the differential diagnosis of the two diseases was difficult in patients showing type II PTP images. SPV findings were primarily hypervascularization (78.1%) and vasodilation (68.8%) in the patients with tumor-forming pancreatitis. Although encasement (smooth encasement) was noted in 31.3%, obstruction was found in only 3.1%. In the patients with pancreatic cancer, obstruction was observed in 85.3%, and encasement (irregular encasement) was noted in 78.9%. However, hypervascularization or vasodilatation was infrequent, and the tumor was characteristically imaged as a hypovascular area. PTP and SPV were considered to be useful for the differential diagnosis of tumor-forming pancreatitis and pancreatic cancer.

[Cardiac amyloidosis]

In our experience, QS pattern of poor R wave progression and atrio-ventricular block of varying degrees on electrocardiogram, cardiomegaly with pleural effusion on chest X-ray film, left ventricular wall thickening, pericardial effusion and findings suggesting left ventricular diastolic dysfunction on echocardiogram and increased right ventricular end-diastolic pressure in cardiac catheterization were frequently observed in patients with cardiac amyloidosis. Though none of these findings are specific, we should suspect cardiac amyloidosis as a possibility when some of these signs are observed in patients with chronic cardiac failure of unknown etiology. Left ventricular mass obtained from echocardiography could be useful predictive parameter of prognosis in patients with cardiac amyloidosis.

Prognostic benefit in cytoreductive surgery for curatively unresectable hepatocellular carcinoma - comparison to transcatheter arterial chemoembolization

As a strategy for treating advanced hepatocellular carcinoma (HCC), cytoreductive surgery was studied comparing to transcatheter arterial chemoembolization (TACE). Patients who had curatively unresectable intrahepatic multiple HCC with the main tumor 30 mm or more in size were selected for this study. The patients were classified into two groups; i) cytoreductive surgery group (CRS group): 28 patients in whom the main tumor was resected but other cancer nodules remained in the remnant liver, ii) TACE group: 25 patients at Child A grade who underwent TACE, and in whom it was also evaluated retrospectively that the main tumor had been resectable. The cumulative 5-year survival rate was significantly higher in CRS (48.7%) than TACE (17.1%) group. Multivariate analysis revealed that performing cytoreductive surgery was a significant and independent factor to prolong survival. However, 6 of 28 patients died within one year of surgery. Residual tumor thrombus, and the absence or non-effectiveness of adjuvant therapy were significant high risk factors for postoperative death within one year. Conclusively, cytoreductive surgery contributes to a significant lengthening of survival in patients with advanced HCC. To reduce the risk of early postoperative death, the importance of postoperative adjuvant therapy is also recognized.

Palmaz-Schatz stent for hepatic artery stenosis during hepatic arterial infusion chemotherapy

Hepatic arterial infusion chemotherapy using an implantable port system was performed on a 40 year-old man with advanced hepatocellular carcinoma. When the in-dwelling catheter was inserted into the common hepatic artery (CHA), intimal dissection occurred as a result of the catheterization causing severe stenosis. On day 55 after intimal dissection, an in-dwelling Palmaz-Schatz stent was inserted after percutaneous transluminal angioplasty (PTA). CHA blood flow was shown to have improved on Digital subtraction angiography (DSA) and Doppler ultrasound after the in-dwelling Palmaz-Schatz stent. Thus a partial response was shown. The DSA from the implantable port system showed adequate patency 6 months after. This is the first report describing the usefulness of a Palmaz-Schatz stent for the severe stenosis of the CHA caused by the technique of catheterization.

Evaluation of curability and prediction of prognosis after surgical treatment for hepatocellular carcinoma by lens culinaris agglutinin-reactive alpha-fetoprotein

The clinical significance of serum lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), which can distinguish between hepatocellular carcinoma and hepatitis by detecting a sugar chain micro heterogeneity, was evaluated for its possible ability to recognize previously undetectable residual tumors, and for increasing the accuracy of prognosis after surgical treatment for hepatocellular carcinoma. Serum lens culinaris agglutinin-reactive alpha-fetoprotein was measured pre- and post-operatively in 130 patients who underwent curative surgical treatment for hepatocellular carcinoma. The preoperative AFP-L3 positive rate was 35.4%. AFP-L3 remained positive postoperatively in 28 of the 46 preoperative AFP-L3 positive patients, and converted to positive in 4 of the 84 preoperative AFP-L3 negative patients. Regardless to preoperative AFP-L3, the postoperative AFP-L3 positive patients had a poorer recurrence-free rate (p<0.0001). The postoperative L3 positive patients had a high incidence of recurrence due to metastasis, but did not have recurrence due to multicentric origin. Multivariate analysis revealed that AFP-L3 (p<0.0001) was the most independently significant factor for predicting survival after surgery among several conventional prognostic factors. Thus, AFP-L3 is a valuable marker for evaluation of curability of surgical treatment and for improving the accuracy of prognosis.

[Assessment of localized hypertrophy in the basal part of the interventricular septum in the elderly]

The basal part of the interventricular septum (IVS) is known to show different hypertrophic features from those observed in the other parts of the left ventricular wall. These are considered to reflect physiological changes that occur with normal aging. However, these changes have not been carefully evaluated, and their clinical significance has not been defined. We assessed these changes echocardiographically. The subjects were patients at least 70 years of age in whom localized hypertrophy in the basal part of the IVS was seen during the whole cardiac cycle on echocardiography. The prevalence was 6.3% among 96 consecutively studied patients. All 6 patients had a history of hypertension. Echocardiographic findings were as follows: 1) the left atrium was mildly or moderately dilated, 2) there was no evidence of either dilatation or narrowing of the left ventricular cavity, 3) the left ventricular wall motion appeared normal and indices of systolic function were within normal limits in all subjects except one who had a history of myocardial infarction, 4) the angle formed by the aorta and the IVS averaged 106.7 degrees (range: 95 to 120 degrees), 5) Doppler examination showed increases in the ratio of the peak flow velocity during atrial systole to the peak flow velocity early in diastole, and 6) prolongation of the deceleration time of the flow velocity early in diastole. The last of these findings suggested left ventricular diastolic dysfunction, but peak flow velocity at the left ventricular outflow tract was normal. There was no evidence of stenosis of the left ventricular outflow tract. Localized hypertrophy in the basal part of the IVS in elderly patients could be a type of cardiac hypertrophy caused by hypertension. On echocardiography, the basal part of the IVS seemed to protrude toward the left ventricular cavity, but there was no evidence of stenosis in the left ventricular outflow tract.

Heart failure in 3 patients with acromegaly: echocardiographic assessment

We evaluated 3 patients with acromegaly who developed heart failure. Heart failure appeared to be due to acromegalic cardiomyopathy in 2 patients who did not have hypertension or evidence of coronary artery disease, and it was possibly due to acromegalic cardiomyopathy combined with familiar hypertrophic cardiomyopathy in 1 patient. The common echocardiographic findings in the present three cases were: 1) enlargement of the left atrium, 2) markedly dilated left ventricular cavity with diffuse hypokinesis, 3) decrease of indices of the left ventricular systolic function, and 4) no evidence of left ventricular hypertrophy. Echocardiographic findings in acromegaly with congestive heart failure resemble those of idiopathic dilated cardiomyopathy.

Beneficial effects of mechanical reperfusion therapy on left ventricular remodeling and late outcome following myocardial infarction

The long-term relative benefits of thrombolysis and mechanical reperfusion therapy following acute myocardial infarction (AMI) have not been established. The purpose of this study was to compare left ventricular function, left ventricular remodeling and late outcome after AMI for different reperfusion therapies. Thirty consecutive patients suffering their first anterior wall myocardial infarction with coronary stenoses limited to the left anterior descending coronary artery were studied. They included 10 patients who underwent intracoronary thrombolysis (ICT), 10 who underwent PTCA and 10 who underwent noninterventional medical treatment. All patients underwent coronary angiography (CAG) during the acute phase of AMI and also during the follow-up period, and left ventriculography during the follow-up period and clinical follow-up was performed (mean clinical follow-up period: 53 +/- 31 months). No significant difference in global ejection fraction was noted among the groups, although the end-diastolic volume index (EDVI) in the PTCA group (79.4 +/- 17.5 ml/m2) was significantly smaller than in the noninterventional (106.1 +/- 25.1 ml/m2) and ICT (107.9 +/- 28.3 ml/m2) group (p < 0.05). The regional wall motion index (RWMI) for the anterior region in the PTCA group (-2.7 +/- 0.8) was greater (p < 0.05) than in the noninterventional (-3.4 +/- 0.6) and ICT (-3.3 +/- 0.6) groups. A significant linear correlation was found between EDVI and % diameter stenosis and also between RWMI and % diameter stenosis following reperfusion (p = 0.01). There was no difference in the incidence of cardiac death, nonfatal reinfarction, bypass surgery or congestive heart failure among the groups. Disturbed left ventricular regional wall motion and remodeling benefit most from angioplasty because of prompt restoration of adequate blood flow. However, there was no difference in late outcomes following AMI among the three groups.

[Preoperative evaluation of the limitation of hepatic resection using 99mTc-GSA (galactosyl human serum albumin) scintigraphy]

Preoperative evaluation of the operative indication of hepatic resection using the parameters obtained by 99mTc-GSA scintigraphy has been done. In particular, the accurate evaluation of the postoperative hepatic functional reserve essentially depends on these parameters. In the present study, a preoperative evaluation of postoperative hepatic functional reserve using 99mTc-GSA scintigraphy was performed in our operated cases retrospectively.

PATIENTS AND METHODS

Thirty-eight patients who underwent hepatic resection were studied on 99mTc-GSA scintigraphy before and after operation. These patients were divided into two groups. Group A; had no postoperative complications (n = 31). Group B; had some postoperative complications (n = 7). Preoperative parameters of 99mTc-GSA liver scintigraphy (HH15, LU15) were calculated from the activities of liver and cardiac ROIs at 5 and 15 minutes after injection. The resection ratio (RR) was obtained by comparing the liver volumes which were calculated from the pre- and postoperative SPECT studies. The resectability indices (Res) were as follows: Res (LU15) = LU15 x (100-RR(%)/100, Res (HH15) = (1/HH15) x (100-RR (%)/100.

RESULTS

There were statistically significant differences in the distribution of Res between A and B groups (p = 0.002, Mann-Whitney test). The values of Res, of which half of patients have complication, were 1.10 (Res (HH15)) and 16.4 (Res (LU15)).

CONCLUSION

The resectability indices using 99mTc-GSA liver scintigraphy are useful for the preoperative evaluation of the limitation of hepatic resection.

Plasmapheresis in the treatment of rapidly progressive glomerulonephritis

The present study was carried out to examine the efficacy of plasma exchange in patients with rapidly progressive glomerulonephritis (RPGN). Seventeen patients with RPGN were treated with plasmapheresis as adjunct to immunosuppressive therapy. Of these, 4 had antiglomerular basement membrane (GBM) antibody-mediated glomerulonephritis (GN), 8 had immune-complex GN (5 SLE, 2 HSP, 1 cryoblobulinemia), 5 had pauci-immune GN (3 peripheral antineutrophil cytoplasmic antibody [P-ANCA], 1 cytoplasmic antineutrophil cytoplasmic antibody [C-ANCA], 1 other). Treatment of 10 of these patients with plasmapheresis within the first month of disease onset resulted in a stable renal function for a period extending from 1 to 3 years, except in 2 patients who had high baseline levels of serum creatinine. In the remaining patients, 2 were treated with hemodialysis 6 years later at the end of follow-up. We conclude that plasmapheresis, when used in combination with immunosuppressive drugs, is beneficial, leading to improved renal function.

[Successful direct percutaneous transluminal coronary angioplasty in a 91-year-old male with acute myocardial infarction complicating cardiogenic shock]

A 91-year-old male patient was admitted to hospital with acute myocardial infarction complicating cardiogenic shock. An emergency coronary arteriogram showed 99% stenosis at the mid-section of the right coronary artery, and in order to achieve an early recovery direct percutaneous transluminal angioplasty (PTCA) was performed through the brachial artery using a 6 french catheter. The lesion was successfully dilated up to 25% residual stenosis. Hypointention had been sustained during the admission; however, it gradually improved and he was discharged on the 31st hospital day. He has been followed up for 6 months after discharge at the out-patient clinic and has not recurrent ischemic episodes. According to other reports on the use of direct PTCA in the elderly, the postdischarge mortality rate is lower than that with medical therapy or thrombolysis. When cardiogenic shock occurs even in the elderly, direct PTCA should be selected as the first choice of treatment.

A randomized trial of aspirin versus cilostazol therapy after successful coronary stent implantation

Percutaneous transluminal coronary angioplasty (PTCA) is widely used to treat patients with ischemic heart disease, but the procedure involves a number of problems, including acute coronary occlusion and restenosis. Although stents have proved useful for preventing post-PTCA restenosis, especially elastic recoil during the acute phase, no method has yet been established to prevent restenosis caused by vascular smooth muscle cell proliferation in the late phase. Cilostazol selectively inhibits the 3'5'-cyclic-nucleotide phosphodiesterase (PDE) III (cyclic guanosine monophosphate-inhibited PDE) of the cyclic adenosine monophosphate PDE family; it also has antithrombotic and vasodilating effects, as well as an inhibitory effect on vascular smooth muscle cell proliferation through PDE III inhibition. From November 1995 to March 1997, the usefulness of cilostazol versus aspirin in preventing subacute thrombosis and restenosis was studied in 70 patients (55 men and 15 women; 82 total lesions) who had undergone successful elective Palmaz-Schatz stent implantation. Patients were randomly allocated to receive aspirin 81 mg/d (40 patients with 45 lesions) or cilostazol 200 mg/d (30 patients with 37 lesions) alone. There was no difference in patients or angiographic characteristics between these groups. No subacute thrombosis, acute complications (ie, death, emergent coronary artery bypass grafting, or hemorrhagic complications), or drug side effects were found in the cilostazol group. The minimal lumen diameter (mean +/- SD) at follow-up was 1.89 +/- 1.08 mm in the aspirin group (41 lesions, 5.63 +/- 1.74 months after stent implantation) and 2.34 +/- 0.74 mm in the cilostazol group (35 lesions, 5.14 +/- 1.91 months after stent implantation), revealing statistically significant dilatation in the cilostazol group. The restenosis rate was 26.8% in the aspirin group, compared with 8.6% in the cilostazol group; this difference was statistically significant. Administration of cilostazol alone after the implantation of intracoronary Palmaz-Schatz stents was useful for the prevention of subacute thrombosis and restenosis.

Influence of exercise on QT dispersion in ischemic heart disease

QT dispersion (QTd: maximum QT interval-minimum QT interval) is associated with severe cardiac arrhythmia and with abnormal ventricular repolarization. We investigated the influence of exercise on QTd in patients with ischemic heart disease. On standard 12-lead electrocardiograms, QTd was measured before and after treadmill exercise in 7 normal subjects, 17 patients with effort angina pectoris (and > or = 75% stenosis on coronary arteriography), and 33 patients with old myocardial infarction. Bazett's formula was used to obtain the corrected QTd (QTcd). The pre-exercise resting QTcd was 45.9 +/- 10.6, 44.3 +/- 15.2, and 74.8 +/- 28.1 msec in the respective groups, being significantly greater in the infarct group (p < 0.05). The QTcd at 5 min after exercise was respectively 49.3 +/- 9.0, 58.8 +/- 19.9, and 75.4 +/- 30.9 msec (p = 0.0347, infarct vs. controls). The difference in QTcd was significant for the angina group before and after physical exercise (p = 0.0003). There was a significant increase of QTcd after exercise in the angina group whether or not the patients were receiving beta-blockers. The infarct patients without beta-blocker therapy showed an increase of QTcd after exercise, while those receiving beta-blockers showed a decrease. The post-exercise difference between these subgroups was significant (p = 0.0351).

CONCLUSIONS

QTcd was significantly increased by exercise in the angina group, possibly reflecting impaired repolarization due to ischemia. Inhibition of the increase in QTd by beta-blockers suggested a possible preventive effect on severe arrhythmias due to nonhomogeneous ventricular repolarization.

[Benefit of monitoring the level of blood flecainide acetate in an elderly patient with ventricular premature contractions]

A 67-year-old woman without organic heart, disease had symptomatic ventricular premature contractions. Because class Ia, Ib and IV antiarrhythmic drugs did not prevent the premature contractions, the patient was treated with flecainide acetate at a dose of 50 mg t.i.d. Adverse reactions were noted. After measurement of the blood drug level, the dose was reduced to 50 mg b.i.d. The adverse reactions disappeared, and the arrhythmia was controlled. Flecainide acetate has a relatively long blood elimination half-life and a narrow safety margin. When some antiarrhythmic drugs are used in elderly patients, blood drug level monitoring is useful in preventing adverse reactions and in designing appropriate therapy.

[Examination of scanning technique for lung cancer screening with helical CT]

As a new application of helical CT scanning we evaluated the parameters for lung cancer screening with an extremely low doses and large helical pitch. On the phantom studies, the image quality obtained with the low dose parameter was not inferior to that of the usual screening technique but artifacts were increased with the large helical pitch. A scanning technique using 120 kv, 40-60mA, 10mmth, 20mm/ sec, and a reconstruction pitch of 2 was used for lung cancer screening (screening parameters) (50 cases), and comparison was made between the detectability of the screening parameters and the routine parameters (120 kv, 200mA, 10mmth, 10-13mm/sec, and a reconstruction pitch of 1-1.3). Detectability with the screening parameters was as follows: nodular lesions (< 5mm in size: 76%. 5-10mm: 90-93% 10mm < 100%), linear lesions: 94-95%, infiltrations: 93-100%. There were no false negative lesions, when the reconstruction pitch of the screening parameters was changed from 1 to 0.25. In conclusion, reconstruction pitch had the most influence on lesion detectability.

[Usefulness of continuous arterial infusion chemotherapy for post operative multiple recurrence and residual hepatocellular carcinoma]

Twenty five patients with postoperative multiple recurrence and residual hepatocellular carcinoma received continuous arterial infusion of CDDP and 5-FU via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days as one course, and 4 courses were basally administered. The efficacy rate was 60%, and there were 7 (28%) CR (complete response) cases. The survival rate was 76.0% for 1 year and 36.5% for 3 years, which is a favorable result considering their advanced stage. Thus, this treatment seemed to be effective for multiple hepatocellular carcinoma.

Assessment of posterior aortic wall motion using echocardiogram in patients with atrial fibrillation

BACKGROUND AND HYPOTHESIS

Noninvasive evaluation of left ventricular (LV) diastolic function was performed on 12 patients with atrial fibrillation (AF) using posterior aortic wall echocardiogram and a parameter for determining the optimal heart rate in patients with chronic atrial fibrillation was considered.

METHODS

Subjects were divided into two groups; one with no underlying cardiac disease (AF only group; n = 7) and the other with dilated cardiomyopathy (DCM group; n = 5). Left atrial emptying index (LAEI) obtained from the posterior aortic wall echocardiogram was used as the parameter of LV diastolic function, and R-R interval-LAEI relation and minimum R-R interval showing LAEI = 1.0 were investigated and compared between the two groups.

RESULTS

There was a good correlation between R-R interval and LAEI until LAEI of 1.0 was obtained in all patients. Slope of the regression line was significantly steeper in the AF only group than in the DCM group, and minimum R-R interval showing LAEI = 1.0 was significantly shorter in the AF only group.

CONCLUSION

Assessment of R-R interval-LAEI relation was useful for the noninvasive evaluation of LV diastolic function, and this parameter could be used for clinical application to determine the optimal heart rate in atrial fibrillation.

[The study of continuous arterial infusion chemotherapy with CDDP and 5-FU in patients with hepatocellular carcinoma]

Between Feb. 1992 and April in 1995, 22 patients with hepatocellular carcinoma (10, recurrence; 12, unresectable) received continuous arterial infusion of CDDP and 5-FU via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days as one course, and 4 courses were basally administered. Patients were divided into 2 groups (6 hours group and 24 hours group) according to the duration of the administration of 5-FU. There were no differences in efficacy rate between the 2 groups (6 hours group, 64%; 24 hours group, 62.5%), but CR (complete response) cases appeared in only the 6 hours group. There were no severe side effects in the 2 groups, but systemic side effects appeared in 6 hours group more often than in 24 hours group. Only in the 24 hours group, 2 patients had the narrowing and obstruction of hepatic artery which was suggested to be caused by intimal injury due to continuous administration of 5-FU. Continuous arterial infusion chemotherapy with CDDP and 5-FU seemed to be effective. Further study on adequate time and volume of administration including pharmacokinetics is needed to enhance the clinical effectiveness of continuous arterial infusion of CDDP and 5-FU.

[CT finding of right diaphragmatic rupture due to blunt trauma--subhepatic hemothorax]

Owing to the poor detectability of the anatomic location of diaphragm on the parallel plane of computed tomography (CT), capability of CT to predict traumatic ruptured diaphragm has been debated in several reports. A specific hematoma (subhepatic hemothorax) adjacent to the posterior attachment of the right diaphragm was identified on CT. The finding originated from herniated liver that migrated to the posterior thoracic wall as a result of gravity, to separate the hemothorax in the supine position. This was surgically proven in two patients after blunt traumatic accident. The finding is useful in predicting right diaphragmatic rupture on CT study. The formation of subhepatic hemothorax, its differential diagnosis and a brief review of diaphragmatic rupture are discussed.

A case of right atrial mobile thrombus complicating multiple pulmonary emboli

Right atrial thrombi are usually immobile. However, a mobile type mimicking a cardiac tumor, especially myxoma, has been described on rare occasions. We report here a case of atrial thrombus which was mobile in the cardiac chambers. A 29-year-old male was admitted because of exertional dyspnea. On admission, his echocardiogram showed an abnormal mass in the right atrium with a stalk attached to the interatrial septum. It decreased in size on the next day. On the fourth day of admission, it moved to the right ventricle. Multiple pulmonary emboli were revealed by the lung perfusion scintigram. Two days after the administration of intravenous urokinase, the abnormal mass in the cardiac chambers was no longer seen on the echocardiogram. This was a rare case of mobile atrial thrombus associated with multiple pulmonary emboli. Thrombolytic therapy appeared to be effective in this case.

Müllerian duct cyst: ultrasonographic and computed tomographic spectrum

A Müllerian duct cyst (MDC) is the persistent remnant of the Müllerian duct. Reports of symptomatic cases are rare, signs and symptoms include perineal pain, dysuria, infertility, hematuria and genital inflammation. The prevalence of MDC has been previously reported as 4% of newborns and 1% in adult males. Herein we report six cases encountered in the past year. Our detection percentage was 1% and is compatible with the reported values. The imaging evaluation of symptomatic and asymptomatic patients with MDC is discussed as well as the apparent discrepancy between the number of previously reported cases and the reported prevalence.