Adult isolated hypoplasia of left pulmonary artery with exertional angina and abnormal exercise stress test: a case report and treatment implication.

Pulmonary artery hypoplasia, either congenital or acquired, is a rare abnormality seen in adults. We reported the first case of adult, isolated, left pulmonary artery hypoplasia, with exertional angina and prominent ST depression in exercise stress test, that seemed to be caused by exertional hypoxemia. Several vasodilators, including nitroglycerin, prostaglandin E1, and nifedipine, were administered individually, each with subsequent hemodynamic monitoring, pulse oximetric monitoring, and exercise test. Vasodilator administrations reduced pulmonary vascular resistance (baseline, 599; vasodilators, 306, 211, and 284 dyne x sec x m2/cm5, respectively) and attenuated ST depression (by 52, 72, and 27%, respectively) but without an immediate benefit on exercise tolerance. All vasodilators except nifedipine ameliorated exertional hypoxemia (expressed by arterial oxygen saturation during peak exercise, baseline, 69%; vasodilators, 85, 78, and 65%, respectively). Additional oxygen supply after nitroglycerin administration further benefited exertional hypoxemia (arterial oxygen saturation, 96%) and exercise ST depression (attenuated by 82%).

Bacillus popilliae endocarditis with prolonged complete heart block.

Bacillus popilliae, a fastidious, aerobic, gram-positive, spore-forming bacillus, has never been reported as a pathogen in human infectious diseases. We report the first case of a human infected by the pathogen B. popilliae, which presented as endocarditis involving the bicuspid aortic valve and complicated with prolonged (> 30 days; to our knowledge, the longest in the literature) complete heart block. Although surgery may be warranted by previous reports, the patient was successfully managed by medical treatment instead, because of the absence of evidence from various approaches that support the existence of perivalvular extension of infection.

Late development of renal arteriovenous fistula following gunshot trauma--a case report.

A 43-year-old man presenting with symptoms of congestive heart failure, cardiomegaly, and impaired left ventricular (LV) function was diagnosed as having a huge left renal arteriovenous (AV) fistula. The AV fistula might be attributed to a gunshot wound suffered during his military service twenty years ago. Percutaneous transcatheter arterial embolization utilizing multiple spring coils in conjunction with cyanoacrylic glue successfully occluded the fistula, with subsequent improvement of LV function and reduction of LV size on his serial echocardiographic follow-up.

Characterization of the ferrous ion binding sites of apple 1-aminocyclopropane-1-carboxylate oxidase by site-directed mutagenesis.

The putative ferrous ion binding sites (H177, D179, and H234) of apple fruit 1-aminocyclopropane-1-carboxylate oxidase determined by homology comparisons with enzymes which required non-haem Fe2+ for activity were altered by site-directed mutagenesis. The activities of mutants (H177F, D179H, D179A, H234F, and H234D) were completely lost. SDS-PAGE and western immunoanalysis confirmed that loss of enzyme activity in mutants was not due to impaired enzyme expression. These results strongly suggest that H177, D179, and H234 are the Fe2+ binding site.

Transesophageal echocardiographic image of double-chambered right ventricle.

Double-chambered right ventricle is a rare congenital heart disease. Anomalous muscle bundles in the right ventricle divide the right ventricle into two portions and cause intracavitary obstruction of the right ventricle. Transesophageal echocardiography of the double-chambered right ventricle has never been reported. We present a 32-year-old man with double-chambered right ventricle associated with perimembranous-type ventricular septal defect and left superior vena cava. Multiplane transesophageal echocardiography provides excellent views of an anomalous muscle bundle in the right ventricle, which differed from a moderator band by its insertion site on the right ventricle.

Idiopathic dilatation of the pulmonary artery. A case presentation.

Idiopathic dilatation of the pulmonary artery is an uncommon, but not rare, congenital anomaly that is diagnosed by exclusion and generally has a benign clinical course. A left hilar mass on the chest x-ray film is the major presentation. The authors present a case of idiopathic dilatation of the pulmonary artery with posttraumatic chest pain clinically. After serial examinations, idiopathic dilatation of the pulmonary artery was diagnosed. They discuss the phenomenon of transpulmonary valvular pressure gradient and noninvasive tools for long-term follow-up, including transesophageal echocardiography and magnetic resonance imaging.

Nonocclusive ischemic colitis following glycerin enema in a patient with coronary artery disease. A case report.

Acute colonic ischemia is the most common form of intestinal ischemia. Nonocclusive ischemic colitis contributes to some of these disorders. Heart disease, such as congestive heart failure, myocardial infarction, arrhythmias, aortic valve disease, and atherosclerotic cardiovascular disease, account for many of its risk factors. The majority of cases are associated with severe congestive heart failure with low cardiac output, or disease states resulting in dehydration, or the splanchnic vasoconstrictive effect of some medications. Reactive splanchnic vasoconstriction is responsible for nonocclusive ischemic colitis. Ischemic colitis induced by a cleansing enema has been reported once before. The authors present a case of coronary artery disease complicated by colonic ischemia following glycerin enema in preparation for coronary bypass surgery. Reactive inferior mesenteric artery spasm in response to the enema was noted in this case, rather than diffuse mesenteric artery spasm in response to low cardiac output state and vasoconstrictive drugs.

Approximate method for radiative transfer in scattering absorbing plane-parallel media.

An approximate method of solution is developed for calculating the specific intensities in scattering and absorbing plane-parallel media under an unpolarized unidirectional incident radiation. In this method, the phase function for a single scattering is represented by a Legendre series; the scattered intensity is represented by a series consisting of intensities representing the different orders of scattering. In this manner, the original integral-differential transfer equation is reduced to a system of ordinary differential equations for intensities representing various scattering orders. A simple numerical integration in optical depth is all that is necessary to obtain a solution. In the case of isotropic scattering, solutions are given in closed form. The present approximate solutions are compared with exact numerical ones for both the isotropic and anisotropic cases and are found to agree within 10-25%, which is adequate for most engineering applications.