Effect of radiation monitoring method and formula differences on estimated physician dose during percutaneous coronary intervention.

BACKGROUND: Currently, one or two dosimeters are used to monitor radiation exposure in most cardiac laboratories. In addition, several different formulas are used to convert exposure data into an effective dose (ED). PURPOSE: To clarify the effect of monitoring methods and formula selection on the estimated ED for physicians during percutaneous coronary interventions (PCIs). MATERIAL AND METHODS: The ED of physicians during cardiac catheterization was determined using an optically stimulated luminescence dosimeter (Luxel badge). Two Luxel badges were worn: one beneath a personal lead apron (0.35-mm lead equivalent) at the chest and one outside of the apron at the neck. RESULTS: The difference in the average ED of seven physicians was approximately fivefold (range 1.13-5.43 mSv/year) using the six different formulas in the clinical evaluation. The estimated physician ED differed markedly according to both the monitoring method and formula selected. CONCLUSION: ED estimation is dependent on both the monitoring method and the formula used. Therefore, it is important that comparisons among laboratories are based on the same monitoring method and same formula for calculating the ED.

Plexiform schwannoma.

We present a case of plexiform schwannoma, a rare benign peripheral nerve sheath tumour characterized by a multinodular and plexiform growth pattern, that had slowly grown for 40 years on the trunk of a 64-year-old woman. Preoperative biopsy findings, such as a high cellularity and the extent of nuclear atypia of the tumour, led us to suspect a malignant peripheral nerve sheath tumour; but ultimately a benign plexiform schwannoma was diagnosed based on an immunohistochemical review of the excised tumour using various markers including S-100 and Ki67 (MIB1).

Large thrombus in the ascending aorta successfully treated by thrombolysis--an unusual cause of acute massive myocardial infarction.

A 52-year-old woman suffered from acute massive myocardial infarction in association with a large thrombus in the ascending aorta. She was a moderate smoker and was taking hormone supplement therapy for menopausal hormone insufficiency and the contraceptive pill for endometriosis. Cardiac angiography revealed a large mobile filling defect close to the orifice of the left coronary artery, but the left coronary artery could not be visualized. Her hemodynamic condition was impaired so greatly that intraarterial counterpulsation and intravenous thrombolysis was immediately performed. The thrombus dissolved in 1 h and recanalization of the left coronary artery was achieved without serious systemic thromboembolism. She has been doing well with no cardiac events for 7 years. This is the second report of a large thrombus in ascending aorta being the cause of acute myocardial infarction in the whole territory of the left coronary artery, and the first to diagnose such a thrombus antemortem and treat it successfully.

Clinicopathologic analysis of 124 cases of adult T-cell leukemia/lymphoma with cutaneous manifestations: the smouldering type with skin manifestations has a poorer prognosis than previously thought.

Adult T-cell leukemia/lymphoma (ATLL) commonly involves the skin as well as peripheral blood and lymph nodes. During the last 15 years we have studied 124 cases of ATLL with specific skin manifestations. Twenty-one patients (16.9%) were classified as acute, 21 (16.9%) as chronic, 26 (21.0%) as lymphoma, and 56 (45.2%) as smouldering according to Shimoyama's classification. Many patients had nodules/tumors (34.7%), erythematous plaques (22.6%), and erythematous papules (19.4%) similar to those occurring with other cutaneous T-cell lymphomas. Some patients displayed characteristic skin manifestations resembling non-neoplastic cutaneous disorders. The median survival time (MST) of all patients was 12.0 months. The MSTs of individual clinical types were: acute type, 4 months; chronic type, 14 months; lymphoma type, 7 months; and smouldering type, 16 months. In the smouldering type, cases with a deeper infiltration pattern (MST, 14 months) had a more aggressive course than those with a superficial infiltration pattern (MST, 24 months) (p < 0.05). The results indicate that smouldering type ATLL with skin manifestations may have a worse prognosis than without skin manifestations. Moreover, some cases of the smouldering type with specific skin lesions should be classified into another group with a much poorer prognosis.

Development of intracoronary local adhesive delivery technique.

Acute coronary occlusion may occur in weak coronary atherosclerotic lesions, including dissection, ulceration or thrombus. In some cases of occlusion "bail-out" is performed by using recently developed New Devices. However, these have not yet completely solved the problem to this end, we designed a new method of coronary revascularization, the Intracoronary Local Adhesive Delivery Technique, utilizing antithrombotic and absorbable adhesive injected locally into the fragile and morbid arterial wall using a drug delivery PTCA catheter more flexible than the existing New Devices. This adhesive strengthened and hardened the lesions. In this study, we examined the efficacy of making an adhesive cylinder in arteries of similar size to the coronary, through acute animal experiments using the existing clinical adhesives and drug delivery PTCA catheters and 12 femoral arteries of adult goats. We were successful in forming firm tunnels along the inside of six arteries, infused with approximately 0.04 ml Cyanoacrylate. These tunnels were observed with intravascular ultrasound (IVUS) imaging and evaluated microscopically. These results suggest the feasibility of this method as a new approach for making synthetic resinous stents.

[A descriptive study on relationship between nurses' perception of their work and job satisfaction/retention].

This study was based on the results of two surveys (Group A and Group B) designed to identify variables related to nurses' retention and job satisfaction. The survey of Group A was conducted in 1994, and the subjects were nurses who worked at large general hospitals with established nursing administration systems. The survey of group B was conducted in 1995 and the subjects were nurses who worked at small private hospitals with less or no established nursing administration systems. The purpose of this study was to explore and discuss differences between Group A and Group B's Personal backgrounds and perception of their work, and to investigate variables related to nurses' retention and job satisfaction. The survey was designed as a descriptive study using a questionnaire. Questionnaires were comprised of demographic data and contained the following 5 scales; Administration system scale, Interpersonal relationship scale, Professionalism scale, Nurse's self-actualization scale, Overall job satisfaction scale. Two main differences between Group A and Group B which emerged from this study concerned the nurses' educational backgrounds and their perceptions of work. The nurses in Group A, most of whom graduated from 3 or 4 year nursing programs, focused on the nurses' career development, and the nurses in Group B, who had often worked as practical nurses, focused on the nurses work environment. The job satisfaction of both Group A and Group B was correlated with the administration system, interpersonal relationships, and professionalism. In particular, Group B nurses' job satisfaction was strongly related to their perceptions of the nursing administration system including work environment. Group A nurses' job satisfaction was moderately significant with all variables except self actualization which was not found to be related. Although in both groups, nurses who thought about leaving their jobs were found to have low scores on nursing administration system and self actualization scales, Group B scores on these scales were lower than Group A.

Adult T-cell leukemia/lymphoma associated with noninfectious epithelioid granuloma in the skin: a clinicopathologic study.

Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) are infrequently associated with noninfectious granulomas in involved or noninvolved organs. Adult T-cell leukemia/lymphoma (ATLL) is an aggressive lymphoproliferative neoplasm associated with T-lymphotropic virus type 1 (HTLV-1). We describe a case of cutaneous type ATLL, affecting mainly the skin as a maculopapular eruption, in which some skin biopsies contained epithelioid cell granulomas in the lymphoma cutis (ATLL) lesion. These Lennert's-like epithelioid clusters were also present in lymph nodes, which showed some degree of invasion by the ATLL lymphocytes. Although prognosis of ATLL is generally poor, our patient has had a less aggressive course, with a survival time to date of 13 years. Our findings suggest that the presence of epithelioid granulomata in an ATLL patient may be a manifestation of a host response which confers some protection against the disease progression. To our knowledge, this is the first report of a case of ATLL with a noninfectious granuloma similar to a Lennert's lesion.

Spectral analysis of hemodynamics during left ventricular assistance.

In order to analyze the autonomic nervous system during left ventricular (LV) assistance, fluctuations in hemodynamic derivatives were evaluated by a spectral analyzing method using a fast fourier transform (FFT) methodology. After the left pleural cavity was opened through the fourth intercostal space under general anesthesia, a pneumatically driven ventricular assist system was implanted as in left heart bypasses in chronic animal experiments, using three healthy adult goats. Hemodynamic parameters with and without LV assistance were recorded on a magnetic tape in the awake condition then analyzed in a computer system through an A-D convertor. Power spectral analysis was performed on a beat-to-beat basis for the evaluation of the fluctuations. During copulsation mode LV assistance, Mayer wave fluctuations (0.1 Hz) were significantly increased compared with counterpulsation mode LV assist, suggesting an increase in sympathetic tone. Co-pulsation mode LV assist is reported to increase the afterload of the natural left ventricle, thus, the sympathetic tone may be increased to maintain a natural heart output.

Human T lymphotropic virus-1 infection.

Human T lymphotropic virus-1 (HTLV-1) is a retrovirus which infects T lymphocytes (CD4+) to cause adult T cell leukaemia/lymphoma (ATL), tropical spastic para-paresis and several other HTLV-1 associated disorders. ATL has been reported worldwide but areas of high incidence include Japan (particularly the south-west), Central and South America, northern Iran, West and Central Africa and Melanesia. In the general Japanese population, HTLV-1 carriage is 0.1% but this can be as high as 50% in endemic areas. Six per 10000 carriers are estimated to progress to ATL each year. The three major routes of infection are mother to baby through breast-feeding, sexual intercourse and blood transfusion. There is a lengthy latency period of up to 40 years before the development of ATL. Up to 50% of ATL patients present with a cutaneous eruption. Diagnosis is established by the detection in lymphocytes of monoclonal integration of HTLV-1 proviral DNA. Even with aggressive treatment, ATL patients generally have a poor prognosis.

Fundamental studies concerning planetary quarantine in space.

If there is a possibility that the organisms carried from Earth to space can live for a significant period on planets, the contamination of planets should be prevented for the purpose of future life-detection experiments. In connection with quarantine for interplanetary missions, we have examined the survivabilities of terrestrial microorganisms under simulated space conditions. In this study, examined the survivabilities of terrestrial organisms under simulated Mars conditions. The Mars conditions were simulated by ultraviolet (UV) and proton irradiation under low temperature, high vacuum, and simulated gaseous conditions. After exposure to the simulated Mars condition, the survivabilities of the organisms were examined. The spores of Bacillus subtilis and Aspergillus niger, some anaerobic bacterias and algaes, showed considerably high survivabilities even after UV and proton irradiation corresponding to 200 years on Mars. This subject is not restricted to academic curiosity but concerns problems involving the contamination of Mars with terrestrial organisms carried by space-probes.

In vitro induction of cytotoxic T lymphocytes against HTLV-I-infected T-cells from adult T-cell leukemia patients, asymptomatic HTLV-I carriers and seronegative healthy donors.

We investigated an in vitro method to produce cytotoxic T lymphocytes (CTLs) against HTLV-I-infected T-cells using peripheral blood mononuclear cells (PBMC) of adult T-cell leukemia (ATL) patients, asymptomatic HTLV-I carriers (AC) and seronegative healthy donors. The PBMC were restimulated repeatedly for 4 weeks with HLA-matched HTLV-I-infected T-cells which had been pretreated at 56 degrees C for 30 min to inactivate infectious HTLV-I. The culture medium included 10-100 units/ml of recombinant lymphokines (rIL-1, rIL-2, rIL-4, rIL-6 and rIL-7) and 10% fetal calf serum in RPMI-1640 medium. The cytotoxic activity was measured against HLA-matched HTLV-I-infected T-cell lines after CD4+ or CD8+ cells were positively panned from the cultured PBMC. The PBMC of ATL, AC and healthy donors were able to produce either CD4+ or CD8+ CTLs against HTLV-I-related antigens (env, gag, p21x, p27rex and p40tax) as well as the antigen(s) of as-yet unknown specificity expressed on HTLV-I-infected T-cells. All the CTLs recognized the specific antigens in the context of either class I or class II HLA types. These results indicated that ATL patients, AC and healthy donors were immunocompetent to generate CTLs against HTLV-I-infected T-cells and probably against HTLV-I-transformed T-cells.

HTLV-I messenger RNA is expressed in vivo in adult T-cell leukemia/lymphoma patients: an in situ hybridization study.

Adult T-cell leukemia/lymphoma (ATLL) is a malignancy involving peripheral blood, lymph nodes, skin and other organs. Human T-cell leukemia virus type I (HTLV-I) is etiologically associated with ATLL but cannot be detected by conventional methods in fresh samples of peripheral blood and skin taken from ATLL. The aim of this study was to investigate the feasibility of an in situ hybridization technique for detection of HTLV-I mRNA in atypical lymphoid cells of peripheral blood and skin lesions of patients with ATLL. We detected variable amounts of HTLV-I tax mRNA in the nuclei and cytoplasm of these cells in fresh peripheral blood samples and skin lesions from ATLL patients, and also in asymptomatic HTLV-I infected donors to a lesser extent. Out of 10 patients with ATLL, 7 showed strong positive in situ hybridization whereas the other 3 were only weakly positive. However, in the last 3 cases, the reaction became strongly positive after cells had been cultured for 24 hr. Furthermore, all 3 asymptomatic HTLV-I-infected donors exhibited a weakly positive response in their apparently mature lymphoid cells.

Geographic independence of HTLV-I and HTLV-II foci in the Andes highland, the Atlantic coast, and the Orinoco of Colombia.

To clarify the ethnic specificity of human T cell leukemia virus type I (HTLV-I) and type II (HTLV-II) carriers among Colombian native Indians, we investigated the geographic distribution of HTLV-I and HTLV-II seroprevalence among the isolated ethnic groups of Mongoloid origin in the Andes highlands and the Atlantic coast of Colombia. HTLV-I carriers were found in 1.6% (1/62 samples) of Inga, 8.5% (5/59) of Kamsa, and 0% (0/55) of Cumbal Indians who live in the Andes highlands at 3000 m above sea level. On the other hand, HTLV-II carriers were found in 4.1% (5/123) of Wayuu Indians, who live in the Guajira region of the Atlantic coast of Colombia at a distance of 1000 km from the Andes highlands. This ethnic specificity of HTLV-II was similarly observed among Guahibo Indians in the Orinoco. The seroprevalence of HTLV-I and HTLV-II was mutually exclusive among Inga, Kamsa, and Wayuu Indians. These results suggest that HTLV-I and HTLV-II may have evolved among Mongoloid populations and been independently transmitted among two different lineages of Colombian native Indians, Andes highlanders and Atlantic coast lowlanders.

Identification of human T cell leukemia virus type IIb infection in the Wayu, an aboriginal population of Colombia.

Human T cell leukemia virus type II (HTLV-II) is endemic in a number of native American populations and high rates of infection have also been demonstrated in intravenous drug abusers (IVDAs). Studies of virus isolates in the latter population have shown the existence of two closely related subtypes of the virus, HTLV-IIa and HTLV-IIb. To characterize the viruses present in native Americans, we analyzed by nucleotide sequence analysis the proviruses from the Wayu, an aboriginal population residing in Colombia, South America. The results showed HTLV-IIb infection in this population, and also demonstrated remarkable conservation of sequence when compared to the proviruses in IVDAs.

T-cell receptor gene rearrangement in cells infiltrating skin eruptions specific to adult T-cell leukemia.

We examined T-cell receptor gene rearrangement in skin lesions and peripheral blood from 6 patients with adult T-cell leukemia (ATL) using the Southern blot method and a c beta 1 probe. A rearrangement signal common to skin lesions of all 6 patients was observed. One patient (Case 4) exhibited another rearrangement signal in the skin lesion and an identical signal was detected in the peripheral blood. This is the first report describing a specific pattern of T-cell receptor gene rearrangement in ATL. The signal obtained is assumed to represent receptors of T cells involved in surveillance of HTLV-I infected T cells.

Differentiation of transiently ischemic from infarcted myocardium by thallium-201 exercises scintigram after active ergometer rehabilitation.

It has been frequently reported that while myocardial viability is neglected in conventional methods of diagnosis such as left ventriculography, ECG, and exercise thallium-201 myocardial scintigraphy (Ex-Tl), revascularization often results in improving left ventricular wall motility. In the present study, the authors contrived a method to accurately evaluate the viability of the myocardium by means of exercise rehabilitation, and tested the method in clinical cases. Among patients with myocardial infarction, we selected a patient with negative viability in the diseased area as determined by chronic ECG, left ventriculography (LVG), coronary angiography and Ex-Tl. This patient went through two weeks of active exercise rehabilitation gauged with an ergometer, and was then re-examined by Ex-Tl. After the evaluation, revascularization was performed for the patient who demonstrated viability of the infarcted myocardium in EX-Tl after rehabilitation, and significant improvement in contractility was shown in the chronic LVG. These findings indicate that our method of detecting potential viability of the infarcted myocardium is of clinical significance.