Prenatal diagnosis of sustained bradycardia with 1 : 1 atrioventricular conduction.

OBJECTIVES: The aims of this study were to elucidate the clinical course of fetal bradycardia with 1 : 1 atrioventricular conduction, and to discuss the optimal management of affected fetuses in the second and third trimesters of pregnancy. METHODS: The hospital records of five fetuses with the diagnosis of bradycardia (100 bpm) with 1 : 1 atrioventricular conduction between 1981 and 2000 in our institution were reviewed. Atrioventricular conduction was evaluated by simultaneous M-mode echocardiographic tracing of the atria and the ventricles. RESULTS: The gestational ages at referral ranged from 19 to 36 (median, 25) weeks, and fetal heart rates ranged from 60 to 80 (median, 80) bpm. Postnatal electrocardiography revealed sinus bradycardia in four (two of which were siblings) of the five cases, and junctional rhythm in the remaining case. Two fetuses with congenital heart defects (CHDs) were delivered by Cesarean section but died postnatally. The three fetuses without CHDs were delivered vaginally and have survived to date for 6, 8 and 15 years. CONCLUSIONS: Fetal bradycardia with 1 : 1 atrioventricular conduction caused by sustained sinus bradycardia or wandering pacemaker is an important type of fetal arrhythmia. Further investigations with a larger number of cases are required to determine the risk factors for predicting the outcome of affected fetuses.

Transient heart murmur in the late neonatal period: its origin and relation to the transition from fetal to neonatal circulation.

To elucidate the origin of transient heart murmur during the late neonatal period, we examined 50 neonates with this type of heart murmur and compared them with 50 controls. We serially examined the morphology of and blood flow in the main pulmonary artery (MPA), the right pulmonary artery (RPA), and the left pulmonary arteries (LPA) using two-dimensional and Doppler echocardiography. The heart murmurs were first noticed at 6 to 60 days after birth (mean 33 +/- 14). At that time, the diameters of both the RPA and the LPA in the heart murmur group were significantly smaller than those in the control group, and the velocities of blood flow in the right and left pulmonary arteries in the heart murmur group were significantly greater than those in the control group. When the heart murmur disappeared, the diameters and the flow velocities of both the RPA and the LPA were not different compared with the control group. Two cases in the heart murmur group continued to have a heart murmur and were diagnosed as having intrinsic congenital peripheral pulmonary artery stenosis. In conclusion, our findings suggest that a transient heart murmur in the late neonatal period is caused by transient branch pulmonary arteries stenosis during the transitional circulation from fetus to neonates.

Assessment of DNA content in formalin-fixed, paraffin-embedded tissue of lung cancer by laser scanning cytometer.

A new cytometric device, a laser scanning cytometer was developed to overcome the limitations of flow cytometry (FCM) and image analyses. The purpose of this study was to develop a method that allows laser scanning cytometry (LSC) to be used for measuring the cellular DNA content of paraffin-embedded tissues. Paraffin-embedded lung cancer tissue from 30 patients was analyzed by both FCM (p-FCM) and LSC (p-LSC). In addition, touch preparations from fresh frozen tissues were prepared to provide material for LSC (f-LSC). The limits of agreement for the DNA indices (DI) measured by p-LSC and p-FCM were -0.07 to 0.07, indicating that for a given case, these methods would be expected to differ by no more than 0.07. The limits of agreement for comparisons between the other materials and methods were wider and depended upon the size of the measurements. Agreement between f-LSC and p-FCM was good for small DI values, but poor for large values. Agreement between f-LSC and p-LSC was poor for small and large DI values, but good for moderately sized values. Discordancies in DNA ploidy status between different materials and methods may have been caused by either the heterogeneity within tumors, sampling errors or differences in the interpretation of histograms. This method allows a comparison of the results of DNA analysis with histologic findings from hematoxylineosin-stained sections and the prognosis of the patients.

Detection of human T-lymphotropic virus type I p40tax protein in cerebrospinal fluid cells from patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis.

We investigated the role of viral transcripts of human T-lymphotropic virus type I (HTLV-I) in the cerebrospinal fluid (CSF) cells and peripheral blood mononuclear cells (PBMCs) of patients with human T-lymphotropic virus type I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). To detect the HTLV-I p40tax protein, we developed a new sensitive method of immunohistochemistry combined with tyramide signal amplification and quantitative analysis. Seven patients with HAM/TSP were examined. As controls, four patients with other neurological diseases were examined; two of these patients were infected with HTLV-I and the other two were not. Both the CSF cells and PBMCs were reacted with a monoclonal antibody, Lt-4, for p40tax protein, followed by secondary antibody labeled with horseradish peroxidase. This was visualized by fluorescein directly labeled with tyramide and the number of positive cells was quantified with a Laser Scanning Cytometer. In the samples from patients with HAM/TSP, the HTLV-I p40tax protein was successfully detected by tyramide signal amplification, but not without it. In HAM/TSP patients, 0.04-1.16% of the CSF cells and 0.02-0.54% of PBMCs were positive for the HTLV-I p40tax protein, respectively. The expression of the HTLV-I p40tax protein in the CSF cells was more frequent than that in PBMCs in both HAM/TSP patients and HTLV-I carriers, and was also more frequent in the patients with HAM/TSP of shorter duration of illness. This technique could be a powerful tool to investigate the pathogenic mechanism of diseases associated with HTLV-I.

Fetal arrhythmias: intrauterine diagnosis, treatment and prognosis.

Fetal echocardiography can provide useful information for the evaluation of fetal arrhythmias. Between 1980 and 1993, 44 fetuses with arrhythmias were diagnosed in utero at 12 and 40 weeks of gestation in Kurume University Hospital. Fetal bradycardia, tachycardia and ectopic beats were revealed in 17, seven and 20 fetuses, respectively, and their clinical features and prognosis were evaluated. In the 17 fetuses with bradycardia, eight were associated with congenital heart defect, and six of these developed to fetal hydrops. Of the 17 fetuses, four died in utero, one was terminated, and six died after birth. The other six cases survived. Three of these had a pacemaker implanted after birth. In the seven fetuses with tachycardia, transplacental anti-arrhythmic drugs were administered in five cases and conversion of the arrhythmia was achieved in four. None of the cases was associated with any congenital heart defect, and none died. Three infants had paroxysmal tachycardia postnatally. In the 20 fetuses with ectopic beats, arrhythmia was observed postnatally in 10, but all of these were resolved within 3 months after birth. Fetal bradycardias carried a poor prognosis in most cases and further studies are required to establish effective treatment. Some cases of fetal tachycardia developed recurrent tachycardia postnatally. Close follow-up of the newborn is therefore necessary.

Evaluation of atrial, ventricular and atrioventricular septal defects by cine magnetic resonance imaging.

Cine magnetic resonance imaging (MRI) was performed on 20 patients (mean age: 5.3 +/- 4.4 years) with atrial, ventricular, or atrioventricular septal defects for evaluation of cardiac structure and blood flow. Prior to cine MRI, electrocardiographically gated MRI using multislice acquisition was performed on all patients to localize optimal slice location. Cine-MRI was obtained with a 30 degrees flip angle, 15 msec echo time, and 30 msec pulse repetition time, on a 256 x 256 or 128 x 128 acquisition matrix. Abnormalities of cardiac structure were well defined in all patients by gated cardiac imaging. In 18 of the 20 patients, cine-MRI was able to detect shunt flow, visualized as a low intensity signal in comparison with the surrounding blood flow. Cine-MRI can provide not only accurate anatomy of cardiac structures but functional assessment of the cardiac chamber, wall topology and flow relations. Cine-MRI will become an important noninvasive technique for assessment of anatomy and physiology in congenital heart disease.

[A scanning electron microscopic study on experimental ischemic lesions in dogs].

Occlusion of minute vessels in the bowel wall is thought to be a cause of ischemic lesions. This study was performed to clarify the pathohistology and the morphology of these various lesions. Microbarium suspension was injected into the mesenteric vessels of twenty four dogs and the ischemic lesions were produced experimentally. The degree of the bowel damage was parallel to the amount of injected microbarium suspension. The resected specimen of the various stages of the disease was studied histologically and morphologically by a scanning electron microscopy. With the small amount of barium suspension the lesions were confined to the mucosal layers. The epithelial cells regenerated regularly and the villi normalized rather quickly, and these lesions healed within one to two weeks (transient form). With the large amount of barium suspension the lesions involved both submucosal and muscular layers. The epithelial cells regenerated irregularly and the villi rearranged to abnormal forms. These lesions healed in two to four weeks leaving the stenosis due to scar formation (stricturing form). This study suggests that scanning electron microscopic investigation can be used to assess the details of morphological changes of ischemic mucosa, special reference to the degeneration and regeneration process of epithelium of the villi.

[A case of rectal carcinoma disappeared by the preoperative radiation].

A 64-year-old man was admitted to our department with a diagnosis of rectal carcinoma. Preoperative histological diagnosis was highly differentiated adenocarcinoma of Dukes' A classification (Rb', Is', 20-25 mm in diameter, PM'). Preoperative radiation (2.5 Gray/time, total 30 Gray) and chemotherapy (PSK 3g/day x 3 weeks, ACNU 30 mg/m2/week x 3 weeks) were performed on this lesion. After these therapies, form of the tumor changed to IIa', SM', which was recognized by endo-scopic examination with rectal echography. A reduction of the size was 25%. Low anterior resection, curative operation, was performed 2 weeks after the therapy. The resected rectum was examined in detail, resulting in complete disappearance of the carcinoma cell and the tumor was replaced by the inflammatory cells, fibroblasts and granular cells. These findings were compatible with grade IVB of Ohboshi-Simosatos' classification.

[Cine magnetic resonance imaging for evaluating flow dynamics in congenital heart diseases with left-to-right shunts].

Cine magnetic resonance imaging (cine MRI) was used to evaluate the cardiac structures and blood flow in congenital heart diseases with left-to-right shunts. Fifteen children with left-to-right shunts which were confirmed by echocardiography or angiography were investigated in the present study. Five children each had atrial septal defect, ventricular septal defect, and complete endocardial cushion defect. Their ages ranged from 4 months to 13 years (mean 5.5 years). Prior to cine MRI, the ECG-gated cardiac imaging using multi-slice acquisition was performed in all the children to localize the optimal slice for cine MRI. To select the optimal imaging planes for various cardiac structures, we used axial, coronal, sagittal and four-chamber views. Cine MRI was demonstrated by a fast low 30 degree flip angle imaging technique, with a 15 msec echo time, a 30-40 msec pulse repetition time, and a 256 x 256 or 128 x 128 acquisition matrix. Abnormalities of cardiac structures were defined extremely well in all the children using ECG-gated cardiac imaging. In 14 of the 15 children (93%), cine MRI clearly detected a left-to-right shunt flow, which was visualized as a low signal intensity area compared to the surrounding blood flow. Noninvasively, cine MRI provides accurate images of the anatomy of the cardiac structures, makes functional assessments of the cardiac chambers and walls, and flow relationships. It has no limitations of imaging planes imposed bones and lung, and is not associated with technical difficulties as required with echocardiography which has small cardiac window.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascularizing the ischemic jejunum by intra-seromuscular implantation of a gastroepiploic vascular pedicle--an application of experimental esophageal reconstruction.

Many experimental studies have been done in an attempt to feed various ischemic organs. Of these, both direct intraorganic vascular implantation, and vascular anastomosis, appear to show promise for vascularizing the ischemic gastrointestinal tracts. Preliminary experiments were done in 24 Mongrel dogs to establish the blood flow of the jejunum by direct epiploic vascular pedicle implantation. Morphological development of the communicating vascular system, newly formed between the implanted epiploic vessel and the indigenous vascular network of the jejunum, was clarified by microangiography and histology. In 20 dogs, esophageal reconstruction was successfully accomplished, using the jejunal loop vascularized as described above. The total length of the jejunal segment, and the esophagojejunal anastomotic portion, had neither signs of circulatory disturbance nor necrosis, one, three and twelve months post-operatively. Our experimental findings suggest that direct vascular implantation is the simplest way to vascularize the ischemic intestinal tract and may also be applicable widely in the field of abdominal surgery.