Internal thoracic artery malperfusion syndrome after bilateral internal thoracic artery grafting: report of a case.

A 58-year-old man with postinfarction unstable angina was referred to the Department of Cardiovascular Surgery at the Saiseikai Kitakami Hospital for urgent coronary revascularization. The bilateral internal thoracic arteries (ITAs) were subsequently utilized to revascularize the myocardium. The left anterior descending artery (LAD) was revascularized with the in situ right ITA and the obtuse marginal artery was revascularized with the in situ left ITA. Although he was successfully weaned from cardiopulmonary bypass, he collapsed hemodynamically 15 min later. Thus, he underwent supplementary vein bypass grafting to the distal LAD and the diagonal artery. Postoperatively, his course was uneventful, apart from the perioperative infarction, and a coronary arteriogram demonstrated patent bilateral ITAs and vein graft. This case report emphasizes the importance of early recognition of this rare syndrome and advocates surgical treatment consisting of supplementary vein grafting.

Skin organ culture model for examining epidermal melanization.

To clarify the regulatory mechanism of skin pigmentation through epidermal proliferation and differentiation, organ cultures of pigmented guinea pig skins have been studied for their melanogenic responses to exogenous stimuli. Melanogenic activity was measured by both tyrosinase activity assessed by observing release of 3H2O from tissue after incubation with 3H-tyrosine and melanin synthesis, indicated by the incorporation of 14C-2-thiouracil into tissue. Those skin explants that were maintained in serum-free media under air conditions equilibrated with 5% CO2, 50% O2, and 45% N2 formed new, chemically analyzable pigment in the tissue within 4 d of culture. This melanization was accompanied by an increased number of melanocytes as well as by enhanced tyrosinase activity and elevated melanin synthesis. This organ culture system responded well to known tyrosinase inhibitors such as phenylthiourea, which decreased melanogenic activity. Of the arachidonic acid metabolites tested, PGE2, LTC4, LTB4, and 5-HETE were found to significantly stimulate melanogenic activity as indicated by tyrosinase activity, whereas PGF2-alpha, 12-HETE, and 15-HETE did not. Among several known growth factors, only bFGF significantly stimulated melanogenesis in the organ cultured melanocytes. TGF-alpha, which increased DNA synthesis, had a slightly stimulating effect on melanogenesis, whereas TGF beta, which inhibited DNA synthesis, did not stimulate melanogenesis, but rather slightly decreased it. 8-methoxypsoralen+ultraviolet A-treated skin that underwent a marked pigmentation within 14 d in vivo demonstrated enhanced melanogenesis in the organ culture system in proportion to its in vivo pigmentation. Our organ culture system might provide an opportunity to examine the mechanism of action of epidermal melanization.

[Evaluation of exercise thallium-201 myocardial single photon emission computed tomography in silent myocardial ischemia].

To evaluate the diagnostic significance of exercise Tl-201 myocardial SPECT in silent myocardial ischemia, 41 patients with angiographically-proven coronary artery disease (27 effort angina, 14 post-infarction angina) were tested using this method. Double product (blood pressure x heart rate) during exercise was used as a hemodynamic parameter. Thirty-two projections were obtained throughout 180 degrees by a rotating gamma camera, immediately, and four hours after exercise. Myocardial Tl-201 washout rate of the entire left ventricle was presented in two-dimensional polar function maps. Normal lower limit of myocardial Tl-201 washout rate was defined as mean-2SD of normals, and the region with a washout rate lower than normal was defined as an ischemic region. The location of myocardial ischemia was visually determined using a Bull's eye polar map. The ischemic size was quantified by the defect volume ratio (ratio of the ischemic myocardium to total myocardium). Coronary lesions were quantitatively assessed by the Pujadas score using coronary angiography. Results were as follows: There was no significant difference between painful myocardial ischemia and silent myocardial ischemia according to double product and the Pujadas scores. In most silent ischemia, the region of the reduced washout rate was in the inferior or lateral area of the Bull's eye polar map, whereas it was in the anterior area in painful ischemia. The defect volume ratio indicating the extent of ischemia was smaller in silent ischemia than in painful ischemia. In conclusion, the ischemic location and size may be contributing factors in silent myocardial ischemia.

Relationship between the occurrence of late potential on the body surface ECG and cardiac performance in myocardial infarction.

Comparative evaluations of the percent of the perimetric circumference of infarction and cardiac performance for the occurrence of late potential were performed in 12 normal subjects and 22 patients with old myocardial infarction (MI). All patients were in normal sinus rhythm without bundle branch block. Bipolar X, Y, and Z leads were signal-averaged using a bandpass filter with a low-cut frequency of 100 Hz and a high-cut frequency of 300 Hz. The filtered signals for the three leads were displayed and combined into a vector magnitude, square root of X2 + Y2 + Z2. The percent ratio of the root mean square voltage in the last 40 msec of the QRS complex was calculated against that of the total filtered QRS (%RMS40). The value of the standard deviation (SD) in the phase distribution was obtained by the Fourier analysis of multi-gated blood pool images. Significant differences were observed among MI with late potential, MI without it and the normal subjects for %RMS 40 (5.7 +- 2.8% vs 26.9 +- 8.1, 37.5 +- 10.8%). Left ventricular ejection fraction was lower in MI with late potential (19.7 +- 7%) compared to that of MI without it (33 +- 18%) and the normal subjects (60 +- 4%); the value of SD was higher in MI with late potential (64 +- 21 degrees), compared to that of MI without it (43 +- 20 degrees) and the normal subjects (9 +- 4 degrees). These findings showed that the percent ratio of the last 40 msec RMS voltage (%RMS 40) was found to discriminate effectively among MI with and without late potential and normal subjects. It was suggested that the amount and structure of the infarcts may be important factors in the occurrence of late potential.

Changes in hemodynamics due to the contrast medium during left ventriculography.

Seventeen patients with heart diseases examined by left ventricular angiography were divided into two groups consisting of those with a clinical history of heart failure (CHF+) and those without (CHF-). Changes in hemodynamics, circulating blood volume, and plasma volume due to injection of the contrast medium were studied, and the following results were obtained. Both the CHF- and CHF+ groups showed an increase in heart rate after injection of the contrast medium, but a statistically significant difference (p less than 0.05) was noted only at one and two minutes after angiography in both groups. Left ventricular systolic pressure decreased after injection of the contrast medium in both groups, but the CHF+ group required a longer time for recovery. In the CHF- group, the left ventricular end-diastolic pressure increased slightly after injection of the contrast medium, but in the CHF+ group it increased markedly with a statistically significant difference (p less than 0.01). Stroke volume, measured by a noninvasive, continuous cardiac output monitor according to the impedance method, increased upon injection of the contrast medium in the CHF- group. However, in the CHF+ group it decreased, although no statistically significant difference was noted in either group. Cardiac index increased markedly upon injection of the contrast medium in the CHF- group with a statistically significant difference (p less than 0.01), but hardly any change was observed in the CHF+ group.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential analysis of experimental hypermelanosis induced by UVB, PUVA, and allergic contact dermatitis using a brownish guinea pig model.

In moderately colored guinea-pig skin, UVB, PUVA, and allergic contact dermatitis were shown to induce hyperpigmentation that resembled the pigmentary changes observed in mongoloid human skin. Using this model, we examined the effects of chemical agents, including tyrosinase inhibitors and sunscreen agents, on the color changes induced by UV irradiation. The daily exposure of brownish guinea-pig skin to UVB irradiation at a variety of energies for 3 successive days induced clearly visible black pigmentation on the irradiated rectangular areas of the flank within a few days of irradiation, the maximum being reached about 1 week after irradiation, i.e., similar to the changes that occur in pigmented human skin. Split epidermal sheets prepared from untreated pigmented guinea pigs exhibited 200-400 melanocytes/mm2; 1 week after UV irradiation, the applied areas show an increased number of strongly dopa-positive melanocytes with stout dendrites (800-1,000 cells/mm2). UVA irradiation following an intraperitoneal injection of 8-methoxypsoralen (8-MOP) also produced black pigmentation 1 week after irradiation, and this was paralleled by a marked increase in the number of dopa-positive melanocytes in dopa-reacted split epidermal sheets. Allergic contact dermatitis produced by the application of 1-phenylazo-2-naphthol induced hyperpigmentation after an interval of about 14 days in 10 of the 21 allergy-acquiring animals examined. This induced pigmentation was accompanied by an increase in the number of dopa-positive melanocytes as compared to the number seen in controls. In contrast, allergic contact dermatitis produced by the application of dinitrochlorobenzene failed to induce such a high ratio of postpigmentation, with only 3 of the 21 allergy-acquiring animals showing hyperpigmentation and 5 showing depigmentation; in the latter, there was a slight decrease in the number of dopa-positive melanocytes. To study the preventive effect of tyrosine inhibitors on UVB-induced pigmentation, daily topical applications of these compounds were performed after three daily UVB irradiations. Treatment with 10% hydroquinone for 10 days interrupted UVB-induced pigmentation and resulted in a marked reduction in the number of epidermal melanocytes as compared to the number found in UVB-irradiated, untreated control skin.