Clinical and histopathological studies in children with supraventricular tachycardia.

To determine whether myocardial changes in patients with supraventricular tachycardia (SVT) are primary or secondary to persistent tachycardia, 11 patients with SVT were studied. These patients were divided into 2 groups with respect to the type of SVT. Group I consisted of 5 patients with incessant SVT and one with multifocal atrial tachycardia, while group II consisted of 4 patients with paroxysmal supraventricular tachycardia and one with short-run supraventricular premature contraction. All of the patients underwent electrophysiological study and endomyocardial biopsy from the right ventricle following routine cardiac catheterization. In group II, there were no significant abnormalities in the clinical and hemodynamic parameters. In group I, 3 patients had clinical features of dilated cardiomyopathy including abnormal ECG, chest X-ray and hypokinesis on left ventriculography. Induction and termination of SVT were possible in 2 patients in group I and in 4 of the 5 patients in group II. The only significant histologic difference between group I and group II was fibrosis. A high incidence of histopathological abnormalities, such as hypertrophy, degeneration, interstitial fibrosis and disarray was observed in both groups. The incidence of significant pathology was higher in group I than in group II. Almost all of the patients were given antiarrhythmic drugs. One patient underwent a successful surgical procedure and normal cardiac function returned after resection of the foci of the right atrium. Our present results suggest that patients with SVT who have incessant or recurrent SVT should undergo not only intracardiac electrophysiologic study but also endomyocardial biopsy for the evaluation of myocardial damage, since SVT might be the initial sign of cardiomyopathy.

[Radiotherapy in the conservative management of breast cancer].

Breast conserving therapy is now considered standard treatment in patients with early breast cancer, and it yields equal local control and survival equal to those of radical mastectomy, in Europe and the United States. After many reports from western countries, Japanese surgeons started conservative treatment for early breast cancer. The aim of radiotherapy is to eradicate residual tumor after quadrantectomy or lumpectomy. Indication for this management by Fujio Kasumi at the Cancer Institute Hospital is T1, N0, M0. We reported here the method of radiotherapy, that is energy of photon, treatment field and total dose, which are discussed by the study group of the Japanese Society for Therapeutic Radiology and Oncology.

[Histopathological analysis of myocardial damages following Kawasaki disease with repeated endomyocardial biopsy].

Since Kawasaki disease was first reported 20 years ago, many investigations about cardiac complications and treatment have been carried out. However, etiology still remains unknown. Although many studies focused on coronary artery lesions (CAL) have been reported, there have been only a few reports of pathological studies on myocardial after-effects of Kawasaki disease using endomyocardial biopsy. In order to investigate the myocardial sequelae, repeated coronary arteriography and endomyocardial biopsy were performed in thirteen patients of Kawasaki disease with coronary artery lesions. Their ages ranged from 19 months to 12 years in the first study, 4 years to 15 years in the second study, and the male to female ratio was 8:5. In this study the interval between the first study and the second one was more than two years and six months. In the second study, progression of the CAL was noticed in 23% of the cases. It was unchanged in 54%, and regression was observed in 23%. Twenty-three percent of the patients were found to have an ejection fraction of less than 55%, and abnormal regional wall motion was found in 62% of the patients. Myocardial changes in the second endomyocardial biopsy were interstitial fibrosis in 62%, degeneration in 54%, disarray in 32% and inflammatory cell infiltration in 23%. One of the cases with Kawasaki disease, who had mild CAL, revealed massive inflammatory cell infiltration and myocytolysis in the second study performed seven years after onset, which suggested chronic myocarditis. Myocardial changes in the patients with advanced CAL were relatively mild, and low EF and abnormal regional wall motion were not always related to severity of CAL.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary arterial calcification in Kawasaki disease.

The purpose of this paper is to describe the clinical characteristics and significance of the coronary arterial calcification due to Kawasaki disease (KD), based on our five patients. The coronary arterial lesions (CAL) were in segments 1, 2, 5, 6 and 11 according to the classification of the American Heart Association. The interval from the onset to the first appearance of coronary calcification was 17 months to 61 months. Progression of CAL into coronary arterial stenosis or myocardial infarction occurred in all five patients. In the comparative study between the patients with calcified CAL and those with non-calcified CAL, the maximal size of CAL of the former was 8 mm or larger in contrast with that of the latter (less than 8 mm). It is concluded that coronary arterial calcification is one of the important signs which suggest the presence of the advanced CAL in the follow-up of children with a history of KD.

[Clinical investigation on the patients with tachyarrhythmic syncope with special reference to comparative study between long QT syndrome and ventricular tachycardia without long QT interval].

The long QT syndrome (LQTS) is one of the important diseases that may lead to sudden death mainly in childhood, however etiology and pathogenesis are still poorly understood. The group studied consisted of 6 patients with a history of ventricular tachyarrhythmic syncope, 3 with long QT syndrome (LQTS) and 3 without long QT interval, and of 4 patients with ventricular tachycardia without syncopal episode. Their ages ranged from 5 years to 17 years. Histopathology of endomyocardial biopsy was nonspecific and mild in two cases but in one patient with LQTS, who had several episodes of syncope and refractory ventricular arrhythmia, remarkable subendocardial fibrosis, interstitial fibrosis and hypertrophy of myocytes were demonstrated. As far as ventricular tachycardia without long QT interval was concerned, in the patients with VT with syncope, histopathological abnormalities were more remarkable than in those without syncope. Electrophysiological findings in the patients with LQTS showed no characteristic findings, but only mild abnormalities with functional atrioventricular conduction disturbance on programmed atrial pacing. No inducible VT was demonstrated. Although electrophysiologic study and endomyocardial biopsy are of limited value, such studies are considered to be worthwhile for treating ventricular arrhythmias, and making a prognosis of the patients with tachyarrhythmic syncope and LQTS.

[Clinical investigation on childhood HCM; long-term follow-up study with special reference to electrophysiology, histopathology by endomyocardial biopsy and ambulatory and exercise electrocardiography].

In order to determine the prognosis and risk factors of childhood HCM, we investigated clinical parameters, such as the age of onset, symptoms and signs related to HCM, dysrhythmias and ST-T and changes by Holter ECG and exercise ECG, electrophysiological study and histopathological study by endomyocardial biopsy. Heart murmur was the commonest sign although only one patient revealed a significant left ventricular outflow tract gradient of more than 20 mmHg. The peak age of patients diagnosed as having HCM was 10 to 15 years. The major ECG manifestations of our series showed specific findings and in some cases ECG changed remarkably during the follow-up period. The diagnosis of apical hypertrophy should be made with caution in childhood. Holter ECG seemed to be indispensable for the follow-up of childhood HCM because Holter ECG in our patients manifested such significant findings as ventricular premature contractions or couplets or ST depression. The degree of clinical severity did not always correlate with the histopathological severity obtained by endomyocardial biopsy. As HCM in childhood is heterogeneous and multifaceted, there is no one therapy, and prognosis and proper treatment with close observation should be carried out in each individual case.

Age of menopause in Japanese women: trends and recent changes.

The age of menopause was investigated in a survey conducted in 1987 in 13,996 Japanese women aged 22-86 years, the findings being as follows: (1) The percentage of post-menopausal women showed a sharp linear increase between the ages of 49 and 53 years, the figure being 42.7% at age 50. The rate of increase was slightly lower after 50 years of age. (2) Among the 6477 post-menopausal women, the age at which the peak number had undergone menopause was 50 years (17.7%), followed by 49, 52 and 48 years. The crude mean age of menopause was 49.33 years in post-menopausal subjects aged over 40. The mean age of menopause in urban and rural women was not significantly different. (3) The crude mean age of menopause, calculated by classifying those aged 50 (born in or before 1937) into groups corresponding to 5-year age intervals, was highest in the 1928-32 birth-year group, followed, in descending order, by the 1923-27, 1918-22, 1917 or earlier and 1933-37 groups in all post-menopausal and in urban subjects, while in rural subjects it was highest in the 1918-22 group. However, overall, the adjusted mean age of menopause was highest (50.2 +/- 3.24 years) in the 1928-32 birth-year group, followed by the 1923-27 and 1933-37 groups.

Effects of orally administered human epidermal growth factor on natural and delayed healing of acetic acid-induced gastric ulcers in rats.

We examined the effects of orally administered human epidermal growth factor (hEGF) on healing of acetic acid-induced gastric ulcers in rats. hEGF, given twice daily at 30 and 100 micrograms/kg for 2 weeks or at 100 micrograms/kg for 4 weeks to rats with ulcers, had no effect on natural healing or the gastric secretion, delayed one caused by indomethacin. Oral hEGF had no effect on basal histamine-stimulated gastric secretion, and stomach weight. These results indicate that oral hEGF has no biological activity on the pathophysiology of the stomach.

Endomyocardial biopsy in children with Kawasaki disease.

To study the histopathology of the myocardium in Kawasaki Disease (KD) with various coronary angiographic findings, right endomyocardial biopsy specimens were evaluated on 20 boys and 16 girls with this disorder. KD with coronary artery lesions (CAL) showed various histopathological abnormalities, such as myocellular hypertrophy in 44%, degeneration in 61%, interstitial fibrosis in 44% and endomyocardial changes in 22%. KD without CAL revealed myocellular hypertrophy in 44%, degeneration in 50%, disarray in 28% and interstitial fibrosis in 6%. As in patients with long-standing KD, more than three years after onset, myocardial changes such as myocellular hypertrophy, disarray and interstitial fibrosis persisted, it is suggested that cardiomyopathy may develop in some patients with KD.

[Histopathological studies of endomyocardial biopsy on the children with Kawasaki disease].

Since there has been many reports on the coronary artery lesions in the patients with Kawasaki disease, but only a few reports on histopathological investigation employing endomyocardial biopsy, histopathological study was performed in eighteen children of Kawasaki disease with coronary artery lesions and eighteen children of Kawasaki disease with intact coronary artery, aged from one year and ten months to fourteen years. There were twenty males and sixteen females. Comparing Kawasaki disease who had coronary artery lesions with those not, there was no striking difference in histologic findings. Kawasaki disease without coronary artery lesions revealed myocellular hypertrophy, degeneration of myocytes, disarray, interstitial fibrosis and endocardial changes in 44%, 61%, 11% and 44%, respectively. Among Kawasaki disease who had coronary artery lesions, children with coronary artery stenosis showed a higher incidence of histological abnormalities than those with coronary artery aneurysm. Some cases of Kawasaki disease were recognized to have significant myocardial abnormalities even in three to six years after onset, which seemed to persist whether or not they would have coronary artery lesions. Since Kawasaki disease who would have myocardial damages might have the potential for developing cardiomyopathy, careful attention should be payed to myocardial lesions as well as sequelae of coronary artery lesions.