[Effects of home oxygen therapy on patients with chronic heart failure].

OBJECTIVES: Dyspnea on exertion and/or hypoxemia due to nocturnal respiratory disturbance may occur in patients with stable chronic congestive heart failure. Such patients with respiratory disorder during sleep have a poor prognosis. The effects of treatment with home oxygen therapy on patients with congestive heart failure are unclear when symptoms are stable at rest. This study investigated the effects of home oxygen therapy on patients with stable chronic congestive heart failure. METHODS: Thirty-three patients with stable chronic congestive heart failure(New York Heart Association functional class II-IV) and hypoxemia during exercise or sleep were treated with oxygen above the level of 90% SaO2. The following factors were compared before and after home oxygen therapy: Subjective minimal capacity on exercise(metabolic equivalents: METs) before and 1 month after patients first became aware of dyspnea on effort using the specific activity scale(SAS); SaO2 at rest before and 1 month after; and frequency of admission during 1 year due to deterioration of heart failure. RESULTS: After home oxygen therapy, SAS improved from 2.5 +/- 0.9 to 3.3 +/- 1.0 METs(p < 0.0001), and SaO2 at rest improved from 92.8 +/- 2.5% to 96.3 +/- 1.6%(p < 0.0001). The frequency of admission was decreased from 1.3 +/- 1.2 to 0.8 +/- 1.2 times(p = 0.03). CONCLUSIONS: Home oxygen therapy is effective for improving the symptoms and activity of daily life in patients with chronic heart failure. Home oxygen therapy may prevent the deterioration of heart failure.

A unique case of central diabetes insipidus (DI) associated with transient pituitary stalk enlargement: close observation over several years using magnetic resonance imaging (MRI) and hypophysial endocrine tests.

We had the opportunity to closely observe a unique case of central diabetes insipidus (DI), in which dramatic changes in both radiological findings and hypophysial functions were seen. A 63-year-old female developed central DI, and magnetic resonance imaging (MRI) revealed a mild thickening of the pituitary stalk and lack of hyperintense signal associated with normal neurohypophysis on T1-weighted images. About three months later, the stalk was found to be remarkably expanded like neoplasm; however, anterior pituitary functions were almost normal on that occasion, except for the absence of GH response to an insulin tolerance test. About nine months after the onset of DI, secondary hypoadrenalism and hypothyroidism, which required replacement therapy, developed transiently, but recovered about one year later. Results of hypophysial endocrine tests during this period showed that the dysfunction was predominantly suprapituitary in nature. As time passed, the stalk lesion began to shrink spontaneously and another MRI, obtained five years after the onset of DI, disclosed normal findings for the infundibulo-hypophysial system, except for lack of the hyperintense signal of the neurohypophysis. The patient has since been healthy, except for the DI, which has been controlled by treatment with vasopressin. We report here a unique case of central DI associated with transient pituitary stalk enlargement.

[Effects of low dose pimobendan in patients with cor-pulmonale].

The acute and chronic efficacy of low dose pimobendan (1.25 mg x 2/day) was evluated in patients with cor-pulmonale. Fifteen patients (12 men, 3 women, mean age 73 +/- 5 yr) with right ventricular dysfunction judged by Tei's Doppler index (> or = 0.4) and poor working capacity (exercise tolerance: 2.2-6.6 MET) were studied. Mean pulmonary artery pressure, cardiac output, total pulmonary resistance using Swan-Ganz catheter, and arterial oxygen and carbon dioxide pressure (PaO2, PaCO2) were measured before and 24 hr after pimobendan administration. Maximal oxygen intake (MET), saturation of arterial blood oxygen at rest and desaturation by treadmill stress test were measured before and 1 month after pimobendan administration. Pulmonary artery pressure decreased (17.6 +/- 4.7 to 10.2 +/- 2.3 mmHg, p < 0.001) and cardiac output increased (3.5 +/- 0.6 to 5.1 +/- 0.9 l/min, p < 0.001), resulting in decreased total pulmonary resistance (5.0 +/- 1.3 to 2.1 +/- 0.7 U, p < 0.001), and a mild decrease in PaO2 (74 +/- 8 to 70 +/- 10 mmHg, p < 0.05). Exercise tolerance improved significantly (4.8 +/- 1.7 to 6.8 +/- 2.2 MET, p < 0.001), without deterioration of PaO2 and desaturation. These results indicate that low dose pimobendan is useful for the treatment of patients with cor-pulmonale.

[Invasive amebiasis at an institution for the mentally retarded in Hyogo Prefecture].

An outbreak of amebiasis caused by Entamoeba histolytica occurred at an institution for mentally retarded persons in Hyogo Prefecture. Twelve out of a total of 49 admitted persons exhibited E. histolytica cysts in their stool, and 13 including persons in whom no cysts had been detected showed positive serological reactions for E. histolytica infection. However, neither the cyst nor the antibody against the organism was detected in the staff members of the institution. Indirect fluorescence antibody test and sandwich enzyme-linked immunosorbent assay with a monoclonal antibody specific for pathogenic strains of E. histolytica revealed that all trophozoite strains grown from cysts in stool samples from five patients were pathogenic. Epidemiological analysis strongly suggested that a patient in the institution had been infected with an organism from a patient outside the institution, and that infection may have spread among the admitted persons due to abnormal behavior. Administration of metronidazole resulted in effective elimination of the cysts from the stool of the cyst-carriers.

The effect of isosorbide dinitrate on exertional hypotension in old myocardial infarction.

Four patients with old myocardial infarction (OMI) revealed exertional hypotension in the treadmill exercise test. All had a multivessel disease, severe left ventricular dysfunction and exercise-induced ST depression or angina to indicate additional myocardial ischemia. After 5 mg of oral isosorbide dinitrate (ISDN), the response of blood pressure was improved with a delayed onset of ST depression or angina. To confirm the effect of ISDN on the pressure response to exercise, 26 patients with OMI were further studied. In patients without ST depression and angina (Group I), the systolic blood pressure (SBP) at the matched work load was significantly decreased after ISDN. However, in patients with ST depression or angina (Group II), SBP at the matched work load was not altered after ISDN. The increment of change in SBP due to ISDN, namely from the resting level to the matched work load, was significantly larger in Group II than in Group I. In addition, the patients with marked left ventricular dysfunction in Group I revealed a more change in SBP due to ISDN than the others in Group I. It was concluded that exertional hypotension or suppressed pressure response of OMI could be corrected by 5 mg of oral ISDN due to its favorable effects on the exercise-induced myocardial ischemia and preexisting left ventricular dysfunction.

[Comparison of exercise capacity with resting left ventricular function evaluated by various non-invasive methods in patients with old myocardial infarction].

The purpose of this study was to investigate the relationship between exercise capacity and resting left ventricular function assessed by several non-invasive methods in patients with old myocardial infarction. Subjects were 25 male patients whose endpoint was either dyspnea or general fatigue at the symptom-limited maximal graded treadmill exercise test according to Bruce protocol. The indices obtained by non-invasive cardiac examinations included left ventricular fractional shortening (% FS), scintigraphic infarct size (% SIS) by 201Tl myocardial scintigraphy and PEP/ET (so-called Weissler's index). A significant correlation of exercise duration with % FS (r = 0.67, p less than 0.001) or with % SIS (r = -0.55, p less than 0.02) indicated that the more was impaired resting left ventricular function, the more was decreased exercise capacity. Also, a significant correlation of systolic blood pressure at the end-point in exercise test with % FS (r = 0.58, p less than 0.005) or with % SIS (r = 0.69, p less than 0.001) indicated that inadequate blood pressure response might be partially attributed to impaired left ventricular function during exercise. The response of heart rate at the Bruce protocol stage I correlated with % FS (r = -0.67, p less than 0.001) and with % SIS (r = 0.53, p less than 0.02), respectively. These findings may be interpreted as chronotropic compensatory mechanism for limited stroke volume during exercise in patients with imparied left ventricular function. Thus, it was concluded that resting left ventricular function assessed by non-invasive cardiac examinations may predict exercise capacity prior to the test to some extent. These informations can be utilized for the decision of the planning at cardiac rehabilitation and also for the guidance in daily activities. Additionally, low level exercise test with treadmill is considered to be valuable for screening cases with impaired left ventricular function in old myocardial infarction.

Seroepidemiologic studies of acute hemorrhagic conjunctivitis virus (enterovirus type 70) in West Africa. II. Studies with human sera collected in West African countries other than Ghana.

Human sera were collected in Senegal, Nigeria, Ivory Coast, Dahomey, Liberia, Gabon and Togo during the pre-epidemic period of acute hemorrhagic conjunctivitis (AHC) from 1965 to 1969, and tested for virus neutralizing (VN) antibody to enterovirus type 70 (EV70). Of these, 1109 (91%) were antibody negative (less than equal to 1:4), 116 (9%) neutralized at a dilution of 1:8 or over, and 45 (4%) at dilutions of at least 1:16. The distribution pattern is not significantly different from that of sera collected from Kenya in 1967 or from army recruits in the United States, Argentina, Brazil and Colombia in the 1960s. Sera collected during the post-epidemic period (1970 to 1977) in Senegal, Sierra Leone, Mali, Upper Volta, Chad, Niger and Gabon were also examined; 1573 (68%) were VN antibody negative (less than or equal to 1:4), while 733 (32%) and 433 (19%) had titers of 1:8 or greater and 1:16 or over, respectively. There is a significant difference in distribution between pre- and post-epidemic antibody titers (p less than 0.001), although the incidence of AHC was lower in these countries than in Ghana and Southeast Asia. The prevalence of VN antibodies tends to be lower in the dry, hot inland areas and thus humid coastal monsoonal climates and dense populations seem to favor the spread of AHC.

Hemoagglutination and hemagglutination inhibition tests with enterovirus type 70.

Human type "O," guinea pig, and chicken erythrocytes were agglutinated by enterovirus type 70 at 4 degrees C or room temperature. A hemagglutination inhibition test, using human "O" erythrocytes, is described for the serological diagnosis of acute hemorrhagic conjunctivitis caused by enterovirus type 70.

Growth characteristics of acute hemorrhagic conjunctivitis virus in monkey kidney cells. III. Viral RNA synthesis at permissive and nonpermissive temperatures.

Monkey kidney cells infected with the J 670/71 strain of acute hemorrhagic conjunctivitis (AHC) virus in the presence of actinomycin D synthesized two species of viral RNA. One species had properties similar to the virion RNA, sedimented in a sucrose gradient with a sedimentation coefficient of 34S, and was sensitive to RNase. The other species sedimented at 18S and was resistant to RNase. The inability of AHC virus to replicate at 39 degrees was attributed to a lack of virus-specific RNA synthesis in infected cells.

Virological and serological studies of neurological complications of acute hemorrhagic conjunctivitis in Thailand.

An extensive outbreak of acute hemorrhagic conjunctivitis (AHC) occurred from September to December 1974 in Thailand. At least 29 patients with polio-like motor paralysis that complicated AHC were hospitalized in Bangkok. Paired or triplicate samples of serum from 16 patients were tested for neutralizing antibody to enterovirus type 70 (EV70). A significant rise in titer of antibody was found for two patients, and the other 14 had neutralizing antibody titers ranging from 1:8 to 1:512 without an increasf larger than or equal to 1:16, a level which is considered to be diagnostically significant. Neutralizing antibody to EV70 was detected in 19S fractions of nine sera examined, but neutralizing antibody to three types of poliovirus was confined to 7S fractions. EV70 was isolated from one of seven stool specimens collected on day 37 after the onset of AHC and none of 10 samples of cerebrospinal fluid. These results and additional clinical and epidemiologic findings gave further support to the hypothesis that EV70 infection can cause polio-like motor paralysis as a complication of AHC.

Growth characteristics of acute hemorrhagic conjunctivitis (AHC) virus in monkey kidney cells. II. Temperature sensitivity of the isolates obtained at various epidemic areas.

Acute hemorrhagic conjunctivitis (AHC) virus strains isolated in eight different areas during epidemics of AHC were tested for the reproductive capacity at 33, 37 and 39 degrees. All of the 25 strains tested grew better at 33 degrees but restrictively at 39 degrees. The degree of temperature sensitivity varied slightly from one strain to the other, but generally exceeded that of attenuated poliovirus type 1, strain LSc2ab. Temperature-resistant clones were selected by repeated passages of originally temperature-sensitive prototype strains at supraoptimal temperature. The importance of using a low temperature (32-34 degrees) for isolation of virus from external tissues of the body and for subsequent passages has been emphasized. It was suggested that the relatively low temperature of the conjunctiva has played a role in perpetuating temperature sensitivity of this virus.

Serologic characterization and sero-epidemiologic studies on acute hemorrhagic conjunctivitis (AHC) virus.

Serologic and sero-epidemiologic characteristics of AHC virus infection were studied by neutralization test (NT). Four-fold or greater virus neutralizing (VN) antibody response was demonstrated to the Japanese isolate of AHC virus (the J 670/71 strain) in 77.3% and 66.7% of paired sera from clinical AHC patients in Japan (1971-1973) and Tunisia (1973). The four patients from Indonesia studied in 1972 showed similar antibody response. Cross-neutralization tests of AHC virus isolated in Japan (1971), Taiwan (1971), Hong Kong (1971), Thailand (1972), Indonesia (1972), Singapore (1972), Morocco (1971) and England (1971) with three kinds of antisera prepared against Japanese, Hong Kong and Moroccan AHC virus isolates indicated their antigenic identity. However, isolates from Sinapore in 1970 (Singapore 70 virus) were not neutralized with the AHC virus antisera mentioned above: Singapore 70 virus constitutes another antigenic type, to which, however, no VN antibody rise was found in paired patients' sera from Japan, Tunisia and Indonesia. Thus, no serologic evidence supporting an etiologic role of this virus group in the development of AHC was found. Although cross-tests using monospecific antisera suggested some cross-relation between AHC and both echovirus type 4 (E4) and coxsackie A (CA), type 19, no serologic relationship between AHC and these viruses was found. Sera from healthy individuals collected before and after AHC outbreaks were tested for VN antibody against AHC virus in Japan and two epidemic foci, Ghana and Indonesia. Before the epidemic, 80 to 90% of the people lacked antibody in the three countries, but 39.7% and 45.2% of inhabitants posessed VN antibody of 1:8 or over in Ghana and Indonesia after the outbreak. In Japan, however, only a slight increase was found in VN antibody prevalence afterwards. Serologic study showed that 41.5% of horse sera were VN positive at dilutions of 1:8 or more; many cattle sera also had a low VN titer but few cynomologus monkey sera had VN activity.