Guidelines from the Japanese Society of Echocardiography: Guidance for the management and maintenance of echocardiography equipment.

Echocardiography plays a pivotal role as an imaging modality in modern cardiology practice. Information derived from echocardiography is definitely helpful for patient care. The Japanese Society of Echocardiography has promoted echocardiography in routine clinical and research use. One of the missions of the Society is to provide information that is useful for high-quality examinations. To ensure this, we believe that equipment in good condition and a comfortable environment are important for both patient and examiner. Here, the Guideline Preparation Committee of the Japanese Society of Echocardiography has established brief guidance for the routine use of echocardiography equipment.

Practical production of (S)-1,2-propanediol and its derivative through baker's yeast-mediated reduction.

The enantiomeric excess (ee) of (S)-1,2-propanediol produced by baker's yeast-mediated reduction of 1-acetoxy-2-propanone was improved to 96% ee by a fed-batch operation of the substrate. A similar reduction of 1-benzoyloxy-2-propanone stopped because of the inhibition toward the enzymes for NADPH regeneration by the reduction product. The inhibition was prevented using resin that adsorbs the product from the reaction mixture, and 70 g/l substrate was reduced yielding (S)-1-benzoyloxy-2-propanol at > 99% ee.

A case of Caroli's disease: usefulness of color Doppler sonography for evaluating the malformation of the intrahepatic bile ducts.

Caroli's disease is a rare congenital disorder with multiple cystic dilatations of the intrahepatic bile ducts. In addition to the nonobstructive localized dilatation of the bile ducts, intraluminar bulbar protrusions of the wall and bridge formation across dilated lumina have been demonstrated on sonography and computed tomography. We present a case in which color Doppler sonography clearly showed a blood flow signal toward the periphery of the liver in the protrusion of the dilated intrahepatic bile ducts. Color Doppler sonography is a useful noninvasive method for evaluating the malformation of Caroli's disease.

[Long-term prognosis in patients with echocardiographic left ventricular dysfunction masquerading as dilated cardiomyopathy].

The long-term prognosis and prognostic factors were assessed in patients with left ventricular dilatation with impaired function secondary to idiopathic dilated cardiomyopathy (DCM) or to heart diseases of various pathogeneses masquerading as DCM (DCM-like). The echocardiographic criteria for DCM-like disease were 1) left ventricular end-diastolic dimension exceeding 60 mm and 2) fractional shortening less than 15%. Those who showed improvement in either of these 2 parameters within 3 months were excluded from this study. One hundred and fifty-eight of 35,250 serially examined patients fulfilled the definitions. The pathogeneses of diseases were valvular heart disease (VHD) in 30 patients, ischemic heart disease (IHD) in 37, alcoholic cardiomyopathy (AC) in 12, hypertensive heart disease (HHD) in 31 and DCM in 48. All of the survivors were followed for more than 24 months; an average of 40 months. During this period, there were a total of 75 deaths, 18 (27%) of whom were judged as sudden death. Five-year survival rates calculated using the Kaplan-Meier method in AC and HHD were 86% and 77%, respectively, which were significantly higher than those in DCM (48%; p < 0.05); whereas, patients with VHD and IHD had lower values (60% and 46%, respectively) which were nearly equal to those in DCM. Factors that contributed to the increase in total cardiac mortality were advanced age, higher NYHA functional class, larger cardiac size on chest radiograph and history of heavy alcohol intake. Each of these factors were closely related to the specific pathogeneses as follows: age to IHD, cardiac size to VHD, and NYHA functional class to DCM. Long-term prognosis of DCM-like heart diseases, especially those of IHD and VHD, seemed to be as bad as those of DCM.

[Tricuspid regurgitation in mitral valve prolapse studied by two-dimensional color flow mapping].

To assess the incidence of tricuspid regurgitation (TR) in mitral valve prolapse (MVP), 96 patients with MVP and 23 normal control subjects were studied. Subjects in the MVP group were further classified as a group with mitral regurgitation (MR(+) group: 61 cases), and MR(-) group (35 cases). The presence of TR in each group was studied by two-dimensional color flow mapping using a Toshiba SSH-65A apparatus. The incidence of TR was 49% in the MR(+) group and 34% in the MR(-) group, and both (35 cases). The presence of TR in each group was studied by two-dimensional color flow mapping using a Toshiba SSH-65A apparatus. The incidence of TR was 49% in the MR(+) group and 34% in the MR(-) group, and both values were statistically greater than 9% in the control group (p less than 0.001 and p less than 0.05, respectively). A female preponderance was observed only in the MR(+) group. Tricuspid valve prolapse was observed in six cases (10%) in the MR(+) group, two cases (6%) in the MR(-) group, and none in the control group. The mean tricuspid ring dimension did not differ significantly among the three groups. The female patients in MR(+) group had statistically greater measurements than the normal female subjects (p less than 0.01). In conclusion, the incidence of TR was statistically greater in female patients in the MR(+) group than in females in the other groups. It is suspected that functional or pathological changes which induce MVP are likely to progress to the tricuspid ring in female patients.

[Pulmonary regurgitation with special reference to the shape of the pulmonary valve ring: a pulsed Doppler and angiographic study].

Using pulsed Doppler echocardiography and cineangiography, the significance of pulmonic valve ring dimensions in the genesis of pulmonic regurgitation (PR) was studied in 40 patients, including 12 with valvular disease, 19 with coronary artery disease and nine with the normal heart. In nine of the 40 subjects, pulmonary hypertension (mean pulmonary artery pressure greater than or equal to 20 mmHg) was observed. The criterion for diagnosing PR was disturbed flow patterns recorded just below the pulmonic valve which spanned more than 40% of diastole, exceeding 1.5 KHz in peak frequency (corresponding to a flow velocity of about 50 cm/sec). Sagittal and transverse diameters of the pulmonic valve ring (PRDs, PRDt) at the upper edge of the pulmonary sinus, and the sagittal diameter of the pulmonary sinus (PSD) at the level of its maximal bulging were measured using pulmonary angiography. PR was detected in 15 subjects (37.5%). The prevalence of PR among three groups regardless of the absence or presence of pulmonary hypertension was not significantly different. The peak frequency of the regurgitant flow signals as well as the farthest point of the signals detected did not differ among the three groups irrespective of pulmonary hypertension. The ratio of the PRDs to the PRDt (PRDs/PRDt) was greater in patients with PR than in those without PR (p less than 0.001), but no correlation was established between PRDs/PRDt and mean pulmonary artery pressure. The PRDt index and PRDs index (normalized by body surface area) correlated well with the mean pulmonary artery pressure (r = 0.70, p less than 0.001 and r = 0.62, p less than 0.001, respectively). PSD also correlated with the mean pulmonary artery pressure (r = 0.49, p less than 0.01), whereas, PSD/PRDs correlated inversely with the mean pulmonary artery pressure (r = 0.40, p less than 0.01), indicating a relatively more prominent dilatation of the PRDs than of the PSD in cases with pulmonary hypertension. These results suggest that the etiology of PR in our series of patients was primarily attributable to the distortion of the pulmonic valve ring. The wide-spread concept that pulmonary hypertension dilates the pulmonic valve ring, leading to the development of PR, should be criticized.

Comparative studies on the metabolism of 2-(tetrahydrofuryl)-5-fluorouracil and 5-fluorouracil.

5=Fluorouracil inhibited DNA synthesis markedly using various DNA precursors such as deoxyuridine, orotic acid, uracil, and uridine except for thymidine. 2-(Tetrahydrofury)-5-fluorouracil (FT-207) did not inhibit DNA synthesis with any of the precursors tested. The metabolisms of 5-fluorouracil and FT-207 in mice and rats were studied. When administered intravenously 5-fluorouracil was rapidly degraded to fluoro-beta-alanine in both mice and rats, while at most 70% of FT-207 was slowly degraded after a prolonged period. The metabolites of FT-207 were found to be 5-fluorouracil and fluoro-beta-alanine in both species of animals. In vitro degradation of FT-207 into 5-fluorouracil was observed mainly in the microsomal fraction in the presence of NADPH. This result suggested that microsomal electron-transport system was concerned with the degradation of FT-207.

Effect of thymidine and thymidylate analogs on nucleic acid synthesis in tumor cells.

Synthetic 5'-amino-5'-deoxythymidine (5'-AdThd), alpha,beta-methylenethymidine diphosphate (alpha,beta-MTDP), and alpha,beta-methylenethimidine triphosphate (alpha,beta-MTTP) were found to inhibit thymidine kinase. Using thymidine kinase extracted from FM 3A/B cells (a strain of mouse mammary gland tumor cells), the Ki values of 5'-AdThd, alpha,beta-MTDP, and alpha,beta-MTTP against thymidine were calculated to be 9.2 X 10(-5)M, 2.3 X 10(-5) M, and 1.8 X 10(-5) M, respectively. At concentrations above their Ki values alpha,beta-MTDP and alpha,beta-MTTP did not inhibit incorporation of labeled thymidine into DNA of cultured cells, whereas 5'-AdThd did. Under the same conditions all three compounds inhibited TMP incorporation. The inhibitions of thymidine and TMP incorporation were specific, since the incorporation of deoxyguanosine was scarcely inhibired by 5'-AdThd. These results suggested that the specific inhibition of thymidine and TMP incorporation was mostly due to reduction in permeability of the cells to these substrates rather than to inhibition of thymidine kinase activity.

Intracellular distribution of various enzymes concerned with DNA synthesis from normal and regenerating rat liver, and Yoshida sarcoma.

During the fractionation of various enzymes concerned with DNA synthesis from the postmicrosomal supernatant fraction of various tissues, DNA polymerace [EC 2.7.7.7], thymidine kinase [EC 2.7.1.75], dTMP kinase [EC 2.7.4.9], deoxycytidine kinase [EC 2.7.1.74], and deoxycytidine monophosphokinase (dCMP kinase) [EC 2.7.4.14] were found in the pellet fraction of postmicrosomal supernatant. Further, the uridine kinase [EC 2.7.1.48] and aspartate transcarbamylase [EC 2.1.3.2] activities of postmicrosomal supernatant from various tissues were also present in this pellet fraction. The activities of DNA polymerase, thymidine kinase, uridine kinase, and aspartate transcarbamylase from normal and regenerating rat liver, and Yoshida sarcoma were higher in the pellet fraction than in the supernatant. On the other hand, the activities of dTMP kinase, dCMP kinase, and orotidine-5'-phosphate decarboxylase [EC 4.1.1.23] were lower in the pellet fraction than in the supernatant. The pellet fractions of regenerating rat liver and Yoshida sarcoma showed a remarkable incorporation of various precursors (thymidine, dTMP, deoxycytidine, and dCMP) into DNA in the presence of a suitable DNA template, ATP and all four deoxynucleoside 5'-triphosphates for DNA synthesis. Normal adult rat liver catalyzed a much smaller incorporation of all these precursors, except for dCMP.