Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction.

BACKGROUND: We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct-related lesion (IRL). HYPOTHESIS: The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock. METHODS: The study group consisted of 53 patients with single-vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non-shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI. RESULTS: Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phosphokinase (CPK-MB). the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non-shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK-MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI. CONCLUSION: This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.

Effect of the stenosis location and severity on left ventricular function after single-vessel anterior wall myocardial infarction.

BACKGROUND: The purpose of the current study was to determine how the location of the infarct-related lesion (IRL) and the degree of stenosis during the acute and chronic phases of infarction might affect left ventricular (LV) function in patients with acute anterior wall myocardial infarction. METHODS: Ninety consecutive patients with a first single-vessel anterior wall myocardial infarction (male/female ratio 75:15, mean age 60+/-9 years) underwent coronary angiography (CAG) immediately and 1 month after infarction. Patients were grouped according to IRL location (proximal [Coronary Artery Surgery Study (CASS) No. 12] or distal [CASS No. 13] to the first diagonal branch of the left anterior descending artery) and according to the severity of stenosis at 1 month (severe stenosis [IRL >75%] and mild stenosis [IRL < or =75%]). At the time of infarction and 1 month and 1 year after infarction, total wall motion index (TWMI), left ventricular end-diastolic dimension (LVDd), left ventricular end-systolic dimension (LVDs), and fractional shortening (FS) were determined. RESULTS: TWMI was greater and FS was lower for CASS No. 12 lesions than for CASS No. 13 lesions. CASS No. 12 lesions were associated with a greater LVDd at 1 year and a greater LVDs throughout 1 year of observation. The patients with mild stenoses had significant improvements in TWMI and FS over time, whereas those with severe stenoses showed no improvement. Multivariate analysis showed that the independent factors predicting left ventricular function were IRL location at CASS No. 12, initial TIMI 0-1 flow in the IRL at emergency coronary artery graft, and the presence of a severe stenosis at 1 month. CONCLUSIONS: In patients with severe stenoses at 1 month at CASS No. 12, left ventricular functional recovery is delayed and the left ventricular chamber is enlarged. In patients with CASS No. 13 lesions, left ventricular function is preserved well, regardless of the severity of residual stenosis.

Prognosis of aortic intramural hemorrhage compared with classic aortic dissection.

Aortic intramural hemorrhage occurs fairly frequently among patients with aortic dissection, and may not have a poor prognosis if it is Stanford type B. In patients with type A aortic dissection, cardiac tamponade should be ruled out during observation.

Quantitative evaluation of coronary stenosis by coronary magnetic resonance angiography.

Coronary magnetic resonance angiography (coronary MRA) can detect, noninvasively, a high proportion of severe stenotic lesions found on coronary angiograms. However, quantitative evaluation of coronary artery stenosis by coronary MRA has been performed only in a small number of patients. This study was designed to determine whether coronary MRA can assess the degree of stenosis using the two-dimensional segmented turbo-FLASH method (2D method). We studied 108 patients with technically adequate coronary MRA images. The blood flow signal intensity on coronary MRA was classified as markedly decreased, moderately decreased, or normal. The severity of coronary artery stenosis was determined by the caliper method, and coronary stenosis was rated using a seven-point scale (0%, 25%, 50%, 75%, 90%, 99%, and 100%) in accordance with the American Heart Association classification system. Patients were classified into three groups: normal coronary artery (0%-25% stenosis), moderate stenosis (50%-75% stenosis), and severe stenosis (90%-100% stenosis). The degree of stenosis on coronary angiography and the decrease in coronary MRA signal intensity were compared. The right coronary artery was evaluated in 64 patients and the left coronary artery in 73 patients. When a marked or moderate decrease in coronary MRA blood flow signal intensity was defined as indicating stenosis, the sensitivity and specificity of coronary MRA for detecting angiographically severe stenosis were 85% and 80%, respectively. A moderate decrease in coronary MRA blood flow signal intensity detected angiographically moderate stenoses with a sensitivity of 38% and a specificity of 83%. Coronary MRA can detect a high proportion of severe stenoses but only a low proportion of moderate stenoses. Technical improvements are required before coronary MRA can be used clinically.

Amplification of c-myc in hepatocellular carcinoma: correlation with clinicopathologic features, proliferative activity and p53 overexpression.

Expression of the proto-oncogene c-myc has been implicated in liver regeneration and hepatocarcinogenesis. The biologic significance of c-myc gene amplification in human hepatocellular carcinoma, however, is unconfirmed. We correlated c-myc gene amplification with clinicopathologic features, proliferative activity, and p53 expression in 42 resected tumors. c-myc amplification in tumor tissue was determined using a differential polymerase chain reaction, a useful procedure for the evaluation of gene amplification in archival formalin-fixed paraffin-embedded tissues, in comparison with a dopamine D2 receptor gene. Proliferative activity was estimated by numbers of argyrophilic nucleolar organizer regions and immunohistochemical nuclear labeling rates using a monoclonal antibody against Ki-67. The c-myc gene was amplified in 14 of 42 tumors (33.3%). Amplification of c-myc was more frequent in younger patients and in larger tumors, and less differentiated tumors. No correlation was noted with alpha-fetoprotein level or viral hepatitis state. The amplification showed positive correlation with both proliferative activity and p53 overexpression. Disease-free survival in patients showing c-myc amplification was significantly shorter than in those without amplification. These results suggest that c-myc amplification is an indicator of malignant potential and poor prognosis in hepatocellular carcinoma. c-myc amplification and p53 alteration may be coparticipating events in the progression of these tumors.

Low MIB-1 labeling index in anti-HCV positive hepatocellular carcinoma.

It has been reported that hepatitis C virus-related hepatocellular carcinoma (HCC) patients survive longer than hepatitis B virus-related patients. In this study, since HCC patients positive for anti-HCV antibody had significantly longer disease-free survival (p<0.05), we evaluated the proliferative activity of 58 resected HCCs and the status of their viral infections. Ki-67 (MIB-1) immunostaining, argyrophilic nucleolar organizer regions and c-myc gene amplification were examined as parameters of proliferation, and p53 overexpression was examined in relation to clinicopathologic features and prognosis. Thirty-nine patients with HCC (67%) were positive for anti-HCV antibody alone, five (9%) were negative for both anti-HCV and HBV antibodies, two (3%) were positive for both anti-HCV and HBV antibodies, and 12 (21%) had HBsAg alone. HCC patients with anti-HCV antibody had a lower MIB-1 labeling index (LI) than HCC patients negative for the antibody (p<0.05), irrespective of the serum HBsAg status. However, there was no significant correlation between anti-HCV antibody and other proliferative parameters. MIB-1 could simply be related to cellular proliferation. On the other hand, the other parameters may be related to tumor progression as well as proliferation. HCV-related HCC does have lower proliferative activity and a better prognosis.

[Effect of steroids on postoperative pain and pyrexia].

Effect of steroid (Solucortef or Solumedrol) 1g on postoperative pain and pyrexia was investigated in 103 patients after total hip joint or knee joint replacement. In control group without intraoperative steroid administration, 95.0% of the patients suffered postoperative pain, but in group with intraoperative steroid administration, postoperative pain was observed in 33.3% of patients. Supplemental administration of dichlofenac sodium 50 mg could not reduce postoperative pain. Intraoperative administration of a large dose of steroid was also effective in relieving postoperative pyrexia.

[A biliary endocrine cell carcinoma: a report of two cases].

An endocrine cell carcinoma is a carcinoid tumor that has an especially malignant prognosis. We herein report on 2 cases of a biliary endocrine cell carcinoma. Case 1 involved a 68 year old man manifesting a fever, jaundice, hepatomegaly and a ballooned gallbladder. After decreasing the jaundice by PTCD, an exploratory abdominal operation was performed. As a tumor was found at the papilla of Vater, a pancreaticoduodenectomy was done. Case 2 involved a 72 year old woman who was diagnosed as having a gallbladder tumor and cholelithiasis. She was given a cholecystectomy and a choledocholithotomy. These 2 cases had hepatic metastasis within a year and subsequently died. Procedurally, an endocrine cell carcinoma should be treated separately from classical carcinoid tumors.

[The effect of the sympathetic nervous system on cervical spondylosis (author's transl)].

A study on the effect of injury to the cervical spine, especially the so-called whiplash injury of the neck, has revealed that many patients who have sustained cervical trauma complain of, or later develop, vertigo similar to that encountered in Ménière's syndrome. Some authors offer clinical evidence to show that vertigo results from cervical nerve root irritation which is due to hypertrophic arthritis of the cervical spine and which responds to cervical traction. The etiology of this symptom-complex, however, remains unknown and, presenting a controversial problem, while some authors point out that irritation of the sympathetic nervous system may be important in this symptom (Mèniére-like syndrome, Barré-Lieou syndrome). In this study, the significance of the sympathetic nervous system in cervical spondylosis was examined. A) The effect of electric stimulation (2V, 20cps, 1msec, 1mA) of the human anterior longitudinal ligament of the cervical spine on the finger plethysmograph (PTG). This stimulation resulted in manifest alteration of PTG, such as the appearance of tense wave or contracted wave, change of pattern and tachycardia. B) Stimulation of the tissue adjacent to the cervical vertebral column which affects the sympathetic nervous system by way of the central nervous system (ventro-median nucleus of hypothalamus: VMH) was examined by using local electroencephalogram (local-EEG) of cats. By electric stimulation (4-6V, 50cps, 1msec, 1mA) of the tissue adjacent to the cervical vertebral column, local-EEG of VMH was accelerated remarkably and blood pressure was increased. Stimulation of the sciatic nerve caused moderate acceleration with excessive electric stimulation (4-10V, 20cps, 1msec, 1mA); however, stimulation of muscles of the neck and back caused no acceleration. Sensitive receptors are probably located adjacent to the cervical vertebral column. Stimulation of the sympathetic nerve may result from stimulation of the central nervous system (hypothalamus) caused by irritation resulting from excessive instability of the cervical vertebrae. The stimulation of the sympathetic nerves may be important clinically in the pathogenesis of Barré-Lieou syndrome in cervical spondylosis.