Effect of sample collection site on semen parameters of healthy young volunteers.

The effect of sample collection site on semen parameters in ten men aged between 22 and 24 years was investigated. Sperm was collected at two sites: in a university hospital restroom for general use and in a one-person hospital room. Samples were collected from the same individual twice, with an interval of two weeks between collections. Semen parameters for the two sites were compared. Samples were collected after a minimum of three days and not longer than seven days of sexual abstinence. Sperm concentration did not differ significantly between the university hospital restroom location (86.8 +/- 25.4 x 10(6)/ml; mean +/- standard deviation) and the private hospital room (97.1 +/- 72.0 x 10(6)/ml). There was no difference in the total motile sperm count or daily sperm production between the collection sites. These results suggest that the collection site has little effect on semen parameters.

Individual variation in semen parameters of healthy young volunteers.

Individual variation in semen parameters was investigated in healthy young volunteers. Semen samples were collected approximately once a month over a one-year period for a total of 93 samples (5 to 10 samples per subject) from 12 volunteers in their twenties. Semen analysis was carried out according to the WHO Manual. The amount of variation in each semen variable was calculated for each subject by dividing the maximum value by the minimum value. The results showed that the semen volume varied by 1.9+/-0.8 fold (1.3 to 4.2 fold), the sperm concentration by 4.8+/-4.3 fold (1.5 to 17.2 fold), the percentage of sperm with forward progression by 2.8+/-1.4 fold (1.6 to 6.4 fold), the percentage of sperm with rapid linear progression by 3.4+/-2.6 fold (1.7 to 10.9 fold), the percentage of sperm with normal morphology by 1.9+/-0.4 fold (1.3 to 2.4 fold), and the percentage of live sperm by 1.5+/-0.4 fold (1.1 to 2.6 fold). A between-group comparison showed significant differences in all of the variables except the percentage of sperm with normal morphology. These results suggest multiple and considerable semen analyses are needed when evaluating semen parameters.

Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery.

We investigated the relation between left anterior descending (LAD) coronary artery morphology and inferior lead ST-segment changes to elucidate the clinical significance of such changes in 159 patients with anterior wall acute myocardial infarction (AMI). Patients with 1-vessel LAD artery lesions were divided into an ST depression group (n = 40), an ST elevation group (n = 25), and a no-ST-change group (n = 94) based on ST-segment changes in the inferior leads. The relation between each group and the infarct-related lesion and the presence of a wrapped LAD artery was then investigated. The percentage of patients with the infarct-related lesion in the proximal LAD artery was significantly higher in the ST depression group and significantly lower in the ST elevation group. The percentage of patients with a wrapped LAD artery was significantly higher in the ST elevation group and significantly lower in the ST depression group. The wall motion index determined echocardiographically was significantly higher in the ST depression group and the no-ST-change group than in the ST elevation group. Our findings suggest that inferior lead ST-segment changes during anterior wall AMI arise as a result of competition between reciprocal changes caused by high lateral wall AMI due to lesions of the proximal LAD artery, which depress the ST segment, and inferoapical wall AMI due to a wrapped LAD artery, which elevates the ST segment. In patients with no ST-segment changes, echocardiography was useful for distinguishing the amount of affected LAD artery territory.

Myocardial damage and left ventricular dysfunction in patients with and without persistent negative T waves after Q-wave anterior myocardial infarction.

Persistent T-wave inversions during the chronic stage of Q-wave myocardial infarction (MI) indicate the presence of a transmural infarction with a fibrotic layer pathologically. The aim of the present study was to examine the relation between left ventricular (LV) damage and changes in polarity of the T waves from the acute to chronic phase in patients with Q-wave anterior wall MI. We studied 140 patients with persistent T-wave inversions in leads with Q waves (negative T-wave group) and 158 patients with positive T waves (positive T-wave group) at 12 months after anterior MI. In the positive T-wave group, the precordial T waves reverted from a negative to a positive morphology < 3 months after MI in 21 patients (3 M-positive T-wave subgroup), 3 to 6 months in 52 patients (6 M-positive T-wave subgroup), and 6 to 12 months in 75 patients (12 M-positive T-wave subgroup). Ten patients had persistent positive T waves without initial T-wave inversion (persistent positive T-wave group). Wall motion index and LV dimension were higher and the wall thickness for the infarct area and LV ejection fraction were lower in the negative T-wave than in the positive T-wave groups, except the persistent positive T-wave group in the chronic stage (p < 0.0001). Wall motion in the infarcted area improved over the course of 1 year in the 3 M-, 6 M-, and 12 M-positive T-wave subgroups (p < 0.0001), but not in the persistent positive T-wave group. Among the patients with T-wave inversions after admission, those who had persistent negative T waves after 12 months had worse LV function. In patients with initial T-wave inversion, earlier normalization of the precordial T waves was associated with greater improvement in LV function. Patients with persistent positive T waves without initial negative T waves had poorer recovery of LV function than patients with persistent negative T waves. We conclude that the presence of inverted T waves in leads with abnormal Q waves 12 months after MI and the time required for T-wave normalization can be used to assess the degree of LV dysfunction.

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction.

BACKGROUND: Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI. HYPOTHESIS: The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI. METHODS: Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death. RESULTS: In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1. CONCLUSION: Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.

A new coronary artery disease index of treadmill exercise electrocardiograms based on the step-up diagnostic method.

Treadmill exercise electrocardiography (ECG) is one of the most common noninvasive methods for detecting ischemic heart disease. However, this method has problems due to false-positive and false-negative results in a significant number of patients. The aim of this study was to determine whether the diagnostic accuracy of treadmill exercise ECG for detecting significant coronary stenosis can be improved by employing a step-up diagnostic method using multiple diagnostic indicators. We studied 273 consecutive patients (mean age, 56 +/- 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise ECG and coronary angiography for ischemic chest pain. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 patients had left main truncus disease. A multivariate logistic regression analysis was used to select 3 treadmill exercise electrocardiographic parameters that were independent predictors of the presence or absence of significant coronary stenosis: exercise-induced maximum ST-segment depression, QT dispersion immediately after exercise, and Athens QRS score. Significant coronary stenosis was diagnosed with a sensitivity of 84% and a specificity of 90% when a step-up diagnostic method using these 3 indicators was employed. These results were better than those obtained for each indicator alone (exercise-induced maximum ST-segment depression: sensitivity, 66%, and specificity, 73%; QT dispersion immediately after exercise [> or =60 ms positive]: sensitivity, 76%, and specificity, 86%; and Athens QRS score [< or =5 mm positive]: sensitivity, 72%, and specificity, 72%). We conclude that this step-up diagnostic method, using multiple diagnostic indicators, is a clinically useful predictor of the presence or absence of significant coronary stenosis.

Transition from classic aortic dissection to aortic intramural hemorrhage--a case report.

A 64-year-old man was hospitalized with chief complaints of chest and back pain. A diagnosis of Stanford type A aortic dissection with a false lumen extending from the ascending to the descending aorta was made based on the results of computed tomography (CT). A CT obtained the following day showed resolution of the false lumen and increased brightness of the aortic wall, typical of aortic dissection with intramural hemorrhage. Although previous studies have described a gradual transition from aortic intramural hemorrhage to aortic dissection with a false lumen, there are no reports of the transition from an aortic dissection with a false lumen to the intramural hemorrhage type of aortic dissection. This patient is of interest when considering the pathogenesis of aortic dissection with intramural hemorrhage and the relationship between the intramural hemorrhage and false-lumen types of aortic dissection.

Usefulness of QT dispersion immediately after exercise as an indicator of coronary stenosis independent of gender or exercise-induced ST-segment depression.

Several recent studies suggest that QT dispersion on a standard 12-lead electrocardiogram is a clinically useful indicator of significant coronary stenosis. In this study, we compared the diagnostic accuracy of QT dispersion immediately after exercise as an indicator of coronary stenosis in men and women, and in the presence or absence of exercise-induced significant ST-segment depression. The subjects were 273 consecutive patients (mean age 56 +/- 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise electrocardiography and coronary angiography for evaluation of angina. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 had left main coronary artery disease. QT dispersion immediately after exercise was significantly greater in patients with significant coronary stenosis than in those without (64 +/- 14 vs 39 +/- 14 ms, p <0.01). QT dispersion immediately after exercise was significantly more sensitive in men (sensitivity 75%; specificity 85%) and significantly more specific in women (sensitivity 77%, specificity 88%) than exercise-induced significant ST-segment depression (men: sensitivity 62%, specificity 74%; women: sensitivity 81%, specificity 68%) as an indicator of significant coronary stenosis. The addition of factors such as gender and the presence or absence of exercise-induced significant ST-segment depression did not significantly alter the sensitivity and specificity of QT dispersion immediately after exercise for detecting significant coronary stenosis (patients with significant ST-segment depression: sensitivity 77%, specificity 88%; patients without significant ST-segment depression: sensitivity 72%, specificity 86%). In conclusion, QT dispersion immediately after exercise is a clinically useful indicator of significant coronary stenosis independent of gender or the presence or absence of exercise-induced significant ST-segment depression.

ST-segment elevation in leads I and aVL predicts short-term prognosis in acute anterior wall myocardial infarction.

Our study demonstrates that ST-segment elevation in both leads I and aVL noted on admission for an anterior acute myocardial infarction does portend a worse short-term survival. Independent predictors of short-term prognosis in an anterior acute myocardial infarction include ST elevation in both leads I and aVL, advanced age, female gender, left ventricular failure, and malignant arrhythmias.

[A case of Down's syndrome associated with testicular seminoma].

Down's syndrome is an inherited disorder caused by trisomy of chromosome 21. In patients with Down's syndrome, an increased risk of leukemia has been observed. Recently, the coincidence of testicular cancer with this syndrome has been also emphasized. We present a case of Down's syndrome associated with testicular seminoma. This is the 19th case of Down's syndrome associated with testicular tumor in Japan.

Enhanced detection of ischemic but viable myocardium by QT interval dispersion on treadmill exercise electrocardiograms of patients with healed anterior wall myocardial infarcts.

BACKGROUND: The presence of ischemic but viable myocardium in infarcted areas is an important indication for coronary revascularization, but is often difficult to detect with the use of treadmill exercise electrocardiography (ECG). HYPOTHESIS: QT interval dispersion (QTd) is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarcted areas. METHODS: Forty-five patients with Q-wave anterior wall myocardial infarctions who underwent treadmill exercise ECG, exercise reinjection thallium-201 (201Tl) scintigraphy, radionuclide angiocardiography, and coronary angiography 1 month after infarction were enrolled in this study. The presence of viable myocardium in the infarct area was determined by exercise reinjection 201Tl scintigraphy. Patients who had no redistribution in the infarct area after reinjection were included in Group 1, and those with redistribution were included in Group 2. RESULTS: QTd immediately after exercise, and the difference between QTd before and immediately after exercise, were significantly greater in Group 2 than in Group 1. The sensitivity, specificity, and accuracy of conventional ST-segment depression criteria for detecting viable myocardium in the infarct area were 48, 64, and 56%, respectively. The measurement of QTd immediately after exercise (abnormal: > or = 70 ms; normal: < 70 ms) improved the sensitivity, specificity, and accuracy to 78, 82, and 80%, respectively. CONCLUSIONS: This novel diagnostic method using QTd-based criteria significantly improves the clinical usefulness of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarct areas in patients with healed Q-wave anterior wall myocardial infarctions.

Value of QT dispersion in the interpretation of treadmill exercise electrocardiograms of patients without exercise-induced chest pain or ST-segment depression.

It has recently been reported that increased QT dispersion seen on standard 12-lead electrocardiograms (ECGs) reflects transient myocardial ischemia. The present study investigates whether increased QT dispersion induced by exercise is a useful indicator for detecting significant coronary stenosis in patients who do not have chest pain or significant ST-segment depression in response to exercise. We studied 135 consecutive patients (mean age +/- SD, 55 +/- 9 years; 97 men and 38 women) who complained of anginal chest pain and who did not have exercise-induced chest pain or significant ST-segment depression during treadmill exercise electrocardiography. Coronary angiography was performed in all of patients. Of the 135 patients, 97 had no significant coronary stenosis, 25 had 1-vessel coronary artery disease (CAD), and 13 had multivessel CAD. QT dispersion immediately after exercise was significantly greater in the group with significant coronary stenosis than without significant coronary stenosis (62 +/- 13 vs 40 +/- 14 ms, p <0.0001). When QT dispersion >/=60 ms immediately after exercise was considered a positive result, this indicator had a sensitivity of 74%, a specificity of 85%, and an accuracy of 81% for the diagnosis of significant coronary stenosis. In conclusion, we have shown that QT dispersion immediately after exercise is useful for detecting significant CAD in patients who do not have exercise-induced chest pain or significant ST-segment depression.

Cardiac rupture and admission electrocardiography in acute anterior myocardial infarction: implication of ST elevation in aVL.

This study determines the usefulness of electrocardiography in the emergency room for assessing the risk of cardiac rupture after acute anterior myocardial infarction (MI). The presence of ST segment elevation on the admission 12-lead electrocardiography was evaluated in 325 consecutive anterior MI patients. A forward-stepwise logistic regression analysis for cardiac rupture was performed with the covariates of age, gender, hypertension, history of MI, reperfusion therapy by coronary angioplasty, and ST segment elevations in leads I, aVL, V1-V6. Cardiac rupture occurred in 16 patients, including 7 with left ventricular free wall rupture (FWR) and 9 with ventricular septal perforation (VSP). For FWR, ST elevation in lead aVL was the only independent predictor (odds ratio = 12.1, P = .0215). For VSP, female gender (odds ratio = 5.32, P = .0201) was the independent predictor. In conclusion, in patients with acute anterior MI, ST segment elevation in lead aVL on the admission electrocardiography is a significant risk factor for left ventricular FWR.

Use of QT dispersion measured on treadmill exercise electrocardiograms for detecting restenosis after percutaneous transluminal coronary angioplasty.

BACKGROUND: Treadmill exercise electrocardiography (ECG) has been used to detect restenosis in patients following percutaneous transluminal coronary angioplasty (PTCA). However, the level of sensitivity achieved using conventional criteria of ST-segment depression is too low to be clinically useful in this population. HYPOTHESIS: QT dispersion is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting restenosis after PTCA. METHODS: We evaluated 104 patients who underwent PTCA for the treatment of single-vessel coronary artery disease and who had no history of myocardial infarction. Treadmill exercise ECG and coronary angiograms were performed 3 months after PTCA to determine the accuracy of diagnosis restenosis based on standard ST-segment depression and QT dispersion criteria. RESULTS: Restenosis was observed in 37 of the 104 patients (36%) 3 months after PTCA. QT dispersion immediately after exercise was significantly greater in patients with than in those without restenosis, as was the difference in QT dispersion before and immediately after exercise. The sensitivity, specificity, and accuracy of ST-segment depression criteria were 59, 64, and 63%, respectively. Measurements of QT dispersion immediately after exercise (> or = 50 ms: positive, < 50 ms: negative) improved the sensitivity, specificity, and accuracy of treadmill ECG for predicting restenosis to 81, 87, and 85%, respectively. CONCLUSIONS: This novel diagnostic method using QT dispersion-based criteria significantly improves the clinical usefulness of treadmill exercise ECG for detecting the presence of restenosis after PTCA.

XX-male syndrome bearing the sex-determining region Y.

The case of a 25-year-old man who presented for evaluation of infertility is described. The physical examination revealed testicular atrophy without gynecomastia. Repeated seminal analyses showed azoospermia, and serum hormonal levels suggested a state of a hypergonadotropic hypogonadism. Chromosomal analysis demonstrated 46XX. Polymerase chain reaction revealed the existence of a sex-determining region Y. The etiology of this rare sex reversal syndrome is discussed and cases reported in Japan are reviewed.

QT dispersion in patients with Duchenne-type progressive muscular dystrophy.

BACKGROUND: A high degree of QT dispersion is a risk factor for arrhythmic sudden death in patients with myocardial infarction and cardiomyopathy. Duchenne-type progressive muscular dystrophy (DMD) is also associated with the development of ventricular arrhythmias. The purpose of this study was to determine the relationship between QT interval dispersion and ventricular arrhythmias in patients with DMD. METHODS: Sixty-seven patients with DMD were studied. Standard 12-lead electrocardiograms and 24-hour Holter electrocardiograms were recorded, and the QT interval was determined in every lead of the standard electrocardiogram to determine the QT dispersion. QT dispersion was compared with the frequency of ventricular arrhythmias and the severity of skeletal muscle damage on the basis of the Swinyard and Deaver 8-stage scale. RESULTS: QT dispersion in all 67 patients averaged 54 +/- 18 ms. The QT dispersion was 49 +/- 16 ms in stage 5 patients, 61 +/- 22 ms in stage 6 patients, 52 +/- 17 ms in stage 7 patients, and 56 +/- 17 ms in stage 8 patients. Ventricular arrhythmias of Lown grade III or higher were observed in 3 of 35 patients with QT dispersion <60 ms and in 14 of 32 patients with QT dispersion >/=60 ms. Logistic regression analysis demonstrated that QT dispersion is an independent risk factor for ventricular arrhythmias of grade III or higher in patients with DMD. CONCLUSIONS: The incidence of ventricular arrhythmias of Lown grade III or higher was greater in patients with QT dispersion >/=60 ms than in patients with QT dispersion >60 ms. QT dispersion therefore is a risk factor for serious ventricular arrhythmias in patients with DMD.

Clinical significance of the disappearance of septal Q waves after the onset of myocardial infarction: correlation with location of responsible coronary lesions.

We investigated the relationship between the disappearance of septal Q waves after myocardial infarction (MI) and the location of the culprit lesion. We studied 82 patients following their first anteroseptal MI who had an electrocardiogram performed before the MI. Septal Q waves were detectable before MI in 56 patients and disappeared after MI in 17 of those patients. The culprit lesion was located proximal to the origin of the first septal branch (S1) in 13 patients (76%). Disappearance of septal Q waves following MI predicted that the culprit lesion was proximal to the origin of S1 (sensitivity, 42%; specificity, 84%; predictive value, 76%; and accuracy, 61%). If septal Q waves that were detected before MI disappeared after MI, the culprit lesion was located proximal to the origin of S1 in 76% of the patients. This finding may be clinically useful in caring for patients following MI.

Nine-year follow-up study of heart rate variability in patients with Duchenne-type progressive muscular dystrophy.

OBJECTIVES: The purpose of this study was to investigate the progression of autonomic dysfunction in patients with Duchenne-type progressive muscular dystrophy (DMD) over time by using heart rate variability. BACKGROUND: Although previous studies suggest the presence of autonomic dysfunction in patients with DMD, the precise cause is not known. On the other hand, it is well known that analysis of heart rate variability provides a useful, noninvasive means of quantifying autonomic activity. High frequency power is determined predominantly by the parasympathetic nervous system, whereas low frequency power is determined by both the parasympathetic and sympathetic nervous systems. METHODS AND RESULTS: Frequency and time domain analyses of heart rate variability during ambulatory electrocardiographic monitoring were performed in 17 patients with DMD over a 9-year period. At the time of entry, the mean patient age was 11 years and the mean Swinyard-Deaver stage was 4. In the first year, high frequency power was significantly lower and the ratio of low frequency to high frequency was significantly higher in patients with DMD than in the normal control subjects. These differences become significantly greater as the disease progressed. At the time of entry, low and high frequency powers increased at night in both groups. However, over time, high and low frequency powers at night tended to decrease. All of the time domain parameters were significantly lower in the patients with DMD at all time points compared with the normal control subjects. CONCLUSIONS: We concluded that DMD patients have either a decrease in parasympathetic activity, an increase in sympathetic activity, or both as their disease progresses.

Heart rate variability during the first month of smoking cessation.

BACKGROUND: Heart rate variability (HRV) is known to increase after smoking cessation. However, no work has been performed concerning HRV immediately after smoking cessation. METHODS AND RESULTS: We studied HRV before and from 1 day to 1 month after smoking cessation and also determined whether there is a relation between HRV and the withdrawal syndrome immediately after smoking cessation. We determined HRV by using a two-channel 24-hour ambulatory ECG system before and 1, 2, 3, 7, 14, 21, and 28 days after smoking cessation in 20 healthy male volunteers who had smoked one or more packs per day for 2 or more years. One day after smoking cessation, heart rate decreased significantly, and all 24-hour time and frequency domain indices of HRV increased except the standard deviations of the normal R-R intervals and the 5-minute mean R-R. The magnitude of increase in these indices peaked 2 to 7 days after smoking cessation and gradually decreased thereafter. The increase in HRV persisted 1 month after smoking cessation. In the 16 subjects with signs of withdrawal syndrome and in the four subjects without evidence of withdrawal before and immediately and 1 month after smoking cessation, HRV increased immediately after smoking cessation and remained elevated after 1 month. CONCLUSIONS: HRV increases immediately after smoking cessation and gradually declines thereafter, which suggests that the effect of smoking on autonomic activity rapidly disappears immediately after smoking cessation. HRV remained unaffected by the presence or absence of the withdrawal syndrome.

Prognosis following acute myocardial infarction in patients with ECG evidence of left ventricular hypertrophy prior to infarction.

This study was designed to determine the relationship between prognosis after myocardial infarction (MI) and left ventricular hypertrophy (LVH). Left ventricular hypertrophy diagnosed by electrocardiography according to the criteria of Sokolow and Lyon was noted in 57 of 223 patients (25.6%) on the pre-MI electrocardiogram (ECG), in 11.2% on an early post-MI ECG, and in 11.3% on the discharge ECG. In-hospital and 1-year postdischarge mortalities were significantly greater in patients with LVH noted on pre-MI ECG than in patients without prior LVH. There was no relationship between the presence of LVH on early post-MI ECGs and in-hospital or postdischarge 1-year mortality. Multivariate analysis revealed that evidence of LVH on a pre-MI ECG and acute congestive heart failure were independent predictors of cardiac death within 1 year of MI in patients over 70 years old. It is concluded that in patients over 70 years of age, the presence of LVH on a pre-MI ECG is a reliable predictor of post-MI prognosis.