Ileal adenomyoma accompanied by primary peritonitis: report of a case.

We report herein the case of a 52-year-old woman who presented with severe abdominal pain and a 2-week history of a yellow vaginal discharge. An emergency operation was performed for localized peritonitis attributed to acute perforated appendicitis. There were no findings to indicate the cause of peritonitis, but by chance, a submucosal tumor was found in the ileum 2m from Bauhin's valve. Appendectomy and wedge resection of the ileum with the submucosal tumor were carried out. The peritonitis was considered to have been idiopathic from bacterial and molecular biological examination of the ascites. Pathological, immunohistochemical, and flow cytometrical findings of the resected ileal submocosal tumor indicated a diagnosis of ileal adenomyoma with no malignancy, which suggested metaplasia of the pancreaticobiliary to gastric epithelium.

Regional cerebral blood flow after status epilepticus.

Two patients with status epilepticus due to specific conditions were examined using MRI and stable Xe/CT CBF. [Case 1] A 30-year-old woman developed a grand mal seizure during delivery. She was comatose, and MRI revealed abnormal high intensity areas bilateral basal ganglia, compatible with eclampsia. Regional CBF was decreased in bilateral occipital lobes and right basal ganglia. Six days after onset. Regional gray matter flow was increased, especially in the thalami and basal ganglia. [Case 2] The patient is a 31-year-old male diagnosed with temporal lobe epilepsy since 10 years. At the onset, he had a prolonged right hemiconvulsion followed by generalized tonic-clonic convulsion. MRI 13 days after onset showed left hemispheric edematous swelling of gray matter. Stable Xe/CT 3 weeks after onset demonstrated increased cortical CBF corresponding to edematous area. The results suggested that regional CBF decreased immediately after status epilepticus and then increased for 1-3 weeks in the interictal period. We speculate that the energy debt incurred during prolonged seizure causes relative ischemic condition in the neurons, with the increase in CBF resulting from accelerated energy production for a long period.

[A case with traumatic internal carotid artery dissection in which the extent of the pseudolumen was defined by MR angiography].

We report a 29-year-old male with traumatic internal carotid artery (ICA) dissection who presented with cerebral ischemia developed after removal of a left acute subdural hematoma and external decompression. CT scans 4 days after the operation showed infarctions of the distribution of the bilateral cerebral hemispheres. Cerebral angiography on the 11th hospital day demonstrated narrowing of the extracranial internal carotid artery at C1-C2 vertebral levels. Slight arterial dilatation and retention of the contrast medium were found just above the narrowing segment, which was suspected to be a pseudolumen. Three D time-of flight MRA showed an intramural hematoma corresponding to the narrowing on the angiography. Original axial MRA images showed that narrowing of the lumen was surrounded by a crescent hematoma and that two flow velocity areas were in the area distal to the narrowing. High flow seemed to be ordinary artery flow rate. The low flow area, including turbulent flow, led to the retention of contrast medium mimicking a pseudolumen. Precise MRA imaging will bring us an accurate diagnosis of extracranial carotid dissections.

Bilateral chronic subdural hematomas resulting in unilateral oculomotor nerve paresis and brain stem symptoms after operation--case report.

An 85-year-old male presented with bilateral chronic subdural hematomas (CSDHs) resulting in unilateral oculomotor nerve paresis and brainstem symptoms immediately after removal of both hematomas in a single operation. Initial computed tomography on admission demonstrated marked thick bilateral hematomas buckling the brain parenchyma with a minimal midline shift. Almost simultaneous removal of the hematomas was performed with the left side was decompressed first with a time difference of at most 2 minutes. However, the patient developed right oculomotor nerve paresis, left hemiparesis, and consciousness disturbance after the operation. The relatively marked increase in pressure on the right side may have caused transient unilateral brain stem compression and herniation of unilateral medial temporal lobe during the short time between the right and left procedures. Another factor was the vulnerability of the oculomotor nerve resulting from posterior replacement of the brain stem and stretching of the oculomotor nerves as seen on sagittal magnetic resonance (MR) images. Axial MR images obtained at the same time demonstrated medial deflection of the distal oculomotor nerve after crossing the posterior cerebral artery, which indicates previous transient compression of the nerve and the brain stem. Gradual and symmetrical decompression without time lag is recommended for the treatment of huge bilateral CSDHs.

The deeper the negativity of the T waves recorded, the greater is the effectiveness of reperfusion of the myocardium.

We evaluated the time course of QT intervals and the amplitude of T waves, and their relationship to subsequent left ventricular regional wall motions in 88 patients with successfully reperfused acute myocardial infarction (MI). The QTc intervals and the amplitude of inverted T waves of lead V3 in patients with anterior MI and of lead III in patients with inferior MI were measured for 1 month after MI. Patients were classified as having severe T wave inversion or mild T wave inversion within 3 days of MI, based on a measurement of 0.5 mV in the anterior MI cases and 0.3 mV in the inferior MI cases. Chronicphase left ventriculography was performed 5 months later, and hypokinesis of the infarct site was measured using the centerline method. The T waves inverted after reperfusion in 86 patients (98%). The inverted T waves deepened twice, with the first negative peak about 48 h and the second negative peak about 18 days after MI. QTc intervals became prolonged as the T waves deepened. The extent of hypokinesis in the chronic phase correlated with the amplitude of inverted T waves and QTc intervals when the T waves were deepest. The group with severe T wave inversion had less extensive hypokinesis, a lower maximum serum creatine kinase level and a shorter time to reperfusion from the onset of symptoms than the group with mild inversion. We conclude that the degree of T wave inversion 48 h after MI is predictive of abnormalities in left ventricular regional wall motions in the chronic phase. A deep inverted T wave in the acute phase of MI indicates an abundantly stunned myocardium.

[Endothelial dysfunction of the infarct-related coronary artery after reperfusion therapy].

The response of the infarct-related coronary artery to acetylcholine (20, 30, 50 micrograms) was investigated in 30 patients without restenosis during a 4-month follow-up period after direct percutaneous transluminal coronary angioplasty (PTCA) of the left proximal anterior descending coronary artery. The patients were divided into two groups according to wall motion as obtained by the centerline method from a left ventricular angiogram: moderate group (n = 10) with reduced wall motion with less than 20 abnormal contraction segments (moderate reduction at the infarcted site), severe group (n = 20) with reduced wall motion with 20 or more abnormal contraction segments (severe reduction). The acetylcholine-induced percentage changes in luminal diameter were assessed at the PTCA site and the distal portion of the coronary artery and the effect of acetylcholine was compared at the two sites. Coronary artery diameter in the moderate and severe groups displayed 8.1 +/- 24.9% and 7.4 +/- 30.8% contraction at the PTCA site and 38.3 +/- 46.3% and 72.5 +/- 28.2% contraction at the distal portion, respectively. Severe group had greater contraction at the distal portion than at the PTCA site. Vasoconstriction of the patent infarct-related coronary artery tended to occur in the infarcted area where wall motion was severely affected. In addition, endothelial dysfunction appears to be induced by a lengthy interruption of epicardial coronary blood flow and is present in the patent infarcted coronary artery without restenosis.

[Two-color flow cytometry analysis of lymphocyte subsets in patients with acute myocardial infarction and post-myocardial infarction syndrome].

Serial changes in lymphocyte subsets were analyzed in 37 patients with acute myocardial infarction (AMI), in 2 patients with postmyocardial infarction syndrome (PMIS), and in healthy subjects (control group) using two-color flow cytometry to investigate cellular immunity after AMI and PMIS. Peripheral blood lymphocyte subsets were measured on admission and at weeks 2, 4, 8, and 16 after the onset of AMI. The white blood cell count was significantly higher on admission and at week 2 in the AMI group compared with the control group. The percentage of CD4-positive helper T cells was significantly higher on admission and at weeks 2 and 4 in the AMI group compared with the control group, and the percentage of CD8-positive suppressor T cells was significantly lower in the AMI group at week 2 than in the control group. The ratio of helper-to-suppressor T cells peaked 2 weeks after the AMI and then decreased gradually. There were no significant changes in the CD4/CD8 ratio, the percentage of cytotoxic T cells, or the percentage of inducer T cells, throughout the observation period. There were no significant differences in the percentage of T cells, B cells, CD4-positive T cells, CD8-positive T cells, and natural killer cells between AMI patients and control subjects. The percentage of activated CD4- and CD8-positive cells was higher in the AMI group at weeks 4 and 8 than in the control group. There was no significant correlation between changes in lymphocyte subsets and infarct size. The percentage of activated CD8-positive cells was consistently higher in the PMIS group compared with the control and AMI groups. The percentage of cytotoxic T cells in one of the PMIS patients was significantly higher than in the AMI group. There were no significant differences in the proportions of other subsets between PMIS and AMI patients. The changes in lymphocyte subsets observed in patients with AMI suggested that immunological competence was enhanced in these patients. Abnormalities in humoral immunity, such as the appearance of anticardiac antibody, have been observed in patients with PMIS. Our results suggest that PMIS is also associated with changes in cellular immunity.

Acute left ventricular failure with pulmonary edema following pericardiocentesis for cardiac tamponade--a case report.

We describe the complications of pericardiocentesis and their management in an 18 year-old man. This patient was admitted because of dyspnea and was found on echocardiogram to have cardiac tamponade with coexisting left ventricular dysfunction. He developed acute left ventricular failure with severe pulmonary edema immediately after pericardiocentesis. This complication may have been caused by an abrupt increase in venous return to the failing left ventricle following the release of the pericardial compression. Therefore, pericardial fluid must be drained with caution in pericardiocentesis, especially in cardiac tamponade patients with left ventricular dysfunction, and hemodynamics should be monitored both during and after this procedure.

[A longitudinal study of brain atrophy and its relation with background factors and common carotid hemodynamics].

This longitudinal study was performed to clarify the relation between brain atrophy and common carotid hemodynamics. A total of 147 patients, including 70 males and 77 females, who had neither neurologic deficits nor organic lesions on computed tomography of the brain, were enrolled in this study. The ages of the patients ranged from 47 to 76 years (mean: 62 years) at the first diagnosis of brain atrophy. The patients were divided into three groups: 66 controls without hypertension or diabetes mellitus (Group I), 60 with hypertension (Group II) and 21 with both hypertension and diabetes mellitus (Group III). Brain atrophy was diagnosed by caudate head index (CHI). Mean blood flow volume (BF) at the right common carotid artery was measured by an ultrasonic quantitative flow measurement system. Both CHI and BF were measured twice at a mean interval 6.5 years. Increment in CHI per year (delta CHI) and decrement in mean blood flow volume per year (delta BF) were calculated. delta CHI of Group I and Group II had a significant relation with aging. delta CHI of Group III showed a larger increase than that of both Group I and Group II in subjects in the sixties. delta CHI had a significant relation with delta BF in each group. These results indicate that complication of both HT and DM, or decrement in mean blood flow volume may cause brain atrophy to progress.

Left ventricular diastolic function in patients on maintenance hemodialysis: comparison with hypertensive heart disease and hypertrophic cardiomyopathy.

To elucidate the differences in the left ventricular diastolic function between patients on maintenance hemodialysis with left ventricular hypertrophy and the those with left ventricular hypertrophy from other causes, 20 patients on maintenance hemodialysis (HD group; mean age 44 +/- 12 years), 12 patients with hypertensive heart disease (HHD group; mean age 43 +/- 10 years), and 10 patients with hypertrophic cardiomyopathy (HCM group; mean age 43 +/- 11 years) were examined non-invasively using diastolic time intervals and digitized echocardiograms. Ten age-matched healthy men (N group; mean age 43 +/- 12 years) were also examined. Compared with the HCM group, the HD and HHD groups had a decreased total left ventricular wall thickness and left atrial dimension, an increased ratio between the left ventricular enddiastolic dimension and total left ventricular wall thickness. The isovolumic relaxation and rapid relaxation periods were prolonged in the order of HCM, HHD, HD and N, but the active suction period was prolonged only in the HCM group. The peak rate of change in the left ventricular dimension during the rapid filling period was decreased in the HCM group, compared with the HD and the HHD groups. These results indicate that hemodialysis patients with left ventricular hypertrophy have some impairment in left ventricular diastolic function, but the degree of the disturbance is similar to that observed in those with hypertensive heart disease, but milder than that observed in those with hypertrophic cardiomyopathy.

Doppler echocardiographic assessment of left ventricular diastolic function in patients with systemic lupus erythematosus.

Thirty patients with clinically inactive systemic lupus erythematosus (SLE) were examined by Doppler echocardiography to investigate the diastolic properties of the left ventricle. Twelve age-matched healthy women were also examined as controls. The pulsed wave transmitral Doppler flow velocity curves were digitized and curves of their first derivatives were obtained. Isovolumic relaxation time (IRT), acceleration and deceleration half-time of the rapid filling wave (E) and atrial contraction wave (A) (AHTe, DHTe, AHTa, DHTa), A/E, peak dE/dt, -peak dE/dt, peak dA/dt, -peak dA/dt were measured. In the SLE group, IRT and DHTe were prolonged, A, A/E, peak dA/dt and -peak dA/dt were increased compared with the control group. We conclude that patients with SLE have abnormal left ventricular diastolic function, even though their disease is clinically inactive.

Angiotensin II receptor antagonist, TCV-116, prevents myocardial hypertrophy in spontaneously hypertensive rats.

Recently, it has been suggested that angiotensin II (AII) might be associated with cardiac hypertrophy and fibrosis. We investigated the preventive effect of an AII receptor antagonist, TCV-116, on the development of cardiac hypertrophy and fibrosis in spontaneously hypertensive rats (SHR) at 24 weeks of age through histopathological study and an AII receptor assay. Treatment with TCV-116, enalapril (an angiotensin-converting enzyme inhibitor, ACEI), and hydralazine for 20 weeks lowered systolic blood pressure (SBP) significantly (-39 mmHg, -45 mmHg, and -45 mmHg, respectively). The heart weight/body weight ratio, cardiac myocyte diameter, and percent cardiac fibrosis were significantly reduced by treatment with TCV-116 and enalapril as compared with hydralazine treatment or no treatment. The AII receptor density was significantly increased by treatment with TCV-116 and enalapril as compared with hydralazine treatment or no treatment. The results of this study suggest that AII receptors are involved in the development of cardiac hypertrophy and fibrosis in SHR. It was demonstrated that the AII receptor antagonist, TCV-116, was comparable to the ACEI, enalapril, in inhibiting the progression of cardiac hypertrophy and fibrosis via the AII receptor.

Immunohistochemical localization of advanced glycosylation end products in coronary atheroma and cardiac tissue in diabetes mellitus.

Advanced glycosylation end products (AGEs) accumulate on long-lived extracellular matrix proteins and have been implicated in the micro- and macrovascular complications of diabetes mellitus. Within the arterial wall, AGE-modified proteins increase vascular permeability, inactivate nitric oxide activity, and induce the release of growth-promoting cytokines. Recently developed anti-AGE antibodies were used in an immunohistochemical analysis of coronary arteries obtained from type II diabetic and nondiabetic patients. High levels of AGE reactivity were observed within the atherosclerotic plaque present in vessels from selected patients with diabetes. Considered together with the pathological effects of AGEs on vascular wall homeostasis, these data support the role of advanced glycosylation in the rapidly progressive atherosclerosis associated with diabetes mellitus.

Doppler echocardiographic assessment of left ventricular diastolic function in patients with progressive systemic sclerosis.

To investigate the diastolic function of the left ventricle in patients with progressive systemic sclerosis (PSS), 13 patients with PSS (3 males and 10 females; group PSS) were examined by Doppler echocardiography. As a control 8 age-matched healthy volunteers (3 males and 5 females; group H) were also examined. Pulse-wave transmitral Doppler flow velocity curves were digitized and curves of the first derivatives were obtained. In group PSS, total left ventricular wall thickness and left atrial dimension were increased, the ratio between the left ventricular end-diastolic dimension and the left ventricular wall thickness was decreased, late peak diastolic filling was increased, isovolumic relaxation time was prolonged, compared with group H. The patients with left ventricular wall thickening out of proportion to left ventricular end-diastolic dimension had decreased early peak diastolic filling. We conclude that patients with PSS have deterioration of left ventricular diastolic function, and the diastolic function is severely disturbed in patients with left ventricular wall thickening out of proportion to left ventricular end-diastolic dimensions.

Bi-directional transmission of molecular information by photon or electron beams passing in the close vicinity of specific molecules, and its clinical and basic research applications: 1) Diagnosis of humans or animal patients without any direct contact; 2) Light microscopic and electron microscopic localization of neuro-transmitters, heavy metals, Oncogen C-fos (AB2), etc. of intracellular fine structures of normal and abnormal single cells using light or electro-microscopic indirect Bi-Digital O-Ring Test.

In 1985, Omura, Y. discovered that, when specific molecules were placed anywhere in the close vicinity of the path of a light beam (laser), their molecular information, as well as information on electrical & magnetic fields, is transmitted bi-directionally along the path of this light beam. Namely, this information is transmitted in the direction the light beam is projected and towards the direction from which the light beam is coming. This finding was applied to the following clinical and basic research: 1) In the past, using indirect Bi-Digital O-Ring Test, human or animal patients were diagnosed through an intermediate third person holding a good electrical conducting probe, the tip of which was touching the part of the patient to be examined. However, in order to diagnose the patient in isolation from a distance, or a dangerous or unmanagable unanesthesized animal, such as a lion or tiger, the author succeeded in making a diagnosis by replacing the metal conducting probe with a soft laser beam which is held by the one hand of the third person whose index finger is placed in close vicinity of the laser beam generated by a battery-powered penlight-type solid state laser generator. Thus, diagnosis within visible distance, without direct patient contact, became a reality. 2) Using a projection light microscope, by giving indirect Bi-Digital O-Ring Test while contacting with a fine electro-conductive probe on the magnified fine structure of normal and abnormal cells, various normal and abnormal intracellular substances were localized through a third person holding a pure reference control substance with the same hand that is holding the probe as an intermediary for the indirect Bi-Digital O-Ring Test. Instead of the photon beam in a light microscope, the author found that, using an electron beam passing through the close vicinity of specific molecules of specimens in an electron microscope, the molecular information is transmitted to the magnified fluorescent screen, and an indirect Bi-Digital O-Ring Test could be performed through a projected penlight-type solid state soft laser beam on the magnified intracellular structure through an observation glass window. Using the magnified fine structure of the cells, by either a light projection microscopic field or electron microscope, in various cancer cells of both humans and animals, Oncogen C-fos (AB2) and mercury were found inside of the nucleus. Integrin alpha 5 beta 1 was found on cell membranes and nuclear cell membranes of cancer cells. Acetylcholine was not found anywhere within cancer cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of manidipine, a novel calcium channel blocker, on quality of life in hypertensive patients.

A multicenter open study was performed to evaluate manidipine monotherapy for 6 months on quality of life in hypertensive patients. One hundred and sixty-six patients with essential hypertension were enrolled. Of these, 2 were excluded because of violation of entry criteria, 4 withdrew from treatment because of side effects, and 12 for personal reasons. Manidipine treatment observed at a daily dose of 10 to 20 mg produced effective reduction in blood pressure during the course of the study. Adverse reactions such as palpitation or headache were experienced by 5 of 166 (3%) patients. Quality of life (QOL), assessed grossly by attending physicians, was rated as improved in 62% and unchanged in 36% of patients. Significant improvements in mean QOL scores were noted in general symptoms, physical symptoms and general well-being, work performance and satisfaction, sleep scale, emotional state, cognitive function, sexual function, and self-control. Elderly patients, age 60 years and older, achieved significant improvement in the same QOL items as in all cases; there was no difference between younger and older age groups. In conclusion, manidipine monotherapy is useful for treating patients, including the elderly, with essential hypertension, and this therapy improves their quality of life.

A histopathological study of age-related changes of the left bundle branch in the human heart.

To study age-related changes in the left bundle branch (LBB), 32 autopsied hearts were examined histopathologically using serial sections according to the method of Lev. Each division of LBB was carefully studied, i.e., the anterior and posterior radiations and the proximal, middle, and distal portions of radiations. An increase of fibrosis and fatty infiltration were observed in the LBB with aging. There was a tendency for fibrosis to be more prominent in the proximal LBB at the site of transition from bundle branch cells to Purkinje cells.

Efficacy and safety of clentiazem in patients with essential hypertension: results of an early pilot test.

The purpose of this study was to evaluate the antihypertensive effect of a new calcium antagonist, clentiazem, on inpatients or outpatients with essential hypertension. After blood pressure was stable and greater than 160/95 mmHg with placebo for at least a 2-week observation period, oral clentiazem was administered once daily and dosage was increased stepwise from 10 to 40 mg over 10 weeks. Blood pressure significantly decreased by the second week of the study, and this hypotensive effect was maintained until the eighth week. Cumulative effective rate (percent of patients whose blood pressure decreased in 20/10 mmHg) in 62 outpatients were as follows; 10.3% at 10 mg, 39.6% at 20 mg, 70.2% at 30 mg, 76.6% at 40 mg. There was no significant postural change observed in the blood pressure from supine to standing position. Side effects such as dizziness, general malaise and gait disturbances were observed in 3 (3.9%) of 76 patients. No abnormal changes in clinical laboratory examinations or electrocardiograms were caused by clentiazem. Thus these data demonstrated that clentiazem produces certain antihypertensive effects with sufficient safety.