Erythema multiforme associated with superficial fungal disease.

An extremely rare case of erythema multiforme associated with dermatophytosis by Trichophyton rubrum infection was reported in a 19-year-old woman. She had a reddish plaque resembling annular ringworm on her left arm. Treatment with an antifungal cream (clotrimazole) on the infected site cleared the condition in three weeks. Spontaneous regression of erythema multiforme in different parts of the body was recognized when the ringworm infection resolved. In recent years, only two cases have been reported in the English literature.

Three cases of organoid nevus on the trunk and extremity.

Organoid nevi are most commonly observed on the scalp. Although they are rarely found on the trunk and extremities, we were able to study 3 cases of organoid nevi involving distributions of this sort. These included a 39-year-old male with a 2 x 6 cm brown area on the left flank (case 1), an 8-year-old female with a 5 x 6 cm hypopigmented macule on the lower left leg (case 2), and a 45-year-old male with a 1.5 x 3 cm brown spot on the back (case 3). All these were histopathologically confirmed to be organoid nevi. The lesion in case 1 revealed basal cell epithelioma, that in case 2 exhibited hypohidrosis caused by poorly developed sweat glands, and the lesion in case 3 was typical, as was an additional one on the same patient's scalp.

[Clinical and experimental studies on vitronectin in bacterial pneumonia].

The pathophysiologic significance of vitronectin in bacterial pneumonia was studied. The following conclusions were obtained. 1) Plasma vitronectin in healthy persons was 252.3 +/- 65.2 micrograms/ml. The level was markedly decreased to 167.0 +/- 42.7 micrograms/ml in patients with bacterial pneumonia. However, it was gradually increased to the normal levels as recovering with pneumonic lesions. It was also found the negative correlation between plasma vitronectin and CRP (r = -0.7) and plasma fibrinogen (r = -0.6) in the course of pneumonia. 2) Vitronectin was localized on elastic fibers of the basement membrane of bronchial epithelium, the alveolar interstitium and the blood vessels in normal lung tissue by immunohistochemical method. On the other hand, vitronectin was significantly localized on inflammatory sites, in particular, fibrin matrix and fibrous sites in pneumonic lesions. These findings were more dominant in severe pneumonia. The results are suggested that reducing in plasma vitronectin appears to be depended on the vitronectin consumption in pneumonic site. 3) In in vitro experiments, activating PMNs, alveolar macrophages and pulmonary fibroblasts were easy to adhered to vitronectin. This adhesiveness to vitronectin was also observed in the strains of S. pneumoniae, S. aureus, and P. aeruginosa, but not in K. pneumoniae and E. coli. These results suggest that vitronectin plays an important role for host defense mechanism by mediating to cell-bacteria interaction and it promotes the recover of injured tissue by induction with pulmonary fibroblasts.

[Long-term administration study on TE-031 (A-56268) in the treatment of diffuse panbronchiolitis].

TE-031 (A-56268), a new macrolide antibiotics, was administered on a long-term basis (6 months) to 12 patients with diffuse panbronchiolitis (DPB). The causative microorganism was identified as H. influenzae in 5 cases, P. aeruginosa in 4 cases and B. catarrhalis in one case. The clinical picture of those patients was monitored, and some basic studies were also carried out. Clinically, all of the patients showed improvement in the symptoms and the various laboratory test values. Bacteriologically, as well, both H. influenzae and B. catarrhalis were eradicated. In addition, P. aeruginosa was eradicated from 2 of the 4 cases, reduced in one case and unchanged in one case. However, even in that one case in which P. aeruginosa was unchanged, the disease symptoms were alleviated. There were no instance of microbial replacement. In spite of the long-term administration of TE-031, There were no side effects. As the basic study, the DPB patients were examined for the presence of antibodies directed at viruses having affinity for the respiratory organs. It was found that a high percentage of the patients showed a high titer of antibodies for influenza virus type III and type II. It was thus surmised that it is likely that viral infection is involved in the progress of this disease. From the standpoint of the progress of DPB, the NK activity was investigated as part of the natural host defense mechanisms. It was found that, compared with healthy controls, the level of NK activity was higher in DPB patients and that it was even higher in patients on long-term TE-031 administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of abnormal left ventricular systolic blood flow in atrial fibrillation].

In atrial fibrillation, it is known that hemodynamics vary according to the preceding R-R intervals. However, the informations of blood flow dynamics have not been available because of the methodological limitations. In this study, blood flow dynamics of atrial fibrillation were assessed using pulsed Doppler echocardiography. The subjects were 160 consecutive patients with atrial fibrillation and without left ventricular asynergy. Using a commercially-available pulsed Doppler instrument (Aloka SSD-910), blood flow patterns in the left ventricle were investigated from the apical long-axis view. The results were as follows: 1. In 22 of the 160 cases (14%), systolic blood flow in the central or apical region of the left ventricle directed towards the apex (termed "back flow"). 2. In the cardiac cycle with "back flow", the preceding R-R interval was shorter; whereas it was longer when "back flow" was absent (591 +/- 103 vs 817 +/- 179 msec, p less than 0.01). Moreover, when a long R-R interval (PPI) followed by a short R-R interval (PI) was observed (greater PPI/PI ratios), the next beat showed distinct "back flow". 3. Left ventricular ejection fraction decreased significantly in patients with "back flow" compared to those without it (42 +/- 15 vs 66 +/- 12%, p less than 0.01). 4. On left ventriculography, the motion of the base of the heart was preserved; however, with "back flow", the motion of the apical area was abnormal, extending towards the apex along the longitudinal axis. 5. Left ventricular ejection flow at the outflow tract disappeared in 13 of the 22 cases with "back flow" in cardiac cycles with short preceding R-R intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Late diastolic mitral regurgitation studied by pulsed Doppler echocardiography.

To evaluate the usefulness of pulsed Doppler echocardiography in assessing late diastolic mitral regurgitation (MR) and to clarify the pathophysiology of MR, 226 consecutive patients who had undergone left ventriculography were studied. By investigating blood flow patterns at the left atrial outflow tract, late diastolic disturbed flow suggesting MR was detected in 15 patients (7%), including 10 (4%) with positive left ventriculographic findings. Among these 15 patients, 14 (93%) had atrial fibrillation and had late diastolic MR in the cardiac cycle with prolonged RR interval. The limitation in number of cardiac cycles that could be analyzed and the rapid heart rate eliminating appearance of the beat with prolonged RR interval may be the reasons for the paucity of late diastolic MR by left ventriculography. Ten patients (66%) with late diastolic MR, including 1 with sinus rhythm, had aortic regurgitation, 3 had high-grade systolic MR and 2 had atrial septal defect. Simultaneous recording of pulmonary artery wedge pressure and left ventricular pressure in 3 patients showed a reversal of pressure gradient in late diastole when the RR interval was prolonged. In conclusion, pulsed Doppler echocardiography was useful for detecting late diastolic MR and in reducing overestimation of systolic MR in left ventriculography induced by erroneous addition of late diastolic MR. The difference of the incidence of this flow between left ventriculography and Doppler examination indicated that this flow depends primarily on heart rate and may come and go in a patient.

[Effect of age on left ventricular relaxation: pulsed Doppler echocardiographic evaluation].

There is no noninvasive index to assess the left ventricular relaxation property during the isovolumic relaxation period except for the isovolumic relaxation time, which is derived from M-mode echocardiography or phonocardiography. The intracardiac blood flow can now be precisely observed using pulsed Doppler echocardiography. We evaluated the left ventricular relaxation property and studied the effect of age on the relaxation property using this method. Cardiac catheterization and pulsed Doppler echocardiography were performed for 27 patients with various heart diseases, none of whom had wall motion abnormalities on left ventriculography, to determine the relationships between invasive and noninvasive parameters. The effects of age were examined in 25 normal healthy persons ranging in age from 26 to 69 years. In all cases, the intracardiac blood flow during the isovolumic relaxation period (isovolumic relaxation flow) as obtained by pulsed Doppler echocardiography was laminar, and directed from the base toward the apex of the left ventricle. The duration of this flow (the time interval from the beginning to the end of this flow; IRT), the acceleration time (the time interval from the beginning to the peak velocity; ACT) and the acceleration rate (the slope of the beginning to the peak velocity; AcR) were measured, and IRT, ln AcT (natural logarithm of AcT) and ln AcR (natural logarithm of AcR) were compared with the parameters obtained by cardiac catheterization. The time constant T of the fall in left ventricular pressure during the isovolumic relaxation period, which was proposed as an index of the left ventricular relaxation property, correlated well with IRT (r = 0.82, p less than 0.001), ln AcT (r = 0.69, p less than 0.001) and ln AcR (r = -0.77, p less than 0.001), but there were no significant correlations with maximum blood pressure, left ventricular ejection fraction, maximal positive dp/dt or the left ventricular end-diastolic volume index. Age and these three Doppler indexes in normal healthy persons correlated significantly as follows; IRT (r = 0.80, p less than 0.001), ln AcT (r = 0.60, p less than 0.001) and ln AcR (r = -0.61, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

[Isovolumic relaxation flow patterns evaluated by pulsed Doppler echocardiography: comparison with invasive parameters].

Left ventricular relaxation property was evaluated by pulsed Doppler echocardiography. The indices obtained from Doppler signals within the left ventricle (LV) during the isovolumic relaxation period (IRF) were compared with the hemodynamic parameters obtained from cardiac catheterization studies. Subjects of this study were four patients with hypertrophic cardiomyopathy, four with hypertensive heart disease, three with angina pectoris, and seven normal subjects. All of them had no wall motion abnormalities and their ejection fractions were more than 0.60. The three indices of IRF were the time interval from the start of IRF to the time immediately before the rapid filling flow (isovolumic relaxation time; IRT), the time interval from the start to the peak (acceleration time; AcT), and the slope from the start to the peak (acceleration rate; AcR). The peak pressure (peak P) was measured at the same time. The positive and negative deflections of the first derivative of left ventricular (LV) pressure (+dp/dt and -dp/dt) and the time constant of LV pressure fall (time constant T) were calculated from LV pressure using a micromanometer-tipped angiocatheter. The end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction (EF) were calculated from the LV angiogram. There were no significant correlations between the three IRF indices (IRT, AcT and AcR) and the hemodynamic parameters (peak P, EDVI, +dp/dt and -dp/dt). However, the time constant T, which is a good index of LV relaxation property and which is relatively free from afterload and preload, correlated well with IRT (r = 0.75, p less than 0.001), AcT (r = 0.60, p less than 0.01), and AcR (r = -0.66, p less than 0.01). It was concluded that the indices obtained from the blood flow patterns of the left ventricle during isovolumic relaxation were useful for estimating left ventricular relaxation property non-invasively and quantitatively.

[Late diastolic mitral regurgitation: pulsed Doppler echocardiographic study].

Since the description of late diastolic mitral regurgitation (MR) detected by left ventriculography, the risk of overestimating systolic MR has been pointed out. However, it has not been well studied by pulsed Doppler echocardiography, though this method is thought to be extremely useful to analyze systolic MR. The purpose of this study was to evaluate the usefulness of pulsed Doppler echocardiography in assessing late diastolic MR and to clarify the pathophysiology of this MR. With the probe in the apical position, the blood flow pattern at the left atrial outflow tract was investigated in 226 consecutive cases who underwent left ventriculography. Late diastolic MR, which could not be attributed to ventricular premature contraction, was observed in 10 cases (4.4%) by left ventriculography. Meanwhile, by pulsed Doppler echocardiography, late diastolic disturbed flow directing towards the left atrial cavity in late diastole was detected in 15 cases (6.6%) including 10 cases with positive left ventriculographic MR. Among these 15 cases, 14 (93%) had atrial fibrillation and exhibited this MR only in the cardiac cycle with prolonged R-R intervals. The limitation in number of cardiac cycles which could be analyzed and the rapid heart rate eliminating the appearance of the beat with prolonged R-R intervals may be the reasons for the paucity of late diastolic MR by left ventriculography. Ten cases (66%) of late diastolic MR, including one with sinus rhythm, had aortic regurgitation, three cases showed high-grade systolic MR, and two had atrial septal defect. The simultaneous recording of pulmonary arterial wedge pressure and left ventricular pressure in three patients show a reversal of pressure gradient across the mitral valve in late diastole when the R-R interval was prolonged. In conclusion, pulsed Doppler echocardiography is useful in detecting late diastolic MR, and in reducing overestimates of systolic MR by ventriculography which was induced by erroneous addition of late diastolic MR, because Doppler method has better time resolution in phase analysis. We believe that incomplete premature mitral valve closure caused by a delay in left ventricular contraction following prolonged R-R intervals, and the reversal of left atrial-left ventricular pressure gradient induced by left ventricular over-filling played important roles in the occurrence of late diastolic MR.

Schwartz-Jampel syndrome associated with von Willebrand's disease.

We report a very rare case of Schwartz-Jampel syndrome associated with von Willebrand's disease. This association might be coincidental because of the different modes of inheritance of the two disorders. However, we speculate that there might be some link between the two disorders, for example in the locus of the affected gene.

[Quantitation of mitral regurgitation by left ventricular blood flow dynamics: a pulsed Doppler echocardiographic study].

Using pulsed Doppler echocardiography, the blood flow dynamics in the left ventricular cavity were studied in 52 cases with mitral regurgitation (MR) (32 cases of grade 1 or 2 and 20 cases of grade 3 or 4 according to the Sellers' classification) were studied to quantify the severity of MR. Twelve healthy subjects served as the control. The results were as follows: At the mitral orifice, systolic laminar flow toward the left atrial cavity was observed in 17 cases with grade 3 or 4 MR. This flow was shown to begin at the isovolumic contraction phase and it had a higher velocity in end-systole. Thus, it could easily be differentiated from ejection flow observed in the left ventricular outflow tract. The duration of systolic blood flow in the mid-ventricle was significantly prolonged over that in the outflow tract in cases with grade 3 or 4 MR compared to those with grade 1 or 2 MR (grade 1 or 2: 4 +/- 27 msec, grade 3 or 4: 65 +/- 35 msec, p less than 0.001), indicating that MR continued even after the end of left ventricular ejection. The velocity of early diastolic left ventricular inflow was estimated for cases having isolated MR (16 cases with mitral chordal rupture and one case of mitral valve prolapse syndrome). In the healthy subjects and cases with grade 1 or 2 MR, the velocity was less than 84 cm/sec. The velocity was increased more than 100 cm/sec in grade 3 or 4 MR. These observations indicated the clinical potential of abnormal blood flow dynamics in the left ventricular cavity in the semi-quantification of MR.

Protection against experimental Bordetella bronchiseptica infection in mice by active immunization with killed vaccine.

Mice immunized with a killed vaccine of phase I Bordetella bronchiseptica were challenged with various numbers of virulent B. bronchiseptica by intraperitoneal, intracerebral, or intranasal routes. The course of infection was compared among these routes, and the protective effect of vaccination was quantitatively analyzed. In ddN mice infected intraperitoneally with 1.8 X 10(8) cells (ca. 80 times the 50% lethal dose [LD50]) the organisms rapidly increased in the intraperitoneal fluid, spleen, and liver within few days and caused splenic atrophy, septicemia, and death. However, immunizations with 5 X 10(9) cells gave the mice a high agglutinin titer and suppressed the increase in the number of organisms. With four immunizations, the lungs and livers were clear within 3 days, and with one or two immunizations, they were clear within 7 days. These immunizations effectively protected the mice from death but did not protect them from splenic atrophy. In the intracerebral infection with 1.4 X 10(6) cells (ca. 1.2 X 10(5) LD50), the number of organisms rapidly increased in the brain and caused encephalitis, splenic atrophy, and death. However, four or five immunizations completely suppressed the increase in the brain and protected the mice from death and splenic atrophy. After intranasal infection with 4 X 10(6) cells (ca. 25 LD50), the organisms rapidly increased in the nasal cavity and lungs and caused pneumonia and death. Immunization with 5 X 10(9) cells was effective in clearing the organisms from the lungs and in protecting against death and splenic atrophy. However, the organisms were not cleared from the nasal cavity for 60 to 150 days after the challenge with as little as 10(2) cells, even in the mice with an agglutinin titer as high as 1:10,000.