[A case of traumatic cardiac contusion accompanied by the rupture of pericardium].

We experienced a case of traumatic cardiac contusion accompanied by the rupture of the pericardium after multiple blunt trauma sustained in a traffic accident. A 26-year-old woman who had suffered from blunt chest and abdominal trauma was admitted to our hospital, being unconscious with multiple severe injuries including pelvic fracture, bilateral hemothorax, and multiple fractures in the extremities. The patient was in a shock status. We performed the transcatheter arterial embolization of the internal iliac arteries to control the bleeding, when aortography showed that the contrast media extravasated toward the left thoracic cavity. Immediately, an operation for blunt chest trauma was performed. Blood was flooding out of the ruptured pericardium because of the contusion of myocardium. The postoperative course was uneventful. Blunt chest trauma is usually accompanied by multisystem injury. Therefore, it is imperative to determine the priority of treatment based on preoperative examination in patients having multiple injuries.

[Development of core/targetoid fibers in the diaphragm of chronically hypercapnic rats].

We tested the hypothesis that chronic hypercapnia contributes to the development of core/targetoid fibers in ventilatory muscles. Five Wistar rats were kept in 5% CO2 in air for 13 weeks. Arterial blood gases (mean +/- SE) were pH 7.402 +/- 0.017, PaCO2 47.4 +/- 2.4 Torr, and PaO2 105.2 +/- 13.2 Torr. While the rats were chronically hypercapnic, their mean minute ventilation was about 1.7 times higher than that of rats that breathed air. This level was maintained throughout the exposure to CO2. Approximately 6% to 12% of the diaphragmatic type-I fibers were replaced by core/targetoid fibers in 3 of 5 chronically hypercapnic rats but not in the 3 control rats. Chronic hypercapnia may have continuously stimulated the respiratory center and resulted in more work done by the ventilatory muscles. Long-term overuse of the ventilatory muscles, which may occur in patients with chronic respiratory failure, can cause morphological changes in type-I fibers in the diaphragm.

Left ventricular-coronary sinus shunt through a septal aneurysm after mitral valve re-replacement.

We describe a case in which a left ventricular-coronary sinus communication through a dissecting ventricular septal aneurysm developed after a redo mitral valve replacement. The outlet orifice of the communication was located in the side wall of the ostium of the coronary sinus. Both the communication and the aneurysm were successfully dealt with by performing a right atriotomy and by opening the aneurysm from its outlet orifice.

[Recurrence and prognosis in ischemic stroke patients with anticardiolipin antibody in Japan].

Anticardiolipin antibody (aCL) is considered to be one of the contributory factors in the development of cerebral infarction. We compared the recurrence and prognosis of 20 ischemic stroke patients with positive IgG aCL who had no collagen vascular diseases with those in 120 patients with negative IgG aCL. The aCL-positive patients comprised 18 females and 2 males aged 43-79 (mean 64) years and the mean follow-up period was 5.6 years. The aCL-negative patients comprised 82 males and 38 females aged 40-84 (mean 64.2) years and the mean follow-up period was 5.8 years. There was no significant difference in age and mean follow-up period between the two groups. We examined the recurrence rate and the intervals from the onset to the recurrence in both groups. We investigated the relationship between the recurrence of stroke and chronological changes in titer of aCL in patients with positive aCL. We also evaluated the effectiveness of antiplatelet agents for the prevention of recurrent stroke in both groups. A positive aCL level was defined as one which was > 3 standard deviations (S.D.) above the mean level for normal controls. A high titer of aCL was defined as being > 7 S.D. above the normal mean value. Among the 20 patients with positive aCL, recurrence of ischemic stroke occurred in 10 (50%) (cerebral thrombosis in 8 and cerebral embolism in 2) and myocardial infarction developed in 2 patients. As regards the number of ischemic episodes of stroke, recurrence occurred twice in 4 and once in 6 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of syringomyelia with proximal dominant muscle weakness and without superficial sensory disturbance].

A 43-year-old woman had noticed muscular weakness in her arms for four years before her admission. Muscle weakness and atrophy were prominent in the bilateral deltoid muscles, but muscular strength was almost unimpaired in the bilateral forearms and intrinsic muscles. There was no sign of sensory impairment except vibratory sensation. EMG revealed neuropathic NMU. X-P of the cervical spine showed enlargement of the spinal canal diameter, and MRI of the spinal cord revealed a large syrinx. On the basis of metrizamide CT and cranial MRI, a diagnosis of syringomyelia with Chiari malformation (type I) was made. Despite the presence of a large syrinx extending from C 1 to Th 11, the only detectable neurological sign was proximal weakness of the upper extremities simulating myopathy.

[An autopsy case of cerebral embolism caused by atrial myxoma].

We reported an autopsy case of a 14-year-old girl with cardiac myxoma, presenting sudden onset of consciousness disturbance and right hemiplegia while running in an 800 meter race. Though CT scan showed no abnormal findings, cerebral angiogram revealed an embolic stenosis of the left middle cerebral artery, and abdominal aortogram showed complete obstruction of the bilateral common iliac artery. Histological study of emboli taken from obstructed femoral arteries showed systemic embolization of the cardiac myxoma. She died three days after admission. Autopsy was performed. Myxoma tissue was not found, but its stalk was left in the left atrial septum. The brain was very edematous, and a myxoma emboli was found in the left middle cerebral artery. Systemic embolization of myxoma to spleen, kidneys, liver, pancreas, etc. was found histologically. Left atrial myxoma is a rare but potentially treatable cause of stroke, and should be included in the differential diagnosis of cerebral vascular disease, especially in young patients.

[The effect of sex hormones on tubular aggregates in normal mouse skeletal muscles].

Although tubular aggregates (TAs) are nonspecific findings observed in various neuromuscular disorders, they are specifically recognizable in the muscles of patients with periodic paralysis. However, their function and significance are still unknown. We have previously reported that TAs were observed in normal male, but not in female mouse muscles. To clarify the effects of sex hormones on morphogenesis of TAs, the following studies were performed. In normal male mice (ICR/JCL, N = 102), TAs began to appear at 3-4 months, and were seen in all animals above 6-7 months of age. On the other hand, in normal female mice (N = 50), TAs were observed in only 2 mice, at 14 and 18 months of age. When mice were castrated (N = 69: male 34/female 35), TAs were not found in either males or females. The results suggested that there is a close relationship between TA formation and male hormone. Testosterone propionate (TP) was administered to both castrated and un-castrated mice (N = 167: male 84/female 83). TAs were not found in castrated, TP 10 mg/2M implanted mice (N = 22: male 12/female 10). When TP was increased to 20 mg/1M, TAs began to appear in both male and female, castrated and un-castrated mice at 3 months, and were observed in 100% of mice, except female un-castrated mice, older than 4-5 months of age. Accordingly, a fairly large amount of TP above a certain threshold and a long incubation time of at least 3 months is necessary to induce TAs in the skeletal muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of respiratory insufficiency due to tracheobronchial compression by aneurysms of the ascending aorta and innominate artery.

Two patients with life-threatening respiratory insufficiency resulting from tracheobronchial compression by expanding aneurysms of the ascending aorta and innominate artery were successfully treated by cardiopulmonary bypass, even in the presence of significant aortic regurgitation. The pertinent surgical procedures are described.

Appearance and disappearance of empty delta sign in superior sagittal sinus thrombosis.

The diagnostic value of the empty delta sign on post-infusion CT films was investigated in five patients with superior sagittal sinus thrombosis subsequently verified angiographically and/or pathologically. The empty delta sign, which has been considered to be unique and reliable in the diagnosis of cerebral venous sinus occlusion, was observed only on CT films taken one to four weeks after onset, and was not seen in the extremes of the acute or the chronic stage of the illness. These observations may explain why this sign has not been apparent in some reports concerning the CT findings of superior sagittal sinus thrombosis. Recanalization within the thrombus may be the reason why this sign was no longer apparent in the chronic stage of the patients with superior sagittal sinus thrombosis.

Protective effects of glutamate and aspartate on the ischemic and reperfused myocardium of hearts from starved rats.

To determine the protective effects of amino acids on the ischemic and reperfused myocardium, an experimental study was carried out. Rats were starved for 20 days, then separated into the following three groups: group I: control, group II: glutamate and aspartate were administered before aortic cross clamping for 5 minutes, and added to the cardioplegic solution, group III: glutamate and aspartate were given during the initial 15 minutes of reperfusion. After 25 minutes of equilibration, the hearts were made ischemic at 35.5 degrees C for 45 minutes, and arrested with high potassium cardioplegic solution immediately after aortic cross clamping. The recovery of cardiac output in group II was significantly (p less than 0.05 vs group I & III) better than that in groups I and III, with no difference between groups I and III. Tissue analysis for high energy phosphate compounds revealed that the levels of ATP and total adenine nucleotides were significantly (p less than 0.05 vs group I & III) higher in group II. Lactate output during the initial three minutes of reperfusion was decreased to the greatest extent in group II. Metabolic studies involving the examination of oxygen utilization also revealed no differences between groups I and III. Thus, addition of glutamate and aspartate before and during aortic cross clamping is effective for reducing ischemic damage, however, the administration of these amino acids during the reperfusion is without significant effects.

Relationship between perfusion pressure and myocardial microcirculation in the beating empty or spontaneously fibrillating heart.

The influence of graded perfusion pressure (30, 60, and 90 mmHg) at cardiopulmonary bypass were studied on beating empty hearts (BEH) or spontaneously fibrillating hearts (SFH) in the normothermic state. The adequacy and distribution of coronary flow and the myocardial oxygen consumption (MVO2) were examined using the tracer microsphere technique in twelve mongrel dogs. In the SFH, the left ventricular (LV) endocardium (ENDO)/epicardium (EPI) flow ratio indicated significant decrease at 30 and 60 mmHg (0.83 +/- 0.05 and 0.86 +/- 0.06, p less than 0.005, respectively), but was recovered to control value at 90 mmHg (1.01 +/- 0.13). In the BEH, these low perfusion pressures did not result in an abnormal flow distribution in the LV (1.03 +/- 0.03 at 30 mmHg). The flow distribution to the right ventricle (RV) relatively increased in both the BEH and the SFH (p less than 0.001). The ENDO/EPI ratio of the RV did not decrease at 30 mmHg in both groups (1.11 +/- 0.03 in BEH and 1.16 +/- 0.08 in SFH). Coronary blood flow and MVO2 were significantly higher in the SFH than in the BEH. Coronary blood flow increased significantly with increase in the perfusion pressure, in both groups. The MVO2 was constant in the BEH, regardless of the perfusion pressure, but increased in the SFH at increasing pressure. These results show that in the SFH, subendocardial underperfusion of the LV is induced at the perfusion pressure of 30 and 60 mmHg.

Cardiodynamic effects of experimental right bundle branch block in canine hearts with normal and hypertrophied right ventricles.

Cardiodynamic effects of acute experimental right bundle branch block (RBBB) were studied in canine hearts: group A included 15 normal hearts; group B-1 had seven hearts with mild right ventricular hypertrophy (RVH), and group B-2 had 11 hearts with marked RVH. The main sequential changes following RBBB were marked prolongation of the Q upstroke interval of the right ventricle and striking shortening of right ventricular systolic time that affected right and left ventricular interaction, particularly in the hearts with RVH. Hemodynamic changes were: the right ventricular end-diastolic pressure was elevated markedly (4.4 +/- 2.2----9.8 +/- 2.6 mm Hg, p less than 0.001) in group B-2, moderately (p less than 0.01) in group B-1, and not at all in group A. The right ventricular positive peak dp/dt decreased remarkably (1036 +/- 151----827 +/- 152 mm Hg/sec, p less than 0.001) in group B-2 and negligibly in the other groups. A significant correlation existed between the percentage of decrease in right ventricular peak dp/dt and the QRS duration of RBBB in each group (p less than 0.01). The left ventricular peak negative dp/dt decreased distinctly (2570 +/- 326----+/- 2055 +/- 362 mm Hg/sec, p less than 0.01) in group B-2 and not at all in the other groups. The stroke volume showed 12% decrease in group B-2 (p less than 0.001), 8% decrease in group B-1 (NS), and no decrease in group A. In the presence of RVH, acute RBBB causes significant impairment of right and left ventricular function. The magnitude of the impairment invariably depends upon both the prior degree of RVH and the width of the QRS complex.