Favorable effects of pindolol in dilated cardiomyopathy.

We describe the clinical course of a patient with tachycardia at rest, biopsy proven dilated cardiomyopathy, and moderately severe left ventricular systolic dysfunction. Short-term use of pindolol produced a significant fall in heart rate and cardiac output at rest and during exercise. However, after addition of pindolol to the patient's previous regimen of digoxin and furosemide, he made a rapid clinical recovery and has maintained clinical improvement during the last four years of follow-up. The pattern of clinical response suggests that pindolol may have contributed substantially to this patient's recovery.

Detailed topography of the fermi surface of Sr2RuO4

We apply a novel analysis of the field and angle dependence of the quantum-oscillatory amplitudes in the unconventional superconductor Sr2RuO4 to map its Fermi surface (FS) in unprecedented detail and to obtain previously inaccessible information on the band dispersion. The three quasi-2D FS sheets not only exhibit very diverse magnitudes of warping, but also entirely different dominant warping symmetries. We use the data to reassess recent results on c-axis transport phenomena.

In-plane anisotropy of upper critical field in Sr2RuO4

We investigated the behavior of the spin-triplet superconductor Sr2RuO4 ( T(c) approximately 1.5 K) under the magnetic fields parallel to the quasi-two-dimensional plane. The upper critical field H(c2) exhibits a clear fourfold anisotropy of about 3% at 0.35 K. Furthermore, we detected an additional transition feature below H(c2) in both the ac susceptibility and the specific heat. These second-transition features as well as the pronounced in-plane H(c2) anisotropy disappear above 0.8 K or under intentional field misalignment of less than 1 degrees. Most of these characteristics are consistent with the predicted emergence of the second superconducting phase with a line-node gap.

[Primary localized amyloidosis of the urinary bladder: a case report].

A case of primary localized amyloidosis of the urinary bladder is reported. A 57-year-old male who complained of macrohematuria visited our hospital. Cystoscopic examination revealed a broad basic tumor from the anterior wall to the right wall. Suspecting a bladder tumor we performed a transurethral resection. However, the histopathological examination of the specimen revealed amyloid deposition and no malignant changes. Serum electrophoresis pattern was normal and urinary Bence-Jones protein was negative. Neither rectal nor gastric biopsy revealed amyloids. From these findings, we made a diagnosis of the primary localized amyloidosis of the urinary bladder. We collected 42 cases from the Japanese literature and discuss the clinical features of this disease.

[Secondary non-Hodgkin lymphoma of the prostate: a case report].

A 72-year-old man presenting with difficulty of urination, was diagnosed with benign prostatic hyperplasia and transurethral resection of prostate (TUR-P) was performed. However, pathological diagnosis of 40% of the TUR-specimen was of malignant lymphoma. Immunohistochemical examination revealed B-cell origin, diffuse and medium-cell type, according to the LSG classification. Then we performed chemotherapy with a combination of cyclophosphamide, adriamycin, vincristine and prednisolone. Trans-rectal biopsy specimens of the prostate after 3 courses of chemotherapy, revealed no cells of malignant lymphoma.

[Two-step ultra high-dose chemotherapy with peripheral blood stem cell autotransplantation for refractory testicular cancer: a case report].

A 35-year-old male had advanced nonseminomatous germ cell tumor (stage IIIC, embryonal cell carcinoma) which proved refractory to conventional PVB combined chemotherapy. He was then treated with an ultra high-dose chemotherapy consisting of carboplatin (1.5 g/m2) and etoposide (1.3 g/m2), followed by the transplantation of peripheral blood stem cells (PBSCT) with a total of 1.9 x 10(5)/kg granulocyte colony-forming cells (CFU-GM). Because he developed lung metastasis, escalated doses of carboplatin (2.0 g/m2), and etoposide (1.8 g/m2) combined with cyclophosphamide (7.0 g/m2) were given with peripheral blood stem cell transplant of 3.2 x 10(5)/kg CFU-GM. He has remained free of any recurrence without maintenance therapy.

[Clinical statistics on outpatients, inpatients and operations at the Department of Urology, Hyogo College of Medicine, in 1982].

Statistical studies on 2,040 new outpatients, 575 inpatients and 570 operative procedures at our department in 1982 revealed the following. The most frequent diseases among the outpatients were urogenital infections followed by anomalies and tumors. Over half of the inpatients were pediatric patients and the major diseases among inpatients were hypospadias, vesicoureteral reflux, urolithiasis, congenital urethral stenosis and undescended testis. A total of 570 operations were performed on 531 patients, and the major five operations were hypospadias repair (79), optic internal urethrotomy (71), TUR-P (49), ureterocystoneostomy (33) and orchidopexy (32).

[Histological statistics of malignant urogenital tumors].

A statistic survey was carried out on the histology of the 465 malignant tumors at our urological department during the last 10 years. The most frequent tumors were bladder tumor (50%), prostatic tumor (17%) and renal tumor (15%). Histological typing and grading were tabulated for each tumors.

[A study on normal coronary arteriogram by provocation and spontaneous anginal attack: 4 cases of ST elevated angina with normal coronary arteries by provoked and spontaneous attacks].

During 3 years and 5 months, we experienced 3 of 172 cases of provocations on normal coronary arteries which presented ST elevated angina by ergonovine provocations. The incidence was 2.5% and 4% for all ergonovine provocations and intracoronary ergonovine provocations respectively. One case presented spontaneous attack in coronary arteriography, indicating similar state to occur not only with provocation but also in spontaneous attack. Examination of literature revealed no apparent report on such cases as this. For pathogenesis, the possibility of changes of small vessels was suggested in view of various literature and its specificity to the coronary arterial region.

Genome-wide distribution of Auts2 binding localizes with active neurodevelopmental genes.

The autism susceptibility candidate 2 gene (AUTS2) has been associated with multiple neurological diseases including autism spectrum disorders (ASDs). Previous studies showed that AUTS2 has an important neurodevelopmental function and is a suspected master regulator of genes implicated in ASD-related pathways. However, the regulatory role and targets of Auts2 are not well known. Here, by using ChIP-seq (chromatin immunoprecipitation followed by deep sequencing) and RNA-seq on mouse embryonic day 16.5 forebrains, we elucidated the gene regulatory networks of Auts2. We find that the majority of promoters bound by Auts2 belong to genes highly expressed in the developing forebrain, suggesting that Auts2 is involved in transcriptional activation. Auts2 non-promoter-bound regions significantly overlap developing brain-associated enhancer marks and are located near genes involved in neurodevelopment. Auts2-marked sequences are enriched for binding site motifs of neurodevelopmental transcription factors, including Pitx3 and TCF3. In addition, we characterized two functional brain enhancers marked by Auts2 near NRXN1 and ATP2B2, both ASD-implicated genes. Our results implicate Auts2 as an active regulator of important neurodevelopmental genes and pathways and identify novel genomic regions that could be associated with ASD and other neurodevelopmental diseases.

Hemodynamic effects of nifedipine in acute myocardial infarction with observations on infarct size.

To assess the safety of the slow calcium-channel blocker nifedipine in patients with acutely evolving myocardial infarction, hemodynamic effects of the drug were studied in 12 patients and infarct size was determined by enzymatic method in 14 patients presenting within 12 h of onset of pain. Nifedipine (3 doses of 20 mg given sublingually at 8-h intervals) produced a significant increase in heart rate and cardiac output accompanied by a fall in systemic arterial pressure and vascular resistance. These effects were sustained for a 24-h period of study. Despite an increase in heart rate and cardiac output, there was no worsening of symptoms or electrocardiographic evidence of myocardial ischemia. Assessment of infarct size did not reveal any differences between the control group and the patients who received nifedipine. We conclude that nifedipine may be safely given to patients with acute myocardial infarction. The drug may be usefully employed in patients with acute myocardial infarction accompanied by angina or hypertension.

[Relationship between myocardial perfusion state immediately after reperfusion therapy and left ventricular wall motion improvement in patients with acute myocardial infarction].

The relationship between myocardial contrast echocardiography and improvement of the left ventricular wall motion was studied as an indicator of the prognosis of patients with acute myocardial infarction. Ten patients with acute anterior myocardial infarction who demonstrated successful reperfusion (improved to TIMI grade III) and patency of the responsible coronary artery during the chronic stage (one month after the onset) were selected. The contrast study used 2 ml of sonicated iopamidol injected into the left coronary artery. Two-dimensional echocardiograms were taken at the level of papillary muscle on the short axis for recording in VTR. The results of the contrast study were evaluated using a contrast defect score based on the degree and width of the contrast defect. Percent wall motion improvement was measured as an index of improvement of the left ventricular wall motion and CKmax was used for estimating the extent of myocardial necrosis. There was a good correlation between contrast defect score and CKmax (r = 0.853) or % wall motion improvement (r = 0.77). No correlation was found between coronary occlusion time and CKmax nor between coronary occlusion time and % wall motion improvement. The results suggest that if the score is high, recovery of left ventricular wall motion cannot be expected in patients with acute myocardial infarction who demonstrate successful reperfusion. In such cases, myocardial perfusion has not been effectively restored and myocardial necrosis extended over a wide area. If the score is low, recovery of the wall motion can be expected in the chronic stage even though abnormal left ventricular wall motion area is extensive immediately after reperfusion therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute hemodynamic and neurohumoral effects of pindolol: a beta-adrenoceptor antagonist with high intrinsic sympathomimetic activity in patients with dilated cardiomyopathy.

It has been claimed that beta-adrenoceptor antagonists produce clinical improvement and increase longevity in patients with idiopathic dilated cardiomyopathy. Dilated heart is critically dependent upon adrenergic support to maintain forward output. Acute withdrawal of such support, even with small doses of beta-blockers, may worsen myocardial function sufficiently to limit their widespread use. Pindolol (P), a potent beta-adrenoceptor antagonist, possesses high intrinsic sympathomimetic activity. Administration of P to patients with dilated cardiomyopathy may protect against the effects of high circulating catecholamines and at the same time partially maintain intrinsic left ventricular function. We examined the acute hemodynamic effects of P (2.5 mg orally) in seven patients with dilated cardiomyopathy (average ejection fraction, 23%) and resting tachycardia (average, 111 beats/min). As compared to baseline values, P produced a highly significant fall in heart rate (rest, 19%, p less than 0.001; exercise, 24%, p less than 0.01), cardiac output (rest, 20%, p less than 0.01; exercise, 25%, p less than 0.001), and systemic arterial pressure (exercise only, 13%, p less than 0.05). Calculated systemic vascular resistance increased significantly at rest (17%, p less than 0.05). Pulmonary artery pressures did not change. Compared to normal subjects, baseline norepinephrine levels were markedly elevated in patients with dilated cardiomyopathy at rest and during exercise. Pindolol produced a further significant increase in norepinephrine levels. Two of seven patients became appreciably short of breath after P. Despite its substantial intrinsic sympathomimetic activity, pindolol, like other beta-adrenoreceptor antagonists, produces significant hemodynamic impairment in patients with congestive cardiomyopathy. An exaggerated norepinephrine response after the drug may, by increasing peripheral vascular resistance, lead to further deterioration in left ventricular performance.

[Transient appearance of asynergy on the echocardiogram and electrocardiographic changes simulating acute myocardial infarction following non-cardiac surgery].

Two-dimensional echocardiography (2-D echo) was performed for six postoperative patients who had acute myocardial infarction (AMI)-like electrocardiographic (ECG) changes. All but one, who had coronary T waves, demonstrated abnormal Q waves in V1-V4, decreased amplitude of R waves, and low voltage in limb leads. ST elevation was also observed. Abnormal Q waves in V1-V4 began to resolve in a few days and the QRS complex reverted to normal within one month; however, coronary T waves were observed for at least three months. In the remainder one, persistent Q waves were present from the onset. 2-D echo, performed simultaneously with ECG, showed akinesis or dyskinesis accompanied by ventricular dilatation, not only at the anterior septum, anterior wall and around the apex, but in more extensive areas in four of five cases with abnormal Q waves in V1-V4. In two other cases, which showed abnormal Q or coronary T waves alone, akinesis was limited to the anterior septum and to the septal site and anterior wall of the apex. All abnormal findings on 2-D echo completely resolved within one month, as the ECG findings returned to normal. Compared with typical AMI showing abnormal Q waves in V1-V4, asynergy was recognized in more extensive areas and abnormal wall motion indices significantly improved in the postoperative cases. In the postoperative cases with AMI-like ECG, the CPK-MB fraction increased; however, the peak level of CPK was lower than that in typical AMI. On the basis of these results, transient AMI-like ECG findings in postoperative cases are due to extensive myocardial damage, which is probably derived from focal myocytolysis.