[Anomalous origin of the left coronary artery from the pulmonary trunk with myocardial infarction and severe left ventricular dysfunction in infancy--assessment of myocardial damage using SPECT studies with 201TlCl and 123I-BMIPP].

A 4-month-old male infant with Bland-White-Garland (BWG) syndrome complicated myocardial infarction was reported. Signs included tachypnea, coughing, and failure to thrive. However, there was no sign of myocardial infarction. A chest radiograph revealed cardiomegaly (CTR = 65%) and electrocardiogram showed abnormal Q waves in I, aVL, V6 leads. Cardiac catheterization and angiography revealed marked dilatation of left ventricle (end-diastolic volume = 384 ml/m2) and extremely depressed ejection fraction (16%), confirming the diagnosis of BWG syndrome. A 201TlCl-myocardial SPECT demonstrated apical defect and hypoperfusion in the anterolateral, inferoposterior walls, whereas 123I-beta-methyl-p-iodophenylpentadecanoic-acid (123I-BMIPP) SPECT showed a wider defect area. SPECT studies with 201TlCl and 123I-BMIPP, are useful to assess myocardial viability more accurately in BWG syndrome.

[Relationship between health services and medical care expense].

The relationship of health services for the elderly to medical care expenses for persons over 40 in age was studied by examining data for fiscal year 1992 in 393 municipalities among the municipalities throughout the country where actual conditions have been surveyed. Analysis was by multiple regression analysis. Results showed that medical expenses for every disease were lower in the municipalities which had a higher rate of execution of general health examinations, stomach cancer examinations, and home-visit guidance. This tendency was particularly remarkable in the case of diseases of the circulatory system. In contrast, medical care expenses were high in the municipalities which had a higher demand rate for medical counseling or a higher rate of attendance in health consultation. However the relation of rate of execution of functional training, or attendance rate at the health education sessions, or the rate of performance of detailed examinations was not clear.