Isolation of chlamydia psittaci from domestic cats with oculonasal discharge in Japan.

Eight strains of Chlamydia psittaci were isolated in Japan from the nasal and conjunctival swabs of six household cats using the L929 cell line of mouse fibroblast origin. The isolates were identified as C. psittaci on the basis of the formation of characteristic inclusion bodies in the cell culture detected by Giemsa stain and immunofluorescence. Comparison of nucleotide sequences of the ompA gene amplified from the three isolates with the published sequence of feline FEPN strain of C. psittaci showed almost 100% homology.

A non-binary direct digital synthesizer with an extended phase accumulator.

We describe a new direct digital synthesizer (DDS) in which output tuning resolution is flexibly controlled. The new DDS has an extended phase accumulator (EPA) controlled by two frequency control words; one determines the wave number within a single EPA operation cycle, and the other determines the length of the cycle. The EPA allows the DDS to provide jitter-free signals, the frequencies of which are given by arbitrary fractional expressions. (The denominator is fixed in conventional DDS that use normal phase accumulators.) Experimental results showed that the EPA worked well, allowing flexible output tuning resolution.

[The efficacy of a comprehensive smoking cessation class, combined with nicotine patch and gum replacement therapy].

A six-month comprehensive smoking cessation class was conducted in our hospital, and the results were evaluated after one year. To increase the rate of smoking cessation, a smoking cessation support team composed of a medical doctor, a pharmacist, nurses, a registered dietitian, and a physical therapist was formed. The team provided specialized lectures and comprehensive group counseling programs every two weeks for the first two months and every month for the next four months. Each participant's expired carbon monoxide concentration and body weight were measured at every attendance. The participant continued with beneficial behavioral treatment for smoking cessation for six months, with nicotine replacement therapy (NRT) for the first eight weeks. The protocol of our NRT consisted of both the routine use of nicotine patches (Nicotinell TTS) and the rescue use of nicotine gum (Nicorette). We first ascertained each participant's degree of nicotine dependence, using the Fagerström Tolerance Questionnaire score, and daily nicotine intake was estimated by a detailed questionnaire. We then divided the participants into two NRT groups according to their nicotine dependence. The higher nicotine dependence group consisted of those whose Fagerström Tolerance Questionnaire score was more than 5 points or whose estimated nicotine intake was more than 10 mg/day. This group they used Nicotinell TTS 30 (TTS 30) for the first four weeks, TTS 20 for the next two weeks, and TTS 10 for the last two. In the lower dependence group. TTS 20 and TTS 10 were each given for four weeks. Nicotine gum use was restricted to 4 pieces a day for the first week and reduced by one per day each subsequent week. As a result, there was an 81.3% smoking cessation rate after eight weeks, 70.3% after six months, and 58.2% after one year. In conclusion, two courses of routine nicotine patch use, with the addition of restricted rescue use of nicotine gum, can produce better longterm abstinence results than previously reported NRTs, suggesting that this may be one of the best ways to cease smoking. We also emphasize that intensive group counseling programs and lectures supported by doctors and medical teams, as well as a continuing behavioral treatment component, may be indispensable for enhancing longterm sustained abstinence rates.

Severe proteinuria, sustained for 6 months, induces tubular epithelial cell injury and cell infiltration in rats but not progressive interstitial fibrosis.

BACKGROUND: Sustained proteinuria is reported to be very harmful to the tubulointerstitium, leading to severe interstitial injury. However, it remains unclear whether sustained proteinuria itself is responsible for severe interstitial injury because, in the previously reported models, the development of factors other than proteinuria in tubulointerstitial lesions could not be excluded completely. METHODS: After treatment to induce immune tolerance to mouse immunoglobulin, 20 rats were injected with anti-rat slit diaphragm monoclonal antibody (mAb) 5-1-6 twice a week for 6 months and were then sacrificed. RESULTS: mAb 5-1-6 induced massive proteinuria in 11 rats. In nine rats with mild proteinuria, no histological alteration could be detected with light microscopy and immunofluorescence. In nephrotic rats, light microscopy showed minor glomerular abnormalities, with interstitial oedema, tubular epithelial cell degeneration and interstitial cell infiltration. Immunofluorescence revealed increased expression of vimentin and an increased number of OX1-, OX19- and ED1-positive cells. However, we could not detect any accumulation of type I and IV collagen or laminin in the tubulointerstitium. RT-PCR showed that the expression of mRNA for type I collagen was not increased, compared with that in control rats. CONCLUSIONS: We succeeded in developing a model of persistent nephrosis without severe glomerular abnormalities, nephrectomy or other manoeuvres known to induce disturbed haemodynamics, using an agent without tubulointerstitial toxicity, and considered it to be suitable for investigating the direct toxicity of proteinuria. In this model, isolated massive proteinuria induced interstitial injury. However, the degree of injury was suggested to be much less than that observed in other previously developed models.

Clinical and angiographic follow-up after single long GFX coronary stent implantation.

In order to identify predictors of late restenosis after GFX stent implantation, procedural and 6-month clinical and angiographic follow-up data of prospectively entered 141 consecutive lesions treated with a single long (24 or 30 mm) GFX stent were compared to 66 consecutive lesions requiring a single short (12 or 18 mm) stent. The initial clinical success rate of 97% and thrombosis rate of 1.4% with long stents were similar to 97% and 0% with short stents (P = NS). Their respective binary restenosis rates were 34.7% and 23.3% for long and short stents as a whole (P = NS), but being 10.0% for 12 mm, 26.0% for 18 mm, 31.3% for 24 mm, and 39.2% for 30 mm. When proximal and distal reference diameters at baseline were compared between the lesions with and without restenosis, proximal reference diameters were not statistically different (3.02+/-0.42 mm vs. 3.18+/-0.62 mm) and the restenosis group had significantly smaller distal reference diameters (2.15+/-0.48 mm vs. 2.55+/-0.53 mm, P<0.0001). The treatment of long lesions with single long-stent implantation can be accomplished with high success and low complication rates. Single long-stent implantation may be effective, if the distal reference size of the long narrowing is big enough to accept the stent.

Ten-years clinical follow-up following successful percutaneous transvenous mitral commissurotomy: single-center experience.

The purpose of this study is to report the long-term follow-up outcome of patients undergoing percutaneous transvenous mitral commissurotomy (PTMC). The follow-up of 68 of 82 (83%) consecutive patients undergoing successful PTMC (mitral valve area of more than 1.5 cm(2) without major complications) in 1987 using the Inoue balloon was analyzed. The mean age at the time of PTMC was 52 +/- 11 years and 81% were female patients. The mean follow-up interval was 98 +/- 37 months (6 to 123). Actuarial survival rate was 98%, 97%, and 86% at 1, 5, and 10 years, respectively; the event-free (death, mitral valve replacement, and repeat PTMC) survival rate was 90%, 85%, and 66% at 1, 5, and 10 years, respectively. According to the echocardiographic findings, patients could be divided into three groups: pliable valve, semipliable valve, and rigid valve. Multivariable analysis identified echocardiographic subgrouping as the major significant predictor of any event: the event-free survival rate being 70% in group 1, 66% in group 2, and 20% in group 3 (P < 0.05). Echocardiographic follow-up was available in 49 of 68 patients (72%); the mitral valve area changed from 1.4 +/- 0.5 before to 2.1 +/- 0.4 immediately post-PTMC, and 1.8 +/- 0.4 cm(2) 10 years after the procedure. The long-term follow-up outcome following successful PTMC was favorable and seems to support it as a viable alternative to surgical commissurotomy in selected patients. Patients with rigid valves should be selected very carefully.

Granulocyte colony stimulating factor-producing diffuse malignant mesothelioma of pleura.

We report the rare case of a 61-year-old man with a diffuse malignant mesothelioma of mixed subtype which produced granulocyte colony-stimulating factor (G-CSF). The white blood cell (WBC) was elevated to 85,100/mm3 without any evidence of infection, and the G-CSF level in the pleural effusion was also increased at 13,200 pg/ml. The lobes of the lung were encased in a tumor. Histopathologically, the tumor cells were of a polymorphous morphology with an epithelial and sarcomatoid mixed pattern. Immunohistochemistry showed that the tumor cells were positive for vimentin, cytokeratin, epithelial membrane antigen, thrombomodulin, and G-CSF, and negative for carcinoembryonic antigen (CEA), CD34, and surfactant apoprotein-A.

Thrombectomy with AngioJet catheter in native coronary arteries for patients with acute or recent myocardial infarction.

The AngioJet thrombectomy catheter removes thrombi by rheolytic fragmentation and suction. The purpose of this study was to identify the efficacy and safety of this new device. Myocardial infarction (MI) is associated with intracoronary thrombus. Intracoronary thrombus has been identified as a risk factor of unfavorable outcome after percutaneous transluminal coronary angioplasty. To what extent the AngioJet is applicable or effective for acute or recent MI in native coronary artery is not clear. Thrombectomy with the AngioJet was attempted in 31 patients with 31 native coronary arteries selected from 304 patients with acute or recent MI. Follow-up angiography was performed at 3 to 6 months. Procedure success was achieved in 29 patients (94%). Adjunctive balloon angioplasty was performed after AngioJet thrombectomy in 30 patients (97%), and in only 1 patient (3%) AngioJet thrombectomy was the sole procedure. Subsequent stenting after balloon angioplasty was attempted successfully in 12 patients (40%) without thrombotic complications. Thrombolysis In Myocardial Infarction trial flow grading increased from 0.70 +/- 0.97 before to 2.61 +/- 0.88 after AngioJet thrombectomy (p <0.0001), to 2.84 +/- 0.64 after adjunctive procedures (p = 0.070). At follow-up angiography restenosis rate was 21% but Thrombolysis In Myocardial Infarction flow 3 was present in all patients. The restenosis rate of stented patients was 8%. There were no major events during in-hospital and follow-up. The AngioJet can be used safely and successfully to remove thrombus from the native coronary artery of patients with MI. Thrombus removal makes subsequent stenting safe and uncomplicated. The restenosis rate was considered to be acceptable.

Initial and follow-up results of the ACS multi-link stent: a single center experience.

The Palmaz-Schatz (PS) stent has effectively reduced restenosis; however its rigidity makes it sometimes difficult or impossible to deliver. The initial and follow-up outcomes with the ACS Multi-Link stent (deployed from April to November 1995) were evaluated in 70 patients (79 lesions): unplanned in 34% (abrupt closure 1%; threatened closure 5%; suboptimal results 28%) and planned in 66%. Three to six month follow-up angiograms were analyzable in 67 lesions; 96% procedural (in nine lesions PS stenting had failed) and 95% clinical success were achieved. In-hospital mortality was 1.4%. Myocardial infarction occurred in 2.9%, and subacute stent thrombosis in 1.4%. Stenting improved immediately the minimal luminal diameter (from 0.97+/-0.41 mm to 2.72+/-0.31 mm), but at 6 months it had decreased to 1.89+/-0.44 mm. Angiographic restenosis (<50% diameter stenosis) occurred in 11, a rate of 16.4%; target lesion revascularization (TLR) was required in six (re-PTCA in five or bypass surgery in one; 6/67=8.7%). Actuarial 1-2 year survival rate was 91%, 80% surviving free from major complications or need for TLR. We conclude that the ACS Multi-Link stent can be implanted in lesions unsuited for the PS stent with a high success rate, and an anticipated restenosis rate perhaps comparable to with the PS stent.

Altered anionic GBM components in monoclonal antibody against slit diaphragm-injected proteinuric rats.

BACKGROUND: We previously reported that monoclonal antibody (mAb) 5-1-6 bound to renal filtration slits induces massive proteinuria without causing ultrastructural changes in the glomerulus. This study evaluated the underlying mechanisms of the increase in glomerular permeability. METHODS: The distribution of endogenous albumin and IgG in the glomerular basement membrane (GBM) was studied in in situ drip-fixed glomeruli of Munich-Wistar rats by use of immunogold immunocytochemistry in the presence and absence of mAb 5-1-6. The density of foot process glycocalyx components was estimated by labeling with Limax fluvus lectin- or Helix pomatia lectin-gold complexes. Anionic sites in the GBM were examined by labeling with cationic gold at pH 2.0 or 7.4. Carboxyl groups, which also furnish an anionic charge to the GBM, were examined by specific biotinylation and colloidal gold probe methods. In addition, the infusion-staining of anionic sites was performed by use of ruthenium red in both Munich-Wistar and Wistar rats. RESULTS: The urinary excretion of albumin and IgG was increased markedly in the treated rats, indicating a non-selective barrier defect. In the control rats, albumin and IgG molecules were mainly located along the inner half of the GBM, and to a lesser degree in the lamina rara externa. In the treated rats, the albumin and IgG moieties were more equally distributed throughout the width of the GBM. Newly appearing, small dense peaks at the outer side of the GBM were evident, indicating a barrier function of outer zone of the GBM and/or epithelial cell layer. No intergroup differences in the density of lectin binding sites on foot processes were seen. The reduction in the number of ruthenium red-positive anionic sites and cationic gold (pH 2. 0)-labeled anionic sites in the lamina rara externa was significant in the treated rats at day 3, indicating a possible alteration of charged proteoglycan in the lamina rara externa. No such changes were seen with cationic gold (pH 7.4)-labeled anionic sites in the GBM. The density of labeled carboxyl groups was significantly reduced in the treated rats relative to the controls. CONCLUSIONS: These results show that the injection of mAb 5-1-6 induced a perturbation of the charge- and probably the size-selective glomerular filtration barrier. The observed reduction in the levels of various negatively charged substances resulted in massive proteinuria, implying that alteration of target antigens can affect the integrity of the GBM constituents maintaining the normal barrier function.

Stenting after thrombectomy with the AngioJet catheter for acute myocardial infarction.

The presence of massive intracoronary thrombi may contraindicate stenting. The AngioJet catheter rheolytic thrombectomy prepared the road for an easy and uneventful stenting in 2 patients with acute myocardial infarction (AMI) and thrombi. This combination provides a promising strategy for patients with AMI and angiographic evidence of massive thrombi.

Initial Experience with the ACS MultiLink Stent: Serial Angiographic Follow-up and Comparison with the Palmaz-Schatz Stent in Matched Lesions.

To evaluate the efficacy of the more flexible ACS Multi-Link stent, a prospective angiographic follow-up study was performed. Implantation of the ACS Multi-Link stent was attempted in 70 consecutive patients with 79 coronary lesions from April to November 1995. Clinical success defined as final % diameter stenosis of < 50% without death, bypass surgery nor Q wave myocardial infarction was achieved in 95% of the patients. There was 1 in-hospital death due to acute pulmonary embolism. In-hospital subacute stent occlusion occurred in 2 cases. Follow-up angiograms were obtained in 62 (83%) eligible lesions. The minimal luminal diameter improved from 0.97 +/- 0.41 to 2.72 +/- 0.30 mm, but started to decrease at 1 month (2.38 +/- 0.42 mm), and continued to decrease throughout the 6 months (1.96 +/- 0.41 mm). Angiographic restenosis (stenosis ³ 50%) occurred in 16% of the lesions, a rate smaller though not significantly different from the 25% with the Palmaz-Schatz stent. A revascularization procedure of the target lesion was required in 6% of the patients. Multivariate analysis identified lack of post-dilatation, type of lesion, lesion length and pre-procedural reference diameter to be predictors of angiographic restenosis. In conclusion, the ACS Multi-Link stent can be implanted successfully with a low complication rate and a clinical outcome at least comparable to the Palmaz-Schatz stent.

Initial Experience with the ACS Multi-Link Stent: Serial Angiographic Follow-Up and Comparison with the Palmaz-Schatz Stent in Matched Lesions.

To evaluate the efficacy of the more flexible ACS Multi-Link stent, a prospective angiographic follow-up study was performed. Implantation of the ACS Multi-Link stent was attempted in 70 consecutive patients with 79 coronary lesions from April to November 1995. Clinical success defined as final % diameter stenosis of < 50% without death, bypass surgery or Q-wave myocardial infarction was achieved in 95% of the patients. There was 1 in-hospital death due to acute pulmonary embolism. In-hospital subacute stent occlusion occurred in 2 cases. Follow-up angiograms were obtained in 62 (83%) eligible lesions. The minimal luminal diameter improved from 0.97 +/- 0.41 to 2.72 +/- 0.30 mm, but started to decrease at 1 month (2.38 +/- 0.42 mm), and continued to decrease throughout the 6 months (1.96 +/- 0.41 mm). Angiographic restenosis (stenosis ³ 50%) occurred in 16% of the lesions, a rate smaller though not significantly different from the 25% with the Palmaz-Schatz stent. A revascularization procedure of the target lesion was required in 6% of the patients. Multivariate analysis identified lack of post-dilatation, type of lesion, lesion length and pre-procedural reference diameter to be predictors of angiographic restenosis. In conclusion, the ACS Multi-Link stent can be implanted successfully with a low complication rate and a clinical outcome at least comparable to the Palmaz-Schatz stent.

Initial experience with the Cordis stent: analysis of serial angiographic follow-up.

To evaluate the efficacy of the more flexible Cordis stent, a prospective angiographic follow-up study was performed. Implantation of the Cordis stent was attempted in 99 consecutive patients with 103 native coronary lesions from January 1994 to July 1995. Clinical success, defined as final diameter stenosis of < 50% without death, bypass surgery, or Q-wave myocardial infarction, was achieved in 88% of the patients. There were no in-hospital deaths. In-hospital subacute stent occlusion occurred in only one case. Follow-up angiograms were obtained in 86 (95%) eligible lesions. The minimal luminal diameter improved from 1.03 +/- 0.31 to 2.82 +/- 0.31 mm, but started to decrease at 1 mon (2.57 +/- 0.24 mm), and continued to decrease throughout the 6 mon (2.00 +/- 0.61 mm), the biggest reduction being between 1 and 3 mon (-0.57 +/- 0.50 mm). Angiographic restenosis (stenosis > or = 50%) occurred in 23% of the lesions; a revascularization procedure of the target lesion was required in 12% of the patients. Multivariate analysis identified age, diabetes mellitus, and preprocedural reference diameter to be predictors of angiographic restenosis. In conclusion, the Cordis stent can be implanted successfully with a low complication rate and a clinical outcome at least comparable to other stent studies.

Remodeling of human coronary arteries undergoing coronary angioplasty or atherectomy.

BACKGROUND: Recently, long-term constriction of the vessel has been suggested as an alternative mechanism of restenosis after coronary angioplasty. METHODS AND RESULTS: To understand remodeling of human coronary arteries undergoing coronary angioplasty or atherectomy, serial intravascular ultrasonographic examinations were performed at preintervention and postintervention examinations and at 24 hours, 1 month, and 6 months. Complete serial data were obtained in 61 lesions (balloon angioplasty, 35 lesions; directional atherectomy, 26 lesions). Lumen area improved from 6.81+/-2.24 mm2 after intervention to 8.22+/-2.79 mm2 at 1 month (P=.0001) and decreased to 4.88+/-2.86 mm2 at 6 months (P=.0001). Vessel area enlarged from 17.32+/-5.35 mm2 after intervention to 19.39+/-5.33 mm2 at 1 month (P=.0001) and decreased to 16.33+/-5.54 mm2 at 6 months (P=.0001). Plaque+media area increased significantly from postintervention examination to 24 hours (10.51+/-4.38 versus 10.96+/-4.49 mm2, P=.0008) and from 24 hours to 6 months (10.96+/-4.49 versus 11.45+/-4.45 mm2, P=.03). Changes in lumen area in each study interval correlated more closely with changes in vessel area than with changes in plaque+media area. Restenotic lesions compared with nonrestenotic lesions had a greater decrease in the vessel area between 1 month and 6 months (-4.33+/-2.73 versus -2.49+/-2.15 mm2, P=.006) and greater increase in the plaque+media area both within 24 hours (0.84+/-1.22 versus 0.27+/-0.38 mm2, P=.04) and between 24 hours and 6 months (1.19+/-2.19 versus 0.18+/-1.46 mm2, P=.04). CONCLUSIONS; Remodeling after coronary angioplasty or atherectomy was characterized by early adaptive enlargement and late constriction of the vessel.

[A case of anti-basement membrane (BM) mediated disease presenting renal and pulmonary symptoms by divergent timing].

A case of 49-year-old man with anti-GBM antibody and who manifested pulmonary and renal symptoms at divergent times. Thirty-six years previously, renal disease with unneglectable degree of proteinuria was noticed. One month before admission, he was found by chance to have elevated serum creatine (Scr); 3.4 mg/dl. At admission, his Scr was 13.7 mg/dl and Hb 12.7 g/dl, TP 5.2 g/dl with 3+ proteinuria and no glucosuria. He was a heavy smoker and remained so while admitted. Renal biopsy presented fibrocellular crescents in 100% of glomeruli with striking tubulointerstitial involvement. Immunofluorescence showed linear IgG deposition along the glomerular capillary wall. Hemodialysis was instituted, and after 13 hospital days, anti-GBM antibody at admission was high at 128 U, with negative PANCA. Plasmapheresis was also performed, but on the next day pulmonary hemorrhage occurred with a concomitant rise of anti-GBM to 250 U. Thus, steroid pulse therapy was conducted in combination with plasmapheresis. Pulmonary hemorrhage subsided along with lowering of anti-GBM (48 U), but renal failure persisted. The patient died of septicemia. Based on the clinical course of the case, the term "anti-BM mediated disease" may more properly delineate the entity of the disease rather than the classical eponym "Goodpasture's disease" which requires coexistence of pulmo- and renal manifestations for definition.

Serial angiographic follow-up after successful direct angioplasty for acute myocardial infarction.

This serial follow-up study was designed to identify the time course of reocclusion and/or restenosis after direct angioplasty for acute myocardial infarction. Direct angioplasty for acute myocardial infarction was attempted in 160 patients. Of the 141 patients who underwent successful reperfusion and were discharged, 137 (97%) were enrolled in this study. At the 3-week follow-up study (100% eligible), angiographic restenosis of the infarct-related artery was documented in 21 patients (16%), 9 (43%) of which were reocclusions. At 4 months in 100 patients (92% of those eligible), restenosis was newly documented in 28 infarct-related arteries (28%), 3 of which were reocclusions (11%). At 1 year in 64 patient (89% of those eligible), restenosis was newly documented in 5 infarct-related arteries (7.8%), with no reocclusions. The cumulative restenosis rate was 20% at 3 weeks, 43% at 4 months, and 47% at 1 year; when divided into occlusive and nonocclusive types, restenosis rates were 12% and 8.8% at 3 weeks and 14% and 29% at 4 months, respectively. Restenosis was most prevalent within the first 4 months and rarely occurred after that. When restenosis is manifested as reocclusion, it occurs earlier than in nonocclusive restenosis, often within 3 weeks.

Three-year follow-up after implantation of metallic coronary-artery stents.

BACKGROUND: Coronary-artery stents are known to reduce rates of restenosis after coronary angioplasty, but it is uncertain how long this benefit is maintained. METHODS: We evaluated clinical and angiographic follow-up information for up to three years after the implantation of Palmaz-Schatz metallic coronary-artery stents in 143 patients with 147 lesions of native coronary arteries. RESULTS: The rate of survival free of myocardial infarction, bypass surgery, and repeated coronary angioplasty for stented lesions was 74.6 percent at three years. After 14 months, revascularization of the stented lesion was necessary in only three patients (2.1 percent). In contrast, coronary angioplasty for a new lesion was required in 11 patients (7.7 percent). Follow-up coronary angiography of 137 lesions at six months, 114 lesions at one year, and 72 lesions at three years revealed a decrease in minimal luminal diameter from 2.54 +/- 0.44 mm immediately after stent implantation to 1.87 +/- 0.56 mm at six months, but no further decrease in diameter at one year (in patients with paired angiograms, 1.95 +/- 0.49 mm at both six months and one year). Significant late improvement in luminal diameter was observed at three years (in patients with paired angiograms, 1.94 +/- 0.48 mm at six months and 2.09 +/- 0.48 mm at three years; P < 0.001). CONCLUSIONS: Clinical and angiographic outcomes up to three years after coronary-artery stenting were favorable, with a low rate of revascularization of the stented lesions. Late improvement in luminal diameter appears to occur between six months and three years.