Chlamydia pneumoniae in atherosclerotic and nonatherosclerotic tissue.

The positivity rate and localization of Chlamydia pneumoniae were investigated in atherosclerotic and nonatherosclerotic tissues by immunohistochemistry, polymerase chain reaction, and cell culture. In total, 67 atheromatous plaques from Japanese symptomatic patients and 110 nonatherosclerotic tissues and organs were evaluated. Of these, 62% of atherosclerotic plaques from symptomatic patients were infected with C. pneumoniae compared with just 2% of nonatherosclerotic tissues. Immunohistochemically stained C. pneumoniae were found most often in smooth muscle cells, less often in macrophages, and in a few endothelial cells.

Chlamydia pneumoniae in coronary and iliac arteries of Japanese patients with atherosclerotic cardiovascular diseases.

Recent studies suggest the association of atherosclerotic cardiovascular diseases with Chlamydia pneumoniae infection in western populations. It is of great interest whether such an association exists in Asians with their distinct genetic background. Symptomatic patients with coronary heart disease (29) or arteriosclerosis obliterans (10) who underwent directional endo-atherectomy were studied. Atherectomy specimens of coronary and iliac arteries were examined for C. pneumoniae by culture, nested PCR and immunohistochemical stain (IHC) with one Chlamydia genus-specific, two C. pneumoniae species-specific, and two C. trachomatis species-specific monoclonal antibodies. Among the 29 patients with coronary artery disease, C. pneumoniae was detected in the coronary arteries of 13 by IHC, 16 by PCR and 20 by IHC or PCR, or both. C. pneumoniae was also found in the iliac arteries of four patients by IHC, three by PCR and five by IHC or PCR, or both, of the 10 patients with arteriosclerosis obliterans. Attempts to isolate C. pneumoniae by culture were unsuccessful. The re-stenotic rate after atherectomy was higher in the C. pneumoniae-positive group than in the negative group, but not significantly so. These findings support the high incidence of C. pneumoniae in atherosclerotic lesions of symptomatic patients with coronary heart disease and arteriosclerosis obliterans in Asians.

Ten-year longitudinal clinical evaluation of a visible light cured posterior composite resin.

Using modified USPHS criteria, we evaluated annually for ten years 91 cases restored with visible light cured posterior composite resin LFP (Base resin: UDMA; filler: micro crushed type, alumino-silicate, barium glass and silica, 85 wt%, 74 vol%). The 91 cases restored with LFP decreased to 68 in ten years. Of the 23 cases that were lost, one resulted from a pulpal reaction immediately following restoration, four were extracted owing to periodontal disease or extrusion of third molars, two became abutments owing to loss of an adjacent tooth, eight had recurrent caries, and eight were lost owing to caries on a surface having no relationship to the composite resin restoration. Because we observed comparatively little wear, good marginal adaptability, and no discoloration, we concluded that the ten-year clinical success of LFP was on the whole very good, and that this resin has adequate clinical merit as a restorative material for posterior teeth when restricted to restorations covering comparatively small areas.

[Oral rehydration therapy: an analysis of its results and impact on the hospitalization and mortality of children with diarrhea]. / Terapia de hidratación oral: análisis de resultados e impacto en la hospitalización y mortalidad de niños con diarrea.

We present results of four years in oral rehydration therapy (ORT) in the Hospital Infantil del Estado de Sonora. There was 10.2 consults by diarrhoea for day. Children lower of one year old received oral rehydration therapy in 86.8%, were included 11% of prolonged diarrhoea and 32.3% of children with malnutrition. During the procedure diarrhoea there was complicated in 3% with paralytic ileus sepsis and pneumonia. Effectivity of ORT was in 90.9%; 92.8% in light dehydration and 78.7% moderate. Failure in 8.6% was due to vomitus, no acceptation of the oral solution, abundant evacuations and other complication presented. Were observed reduction in hospitalization, rate of 19.2% in 1986 to 38.4% in 1989. The diarrheal mortality decreased in the Urgence Department in 42% and in the Infectology Department in 54%. We considered these results as satisfactory, but are susceptible to better when we diffuse more the oral rehydration therapy in own region.

PIP: A retrospective study was conducted of the daily reports of the Outpatient Emergency Service of the Children's Hospital of the State of Sonora. Records of children receiving oral rehydration therapy between January 1986 and December 1989 were reviewed to assess the efficacy of the treatment and its impact on hospital admissions and mortality. Children of any age and nutritional status with diarrhea of any etiology and duration were included. Children in shock or with contraindications to oral therapy were excluded. 975 of the 14,893 children consulting for diarrhea in the four years (6.5%) received oral rehydration therapy. 868 of the children (89.0%) had acute diarrhea and 107 (11%) had prolonged diarrhea defined as over two weeks duration. The average patient age was 7.4 months and 847 (86.9%) were under one year old. 754 of the children had mild and 221 had moderate dehydration. 315 of the children (32.3%) were malnourished. 123 of the 975 children were hospitalized. Treatment was considered to have failed in 84 cases (8.6%), including 29 with persistent vomiting, 20 who did not accept oral rehydration solution, 18 with fecal output exceeding 10 ml/kg/h, and 17 with complications of diarrhea. The 847 children successfully rehydrated by the oral route represented a reduction of 29.1% in hospitalizations for diarrhea over the four years, during which 2062 children were hospitalized for intravenous rehydration. The magnitude of the reduction in hospital admissions increased from 19.2% in 1986 to 38.4% in 1989. The case fatality rate from diarrhea declined from an average of 7.0% between 1980 and 1985 to an average of 4.0% between 1986 and 1989. Mortality from prolonged diarrhea averaged 6.0% between 1984 and 1989.

Primary cardiac hemangiopericytoma causing rupture of the right atrium and chronic cardiac tamponade.

A 53-year-old woman presented with symptoms of dyspnea on exertion and edema of lower extremities. Chronic cardiac tamponade caused by the rupture of the right atrial wall was diagnosed by two-dimensional contrast echocardiography. Autopsy findings revealed primary cardiac hemangiopericytoma.

Prediction of degree of residual stenosis in coronary thrombolysis.

In order to predict the residual stenosis in coronary thrombolysis, the factors easily obtained from clinical history--age, gender, history of angina before acute myocardial infarction (AMI), family history, hypertension, diabetes, hypercholesterolemia, smoking, and interval between onset of AMI and recanalization--were observed in 114 patients with successful coronary thrombolysis. In 55 patients with angina before AMI, 29 patients had residual stenosis greater than or equal to 75% and 26 patients had residual stenosis less than 75%. In 59 patients without angina before AMI, 15 patients had residual stenosis greater than or equal to 75%, and 44 patients had residual stenosis less than 75%. The presence or absence of angina before AMI was the main variable that discriminated the groups of residual stenosis of more or less than 75%, which was the only significant independent variable to predict the residual stenosis. These data suggest that the presence of angina pectoris before AMI is likely to be associated with a significant degree of residual stenosis after thrombolysis.

A case of cardiac amyloidosis presenting with symptoms of exertional syncope.

A 54-year-old man presented with symptoms of exertional syncope. Cardiac amyloidosis was diagnosed by endomyocardial biopsy. Exercise tolerance test revealed a failure of increased heart rate followed by sinus arrest, associated with syncope. Autopsy revealed amyloid deposits in the sinoatrial node.

Multiple coronary thrombosis in a patient with thrombocytosis.

A 59-year-old woman was admitted with acute inferior myocardial infarction. Cardiac catheterization revealed total occlusion in the right coronary artery and thrombus-like filling defect in the left anterior descending coronary artery. With simultaneous intracoronary urokinase infusion to the right and left coronary arteries, the right coronary artery became patent and the thrombus in the left anterior descending coronary artery was released to the distal coronary artery. Thrombocytosis was disclosed by laboratory examination. The relationship between myocardial infarction and thrombocytosis is discussed.

Difficult deflation of Probe balloon due to twisting the system.

While using the balloon-on-a wire device, we experienced a case of difficult deflation of the Probe balloon system. Blockage of the balloon system was possibly caused by twisting the system to reach and pass the lesion in the branch of left circumflex coronary artery. The duration of inflation was 20 min, causing prolonged ischemia.

Presence of angina pectoris before acute myocardial infarction and degree of residual stenosis after coronary thrombolysis.

This study tested the hypothesis that the degree of residual stenosis after coronary thrombolysis reflected that of original stenosis presented by symptom of angina before acute myocardial infarction (AMI). The relation between the presence of angina before AMI and the degree of residual stenosis after coronary thrombolysis was observed in 57 patients with successful coronary thrombolysis for AMI. Patients with significant coronary artery stenoses other than the artery responsible for AMI were excluded from this study. In 22 patients with chronic angina for 2 weeks or longer before AMI, 14 patients had a residual stenosis of 75% or more and 8 patients had a residual stenosis of less than 75%. In 35 patients with angina for less than 2 weeks or not at all before AMI, 9 patients had a residual stenosis of 75% or more, and 26 patients had a residual stenosis of less than 75% (p less than 0.01). In the course of progression of coronary artery disease, some patients had AMI without severe underlying stenosis and others with severe underlying stenosis. Patients with chronic angina before AMI might tend to have AMI with acute occlusion superimposed on the severe organic stenosis. Patients without chronic angina before AMI would be more at risk for AMI caused by acute occlusion without underlying severe stenosis.

Angiography of right gastroepiploic artery for coronary artery bypass graft.

We describe the angiographic technique of grafting the right gastroepiploic artery to the coronary artery. With the femoral approach, our specially devised catheter was placed in the common hepatic artery or gastroduodenal artery. The gastroepiploic artery and graft to the coronary artery were visualized satisfactorily by manual injection of contrast media.