[Ventricular septal defect with aortic valvular regurgitation complicated with infective endocarditis; report of a case].

We report a case of ventricular septal defect (VSD) associated with infective endocarditis complication of aortic and pulmonary valvular regurgitation. He received treatment for pyelonephritis and after 2 months he was suffering from congestive heart failure. Echocardiography showed vegetation on the aortic valve and the anterior semilunar cusp of the pulmonary valve. He was referred to our department for surgical repair. Aortic valvular replacement, pulmonary valvular repair and direct closure of VSD were performed. The postoperative course was uneventful and the patient discharged at 28 postoperative day.

[Noonan syndrome with atrial septal defect and hypertrophic cardiomyopathy].

Noonan syndrome is one of the most common nonchromosomal syndromes seen in children with congenital heart disease. The major cause of death is congestive heart failure. We report a case of Noonan syndrome with hypertrophic cardiomyopathy and arterial septal defect (ASD). Since 10 years old he had been suffering from congestive heart failure. ASD patch closure with a fenestrated flap valve patch was performed at 12 years of age. After operation, left-to-right shunt flow through the patch gradually decreased and he was discharged at 19 postoperative day in good condition.

[A low birth weight infant (904 g) associated with ventricular septal defect].

Published data has suggested that low body weight is risk factor for surgical intervention in congenital heart disease. We report a case of a low birth weight infant with ventricular septal defect (VSD) and pulmonary hypertension (PH). A female infant was born at 31 weeks' gestation. The birth weight was 904 g. At birth she was suffering from congestive heart failure. We diagnosed VSD and PH. We performed pulmonary artery banding at 23 days of age. She accepted the band at a circumference of 15.5 mm. And we performed VSD patch closure and de-banding at 175 days of age. After operation she was on good course and discharged at 19 postoperative day.

Clinical outcome of laryngotracheal separation for intractable aspiration pneumonia.

OBJECTIVES: To confirm that laryngotracheal separation (LTS) is a satisfactory treatment for patients with intractable aspiration pneumonia, even though it does not require tracheoesophageal anastomosis. STUDY DESIGN: Retrospective. METHODS: Nine patients with intractable aspiration pneumonia underwent LTS at our institution from 1996 to 1999. Two patients underwent postoperative barium swallow radiography. RESULTS: Neither halitosis nor stimulation of the cough reflex occurred due to pooled secretions in the blind pouch of the proximal tracheal segment. Barium swallow radiography confirmed that the secretions drained within 40 min by swallowing or a change in patient position. CONCLUSION: LTS is a satisfactory solution to the problem of chronic aspiration. Neither pooled secretions in the proximal tracheal segment nor fistula formation were significant postoperative problems.

Development of clover yellow vein virus as an efficient, stable gene-expression system for legume species.

A highly infectious cDNA clone of clover yellow vein virus (pClYVV) was tested as a viral vector, especially for legume species. The genes for green fluorescent protein (GFP) and soybean glutamine synthetase (GS) were inserted between the genes for P1 and HC-Pro on pClYVV to create three recombinant plasmids: pClYVV-GFP, pClYVV-GFP-GS, and pClYVV-GFP:GS. In the former two constructs all the junctions between the inserted proteins contained the sequences of protease cleavage recognition sites, whereas the third construct expressed a fusion of GFP and GS. Western blot analyses showed that GFP and GS appeared to have been precisely excised from the viral polyprotein with the viral proteases (P1 and NIa). Under UV irradiation, green fluorescence was detected in infected broad bean, kidney bean, and soybean plants. The stability of the constructs in the symptomatic tissues was confirmed by RT-PCR and Western blot analyses. The plants expressing GS together with GFP became tolerant to the herbicide glufosinate, and flowered early. As the GS gene, one of the nodulin genes for nitrogen fixation, is expressed in legume species, this system will be useful for examining the function of genes important to legume plants.

Laryngeal closure pressure during phonation in humans.

We investigated the laryngeal closure pressure during sustained phonation in five healthy adult men with no pathological lesions in the glottis using a round pressure transducer with a diameter of 10 mm and a thickness of 1 mm. The transducer was placed between the vocal processes through the mouth. Subjects were asked to utter a sustained phonation of the vowel sound /eh/ at varying pitch and intensity in modal register. The laryngeal closure pressure ranged from 0 to 200 cmH2O. At a comfortable pitch and intensity, the pressure was below 50 cmH2O. The pressure was correlated with pitch, but not with intensity.

The process of closure of experimental retinal holes in rabbit eyes.

BACKGROUND: To investigate the healing process of retinal holes, including the identification of the cell types which play an important role in the process, we created experimental retinal holes with minimal damage to retinal pigment epithelium (RPE) in rabbit eyes. METHODS: Pars plana vitrectomy was performed in the rabbit eye. A dome-shaped retinal detachment (bleb; diameter 1.5 mm) was made by injecting balanced salt solution into the subretinal space, followed by making a retinal hole (diameter 0.5 mm) in the center of the bleb with a silicone-tipped extrusion needle. In one group of rabbits, fluid-air exchange was performed and sulfur hexafluoride gas was injected into the vitreous cavity postoperatively. In another group, gas tamponade was not performed. The operated eyes were examined ophthalmoscopically and enucleated at 1, 4, 7, 14, 30, and 90 days after surgery. Tissues were prepared in 5-microm sections for hematoxylin-eosin staining and immunohistochemistry with antibodies to cytokeratin 18 and glial fibrillary acidic protein (GFAP) and examined by light microscopy. RESULTS: In the gas-injected eyes, the retinal holes were ophthalmoscopically closed by 7 days after the surgery. Microscopic examination revealed that the sensory retina around the retinal hole was reattached, and the area of retinal defect was covered with cells which were positive for cytokeratin 18 and GFAP by 7 days after the surgery. In the eyes without gas tamponade, the retinal holes did not close during the observation period. CONCLUSIONS: These findings suggest that early attachment between the sensory retina and RPE could be essential for closure of a retinal hole, where glial and RPE cells might play an important role. This model seems to be useful to investigate the process of closure of retinal holes.

Preoperative anal sphincter high pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity predict early postoperative defecatory function after low anterior resection for rectal cancer.

PURPOSE: The aims of this study were to correlate postoperative defecatory function after low anterior resection with clinical factors and physiologic parameters and to explore the possibility of predicting early postoperative defecatory function after low anterior resection. METHODS: Thirty-two patients who underwent low anterior resection for rectal cancer were studied. Anorectal physiologic studies were performed preoperatively and six months postoperatively; maximum resting pressure, maximum squeeze pressure, length of the high pressure zone, neorectal sensory threshold, neorectal maximum tolerable volume, and anal mucosal electrosensitivity were recorded. Preoperative and postoperative defecatory function was scored between 0 (worst) and 6 (best) on the basis of bowel frequency, fecal incontinence, and urgency. RESULTS: In univariate regression analyses, a longer preoperative high pressure zone and a more sensitive anal mucosa were associated with better postoperative defecatory function. Using multiple regression analysis, in which age, gender, the level of anastomosis, and preoperative physiologic parameters were examined as independent variables, a longer preoperative high pressure zone, a larger preoperative maximum tolerable volume, and lower sensory threshold of the anal canal were associated with better postoperative defecatory function. Postoperative function score was found to be predictable using the following formula: 1.47 + 0.496 x high pressure zone (cm) + 0.007 x maximum tolerable volume (ml) - 0.247 x sensory threshold (mA) of the anal canal. CONCLUSION: Early postoperative defecatory function after low anterior resection is predictable from preoperative high pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity.

[Environmental control for allergic diseases--avoiding and killing effect on housedust-mite by eastern red cedar].

Housedust-mite has been a trigger factor for allergic diseases such as asthma, rhinitis and eczema. Therefore, it is important to remove housedust-mite from the environment of an allergic patient. Eastern red cedar is one kind of cypress tree which grows naturally in Northern America. It is used for the material of pencils, and the essence of soap. Its oil is used for oily substance for microscope lens. Using original system, we examined eastern red cedar and its oil, and found that it is effective for killing and preventing housedust-mites. The result was very effective. In conclusion the eastern red cedar and its oil seems to be useful for controlling mites in the home environment of allergic patients.

Quantitative assessment of macular edema with retinal vein occlusion.

PURPOSE: To evaluate the retinal thickness analyzer, a new image analyzer involving laser-slit biomicroscopy, for quantitative assessment of retinal thickness in patients with macular edema secondary to retinal vein occlusion. METHODS: Fifty-eight patients (central retinal vein occlusion, 22 eyes; branch retinal vein occlusion, 36 eyes) with a clinical diagnosis of macular edema associated with retinal vein occlusion were evaluated. Retinal thickness analysis was performed with the retinal thickness analyzer. A green helium-neon laser slit directed into the eye was scanned to generate optical cross-sections of the retina. Images were analyzed by an automated software algorithm, and a detailed map of the retinal thickness was obtained. RESULTS: Laser-slit images obtained with the retinal thickness analyzer in patients with macular edema associated with retinal vein occlusion disclosed intraretinal changes such as retinal edema, cystoid spaces, and hemorrhages. Linear regression analysis showed a significant relationship between the macular thickness in the central fovea and corrected visual acuity reported on a logMAR scale (P = .002, adjusted R2 = 0.40 in central retinal vein occlusion; P = .002, adjusted R2 = 0.34 in branch retinal vein occlusion). CONCLUSION: We confirmed the capability of the retinal thickness analyzer to provide rapid and precise evaluation of macular thickening in patients with retinal vein occlusion.

[Ipsilateral central-type facial palsy and contralateral hemiparesis associated with unilateral medial medullary infarction: a case report].

Clinical pictures of medial medullary syndrome are variable, depending upon the extent of the lesion. Facial palsy has rarely been observed even in medullary infarction. However, central-type facial palsy is usually found contralaterally to the infarct area at the level of the rostral medulla. In the present report, we discuss the pathogenesis of the neurological manifestations in a 57-year-old man with hypertension. The patient presented with mild left facial palsy of central type, right hemiparesis, paresthesia, with deep sensory disturbance of the right extremities. An MRI of the brain showed an infarction localized in the medial region of the left upper medulla. Although the exact course of the supranuclear facial pathways remains controversial, the ipsilateral central facial palsy in this patient is considered to have two possible causes: the interruption of aberrant fibers of the corticobulbar tract, which branch off and swing back at the level of the upper-middle medulla, or the disruption of recurrent ascending fibers from the contralateral pyramidal tract, through decussation.

Influence of the sensory retina on healing of the rabbit retinal pigment epithelium.

PURPOSE: To compare the healing process of the retinal pigment epithelium (RPE) with and without the overlying sensory retina. METHODS: A dome-shaped retinal detachment was created in the pigmented rabbit eye by injecting balanced salt solution into the subretinal space. The detached retina was partially removed with a vitrector; in some eyes, the detached retina was removed completely. RPE about 1.5 mm in diameter was removed from Bruch's membrane and aspirated through the retinal break. All eyes were examined morphologically. RESULTS: Independent of the sensory retina, 4 days postoperatively the RPE wound was covered by immature RPE cells that gradually formed an epithelial-like sheet by 2 weeks postoperatively. In eyes with overlying sensory retina, regenerated RPE cells similar to normal RPE cells formed a monolayer in most areas. The RPE-photoreceptor outer segment interface gradually organized. In eyes with no sensory retina, the regenerated RPE cells were longer, mounded, and their microvilli were shorter and disorganized. The RPE cells were multilayered in some areas and often had a tubuloacinar structure. CONCLUSIONS: The RPE wounds healed rapidly, independent of the presence of the overlying sensory retina, up to 2 weeks after RPE removal. Reconstruction of the RPE monolayer and the apical morphology of regenerated RPE cells were influenced by the sensory retina.

[Weber's syndrome of ischemic vascular origin--a clinical and neuroradiologic study].

A series of 4816 patients with cerebrovascular disease have undergone CT and/or MRI examinations over the last 25 years at the Higashi Nagoya National Hospital and the Nagoya National Hospital. Of these, we experienced 5 cases (4 men and 1 woman) of Weber's syndrome: two cases were resulted from cerebral embolism and three from cerebral thrombosis. All of the patients had left hemiparesis and right oculomotor palsy. On full investigation, complete unilateral external and internal oculomotor palsy was seen in two patients, while the remaining three patients showed pupillary sparing. The patients with complete oculomotor palsy presented with left hemiparesis as the initial symptom. In addition to oculomotor palsy and crossed hemiparesis, two patients had paralysis of the face and one patient had tongue muscle on the opposite side of the lesion and disorders of sensation. Positive Babinski's sign was found in four of the five patients. In one patient with unilateral glossoplegia on the side of hemiparesis, CT or MRI revealed a limited low-density or low signal intensity (T1) area in the inner part of the crus cerebri, and in the other patient who also had hemihypesthesia, the low-density or low-signal intensity (T1) area expanded into the dorsal midbrain. We would like concluded that the frequency of Weber's syndrome was very low though this syndrome was well celebrated, and the careful clinical observation of the neurological features of affected patients guided to the obvious site of lesion in the midbrain.

[Studies on the identification of sulfadimidine in pork by high performance liquid chromatography with photodiode array detector and gas chromatograph-mass spectrometry].

Sulfadimidine (SDD) was detected in pork imported from Mexico by HPLC with gradient elution system. UV spectrum of the peak was measured and confirmed by photodiode array detector, moreover identified by GC/MS after methylation with diazomethane. Content of SDD in the sample was 0.1 ppm and detection limit of SDD by the proposed method was 0.02 ppm. Application of this method to CLP, SMR, SMM, SDM and SQX was studied, and satisfactory results were obtained.

[A case of Down's syndrome with chronic inflammatory demyelinating polyradiculoneuropathy].

A 19-year-old male patient with Down's syndrome accompanied by relapsing and steroid-dependent chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) was reported. He had been well until the beginning of June 1988, and he rapidly developed a gait disturbance and symmetrical numbness in his arms and legs at the end of that month. He also suffered from difficulty in swallowing and dyspnea soon afterward. A physical examination revealed the specific clinical features of Down's syndrome, but no particular signs. Neurological examination showed the following abnormal findings; fixed nystagmus, diminished gag reflex, flaccid tetraparesis, and distal dominant dysesthesia of upper and lower extremities. Deep tendon reflexes were diminished and Babinski's sign was negative. No autonomic dysfunction was detected. Routine hematology and biochemistry screening test revealed normal level except for increasing GPT and IgG. Protein and gamma globulin values in cerebrospinal fluid (CSF) were elevated without pleocytosis. Nerve conduction velocities were slighty reduced. Pulse therapy and corticosteroid treatment improved on clinical course and CSF results. CIDP probably results from an abnormal immune responsiveness. Down's syndrome has often been taken for autoimmune abnormality. It is of great interest whether there is a close connection of autoimmune abnormality between Down's syndrome and CIDP. This might be the first case report of Down's syndrome associated with CIDP, judging from our survey of the literature in Japan and other countries.

Effects of aldose reductase inhibitor (M79175) on ERG oscillatory potential abnormalities in streptozotocin fructose-induced diabetes in rats.

The effects of an aldose reductase inhibitor (M79175) on electroretinogram (ERG) oscillatory potential abnormalities was studied in rats with streptozotocin fructose-induced diabetes. The ERG oscillatory potential was recorded under scotopic conditions without general anesthesia in the diabetic rats, before and 4, 8 and 12 weeks after administration of M79175. The ERG tracings were analyzed for peak latencies, peak intervals and amplitudes; the peak latencies and intervals were prolonged and the amplitudes were reduced in untreated diabetic rats, but the prolongation of the peak latencies and intervals were suppressed in diabetic rats receiving M79175. The amplitudes were reduced in the treated rats as in the untreated rats. The results of this investigation suggest that M79175 is effective to suppress progression of diabetic retinopathy in its early stage.

Effects of fasting on biperiden pharmacokinetics in the rat.

The effects of fasting on the pharmacokinetics of biperiden in rats were examined. Total clearance of biperiden was greater than 90% ascribable to hepatic clearance and was essentially blood-flow dependent. The number of compartments in the preferred pharmacokinetic model of biperiden changed from three (for normal rats) to two (for fasted rats). The smaller mean residence time (MRT) values found for fasted rats were attributable to decreases in distribution volume. Biperiden showed much higher lipophilicity than haloperidol, thiopental, and hexobarbital, and its tissue-to-plasma partition coefficient in adipose tissue was 20-fold higher than that in muscle. The influence of changes in volumes of adipose tissue and muscle on distribution volume (Vdss/BW) was evaluated from tissue-to-plasma partition coefficients. The value of Vdss/BW was predicted to decrease with decrease of adipose tissue, and to increase with decrease of muscle tissue. These results suggest that the observed decrease of Vdss/BW in fasted rats reflects reduced capacity to trap biperiden in the body, especially in adipose tissue. Possible clinical implications of these results are discussed.