Comparison of results of intracoronary implantation of the Plamaz-Schatz stent with conventional balloon angioplasty in chronic total coronary arterial occlusion.

We compared angiographic and clinical outcomes after successful revascularization of chronic total coronary arterial occlusion with the placement of the Palmaz-Schatz stent (43 patients) and conventional balloon angioplasty (53 patients). After the procedure, the coronary stent led to a greater minimal lumen diameter than conventional balloon angioplasty (2.6 vs 1.7 mm, p < 0.001), resulting in a smaller residual stenosis (6.5% vs 36.7%, p < 0.001). At 6-month follow-up, there was no significant difference in late loss between the groups, resulting in a larger minimal lumen diameter at follow-up in the stent group (1.8 vs 1.1 mm, p < 0.001). The incidence of restenosis was lower in the stent group (27.9% vs 56.6%, p < 0.005). The frequency of the combination of myocardial infarction and coronary artery bypass graft surgery tended to be less in the stent group (2.3% vs 11.3%, P = 0.09). Placement of the Palmaz-Schatz stent improved left ventricular ejection fraction by 26% in patients who had reduced left ventricular function (p < 0.05), but conventional balloon angioplasty did not. Thus, placement of the Palmaz-Schatz stent provided a wider lumen than did conventional balloon angioplasty and, therefore, reduced the incidence of restenosis in chronic total coronary arterial occlusion. The lower restenosis rate of coronary stenting would be beneficial for long-term clinical outcome in patients with chronic total occlusion.

Surface coil MR imaging of orbital blowout fractures: a comparison with reformatted CT.

Four patients with orbital blowout fractures were evaluated by surface coil MR imaging, and the resulting images were compared with computer reformatted CT scans. The surface coil afforded significant improvement in spatial resolution, resulting in better demonstration of the blowout fracture. Surface coil MR was found superior to CT in the assessment of fracture site, extent of prolapsed orbital fat, and muscle entrapment.

Intraocular lesions in patients with systemic disease: findings on MR imaging.

Twenty-one intraocular lesions associated with various systemic diseases in 15 patients were studied by MR imaging. The disorders included diabetes mellitus, cardiovascular disease, Behçet disease, sarcoidosis, and ankylosing spondylitis. MR was performed on a 0.5-T system using a surface-coil technique. Ophthalmoscopic visualization of the fundus was precluded by the presence of opaque media in all cases. MR was found to be effective in demonstrating intraocular bleeding, vitreous opacity, detached lesions of the posterior pole, and eyeball deformity. Surface-coil MR is a useful adjunct in the evaluation of the eyes affected by systemic diseases, especially in patients with opaque media.

Hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia: report of a case.

A case of hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia is reported. The patient had persistent severe jaundice with hepatosplenomegaly. A liver tumor was suspected because of the elevated serum alpha-fetoprotein and was shown by ultrasonography at 6 years of age. The tumor was treated with percutaneous ethanol injection therapy (PEIT). Nine months after initiation of PEIT, the patient died of massive bleeding from a metastatic tumor.

Evaluation of biventricular interaction in various cardiac diseases by pulsed Doppler echocardiography.

We evaluated the biventricular interaction in various cardiac diseases by pulsed Doppler echocardiography. A/R (atrial peak filling velocity/rapid peak filling velocity) from inflow wave and PEP/ET (pre-ejection period/ejection time) from outflow wave were measured as parameters of both ventricular function. In 20 normal cases, A/R and PEP/ET correlated well between the right and left ventricles, respectively. In 6 cases with pulmonary hypertension, both values of A/R and PEP/ET were higher than those in normal cases in the right ventricle, but not in the left ventricle. In 15 cases with left ventricular infarction, these values were higher than those in normal cases. Not only in the left ventricle but also in the right ventricle, and good correlation between both ventricles was observed in each parameter. In 15 cases with hypertrophic nonobstructive cardiomyopathy and 15 cases with dilated cardiomyopathy, both values of A/R and PEP/ET in the both ventricles were also higher than those in normal cases, respectively, however, both parameters did not correlate with the both ventricles. It is suggested that the right ventricular function is influenced not only by the afterload or interventricular septal function, but also by the myocardial property of the right ventricle itself, in cases with cardiomyopathies.

[Magnetic resonance imaging of diseased cervical and lumbar intervertebral discs].

Magnetic resonance images (MRI) of diseased cervical and lumbar intervertebral discs involving both intrinsic and extrinsic cord lesions were examined using either a 0.15 T resistive or a 0.5 T superconductive magnetic imaging system. High resolution images were obtained by means of a surface coil in most cases. The vertebrae, intervertebral discs, and spinal cord were delineated in greatest detail on spin-echo (SE) images with a long repetition time (TR) and a short echo time (proton density-weighted image), on which the spinal cord was appreciated without overshadowing by the cerebrospinal fluid-filled subarachnoid space. Protrusion of degenerated intervertebral discs into the spinal canal was clearly demonstrated not only on sagittal but also on parasagittal and transverse views. The location of protruded discs and compression of the spinal cord, caudal sac, and nerve roots were well visualized three-dimensionally. Pathological features of intervertebral discs were better appreciated on T2-weighted images with long TR and SE pulse sequences. Degeneration of intervertebral discs resulted in decreased signal intensity in cases involving lumbar disc lesions but not those involving cervical disc lesions. In a case of suspected myelomalacia, the intrinsic cord lesion resulting from traumatic disc protrusion appeared as focal low signal intensity on T1-weighted images and as somewhat high intensity on T2-weighted images. The inversion recovery sequence with median inversion time displayed an inferior image of low contrast and was judged uninformative in comparison to SE images. The authors' observations demonstrate that MRI is an essential diagnostic technique for spinal cord disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

[Concentrations of cefmenoxime and cefotiam in the bile and gallbladder tissue following intravenous administration in patients with biliary tract diseases].

To test the effectiveness of cefmenoxime (CMX) and cefotiam (CTM) in patients with biliary tract diseases, concentrations of either antibiotic were measured after an intravenous bolus injection of 1.0 g of CMX or CTM, or simultaneous injection of both (1.0 g each). CMX or CTM was injected in 76 patients with biliary tract diseases (mostly cholelithiasis) prior to a cholecystectomy and concentrations of CMX or CTM were measured by the bioassay (agar well) method at 30 to 60 minutes after the injection. Average concentrations of both CMX and CTM in gallbladder bile and gallbladder tissue sufficiently exceeded the minimal inhibitory concentration (MIC) against main causative organisms of biliary tract infections. Concentrations of both antibiotics in gallbladder bile were significantly higher in patients with patent cystic ducts than with obstructed cystic ducts. Concentrations of both antibiotics in the gallbladder tissue reached at a similar high level regardless of the patency of the cystic ducts, but concentrations were lower in severely inflamed gallbladders. CMX and CTM were administered alternatively (cross-over fashion), or simultaneously (combined) to 13 patients with T-tube drainage or percutaneous transhepatic cholangio-drainage, and concentrations of both antibiotics in bile from the drainage tube were measured by high performance liquid chromatography at hourly intervals after the injection. Concentrations of both antibiotics were far greater than MICs against main attributable microorganisms in biliary tract infections. The concentration of CMX slightly exceeded that of CTM. Concentrations of both antibiotics were lower in bile of patients showing abnormally high serum GTP, A1-P, and total bilirubin levels than in bile of patients with normal values of these variables. It is speculated that the secretion of both antibiotics in the bile may decrease in cases with severe hepatic failure, but effective concentrations of both antibiotics in the gallbladder tissue should be maintained as long as the blood circulation in the gallbladder was maintained.

Analysis of ventricular arrhythmias in patients with dilated cardiomyopathy--relationship between the effects of antiarrhythmic agents and severity of myocardial lesions.

In order to investigate the usefulness of antiarrhythmic drugs in patients with dilated cardiomyopathy (DCM), 42 patients with DCM were studied using 24 h ambulatory ECG monitoring, echocardiography and right ventricular endomyocardial biopsy. All 42 patients had ventricular arrhythmias with a Lown's classification of grade II or greater (grade IVb, 25; IVa, 7; III, 7; II, 3). The patients with grade IV arrhythmias tended to have greater dilating of the left ventricle and more pronounced interstitial myocardial fibrosis than patients with lower grades. Following procainamide and/or disopyramide treatment the severity of the ventricular arrhythmias improved in 12 (29%) of the 42 patients, did not change in 27 patients (64%), and deteriorated in 3 patients (7%). Treatment with aprindine or mexiletine was effective in 7 (50%) of the 14 patients who did not respond to procainamide and/or disopyramide. Although there were no significant differences in left ventricular dimension and contractility between patients in each group who did and did not respond to antiarrhythmic treatment, those who did respond had less interstitial myocardial fibrosis. Thus, in the procainamide and/or disopyramide treated group the percent interstitial fibrosis in responding vs nonresponding patients was 10.3 +/- 4.1% vs 18.7 +/- 8.3% (p less than 0.05) respectively, while in the group treated with aprindine or mexiletine these figures were 13.0 +/- 3.2% vs 26.1 +/- 7.9% (p less than 0.02), respectively. In conclusion, the effect of antiarrhythmic drugs in DCM was dependent on the severity of the pathological changes in the myocardium, and antiarrhythmic drugs should be appropriately used for the management of ventricular arrhythmias in DCM.

Effects of a new cardiotonic agent, "TA-064", in patients with dilated cardiomyopathy--relationship between cardiac effect of TA-064 and severity of myocardial lesion.

In 18 patients with dilated cardiomyopathy (DCM), the effects of a new cardiotonic agent, TA-064, given in both consecutive and intermittent (3 days on, 11 days off) oral doses were studied for 3 months by echocardiography and endomyocardial biopsy. After 3 months of consecutive administration, 11 patients (61%) had improved symptomatically and the %FS increased (p less than 0.001) and LVDd decreased (p less than 0.05), but the other 7 patients had not improved. At the pretreatment state these 7 patients in whom TA-064 was not effective had smaller %FS (p less than 0.01) and larger LVDd (p less than 0.05) than the 11 patients in whom the drug was effective. The non-effective group also had more severe myocardial fibrosis (p less than 0.05) and cellular hypertrophy (p less than 0.01) than the effective group. After 3 months of intermittent administration in 10 patients in whom consecutive administration had been proved effective, 7 patients sustained symptomatic improvement and increased %FS (p less than 0.01), but the other 3 patients did not sustain the improvement. The latter group had smaller %FS, larger LVDd and more severe myocardial fibrosis than the former group at the pretreatment state. These results indicate that the effects of TA-064 are dependent on the severity of basal cardiac function and myocardial damage, and that in patients with milder DCM, the effects can be sustained by intermittent administration.