The administration of intravenous gamma-globulin (IVGG) for Kawasaki disease was investigated throughout Japan in 1993 by obtaining information from pediatric departments in 2652 hospitals that had more than 100 beds. Of 11,221 reported patients, 8958 patients (79.8%) received IVGG treatment. Of all the patients to whom IVGG was administered, the most common total dose was 1000 mg/kg (36.3%) followed by 2000 mg/kg (16.9%) and 1200 mg/kg (16.8%). The treatment was started in 53.8% by day 5 of the illness and in 83.7% by day 7. The proportion of those with cardiac sequelae was higher among patients administered > 2000 mg/kg or in those started on IVGG on day 9 of their illness or later. The possible reasons are (1) those who were more severely affected were treated with high-dose IVGG earlier; or (2) IVGG does not effectively prevent cardiac sequelae. We concluded that there is a risk of unfavorable effects with IVGG regarding cardiac sequelae when the IVGG dose is > 2000 mg/kg or if IVGG is started on day 9 or later. We believe that only a randomized controlled trial, undertaken prospectively, can adequately address the question of the optimal use of IVGG.

Child, Preschool↗

PubMedDate not supplied

Spontaneously reduced midgut malrotation: CT diagnosis.

Midgut malrotation is a relatively rare congenital malformation that arises from an error of rotation and fixation of the midgut. We report a case of spontaneously reduced duodenal malrotation diagnosed by computed tomography and roentgenography after the ingestion of barium.

Adult↗

PubMedDate not supplied

Lifestyle determinants for social activity levels among the Japanese elderly.

We conducted a self-administered questionnaire survey to a total of 5239 elderly persons in four areas in Japan in 1993, which inquired about past lifestyles and present social activities. Based on the survey data, we first developed social activity measures, and then examined associations of the present total social activity measure with past lifestyles and physical conditions. The lifestyles significantly associated with high social activity after 65 years of age were 'high educational attainment'; having been 'healthy', 'plump', 'physically active' and 'having had hobbies' at about 50 years of age; and having 'frequent intake of many kinds of foods' during 30-50 years of age. Intake during 30-50 years of age of Japanese-style foods (rice, soybean paste soup, bean curd, pickles), noodles, beans, plant roots and potatoes was not significantly linked with the social activity levels at old age in either males or females. The same was true for smoking and drinking habits at about 50 years of age. Our findings essentially suggest the importance of a positive attitude at middle age to maintain and promote health status and improve lifestyles in order to attain high social activity at old age.

Journal Article↗

PubMedDate not supplied

MRI in thorotrastosis.

Magnetic resonance imaging (MRI) and computed tomography (CT) were performed in four patients with thorotrastosis. On CT scan, Thorotrast (thorium oxide) deposition was shown as high-density areas in the liver and spleen and the abdominal lymph nodes. These deposits were not found on MRIs. Splenic volume was significantly small due to atrophy. The contrast-noise ratio in the spleen on T1-weighted images was significantly lower. Thorotrast deposition does not affect MRI appearance; therefore it may be useful for the early detection of malignant tumors as a complication of thorotrastosis.

Aged↗

PubMedDate not supplied

Comparison of [123I]metaiodobenzylguanidine kinetics with heart rate variability and plasma norepinephrine level.

BACKGROUND: [123I]Metaiodobenzylguanidine (MIBG) imaging has been used to assess cardiac sympathetic nerve abnormalities. We evaluated the clinical significance of myocardial MIBG imaging as a measure of cardiac sympathetic nervous system function by comparing it to heart rate variability and plasma norepinephrine level. METHODS AND RESULTS: In 211 subjects, we analyzed heart rate variability with 24-hour electrocardiography, performed scintigraphy with MIBG, and measured plasma norepinephrine levels. Time and frequency domain measures of heart rate variability were calculated with the Marquette heart rate variability program (Marquette Electronics, Milwaukee, Wis.). Early and late myocardial MIBG uptakes were measured at 15 and 150 minutes after injection, respectively. MIBG clearance rate from the heart and heart-to-lung and heart-to-mediastinum ratios of MIBG activities were calculated. On the whole, heart rate variability, including low-frequency power, correlated positively, but modestly so, with late MIBG uptake and negatively with MIBG clearance rate. The plasma norepinephrine level correlated negatively with late MIBG uptake and with heart rate variability, including low-frequency power, and positively with MIBG clearance rate. Similar correlations were also observed in patient subgroups with coronary artery disease, diabetes mellitus, and renal failure, but these correlations were weak (R2 < 0.5). CONCLUSIONS: Increased cardiac sympathetic nervous system activity may be associated with increased myocardial MIBG clearance and decreased heart rate variability, including low-frequency power. Because these associations were not strong, however, the combination of heart rate variability with MIBG may allow an interactive assessment of the cardiac autonomic nervous system.

3-Iodobenzylguanidine↗

PubMedDate not supplied

Assessment of myocardial fatty acid metabolism in atrioventricular synchronous pacing: analysis of iodine 123-labeled beta-methyl iodophenyl pentadecanoic acid SPECT.

BACKGROUND: We used beta-methyl iodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) to evaluate fatty acid metabolism in patients who were candidates for permanent pacemaker implantation and in patients with atrioventricular (AV) synchronous pacing. METHODS AND RESULTS: We performed BMIPP SPECT studies in 66 patients with bradyarrhythmia, of whom 11 patients were candidates for permanent pacemaker implantation, 27 patients had atrial pacing (atrial sensing, inhibited mode, simple programmable [AAI]), and 28 patients had atrial synchronous ventricular inhibited pacing (ventricular pacing, 2-chamber sensing, atrial-triggered and ventricular-inhibited, multiprogrammable [VDD]) or atrial and ventricular pacing in sequence (atrial and ventricular sensing, atrial-inhibited and atrial-triggered, ventricular-inhibited, multiprogrammable [DDD]). A qualitative assessment revealed that the BMIPP uptake at the septal, inferior, and apical regions was significantly decreased in the patients with VDD/DDD compared with both the candidates for permanent pacemaker implantation and the patients with AAI. The total extent score (ES) and severity score (SS) were significantly higher in the patients with VDD/DDD than in the other 2 groups. Significant regional differences of both ES and SS values were observed at the septal and inferior regions in the patients with VDD/DDD compared with the other groups. No differences were found between the qualitative and quantitative measures of BMIPP uptake in the candidates for permanent pacemaker implantation and those in the patients with AAI. CONCLUSION: Our study suggests that AV synchronous right ventricular pacing resulting in the delayed conduction and depolarization of myocardial cells may directly interfere with regional cellular free fatty acid uptake and metabolism.

Aged↗

PubMedDate not supplied

PEEP therapy for patients with pleurotomy during coronary artery bypass grafting.

Severe pulmonary oxygenation impairment resulting from peripheral lung atelectasis occurred in some patients with pleurotomy during the harvest of the internal mammary artery graft followed by coronary artery bypass grafting (CABG). We studied the efficacy of intraoperative positive end-expiratory airway pressure (PEEP) therapy for the prevention of postoperative pulmonary oxygenation impairment. A total of 66 patients with solitary CABG procedure were included in this study. The pleural cavity was intraoperatively opened in 44 patients and not opened in 22. PEEP therapy was not used in any patient before May 1996 (referred to herein as the former period) and was used more recently in eight patients with pleurotopmy (referred to herein as the latter period). PEEP was initiated immediately after pleurotomy during the harvest of the internal mammary artery graft. Without PEEP therapy, values of PaO2, A-aDO2, and respiratory index (RI) were worse in patients with pleurotomy than in those without pleurotomy. Meanwhile, there were no major differences in these values between patients with or without pleurotomy after the induction of PEEP therapy. Respiratory insufficiency (A-aDO2 > 400 mmHg and RI > 1.5) was detected in six patients with pleurotomy in the former period. Three of these six patients required over 1 week of long-term mechanical respiratory support. No respiratory insufficiency occurred in patients of the latter period. In conclusion, PEEP therapy, which is initiated just after pleurotomy, may prevent oxygen impairment and pulmonary atelectasis after extracorporeal circulation (ECC) and is recommended for patients with pleurotomy, especially for patients with preoperative low respiratory function.

Aged↗

PubMedDate not supplied

Effect of human granulocyte colony-stimulating factor on neutropenia induced by radiotherapy and chemotherapy.

This study was designed to test the effect of human granulocyte colony-stimulating factor (hG-CSF) in patients at risk for neutropenia caused by radiotherapy plus chemotherapy. Twelve patients with advanced esophageal tumor were treated after operation with 'sandwich' radiochemotherapy (successive treatment with chemotherapy-radiotherapy-chemotherapy). hG-CSF was given subcutaneously at a dose of 2 micrograms/kg/day for 3-5 days after the white blood cell counts decreased to less than 3,000/mm3. Neutrophil counts significantly recovered to normal levels within 5 days in all patients treated with hG-CSF. No significant changes in the lymphocyte, platelet and red blood cell counts were shown. No side effects were observed. These results indicate that hG-CSF is a useful tool for the treatment of neutropenia induced by radiotherapy and chemotherapy.

Aged↗

PubMedDate not supplied

A study on tea aroma formation mechanism: alcoholic aroma precursor amounts and glycosidase activity in parts of the tea plant.

We have shown in molecular basis that alcoholic tea aroma is mainly formed by endogenous enzymatic hydrolysis of glycosidic aroma precursors during manufacturing. Amounts of alcoholic aroma precursor and glycosidase activity in each part of the tea shoot (Camellia sinensis var. sinensis cv Yabukita and a hybrid of var. assamica & var. sinensis cv Izumi) were indirectly measured by means of a crude enzyme assay. The aroma precursors were abundant in young leaves and decreased as the leaf aged. Glycosidase activity also decreased as leaves aged, but was high in stems.

Carbohydrate Conformation↗