Clinicopathologic aspects of ischemic heart disease in the elderly.
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Biomedical subjects
Publications and source records attributed to K Ueda.
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The incidence and pathologic features of cardiac lesions in 184 autopsied aged patients with disseminated intravascular coagulation (DIC) were reported. Coronary thrombosis was noted in 31 (16.8%), fresh myocardial necrosis in 60 (32.6%) and massive myocardial hemorrhage in 49 (26.6%) of these patients. Fresh myocardial infarction was present in 16 (8.7%) patients, 13 of whom manifested coronary thrombosis. The site of thrombi deposition was closely related to preexisting stenotic lesions of the coronary arteries. Only 3 of 16 patients with disseminated intravascular coagulation and acute myocardial infarction had typical cardiac symptoms. In most patients, the electrocardiographic changes were equivocal or not diagnostic for the diagnosis of acute myocardial infarction. We suggest the possibility that coronary thrombi in disseminated intravascular coagulation may gradually increase in extent and severity, leading to confluent areas of myocardial necrosis. The possibility of death due to heart failure, arrhythmia or cardiac rupture, points to the importance of recognizing the frequent cardiac involvement in aged patients with disseminated intravascular coagulation.
Effect of vitamin A compounds on the covalent binding of benzo(a)pyrene [B(a)P] to subnuclear components was studied using rat liver nuclei in vitro. The retinol-induced inhibition of the covalent binding of B(a)P depended both on the dose and the time of addition. Retinal and retinyl acetate were both potent inhibitors, but retinoic acid was less effective. Retinol induced marked inhibition of B(a)P binding to DNA and protein of the nuclear matrix but had little or no effect on the labeling of bulk DNA and protein in chromatin fractions.
The action of mitomycin C on double-stranded replicative form I DNA (RF I DNA; supercoiled, covalently closed, circular duplex DNA) of bacteriophage phi X174 was investigated using the technique of agarose gel electrophoresis. Mitomycin C reduced with sodium hydrosulfite (sodium dithionite, Na2S2O4) caused single strand scission in phi X174 RF I DNA in the presence of Cu2+. Cu2+ was essential for this DNA cleave action, and other transition metal ions such as Fe2+, Fe3+, Mn2+, Co2+ and Zn2+ were of no effect. This DNA strand scission was inhibited by catalase (EC 1.11.1.6) and various radical scavengers. This DNA strand scission was caused by free oxygen radicals generated during autoxidation of reduced mitomycin C in the presence of Cu2+.
Numerous vegetating plaques developed in a 63-year-old man followed up for the management of pemphigus vulgaris of 5 years' duration. These lesions occurred over the trunk and right upper arm with no involvement in the intertriginous area, and were controlled with systemic steroid and ODT. Direct immunofluorescence test showed heavy deposition of fibrinogen in the papillary dermis. To our knowledge, the occurrence of pemphigus vegetans in the non-intertriginous area is rare.
Adenosine deaminase (ADA) and ecto-5'-nucleotidase (5'-N) activities were examined in peripheral leukocytes from patients with leukemias, including nine patients with chronic myeloid leukemia (CML) in blast crisis. Four of none cases of CML in blast crisis were myeloid and the remaining lymphoid morphologically. The diagnosis of CML in lymphoid blast crisis was further contributed by the measurement of terminal deoxynucleotidyl transferase (TdT) activity. In all four cases of lymphoid blast crisis and one of myeloid blast crisis, leukemia cells had high 5'-N activity, while there was a little or no detectable activity in those from four cases of myeloid blast crisis and all of CML in chronic phase. ADA activity was high in seven of nine patients with blast crisis. Taken together, leukemia cells from two cases of lymphoid blast crisis had high ADA and 5'-N activities comparable to those in acute lymphocytic leukemia (ALL) cells. In contrast, the enzyme activities of leukemia cells from all but one patient in myeloid blast crisis were in a range similar to acute myeloid leukemia cells. The implications of these findings are as follows: (1) 5'-N may be used as a new biochemical marker of CML in lymphoid blast crisis. (2) Some lymphoid cells of CML in blast crisis have high ADA, 5'-N, and TdT activities and thus are very similar to ALL cells.
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To assess whether surgical procedures have fulfilled patients' expectations, questionnaires were sent to 41 patients who had undergone surgical-orthodontic correction of skeletal Class III malocclusions. Ninety per cent of the patients answered that they were satisfied with the results in regard to their chief problems and 85% had improved masticatory function. A favorable change in appearance was recognized by 24 patients, whereas 15 patients noticed no major changes, and two were displeased with the changes. Patients' expectations were not always satisfied despite evident improvement by objective standards. Factors affecting their satisfaction with the results of the surgery are discussed.
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The pathogenicity of Propionibacterium acnes was studied using immunodeficient and germ-free (GF) mice. P. acnes injected i.p. to immunocompetent (ddY and BALB/c-nu/+) and -deficient mice (CBA/N and BALB/c-nu/nu) decreased rapidly and only as small number were recovered from organs from day 7 on. The organisms injected similarly into GF-immunocompetent (GF-CF1) mice also decreased but when injected into GF-immunodeficient (GF-BALB/c-nu/nu) mice a small number persisted as late as week 4. When GF-immunocompetent (GF-ICR) mice were treated with cortisone and anti-mouse thymocyte serum, a small number of organisms were also recovered for 4 weeks after injection. Upon injection into irradiated GF-nu/nu mice, the number of viable P. acnes decreased relatively slowly and were recovered even at week 22. After oral administration a small number of P. acnes were readily detected from organs of GF-nu/nu mice but rarely from GF-nu/+ mice. The results indicate that P. acnes organisms have very low pathogenicity to mouse. However, small numbers persisted in organs of P. acnes-monoassociated immunodeficient mice. The mechanisms of this persistency of the nonpathogenic bacteria is discussed.
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The extensibility of the pulmonary artery (PA) were examined using a combined hemodynamic and ultrasonic technique in 14 patients with atrial septal defect (ASD), three with ASD and pulmonary hypertension (PH), 17 with ventricular septal defect (VSD) and 11 with VSD and PH. Seven patients with neither intracardiac shunt nor PH served as controls. The tension (T) of PA was measured as the product of the pressure and the diameter (D) and was found to be high in the patients with intracardiac shunt. The resting diameter of PA (D0) was calculated as the intersect with the D axis in the regression line of PA tension-diameter relation. The Lagrangian strain of PA [(D--D0)/D0] was obtained using D0 and correlated with T yielding a linear regression equation. The elastic modulus (E) was obtained as the slope of this equation. E in the patients with ASD [(1.0 +/- 0.5) x 10(5) dynes/cm] or VSD [(9.8 +/- 4.6) x 10(4) dynes/cm] were slightly higher than that of the control [(6.7 +/- 2.9) x 10(4) dynes/cm], but these differences were not statistically significant. However, E in the patients with ASD and PH [(2.5 +/- 1.3) x 10(5) dynes/cm] or in the patients with VSD and PH [(2.6 +/- 0.9) x 10(5) dynes/cm] were significantly higher than the control. E seemed unlikely to be causally related to the resistance of PA capillary beds, and was suggested to be influenced by the histological changes of the pulmonary trunk. It was concluded that the extensibility of PA in the patients with ASD or VSD was not altered secondary to the increased blood flow unless PH was associated.
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