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OBJECTIVE: To treat end-stage cardiomyopathy, we evaluated endoventricular circular patch plasty, partial left ventriculectomy, and valvular reconstruction alone in our 2-year experience. METHODS: Among 86 patients with heart failure evaluated between December 1996 and February 1999, 33 patients with ischemic cardiomyopathy (25 men and 8 women; mean age 61 +/- 7.8 years; New York Heart Association class 3.5 +/- 0.5) were treated with endoventricular circular patch plasty combined with coronary bypass grafting (84%) and mitral reconstruction (36%). The other 53 patients with nonischemic cardiomyopathy (45 men and 8 women; mean age 48 +/- 14.3 years, New York Heart Association class 3.7 +/- 0.5), were treated by left ventricular reduction by partial left ventriculectomy (n = 37) or patch plasty (n = 3) and valve reconstruction alone (n = 13). The first 24 patients (group I) underwent ventriculectomy with or without valve reconstruction; the more recent 29 patients (group II) underwent left ventricular reduction (n = 16) or valve reconstruction alone (n = 13) on the basis of the intraoperative echocardiographic evaluation to observe changes of wall motion and thickness during cardiopulmonary bypass. RESULTS: Ischemic Group: Hospital mortality in elective (n = 26) and emergency (n = 7) operations was 4% and 43%, and 3 patients died in the late postoperative period. Mean New York Heart Association class and ejection fraction improved from 3.5 +/- 0.5 to 1.5 +/- 0.7 and from 23% +/- 7.7% to 36% +/- 8.6%, respectively. Left ventricular end-diastolic and end-systolic volume indexes decreased from 162 +/- 46 mL/m(2) to 110 +/- 39 mL/m(2) and from 130 +/- 47 mL/m(2) to 70 +/- 32 mL/m(2), respectively. Nonischemic Group: In 40 patients with left ventricular reduction, hospital mortality in elective (n = 33) and emergency (n = 7) operations was 6% and 86%, and 5 patients died in the late postoperative period. Mean New York Heart Association class and ejection fraction improved from 3.7 +/- 0.5 to 1.7 +/- 0.6 and from 18% +/- 6.4% to 31% +/- 5.9%. Left ventricular end-diastolic and end-systolic volume indexes decreased from 203 +/- 45 mL/m(2) to 110 +/- 37 mL/m(2) and from 164 +/- 40 mL/m(2) to 79 +/- 33 mL/m(2), respectively. In 13 patients undergoing valve reconstruction alone (12 mitral with or without tricuspid and 1 tricuspid plus left ventricular assist device), hospital mortality in elective (n = 9) and emergency (n = 4) operations was 0% and 50% with no late deaths. Mean New York Heart Association class and ejection fraction improved from 3.6 +/- 0.5 to 2.0 +/- 0.5 and from 22% +/- 6.0% to 30% +/- 14.5%, respectively. Mean left ventricular end-diastolic and end-systolic volume indexes decreased from 170 +/- 34 mL/m(2) to 150 +/- 50 mL/m(2) and from 140 +/- 38 mL/m(2) to 104 +/- 40 mL/m(2), respectively. Overall mortality decreased from 50% in group I to 10% in group II. The survival estimates at 2 years were 77% (confidence limits 57%-88%) in the ischemic group and 63% (confidence limits 47%-75%) in the nonischemic group (no significant difference). The analysis of our data showed that the factors influencing the surgical results for dilated cardiomyopathy were presence of severe mitral regurgitation, preoperative New York Heart Association functional class IV with emergency operation, and operative procedures with randomly performed partial left ventriculectomy without an intraoperative echo test. CONCLUSION: Endoventricular circular patch plasty, partial left ventriculectomy, and solo valve reconstruction can be performed with an acceptably low risk as elective operations. The selection of operative procedures in idiopathic dilated cardiomyopathy and avoidance of emergency surgery improved operative mortality and morbidity. Among patients who survived at least 1 year, there were no late deaths up to 30 months' follow-up.

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The Batista operation was performed in 30 patients (25 men and 5 women, mean age 47 years) to treat cardiac failure due to non-ischemic cardiomyopathy, mostly idiopathic dilated cardiomyopathy, from December 1996 to June 1998. Preoperative New York Heart Association (NYHA) class was IV in 21 patients including 17 receiving inotropic support, and class III in 9 patients. Seven patients required emergency surgery because of on-going shock and 23 patients were operated electively. Combined cardiac procedures were; mitral valve reconstruction in 26 patients (19 replacements, 7 repairs), tricuspid annuloplasty in 15, aortic valve replacement in 3 and one each of maze and coronary artery bypass grafting. All patients successfully weaned from cardiopulmonary bypass. Intraaortic balloon pump was used in 6 patients but no left ventricular assist device was used. Two of 23 patients (8.7%) who underwent elective operation died during hospitalization and 3 patients (13.0%) died in the late period. Six of 7 patients (85.7%) with emergency operation died in the hospital and only one survived. Sixteen of 19 survivors returned to NYHA class I-II, and 3 were in class III. Mean ejection fraction increased from 18 +/- 6% to 31 +/- 5%. Diastolic dimension decreased from 79 +/- 8 to 60 +/- 8 mm. End-diastolic and systolic volume indices decreased from 203 +/- 43 to 103 +/- 25 ml/m2 and from 164 +/- 39 to 70 +/- 25 ml/m2, respectively, at the second postoperative week. Six patients had ventriculography at one year after the operation, and no redilation was noted. Increased thickness of left ventricular wall was observed postoperatively. The Batista operation can be performed with relatively low risk and clinical improvement was obvious in elective operation, wheras risk is very high in emergency cases. Therefore, proper guidelines for patient selection and choice of procedure are critically important to achieve a successful outcome in the Batista operation.

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The Batista operation is intended to improve cardiac function by reducing the diameter of the left ventricle by excising of a sizable amount of the left ventricular free wall. Candidates for this operation are patients awaiting cardiac transplantation due to end-stage dilated cardiomyopathy and those unsuitable for transplantation because of age, physical or economical reasons. We performed this operation in 10 patients between December 1996 and October 1997. The baseline indication is left ventricular diastolic dimension > or = 70 mm and New York Heart Association (NYHA) class III or IV. There were eight men and two women aged from 16 to 60 years (mean 46 years). All had non-ischemic cardiomyopathy including seven idiopathic and one each of hypertrophic, arrhythmogenic right ventricular and valvular (sarcoidosis) cardiomyopathy. Eight patients were in NYHA class IV and six needed inotropic drip therapy prior to the operation. Nine patients had significant mitral regurgitation and six had tricuspid insufficiency concomitantly. Eight patients underwent mitral valve replacement and one was treated with mitral valve plasty. Six patients also had tricuspid plasty combined with partial left ventriculectomy. Eight patients survived. Mean value of left ventricular end-diastolic diameter was reduced from 77.8 mm to 59.8 mm, left ventricular end-diastolic volume index was reduced from 189.3 to 99.2 ml/m2, ejection fraction was increased from 19.0% to 33.8% and NYHA class improved from 3.8 to 1.8. Six months later, left ventricular dilatation was not noticed in four patients examined. The Batista operation offers real hope for patients with end-stage dilated cardiomyopathy, but we still have much to learn.

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This study was conducted to show a higher prevalence of interdigital tinea pedis in athletes by comparing athletes and non-athletes, and to examine swimming pools as a route of infection. The subjects were 282 athletes, 137 non-athletes, and 140 students enrolled in a swimming class at the University of Tsukuba. This study included the taking of cotton-swab samples from the interdigital skin surfaces of both feet and cultures, microscopical examinations of scales collected from subjects with lesions, and questionnaires. There was a significant difference between athletes and non-athletes in the prevalence of the relevant pathogens, and a higher risk of infection was shown in athletes. The study also found that 63.6% of the swimming class students were carriers, and that 85.0% of their dermatophytes were Trichophyton mentagrophytes. In addition, dermatophytes were also isolated from the floors of the swimming pool and the public baths. The results of these controlled studies suggested that there was a significant risk of dermatophytosis in both athletes and non-athletes using the swimming pool.

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To treat end-stage dilated cardiomyopathy, we have performed volume reduction left ventriculoplasty (as introduced by Randas Batista in Brazil) in four patients since December 1996. All patients had end-stage idiopathic cardiomyopathy. Mitral valve replacement was also performed in three patients. In all four patients, improvement of left ventricular function was noted. One patient died of respiratory failure on the 12th postoperative day. The other three patients recovered successfully from the operation (i.e., they were discharged from hospital with the functional status in New York Heart Association Class I or II). We conclude that the Batista operation provides a real hope for patients with end-stage dilated cardiomyopathy.

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There is a controversy on the effects of physiological levels of glucocorticoids on natural killer (NK) cytotoxity. Therefore, the effects of exogenously administered dexamethasone on NK cytotoxity in 8-week-old male, Fischer 344 rats were studied. We suppose that the reason for the controversy is insufficient sensitivity of the ordinal radioactive chromium-release assay for normal healthy subjects or animals. Therefore, we developed a new index, a resistance to artificial immunosuppressor, cyclosporine A (CsA) using rat NK activity as an indicator, and named this index, increased resistance to immunosuppressor (IRIS). After some basic, characterizing studies, authors confirmed the fact that continuous doses of dexamethasone (DEX) attenuated NK suppression of CsA. In protocol 4, 18 rats were randomly divided into three groups: the first (DEX + CsA) was injected for 5 days with 0.1 mg DEX/kg/day and a single dose of CsA on the final day, intraperitoneally; the second (SAL + CsA) was treated with an equal volume of saline and CsA; the third (DEX + SAL) was treated with DEX but not CsA. The IRIS in NK activity was increased significantly (P < 0.01) with 5 days injection of DEX. These results demonstrated that physiological, and continuous dosage of glucocorticoids stimulated IRIS in NK activity in rats, and this suggests that appropriate stimuli through the hypothalamic-adrenal axis might be acting, at least, as a defence against immune collapses or dysfunctions.

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Multivessel disease and decreased left ventricular ejection fraction (LVEF) are believed to be significant predictors of the outcome in patients with acute inferior myocardial infarction (AIMI). We attempted to determine new electrocardiographic (ECG) markers for detecting concomitant left anterior descending (LAD) disease and/or decreased left ventricular function in patients with AIMI. Eighty patients with AIMI were evaluated within 6 h of the onset of symptoms and grouped according to the presence (Group 1) or absence (Group 2) of concomitant LAD disease. All of the patients underwent coronary angiography and left ventriculography 4-6 weeks from the onset of their infarction. We studied the validity of two new ECG markers: S-T depression deeper in lead V5 than in V4 (S-T decreases V5 > V4) and negative U waves (NUs) > 0.5 mm (50 muV) in leads V4-6. The sensitivity and specificity of S-T decreases V5 > V4, NUs in V4-6, or both, in detecting concomitant LAD disease were 56% and 83%, 59% and 87%, and 35% and 98%, respectively. LAD lesions in patients who showed either of these new markers (74% of those with S-T decreases V5 > V4 and 80% of those with NUs in V4-6) were mostly in the proximal segments (AHA segments #6 or #7). Patients with either S-T decreases V5 > V4 or NUs in V4-6 tended to have asynergy in the anterolateral segment, while there was a strong correlation between the asynergy of the anterolateral and septal segments in patients who showed both ECG markers.(ABSTRACT TRUNCATED AT 250 WORDS)

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To clarify the origin and maintenance of epileptogenesis, morphological changes in the hippocampus of amygdaloid-kindled mice were analyzed at different stages of kindling. The granule cell size in dentate gyrus and the pyramidal cell size in CA1 were clearly decreased depending on seizure stage. The cell size in CA2 was increased and density in dentate gyrus and CA2 was reduced, significantly. The morphological changes in hippocampus associated with kindling must be closely related to the acquisition and the maintenance of epileptogenesis. The results support the hypothesis that seizure-induced damage of neurons may lead to formation of new synaptic connections that produce abnormal hyperexitability and result in seizures.

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A patient is reported in whom exercise induced reversible ischemic left anterior fascicular block and far advanced right bundle branch block. Master's two step exercise test for pre-operative check-up revealed significant ST elevation in leads V1-5, negative U waves in leads V3-5 and fascicular blocks with retrosternal anginal chest pain. Long acting nitrate and nicorandil relieved the fascicular blocks.

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We evaluated the relationship between the site of infarction and the infarct-related coronary arteries from electrocardiograms (ECGs) recorded early after the onset of chest pain in patients with an initial acute inferior myocardial infarction (IMI). The subjects were 80 patients (mean age 57 +/- 12 years) with IMI admitted within 6 hours from the onset of chest pain. This was prior to the thrombolytic era. We analyzed the ECGs on admission, at 24 hours and at 4 weeks. All patients underwent left ventriculography and coronary angiography at 4-6 weeks from the onset of the IMI. Left ventricular ejection fraction (EF) and regional area changes were measured. The infarct-related coronary artery was determined by the site of the asynergy. Patients were allocated into 2 groups according to the infarct-related artery, i.e. right (RCA, n = 52) and left circumflex (LCX, n = 28). Parameters measured were ST elevation, amplitude and width of R wave and R/S ratio in leads V1 and V2, and amplitude of U waves in leads V1 to V3. We defined the U wave as a prominent positive U wave (PPU) if it was > 0.5 mm (50 microV) in height. A significantly greater number of patients with PPU showed asynergy in posterolateral segments compared to those without PPU. The EF was significantly lower in patients with PPU than in those without (46 +/- 12% vs 54 +/- 13%, p < 0.05). Patients with PPUs eventually showed ECG evidence of posterior infarction (increased R wave duration and R/S ratio > or = 1 in lead V1 or V2) by 4 weeks compared to those without PPUs. Also a significantly greater number of patients with PPUs developed posterior infarction shown by left ventriculograms than those without PPUs. As to the infarct-related coronary arteries, a significantly greater number of patients with LCX disease showed concomitant posterior infarction than those with RCA disease. Also, a significantly greater number of LCX patients showed PPUs and ST elevations in leads V5 and V6 than those with RCA disease. The sensitivity of PPUs and ST elevations in leads V5 and V6 suggesting LCX disease was 60% and the specificity was 98% with a predictive accuracy of 87%. Therefore, we conclude that PPUs in leads V1-3 and ST elevations in leads V5 and V6 are specific markers for the diagnosis of LCX-related infarction in the setting of evolving IMI.

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We evaluated the site and infarct-related arteries from electrocardiograms (ECGs) recorded early after the onset in cases of inferior infarction (IMI). The subjects were 80 patients with IMI admitted within 6 hours from the onset. We analyzed the ECGs on admission, at 24 hours, at 4 weeks. All patients underwent ventriculography and coronary angiography at 4-6 weeks from the onset. Regional wall motion and ejection fraction (FF) were measured. The infarct-related artery was decided on by the site of the asynergy. Patients were allocated into 2 groups according to the infarct-related artery; ie right (RCA, n = 52) and left circumflex (LCX, n = 52). Parameters measured were leads showing ST elevation (ST increases), width of R waves and R/S ratio in V1,2. Amplitude of U waves in V1-3. We defined U greater than or equal to 0.5mm as abnormal (GU). A significantly greater number of patients with GU showed asynergy in posterolateral and posterobasal segments compared to those without GU. The EF was significantly lower in patients with GU. As to the infarct-related arteries, a significantly greater number of patients with LCX disease showed concomitant posterior infarction (PMI) than those with RCA disease. Also a significantly greater number of those with LCX disease showed GU and ST increases in V5,6 than those with RCA disease. Therefore, we conclude that GU in V1-3 is a new marker suggesting posterolateral and posterobasal damage, and GU in V1-3, ST increases in V5,6 and electrocardiographic PMI are specific markers for the diagnosis of LCX related infarction.

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Sixty consecutive patients who underwent coronary angiography and left ventriculography from six to eight weeks after the onset of definite inferior myocardial infarction were divided into three groups according to the polarity of U waves in (1) leads II, III, a VF and (2) in leads V4 to V6 (positive = Group P, flat or isoelectric = Group F, and negative = Group N). The following parameters were analyzed: (1) ECG score; (2) global ejection fraction: (3) regional area change: (4) number of asynergic, and akinetic segmental radii; (5) number of asynergic and akinetic areas: and (6) number of diseased coronary arteries and the incidence of left anterior descending artery (LAD) disease. There were no significant differences among the three groups according to the polarity of U waves in two subgroups by the site of U waves in age, gender, systemic blood pressure, and ECG scores. The polarity of U waves in leads II.III.a VF (subgroup 1) correlated with the size of myocardial infarction; regional area changes in inferior segment (Area 2) were 64.1 +/- 8.2 in group P1, 31.8 +/- 14.7 in group F1, and 21.0 +/- 15.8 in group N1 (p less than 0.01, F = 32.8). The polarity of U waves in leads V4-6 (subgroup2) correlated with anterolateral wall motion; regional area changes in anterolateral segments (Area 5) were 76.8 +/- 11.6 in group P, 66.5 +/- 18.5 in group F, and 48.9 +/- 17.1 in group N (p less than 0.01, F = 18.6). The incidence of multivessel disease increased from group P2 (36.4%), to group F2 (54.5%), to group N2 (75.0%), and the incidence of LAD disease increased from 27.3%, to 45.5%, to 68.8%, respectively. A negative U wave in either location suggested severely decreased apical wall motion, and there was a tendency for global ejection fractions to decrease in the following order: group P, group F, and group N. From these results, the authors conclude that the polarity of U waves may be one of the parameters correlating with the wall motion and left ventricular function in prior inferior myocardial infarction.

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The significance of the polarity of U waves in left precordial leads in patients with a prior anterior myocardial infarction was evaluated in relation to left ventricular function and wall motion by left ventriculography. Ninety-six such patients, with a mean age of 53 years, were divided into three groups according to the polarity of U waves: positive U waves (group P), isoelectric or flat U waves (group F), and negative U waves (group N). The following parameters were analysed: (1) Selvester ECG score; (2) global ejection fraction (EF); (3) regional area change; (4) number of asynergic and akinetic segmental radii; (5) asynergic and akinetic areas. Fifteen patients served as controls. The Selvester ECG scores increased progressively and EF decreased successively with statistically significant differences between groups P, F, and N (P less than 0.01, respectively). The sensitivity of negative U waves for predicting EF of less than 50% was 88.0%, the specificity 81.9%, and the accuracy 84.4%. The incidence of regional area change at the apex of less than 20% was 10.0% in group P, 35.9% in group F, and 74.3% in group N (P less than 0.01). The number of dyssynergic and akinetic radii, and asynergic and akinetic areas increased progressively from group P to F, to N (P less than 0.01). These results demonstrate that the polarity of U waves correlated significantly with left ventricular function and wall motion as well as the size of myocardial infarction. Negative U waves are an important sign of extensive myocardial infarction involving the apex with global ejection fraction of less than 50%. Negative U waves may be associated with lateral ischaemia.

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