SUMMARY A patient with Mobitz type 2 heart block caused by a mesothelioma of the atrioventricular node died of a subarachnoid haemorrhage at the age of 33 two years after implantation of a permanent pacemaker. Mesothelioma of the atrioventricular node is rare, and reported cases have all been diagnosed post mortem. Mesothelioma of the atrioventricular node should be considered in the differential diagnosis of heart block in children or young adults. This is the first case to be reported in Japan.Case report A 31 year old man was admitted to hospital because of poor appetite. On routine physical examination, a grade 2/6 systolic murmur was heard at the left sternal border. No cyanosis was noted. The liver was not palpable. Serum aspartate aminotransferase and alanine aminotransferase activities were 58 U/l and 29 U/I respectively. A liver biopsy showed a cirrhotic pattern, and he was diagnosed as having alcoholic cirrhosis.At night his heart rate fell to 30 beats/min, and an electrocardiogram showed 2:1 atrioventricular block with a narrow QRS complex (Fig. 1). His bundle electrograms were recorded using standard catheter techniques. The HV interval was normal (30 ms) and the AH interval prolonged (150 ms).
The 620 cases with a history of maternal rubella and/or with one or more of cataract, CHD and deafness born in the Ryukyu Islands in 1965 were subjected to clinical studies and 360 cases were diagnosed as rubella syndrome. Rubella retinopathy makes a reliable diagnostic basis for rubella syndrome. As for the typical combination of clinical manifestations, the cases with cataract have CHD, deafness and retinopathy; the cases with CHD not accompanied by cataract have deafness and retinopathy; and the cases with deafness not accompanied by cataract and CHD either have or have not retinopathy. The cases with cataract alone or with CHD can extremely rarely be denned as having rubella syndrome. There existed the close relationship between the combination of clinical manifestations and the time of maternal rubella infection.
The main clinical manifestations of rubella syndrome are cataract, congenital heart disease (CHD), and deafness appearing singly or two or more together1)2). Etiology of the congenital cataract, CHD, or deafness is mostly not explained; and only a small portion of the incidence is due to intrauterine rubella infection. For the future of the patients in the above conditions and for their parents, clarification as to whether they are or are not due to rubella is very important. Current general practice for the diagnosis of rubella syndrome is laboratory diagnosis that measures rubella hemagglutination inhibition (HI) antibodies3)4). As the infants grows in age, the above mentioned technique may not assure an absolute judgment5)6). This makes it necessary to arrive at diagnosis from the clinical findings. A prompt, direct diagnosis from the clinical findings alone will be very convenient. In the Ryukyu Islands where there was a high incidence of rubella syndrome in infants in the second half of 1965, we analyzed clinical findings of the affected children with cataract, CHD or deafness on the basis of serological diagnosis. The diagnostic significance of the clinical findings was so studied. Hence our report in this paper.
Summary
Purified hog gastric mucin was administered to low birth‐weight infants at a dose of 7 mg per kg body weight per day and the following results were obtained:
1) The rate of body‐weight increase was higher in the mucin‐administered group than in the nonadministered group.
2) In regard to the intestinal microflora of the mucin‐administered group, L. bifidus became predominant and the pH value of the feces was lowered. Thus, a likeness in fecal properties to breast‐fed infants was brought about in bottle‐fed infants.
3) In addition to mucin, when lactulose was administered at a dose of 0.8 g per kg body weight per day, the enhanced growth of intestinal L. bifidus and the lowered pH value were more profound from the possible synnergistic action than in the group administered with mucin alone.
From these results, the supplementation of powdered milk with mucin enhances the growth of bottle‐fed infants and brings about a likeness in fecal properties to breast‐fed infants. Further supplementation with lactulose results in much more likeness in fecal properties to breast‐fed infants.
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