To investigate relationships between carotid arterial intima-media thickness (IMT) and age in childhood, we performed high-resolution carotid arterial ultrasonography in 60 healthy children (27 boys, 33 girls; age range, 5-14 years) determined by screening to have no dyslipidemia or hypertension. No plaque formation was found, and irregularity of IMT (root mean square roughness of IMT) did not correlate with age. Mean IMT increased in a linear manner with age [IMT in millimeters = (0.009 x age in years) + 0.35] ( r = 0.39, P = 0.002). This correlation remained significant after adjustment for gender, parental smoking, systolic and diastolic blood pressure, body mass index, and serum concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. None of these known cardiovascular disease risk factors in adults had a significant relationship with age-adjusted IMT in children. While circumferential wall stress and diastolic blood pressure were not correlated with age, mean IMT and lumen diameter showed significant positive relationships with circulating blood volume, which was calculated as the function of height and weight. These data suggested that age-dependent physiologic thickening of arterial walls begins in childhood.

To examine the clinical efficacy and the mechanism of action of polysaccharide K (PSK), a protein-bound polysaccharide extracted from a Basidiomycetes fungus, a randomized double-blind trial was performed by administering PSK to 56 patients and a placebo to another group of 55 patients after surgical operations on their colorectal cancers. The rate of patients in remission (or disease-free) was significantly higher in the PSK group than in the placebo group; the difference between both groups was statistically significant at P less than 0.05 by the log-rank test. The survival rate of patients was also significantly (P less than 0.05) higher in the PSK group than in the control group. The most significant laboratory finding was that polymorphonuclear leukocytes from PSK-treated patients showed remarkable enhancement in their activities, such as random and/or chemotactic locomotion, and phagocytic activity, when compared with those in the control group. In conclusion, PSK was useful as a maintenance therapy for patients after their curative surgical operations for colorectal cancer. The beneficial effects were probably due to the activation of leukocyte functions as one of the many biological-response-modifying (activities induced by PSK).

We investigated the changes in polymorphonuclear leukocyte (PMN) subpopulations that accompany severe bacterial infection and examined their usefulness as a parameter for assessing the severity of infection. The Percoll density gradient was used to fractionate neutrophils into subpopulations of high density (1.09-1.10), intermediate density (1.08-1.09), and low density (1.07-1.08) with the majority of neutrophils from normal volunteers being of high density. By contrast, neutrophils from infected patients were of intermediate or low density, while those from severely infected patients showed a high percentage of the low density fraction with functional changes in lower chemotactic and beta-gulcuronidase activity. When each density subpopulation in the normal blood neutrophils was tested, low density PMNs had the lowest chemotaxis and minimal beta-glucuronidase activity. These results indicate that the increase in low density PMNs in patients with severe infection clearly reflects the functional impairment of PMNs. Flow cytometric analysis demonstrated that the neutrophils from severely infected patients had an decrease in CD10 expression. The percentage of CD10 positive PMNs correlated well with the severity of infection and with the clinical course of the patients. Thus, we conclude that PMN-density and CD10 expression change during severe bacterial infection, and that the measurement of PMN-subpopulations may be used to complement the clinical assessment of the severity of infections.

eripartum cardiomyopathy is a rare cardiac disorder leading to heart failure in the last month of pregnancy or up to 5 months postpartum. 1 Although the etiology has not been determined, investigators have noted a high incidence of embolism with peripartum cardiomyopathy; 2 cardiac mural thrombi have been found at autopsy in some patients and thrombi have been demonstrated in the left ventricle, and in a few instances in the right ventricle, by 2-dimensional (D) echocardiography. 3 Furthermore, the course of intracardiac thrombus associated with peripartum cardiomyopathy has not been reported. We present a case of peripartum cardiomyopathy with biventricular thrombi that was managed successfully using anticoagulant therapy. Case ReportA 23-year-old woman was admitted to hospital with palpitations, nocturnal dyspnea, and orthopnea 6 weeks after a normal first delivery of a healthy baby. Because her antenatal care had been uneventful, she was suspected to have peripartum cardiomyopathy and was referred to Tsukuba University Hospital for further evaluation. Chest radiography revealed cardiomegaly, with a cardiothoracic ratio of 61% and pulmonary venous congestion. Echocardiography showed left ventricular dilation with a left ventricular end-diastolic dimension of 55 mm and decreased systolic function with a left ventricular ejection fraction of 33%. She had a history of an atrial septal defect that had been treated by surgery at age 5. She had no history of excessive alcohol consumption.On examination, her pulse was 68 beats/min and blood Circulation Journal Vol.66, September 2002pressure was 98/68 mmHg. A third heart sound and a grade 2/6 pansystolic murmur was audible at the apex. Crepitations were not heard over the lung fields and edema was absent. Most laboratory findings, including cardiac enzymes, were within normal limits. Anticardiolipin 2-glycoprotein I complex antibody was absent, but D dimer, 2 plasmin inhibitor·plasmin complex, human atrial natriuretic peptide, and brain natriuretic peptide were all elevated ( Table 1). Titers of antiviral antibodies for 5 viruses (Coxsackie A-4, A-5, A-9, B-3, B-4) were measured on the day of admission and 3 weeks later, and no significant change was observed. The electrocardiogram revealed right axis deviation, negative T wave changes in leads I, aVL and V2-6, and QT prolongation (QTc 0.47 s). A repeat echocardiogram confirmed biventricular dilation, left atrial enlargement, marked generalized hypokinesis with a left ventricular enddiastolic dimension of 57 mm and a left ventricular ejection fraction of 18% (Fig 1A), grade 2 mitral and tricuspid regurgitation, and apical thrombi in both ventricles (Fig2A). The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile. There was no Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have bee...

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Noninvasive ultrasonographic assessment of carotid artery intima-media thickness (IMT) can improve risk stratification for coronary artery disease (CAD) in certain patients. Several measurements have been used to evaluate carotid atherosclerosis by ultrasonography. Although it has been reported that angiographic arterial irregularities correlate with pathologic changes of atherosclerosis and the occurrence of cardiovascular events, only a few studies have assessed carotid arterial wall irregularity by ultrasonography. The purpose of this study was to evaluate the irregularity of IMT quantitatively, and its association with the presence or absence of CAD. The correlation of maximum and mean IMT values, and IMT irregularity with the presence or absence of CAD, was investigated in 90 patients who had undergone coronary angiography. IMT was measured by manual tracking of the far wall of the common carotid arteries, carotid bulbs, and internal carotid arteries. The IMT irregularity was defined as the root mean square (RMS) difference between each IMT and averaged IMT. Multiple logistic regression analysis, after adjustment for coronary risk factors, indicated that the RMS difference was a more accurate predictor of CAD than were the mean or maximum IMT values. These results indicate that the evaluation of IMT irregularity by ultrasonography is a useful predictor for the presence of coronary atherosclerosis.

BackgroundParacecal hernias, also known as pericecal hernias, are an exceptionally rare type of internal hernia. We report a unique case of paracecal hernia due to membranous adhesion of the omentum to the right paracolic gutter.Case presentationAn 86-year-old female was admitted to our hospital with vomiting and abdominal pain. Laboratory findings showed a slightly elevated C-reactive protein level. Computed tomography scan showed dilated loops of the small intestine in the right paracolic gutter with medial displacement of the cecum and ascending colon. Internal hernia around the cecum due to postoperative adhesion after appendectomy was suspected, and she underwent emergency laparotomy. Intraoperative findings revealed the adhesion between the omentum and right paracolic gutter forming a cavity with the small intestine incarcerated. No abnormal adhesion in the ileocecal region was seen. We transected the omental adhesion from the orifice to the far end of the cavity near the hepatic flexure of the colon to release strangulation and to prevent recurrence. The patient was discharged on postoperative day 14 without complications.ConclusionsParacecal hernias have a type of membranous adhesion of the omentum to the right paracolic gutter. Surgeons should be aware of this paracecal hernia type, when they encounter the internal hernia.

Contrast echocardiography identified uniform flow characteristics with blood in the filling flow front moving in well-developed vortices and resulting in a left ventricular filling delay in the impaired left ventricle in spite of an increased early transmitral flow velocity.