The anterior corneal surface shifts from with-the-rule to against-the-rule astigmatism with aging, whereas the posterior corneal surface remains as against-the-rule astigmatism in most cases. The variation in the anterior astigmatism is the most important factor contributing to this change. Total corneal astigmatism is a better predictor than keratometric astigmatism for selecting toric intraocular lenses.

The goal of this study was to assess the relationship between the degree of irregular regeneration of hepatocytes (IR) and the development of hepatocellular carcinoma (HCC). We examined the liver biopsy specimens from patients with chronic liver disease (CLD) The incidence of hepatocellular carcinoma (HCC) has been markedly increasing in Japan. 1 HCC is associated with high morbidity and mortality in comparison with other cancers. The reasons for the poor prognosis are that most of the HCC cases in Japan are complicated with cirrhosis, the liver function of these patients is markedly reduced, radical surgical resection is difficult to perform, and the recurrence rate is high. To prevent the development of HCC among those with chronic liver disease (CLD) and to improve the survival rate of those with HCC, it is important to assess the direct causal factors and risk factors for hepatocarcinogenesis. It is unknown, however, which molecular-genetic mechanisms contribute to the carcinogenesis of HCC from viral liver disease. Several studies on the hepatocellular changes that may contribute to the pathogenesis of HCC have been reported, 2-8 since Anthony described large cell dysplasia as a marker of a high carcinogenic state in chronic liver disease. 2 Uchida et al. [9][10][11] and Shibata et al. 12 reported that irregular regeneration of hepatocytes (IR), which develops as a result of repeated cycles of necrosis and regeneration of hepatocytes in chronic hepatitis, is the most important predictive factor for the development of HCC. In the present study, an IR score was assigned to the noncancerous liver tissue of patients with clinically diagnosed HCC who had undergone surgical resection of the HCC. This was compared with the tumor morphology, biochemical parameters, and tumor markers. The IR scores of the noncancerous liver tissue from patients with B-viral, C-viral, or nonBnonC (NBNC)-HCC, and the IR scores of liver biopsy specimens of those with CLD were compared. Although a study of this question has appeared recently, 13 the IR scores of the noncancerous liver tissue of HCC patients and the IR scores of CLD patients have not been compared., MATERIALS AND METHODSStudy Population. One hundred eight patients with HCC who underwent surgical resection of HCC at Nihon University Itabashi Hospital between 1992 and 1998 were included in this study. HCC had been diagnosed with image diagnosis by abdominal angiography and tumor biopsy. Twenty-four patients had B-viral HCC (B-HCC), 67 had C-viral HCC (C-HCC), and 17 had NBNC-HCC. A patient was diagnosed with B-HCC if he or she had HCC and was positive for hepatitis B virus surface antigen by enzyme-linked immunosorbent assay (EIA; Dainabot, Matsudo, Japan) and negative for hepatitis C virus (HCV) antibody (second generation EIA; Dainabot). A patient was diagnosed with C-HCC if he or she had HCC and was positive for HCV antibody and negative for hepatitis B surface antigen. A patient was diagnosed with NBNC-HCC if he or she had HCC and was negative for hepatitis B surface a...

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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