Left ventricular outflow tract obstruction with abnormal papillary muscles

AbstractA 65-year-old man with a history of hypertension was admitted to our hospital with fainting and syncope. He had experienced recurrent syncope since 20 years of age. On admission, systolic heart murmur was audible at the apex of the heart. Echocardiography revealed anteriorly displaced papillary muscles (PMs), elongation of the anterior mitral valve leaflet (AML), and systolic anterior motion (SAM) of the AML. Color Doppler imaging showed accelerated flow with a pressure gradient (PG) of 56mmHg at the left ventricular outflow tract (LVOT). Cardiac magnetic resonance imaging revealed mild asymmetric septal hypertrophy and multiple accessory PMs. Cine images clearly demonstrated SAM and LVOT obstruction due to anteriorly displaced PMs. Based on these findings, the patient was diagnosed as having hypertrophic cardiomyopathy and LVOT obstruction due to abnormal PMs. Oral administration of bisoprolol (2.5mg/day) was initiated, because the patient rejected surgical treatment. Follow-up echocardiography revealed a gradual decrease in the LVOT-PG to 24mmHg, and no episodes of fainting or syncope have recurred for 2 years after the initiation of bisoprolol.<Learning objective: Abnormal papillary muscle (PM) is an unusual cause of left ventricular outflow tract (LVOT) obstruction, and cardiac magnetic resonance (CMR) imaging has been reported to be useful for diagnosis of abnormal PM. Abnormal PMs with LVOT obstruction are usually treated by surgical correction, and therefore, reports on medical treatment are limited. We report a case of LVOT obstruction due to abnormal PMs, which was accurately diagnosed by CMR imaging and successfully treated with a beta-blocker.

心筋症ハムスターのコラーゲン代謝に及ぼすカルシウム拮抗剤およびアンジオテンシン変換酵素阻害剤の影響

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1043号, 学位授与年月日：平成4年3月25日,学位授与年：199

Photoluminescence and photoluminescence excitation spectra from AlN doped with Gd3+

The photoluminescence (PL) spectra from Al0.98Gd0.02N andAl0.87Gd0.13N consisting of Gd3+ related 3.95 eV sharp emis-sion lines and other bands, and the PL excitation (PLE) spec-tra from 3 to 7 eV have been investigated by using a highly linear polarized synchrotron radiation light source. The Gd related 3.95 eV sharp lines in the PL spectra are similar to those in other cathodoluminescence (CL) and PL research. However, the broad emission bands around 3.95 eV lineswhich are normally found in other CL works are not ob- served. Other broad emission bands are clearly observed in the energy region of 1.5 ~ 3.5 eV. PLE spectra monitored at both the 3.95 eV sharp line and the broad emission band ofAl0.98Gd0.02N clearly indicate that these emission processes are host excitations which are reflected by an AlN-like band structure and crystalline anisotropy. On the other hand, the PLE and optical reflectance spectra of Al0.87Gd0.13N reveal an unclear band structure with a long band tail in the lower en-ergy side

Candida albicans keratitis modified by steroid application

The paper reports on Candida albicans ocular infection modified by steroid eye drops. A 74-year-old male complained of conjunctival injection and pain in his right eye three months after pterygium and cataract surgery. After treatment with antibiotics and steroid eye drops for three days, he was referred to our hospital. Clear localized corneal endothelial plaque with injection of ciliary body was observed. No erosion of the corneal epithelium, or infiltration of stromal edema was observed, suggesting that the pathological organism derived from the intracameral region. Because ocular infection was suspected, steroid eye drops were stopped, which led immediately to typical infectious keratitis in the pathological region, with epithelial erosion, fluffy abscess, stromal infiltration, and edema. For diagnostic purposes, the plaque was surgically removed with forceps and the anterior chamber was irrigated with antibiotics. The smear and culture examination from the plaque revealed C. albicans surrounded by neutrophils. However, aqueous fluid and fibrous tissue after gonio procedure contained no mycotic organisms. Topical fluconazole, micafungin, and pimaricin with oral itraconazole (150 mg/day) were effective. Special attention is needed when prescribing steroid eye drops to treat corneal disease especially postoperatively. Diagnosing infectious keratitis is sometimes difficult because of modification by some factors, such as postoperative conditions, scarring, and drug-induced masking. Here, we report on mycotic keratitis modified by postoperative steroid administration

Photo-Induced Cell Damage Analysis for Single- and Multifocus Coherent Anti-Stokes Raman Scattering Microscopy

In this study, we investigated photo-induced damage to living cells during single- and multifocus excitations for coherent anti-Stokes Raman scattering (CARS) imaging. A near-infrared pulsed laser (709 nm) was used to induce cell damage. We compared the photo-induced cell damage in the single- and the multifocus excitation schemes with the condition to obtain the same CARS signal in the same frame rate. For the evaluation of cell viability, we employed 4',6-diamidino-2-phenylindole (DAPI) fluorophores that predominantly stained the damaged cells. One- and two-photon fluorescence of DAPI fluorophores were, respectively, excited by an ultraviolet light source and the same near-infrared light source and were monitored to evaluate the cell viability during near-infrared pulsed laser irradiation. We found lower uptake of DAPI fluorophores into HeLa cells during the multifocus excitation compared with the single-focus excitation scheme in both the one- and the two-photon fluorescence examinations. This indicates a reduction of photo-induced cell damage in the multifocus excitation. Our findings suggested that the multifocus excitation scheme is expected to be suitable for CARS microscopy in terms of minimal invasiveness

Photo-Induced Cell Damage Analysis for Single- and Multifocus Coherent Anti-Stokes Raman Scattering Microscopy

In this study, we investigated photo-induced damage to living cells during single-and multifocus excitations for coherent anti-Stokes Raman scattering (CARS) imaging. A near-infrared pulsed laser (709 nm) was used to induce cell damage. We compared the photo-induced cell damage in the single- and the multifocus excitation schemes with the condition to obtain the same CARS signal in the same frame rate. For the evaluation of cell viability, we employed 4', 6-diamidino-2-phenylindole (DAPI) fluorophores that predominantly stained the damaged cells. One-and two-photon fluorescence of DAPI fluorophores were, respectively, excited by an ultraviolet light source and the same near-infrared light source and were monitored to evaluate the cell viability during near-infrared pulsed laser irradiation. We found lower uptake of DAPI fluorophores into HeLa cells during the multifocus excitation compared with the single- focus excitation scheme in both the one- and the two-photon fluorescence examinations. This indicates a reduction of photo-induced cell damage in the multifocus excitation. Our findings suggested that the multifocus excitation scheme is expected to be suitable for CARS microscopy in terms of minimal invasiveness

Regional microclimate humidity of clothing during light work as a result of the interaction between local sweat production and ventilation

Purpose – The aim of this study is to explore the influence of the clothing ventilation in three body regions on the humidity of the local clothing microclimates under five work-shirts immediately after the onset of sweating in light exercise. Design/methodology/approach – The clothing microclimate ventilations were measured at chest, back and upper arm using a manikin. Separate wear trials were performed to determine the sweat production and the humidity of the clothing microclimate at the same locations as where the ventilation was measured during light exercise. Findings – Every shirt shows the greatest value of ventilation index (VI) for the chest and the smallest one for the upper arm. The values of VI differ remarkably at the chest among the five shirts. Comfort sensation became gradually worse as the time passed after starting exercise. There was no significant difference among the clothing conditions in mean values of rectal temperature, local skin temperatures, microclimate temperatures, microclimate relative humidities and local sweat rates at three regions over 10?min after the onset of sweating. A relationship was observed between the ratio of the mean moisture concentration in the clothing microclimate to the mean sweat rate at the chest and the back and the VI. Originality/value – The results suggest that clothing ventilation should be measured in different body regions in response to sweat rates in corresponding regions