Erectrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) can be used to assess myocardial perfusion and left ventricular function simultaneously. Various clinical applications of gated SPECT and their usefulness have been reported. The functional variables that can be determined with gated SPECT have been limited to systolic indices. Therefore, we evaluated left ventricular diastolic function with gated SPECT using data obtained from various frames per cardiac cycle and found that date generated from 32-frames are suitable for clinical use. Serial assessment of left ventricular function was also performed during bicycle exercise and dobutamine stress by means of gated SPECT using short-time data collection. These techniques, therefore, have the potential to provide useful information for evaluating myocardial conditions, such as hibernation and residual ischemia in infarct areas. Recently, we have developed a new technique for three-dimensional registration of CT coronary angiography (CTCA) and ECG-gated myocardial perfusion SPECT. This technique of registration may assist the integration of information from gated SPECT and CTCA and may have clinical application for the diagnosis of ischemic heart disease. These various applications would contribute to the development of nuclear cardiology.

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Objectives: We assessed the usefulness of ²⁰¹thallous chloride (TlCl)/¹²³I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual-isotope single-photon emission computed tomography (SPECT) to identify the "no-reflow phenomenon," defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction.
Methods: ²⁰¹TlCl/¹²³I-BMIPP SPECT was performed in 73 patients within approximately 1 week of initial acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). We divided the left ventricular myocardium into 17 segments on each SPECT image and scored tracer accumulation in each segment with a five-point scoring system according to the American Heart Association criteria. Total severity scores were calculated by summing the scores for all 17 segments. The mismatch ratio between myocardial perfusion and metabolism was derived from the ²⁰¹TlCl and ¹²³I-BMIPP total severity scores: mismatch ratio=(¹²³I-BMIPP total severity score -²⁰¹TlCl total severity score)/¹²³I-BMIPP total severity score. Patients were classified according to Thrombolysis in Myocardial Infarction (TIMI) flow grade as having TIMI reflow grade 0-I (TIMI 0-I reflow group; n=11), II (TIMI II reflow group; n=17) and III (TIMI III reflow group; n=45). The TIMI III reflow group was subdivided into two groups with ²⁰¹TlCl total severity scores of ≤13 (TIMI III (A) reflow group; n=36) and ≥14 (TIMI III (B) reflow group; n=9), respectively.
Results: The mismatch ratios in the TIMI II (0.4 ± 0.3) and TIMI III (0.4 ± 0.2) reflow groups were significantly higher than that in the TIMI 0-1 reflow group (0.1 ± 0.1, p<0.05). Although coronary angiography revealed TIMI III flow after reperfusion, the mismatch ratios in the TIMI III (B) reflow group (0.2 ± 0.1) and in the TIMI 0-I reflow group (0.1 ± 0.1) were significantly lower than that in the TIMI III (A) reflow group (0.4 ± 0.2, p<0.01), reflecting noneffective recanalization (so called no-reflow phenomenon).
Conclusion: ²⁰¹TlCl/¹²³I-BMIPP dual-isotope myocardial SPECT reveals the biochemical degree of the no-reflow phenomenon, whereas coronary angiography shows recanalized vascular flow only. Dual-isotope myocardial SPECT might be useful for evaluating reperfusion therapy.

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Objective: The aims of this study were to assess the frequency of inpatient falls and to evaluate potential risk factors in an academic hospital.
Methods: An electronic audit of the inpatient database at the Tama-Nagayama Hospital of Nippon Medical School from April 2004 through March 2005 was performed. Inpatient falls were registered regularly with incident reports submitted by nurses and other hospital employees discovering the fall. All inpatients were analyzed for potential risk factors using univariate and multivariate logistic regression analysis.
Results: Of the 8,537 patients, 109 (1.3%) fell. Multivariate logistic regression analysis showed that inpatient falls were significantly associated with a patient age of 51 to 70 years (odds ratio, 2.4; 95% CI, 1.3∼4.7) or of 71 to 90 years (odds ratio, 4.2; 95% CI, 2.4∼8.1); with a hospital stay of 15 to 21 days (odds ratio, 3.4; 95% CI, 1.6∼7.0), 22 to 28 days (odds ratio, 4.3; 95% CI, 1.8∼9.5), or 29 days or longer (odds ratio, 13.8; 95% CI, 8.3∼24.1); with admission to the surgery (odds ratio, 2.0; 95% CI, 1.1∼3.5), orthopedics (odds ratio, 2.5; 95% CI, 1.1∼4.9), neurosurgery (odds ratio, 3.0; 95% CI, 1.5∼5.9), or urology service (odds ratio, 3.9; 95% CI, 1.8∼8.2); and with no surgical procedure (odds ratio, 1.6; 95% CI, 1.0∼2.6).
Conclusions: The present study demonstrates that patient-related factors, such as age and length of stay, and treatment-related factors, such as no surgical procedure and admission to the surgery, orthopedics, neurosurgery, or urology service, are independent risk factors for inpatient falls. The results suggest that fall-prevention programs should target patients with these risk factors.

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Objective: The purpose of this study was to assess the effect of first-trimester ultrasound examination for chromosomal aberrations in women who underwent amniocentesis.
Methods: To evaluate trends in the indications of amniocentesis and the number of chromosomal aberrations, we reviewed all amniotic fluid samples from genetic amniocentesis processed by the Tama-Nagayama Hospital of Nippon Medical School from 1991 through 2005. The referral indications included first-trimester abnormal ultrasound finding.
Results: A total of 1,054 women underwent genetic aminiocentesis in the first- to early second-trimester, and 1,063 amniotic samples were processed. The overall rate of chromosomal aberrations was 3.3% (35 of 1,063 samples), and the rate of aberrations remained unchanged during the study period. The number of cases with abnormal ultrasound finding increased from 5 (1.1%) in the first 5-year period to 46 (19.4%) in the last 5-year period (p<0.01). In contrast, the number of amniotic fluid samples per year tended to decline during the study period.
Conclusion: First-trimester ultrasound examination had a significant effect on our amniocentesis cases. The application of first-trimester ultrasound examination may be associated with a lower rate of invasive genetic testing.

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Background: An anion exchange resin has been reported to lower blood glucose levels in patients with type 2 diabetes.
Aim: To examine, in comparison with an α-glucosidase inhibitor, the usefulness of colestimide in lowering blood glucose levels in patients with type 2 diabetes and hypercholesterolemia.
Methods: Thirty-three patients with type 2 diabetes and hypercholesterolemia were more or less randomly assigned to receive either colestimide (17 patients) or acarbose (16 patients). At 10 time points before and after administration, plasma glucose levels and serum lipid concentrations were measured in all subjects, and the J-index and M-value were calculated.
Results: Patients receiving colestimide showed significant decreases in glucose levels 2 hours after breakfast (from 216.9 ± 37.2 mg/dl before treatment to 191.1 ± 40.9 mg/dl after treatment; p=0.008), in the J-index (from 42.6 ± 14.5 to 32.6 ± 9.8; p<0.001), and in the M-value (from 23.1 ± 12.1 to 14.6 ± 7.1; p<0.001).
Conclusion: In patients with type 2 diabetes and hyperlipidemia, colestimide was suggested to have blood glucose-lowering activity as does acarbose.

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We report on an infant with Beals syndrome (congenital contractural arachnodactyly [CCA], MIM 121050) with transient cardiomyopathy showing ballon-like dilatation of the left ventricle that was similar to noncompaction. The patients father and two of his brothers were also found to have CCA without cardiovascular complications. CCA, which is caused by a mutation of the gene for fibrillin 2 protein is similar to Marfan syndrome (MIM 154700), which is caused by a mutation of fibrillin 1 but produces a life-threatening cardiovascular complications. This is the first report of CCA with transient cardiomyopathy. We discuss the mechanism of the spontaneous improvement of cardiomyopathy in this case on the basis of expression of the responsible gene.

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We describe an uncircumcised male infant treated for urinary tract infection who exhibited multiple hormonal and electrolyte abnormalities consistent with a diagnosis of transient pseudohypoaldosteronism. Successful treatment of the urinary tract infection was accompanied by the resolution of all hormonal and electrolyte abnormalities, including hyperaldosteronemia, hyperreninemia, hyponatremia and hyperkalemia. Radiographic examination revealed marked left dilatation of the renal pelvis and hydroureter but no vesicoureteral reflux. Owing to the possibilities of future renal scarring, decreased renal function, and hypertension, evaluation of urinary tract malformation and appropriate hormonal studies should be performed in infants with urinary tract infection and hyperkalemia.

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A 6-year-old boy was hospitalized because of dark feces and facial pallor of 1 weeks duration. Other gastrointestinal symptoms, including vomiting and abdominal pain, were absent, but he felt dizziness when standing and fatigue on effort. Hematologic studies revealed iron-deficiency anemia, and endoscopy showed gastric erosions and a duodenal ulcer. All test results for Helicobacter pylori infection, including H. pylori antigen in stool, anti-H. pylori IgG immunoassay in serum, and the ¹³C-urea breath test, were positive. Because an H. pylori-associated gastric ulcer had been diagnosed with endoscopy in the patients father 3 years earlier, father-son transmission was suspected. The patient was treated with triple-agent eradication therapy (proton pump inhibitor [lansoprazol], amoxicillin, and clarithromycin) for 2 weeks. One month after therapy was completed, eradication of H. pylori was confirmed by negative results on the stool antigen test. Peptic ulcer disease can occur in young children, as in this case. The stool antigen test kit is a useful and reliable method that can be used even in preschool children to diagnose H. pylori infection.

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