The electrophysiology of the heart changes dramatically during development. These changes in electrical properties are caused by changes in the number (density) and types of ion channels, with resultant changes in the magnitude and kinetic properties of the various types of ionic currents. The alterations in the ion channels are resposible for the changes in the resting potential and characteristics of the action potentials. In this review, we focused on the developmental changes of the L-type Ca2+ channel (especially its regulation via β-adrenoceptor, and muscarinic acetylcholine agonsist, tyrosine kinase) and the T-type Ca2+ channel. As mentioned in this review, the immature heart differs from the adult heart in both size and function. Therefore, we have to pay attention to the characteristics of the immature heart when we treat neonates and children.
When we examine patients with drug eruption, we often cannot decide whether to withdraw or change prescription drugs. In severe cutaneous adverse reactions, the worse of constitutional symptom, as in Stevens-Johnson syndrome and toxic epidermal necrolysis, and the mortality rate are high. However, when we suspected a drug eruption, the symptoms and sequence are not known, and we tend not to understand treatments for severe cutaneous adverse reactions. In this report, I describe symptoms and causative agents of anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome. Furthermore, I explain methods of drug discontinuation, explanation to patients, treatment of drug eruption, and examination of causative agents.
Chronic hepatitis C, attributed to infection with hepatitis C virus (HCV), is a global health problem. The overall prevalence of viral hepatitis C in Japan is estimated to be 1.5∼1.7%. Clinically, HCV can establish a persistent, chronic infection contributing to progressive liver disease, including cirrhosis and hepatocellular carcinoma (HCC), requiring intensive treatment regimens such as transcatheter arterial embolization, radio frequency ablation and percutaneous ethanol injection therapy, and possible liver transplantation. Determination of viral genotype has been identified as one parameter that could provide direction in the clinical management of patients with chronic HCV infections. Occurrence of HCC is another serious problem in the management of chronic HCV infection. Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. Thus image-guided, percutaneous ablation techniques have been developed and widely accepted applications for the treatment of HCC of early cirrhosis or inoperable patients whose hepatic conditions is poor. This article offers background on determination of HCV genotypes and the relevance of viral genome characterization in the current treatment using anti viral agents, and also exemplify recent advance in non-surgical treatment of HCC.
Cholesterol crystal embolism (CCE) is a systemic disorder caused by microshowers of cholesterol crystals. It brings about decreased microcirculation and is manifested in various organs including the kidneys, skin, brain and extremities. Cholesterol microshowers are thought to occur in about 50% of invasive vascular procedures, but most cases are clinically silent. CCE has a high mortality rate, but there are as yet no established methods for managing it. We report two cases (63-year-old and 73-year-old males) of progressive renal insufficiency with eosinophilia and peripheral ischemic symptoms such as livedo reticularis and foot pain following percutaneous coronary intervention (PCI) for acute myocardial infarction. In the first case, we made a diagnosis of CCE based on clinical findings, which included deteriorating renal failure after PCI, peripheral eosinophilia, livedo reticularis, smoking history, uncontrollable hypertension, and severe atherosclerotic plaque of the aorta demonstrated by transesophageal echocardiography. In the second case, skin biopsy specimens confirmed a diagnosis of CCE. In both cases, treatment with prostaglandins and statins was unsatisfactory. However, additional treatment with LDL apheresis (LDL-A) and corticosteroids improved the eosinophillia, livedo reticularis, foot pain and renal function, suggesting that this combined treatment may have a beneficial effect on CCE.
Faculty teaching of the Anatomy Dissection Course was evaluated by 101 medical students using an Internet site accessed via computers or cellular telephones. The total number of answers was 263, and the response rate was 52%. Access to the site was by cellular telephones in 95.8% of cases (63.9% off-campus) and by on-campus computers provided by the college in only 1.5% of cases. The cellular telephone was most often cited (61.7% of answers) as the "most appropriate tool for answering the questionnaire." Students attached great importance to accessibility or handiness when answering the questionnaire. We suggest that the cellular telephone is a useful digital device for educational assessment by students.