Four patients with fulminant myocarditis (two males and two females, age 21-67 years old) were examined during 1995-2001. Fulminant myocarditis was diagnosed based on clinical features, abnormal electrocardiographic and echocardiographic findings, and increased serum enzyme levels. In three of four cases, the diagnoses were confirmed histologically in autopsy. All four patients had flu-like symptoms and fever at the start. One patient died suddenly next day. Other three patients went into cardiogenic shock five and seven days after the onset of symptoms and hospitalized, and treated with temporary pacing, steroid pulse therapy, catecholamine (in all three patients) and percutaneous cardiopulmonary support : PCPS (in one patient), but they died within ten days. Electrocardigrams showed ventricular escape rhythm, ST elevation associated with Q wave, and low voltage of the QRS complex. Markedly increased serum enzyme levels, severe metabolic acidosis and disseminated intravascular coagulation were thought to be indicative of poor prognosis. Early recognition of cardiac involvement and using of PCPS without hesitation in an acute phase could improve the outcome of fulminant myocarditis.
Myocarditis ; Clinical ; Therapeutic brand of coal tar ; symptoms <1> ; Serum

We performed dietary guidances for 15 male elite athletes (23±3 years of age) participating a training program for vigorous endurance run. Nutrient allowances for the athletes were determined by the guidelines of Japanese Dietary Allowances (5 th ed.), considering their physical activities at the highest level IV; total energy 3, 500 kcal, protein 140g, lipid 100g, carbohydrate 510g, calcium 1, 500 mg, iron 25 mg, vitamin A 8, 000 IU, thiamine 4.0 mg, riboflabin 5.0 mg and vitamin C 200 mg per day. We also developed food group allowances for the athletes based on their nutrient allowances and current young-aged Japanese dietary styles ; cereals 400 g, potatoes and starches 60 g, sugars 20 g fats and oils 30g, pulses 120g, meats 150g, fishes and shellfishes 150g, eggs 80g, milks 600g, green and yellow vegetables 300 g, the other vegetables 350 g, fruits 400 g and algae 20 g per day. For the experimental period of 45 days, daily diets adjusted to approximate 120% of the dietary allowances were served to the athletes who were free taking snacks and drinks. Dietary guidances for the athletes were assessed by monitors of their dietary intakes, physical constitution and clinical examinations in blood. Means of the dietary intakes of the athletes were 96-99% of the dietary allowances, determined by a nutritional survey with the 24 hrs recall method. There were less changes in the physical constitution of the athletes before, during and after the experimental period; body weight 57±2 kg and body fat 8.8 ± 2.4%. Values of the clinical marks in the blood of the athletes were maintained normally for a half year including the experimental period; red blood cells 507±9×104 cells/mm3, hemoglobin 15±0.4g/dl and hematocrit 46.6±0.7%.
It is concluded that suitable nutritional guidances and managements for young-aged male vigorous endurance runners lead good in their health and physical maintenances, which may have important consequences for their physical development as elite athletes.

Background/Aims: Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms. Methods: Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group. Results: Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05). Conclusions The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.

Background/Aims: Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms. Methods: Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group. Results: Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05). Conclusions The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.