The 37-year-old woman underwent mitral valve replacement (MVR) with a Carpentier-Edwards bioprosthesis for hypertrophic obstructive cardiomyopathy (HOCM) 14 years previously. Since the 10th postoperative year, progressive right heart failure due to tricuspid valve regurgitation was recognized. Therefore, reoperation was recommended. At the time of reoperation in the 14th postoperative year, the cavity of the left ventricle was markedly diminished. In particular, deformitiy of the right ventricle was found. This was considered to be the effect of progressive septal hypertrophy. The mitral valve was replaced with a 25mm Carpentier-Edwards and the tricuspid valve with a 31mm Carpentier-Edwards bioprosthesis. Although the weaning from the cardiopulmonary bypass was uneventful, postoperative right heart failure occured with hyperbilirubinemia followed by multiple organ failure. She died on the 47th postoperative day. At autopsy, the intraventricular septal thickness was 24mm and the cavities of left and right ventricle were almost occluded by septal hypertrophy. This is considered to be a rare case of long-term survival after MVR in a patient with HOCM.

We assumed that changes in the excitability of motor nerves play some role in the stiffness of the neck, shoulders, and extremities in patients with vertigo. To obtain a better understanding of this phenomenon, we stimulated the receptors involved in body equilibrium with external stimuli, i.e., 1) caloric stimulation of the semicircular canals and 2) neck movements, and investigated changes in the F wave and the surface electromyogram (S-EMG) of the posterior cervical region.
The subjects were 40 healthy adults. Caloric stimulation of the semicircular canals was performed by infusing15°C water, and changes in the F wave examined. In addition, changes in the S-EMG by stimulation at temperatures of 5°C or 44°C were investigated. We examined changes in the F wave by the neck movements in association with theresults of the blindfold ed vertical writing test. The F wave of a patient with vertigo was also examined.
During vertigo induced by caloric stimulation of the semicircular canals, the excitability of the F wave on both the stimulated and non-stimulated sides increased, the S-EMGs showed decreased excitability on both the stimulated and non-stimulated sides during maximum voluntary contraction in the subject who experienced severe vertigo, nystagmus, and nausea. The changes in the F wave induced by the neck movements were small. However, excitability increased more significantly during posterior flexion than during other movements, and the angle of deviation of the letters written blindly tended to deviate most markedly toward the left during posterior flexion. The F wave of the patient with vertigo showed excitability, but it tended to decrease as the vertigo diminished.
These findings suggest that vertigo is accompanied by changes in the excitability of motor nerves. These changes are somehow related to the muscle stiffening that results from vertigo.

The purpose of this study was to compare effects of different amounts of carbohydrate (CHO) in beverage on plasma glucose (GLU) concentration during exercise after feeding breakfast. Seven healthy Japanese male subjects performed 30-min cycling at an intensity on the 75% of maximal load at 3-h after feeding breakfast under 3 types of CHO (0 g, 30 g and 150 g) beverage conditions. The subjects ingested 500 mL of beverage dissolved each amount of glucose at 30-min before the exercise. The GLU concentrations were measured at 35- and 10-min before the exercise and every 5-min during the exercise. The minimum GLU concentrations under the 30 g condition for all subjects were lower than a criterion for hypoglycemic (72 mg / dL). The mean value also fell below the criterion at from 10- to 20-min during exercise. The minimum GLU concentration under the 150 g condition of only one subject was lower than the criterion, but the mean value did not fall below the criterion. Significant negative correlations were found between the subjects’ maximum oxygen uptake (VO2max) and the decreases in GLU concentration from maximum to minimum under both the 30 g (r = -0.947, p < 0.01) and 150 g conditions (r = -0.884, p < 0.01). This study clarified that feeding breakfast at 3-h before the exercise followed by the 30 g CHO beverage ingestion at 30 min before the exercise induced exercise-induced hypoglycemia, and that the subjects with higher VO2max had the greater decreases in GLU concentration.