Effects of a neem extract on blood feeding, oviposition and oocyte ultrastructure in Anopheles stephensi Liston (Diptera: Culicidae)

Secondary metabolites of the neem tree (Azadirachta indica A. Juss., Meliaceae) exhibit a wide range of biological activities in insects. However, few studies have addressed the effects of neem extracts or compounds in arthropods of medical importance. In this study, a laboratory strain of Anopheles stephensi was used to assess the effects of a commercial formulation (Neem Azal) (NA)), containing azadirachtin A at 34%, on blood feeding, oviposition and oocyte ultrastructure. Oral administration of Neem Azal) to A. stephensi females through artificial blood meals did impair blood intake and oviposition in a concentration dependent manner. Similar results were obtained on females, which had consumed Neem Azal) in sucrose solution before taking a blood meal of plain blood. Neem treated females displayed a delay in oocyte development in both the phase of vitellogenesis and the phase of choriogenesis. The ultrastructural studies on ovaries from Neem Azal) treated females revealed distinct structural modifications indicative of: (i) a complete block of oogenesis, (ii) impairment of vitellogenesis and vitelline envelope formation, (iii) a severe degeneration of follicle cells. In agreement with results obtained in other insects, this study indicates that Neem Azal) impairs hormone control of oogenesis and exerts a cytotoxic effect on both follicular cells and oocytes of the Asian malaria vector A. stephensi.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

CCR5 and CXCR4 chemokine receptor expression and beta-chemokine production during early T cell repopulation induced by highly active anti-retroviral therapy

Expression of chemokine receptors and beta-chemokine production by peripheral blood mononuclear cells (PBMC) were determined in HIV-1-infected individuals before and after highly active anti-retroviral therapy (HAART) and their relationship to viral load, T cell phenotype and the expression of immunological activation markers was examined. We found that the expression of CCR5 is up-regulated in HIV-1-infected individuals while CXCR4 appears down-regulated on both CD4 and CD8 T cells compared with normal controls. These alterations are associated with the high levels of viral load. In addition, a relationship was observed between the degree of immune activation and chemokine receptor expression on T cells. However, after 3 months of combined anti-retroviral regimen, expression of CXCR4 significantly increased while CCR5 decreased when compared with pretherapy determinations. This was seen in strict association with a dramatic decrease of viral load and an increase of both CD45RA+/CD62L+ (naive) and CD45RA-/CD62L+ or CD45RA+/CD62L- (memory) T cells accompanied by a significant decrease of the expression of immune activation markers such as HLA-DR and CD38. At enrolment, both spontaneous and lectin-induced RANTES, macrophage inflammatory protein-1alpha (MIP-1alpha) and MIP-1beta production by PBMC were higher in HIV-1-infected individuals compared with normal controls, although differences for MIP-1beta were not statistically significant. However, RANTES and MIP-1alpha production decreased during HAART at levels closer to that determined with normal controls, while MIP-1beta production was less consistently modified. These data indicate that the expression of chemokine receptors CCR5 and CXCR4 and the production of beta-chemokines are altered in HIV-infected individuals, and suggest that their early modifications during HAART reflect both the peripheral redistribution of naive/memory T cell compartments and the decrease in levels of T cell activation. Such modifications in the expression of host determinants of viral tropism and the production of anti-viral molecules may play a role in the emergence of virus variants when a failure of HAART occurs.

Laboratory evaluation of the bioinsecticide Spinosad for mosquito control

Spinosad, a naturally occurring product of the fermentation of the bacterium Saccharopolyspora spinosa, is a highly effective bioinsecticide against a broad range of agriculturally important insect pests, and this agent has an excellent environmental and mammalian toxicological profile. In this study the efficacy of a Spinosad-based product (Laser 4.8% emulsifiable concentrate) was evaluated in laboratory bioassays against laboratory-reared mosquito strains of 3 species of medical importance: Aedes aegypti, Anopheles stephensi, and Culex pipiens. Spinosad was particularly effective against larval Aedes and Culex, with a less marked activity against anophelines (24-h median lethal concentration = 0.0096, 0.0064, and 0.039 mg/liter, respectively), showing a persistence of the insecticide action of about 6 wk in laboratory containers. The activity of the Spinosad-based product against adult mosquitoes (toxicity by ingestion and a possible irritant or repellent effect on gravid females) also was evaluated. Results are discussed and compared with those available in the literature.

Basic fibroblast growth factor supports human olfactory neurogenesis by autocrine/paracrine mechanisms

Throughout life, olfactory sensory neurons are renewed from a population of dividing stem cells. Little is known about the molecular mechanisms that regulate the activation, self-renewal and differentiation of olfactory neuronal precursors; however, evidence indicates that soluble mediators may play a central role in olfactory neurogenesis. To identify molecules that regulate olfactory self-renewal and differentiation, we have recently established, cloned and propagated in vitro primary long-term cell cultures from the human fetal olfactory neuroepithelium. Here we show that primary human olfactory neuroblasts synthesize and release biologically active basic fibroblast growth factor which, in turn, supports neuroblast growth by autocrine/paracrine mechanisms. The growth-promoting activity of basic fibroblast growth factor is dose dependent and is accompanied by morphological changes of the cells and by an increase in the expression of neuronal-related genes. These observations indicate that endogenous basic fibroblast growth factor participates in controlling olfactory self-renewal and suggest that this cytokine represents a key regulatory element of olfactory neurogenesis.

Non-hodgkin's lymphoma of the liver in patients with AIDS: sonographic, CT, and MRI findings

PURPOSE

We analyzed the sonographic, CT, and MRI findings in acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) of the liver to evaluate the role of sonography in the diagnosis of this disease.

METHODS

We retrospectively reviewed sonograms and CT scans on 26 patients who had human immunodeficiency virus with liver lymphoma, either primary (10 cases) or secondary (16 cases), from 1992 to 1999. We also reviewed MR images on 12 of the patients. All patients had pathologically proven NHL; all imaging studies were obtained within 2 weeks of sonographically guided fine-needle aspiration biopsies. Lymphoma was the initial AIDS-defining illness in 38% of the patients.

RESULTS

NHL occurred as multiple lesions in most cases of both primary (7 of 10 cases) and secondary (15 of 16 cases) liver lymphoma. No imaging finding was specific for the diagnosis of hepatic lymphoma. The hepatic lesions were hypoechoic in 25 of 26 cases; in the remaining case, there was a large isoechoic mass. On unenhanced and contrast-enhanced CT, the lesions were hypodense in all cases, with a thin enhancing rim in 6 patients. On MRI, the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images.

CONCLUSIONS

Sonography may be helpful in the diagnosis of focal hepatic lymphoma in patients with human immunodeficiency virus. Sonographically guided fine-needle aspiration biopsy provides a definitive diagnosis. CT was crucial in the staging of lymphoma. MRI appears appropriate for studying liver NHL in selected cases.

Lymphomononuclear cells from multiple sclerosis patients spontaneously produce high levels of oncostatin M, tumor necrosis factors alpha and beta, and interferon gamma

Proinflammatory cytokines are deemed to play a pivotal role in the pathogenesis of multiple sderosis (MS). They provide signals for T-cell activation and inflammatory cell recruitment in the brain and might directly alter neuroglial and neuronal cell survival and function. We found that peripheral blood mononuclear cells (PBMCs) from MS patents spontaneously produce high levels of TNFalpha, TNFbeta, IFNgamma, and oncostatin M (oncM), a proinflammatory cytokine actng on cells of neural, vascular, hematopoietic, and lymphoid origin. Spontaneous production of these cytokines was significantly higher (p < 0.01) in PBMC short-term culture supernatants from MS patients than in blood donors (HC). On average, lectin-induced production of these cytokines by PBMC was higher in MS patents than in HC significantly so only for TNFalpha (p = 0.013). Determination of TNFalpha, TNFbeta IFNgamma, and oncM in corresponding sera showed that on average, oncM levels were higher in MS patients than in HC, though the results were not statistically significant whereas levels of TNFalpha, TNFbeta and IFNgamma were below the assay threshold in most patients. The finding that MS PBMCs are primed in vivo to produce and release high levels of proinflammatory cytokines suggests the presence of a basal activation of the immune system which, in turn, may play a role in the complex circuitry of molecular and cellular interactions responsible for neurologic damage in MS.

Appropriateness: analysis of outpatient radiology requests

PURPOSE

This study assessed radiology requests and the influence of previous radiological procedures on their specificity and appropriateness, evaluated diagnostic outcomes and recorded the economic impact of inappropriate examinations.

MATERIALS AND METHODS

We prospectively analysed 4,018 outpatient requests, the appropriateness of which was assessed using an evaluation form. Economic analysis was based on costs listed in the Italian National Health Services (NHS) national tariff as established by the Ministerial Decree of 22 July 1996. Statistical analysis was carried out using Pearson's test and univariate and multivariate logistic regression models.

RESULTS

Of 4,018 outpatient requests, 57% were not included in a follow-up protocol and 56% were found to be appropriate. The diagnostic question was confirmed in 66% of cases considered appropriate (p<0.001). The existence of previous investigations had a significant impact on appropriateness and diagnostic outcome (p<0.001). The total cost of the requests was 257,317 euro, with inappropriate requests accounting for 94,012 euro (36.5%).

CONCLUSIONS

We found a 56% rate of appropriate requests and demonstrated that appropriate prescriptions provided with a specific clinical question led to significantly higher confirmation rates of the diagnostic hypothesis. In addition, inappropriate requests had a major negative economic impact.

Myocardial ultrasonic tissue characterization in pediatric and adult patients with hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) has different clinical and prognostic aspects in young than in adult patients. This study was undertaken to determine whether these reported differences are reflected by changes in ultrasonic backscatter parameters and whether oral treatment with verapamil modifies backscatter variables in children with HCM.

METHODS AND RESULTS

Sixty-eight subjects underwent backscatter analysis to assess the ultrasonic myocardial reflectivity and the amplitude of the cardiac cycle-dependent variation of the backscatter power curve. Subjects were divided into four groups: 10 HCM and 23 normal subjects < 10 years old and 17 HCM and 18 normal adults. Myocardial reflectivity and amplitude of the cyclic variation were assessed in the septum and in the posterior wall of all subjects. The children with HCM were restudied after long-term oral administration of verapamil. Both children and adult patients, compared with the normal control groups, showed a significant reduction in the amplitude of the cyclic variation both in the septum and in the posterior wall. In contrast, myocardial reflectivity, although significantly increased in adult HCM patients, was unchanged in the young HCM group. Verapamil administration did not significantly alter the results in the children with HCM.

CONCLUSIONS

These data demonstrate that in young HCM patients, the ultrasonic myocardial reflectivity is normal, in contrast to the significant increase observed in adult patients affected by the same disease. This observation is in accord with the different clinical manifestations reported in young HCM patients and indicates an age-dependent difference in the echogenic structure of the hypertrophied myocardium in HCM.

Decreased T cell apoptosis and T cell recovery during highly active antiretroviral therapy (HAART)

T cell apoptosis represents a common mechanism of T cell depletion in HIV-1-infected individuals reflecting maturational and functional T cell abnormalities either directly or indirectly induced by the virus. In the present study, the effects of highly active antiretroviral therapy (HAART) on the spontaneous apoptosis of distinct T cell subsets were investigated during a 6-month follow-up in a cohort of HIV-1-infected individuals with CD4(+) cell counts between 100 and 500 cells/microliter and plasma HIV-1 RNA levels >/=10, 000 copies/ml. We determined that the rapid and sustained increase of both naive (CD45RA(+)CD62L(+)) and memory (CD45R0(+) and CD45RA(+)/CD62L(-)) CD4(+) and, to as lesser extent, CD8(+) T cells in peripheral blood was associated with a significant decrease of apoptotic CD4(+) and CD8(+) as well as CD3(+)CD4(-)CD8(-) T cells. Among CD4(+) lymphocytes, at enrollment, the highest frequency of apoptotic cells was observed within the memory compartment, as defined by CD45R0 expression. During HAART, however, the frequency of CD4(+)CD45R0(+) apoptotic T cells progressively decreased in association with a significant downregulation of surface activation markers that indicated decreased levels of systemic immune stimulation. These results indicate that effective viral suppression can contribute to progressive normalization of maturational and functional T cell abnormalities responsible for the high levels of T cell apoptosis in HIV-1-infected individuals. This, in turn, may contribute to a reduced rate of T cell loss and immune reconstitution during HAART.

Diagnostic imaging of hepatic tuberculosis: case series

BACKGROUND

Hepatic tuberculosis (TB) shows non-specific symptoms, and liver imaging may provide diagnostic clues. Here we describe a series of patients with hepatic TB showing characteristic radiological findings.

METHODS

Single-centre retrospective evaluation of patients with hepatic TB diagnosed over a period of 16 years who underwent ultrasound, computed tomography (CT) and/or magnetic resonance imaging (MRI). Hepatic lesions were classified as miliary, nodular, serohepatic or cholangitis.

RESULTS

Of 14 patients with hepatic TB, five were co-infected with the human immunodeficiency virus. All patients had additional extrahepatic TB localisations. An interferon-gamma release assay was performed in 11/14 patients, ultrasound and CT were available for all patients and MRI for four. Observed patterns were miliary (n = 6) with multiple nodules < 2 cm; nodular (n = 5), characterised by a variable number of nodules (2-7 cm); and serohepatic (n = 3), with multiple nodular subcapsular lesions with a thin, smooth wall. Shared findings were hypoechoic lesions on ultrasound, hypodense lesions with ring enhancement on CT, while MRI lesions were hypointense on T1- and hyperintense on T2-weighted images.

CONCLUSIONS

Ultrasound, CT and MRI can independently contribute to detection of hepatic TB. While a miliary pattern or calcifications are characteristic, no pattern is completely pathognomonic and the diagnosis depends on microbiological evidence. Particularly in risk groups, characteristic radiological findings may prompt targeted diagnostic work-up.

Giant Dilatations of Virchow-Robin Spaces in the Midbrain

Virchow-Robin spaces are lesions often seen in the brain parenchyma but their etiopathogenesis remains unsettled. Giant Virchow-Robin spaces placed in the midbrain are extremely rare. We describe three patients with a diagnosis of giant Virchow-Robin spaces in the midbrain, and their clinical and radiologic findings. We reviewed the literature in terms of the etiopathology, anatomic and radiologic appearance and differential diagnosis of the giant Virchow-Robin spaces. The diagnostic role of the high Tesla magnetic resonance devices and new sequences techniques such as three dimensional isotropic acquisition and diffusion tensor imaging were also evaluated in this case series.

Endogenous cytokine production protects T cells from spontaneous apoptosis during highly active antiretroviral therapy

BACKGROUND

The availability of therapeutic regimens that effectively interfere with HIV-1 replication provides novel opportunities to investigate mechanisms of T-cell depletion as well as repopulation in infected individuals.

METHODS

Nineteen HIV-1-infected individuals were investigated during one-year follow-up of highly active retroviral therapy (HAART). The frequencies of apoptotic T cells, as determined by propidium iodide, staining, TUNEL assay and analysis of annexin V, were assessed either in the absence or in the presence of anti-interleukin (IL)2 and anti-IL-4 neutralizing Ab. Spontaneous and lectin-induced cytokine production were assessed by ELISA.

RESULTS

Increments of both naive and memory CD4 and CD8 T cells during HAART are accompanied by a decrease of T-cell apoptosis that, after 12 months of HAART, reaches normal levels. This is associated with increments of both spontaneous and activation-induced production of IL-2 and IL-4 by peripheral blood mononuclear cells (PBMCs), though only the latter was found defective at enrolment. During HAART, blocking of either IL-2 or IL-4 production by PBMCs using neutralizing Ab restores levels of T-cell apoptosis consistent with those determined at enrolment. These data suggest that both IL-2 and IL-4 produced by PBMCs during HAART provide anti-apoptotic signals that can contribute to an increased survival of T cells and may thus play a part in long-term immune reconstitution.

CONCLUSIONS

An effective viral suppression and, possibly, effects of PI on molecular targets other than viral components, can support a progressive normalization of T-cell survival that, at least in part, depends upon the restoration of proper soluble signals. These results provide evidence of a supporting role of endogenous cytokine production in peripheral T-cell repopulation during an effective and prolonged viral suppression. This may be relevant for the definition of immune-intervention targets aimed at immune reconstitution in HIV-1-infected patients.

Cold lesion of a vertebral angioma with Tc-99m-labeled monoclonal antibodies against granulocytes

Antigranulocyte immunoscintigraphy is indicated for diagnostic imaging to determine the location and extent of infection. We present a case of a focal cold lesion in a vertebra of a patient thought to have a septic focal lesion. Whole-body scanning and dorsal spine SPECT revealed no focal increased uptake. CT and MR studies revealed the presence of a vertebral angioma. Conditions associated with a defect of uptake in immunoscintigraphy are discussed.

Cross-linking of at least three binding sites mediates signal transduction in a CR2-positive Burkitt lymphoma derived cell line (Raji)

In this study we demonstrate that Raji cells, a CR2-positive Burkitt lymphoma-derived cell line, during cell growth, need the cross-linking of multiple OKB7 binding sites or C3d determinants to mediate signal transduction. The loss of one of these affects the cellular response. Moreover, OKB7, the anti-CR2 MoAb, recognizes C3d determinants on the cell surface and inhibits signal transduction induced by anti-C3d polyclonal antibody. Since Raji cells are always CR2 positive during cell growth, we suppose that at least another protein, along with CR2, may be involved in setting up a cell surface complex able to receive and transduce the signal triggered by OKB7. In our experimental system the protein that offers a third binding site to OKB7, may be represented by a 33 kDa protein bearing C3d determinants.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

Natural history studies for the preliminary evaluation of Larinus filiformis (Coleoptera: Curculionidae) as a prospective biological control agent of yellow starthistle

We studied the life history, geographic distribution, behavior, and ecology of Larinus filiformis Petri (Coleoptera: Curculionidae) in its native range to determine whether it is worthy of further evaluation as a classical biological control agent of yellow starthistle, Centaurea solstitialis (Asteraceae: Cardueae). Larinus filiformis occurs in Armenia, Azerbaijan, Turkey, and Bulgaria and has been reared only from C. solstitialis. At field sites in central and eastern Turkey, adults were well synchronized with the plant, being active from mid-May to late July and ovipositing in capitula (flowerheads) of C. solstitialis from mid-June to mid-July. Larvae destroy all the seeds in a capitulum. The insect is univoltine in Turkey, and adults hibernate from mid-September to mid-May. In the spring, before adults begin ovipositing, they feed on the immature flower buds of C. solstitialis, causing them to die. The weevil destroyed 25-75% of capitula at natural field sites, depending on the sample date. Preliminary host specificity experiments on adult feeding indicate that the weevil seems to be restricted to a relatively small number of plants within the Cardueae. Approximately 57% of larvae or pupae collected late in the summer were parasitized by hymenopterans [Bracon urinator, B. tshitsherini (Braconidae) and Exeristes roborator (Ichneumonidae), Aprostocetus sp. (Eulophidae), and unidentified species of Eurytomidae and Ormyridae]. This weevil may be a better choice than the other capitula insects already established in the United States, particularly in colder parts of the plant's range.

Hippocampal Asymmetry with Hippocampal Sulcus Remnants in a Patient with Mild Cognitive Impairment

A 65-year-old woman underwent MRI for a mild cognitive impairment (MCI) at Mini-Mental State Examination (MMSE). MRI showed hippocampal sulcus remnants bilaterally, although they were larger on the right, and left hippocampal atrophy with increased left fimbrio-subicular distance (right side: 1.2 mm; left side: 2.0 mm). The meaning of these findings in relation to clinical aspects is discussed and reviewed according to data from the literature.

Genetic and morphological studies of Trichosirocalus species introduced to North America, Australia and New Zealand for the biological control of thistles

Trichosirocalus horridus sensu lato has been used as a biological control agent of several invasive thistles (Carduus spp., Cirsium spp. and Onopordum spp.) since 1974. It has been recognized as a single species until 2002, when it was split into three species based on morphological characters: T. horridus, Trichosirocalus briesei and Trichosirocalus mortadelo, each purported to have different host plants. Because of this taxonomic change, uncertainty exists as to which species were released in various countries; furthermore, there appears to be some exceptions to the purported host plants of some of these species. To resolve these questions, we conducted an integrative taxonomic study of the T. horridus species complex using molecular genetic and morphological analyses of specimens from three continents. Both mitochondrial cytochrome c oxidase subunit I and nuclear elongation factor 1α markers clearly indicate that there are only two distinct species, T. horridus and T. briesei. Molecular evidence, morphological analysis and host plant associations support the synonymy of T. horridus (Panzer, 1801) and T. mortadelo Alonso-Zarazaga & Sánchez-Ruiz, 2002. We determine that T. horridus has been established in Canada, USA, New Zealand and Australia and that T. briesei is established in Australia. The former species was collected from Carduus, Cirsium and Onopordum spp. in the field, whereas the latter appears to be specific to Onopordum.

Last-male sperm precedence in Rhynchophorus ferrugineus (Olivier): observations in laboratory mating experiments with irradiated males

The Red Palm Weevil (RPW) Rhynchophorus ferrugineus (Olivier 1790) is an invasive pest from southeastern Asia and Melanesia that in the last 30 years has spread widely in the Middle East and Mediterranean Basin. Its stem-boring larvae cause great damage to several palm species of the Arecaceae family, many of which are economically important for agricultural and ornamental purposes. Therefore, great attention has recently been focused in studying this species to identify sustainable and effective eradication strategies, such as sterile insect technique (SIT). The rapid spread of RPW is associated with its high reproductive success. To evaluate the suitability of a SIT strategy, particular physiological and behavioral aspects of RPW reproduction, such as the presence of polyandry and post-copulatory sperm selection mechanisms, were investigated. To determine paternity of progeny from multiply mated females, double-crossing experiments were carried out confining individual females with either a wild-type male or a γ-irradiated male (Co-60). Fecundity and fertility of females were scored to evaluate post-copulatory sperm selection. Results showed that progeny were almost exclusively produced by the sperm of the second male, suggesting that a last-male sperm precedence is expressed at high levels in this species, and providing interesting insights for an area-wide RPW management strategy such as the SIT.

[Exercise two-dimensional echocardiography in recent myocardial infarction. Is it useful in the detection of multivessel disease?]

Exercise two-dimensional echocardiography (2D-ECHO) can be used to detect coronary artery disease in patients (pts) by the development of stress-induced transient asynergy in areas without wall motion abnormalities when at rest. The aim of the study is to verify the accuracy of exercise 2D-ECHO in the identification of high risk pts with multivessel disease after the first acute myocardial infarction (AMI). Technically adequate 2D-ECHO examinations were obtained in 21 of 28 (75%) consecutive patients after acute myocardial infarction. 30-50 days after acute myocardial infarction, these 21 pts (19 males and 2 females, mean age +/- SD = 54.3 +/- 8.7) underwent 2D-ECHO during bicycle exercise in supine position. The marker of multivessel disease was the development, during the stress test, of new areas of asynergy not adjacent to the infarcted area (i.e. transient remote asynergy). Two months after acute myocardial infarction all pts underwent coronary angiography to verify the severity of coronary obstruction (reduction of luminal diameter greater than or equal to 75% in the non infarct related vessel).(ABSTRACT TRUNCATED AT 250 WORDS)