A case of eosinophilic heart disease diagnosed by endomyocardial biopsy findings

A rare case of early stage eosinophilic heart disease was diagnosed by endomyocardial biopsy findings, despite the relatively low peripheral eosinophil blood count (640/mm3).

Synthetic anthracyclines: regiospecific total synthesis of a D-ring indole analogue of daunomycin

The 4-methoxy-5-methylpyrano[4,3-b]indole-1,3(4H,5H)-dione (9), prepared from methyl 3-methoxycarbonyl-1-methylindol-2-yl acetate (6), underwent a strong base-induced cycloaddition reaction with 2-chloro-6,6-ethylenedioxy-5,6,7,8-tetrahydro-1,4-naphthoquinone (11) to give the tetrahydronaphtho[2,3-b]carbazole-7,12-dione (10), regioselectively. The cycloadduct (10) was successfully converted to a D-ring indole analogue of daunomycin (1a).

Stimulation of macrophages by muroctasin to produce colony-stimulating factors

Murocatasin (N2-[(N-acetylmuramoyl)-L-alanyl-D-isoglutaminyl]-N6-stearoyl-L-lysine, MDP-Lys(L18], a muramyl dipeptide derivative, has been reported to increase the number of peripheral granulocytes and monocytes after subcutaneous administration to animals and humans. When macrophage cell lines such as P388D1 and J774.1 cells were incubated with muroctasin in vitro, the production of colony-stimulating factor (CSF) from these cells was increased significantly. By Northern blot analysis, expression of the M-CSF gene, but not the G-CSF gene, in these macrophage cell lines was found to be enhanced by treatment with muroctasin. However, expression of the G-CSF gene in NFSA cells, a fibrosarcoma cell line established as a G-CSF producer, was actually enhanced by incubation with the conditioned medium from P388D1 cells stimulated with muroctasin. Thus, the hematopoietic activity of muroctasin was suggested to be attributable primarily to the enhanced production of M-CSF from macrophages. The enhanced G-CSF production from NFSA cells may be due at least to interleukin-1 released from muroctasin-stimulated macrophages.

[A case of bilateral coronary artery to pulmonary artery fistulas associated with hepatic arteriovenous fistula]

A 55-year-old man, previously treated for primary hypothyroidism, was admitted for evaluation of atypical chest pain. On physical examination, the pulse rate was 60 and blood pressure was 132/84 mmHg. Heart sounds were normal and no murmur was heard. Abdominal palpation showed no abnormal finding, and bruit was not heard. The electrocardiogram was normal and stress-induced ischemia was not found. The chest X-ray showed no sign of pulmonary hyperaemia or mass lesion, and central shadow was normal (CTR = 44%). During right heart catheterization, the pressures were normal in the cardiac chambers, pulmonary artery, and wedge position. A significant increase in oxygen saturation was disclosed at pulmonary artery level (10%) and the upper site of the inferior vena cava (22%). Coronary arteriography found coronary artery fistulas from the left main trunk, the left anterior descending artery, the left circumflex, and the right coronary artery to the pulmonary trunk. The left and right ventriculograms were normal. The digital subtraction angiography of celiac artery showed hepatic arteriovenous fistula. Ultrasonography and computed tomography found no mass lesion of the liver. Since combination of the bilateral coronary artery with pulmonary artery fistula, and hepatic arteriovenous fistula is very rare, the present case is worth noting for the investigation of the pathogenesis of congenital arteriovenous fistulas.

[A case of renal cell carcinoma in a horseshoe kidney: a case report]

A case of renal call carcinoma associated with horseshoe kidney is reported. The patient was a 59-year-old woman complaining of right flank mass. Radiological examination showed right renal tumor and horseshoe kidney, and right nephrectomy was performed. Histological examination showed it to be clear cell type renal cell carcinoma. Only 17 cases of horseshoe kidney with renal cell carcinoma have been reported in Japan. We report the 18th case with a review of the literature.

Serial electrocardiographic and angiographic changes of patients with hypertrophic cardiomyopathy

The characteristics of ECG findings as they relate to myocardial changes during long-term course of hypertrophic cardiomyopathy (HCM) were studied. Serial changes in ECG were compared with changes left ventriculogram and bi-ventriculogram in 15 patients with HCM without intraventricular conduction disturbance. Serial changes in ECG findings, with special reference to the negative T wave, were categorized in three groups; 1) 5 patients with increase or appearance of the negative T wave (A-1 group). 2) 4 patients with decrease or disappearance of the negative T wave (A-2 group). 3) 6 patients without significant changes in the T wave (B-group). A-1 group presented a marked increase in SV1 + RV5, and of the thickness of anterior and apical wall, and a decrease of the peak dV/dt/EDV (end diastolic volume-normalized peak filling rate), serially. End diastolic volume (EDV) and ejection fraction (EF) did not change significantly. The configuration of left ventriculogram changed from a round form to a spade-like form. A-2 group presented a marked decrease in SV1 + RV5, the thickness of anterior and apical wall, peak dV/dt/EDV and peak dV/dt/V (left ventricular volume of the time of peak filling-normalized peak filling rote). EF decreased serially, 2 cases of A-2 group presented the clinical picture of dilated cardiomyopathy in the end stage. In B group, SV1 + RV5, the wall thickness and left ventricular function did not change, serially. In conclusion, serial observations of ECG are useful for assessing alterations in wall thickness, LV-form and LV-function.

Hydrophobic interaction chromatography in alkaline pH

Hydrophobic interaction chromatography is a very powerful protein purification technique which is dependent on strong salting-out salts to increase the hydrophobic interactions between the protein and the ligand. Ammonium sulfate is the salt most commonly used for this purpose, but it cannot be used at very alkaline pH. Monosodium glutamate was therefore tested as a salt for hydrophobic interaction chromatography at pH 9.5. When ribonuclease A, ovalbumin, and beta-lactoglobulin were individually applied to a phenyl superose column in 2 M monosodium glutamate, all three proteins bound to the column and could be subsequently eluted by decreasing the salt concentration. Using this salt, it was possible to separate commercially obtained beta-lactoglobulin into authentic protein and contaminants and to purify the individual proteins from a mixture of ovalbumin and beta-lactoglobulin. These results demonstrate that monosodium glutamate is a useful salt for hydrophobic interaction chromatography. Guanidine and sodium sulfate and sodium aspartate were also examined at the same pH, demonstrating that they also resulted in the binding and elution of the proteins examined.

[Studies on the distribution and polycyclic aromatic hydrocarbons of particulate substances in the vicinity of an expressway. Rep. 3. The present condition and properties of diffusion of pollution by polycyclic aromatic hydrocarbons]

In order to clarify synthetically the situation concerning air pollution by suspended particulate matter (SPM) in the vicinity of the Meishin Expressway, polycyclic aromatic hydrocarbons (PAHs), which are typical substances adsorbed on SPM, were determined by the high-performance liquid chromatography method, and the distribution of the PAHs concentrations was examined. The concentration of benzo(a)pyrene (B(a)P) at a point 60 m from the road edge was 2.93 ng/m3 (9.11 micrograms/g dust). The concentration of benzo(ghi)perylene (B(ghi)P) was 6.62 ng/m3 (20.6 micrograms/g dust) at this point, being the highest of all the PAHs that were analyzed in this study. The concentrations of PAHs that were contained in 1 g of dust were the highest in the SPM fraction from 0.7 to 1.6 micron in diameter. The concentrations of PAHs that were contained in particles under 5.4 microns in diameter, and which are absorbed extremely easily into the lung, occupied more than 90% of the concentrations of PAHs that were contained in the total SPM. When there was a high frequency of perpendicular wind, the concentrations of PAHs in SPM fractions under 1.6 micron in diameter showed a marked tendency to have a clear concentration-distance profile, but when there was a high frequency of parallel wind, it was observed that these concentrations at a point 120 m from the road edge were much higher than at the road edge. The correlation coefficient between the concentrations of B(a)P and the traffic volume of large vehicles was elevated with the increase of distance from the road edge and was statistically significant at a point 290 m from the road edge.

[Clinical application of MRI for urological malignancy. 1: Usefulness of various imaging modalities for local staging of prostatic cancer; a comparison between MRI, CT and transrectal ultrasonography]

Twenty-three pathologically revealed prostatic cancer patients were examined by magnetic resonance imaging (MRI), computed tomography (CT) and transrectal ultrasonography, (US) and 6 of them underwent radical prostatectomy. A localized prostatic cancer was identified as a low intensity area in the outer zone with high intensity or showed a partial or total destruction of the border line between the internal and the outer zone when cancer invaded into the internal zone from the outer zone, on T2 weighted image of MRI, as we have already reported. On US, a localized prostatic cancer was identified as a hypoehoic area in the outer zone, and showed a heterogeneous image when cancer enlarged. On CT, a localized cancer could not be identified. A diagnostic criteria for local staging by MRI was made and preoperative staging were done in 6 total prostatectomy cases. The accuracy of preoperative staging of cancer seemed to be the highest by MRI, because it was more accurate in diagnosing the extracapsular invasion, seminal vesicle invasion and bladder neck invasion of the tumor than by CT and US.

Quantitation of myocardial fibrosis and its relation to function in essential hypertension and hypertrophic cardiomyopathy

Myocardial interstitial fibrosis is an important microscopic feature of hypertrophic cardiomyopathy. To determine whether interstitial fibrosis of the myocardium in hypertrophic cardiomyopathy and essential hypertension differ in quality or quantity, and to determine whether fibrosis affects cardiac function directly, we measured the percentage of fibrosis in patients of both categories and compared the severity of fibrosis with several cardiac functions. Left and right ventricular endomyocardial biopsies were performed in 25 patients with essential hypertension and in 19 patients with hypertrophic cardiomyopathy. Interstitial fibrosis was classified into four different microscopic types, and the percentage of total and of each type was calculated using the point-counting method. Although the percentage of total fibrosis was similar between the two groups, the type of fibrosis was different. There was no correlation between the percentage of total fibrosis and the mean size of myocytes in either group. Although there was a significant correlation between the percentage of total fibrosis and the thickness of the interventricular septum in hypertrophic cardiomyopathy, such correlation was lacking in hypertension. There was no correlation between the percentage of total fibrosis and the ejection fraction, cardiac index, or left ventricular end-diastolic pressure in either group. We concluded that the amount of myocardial interstitial fibrosis in hypertrophic cardiomyopathy is no greater than that in essential hypertension, but the type of fibrosis is different. Furthermore, in subjects in whom the ejection fraction is normal or only slightly decreased, fibrosis does not influence global cardiac functions.

[Serial changes in left ventricular configuration and function in hypertrophic cardiomyopathy]

Fifteen patients, 12 males and three females, with hypertrophic cardiomyopathy (HCM) including three of obstructive type (HOCM) were investigated to observe the long-term course of HCM. Left ventriculography and bi-ventriculography were performed twice serially in all cases. We studied the correlations between the serial ECG changes, especially the negative T wave, and the left ventricular configuration, wall thickness, and left ventricular function. Serial ECG changes included: 1) negativity of the T wave which developed or increased concomitantly with increased voltages of SV1 + RV5 (A-1 group: five cases), 2) the negativity decreased or resolved with decreased voltages of SV1 + RV5 (A-2 group: four cases), and 3) insignificant changes of both T waves and SV1 + RV5 (B group: six cases). In the right oblique views at end-diastole, the configuration of the left ventricle was classified in three forms; (1) spade form (S), (2) round form (R), and (3) intermediate form (SR). The results were as follows: 1. The A-1 group showed increased thickness of the apical and anterior walls, but the thickness of the posterior wall and interventricular septal wall did not change serially. In three cases, the thickness of the interventricular septum showed mild hypertrophy at the initial and final observations. The configuration changed from the R or SR form to the S form. Diastolic dysfunction (peak dV/dt/V, peak dV/dt/EDV) was progressive, but end-diastolic volume and ejection fraction did not change. 2. The A-2 group showed the significantly decreased thickness of the apical and anterior walls. The thicknesses of the posterior wall and interventricular septal wall tended to decrease in all cases. In three cases (75%), the interventricular septal wall was markedly hypertrophied on the initial observation. The configuration changed from the S or SR form to the R form. Left ventricular diastolic function and ejection fraction decreased significantly and end-diastolic volume increased. Two cases showed clinical pictures of dilated cardiomyopathy at the final observation. 3. In the B group, there were no marked changes in wall thickness, left ventricular configuration, or systolic and diastolic functions. In conclusion, serial changes in left ventricular configuration, wall thickness, especially of the anterior and apical walls, and left ventricular function were all compatible with the serial changes of the ECG in hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Optimal timing for valve replacement in chronic aortic regurgitation: analysis based on the myocardial contractility and postoperative prognosis

Left ventricular (LV) function was evaluated considering force-velocity and stress-shortening relationships in 14 asymptomatic (Group 1), 18 symptomatic patients (Group 2), and 53 normal subjects (Group 3) to determine the optimal time for valve replacement in patients with chronic aortic regurgitation (AR). Valve replacement was recommended for all Group 2 patients and for one patient in Group 1, who had sustained ventricular tachycardia. There was one operative death and five deaths remote from surgery; one patient in Group 1 died suddenly of undetermined cause, and four patients in Group 2 died of congestive heart failure (CHF). The LV end-systolic volume index (ESVI) was greater than 100 ml/m2 in the five patients whose death was unrelated to surgery (remote deaths). ESVI was less than 50 ml/m2 in all but two patients in Group 1, and more than 40 ml/m2 in all cases in Group 2. The index of preload, end-diastolic stress (sigma ed), was increased in Groups 1 and 2 as compared with Group 3. A significant positive correlation was observed between end-systolic stress (sigma es) and ESVI (r = 0.71, p less than 0.001) in patients with AR, and this linear line was not as steep as that of Group 3. Afterload (sigma es) and ejection fraction (EF) in Group 1 were within normal range, afterload was normal but EF was reduced in mildly symptomatic patients in Group 2, and severely symptomatic patients had markedly reduced EF and elevated afterload. There was a close correlation between ESVI and end-diastolic volume index (EDVI), and this was expressed as an exponential curve (Y = 21.69e0.006x, r = 0.88, p less than 0.001). This indicates that the rate of shortening of the muscle fiber deteriorates exponentially with enlargement of the ventricle. These observations suggest that in AR patients: 1) afterload and contractility of the ventricle remain normal in the majority of asymptomatic patients by means of compensatory hypertrophy and preload elevation (preload reserve), 2) deterioration of contractility seems to be the factor initiating CHF, and 3) progression of CHF is due to further deterioration of contractility in addition to elevation of afterload (afterload mismatch). It is concluded that careful observations are necessary when ESVI exceeds 50 ml/m2 in asymptomatic patients. Valve replacement is recommended when such patients develop symptoms of CHF, or either when EF falls to less than 50% or ESVI exceeds 100 ml/m2, even if patients remain asymptomatic.

[Primary malignant fibrous histiocytoma of the gallbladder: a case report]

A 75-year-old female patient was admitted to our department because of fever and right hypochondraligia. A giant tumor of the gallbladder was confirmed by CT scanning, ultrasonography and PTC. She underwent complete removal of the main tumor and right hemicolectomy. The extirpated tumor was solid, but partially occupied by coagulated and necrotic tissue, 13 X 11 X 9cm in size, and 900g in weight. On the basis of the histologic features of the tumor, MFH (pleomorphic type) originated from the gallbladder was clearly diagnosed. Her postoperative course was uneventful, but she died of cachexia due to recurrence on 79 days after operation. Malignant fibrous histiocytoma (MFH) is a soft tissue sarcoma, usually developing in the extremities, less commonly in the retroperitoneal and the abdominal cavity. MFH originated from the gallbladder is very rare, and only 3 cases were reported in Japan so far. This is the fourth reported case in Japan.

[Diastolic dysfunction and its relation to myocardial fibrosis in essential hypertension]

This study elucidated diastolic left ventricular dysfunction and whether myocardial interstitial fibrosis correlates with diastolic dysfunction in mild to moderate systemic hypertension (HT). Six normotensive subjects, 18 hypertensive patients without left ventricular hypertrophy (LVH) and 10 hypertensive patients with significant LVH were evaluated. M-mode echocardiography was used to determine fractional shortening (FS), isovolumic relaxation time (IRT), and left ventricular filling volume during rapid and slow filling periods and the atrial contraction period (RFV, SFV, ACV). The quotients of the left ventricular filling volume and the end-diastolic volume and stroke volume were also calculated. Simultaneous biventriculography was used to determine the end-diastolic thickness of the interventricular septum and posterior wall. Right ventricular endomyocardial biopsies were performed to calculate the percentages of fibrosis. The FS was normal in all groups. The percentages of fibrosis in the two HT groups were significantly greater than those in the normals. The IRT of the HT groups was significantly greater, and the RFV, RFV/EDV and RFV/SV were significantly less than those of the normals. Multiple regression analysis showed that the wall thickness and the percentages of fibrosis correlated significantly with IRT, RFV, RFV/EDV and RFV/SV. The standard coefficients of correlation of wall thickness and the percentages of fibrosis were 0.333 and 0.239 in respect to IRT, and -0.304 and -0.473 in respect to RFV. There were significant correlations between the percentages of fibrosis and RFV (r = -0.675), RFV/EDV (r = -0.664) and RFV/SV (r = -0.602) in the normals and in cases of HT without LVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressed myocardial contractility in mitral stenosis--an analysis by force-length and stress-shortening relationships

To determine whether low ejection fraction (EF) in mitral stenosis (MS) is the result of depressed contractility or is mediated by other factors, left ventricular (LV) function was analyzed by force-length and stress-shortening relationships. Thirty patients without heart disease served as normal controls (Group 1). Forty-three patients with MS were divided into 2 subgroups: Group 2 (n = 19) had EF within one standard deviation of the mean of Group 1, and Group 3 (n = 24) had EF below it. Normal EF (Group 2) was associated with low preload (end-diastolic stress) and low afterload (end-systolic stress), and preload and afterload were in the normal range in patients with low EF (Group 3). A significant negative correlation was observed in the whole group of patients with MS between EF and end-systolic stress (Y = -0.14X + 72.8, r = -0.61, p less than 0.001), and a positive correlation between end-systolic stress and volume (Y = 1.39X + 65.4, r = 0.45, p less than 0.01). These observations suggest that systolic shortening and end-systolic volume of the left ventricle are in part governed by afterload in this disease. It is concluded that low EF of MS is not mediated by reduced preload or inappropriately elevated afterload, and contractility of the ventricle is mildly depressed in MS.

Mechanism of renal excretion of carumonam in rats, rabbits, dogs, and monkeys

The mechanism of the renal excretion of carumonam (CRMN) was investigated in rats, rabbits, dogs, and monkeys. Stop-flow analysis in dogs demonstrated that CRMN is exclusively excreted by glomerular filtration. There was no specific CRMN peak corresponding to the peak of p-aminohippuric acid (PAH) secretion or to the trough of Na+-K+ reabsorption in the stop-flow pattern. Although the PAH peak disappeared when probenecid was administered, the CRMN stop-flow pattern showed no change. In rabbits, however, the CRMN concentration peak corresponding with the PAH peak was detected in the stop-flow pattern; the CRMN peak disappeared when probenecid was administered. The pharmacokinetic parameters in plasma, such as the area under the concentration-time curve, the half-life, and the clearance rate, were affected by probenecid in rats, rabbits, and monkeys, but not in dogs. The results suggest that the renal excretion of CRMN in dogs takes place exclusively through glomerular filtration. In rats, rabbits, and monkeys, however, CRMN is excreted through both glomerular filtration and renal tubular secretion.

Augmentation of immune responses by a muramyl dipeptide analog, MDP-Lys(L18)

The effects of N2-(N-acetyl-muramyl-L-alanyl-D-isoglutamyl)-N6-stearoyl-L-lysine (MDP-Lys(L18], a muramyl dipeptide (MDP) analog, on the immune responses in mice were studied. MDP-Lys(L18) augmented the mitogenic responses of splenic lymphocytes to phytohemagglutinin (PHA) and lipopolysaccharide (LPS) at 0.1-10 micrograms/ml, and antibody formation to sheep red blood cell (SRBC) in normal and immunosuppressed mice, and to dinitrophenyl (DNP)-Ficoll. In addition, MDP-Lys(L18) potentiated polyclonal B cell activation both in vivo and in vitro. It was also found that MDP-Lys(L18) augmented the cellular immune responses, such as mixed lymphocyte reaction (MLR) and delayed type hypersensitivity (DTH). These effects of MDP-Lys(L18) were more potent than those of MDP. These findings may be attributed to the interleukin 1 (IL-1)-inducing activity of MDP-Lys(L18).

Coronary angiographic characteristics in Japanese patients with heterozygous familial hypercholesterolemia

Coronary angiographic findings were analyzed in 51 consecutive patients (36 males and 15 females) with heterozygous familial hypercholesterolemia (FH) and 279 consecutive patients (216 males and 63 females) without FH (non-FH). The coronary stenosis index and over 75% stenosis vessel subset were almost three times as high in the FH group. The incidence of myocardial infarction was almost twice as high in the FH group. Levels of total cholesterol and its lipoprotein fractions, except HDL-cholesterol, were almost twice as high in the FH group. In the FH group aged under 50 years, the two parameters of coronary angiogram and the incidence of myocardial infarction were significantly higher in males than in females. However, in the group aged over 50 years, all three parameters were not significantly different between those in males and females. The level of HDL-cholesterol was significantly lower in males than in females. A significantly higher incidence (18%) of coronary ectasia was observed in the FH group compared with the incidence (2%) in non-FH. All patients with coronary ectasia were males, except one female with FH. On comparison of the males among the FH patients with those among the non-FH patients matched for total cholesterol, age and other risk factors, the FH patients were associated with a significantly higher degree of coronary atherosclerosis and lower level of HDL-cholesterol. Seven FH patients with a normal coronary angiogram were observed. However, any factors as regards age, total cholesterol, HDL-cholesterol and Achilles tendon thickness failed to distinguish between the FH patients with a normal coronary angiogram and those without.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of von Recklinghausen's disease localized in the lower abdominal and external genitalia]

A case of von Recklinghausen's disease localized to the lower abdominal and the external genital region is reported. The patient was a 14-year-old male who complained of an abnormality of the external genitalia. There was a subcutaneous mass with the skin pigmentation, which surrounded the penis, so that the foreskin appeared like a cyst. Excision of the subcutaneous mass and plastic operation of the penis were performed. Histological examination showed it to be diffuse neurofibroma. There has been no recurrence two years after the operation. This type of von Recklinghausen's disease has not been reported in Japan.

[Electrocardiographic and angiographic follow-up of patients with hypertrophic cardiomyopathy]

Electrocardiographic follow-up was conducted for 17 patients with hypertrophic cardiomyopathy including six cases who received left ventriculographic follow-up. 1. Serial ECG changes were as follows: 1) In seven patients negativity of the T wave appeared or increased concomitantly with increased voltage of SV1 + RV5 (A-1 group). 2) In four patients, negativity of the T wave decreased or disappeared with the decreased voltage of SV1 + RV5 (A-2 group). 3) In six patients, there were insignificant changes of both T wave and SV1 + RV5 (B group). 2. Results of serial left ventriculography and biventriculography were as follows: 1) Two patients (A-1 group) showed an increased voltage of SV1 + RV5 (25 mm----48 mm, 42 mm----54 mm), and increased thickness of the apical wall (10 mm----12 mm, 8 mm----11 mm) and the anterior wall (13 mm----16 mm, 10 mm----16 mm). However, the thickness of the posterior and interventricular septal walls did not change. The configuration of the end-diastolic left ventriculogram (RAO 30 degrees) changed from a round configuration to the so-called "beak" configuration. 2) Two patients (A-2 group) showed a decreased voltage of SV1 + RV5 (81 mm----26 mm, 73 mm----53 mm), decreased thickness of the apical wall (18 mm----10 mm, 21 mm----15 mm) and the anterior wall (12 mm----9 mm, 17 mm----12 mm). The end-diastolic left ventriculogram changed from a spade-like configuration to a round configuration. In the analysis of diastolic function measured by digitized cineangiograms using a picture-analyzer, diastolic dysfunction was already present at the initial observation. The diastolic and systolic dysfunction progressed during serial observations. These patients showed the clinical pictures of dilated cardiomyopathy at the final observation. 3) Two patients with no remarkable changes of the T wave (B group) showed insignificant changes in configuration of the left ventriculogram and wall thickness. In conclusion, serial changes in configuration of the left ventricle and wall thickness, especially of the anterior and apical walls, are compatible with the serial changes of the ECG in hypertrophic cardiomyopathy. The patients whose negative T waves decreased or disappeared had diastolic dysfunction at the initial observation, and deterioration of both diastolic and systolic dysfunctions during serial observations.

Intravenous isosorbide dinitrate infusion in the management of unstable angina pectoris refractory to conventional medical therapy

During the past 2 years, 102 patients were treated for unstable angina pectoris (AP) in our department. Fifteen of them had recurrent chest pain at rest despite treatment with various anti-anginal agents, or prolonged chest pain unresponsive to sublingual nitroglycerin; they received intravenous isosorbide dinitrate (ISDN) infusion. A rapid bolus injection of 2 to 6 mg followed by an infusion of 2 to 5 mg/hr was given to 10 patients with acute chest pain, and 5 patients, who were free of chest pain at the time, but had repeated episodes of angina in the past 24 hours, were given ISDN infusion without a bolus injection. Chest pain disappeared completely in 13 patients, but recurred in 2 of them when the dose was tapered. Two other patients experienced recurrent chest pain during ISDN infusion, and additional boluses were given. The hospital course was uneventful in 11 patients. Four patients who had recurrent anginal attacks underwent emergency coronary cineangiography under intraaortic ballon counterpulsation and aorto-coronary bypass surgery. There were no hospital deaths, no one had subsequent acute myocardial infarctions, and only 2 patients had mild to moderate headache as a side effect. Although the patient population is small, intravenous ISDN infusion is useful in the management of severe unstable AP.

Evaluation of left ventricular contractility in hypertrophic cardiomyopathy from end-systolic pressure-volume relation

To evaluate myocardial contractility in hypertrophic cardiomyopathy (HC), we obtained the end-systolic pressure-volume relation (ESPVR) and the end-systolic stress-volume relation (ESSVR) by changing loading conditions with Angiotensin II. The left ventricular (LV) stress-shortening relation was also analyzed in order to assess myocardial contractility. LV end-systolic pressure, end-systolic volume, end-systolic stress, and ejection fraction were obtained at rest and during Angiotensin II infusion with simultaneous recordings of pressure and volume in 9 patients with hypertrophic cardiomyopathy and 9 normal subjects (N). The slopes of ESPVR, Emax, showed no significant difference (HC: 3.1 +/- 2.3 vs N: 2.6 +/- 1.4 mmHg/ml, ns). The slopes of ESSVR were statistically similar (HC: 5.2 +/- 2.1 vs N: 6.0 +/- 2.8 g/cm2 ml, ns). The slopes of end-systolic stress-ejection fraction relation were also in the same range in both groups (HC: -0.09 +/- 0.05 vs N: -0.10 +/- 0.05, ns). From these two different analyses of LV contractility, we conclude that myocardial contractility is normal in hypertrophic cardiomyopathy and not supernormal, at both chamber and muscle levels. Considering the increased muscle mass in hypertrophic cardiomyopathy (HC: 134 +/- 46 vs N: 74 +/- 19 g/m2, p less than 0.01), the presence of increased numbers of contractile units does not result in enhanced overall chamber contractility.

[Washout rate in hypertrophic cardiomyopathy assessed by exercise myocardial scintigraphy]

The present study clarified the pathogenesis of disproportional hypertrophy in terms of disturbed coronary microcirculation. Twenty-eight patients with hypertrophic cardiomyopathy (HCM) who had normal coronary angiograms were categorized in four groups according to distributions of disproportional hypertrophy on left ventriculography and biventriculography: (1) Interventricular septal hypertrophy, (2) septal and apico-anterior wall hypertrophy, (3) apico-anterior hypertrophy, and (4) nonspecific hypertrophy of the entire wall. All 28 HCM patients and 10 normal volunteers were tested using exercise myocardial scintigraphy, and the circumferential profiles were processed by computer to relate the washout rate and disproportional hypertrophy. Comparison of the mean curves and mean segmental values of the circumferential profiles of the HCM groups with those of the control group showed that the mean initial uptake values of the HCM groups were to be relatively low in the apical segment and in the lower portion of the anteroseptal segment representing disproportional hypertrophy of these segments. The mean values were significantly elevated in the upper portion of the anteroseptal segment which was projected as the largest amount of the myocardium three-dimensionally. The mean washout rates in the HCM groups were significantly decreased in all segments, especially in those segments which reflected disproportional hypertrophy. This trend was also observed in the segments with increased initial uptakes. On comparing the segmental values of all groups, the segments with initial uptakes and/or washout rates with having the mean value minus 2SD of the control group were observed in the profiles of 12 of the 28 HCM patients. These all had decreased washout rates. In 25 of the total segments of the HCM patients, the initial uptakes and/or washout rates were below the normal limit; 21 of these segments had only decreased washout rates, and 16 of these 21 segments belonged to disproportionally hypertrophic wall. These results indicate that the decreased washout rate in the disproportionally hypertrophic wall is characteristic of HCM. It is suggested that the decreased washout rate with the decreased initial uptake is caused by disturbance of the coronary microcirculation. In addition, the decreased washout rate without a decreased initial uptake is caused not only by disturbance of coronary microcirculation, but by a metabolic disturbance of the myocardial cells as well. Furthermore, both disturbances are closely related to the pathogenesis of disproportional hypertrophy.

[Left ventriculography and serial ECG changes in hypertrophic cardiomyopathy with special reference to the negative T wave]

To clarify the correlation between the configuration of the left ventriculogram and serial ECG changes, 16 patients with hypertrophic cardiomyopathy (HCM) associated with asymmetrical septal hypertrophy were examined. In the right oblique view at end-diastole, the configurations were classified by form as round (R, n = 7), round with inferior concavity (R-i, n = 2), spade (S, n = 4) and spade with inferior concavity (S-i, n = 3). These patients were divided into two groups according to serial T wave changes; nine with marked changes (A group) and seven without (B group). Furthermore, group A was separated into two subgroups; seven with increasing negativity or appearance of the negative T wave (A-1 group) and two with decreasing negativity or disappearance of the negative T wave (A-2 group). The results were as follows: Five (71%) of the seven cases with the S and S-i form belonged to the A group. Their apical walls showed marked hypertrophy and their ECGs showed deep negative T waves. The other two cases (29%) belonged to the B group, and did not show marked apical hypertrophy. Four (44%) of the nine cases with the R and R-i form belonged to the A group. They showed mild apical hypertrophy, and initially did not show deep negative T waves. A deep negative T wave appeared in three during observation. The initial depth of the maximum negativity of T wave correlated significantly with apical wall thickness, SV1 + RV5, and the total depth of the negative T wave in precordial leads. During the observation, the A-1 group showed a marked increase of SV1 + RV5. The A-2 group showed a decrease of SV1 + RV5. In conclusion, HCM with deep negative T waves has a tendency to present wide changes in the T wave during serial ECG observation and to show apical hypertrophy on left ventriculography. Cases of increasing negativity of the T wave showed marked increase in voltage of SV1 + RV5. However, cases of decreasing negativity of the T wave showed decreasing SV1 + RV5. These ECG changes, especially the negative T wave changes are reputed to be related to apical wall thickness.

Pharmacokinetics of SCE-1141, a stereoisomer of cefmenoxime, in rats

The pharmacokinetic properties of SCE-1141, an anti stereoisomer of cefmenoxime, were compared with those of cefmenoxime. SCE-1141 levels in plasma and tissues peaked at 30 min after the intramuscular administration of 20 mg/kg; the plasma level declined with a half-life of about 18 min. The area under the concentration-time curve in plasma and the half-life after intravenous administration were similar to those after intramuscular administration. SCE-1141 was distributed at high concentrations in the liver and kidney of normal rats, and at lower concentrations in the liver of rats with acute liver impairment. SCE-1141 levels in plasma and tissues, except liver, were lower than those of cefmenoxime. The 24-h biliary and urinary excretions of SCE-1141 were 73% and 26% of the dose, respectively; these were significantly different from those of cefmenoxime: 33% in bile and 55% in urine. In rats with acute liver impairment, the biliary excretion of SCE-1141 was decreased, and the urinary excretion increased.

Comparative pharmacokinetics of carumonam and aztreonam in mice, rats, rabbits, dogs, and cynomolgus monkeys

The pharmacokinetic properties of carumonam (AMA-1080, Ro 17-2301) were studied in mice, rats, rabbits, dogs, and cynomolgus monkeys and compared with those of aztreonam. Carumonam administered subcutaneously in mice or intramuscularly in rats, rabbits, dogs, and cynomolgus monkeys at a dose of 20 mg/kg was readily absorbed and distributed at high concentrations in the plasma, kidneys, liver, and lungs, as was aztreonam. The peak level of carumonam in plasma, ranging from 41 micrograms/ml in mice to 68 micrograms/ml in monkeys; the area under the plasma concentration-time curve, ranging from 20 micrograms X h/ml in mice to 80 micrograms X h/ml in monkeys; the plasma half-life, ranging from 0.24 h in mice to 1.10 h in dogs; and the plasma clearance, ranging from 4.5 ml/min per kg in monkeys to 16.7 ml/min per kg in mice, resembled respective values of aztreonam. In rats, carumonam was eliminated faster than aztreonam. The levels of both antibiotics in the kidneys and liver were usually higher than respective levels in plasma. The level of carumonam in the kidney was usually higher than that of aztreonam, whereas the level of aztreonam in the liver was usually higher than that of carumonam. Both antibiotics showed similar distribution in the lung and spleen; the levels in these tissues were less than the levels in plasma. Carumonam was excreted mainly in the urine; the recovery ranged from 52% (from dogs) to 73% (from rabbits). The urinary recovery of carumonam from mice, rats, and monkeys was higher, but the recovery of carumonam from rabbits and dogs was lower than that of aztreonam. The biliary excretion of carumonam, amounting to 4.1% from rats and less than 0.3% from rabbits and dogs, was smaller than that of aztreonam, amounting to 19.1% from rats and around 1% from rabbits and dogs. The extent of protein binding at 20 micrograms of carumonam per ml was lower than that of aztreonam. For all species except dogs, which have very low binding in their serum (11% for carumonam and 20% for aztreonam), the binding of carumonam ranged from 21% (in rabbits) to 36% (in rats), whereas that of aztreonam ranged from 55% (in rabbits) to 85% (in rats). Thus, the plasma pharmacokinetics of carumonam and aztreonam were generally similar for all animals tested except dogs, but the two antibiotics differed slightly in their distribution in tissue, excretion, and protein binding in serum.

Rapid tumor regression and induction of tumor-regressing activity in serum by various immune-modulating agents

A rapid decrease in the number of tumor cells from S180 tumors was caused by several antitumor polysaccharides including the beta (1-3)glucans lentinan and TAK-N and a mannoglucan MGA, but not by those lacking antitumor activity. MGA was demonstrated to induce potent tumor-regressing activity in the serum of tumor-bearing mice similar to that reported previously to be induced after an injection of CM-TAK, a carboxymethylated beta (1-3)glucan. It is probable that the induction of rapid regression of established tumors is a phenomenon common to antitumor polysaccharides and some microbiological products and that the tumor-regressing factor in the serum underlies a common mechanism.