Stroke volume generation of the left ventricle and its relation to chamber shape in normal subjects and patients with mitral or aortic regurgitation

The total stroke volume of the left ventricle (LV) is equal to the sum of the regional cavity shrinkage. Since nonuniformity of regional wall motion in LV has been well documented even in normal subjects, the extent of the contribution of each region to total stroke volume cannot be easily determined. To assess the left ventricular regional contributions to total stroke volume under normal conditions and in compensated chronic mitral or aortic regurgitation, LV cineangiograms were analyzed in 14 normal subjects (N), 8 patients with mitral regurgitation (MR) and 10 patients with aortic regurgitation (AR). We assumed that the LV cavity could be viewed as a stack of 30 half-cylindrical discs, 15 in the anterior and 15 in the inferior wall regions. LV chamber shape was more spherical in MR than in N, but was more conical in AR. Percent regional hemichordal shortening was significantly decreased in the anterobasal and anteroapical walls in AR, but was similar between N and MR. The regional contribution to total stroke volume showed a significant quadratic correlation with the end-diastolic regional shape index (N, r = 0.87; MR, r = 0.79; AR, r = 0.90), which was defined as the regional hemiaxial length divided by the LV long-axis length, but was not correlated with percent regional hemichordal shortening. Therefore, stroke volume is generated mainly in the mid-ventricular portion in N and MR, but in the basal portion in AR due to the characteristic change in cavity shape.

Adult T-cell leukaemia/lymphoma with multiple integrations of human T-cell lymphotropic virus type I proviral DNA: differing clinical features are linked to varied proviral integration

Multiple integrations of human T-cell lymphotropic virus type I (HTLV-I) proviral DNA are occasionally found in tumor cells from patients with adult T-cell leukaemia/lymphoma (ATL). However, the clinical implications of multiple integrations of HTLV-I in ATL have not been well established. We studied 95 patients with ATL to elucidate the relationship between the multiple integrations of HTLV-I and the clinical characteristics. The proviral DNA of HTLV-I was examined by standard Southern blot analysis using the probe of an entire HTLV-I genome and the endonucleases with or without cleavage sites within the provirus. Multiple integrations of HTLV-I were detected in eight patients as extraordinary multiple bands; five patients showed multiple bands of the same intensity, and the remaining three showed multiple bands of differing intensities. The patients were divided into two groups based on these band patterns. One group was considered to exhibit one tumour cell clone carrying multiple copies of the provirus, whereas the other was considered to exhibit multiple tumour cell clones, each carrying one copy of the provirus. The former group of patients manifested a highly aggressive clinical course with frequent peculiar organ infiltrations, including the retina, uvea and muscle, along with the presence of large peripheral leukaemic T cells having flower-like nuclei. The latter group demonstrated an indolent clinical course with skin lesions or small leukaemic T cells having cleaved or lobulated nuclei. These findings suggest that the pattern of multiple HTLV-integrations into the tumor cell(s) has clinical implications in ATL. This may help to explain the heterogeneity of this disease.

eagle, a member of the steroid receptor gene superfamily, is expressed in a subset of neuroblasts and regulates the fate of their putative progeny in the Drosophila CNS

We isolated and characterized the eagle gene, encoding a member of the steroid receptor superfamily in Drosophila. In the central nervous system eagle RNA was expressed in a limited number of cells. During stages 10 and 11, eagle RNA expression was observed in four neuroblasts, NB2-4, NB3-3, NB6-4 and NB7-3. Except for NB6-4, eagle RNA expression reached a maximum at the very beginning of expression or in the period of neuroblast delamination. Weak eagle RNA expression was also observed in a few putative progeny of NB7-3 during stages, late 11 and 12. All eagle RNA in abdominal segments disappeared at stage 13. Using an eagle-kinesin-lacZ fusion gene as a reporter, the division, migration, and axonogenesis in eagle-positive cells and their derivatives were examined. At stage 14, several types of neural or glial cells were detected which include EG and EW interneurons joining to the anterior and posterior commissures, respectively. Lack of eagle expression caused altered axonogenesis in an appreciable fraction of eagle-Kinesin-LacZ-positive neurons. Some EG cells failed to acquire the neural fate or underwent an extremely delayed differentiation, while EW neurons produced neurites in abnormal directions, suggesting that eagle may play a critical role in development of the progeny of eagle-positive neuroblasts.

[Acute appendicitis caused by mucorales in a patient with severe aplastic anemia: report of an autopsy case]

A male patient with severe aplastic anemia was admitted for bone marrow transplantation. While waiting for a donor, high doses of methylprednisolone, anabolic steroid and granulocyte colony stimulating factor were given without response. Deferoxamine was administered for prophylaxis of hemochromatosis because of high level of ferritin. Acute right lower abdominal pain and pyrexia developed. A diagnosis of acute appendicitis was made and appendectomy was performed. The histopathological examination of the resected appendix revealed necrotizing hemorrhagic appendicitis with numerous hyphae of Mucorales. Though anti-fungal agent (amphotericin B) administration was continued, he subsequently developed ileo-cecal abscess and eventually died due to myoglobinuric nephropathy caused by extensive necrosis of the iliopsoas muscle. Autopsy revealed dissemination of hyphae of Mucorales in lungs, kidneys, large vessels and muscle of the bilateral lower limbs. Systemic vascular invasion and embolization of fungal hyphae were also observed. However, culture of exudate sampled from ileocecum yielded no Mucorales. It was emphasized that antemortem diagnosis and effective anti-fungal treatments are essential for the management of intestinal mucormycosis. The relation ship between mucormyocosis and deferoxamine was also discussed.

Assessment of pulmonary venous and transmitral flow in closed-chest dogs under various loading conditions by transesophageal Doppler echocardiography

Pulmonary venous flow velocity (PVFVe), pulmonary venous dimension (PVD) and transmitral flow (TMF) velocity were examined under various loading conditions in 15 anesthetized closed-chest dogs by transesophageal Doppler echocardiography (TEE). We also compared PVFVe with pulmonary venous flow volume (PVFVo) simultaneously in open-chest dogs using an ultrasonic flow probe. PVFVo decreased by more than 50% and PVD also decreased significantly during preload reduction, while there was no change in PVFVe. This discrepancy between PVFVo and PVFVe was apparently due to the collapse of pulmonary veins. TMF consisted of both rapid-filling flow velocity and atrial flow velocity components (R and A), while PVF consisted of systolic and diastolic forward flow velocity components (S and D). The peak values of R,A,S and D and the time-velocity integrals of each wave (RI, AI, SI and DI, respectively) were measured. There was a significant correlation between the changes in RI and SI/DI during preload reduction (r = 0.82, p < 0.001) and during after-load increase (r = -0.59, p < 0.05). These results suggest that changes in RI with different loading conditions might be attributable to changes in atrial reservoir volume and conduit volume.

[Ganciclovir prophylaxis for cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation]

We evaluated the efficacy of ganciclovir to prevent the development of cytomegalovirus interstitial pneumonitis (CMV-IP) in patients with bone marrow transplants. Of 35 patients enrolled in this study, 33 were seropositive for CMV or had seropositive donors, and two were seronegative before transplant but were positive for CMV examined by polymerase chain reaction (PCR) on days 30-37. Ganciclovir was given at a dose of 250 mg/body daily from day 30-37 to day 70. Blood, throat swabs, urine and bronchoalveolar-lavage fluid (BALF) were screened for CMV by PCR on days 30-37, 70 and 100. CVM-IP developed in two of 35 patients (5.7%) who received ganciclovir for prophylaxis, as compared with six of 39 historical controls who did not receive ganciclovir. A significant reduction of CMV detection by PCR in blood, throat swabs, and BALF was observed after administration of ganciclovir, on day 70. The incidence of neutropenia, thrombopenia and renal impairment in the study period showed no difference between the study group and the historical control. Early prophylactic use of ganciclovir appears to reduce the risk of CMV disease in allogeneic transplant recipients with positive serology or positive CMV-PCR.

Immunoglobulin gene rearrangement in T-cell-rich reactive pleural effusion of a patient with B-cell chronic lymphocytic leukemia

Pleural effusion in chronic lymphocytic leukemia (CLL) is a relatively rare phenomenon. We report a case of a pleural effusion associated with B-cell CLL but with predominantly reactive T lymphocytes in the effusion. A cell surface phenotype study showed that T lymphocytes predominated in the pleural effusion, although B lymphocytes were predominant in the peripheral blood. Genotypic analysis of the cells in the peripheral blood, bone marrow, lymph node, and pleural effusion showed the same rearrangement pattern of the immunoglobulin heavy chain genes consistent with a B-lymphocytic neoplasm (CLL). A pleural biopsy demonstrated diffuse infiltration of lymphoid cells. Most of the cells demonstrated T cell markers, although some cells revealed B cell markers by immunologic staining. These results suggested that the pleural involvement by B-CLL may have caused a reactive T-lymphocyte proliferation in the pleura and pleural effusion. To our knowledge, this is the first published case indicating that genotypic analysis of immunoglobulin heavy chain gene rearrangement may be useful in the diagnosis of a pleural effusion associated with B-cell CLL.

Increased plasma level of platelet-activating factor (PAF) and decreased serum PAF acetylhydrolase (PAFAH) activity in adults with bronchial asthma

We evaluated the plasma level of platelet-activating factor (PAF), a chemical mediator that induces various symptoms of bronchial asthma, and the activity of serum PAF acetylhydrolase (PAFAH), an enzyme that specifically inactivates PAF, in adults with bronchial asthma. Measurements were made by radioimmunoassay of samples obtained from 137 adult asthmatic patients (137 cases examined in remission and from among these 41 cases were also measured at the time of an asthmatic attack) 59 adult patients with untreated pulmonary tuberculosis and 106 healthy adult volunteers. It was demonstrated that the plasma PAF level was markedly higher and the serum PAFAH activity markedly lower in the asthmatic patients, both in remission and at the time of asthmatic attack, than in the healthy volunteers. The plasma PAF level was more closely associated with asthma both in remission and at the time of asthmatic attack than with pulmonary tuberculosis, whereas there was no significant difference in the serum PAFAH activity between the two diseases. The low serum PAFAH activity in the asthmatic patients may have been due to saturation as a result of continuous reaction to the increased plasma PAF level in those patients.

[Chronic myelocytic leukemia associated with cytomegalovirus induced sialoadenitis after unrelated allogeneic bone marrow transplantation]

A 26-year-old male with chronic myelocytic leukemia was admitted for unrelated allogeneic bone marrow transplantation (BMT). After BMT, he developed swelling of biateral submandibular glands accompanied with pneumonitis possibly due to cytomegalovirus (CMV). Biopsy from the left submandibular gland showed giant cells with nuclear inclusion bodies that were positive for anti-CMV-IE monoclonal antibody, there fore cytomegalic sialoadenitis was diagnosed. The administration of ganciclovir resulted in resolution of the pnumonitis and submandibular gland swelling. Although cytomegalic sialoadenitis is not a life-threating complication in BMT patients, it should be noted that biopsy is very useful for the diagnosis of systemic cytomegalovirus infection.

Comparative effects of type 1 angiotensin II-receptor blockade with angiotensin-converting-enzyme inhibitor on left ventricular distensibility and collagen metabolism in spontaneously hypertensive rats

We compared the cardiac effects of the selective angiotensin II type 1 (AT1)-receptor blockade, FK-739, with an angiotensin-converting-enzyme (ACE) inhibitor, enalapril, on left ventricular (LV) distensibility and collagen metabolism in spontaneously hypertensive rats (SHRs). We treated 14-week-old SHRs with FK-739 (30 mg/kg/day) or enalapril (10 mg/kg/day) for 6 weeks. Both FK-739 and enalapril induced a significant decrease in blood pressure (p < 0.001) and regression of LV hypertrophy (p < 0.001) compared with vehicle, with no differences between the treated groups. Furthermore, FK-739 caused a greater decrease in LV collagen content than did enalapril (FK-739-treated group, 3.06 +/- 0.11 mg/g; enalapril-treated group, 3.47 +/- 0.05 mg/g; p = 0.015) with no change in collagen phenotypes. Hearts taken from rats treated with FK-739 also showed greater LV distensibility than those taken from enalapril-treated rats (FK-739-treated group vs. enalapril-treated group at > or = 15 mm Hg, p < 0.001). These results suggest that, compared with ACE inhibition, AT1-receptor blockade may have additional effects on LV distensibility and collagen metabolism in the regression of LV hypertrophy induced by pressure overload.

The effect of nifedipine on ventriculoarterial coupling in old myocardial infarction

The effect of nifedipine on ventriculoarterial coupling was examined in 8 patients with old myocardial infarction who showed a depressed ejection fraction (37 +/- 7%). Left ventricular (LV) pressure and LV volume were determined simultaneously by micromanometer and conductance catheter, respectively. We measured the slope (Ees) of the end-systolic pressure-volume relation during transient inferior vena caval occlusion, the slope (Ea) of the end-systolic pressure-stroke volume relation, the ratio of Ea to Ees (Ea/Ees), and the work efficiency (the ratio of external work to the systolic pressure-volume area) at baseline and after the sublingual administration of nifedipine (10 mg). Nifedipine slightly increased the heart rate from 71 +/- 14 to 78 +/- 17 beats/min. Although nifedipine had little effect on Ees (2.54 +/- 0.68 vs 2.47 +/- 0.62 mmHg/ml/m2, ns), it significantly decreased Ea from 3.47 +/- 1.16 to 2.37 +/- 0.54 mmHg/ml/m2. Consequently, Ea/Ees decreased from 1.42 +/- 0.47 to 0.97 +/- 0.31 and work efficiency increased from 48 +/- 12 to 59 +/- 13% after nifedipine administration. These data suggest that nifedipine reduces afterload (Ea) and improves left ventriculoarterial coupling without depressing left ventricular contractility in patients with failing hearts due to old myocardial infarction.

The effect of left ventricular chamber compliance on early diastolic filling during coronary reperfusion

This study was designed to assess the changes in left ventricular (LV) diastolic filling and to evaluate the dynamic determinants of LV diastolic filling during coronary reperfusion after acute myocardial ischemia. We examined LV diastolic pressure-volume relations (D-PVRs) using the conductance catheter technique with a high-fidelity micromanometer, and the transmitral flow using transesophageal pulsed Doppler echocardiography in 9 open-chest anesthetized dogs with the pericardium opened. We measured early diastolic peak flow velocity (E), late diastolic peak flow velocity (A), the ratio of peak E to peak A (E/A), operational chamber compliance at the minimum LV pressure [(dV/VdP) nadir], and the time constant of LV relaxation (TC). Acute regional myocardial ischemia was produced by occluding the proximal portion of the left anterior descending coronary artery. Data were acquired at baseline, 10 min after acute myocardial ischemia, and after 15 and 90 min of reperfusion under left atrial pacing at 100 beats/min. During myocardial ischemia, D-PVRs shifted upward and rightward on the same curvilinear relationship compared with that at baseline (LV end-diastolic pressure (LVEDP) from 7.3 to 10.5 mmHg, LVEDV from 25 to 31 ml, both p < 0.01), accompanied by a decrease in peak E and E/A (E from 41 to 25 cm/sec, E/A from 1.7 to 1.1, both p < 0.01) and a prolongation of TC (from 25.4 to 30.3 msec, p < 0.01). After coronary reperfusion, D-PVRs returned to baseline accompanied by an improvement in the peak E and E/A ratio. No significant changes in peak A were observed in any of the stages. There was no correlation between peak E and TC, however, a significant positive correlation was observed between peak E and (dV/VdP) nadir (r = 0.76, p < 0.01). In conclusion, this study demonstrated that, using pulsed Doppler echocardiography, the improvement of diastolic filling after coronary reperfusion was based mainly on changes in early diastolic filling, and that LV operational chamber compliance at early diastole, rather than a LV relaxation property, might play an important role in determining early diastolic filling during coronary reperfusion.

Predicting relapse of chronic myelogenous leukemia after allogeneic bone marrow transplantation by bcr-abl mRNA and DNA fingerprinting

Fourteen patients treated by allogeneic bone marrow transplantation for chronic myelogenous leukemia (CML) were evaluated by the polymerase chain reaction (PCR) for bcr-abl-specific transcripts. Nine patients were transplanted in the first chronic phase, three in the second chronic phase, and two in the accelerated phase. All patients achieved a complete cytogenetic and hematologic remission after bone marrow transplantation. Twelve patients are alive (median, 18 months; range, 5-54 months) and two patients died early. bcr-abl mRNA was persistently detectable for 6 to 54 months in four patients (patients 1, 3, 4, 6). From two of them, DNA fingerprint analysis showed only donor type DNA although bcr-abl mRNA was detectable. bcr-abl mRNA was never detectable posttransplant in three patients (patients 2, 5, 13). Six patients had detectable bcr-abl mRNA (patients 8-12, 14): by 6 months, all of these patients were bcr-abl mRNA negative. One patient (patient 7) had detectable full bcr-abl mRNA again at 12 months, but was then negative at 20 months. Ten patients (patients 2, 4-8, 10-13) had never detectable Philadelphia (Ph1) chromosome t(9.22) translocation, whereas four patients had detectable Ph1 (patient 1, 3, 9, 14); by 6 months, three of four cases were negative. One patient (patient 1) had detectable Ph1 at 44 months, but was negative at 50 months. Three of six patients who initially had bcr-abl mRNA detectable posttransplant (patient 7-9) became negative for bcr-abl mRNA at the time of development of chronic graft-versus-host disease (GVHD). These results suggest that the detection of subclinical Ph1 positive cells by PCR is not associated with imminent clinical or cytogenetic relapse. Moreover, graft-versus-leukemia (GVL) activity may contribute to the treatment of minimal residual disease in CML after allogeneic bone marrow transplantation.

Cloning and nucleotide sequence of the gene encoding dimethyl sulfoxide reductase from Rhodobacter sphaeroides f. sp. denitrificans

The gene encoding dimethyl sulfoxide (DMSO) reductase, which contains a molybdenum cofactor, of the phototrophic bacterium Rhodobacter sphaeroides f. sp. denitrificans was isolated using an oligonucleotide probe, which was synthesized based on a internal amino acid sequence of the purified enzyme. The DMSO reductase gene coded for 822 amino acids (2466 base pairs, M(r) = 89,206) as a precursor form having a signal peptide of 42 amino acids. The deduced amino acid sequence had high homology with those of some enzymes containing a molybdenum cofactor: trimethyl amine N-oxide reductase (48%), biotin sulfoxide reductase (44%), and DMSO reductase (29%) of Escherichia coli.

[Therapy related leukemia]

Eleven therapy related leukemias (TRL) who were hospitalized in the Department of Hematology and Chemotherapy, Kanagawa Cancer Center between October 1983 and December 1993 were identified. Six of the patients were males and five were females. Their median age was 62 years (range from 14 to 75). Three patients had previously received treatment for breast cancer and two patients for malignant lymphoma. The other patients had received treatment for lung cancer, urinary bladder cancer, gastric cancer, brain tumor, maxillary sinus cancer and macroglobulinemia, respectively. Seven patients had been treated with chemotherapy and four patients had been treated with chemotherapy and irradiation for the primary tumor. The TRL cases consisted of 8 acute non-lymphoid leukemias, two acute lymphoid leukemias and one hypoplastic leukemia, respectively. The status of primary tumors at the development of TRL was complete remission in ten patients and partial remission in one patient. Three of the 10 patients who received anti-leukemic therapy entered complete remission and the median survival time was 36 days (from 7 days to 489 days). One patient expired of pneumonia before he received anti-leukemic therapy. TRL patients showed poor response to chemotherapy and had poor prognosis. These data suggest that the use of reduced doses of carcinogenic drugs for primary tumors might be required to prevent the development of TRL.

Comparison of receptor-binding properties among influenza C virus isolates

A total of 10 influenza C virus strains isolated recently in Yamagata City, Japan and shown to belong to the same lineage was compared for the ability to agglutinate chicken and mouse erythrocytes under various conditions. C/Yamagata/10/89 was unique in lacking the ability to agglutinate chicken erythrocytes at a temperature > or = 4 degrees C. This isolate also agglutinated native mouse erythrocytes only very inefficiently, although the high agglutination titer was obtained with the glutaraldehyde-fixed cells. Furthermore, it was found that C/Yamagata/4/88, unlike the other isolates, agglutinated erythrocytes from chickens to lower titers than those from mice, even when assayed at 0 degree C. Comparison of the deduced amino acid sequence of hemagglutinin-esterase among the 6 representative strains including two older isolates, C/Yamagata/26/81 and C/Nara/2/85, suggested that the failures of C/Yamagata/10/89 to agglutinate chicken erythrocytes at > or = 4 degrees C and unfixed mouse erythrocytes to high titers may be due to amino acid changes at residues 337 (Glu-->Lys) and 340 (Thr-->Tyr), respectively, and that a change at residue 347 (Leu-->Ser) may be responsible for the decreased ability of C/Yamagata/4/88 to agglutinate chicken erythrocytes.

[Surgical repair of complete atrioventricular septal defect: annuloplasty by using a smaller VSD patch]

Recent policy for the intracardiac repair of complete atrioventricular septal defect (CAVSD) is demonstrated on the basis of the following theoretical background. In the normal heart, the originating portion of the ascending aorta and the crux intrude between the mitral and tricuspid orifices each from the anterior and from the posterior, separating both the orifices together with a short fibrous septal junction. In CAVSD, however, the common A-V orifice takes an elliptic form without any septal junction. It is considered beneficial, therefore, to surgically produce a short septal junction by using a smaller patch to close the ventricular portion of the AVSD. When the left lateral leaflet is larger, two leaflets valve plasty is suggested and when it is smaller, three leaflets valve plasty is suggested to reconstruct the left-sided A-V valve, although competence of the valve leaflets must be finally secured by doing repeated water injection tests. The size of the orifices of the reconstructed left-sided as well as right-sided A-V valve should also be confirmed not to be stenotic by using Hegar sizers. Since 1991, we have applied this surgical concept in 7 patients with CAVSD. Postoperatively, there was no left A-V valve regurgitation in one and slight regurgitation remained in 6 patients. The result is considered to be satisfactory. Although one patient died due to PH crisis, the cause of death was not related to valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful pregnancy after allogeneic bone marrow transplantation following conditioning with total body irradiation

A 23-year-old woman had a normal full-term delivery 78 months after BMT for ALL. Conditioning therapy was Ara C 1.4 g/m2 x 4, CY 60 mg/kg x 2 and TBI 2.5 Gy x 5 at a dose rate of 3.5 cGy/min. Despite GVHD prophylaxis with short-term MTX and CsA, she developed grade I acute GVHD, but showed no evidence of chronic GVHD. Following amenorrhea for 4 years, menstruation recommenced spontaneously. She had a normal pregnancy 6 years after BMT resulting in a healthy infant with simple hypospadias. This and previous reports indicate that normal pregnancy is possible after BMT with TBI in excess of 10 Gy.