[Estimation of perioperative myocardial infarction in patients under aorto-coronary bypass grafts with plasma level of myosin light chain I and 201Tl SPECT]

After aorto-coronary bypass grafts surgery plasma level of myosin light chain I, determined with monoclonal antibodies to myosin light chain I (LC-I), were studied in 12 patients (pts) without electrocardiographical perioperative myocardial infarction. Rest 201Tl myocardial images were collected before and after surgery. LC-I increased and reached peak levels (15 +/- 7 ng/ml) at 91 +/- 29 minutes after the aortic declamp. From peak levels LC-I rapidly decreased with fast half-time disappearance (1.4 +/- 0.9 hours). In 5 pts of 12 pts LC-I recovered to normal range and MB reached maximum levels (34 +/- 23 IU/L) at 18 +/- 9 hours after declamp. In 4 pts 201Tl images showed improvement and in one 201Tl images showed no changes. In 7 pts of 12 pts LC-I decreased to minimum levels (2.7 +/- 0.6 ng/ml) at 12 +/- 6 hours and then gradually increased to peak levels (5.6 +/- 0.9 ng/ml) on day 3 +/- 0.9. MB reached maximum level (61 +/- 20 IU/L) at 3.2 +/- 1 hours. In 201Tl images 3 pts showed suspected new lesion, 2 pts showed no changes and 2 pts showed improvement. No correlation was noted between peak LC-I level and duration of aortic declamp. No significant relation was suspected between early LC-I peak and irreversible myocardial cell injury. From close relationship between aortic declamp and appearance of LC-I peak, it was concluded that LC-I, accumulated during aortic clamp, was washed out by aortic declamp. Relation was suspected between early LC-I peak and myocardial injury during myocardial protection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Usefulness of recombinant human erythropoietin in cardiac surgery with autologous blood transfusion]

The efficacy and method of administration of recombinant human erythropoietin (EPO) in adult cardiac surgical patients when given preoperatively was evaluated. We used EPO intravenously (iv) with 40 mg ferric oxide for a total of consecutive 47 patients. The patients were divided into group A (n = 14; EPO 200 IU/kg iv 3 times a week from 3 weeks prior to surgery to 2 weeks after surgery, donation of 800 ml) and group B (n = 33; EPO 200 IU/kg iv everyday from 8 days prior to surgery to 2 weeks after surgery, donation of 400 ml). Control groups were group AO (n = 11; donation of 835 +/- 33 ml from 14.8 days prior to surgery) and group BO (n = 7; donation of 406 +/- 34 ml at 7.3 days prior to surgery). All the EPO-treated patients received no homologous blood transfusion while 2 of patients in group BO received some homologous blood transfusion. A hemoglobin change between pre-donation and surgery was +0.14 +/- 1.3 (g/dl) in group A, +0.04 +/- 1.0 (g/dl) in group B, -1.7 +/- 1.3 (g/dl) in group AO and -1.0 +/- 0.6 (g/dl) in group BO. In a comparison of post-surgical hemoglobin levels between group A and group B, we demonstrated that the level in group B, +2.1 +/- 1.8 (g/dl) was significantly higher than that in group A, +11.1 +/- 1.6 (g/dl) 2 weeks after surgery. There was no evidence to show an aggravation of anemia in the pre-surgical period in EPO-treated groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Two cases of pulmonary alveolar proteinosis with increased CEA]

Two cases of pulmonary alveolar proteinosis (PAP) with increased CEA were reported. Case 1 was a 62-year-old male with suspected pulmonary fibrosis, who was transferred to our hospital. Laboratory findings on admission revealed 31.3 ng/ml of CEA. Because he had severe dyspnea, lung biopsy was not carried out. His condition gradually deteriorated and he died of respiratory failure. Autopsy revealed he had PAP and no malignancy. Case 2 was a 48 year-old male referred to our hospital because of dyspnea. Serum CEA was 52.8 ng/ml. Microscopic examination of a transbronchial lung biopsy showed PAP. The level of CEA in bronchoalveolar lavage fluid was 151 ng/ml. Unilateral whole lung lavage was performed twice. With the improvement of chest X-ray findings, serum levels of CEA fell to normal level. The molecular weight of CEA in bronchoalveolar lavage fluid was 180,000. Immunochemical staining of CEA in lung revealed nonspecific findings.

Two-dimensional echocardiographic determinants of interventricular septal configurations in right or left ventricular overload

Configurations of interventricular septum (IVS) and left ventricle were evaluated in 60 normal subjects and in 68 patients with congenital heart disease using two-dimensional short axis cross-sectional echocardiography (2DE). Patients were divided into four groups; right ventricular (RV) pressure overload (n = 21), RV volume overload (n = 12), left ventricular (LV) pressure overload (n = 10), and LV volume overload (n = 25). The radii of curvature of the IVS (IVSr) and LV free wall (FWr) were calculated in end systole and end diastole. Measured IVSr was normalized by dividing IVSr by FWr (IVSr/FWr). End-systolic flattening of IVS was a specific finding in patients with RV pressure overload, since this pattern was not observed in other hemodynamic groups. Echocardiographic determinants of IVSr/FWr in end systole correlated well with RV peak systolic pressure/LV peak systolic pressure ratio (r = 0.878). There was also correlation between IVSr/FWr in end diastole and RV end-diastolic pressure/LV end-diastolic pressure ratio (r = 0.579). Thus, the evaluation of IVS configuration is a useful 2DE method of estimating relative RV systolic pressure in infants and children with congenital heart disease.

[Myocardial imaging in patients with transposition of the great arteries: comparison between Mustard and Rastelli operations]

Thallium-201 myocardial imaging was performed in 21 patients with transposition of the great arteries (TGA). Thirteen patients were studied before operation, eight patients after Mustard operation and five patients after Rastelli operation. Five patients were studied sequentially before and after the surgery. Each image was compared with hemodynamic and angiographic findings in order to assess the usefulness of this method. In the 13 patients with preoperative TGA, it was possible to differentiate TGA with the intact ventricular septum from TGA with associated anomalies such as patent ductus arteriosus or ventricular septal defect, and also TGA with pulmonary hypertension or pulmonary stenosis from TGA without them by evaluating the degree of thallium uptake in the free wall of the pulmonary ventricle (anatomical left ventricle). The degree of thallium uptake was well correlated with systolic pressure of the pulmonary ventricle (r = 0.98). In the 13 patients with postoperative TGA, it was less correlated with the pulmonary ventricular systolic pressure (r = 0.83). Four cases sequentially studied showed a marked decrease in thallium uptake in the pulmonary ventricle 10 to 16 months after Rastelli operation. But the corrected thallium uptake (thallium activity/ventricular systolic pressure) was more increased compared with the uptake of the systemic ventricle after the surgery. This was probably related to a decrease of the pressure load to the pulmonary ventricle following the surgery and to the fact that there should be some delay of a decrease of the ventricular mass. An increased lung uptake of thallium was noted in the cases of tricuspid regurgitation after Mustard operation, but the degree of regurgitation was not clearly correlated with the increase of thallium uptake in the lung. In five cases after Rastelli operation, one patient showed a high degree of thallium uptake of the pulmonary ventricle (anatomical right ventricle), and the conduit valve calcification and severe pulmonary stenosis were confirmed by cardiac catheterization and angiography. Thus myocardial imaging provides a reliable mean for the qualitative and quantitative assessment of TGA before and after operation.

Adriamycin metabolism in man. Evidence from urinary metabolites

We studied the human metabolism of adriamycin by isolating and identifying urinary metabolites which retain adriamycin's specific fluorescence properties. Metabolites were extracted by adsorption to polystyrene polymeric sorbants, separated on silicic acid columns and purified by thin-layer chromatography. Structures were determined by comparative chromatography; infrared, fluorescence, and mass spectroscopy; and enzymatic and chemical degradation. Substances identified were adriamycinol, adriamycinol aglycone, adriamycin aglycone, deoxyadriamycin aglycone, deoxyadriamycinol aglycone, demethyldeoxyadriamycinol aglycone, demethyldeoxyadriamycinol aglycone 4-O-sulfate, and demethyldeoxyadriamycinol aglycone 4-O-beta-glucuronide. Other metabolites have been purified but not identified. Human metabolism of adriamycin involved carbonyl reduction, reductive glycosidic cleavage, hydrolytic glycosidic cleavage, O-demethylation, O-sulfation, and O-beta-glucuronidation. Carbonyl reduction was the major enzymatic conversion occurring in the human.

Daunorubicin metabolites in human urine

We studied the human metabolism of daunorubicin (D) by isolating and identifying metabolites from urine which retained the specific fluorescence properties of D. Metabolites were extracted by adsorption to polystyrene polymeric sorbants, separated on silicic acid columns and purified by thin-layer chromatography. Structures were determined by comparative chromatography, infrared, fluorescence and mass spectroscopy, and enzymatic and chemical degradation. D metabolites identified were daunorubicinol, daunorubicinol aglycone, deoxydaunorubicin aglycone, deoxydaunorubicinol aglycone, demethyl deoxydaunorubicinol aglycone, deoxydaunorubicinol aglycone 13-O-beta-glucuronide, demethyl deoxydaunorubicinol aglycone 4-O-sulfate and demethyl deoxydaunorubicinol aglycone 4-O-beta-glucuronide. Other metabolites have been purified but not identified. Human metabolism of D involves carbonyl reduction, reductive glycosidic cleavage, O-demethylation, O-sulfation and O-glucuronidation. Since daunorubicinol has biochemical properties similar to D, the metabolites may contribute to the pharmacologic and toxicologic effects credited to D.

Glucuronic acid pathway in alloxan diabetic rabbits. (I). Urinary excretion of metabolites related to the glucuronic acid pathway

Studies on the activity of the glucuronic acid pathway in alloxan diabetic rabbits were carried out. Amount of D-glucaric acid, L-ascorbic acid, and D-glucuronic acid in urine increased in the case of the alloxan diabetic rabbits. The transformation from D-glucuronolactone to D-glucaric acid was higher than normal in the diabetic animals. The expired 14-CO2 decreased and urinary excretion of labeled L-gulonic acid increased after administration of 6-14-C-glucuronolactone in the diabetic rabbits. L-Gulonic acid dehydrogenase, lactonase II, and beta-glucuronidase activities were reduced, and UDPGA-pyrophosphatase, D-glucuronic acid-1-phosphatase, and UDPGA-transferase activities increased in the diabetic rabbit liver. From these results, it may be concluded that an increase of endogenous D-glucuronic acid in the diabetic states could be attributed to a metabolid defect in the step of L-gulonic acid dehydrogenation and to the enhancement of UDPGA-pyrophosphatase and D-glucuronic acid-1-phosphate phosphatase activities.