Szygium aromaticum (L.) Merr. Et Perry (Myrtaceae) flower bud induces apoptosis of p815 mastocytoma cell line

This study was conducted to investigate SAFB-induced apoptosis of mast cells as it pertains to both its basic drug mechanism and the potential therapeutics of the pathologic conditions accompanying mast cell proliferation. SAFB induced many apoptotic manifestations as evidenced by changes in cell morphology, generation of DNA fragmentation, activation of caspase 3, and DNA hypoploidy. The reduction of mitochondrial membrane potential and the release of cytochrome c to cytosol were also demonstrated. However, reduction of mitochondrial membrane potential and cytochrome c release were not prevented by caspase inhibitor zVAD-fmk or PTP blockers such as bongkrekic acid and cyclosporin A. Expression levels of Bcl-2 and Fas remained unchanged following SAFB treatment. This results suggest that the clinical effect of SAFB may depend on the pharmacological mechanism regulating the demise of mast cells.

Surface characterizations of variously treated titanium materials

The attachment of cells to titanium surfaces is an important phenomenon in the area of clinical implant dentistry. A major consideration in designing implants has been to produce surfaces that promote desirable responses in the cells and tissues. To achieve these requirements, the titanium implant surface can be modified in various ways. This research was designed to elucidate the relationship between surface roughness (Ra) and contact angle (theta) of various engineered titanium surfaces of commercially pure titanium, titanium-aluminum-vanadium alloy (Ti-6Al-4V), and titanium-nickel (TiNi) alloy. The contact angle was measured using distilled water, 1% sodium chloride solution, human neutrophils, and osteoblast-like cells. Surface oxide crystallography was identified by transmission electron diffraction. It was found that: (1) there were no significant differences in contact angles among the 4 media; (2) for commercially pure titanium, a combined treatment (hydrofluoric acid/nitric acid/water --> sodium hydroxide --> oxidation) showed the lowest theta (10.51 degrees in water), while the surface treated with sulfuric acid showed the highest value (72.99 degrees in water); (3) for all commercially pure titanium samples, when theta is greater than 45 degrees, the contact angle increases linearly with Ra (hydrophobic nature) and the surface is covered with rutile-type oxide only, while the contact angle decreases linearly with Ra when theta is less than 45 degrees (hydrophilic nature) and the surface is covered with a mixture of rutile and anatase oxides; and (4) a similar trend was found on Ti-6Al-4V and TiNi surfaces.

A co-operative study: clinical characteristics of 334 Korean patients with moyamoya disease treated at neurosurgical institutes (1976-1994). The Korean Society for Cerebrovascular Disease

A co-operative study was conducted to determine the clinical characteristics of patients with moyamoya disease who were diagnosed and treated at neurosurgical institutes in Korea before 1995. Twenty-six hospitals contributed 505 cases and among them, the clinical characteristics of 334 patients with definite moyamoya disease were evaluated. The number of patients began to increase from the late 1980s, and after that approximately 20 patients were treated each year. There were two age peaks: from six to 15 and from 31 to 40 years of age. Haemorrhagic manifestations occurred in approximately 43% of the patients. The major clinical manifestations were haemorrhage in adults (62.4%) and ischaemia in children (61.2%). Overall 54.5% of the patients experienced decreased consciousness levels, mainly due to intracranial haemorrhage or cerebral infarction. In the patients with ischemic manifestations, the adult patients were more likely to have cerebral infarction than the pediatric patients (80% vs. 39%) and the pediatric patients were more likely to have TIA (61% vs. 25%). Thirty eight percent of the patients underwent bypass surgery and 53% of these procedures were performed bilaterally. Treatment policies, including indications for bypass surgery and commonly used drugs, were somewhat different according to the institution. Overall favorable outcome was 73%, and the most significant factor affecting poor outcome was haemorrhagic manifestation. This article describes the characteristics of 334 patients with moyamoya disease, who were diagnosed and treated at neurosurgical institutes in Korea before 1995.

Circulating levels of interleukin-8 and vascular endothelial growth factor in patients with carotid stenosis

Interleukin (IL)-8 and vascular endothelial growth factor (VEGF) are important factors that induce the migration and proliferation of endothelial cells, increase the vascular permeability, and the modulate chemotaxis of monocytes. These molecules have been found in human atherosclerotic plaques. However, it is not clear whether the circulating levels of IL-8 and VEGF correlate with the extents of carotid stenosis. In this study, we investigated the relationship between circulating levels of IL-8 as well as VEGF and the extents of carotid stenosis. Sera from 41 patients with carotid stenosis were assessed for concentrations of IL-8 and VEGF by enzyme-linked immunosorbent assay. The degree of stenosis of extracranial carotid artery was calibrated by carotid B- mode ultrasonography. The serum concentration of IL-8 (r = -0.04733, p > 0.05) was not correlated with the degree of stenosis. However, the serum concentration of VEGF (r = 0.4974, p < 0.01) was significantly correlated with the degree of carotid stenosis. These findings suggest that increased serum level of VEGF might be a marker for higher degree of stenosis of extracranial carotid artery.

Additional cytotoxic polyacetylenes from the marine sponge Petrosia species

Ten new polyacetylenic alcohols (1-6, 8-11), along with a known compound, petrocortyne C (7), were isolated from the marine sponge Petrosia sp. The gross structures were established based on NMR and MS data, and the absolute configuration was determined by the modified Mosher's method. These compounds displayed considerable cytotoxicity against a small panel of human solid tumor cell lines. Compounds 1-11 were further evaluated for in vitro inhibitory activity on DNA replication.

Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management

BACKGROUND

Lung isolation and preservation of normal lung are the first lines of therapy in life-threatening massive hemoptysis. If bleeding continues but the side of origin is uncertain, use of a double-lumen tube (DLT) is reasonable. Utilizing a blind method to locate the bronchial cuff of a left-sided DLT without using any instrument, a DLT (Broncho-Cath, Mallinckrodt Medical Ltd., Athlone, Ireland) was successfully positioned without delay in a patient with massive hemoptysis, where auscultation could be misleading or useless and fiberoptic bronchoscope (FOB) was inapplicable. This study was performed to discern whether this blind method could substitute for FOB verification or auscultation in most circumstances where these two methods are unavailable or inapplicable.

METHODS

After receiving informed consent and hospital ethics board approval, 58 elective thoracic surgical patients, aged 17 to 67 years, were enrolled in the study and divided into two groups. A conventional method using an FOB was used to locate the left-sided DLT in 29 patients (group 1). In the other 29 patients (group 2), the blind manual method was used. The left-sided DLT was inserted until some resistance was felt, at which time the bronchial cuff was inflated with approximately 2.0 mL of air. While gently holding the pilot with thumb and index finger of the nondominant hand, the DLT was slowly withdrawn until an abrupt decrease of pilot pressure was sensed. At that moment, the bronchial cuff was deflated, and the DLT was advanced approximately 1.5 cm; using an FOB, its position was checked by an independent observer not involved in positioning the DLT. Success was defined as the point when the proximal margin of the carina was within the margin of safety for the DLT, which is defined as the difference between the length of the left main bronchus and the length of the tube between the proximal margin of the left bronchial cuff and the left lumen tip. Postoperative FOB was performed to evaluate bronchial injury.

RESULTS

In 26 of 29 patients (group 2), the position of the DLT was bronchoscopically confirmed to be a success. The other three cases were deemed to be too shallow; specifically, the bronchial cuffs were slightly herniated onto the carina (acceptable position). This method was more traumatic than FOB-guided DLT intubation (conventional method) (p = 0.001); however, the most severe damage was erosion.

CONCLUSION

This method, which requires no specific instrument and no time-consuming technique, can be taught easily and may be used in a situation where the rapidity of lung isolation or collapse is the key to saving life. We conclude that this blind method can be an alternative to the FOB and/or auscultation for the positioning of DLT in an emergency situation.

A novel factor isolated from Actinobacillus actinomycetemcomitans stimulates mouse B cells and human peripheral blood mononuclear cells

A novel immunostimulating factor (ISTF) of Actinobacillus actinomycetemcomitans ATCC 29522 was isolated and characterized as inducing proliferation of mouse B cells and human peripheral blood mononuclear cells. This factor was isolated from the bacterial culture medium and purified by size exclusion chromatography, dye-ligand affinity chromatography, immunoaffinity chromatography using monoclonal antibodies, and preparative electrophoresis. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the purified ISTF migrated as a single band corresponding to a molecular mass of 13 kDa. ISTF was a proteinaceous material distinct from lipopolysaccharide; it directly induced the proliferation of B lymphocytes but had no effect on the proliferation of T lymphocytes, even in the presence of antigen-presenting cells. A B-lymphocyte-mitogenic activity of ISTF was also shown by flow cytometric analysis of responding cell subpopulations. Immunoblot analysis revealed that ISTF was a component of the outer membranes of bacteria, could exist as a soluble form, and was released by growing and/or lysed bacteria. These results suggest that ISTF produced by A. actinomycetemcomitans may play an important role in immunopathologic changes associated with A. actinomycetemcomitans infections.

Effect of alpha/gamma phase ratio on corrosion behavior of dual-phase stainless steels

Dual-phase stainless steels have been developed in order to reduce the nickel content, which is potentially responsible to an allergic reaction when these steels are used as medical or dental applications. In this study, two different dual-phase stainless steels (2205 and Z100) were electrochemically tested to evaluate their corrosion resistance in three corrosive solutions (i.e., synthetic saliva, 0.9% NaCl solution, and Ringer solution). Particularly, an attempt was made to correlate the corrosion resistance to a metallographic parameter, which is, in this study, the alpha/gamma phase ratio. It was concluded that (1) type 2205 stainless steel exhibited excellent corrosion resistance in all three corrosion media; however 2205 stainless steel decreases its corrosion resistance by increasing chloride concentration in tested electrolytes from synthetic saliva through 0.9% NaCl solution to Ringer solution. (2) X-ray diffraction analysis indicated that the alpha/gamma phase ratio of 2205 (1.735) was higher than that of Z100 (0.905). As a result, it is suggested that by increasing the alpha/gamma phase ratio the material shows more corrosion-prone behavior when being subjected to a hostile environment containing higher chloride ion concentration.

Activated platelets induce secretion of interleukin-1beta, monocyte chemotactic protein-1, and macrophage inflammatory protein-1alpha and surface expression of intercellular adhesion molecule-1 on cultured endothelial cells

Atherosclerosis is an inflammatory disease. Platelet-endothelium interaction plays an important role in the pathophysiology of atherogenesis. We investigated the role of activated platelets for secretion of interleukin (IL)-1beta, monocyte chemotactic protein (MCP)-1 and macrophage inflammatory protein (MIP)-1alpha and expression of intercellular adhesion molecule (ICAM)-1 on endothelial cells. Human umbilical vein endothelial cells (HUVEC) were incubated with non-stimulated or ADP-activated platelets for 6 hr. Secretion of interleukin (IL)-1beta, MCP-1 and MIP-1alpha and surface expression of ICAM-1 were measured by ELISA and flow cytometry. In the presence of activated platelets, the secretion of IL-1beta, MCP-1, and MIP-1alpha and surface expression of ICAM-1 were significantly increased compared with non-activated platelets. The present study shows that activated platelets may contribute to expression of various inflammatory mediators on endothelial cells.

Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: A case report

Cranial irradiation may lead to accelerated atherosclerotic changes to small or medium sized arteries, but stroke associated with pituitary irradiation is not frequent. A patient treated with Gamma Knife radio-surgery (GKRS) for a pituitary adenoma suffered a cerebral infarction with internal carotid artery occlusion 4 years after radiosurgery. The patient was a 35-year-old male presenting with a visual disturbance. Endocrinological tests were normal. MRI revealed a 4.3 by 4.3 cm diameter invasive macroadenoma of the pituitary, projecting toward the suprasellar region and with cavernous sinus involvement with encasement of both internal carotid arteries (ICAs). GKRS was performed for residual tumor after a transcranial resection. The maximum dose was 40 Gy and the dose to the right carotid artery was below 20 Gy. The delayed hemiparesis was accompanied by a right capsular lacunar infarct shown on MRI. The images also showed a marked reduction in tumor size. Total, right ICA occlusion was confirmed by Doppler ultrasound. The patient had no history or signs of heart disease or metabolic disorder which could predispose to cerebrovascular

Murine bone marrow-derived mast cells exhibit evidence of both apoptosis and oncosis after IL-3 deprivation

IL-3 deprivation has been reported to induce apoptosis of bone marrow-derived mast cells. In order to evaluate this type of cell death further, we employed trypan blue and propidium iodide stainings, photometric enzyme immunoassay, fluorescence measurement of caspase-3, DNA electrophoresis, flow cytometry and transmission electron microscopy. In this experiment, although several evidences supporting apoptosis were demonstrated some findings were not consistent with typical apoptosis. On the other hand, electron microscopical observation demonstrated that most cells from all the time phases after IL-3 deprivation showed the morphology of typical oncosis, i.e. cell swelling, disintegration of ultrastructure and subsequent karyolysis. Only a small number of cells from the later time phases showed apoptotic morphology. We here suggest that BMMCs undergo both apoptosis and oncosis after IL-3 deprivation and that the dominant type of prelethal change is oncosis in all time phases, although apoptosis also plays a partial role in the late time phases.

Effect of pre-reperfusion residual flow on recovery from myocardial stunning: a myocardial contrast echocardiography study

BACKGROUND

Myocardial contrast echocardiography (MCE) may be used to assess coronary microvasculature in patients with myocardial infarction. Myocardial contrast echocardiography-no reflow suggests poor functional outcome; however, MCE with reflow does not necessarily indicate good myocardial salvage or sufficient functional recovery from myocardial stunning. In this study, MCE was performed to assess the effect of pre-reperfusion residual flow (PRF) on the recovery from myocardial stunning.

METHODS AND RESULTS

The size of the occluded bed, an area supplied with an infarct-related artery, was determined by comparing pre- and post-reperfusion MCE images in 40 patients with first acute myocardial infarction. Myocardial contrast echocardiography-no reflow was observed after reperfusion in 8 patients. Significant PRF was not recognizable in any of the 8 patients. The other patients with MCE reflow were subdivided into 2 groups on the basis of the ratio of the area perfused by PRF to that of the occluded bed: 14 patients with the ratio of more than 10% (PRF[+]), and the other 18 patients (PRF[-]). The wall motion score (0, normal to 4, dyskinetic) was obtained in the convalescent stage.

RESULTS

(1) Wall motion of the infarct area after day 3 was better in patients with PRF than in patients without PRF. (2) Left ventricular functional improvement in the long term was remarkable in patients with good reflow and PRF(+), modest in patients with good reflow but PRF(-), and not detectable in patients with MCE-no reflow. No significant correlation was found between angiographic collateral grades and PRF.

CONCLUSIONS

The presence of residual flow within the infarct area before reperfusion results in not only good myocardial salvage but also rapid functional recovery from myocardial stunning.

New cytotoxic polyacetylenes from the marine sponge Petrosia

New polyacetylenic alcohols with a C(45) carbon skeleton (2) and with an enone moiety in the alkyl chain (C(46), 1) were isolated from the marine sponge Petrosia sp. The gross structures of 1 and 2 were established by spectral methods, and the absolute stereochemistry was determined by the modified Mosher's method. Compounds 1 and 2 displayed considerable cytotoxicity against a small panel of human solid tumor cell lines. Significant inhibitions on DNA replication by 1 and 2 were also observed which could be explanative of their cytotoxicity.

A cyclitol derivative as a replication inhibitor from the marine sponge Petrosia sp

A bioactive cyclitol derivative (1) was isolated from the marine sponge Petrosia sp. The chemical structure of 1 was determined as (2S)-1-O-(2',3',4',5'-tetrahydroxycyclopentyl)-3-O-(10' '-methylhexadecyl)glycerol. Compound 1 inhibited DNA replication in vitro at the level of initiation.

Cytotoxic polyacetylenes from the marine sponge Petrosia sp

Three C46 (1-3) and three C30 (4-6) polyacetylenic alcohols with cytotoxic activity against a small panel of human solid-tumor cell lines have been isolated from the marine sponge Petrosia sp. Although compound 1 was identified as the stereoisomer of petrocortyne A, the structures of compounds 2-5 have not been previously reported and were established by spectral methods. Compound 6 was identified as the known compound petrosiacetylene D. The stereochemistry of compounds 1-5 was determined by the modified Mosher's method.

Risk factors for breakthrough varicella in healthy children

AIM

To evaluate the risk factors for breakthrough varicella in a follow up study of a cohort of 181 healthy children immunised when aged 9-24 months with a reformulated Oka strain varicella vaccine (SmithKline Beecham Biologicals/Oka).

DESIGN

The children were randomised in a double blind manner into one of four groups to receive one of two production lot vaccine batches, at two different titres (high titre, 10(3.9) and 10(4.0) plaque forming units (pfu); low titre (heat exposed), 10(2.7) and 10(2.8) pfu). The overall seroconversion rate after immunisation was 99%.

RESULTS

One hundred and sixty-eight patients were available for review after a mean (SD) follow up of 35 (9) months after vaccination. Multivariate analysis indicated that risk factors for breakthrough varicella were household contact with varicella (adjusted odds ratio (OR), 19.89; 95% confidence interval (CI), 18.39 to 21.39), vaccination age of < or = 14 months (adjusted OR, 2.30; 95% CI, 1.69 to 2.90), and receiving low titre (10(2.7) pfu) vaccine (adjusted OR, 2.13; 95% CI, 1.54 to 2.73). All children who developed breakthrough varicella, had a modified varicella illness, except for three, all of whom had received low titre vaccine.

CONCLUSION

The identification of young immunisation age (< or = 14 months) and low titre vaccine as risk factors for breakthrough varicella have important implications for the implementation of varicella vaccination programmes in healthy children.

Spreading pattern of epidurally administered contrast medium in rabbits

BACKGROUND

The aim of this study was to examine the precise spreading pattern of epidurally administered contrast medium with small increments of injection volume for determining both the exact volume of the dose required and the site of epidural injection according to different target segments of the spinal cord in a rabbit epidural model.

METHOD

Following pentobarbital anesthesia, the epidural puncture was done surgically with a round-tipped blunt hook. The tip of the epidural catheter was located at either the mid-portion of T7 (T7 group, n = 7) or T12 (T12 group, n = 8). Injection of the contrast medium was started at 0.1 ml/kg and increased by 0.1 ml/kg up to a maximum of 0.6 ml/kg.

RESULTS

In both groups, the extent of spread increased continuously with increasing injected volume (T7 group: r2 = 0.91, P = 0.0001; T12 group: r2 = 0.86, P = 0.0001) and the total spread of contrast medium was similar. However, the spread was not linearly volume dependent. The total number of segments (y) through which the contrast medium spread during changes in its volume (x) in the T7 and T12 groups was calculated as y = 4.0 + 41.8x - 28.1x2 and y = 0.2 + 57.7x - 43.5x2, respectively. The contrast medium spread in both rostral and caudal directions, equally from the catheter tip in the T7 group, whereas it spread rostrally about twice as far as it spread caudally in the T12 group (P < 0.05).

CONCLUSION

In rabbits, it is recommended that at the lower thoracic or lumbar segments the tip of the epidural catheter should be located 1-3 segments below the target segment because of more rostral spread. In the case of mid-thoracic segments, however, placement at the target segment is recommended. In addition, a small titration of volume to achieve a particular range of epidural spread should be required.

Sinus histiocytosis with massive lymphadenopathy. Multiple skull involvements

Sinus histiocytosis with massive lymphadenopathy is a non-neoplastic self-limiting disease of the bone marrow stem cell origin. It is characterized by painless, bilateral cervical lymphadenopathy accompanied by fever, leukocytosis, elevated erythrocyte sedimentation rate and hypergammaglobulinemia. Extranodal involvement including bone is rare. The patient is a 45-year -old female with multiple punch out lesions on her skull. MRI findings included iso-signal intensity mass at the diploid space on T1 weighted image and on T2 weighted image, mild high signal intensity was obtained. Histologically, the lesion showed proliferation of histiocytes in the fibroblastic background with formation of reactive germinal centers and many plasma cells. The histiocytes show round nuclei and occasional nucleoli and abundant cytoplasms. In area, there is lymphocytophagocytosis. Immunohistochemically, the histiocytes were positive for S-100 protein and lysozyme.

[Apical filling abnormality in patients with heart failure assessed with contrast echocardiography using venous injection of Albunex]

Contrast echocardiography by venous injection of Albunex was used to visualize apical filling abnormality in patients with heart failure. 1. Contrast echocardiography was serially performed in 24 patients with acute anterior myocardial infarction. Wall motion of the infarct region was better at any stage in patients without apical filling abnormality than in patients with that. Improvement of filling abnormality was observed prior to that of wall motion abnormality. 2. Influence of tachycardia was assessed on apical filling in 20 patients with old myocardial infarction during rapid atrial pacing. Stress contrast echocardiography evidenced that tachycardia deteriorates apical filling abnormality in patients with chronic heart failure. 3. The effect of amrinone on apical filling was assessed in 60 patients with chronic anterior myocardial infarction. Apical filling abnormality improved in 46% of patients after amrinone infusion. The improvement of apical filling abnormality was closely related to the reduction of preload and improvement of asynergy in the infarct area after amrinone. Both adjunctive therapy and anticoagulant therapy should be considered if apical filling abnormalities are observed by contrast echocardiography.

[Intrapulmonary arterial injection of Albunex for left heart contrast echocardiography]

Contrast enhancement of the left heart cavity and myocardium were assessed after venous injection of the ultrasound contrast agent Albunex. Myocardial perfusion was also assessed using a drug stress and image analyzing system. The study population consisted of 46 patients with normal cardiac function and without coronary artery disease, and 38 patients with effort angina. Contrast echocardiography was performed by imaging the parasternal or apical long-axis view during pulmonary arterial injection of Albunex through a Swan-Ganz catheter. Contrast enhancement in the left ventricular cavity and ascending aorta were visually assessed. Hemodynamic, arterial blood gas and electrocardiography changes were recorded before and after the injection of Albunex. Contrast echocardiography was performed before and during intravenous infusion of dipyridamole to assess left ventricular myocardial enhancement by both visual inspection and peak background-subtracted gray level using an image analyzing system. Doppler flow signal change after the injection of Albunex was assessed in 26 patients using a Doppler guide wire located in the left anterior descending coronary artery. Good contrast enhancement was obtained in all patients in the left ventricular cavity and in 17% of patients in the ascending aorta. No significant changes were observed in hemodynamics, electrocardiograms and aortic gas analysis. Significant myocardial enhancement was not seen in any patient but gray level analysis of the echo images during dipyridamole infusion showed significant enhancement in 25% of the patients without coronary artery disease and in 34% of the patients with effort angina. Doppler flow signal in the coronary artery was significantly augmented in all patients after injection of Albunex and suggests that ultrasound contrast agent reaches coronary arteries in all patients regardless of myocardial contrast enhancement. Contrast echocardiography with pulmonary arterial injection of Albunex is safe and useful to obtain sufficient left ventricular contrast enhancement. For myocardial perfusion assessment, further refinement of the ultrasound contrast agent and echo equipment is necessary.

Different mechanisms of ischemic adaptation to repeated coronary occlusion in patients with and without recruitable collateral circulation

OBJECTIVES

The aim of this study was to investigate the interaction between ischemic preconditioning (IP) and collateral recruitment (CR) during ischemic adaptation in patients.

BACKGROUND

The mechanism of ischemic adaptation still remains controversial in humans.

METHODS

The clinical, electrocardiographic, hemodynamic and echocardiographic responses to three 150-s occlusions of the left anterior descending coronary artery were assessed in relation to CR in 18 patients with effort angina undergoing elective percutaneous transluminal coronary angioplasty.

RESULTS

During the first occlusion, recruitable collateral circulation (RCC) to the occluded myocardium was detected by myocardial contrast echocardiography in 6 patients (Group C) and was not seen in 12 (Group N). In Group N, all patients manifested signs of severe ischemia during each inflation. However, their symptoms and ST segment shift significantly decreased from the first to the third occlusions, suggesting the occurrence of IP. The elevation of mean pulmonary artery pressure and deterioration of anterior wall motion were comparable between the first and the third occlusions in Group N. In contrast, myocardial ischemia was significantly less marked during occlusion in Group C than in Group N, and no preconditioning effect was observed. The extent of RCC did not differ between the first and the third occlusions in each group.

CONCLUSIONS

Both IP and CR may play independent roles in ischemic adaptation in humans. With RCC, myocardial ischemia was greatly reduced. Without RCC, preconditioning clinically and electrocardiographically lessened myocardial ischemia but failed to preserve left ventricular function.

Salutary effect of adjunctive intracoronary nicorandil administration on restoration of myocardial blood flow and functional improvement in patients with acute myocardial infarction

Salutary effect of nicorandil, a K+ adenosine triphosphate channel opener, on restoration of myocardial blood flow and functional improvement after coronary revascularization was investigated in 20 patients with first anterior acute myocardial infarction. Ten patients received intracoronary administration of nicorandil (2 mg) after coronary revascularization; the other 10 patients received coronary revascularization only and served as control subjects. Myocardial contrast echocardiography and two-dimensional echocardiography were performed to assess microvascular integrity and regional function in the infarcted area. Nicorandil improved peak contrast intensity ratio (p < 0.001), calculated as the ratio of peak contrast intensity in the infarcted and noninfarcted areas, indicating the restoration of myocardial blood flow to the infarcted myocardium. Regional wall motion improved more significantly in 1 month in patients who received nicorandil (p < 0.01). Thus our results suggested the usefulness of intracoronary nicorandil administration after coronary revascularization for restoring blood flow and functional improvement in patients with acute myocardial infarction.

Comparison of myocardial contrast echocardiography and coronary angiography for assessing the acute protective effects of collateral recruitment during occlusion of the left anterior descending coronary artery at the time of elective angioplasty

To assess the immediate change in collateral flow distribution within the occluded myocardium and the acute protective effects on myocardial ischemia after coronary occlusion, myocardial contrast echocardiography (MCE) was performed in 15 patients with normal left ventricular function undergoing elective coronary angioplasty of the left anterior descending artery, and the results were compared with those obtained from coronary angiography (CA). The sonicated or nonsonicated contrast material was injected into the right coronary artery before and during coronary occlusion and collaterals were graded on a 4-point scale (none = 0 to good = 3). Development of subjective anginal symptoms, ST-segment shift and wall motion abnormality during coronary occlusion were graded on a 4-point scale (none = 0 to severe = 3). Both MCE and CA detected a significant development in collateral flow during coronary occlusion. There was no significant correlation between MCE and CA collateral grades before or during coronary occlusion. The collateral flow assessed with MCE was inversely but significantly correlated with development of subjective anginal symptoms (r(s) = -0.70, p <0.01), ST-segment shift (r(s) = -0.78, p < 0.005) or wall motion abnormality (r(s) = -0.91, p < 0.001) during coronary occlusion. In contrast, the angiographic collateral flow was not correlated with development of anginal symptoms (r(s) = -0.46, p = 0.10), ST-segment shift (r(s) = -0.41, p = 0.14), or wall motion abnormality (r(s) = -0.26, p = 0.35). The present study suggested that the acute protective effects of coronary collaterals during coronary occlusion were closely associated with myocardial perfusion rather than the angiographic epicardial collateral vessel filling, and thus MCE was useful in assessing the acute protective effects of coronary collaterals during coronary occlusion.

Left ventricular papillary muscle perfusion assessed with myocardial contrast echocardiography

This myocardial contrast echocardiographic study shows that left ventricular posteromedial papillary muscle is supplied by either the right or left coronary artery in most subjects, but may be supplied by both coronary arteries. The posteromedial papillary muscle and its adjacent area may be supplied by a different coronary artery.

Gamma knife radiosurgery in 11 hemangioblastomas

One suprasellar, one mesencephalic, and nine cerebellar hemangioblastomas were treated with the gamma knife in 10 patients (median age 48 years) in Stockholm between 1978 and 1993. Four patients had von Hippel-Lindau disease, a dominant inherited trait predisposing to multiple hemangioblastomas. Six hemangioblastomas were treated with radiotherapy at a median margin dose of 25 Gy (20-35 Gy) before 1990 and the next five with a median of 10 Gy (5-19 Gy). Computerized tomography or magnetic resonance images were available for 10 of the 11 hemangioblastomas at a median follow-up time of 26 months (4-68 months) after radiosurgery. The solid part of six hemangioblastomas shrank in a median of 30 months, whereas four hemangioblastomas were unchanged at a median of 14 months. Five hemangioblastomas had an adjoining cyst and three of these cysts had to be evacuated after radiosurgery. One solitary hemangioblastoma later developed a de novo cyst that also needed evacuation. One patient with two cerebellar hemangioblastomas (margin dose 25 Gy each) developed edema at 6 months and required a shunt and prolonged corticosteroid treatment. The combined follow-up data of the 23 hemangioblastomas in 15 patients from previous literature and the present series indicate that, first, a solitary small- or medium-sized hemangioblastoma usually shrinks or stops growing after radiosurgery. The recommended margin dose is 10 to 15 Gy. Second, the adjoining cyst often does not respond to radiosurgery but requires later, sometimes repeated evacuation.

Diagnostic performance of myocardial contrast echocardiography for detection of stunned myocardium

Improvement in regional wall motion after acute myocardial infarction has been described up to 2 to 3 weeks after the acute event despite restoration of blood flow by early successful reperfusion therapy. The prospective identification of potentially reversible ventricular dysfunction caused by stunned myocardium has significant clinical implications. Twenty-seven patients with acute myocardial infarction underwent myocardial contrast echocardiography (MCE) before, immediately after, and 4 weeks after successful reperfusion therapy. MCE was performed by imaging a parasternal short-axis view during intracoronary arterial injection of 2 ml sonicated ioxaglate (Hexabrix-320). The contrast defect area and contrast-filled area before reperfusion were defined as the risk area and noninfarct area, respectively. The normalized gray level was defined as the ratio of the gray level in the risk area/gray level in the noninfarct area. In 21 patients, wall motion was akinetic or dyskinetic immediately after reperfusion, and 10 of 21 patients in whom wall motion recovered during the chronic stage were defined as patients with stunned myocardium. In patients who showed asynergic wall motion immediately after reperfusion, MCE predicted the recovery of left ventricular wall motion (stunned myocardium) during the chronic stage with a sensitivity of 77%, specificity of 100%, and predictive accuracy of 86%, when a normalized gray level of more than 0.4 was presumed to predict stunned myocardium. We conclude that MCE provided the prospective identification of potentially reversible ventricular dysfunction caused by stunned myocardium, and wall motion in the area of nonenhanced myocardium on MCE immediately after reperfusion is not expected to show reversible dysfunction.

Biochemical and molecular characterization of a strain KA/S2 of Acanthamoeba castellanii isolated from Korean soil

A strain, KA/S2, isolated from Korean soil and morphologically assigned to Acanthamoeba castellanii, was characterized by isoenzyme analysis, and total proteins profile, and mitochondrial (Mt) DNA restriction fragment length polymorphism (RFLP), and compared with four reference strains assigned to the species (the authenitic Castellani, Neff, Ma, and Chang strains). It was found that four isoenzyme, total proteins, and Mt DNA RFLP patterns by eight restriction endonucleases of the strain KA/S2 were identical with those of the Neff strain, isolated from soil of California, USA. The Chang strain was unique in its morphology and total protein patterns. Interstrain polymorphisms of isoenzyme profiles and Mt DNA RFLP patterns were observed among the Castellani, Neff, Ma, and Chang strains. Mt DNA RFLP was confirmed to be highly appropriate for the strain characterization and identification of Acanthamoeba spp.

Two cases of Gamma Knife radiosurgery for low-grade optic chiasm glioma

The effect of radiosurgery on optic gliomas is uncertain. We report two cases of low-grade glioma of the optic nerve and chiasm treated by transcranial subtotal removal and Gamma Knife radiosurgery. The first case was a 2-year-old boy, admitted with visual disturbance and nystagmus. Histopathological examination showed a pilocytic astrocytoma. The tumor volume was 14.4 cm3. Dose planning was performed using axial and coronal T1-weighted enhanced images. The marginal dose was 12 Gy at the 40% isodose line. The dose to the optic apparatus was less than 9 Gy. The second case was a 47-year-old woman, admitted to our hospital with headache and visual disturbance. The histopathological findings showed a fibrillary astrocytoma. The tumor volume was 12.3 cm3. The marginal dose was 14.4 Gy at the 40% isodose curve. The follow-up periods for the two cases were 24 and 43 months, respectively. In both cases the most recent follow-up magnetic resonance scan showed a marked decrease in tumor size, and visual symptoms were improved. No postradiosurgical complications have developed to date. Gamma Knife radiosurgery could be an effective adjuvant therapy for low-grade optic glioma. However, long-term follow-up is required for further evaluation of the efficacy and potential side effects.

Well-differentiated, low-grade osteosarcoma of the clivus

A case of well-differentiated osteosarcoma of the sphenoid bone was reported. The pathological differentiation of this rare entity from fibrous dysplasia, the radiographic appearance, and the differential diagnosis were discussed.

Adrenal 21-hydroxylase deficiency in childhood: 25 years' experience

OBJECTIVE

To review past and present management of congenital adrenal hyperplasia at a single centre, as a guide to best practice.

METHODOLOGY

The records of 89 patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency managed in a children's hospital in Australia over a period of 25 years were reviewed.

RESULTS

The diagnosis was made in infancy in 66 patients (37 males and 29 females) and later in 23 (11 males and 12 females). The mean age for genitoplasty in females with ambiguous genitalia was 18 months before 1984 and 3 months thereafter. Significant differences were found between males and females presenting after infancy with regard to virilization, bone age advancement, risk of true precocious puberty and final height. The mean final height standard deviation scores for seven males and seven females treated from infancy were -1.32 and -1.26, respectively.

CONCLUSIONS

The results emphasize the importance of early diagnosis and good control in ensuring a good outcome for patients with 21-hydroxylase deficiency.

Growth hormone treatment of short Chinese children with beta-thalassaemia major without GH deficiency

OBJECTIVE

Despite regular transfusion and desferrioxamine treatment, growth failure is commonly seen in adolescent children with beta-thalassaemia major. The growth failure has been thought to be due to GH resistance rather than GH deficiency. We investigated the effect of GH on short non-GH deficient children with beta-thalassaemia.

DESIGN

Recombinant human GH was given in a dose of 0.14 IU/kg/day subcutaneously in an open study.

PATIENTS

Fifteen prepubertal Chinese children with beta-thalassaemia major (ranging from 7.16 to 14.7 years in age) with height -1.5 SD or more below the population mean for age and a growth velocity of less than 5 cm/year were treated with growth hormone for one year. All children had peak GH response > 15mlU/l to insulin induced hypoglycaemia and normal thyroid function and adrenal reserve.

MEASUREMENTS

Anthropometric measurements were performed every 3 months. Morning urine was tested twice weekly for glycosuria. Blood count, renal and liver function tests, fasting blood glucose, IGF-I and fructosamine levels were assessed at entry and every 3 months during treatment. Fasting insulin was measured before and after 3 and 12 months of GH treatment. Skeletal maturity was assessed before and after one year of treatment.

RESULTS

Treatment was stopped in two children after 6 months because of poor growth response and noncompliance with treatment and in one child at 9 months because of bone marrow transplantation. In the 13 children, the growth velocity increased from 3.6 +/- 0.7 cm/year to 8 +/- 1.2 cm/year after one year of GH treatment (P < 0.001). IGF-I was low before treatment (10.1 +/- 2.7 nmol/l), rising significantly to 15.8 +/- 4.8, 18.4 +/- 4.6, 19.3 +/- 6.4 and 21.9 +/- 7.5 nmol/l at 3, 6, 9 and 12 months of treatment (P < 0.005). The mean pretreatment bone age in the 13 children was 9.58 +/- 1.41 years and increased to 10.53 +/- 1.43 years after one year of treatment (delta BA/CA 0.95 +/- 0.3 years). None of the patients developed glycosuria or hypertension. There was no significant change in blood count, renal and liver function, thyroid function, fasting blood glucose or insulin concentrations during treatment.

CONCLUSION

Growth failure in these children with normal GH reserve and low serum IGF-I concentrations would suggest GH insensitivity. Supraphysiological doses of exogenous GH can cause a significant increase in serum IGF-I levels and a significant improvement in short-term growth of short children with beta-thalassaemia major.

Urinary 17 alpha-hydroxyprogesterone in management of 21-hydroxylase deficiency

OBJECTIVES

The study was designed to assess the reliability of measurement of 24-hour urinary 17 alpha-hydroxyprogesterone (17-OHP) by radio-immunoassay (RIA) as an alternative biochemical assessment for monitoring the treatment of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) and to assess the need for sample purification by column chromatography to improve assay specificity.

METHODOLOGY

Morning serum 17-OHP was measured using RIA and 24-hour urinary pregnanetriol using gas chromatography. Twenty-four-hour urinary 17-OHP was measured in samples from 17 prepubertal patients with CAH due to 21-OHD, and 20 normal prepubertal children as controls. In 24 urine samples, RIA of 17-OHP was performed with and without column chromatography.

RESULTS

There was a good correlation between 24-hour urinary 17-OHP and 24-hour urinary pregnanetriol (r = 0.962, P < 0.01) and between 24-hour urinary 17-OHP and morning serum 17-OHP (r = 0.955, P < 0.01). There was no significant difference in the RIA of the urine samples with and without purification by column chromatography.

CONCLUSIONS

The measurement of 24-hour urinary 17-OHP is a reliable alternative for the biochemical monitoring of 21-OHD, and RIA specificity is unaffected by omission of column chromatography.

Myocardial salvage: its assessment and prediction by the analysis of serial myocardial contrast echocardiograms in patients with acute myocardial infarction

It has been difficult to assess myocardial salvage in patients with coronary reflow because of the lack of appropriate methods of determining the risk area and assessing effects of coronary reflow in patients, myocardial contrast echocardiography was performed in 28 patients with acute myocardial infarction before reperfusion, immediately after reperfusion, and in the chronic stage with the right and left coronary arterial injection of sonicated ioxaglate. Contrast-deficit and contrast-filled areas before reperfusion were defined as the risk area and noninfarct area, respectively. If the ratio of peak subtracted gray level in the risk area to that in the noninfarct area was < 0.4, the risk area was taken as a contrast defect. Contrast defect was observed even after reperfusion in 8 (29%) patients, and the defect was consistently observed in the chronic stage in all of them. Contrast defect disappeared after reperfusion in the other 20 patients but reappeared in 4 (20%) of them in the chronic stage despite the patent infarct-related vessel. Left ventricular function recovery of the risk area in the chronic stage as assessed with regional wall motion and wall thickness was better in the patients without contrast defect after reperfusion than in patients with persistent or reappeared contrast defect. In conclusion, (1) myocardial salvage is improbable in patients with contrast defect immediately after reperfusion, (2) contrast enhancement immediately after reperfusion does not necessarily imply myocardial salvage in the chronic stage, and (3) myocardial echocardiography in the chronic stage may provide clinically useful information about myocardial salvage in patients with myocardial infarction.

High prevalence of Gymnophalloides seoi infection in a village on a southwestern island of the Republic of Korea

Gymnophalloides seoi (Digenea: Gymnophallidae), a new human intestinal trematode reported from a Korean woman who complained of epigastric discomfort, has been shown to be highly prevalent among the villagers of a southwestern island of the Republic of Korea. For the detection of human infections, fecal examinations were conducted on the inhabitants of a seashore village, where the first patient with a G. seoi infection had resided. Of 98 inhabitants examined, 70 (71.4%) were infected with various intestinal parasites; among them, G. seoi showed the highest rate of egg positivity 48 of 98 (49.0%). Individual worm burdens of G. seoi, as measured by collection of adult flukes after anthelmintic treatment and purgation, ranged from 106 to 26,373 specimens (average per infected case = 3,326). There was no sex-related difference in the prevalence of G. seoi, and the age distribution of the infected cases showed a relatively even pattern. This study confirms that human infection by G. seoi is not an incidental one and provides the first evidence of its high prevalence on this Korean island.

Screening test for growth hormone deficiency: usefulness of L-dopa-propranolol provocative test

This is a retrospective review of 185 short children who were tested for growth hormone (GH) secretion using the L-dopa-propranolol provocative test. One hundred and thirty-three children were deemed to have passed the screening test when a GH concentration of greater than 15 miu/L was elicited after stimulation. Fifty-two failed the screening test, of which 33 were diagnosed as having growth hormone deficiency (GHD) when they had inadequate growth hormone response to insulin-induced hypoglycaemia. The other 19 were low-responders since they showed adequate GH response to insulin tolerance test (ITT). The low-responder rate to L-dopa-propranolol provocative test among short children who are not GH deficient was 12.5%. The low cost of L-dopa and propranolol, the simplicity and safety of the test, and the acceptable rate of low-responders make the test an effective screening test for GHD.

Familial testotoxicosis in a Chinese family

We report two cases of 'familial testotoxicosis' in a family of Southern Chinese descent. The proband, an 8-year 4-month-old boy and his 35-year-old father both presented with early sexual development. In both cases the testicular volume was only 6 ml despite fully developed secondary sexual characteristics. Both patients had adult testosterone concentrations but a suppressed gonadotrophin response to gonadotrophin-releasing hormone. The suppressed gonadotrophin response to gonadotrophin-releasing hormone in the father suggests that autonomous gonadal production of sex steroid by the testes can persist well into adult life in some patients with familial testotoxicosis.

Subendocardial myocardial ischemia as assessed with myocardial contrast echocardiography in patients with ischemic heart diseases

Myocardial contrast echocardiography was used to characterize changes in the regional and transmural myocardial blood flow distribution that were provoked by rapid atrial pacing stress in patients with coronary artery diseases. In patients with coronary organic stenosis, a decrease in the myocardial contrast-enhancement in the subendocardial half after rapid atrial pacing was associated with stress-induced chest pain and electrocardiographic ST-T changes. The decrease in the myocardial contrast-enhancement in the subendocardial half after rapid atrial pacing was not observed in patients without coronary stenosis or after coronary angioplasty. Thus, the finding was considered to reflect myocardial ischemia. Pacing-induced decreases in myocardial contrast-enhancement were observed in some patients with old myocardial infarction and significant resting coronary collaterals. In these patients, myocardial ischemia was considered to have developed at rapid pacing because collateral function was good enough to perfuse the infarct myocardium at rest, but was not good enough to prevent myocardial ischemia at stress. Thus, myocardial contrast echocardiography seems to be particularly useful in assessing myocardial ischemia at stress due to coronary stenosis in patients with angina pectoris and due to poor dynamic collateral function in patients with old myocardial infarction.

Demonstration of functional border zone with myocardial contrast echocardiography in human hearts. Simultaneous analysis of myocardial perfusion and wall motion abnormalities

BACKGROUND

Although the presence of a functional border zone (FBZ), defined as the nonischemic but asynergic myocardium adjacent to the ischemic area, has been demonstrated in animal hearts, it is not known whether this zone exists in humans.

METHODS AND RESULTS

Myocardial contrast echocardiography (MCE) was performed before and during balloon inflation in the area of coronary stenosis by injecting contrast medium through the guiding catheter in 13 patients with effort angina who underwent successful coronary angioplasty. The area showing MCE defect during balloon inflation was determined with reference to the preangioplasty MCE and was regarded as an ischemic area. The size of the FBZ was assessed by measuring the length of the endocardium that showed asynergy in the echo-enhanced (nonischemic) area. The FBZ measured was 13 +/- 4 mm in the short-axis view (n = 5) and 16 +/- 9 mm in the long-axis view (n = 8).

CONCLUSIONS

Nonischemic contractile dysfunction exists even in human hearts. The presence of an FBZ may limit the use of wall motion analysis in assessing the risk or ischemic area in patients with myocardial infarction. MCE appears to be a unique technique for assessing the risk or ischemic area.

Coronary collaterals assessed with myocardial contrast echocardiography in healed myocardial infarction

The epicardial coronary collateral vessels are visualized with coronary angiography, but this method does not provide significant information about the myocardial perfusion supplied with the collaterals. In this study, myocardial contrast echocardiography (MCE) was performed to assess the coronary collaterals in 29 patients with old myocardial infarction. MCE was performed by intracoronary injection of 2 ml agitated amidotrizoate sodium meglumine. The peak background-subtracted gray level (PGL) in the infarct area was determined from the digitized echocardiographic images obtained before and after injection into the noninfarct and donor artery. PGL was compared with the 3-point coronary angiographic grades of collaterals. PGL in the infarct area was significantly lower in patients with poor collaterals than in patients with moderate to good collaterals (5 +/- 4 vs 18 +/- 8 U mean +/- standard deviation, p less than 0.01). PGL in the infarct area was less than 10 U in the 3 patients with severe asynergy despite the moderate to good collateral supply, suggesting that activity of the collaterals was not good enough to preserve the wall motion effectively. It is concluded that (1) the degree of MCE enhancement in the infarct area generally corresponded to the collateral grades assessed with coronary angiography, and (2) MCE may provide a measure of the collateral perfusion.

[Evaluation of function of human collateral coronary arteries using myocardial contrast echocardiography]

The morphology of collateral vessels can be imaged by coronary angiography, but no method has been available for evaluating their function. This is a report of the use of regional myocardial perfusion to visualize collateral flow by means of myocardial contrast echocardiography in 28 patients with old myocardial infarction. Myocardial contrast echocardiography was accomplished by the intracoronary injection of two ml agitated amidotrizoate sodium meglumine. Short-axis images of the left ventricle were recorded on video tape. Those images were digitized off-line into a 512 x 512 pixel matrix. Using coronary angiography, the morphology and function of the collateral vessels were evaluated, then classified as poor, moderate or good. Myocardial perfusion was evaluated using the enhanced gray level after contrast injection, and the level was compared with the morphology and degree of collateral development. The enhanced gray level was evaluated arbitrarily as 3 +/- 2 U (mean +/- S.D.) in the "poor" group; 13 +/- 6 U in the "moderate" group; and 20 +/- 11 U in the "good" group (p less than 0.01 vs the "poor" group; NS vs the "moderate" group). Regional myocardial perfusion via the collateral vessels was generally proportional to the morphology. However, there were a few discrepancies between these two parameters.

[Discrepancies between wall motion abnormalities and regional myocardial perfusion in patients with myocardial infarction: evaluation by myocardial contrast echocardiography]

Regional myocardial perfusions obtained by myocardial contrast echocardiography were compared with wall motion abnormalities evaluated by two-dimensional echocardiography in 26 patients with old myocardial infarction (12 with a QS pattern and 14 with a non-QS pattern on electrocardiograms). Myocardial contrast echocardiography was performed by the intracoronary injection of 2 ml of hand-agitated Urografin-76, and short-axis views of the left ventricle were recorded on VTR. Regional myocardial perfusion was categorized using a three-point scale based on the gray levels, and was compared with wall motion abnormalities of the corresponding region as assessed by two-dimensional echocardiography.

Visualization of subendocardial myocardial ischemia with myocardial contrast echocardiography in humans

Previous studies indicate the degree of myocardial echo contrast enhancement may be related to regional myocardial perfusion. In this study, myocardial contrast echocardiography was used to characterize changes in the transmural myocardial blood flow distribution that were provoked by rapid atrial pacing in 11 patients with one-vessel coronary artery disease. Ten patients without coronary artery disease served as controls. Myocardial contrast echocardiography was performed by intracoronary injection of 2 ml hand-agitated amidotrizoate sodium meglumine (Urografin-76) and by imaging a short-axis view of the left ventricle with two-dimensional echocardiography before and during injection of the contrast agent. The two-dimensional echocardiographic images at end diastole, before and after injection of the contrast agent, were digitized off-line into a 512 x 512 pixel matrix with 256 gray levels/pixel to quantify the degree of the enhancement of the peak gray level after injection. Transmural myocardial blood flow distribution was evaluated by measuring the ratio of the enhanced gray level in the endocardial half (endo) to that in the epicardial half (epi) (endo:epi gray level ratio) in the anteroseptal, posterolateral, and inferior segments before and just after rapid atrial pacing in each patient. In patients without coronary artery disease, there were no differences in the endo:epi gray level ratio between any of the three segments both before and after pacing. Mean values of the three segments were 0.95 +/- 0.08 before pacing and 0.90 +/- 0.13 after pacing, respectively. In contrast, in patients with coronary artery disease, the endo:epi gray level ratio for the segment supplied with stenotic coronary artery decreased after pacing (0.40 +/- 0.21 vs. 0.93 +/- 0.18, p less than 0.01), probably reflecting subendocardial myocardial ischemia, whereas that for the segment supplied with nonstenotic coronary artery remained unchanged (0.88 +/- 0.20 vs. 0.99 +/- 0.23, NS). Thus, changes in transmural myocardial blood flow distribution with rapid pacing, which may be due to transient subendocardial ischemia, are visualized with myocardial contrast echocardiography.

[Regional myocardial perfusion in ischemic heart disease assessed by myocardial contrast echocardiography]

Myocardial contrast echocardiography is a new cardiovascular imaging technique that can be used to evaluate regional myocardial perfusion. Regional myocardial perfusion was studied in 12 patients with normal coronary arteries, 14 patients with old myocardial infarction, four patients with acute myocardial infarction, and 15 patients with effort angina. Conventional two-dimensional echo imaging was obtained during intracoronary injections of relatively small volumes (2 ml) of agitated Urografin-76. The echo intensities were measured before and after injecting contrast agents and the subtraction images were composed by a high-speed image processor (NEXUS 6400). Clear myocardial images were obtained in 10 of 12 the patients with normal coronary arteries, and they reflected well the epicardial arterial architecture by coronary angiography. In cases of old myocardial infarction, the infarcted areas appeared as contrast defects in seven and as slightly enhanced areas in three of the 10 patients. In cases of acute myocardial infarction, contrast defect areas in the myocardial images were less in two cases of successful early coronary thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). However, contrast defects remained unchanged despite good recanalization in one case of delayed PTCA. In cases of effort angina, anginal attacks were successfully induced by rapid atrial pacing in six of the 15 patients. In four of the six patients, contrast enhancement in myocardial imaging during anginal attack decreased more in the endocardial than in the epicardial myocardium, possibly reflecting subendocardial ischemia. It is concluded that this technique can identify regional myocardial perfusion, which is not revealed by coronary angiography, and it is therefore useful for the clinical analysis of ischemic heart disease.

[Effect of calcium antagonist (diltiazem) on left ventricular diastolic properties in essential hypertension: a pulsed Doppler echocardiographic study]

To evaluate the acute effect of diltiazem on left ventricular diastolic properties, we measured transmitral flow in 15 patients with essential hypertension using pulsed Doppler techniques. Before administering diltiazem, the peak velocity (R) and the deceleration rate of rapid inflow decreased significantly as compared with healthy subjects, but the peak velocity during atrial contraction (A) and the A/R increased significantly. Immediately after the intravenous administration of 10 mg diltiazem, blood pressure decreased from 157 +/- 22/96 +/- 12 mmHg to 135 +/- 19/82 +/- 11 mmHg (p less than 0.001) and the heart rate increased from 69 +/- 10/min to 74 +/- 10/min (p less than 0.05). However, 30 minutes after the injection, these returned to control values. The peak velocity and deceleration rate of rapid inflow were 52 +/- 9 cm/sec and 227 +/- 65 cm/sec2, respectively, before administering diltiazem, and five minutes after injection, these parameters increased to 63 +/- 13 cm/sec (p less than 0.001) and 292 +/- 82 cm/sec2 (p less than 0.001), respectively. Thirty minutes later, these values leveled off at 58 +/- 12 cm/sec (p less than 0.01) and 257 +/- 76 cm/sec2 (p less than 0.05), respectively. The peak velocity during atrial contraction was 67 +/- 12 cm/sec before administration, and this did not change significantly after injecting diltiazem. Significant increases in peak velocity and deceleration rate of rapid inflow and decreases in the A/R continued after the blood pressure and heart rate returned to control values. It was therefore concluded that diltiazem improves impaired early diastolic left ventricular filling in essential hypertension.