Diagnostic value of pulsed Doppler echocardiography in acute pulmonary thromboembolism--comparison with pulmonary angiography and pulmonary artery pressure

The ratio of acceleration time to right ventricular ejection time (AcT/RVET) can be derived from the blood flow patterns recorded by pulsed wave Doppler echocardiography. In chronic cor pulmonale, AcT/RVET negatively correlates with pulmonary artery pressure (PAP). The present study evaluated the diagnostic value of AcT/RVET by comparing this variable with indices derived from pulmonary angiography (PAG) and PAP in 16 patients with acute pulmonary thromboembolism (APTE). AcT/RVET, PAP, and PAG severity indices (Miller index (MI) and UPET objective angiographic index (UI)) were measured during the acute phase on admission and the chronic phase after treatment. In the acute phase, AcT/RVET correlated with mean PAP (mPAP) (r=-0.68, p<0.05) and total pulmonary resistance (TPR) (r=-0.66, p<0.05), but not with MI or UI. During the chronic phase, AcT/RVET did not correlate with mPAP or TPR, but with both PAG indices (MI: r=0.76, p<0.05, UI: r=0.65, p<0.05). Before treatment of the APTE, AcT/RVET remained at low levels and could be used as an index of pulmonary hypertension. After treatment, however, following improvement of PAP, AcT/RVET was not useful for evaluating PAP, but might serve as an index for evaluating the volume of residual thrombi.

Sesamin and episesamin induce apoptosis in human lymphoid leukemia Molt 4B cells

The exposure of human lymphoid leukemia Molt 4B cells to sesamin and episesamin which were isolated from unroasted sesame seed oil and identified by MS, and 1H and 13C-NMR, led to both growth inhibition and the induction of programmed cell death (apoptosis). Morphological change showing apoptotic bodies was observed in the Molt 4B cells treated with sesamin and episesamin. The fragmentations by sesamin and episesamin of DNA to oligonucleosomal-sized fragments that are characteristics of apoptosis were observed to be concentration-dependent, respectively. Moreover, the amount of the DNA fragments in the sesamin-treated cells was increased from 2 days, while that in the episesamin-treated cells was elevated at 3 days after addition of the compounds. These findings suggest that growth inhibitions by sesamin and episesamin of Molt 4B cells result from the induction of apoptosis in the cells.

[Correlation of DNA copy number changes to malignancy in oral squamous cell carcinomas by comparative genomic hybridization]

To compare clinical and histopathological findings to tumor DNA copy number changes, comparative genomic hybridization (CGH) was performed on 18 primary oral squamous cell carcinomas. Copy number increases were most frequently observed on 8q, 3q, 13q, 11p, and 11q, while copy number decreases most frequently on 10q, 1p, 18q, 9p, and 19q. Copy number changes in relationship to WHO grading were examined with the result that DNA copy number increase on chromosome 6p23-25 was characteristically observed in the groups of Grade II and Grade III, and DNA copy number decreases on chromosomes 9p21 and 11p11-13 were observed in the same groups. Furthermore, comparison of DNA copy number changes to TNM classification indicated that the decreases on chromosomes 1p36 and 10q25-26 might be related to tumor progression. Moreover, the relationship of DNA amplification or deletion to metastasis was investigated. It was found that the majority of the metastasis-positive tumors showed increases on 3q26 and 17q12-21 and showed decreases on chromosome 18q21. The data suggested that these DNA copy number changes on each chromosome in the three categories might be associated with tumor cell differentiation, tumor size, and lymph node metastasis.

Use of [123I]-BMIPP myocardial scintigraphy for the clinical evaluation of a fatty-acid metabolism disorder of the right ventricle in chronic respiratory and pulmonary vascular disease

The objective of this study was to evaluate whether or not right ventricle (RV) uptake of iodine-123-labelled-beta-methyliodophenylpentadecanoic acid ([123I]-BMIPP) correlated with the degree of right ventricular pressure overload (RVPO). Myocardial scintigraphy of [123I]-BMIPP and thallium-201 (201Tl) was performed on 46 patients with RVPO. We determined the right ventricle (RV)/left ventricle (LV) ratio = (radioactivities of RV)/(radioactivities of LV), and the RV metabolic index (RVMI) = (RV/LV ratio of [123I]-BMIPP)/(RV/LV ratio of 201Tl). We also evaluated the correlation between RVMI and mean pulmonary arterial pressure (mPAP), and between RVMI and total pulmonary resistance (TPR). Significant correlations were found between the RV/LV ratio of [123I]-BMIPP and mPAP and between the RV/LV ratio of [123I]-BMIPP and TPR. In addition, a significant negative correlation was observed between RVMI and mPAP and between RVMI and TPR. RVMI declined as RVPO increased, suggesting the presence of a fatty-acid metabolism disorder of the RV. Moreover, [123I]-BMIPP myocardial scintigraphy could be useful for evaluating a disorder of the fatty-acid metabolism of the RV with RVPO.

Cardiac function in dialysis patients evaluated by Doppler echocardiography and its relation to intradialytic hypotension: a new index combining systolic and diastolic function

AIM, PATIENTS AND METHODS

Cardiac function of 40 patients on maintenance dialysis was examined using a new Doppler index combining systolic and diastolic function. Immediately before dialysis, ultrasonic pulsed Doppler was used to measure right and left ventricular inflow and outflow waveforms. The sum of the isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) was calculated by subtracting the ejection time from the interval between the end of an inflow waveform and the start of the next inflow waveform. The new index was obtained by dividing the sum of the two isovolumetric times by the ejection time. Cardiac function was evaluated in dialysis patients and healthy controls using new indices of the right and left heart systems.

RESULT

Indices of the right and left heart systems in dialysis patients were significantly higher than those in healthy controls. With respect to hypotension during dialysis, patients were divided into two groups, a group with decreased blood pressure (group A: 27 patients) and a group with normal blood pressure (group B: 13 patients). Only the left heart system index in group A was significantly higher. There were no significant differences in other M-mode Doppler indices between the two groups.

CONCLUSION

The new index was a more sensitive evaluator of cardiac function and predictor of hypotension during dialysis compared to standard echocardiographic indices.

Serial changes in negative T wave on electrocardiogram in acute pulmonary thromboembolism

A negative T wave is frequently observed in precordial ECG leads in patients with acute pulmonary thromboembolism. We investigated the clinical significance of negative T wave in 15 patients with acute pulmonary thromboembolism who were treated with thrombolytic agents by measuring the mean pulmonary artery pressure and ratio of right to left ventricular end-diastolic diameter using echocardiography and ECG. The study included only patients with massive acute pulmonary thromboembolism of a mean age of 65+/-9.7 years (+/-SD). A negative T wave was observed on admission in 10 patients but was later detected in 14 of the 15 patients. The mean amplitude of the negative T wave increased within 1 week then decreased after thrombolytic treatment. The peak negative amplitude of the T wave was observed from 1 to 7 days (mean, 2.6+/-1.8 days) and disappeared afterwards. During this period, improvements in both the mean pulmonary artery pressure (37.8+/-11.2 to 19.1+/-6.7 mmHg) and the ratio of right to left ventricular end-diastolic diameter (0.97+/-0.16 to 0.51+/-0.13) were noted in all patients. Our results suggest that an increase in the amplitude of negative T wave in precordial leads after thrombolytic therapy in patients with massive acute pulmonary thromboembolism reflects improvement in cardiopulmonary hemodynamics.

[Extra-intestinal complications of ulcerative colitis: arteriovenous thrombosis/embolism]

Thromboembolic episode is a well known extraintestinal complications of ulcerative colitis, but it is a rare complication in clinically. In the literature there are some interesting observations concerning the factors, may play a major role both in the pathogenesis and in the hypercoagulability in ulcerative colitis. However the exact mechanism of hypercoagulability in patients with ulcerative colitis is still unknown. We reviewed the incidence, the activity and severity of the basic disease, the pathogenesis, the treatment, the prognosis of thromboembolic phenomena in patients with ulcerative colitis.

A possible role of immunoglobulin E in patients with hyperthyroid Graves' disease

To investigate the possible participation of immunoglobulin E (IgE) in the autoimmune process of Graves' disease, incidence of elevation of serum IgE level, TSH receptor antibody (TRAb), and thyroid status were studied in 66 patients with hyperthyroid Graves' disease, 54 patients with Hashimoto's thyroiditis, 19 patients with bronchial asthma, and 15 patients with pollen allergy. In hyperthyroid Graves' patients, elevation of serum IgE levels (> or = 170 U/mL) was found in 19 of 66 patients (29%), 11 of whom had hereditary and/or allergic conditions. Elevations of serum IgE levels were found in 63% of patients with bronchial asthma and in 40% of patients with pollen allergy. Mean values of serum IgE were the same in patients with hyperthyroid Graves' disease and with bronchial asthma. During methimazole treatment TRAb decreased without fluctuation of IgE levels in both groups. The decrease in TRAb was significantly greater in patients with normal IgE than in patients with IgE elevation. After prednisone administration, reduction in TRAb was greater in patients with normal IgE than that in patients with IgE elevation. High incidence of IgE elevation in hyperthyroid Graves' disease and slower reduction in TRAb in association with IgE elevation suggest a difference in the autoimmune processes in Graves' disease with and without elevation of IgE.

Histamine H1 receptor and reactivity of the nasal mucosa in sensitized guinea pigs

OBJECTIVE

Nasal Hypersensitivity to histamine is higher in allergic patients than that in normal control, suggesting that affinity and/or density of H1 receptors in nasal mucosa may be increased in patients with allergic rhinitis. The purpose in this study is to examine the correlation between the hyperresponsiveness and number of histamine H1 receptors in guinea pig nasal mucosa.

METHODS

Guinea pigs were sensitized by DNP-Ascaris antigen. To block histamine H1 receptors, ketotifen was used and the number of receptors was counted by receptor binding assay technique. These data were compared with nasal airway volume (VOL) assessed by acoustic rhinometry of the same animals to know whether the number of H1 receptors is correlated to the nasal responsiveness to the antigen, or not. Eighty animals were divided into five groups which are composed of nonsensitized and sensitized group pretreated with saline, 0.1, 1.0 and 10 mg/kg of ketotifen, respectively.

RESULTS

The number of H1 receptors (Bmax) was significantly increased in sensitized group compared with that in control. It decreased dose dependently by pretreatment of ketotifen. The percent change of VOL showed - 31.1 +/- 4.1% at 10 min and - 42.9 +/- 4.1% at 30 min after antigen challenge in sensitized animals. This was dose dependently inhibited by ketotifen. There was a highly inverse correlation between VOL and Bmax (r = -0.708, P< 0.0001).

CONCLUSION

These results suggest that sensitization increases the number of histamine H1 receptor, and that increased number of H1 receptor in nasal mucosa in sensitized guinea pigs may be one of the causes of nasal hyperresponsiveness to antigen.

EMG activity of the muscles of the neck and forelimbs during different forms of locomotion

We recorded the electromyographic (EMG) activity of 7 skeletal muscles in the forequarters and 1 in the hindquarters of 6 Thoroughbred horses during overground walking, swimming in a circular pool, and walking and trotting in a water treadmill. Bipolar fine wire electrodes were inserted into the muscles and the EMG signals were recorded using a telemetric system. The splenius exhibited tonic EMG activity during swimming. The brachiocephalicus showed its highest intensity during swimming followed by the walk and trot in the water treadmill and then walking overground. The triceps brachii caput longum had a similar activity pattern to the brachiocephalicus. The brachialis showed only weak EMG activity in all 3 types of locomotion. The extensor digitorum communis had higher intensity of EMG activity in the walk in the water treadmill than in other kinds of locomotion. The flexor digitorum profundus exhibited the most intense EMG activity during swimming. These results indicated that swimming evoked strong EMG activity in the antigravity muscles in spite of reduced gravitational force. Walking in the water treadmill may require more intensified EMG activity of the forelimb than the trot in the same treadmill.

A case in which stent insertion is considered to have triggered contrast medium-induced coronary vasospasm

A Gianturco-Roubin II (GR-II) stent was inserted in a 75-year-old man who developed restenosis of the right coronary artery (RCA) after percutaneous transluminal coronary angioplasty (PTCA). Although the vessel became partially occluded after 7 months, it was redilated by PTCA. Follow-up angiography of the RCA and left coronary artery (LCA) was performed 3 months later. Chest pain with bradycardia and hypotension occurred immediately after this examination, and ST elevation appeared in ECG leads II, III, and aVF. Repeat angiography of the RCA confirmed complete occlusion due to a spasm at a site proximal to the GR-II stent. The spasm was resolved by intracoronary infusion of isosorbide dinitrate (ISDN), and PTCA was carried out for extensive recurrent restenosis of the RCA; however, vascular dissection developed at the distal end of the GR-II stent. Therefore, a Palmaz-Schatz (P-S) stent was placed such that its proximal end overlapped the distal end of the GR-II stent. Follow-up angiography 3 months later showed no restenosis, but an episode of vasospasm similar to the previous one occurred immediately after left ventriculography. The RCA was completely occluded proximal to the GR-II stent because of spasm. Although this spasm was gradually relieved by intracoronary infusion of ISDN, marked spasm was also observed distal to the P-S stent; complete relief was achieved by infusion of additional ISDN.

Bone marrow-derived dendritic cells incorporate and process hydrophobized polysaccharide/oncoprotein complex as antigen presenting cells

We have previously shown that a novel hydrophobized polysaccharide/oncoprotein complex vaccine can induce immune responses against the HER2/neu/c-erbB2 (HER2) expressing tumors. Bone marrow-derived dendritic cells (DCs), as antigen presenting cells (APCs), are the first candidates for presentation of tumor antigens. The aim of this study was to see whether DCs are able to elicit antigen specific host immune responses by stimulating the proliferation of T cells after exposure to cholesteryl group bearing pullulan (CHP) and HER2 protein complex. Vaccination by CHP-HER2 complex was as effective as cholesteryl group bearing mannan (CHM) and HER2 complex on which we reported previously. Immunization of mice with HER2 expressing CMS17HE tumor cells generated both CD4+ T cells and CD8+ T cells reactive with CHP-HER2 complex pretreated DCs. In addition, immunization with either CHP-HER2 complex or HER2 protein alone could also generate both CD4+ T cells and CD8+ T cells specifically reactive with CHP-HER2 complex pretreated DCs. The complete rejection of tumors occurred when immunization with CHP-HER2 complex pretreated DCs was started 10 days after tumor inoculation. Therefore, bone marrow-derived DCs pretreated with hydrophobized polysaccharide/oncoprotein complex are a powerful tool for enhancing the effectiveness of oncoprotein for anti-tumor vaccination, opening new options for immune cell therapy.

Simultaneous assessment of right ventricular function and hypertrophy by Tc-99m MIBI

PURPOSE

Tc-99m MIBI allows the simultaneous performance of cardiac blood pool scintigraphy and myocardial SPECT. The authors performed studies to determine whether right ventricular function and hypertrophy can be evaluated simultaneously using Tc-99m MIBI in patients with right heart disease.

METHODS

Using right heart catheterization, several parameters of pulmonary circulation were measured, including right ventricular ejection fraction, in 23 patients with chronic pulmonary disease and pulmonary vascular disease. Within 1 week, right heart blood pool scintigraphy was performed using the first-pass method using Tc-99m MIBI. The right ventricular ejection fraction calculated from right heart blood pool scintigraphy was compared with that measured using right heart catheterization. Myocardial SPECT was performed 1 hour after right heart blood pool scintigraphy. On the short axis images, which allowed optimal visualization of the right ventricle, the right and left ventricular free walls were established as regions of interest. Myocardial wall counts were determined. The right ventricular uptake: left ventricular uptake ratio was calculated to study the relation of that ratio to mean pulmonary artery pressure and total pulmonary resistance.

RESULTS

A significant correlation was observed between the right ventricular ejection fraction calculated on right heart catheterization and that calculated on right heart blood pool scintigraphy. The right ventricular uptake:left ventricular uptake ratio correlated positively with pulmonary artery pressure and total pulmonary resistance.

CONCLUSION

These results suggest that Tc-99m MIBI allows simultaneous noninvasive evaluation of cardiac function and structure, which previously was considered impossible in patients with right heart disease.

Evaluation of right-ventricular function by Doppler echocardiography in patients with chronic respiratory failure

In patients with chronic respiratory failure, right-ventricular function was non-invasively evaluated by Doppler echocardiography. A total of 31 patients (16 men, 15 women; mean age 65.8 +/- 7.12 years) with pulmonary tuberculosis sequelae who had received home oxygen therapy during the preceding 6 or more months, were studied. Right-ventricular inflow and outflow waveforms were recorded, and right-ventricular function was evaluated using a new Doppler index combining systolic and diastolic function. On continuous wave Doppler echocardiography, estimated systolic pulmonary arterial pressure was calculated from the gradient between the right atrium and right ventricle. There was no correlation between the new Doppler index and systolic pulmonary arterial pressure, and some patients showed high index values despite low systolic pulmonary arterial pressure. The new Doppler index facilitated evaluation of ventricular function irrespective of right-ventricular afterload.

Acoustic rhinometry evaluation of nasal response to histamine and antigen in guinea pigs

The effects of antigen and histamine on the changes of nasal passage patency in 112 guinea pigs with or without allergic rhinitis were evaluated by acoustic rhinometry. The percent change of volume from the nostril to 2 cm into the nasal cavity showed significant reduction of 31.10 +/- 4.11% at 10 minutes and 31.10 +/- 4.11% at 30 minutes after antigen challenge in sensitized guinea pigs. The pretreatment with ketotifen, an H1-histamine receptor antagonist as well as mast cell stabilizing drug, blocked dose-dependently the effects of antigen on those changes in volume. Furthermore, instillation of 10(4) micrograms/mL histamine reduced significantly nasal passage patency to 33.77 +/- 4.63% at 10 minutes and 42.76 +/- 3.32% at 30 minutes after challenge compared with that before challenge and ketotifen inhibited the effects of histamine, which indicated that histamine is an important mediator of allergic upper airway responses in guinea pigs. These results show that acoustic rhinometry is a useful technique to assess the nasal blockade in allergic guinea pigs.

Six-year survival after excision of cardiac malignant lymphoma

We report a patient with a postoperative survival period of 6 years after the surgical excision of a cardiac malignant lymphoma. A 35-year-old woman underwent total excision of the tumor arising from the left ventricular outflow tract. After the operation, she was treated with chemotherapy for 6 months. She has been doing well thereafter without any medication. To date there is no evidence of recurrence.

Right ventricular impairment in patients with chronic respiratory failure on home oxygen therapy--non-invasive assessment using a new Doppler index

We evaluated the usefulness of the newly defined Doppler index combining systolic and diastolic myocardial performance, in assessing right-heart dysfunction in 29 patients with chronic respiratory failure caused by old tuberculosis who were on 24-h home oxygen therapy. We measured tricuspid inflow velocity, right-ventricular outflow velocity, late/early diastolic peak velocities (A/E), the ratio between pre-ejection period and ejection time (PEP/ET), and the new index of systolic and diastolic myocardial performance (SDMP) calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. The calculated A/E, PEP/ET and SDMP in our patients were significantly higher than those in age-matched healthy subjects (n = 37, mean age 67 +/- 8 years). There was no overlap in the SDMP index between healthy subjects and patients and the index was not influenced by heart rate. Our results suggest that SDMP index is a better marker than A/E and PEP/ET for the assessment of right-ventricular impairment.

Nasal passage patency in patients with allergic rhinitis measured by acoustic rhinometry: nasal responses after allergen and histamine provocation

We investigated nasal passage patency after allergen and histamine provocation in patients with allergic rhinitis by acoustic rhinometry. In total, 75 outpatients with allergic rhinitis were studied. The threshold of nasal hypersensitivity to histamine was measured by the 10 microliters instillation of serial 10-fold dilution in the ipsilateral nasal cavity. Nasal provocation testing to specific antigen was applied to the anterior part of inferior turbinate in bilateral sides in sitting position. Measurement of nasal patency by acoustic rhinometry was repeated three times in each nasal cavity. The minimal cross-sectional area and total volume of nasal cavity were measured in an individual subject. The minimal cross-sectional area and total volume in the histamine challenged-side significantly decreased on the 10(-2), 10(-1), 10(-0) of end point, and up to 30 min after challenge with the threshold dose, but not in the unchallenged side. This means acoustic reflection technique is sensitive at least 100-fold in comparison with classical method like findings by anterior rhinoscopy and symptom scores. Nasal passage patency after bilateral allergen provocation showed predominant in the unilateral side, suggesting the cross over-reflex effects. It was concluded that acoustic rhinometry is one of the highly quantitative and sensitive method which can observe the change of nasal congestion.

An elevation of stem cell factor in patients with hyperthyroid Graves' disease

Graves' disease is an autoimmune disorder characterized by the presence of antibodies against thyrotropin receptor (TRAb). Stem cell factor (SCF), derived from bone marrow, is known to promote lymphohematopoiesis. To investigate the relation between the alteration in plasma levels of SCF, thyroid hormone status, and TRAb measured by thyrotropin binding inhibition (TBI), 13 untreated, 21 treated, and 4 relapsed hyperthyroid Graves' disease patients, 21 patients with Hashimoto's thyroiditis, 6 patients with subacute thyroiditis, and 11 control subjects were examined. In untreated hyperthyroid Graves' disease patients, serum levels of thyroxine (T4) and triiodothyronine decreased rapidly by methimazole treatment, and TBI decreased progressively, but variably. Simultaneously, the elevated plasma levels of SCF decreased gradually and progressively. The plasma levels of SCF correlated curvilinearly with the serum levels of T4. In 4 patients with relapsed hyperthyroid Graves' disease, TBI was marginally positive in 3 patients and negative in 1, but plasma levels of SCF were elevated significantly in all 4 patients. In patients with subacute thyroiditis and Hashimoto's thyroiditis with or without T4 replacement, plasma levels of SCF did not differ from that of controls. These findings indicate that the elevation of plasma levels of SCF relates to the longstanding thyrotoxic state and that short-term thyrotoxicosis does not significantly affect plasma levels of SCF. It remains to be determined whether the elevation in plasma levels of SCF is induced by excess thyroid hormone, reflecting the hypermetabolic state, or whether the elevation of plasma levels of SCF contributes to stimulation of lymphocytes producing TRAb.

Proposal of a high-field superconducting wiggler for a slow positron source at SPring-8

A low-energy positron beam is a unique probe of materials. In high-energy electron and positron storage rings it is possible to generate intense synchrotron radiation with a photon energy of 1-3 MeV by installing a high-field (8-10 T) superconducting wiggler. High-energy photons are converted to low-energy positrons by using a suitable target-moderator system. For an 8 GeV electron storage ring at a beam current of 100 mA, final yields are estimated to be about 10(8)-10(10) slow-e(+) s(-1) or larger depending on the moderation efficiency, with the size of the positron source 10(1)-10(2) cm(2). In the present work a wiggler magnetic system of 10 T is proposed. The main parameters of the superconducting wiggler are presented.

Design of a local bump feedback system for a variably polarizing undulator

A local bump feedback system is under construction to correct the orbit distortion caused by the magnetic field errors of a double-array undulator used to generate linear and circular polarization of light for a soft X-ray beamline. The local bump orbit is created by steering coils several turns long and four sets of steering magnets. The kick angle of the long steering coils and the steering magnets is determined according to the motion of the undulator and by detecting the beam position.

Liddle's syndrome in an elderly woman

A 78-year-old woman with hypertension was hospitalized with acute bronchitis. However, she was also found to have hypernatremia, hypokalemia, and metabolic alkalosis. Detailed examination showed a low plasma renin activity and plasma aldosterone concentration. A provisional diagnosis of Liddle's syndrome was established and the patient was successfully treated with triamterene. Although Liddle's syndrome is generally considered an inherited hypertensive disease found in young people, a review of the literature indicated that muscle weakness is an important clinical finding in elderly patients with this disease. Liddle's syndrome should be considered in the differential diagnosis of hypertension even in elderly individuals.

Two cases of adult varicella accompanied by hepatic dysfunction

Varicella is a typical acute exanthematous viral infection caused by varicella-zoster virus (VZV). In recently years, as far as hepatic dysfunction caused by viruses other than the hepatitis virus is concerned, there have been a few reports on hepatic dysfunction accompanying varicella following organ transplantation of Europe and America and another report on an immunocompromized adult following treatment for Systemic lupus erythematosis (SLE) in Japan. Nonetheless, we searched the MEDLINE and J MEDICINE listing the publications between 1986 and 1996 and found one report on healthy adults with varicella accompanied by hepatic dysfunction in Europe and America and two reports in Japan. Only Noguchi et al. dealt with the findings of liver biopsy. We examined two healthy adults with varicella and mild-to-moderate hepatic dysfunction, and referred to the results of their liver biopsies. The present paper discusses this issue, citing some references.

Astemizole-induced torsades de pointes in a patient with vasospastic angina

Astemizole (Hismanal), an antihistamine agent, has been reported to be associated with ventricular arrhythmias. In this paper we present a case of QT prolongation and torsades de pointes (TdP) in a 77-year-old woman who had been taking astemizole (10 mg/day) for 6 months because of allergic skin disease. At the time of admission, the serum concentration of astemizole and its metabolites was markedly elevated at 15.85 ng/ml, approximately 3 times the normal level. The patient was also taking cimetidine, a known inhibitor of cytochrome P-450 enzymatic activity, and during her admission was diagnosed as having vasospastic angina. To the best of our knowledge, this is the first report of astemizole-induced QT prolongation and TdP in Japan.

Soft X-ray beamline specialized for actinides and radioactive materials equipped with a variably polarizing undulator

This report presents the design of an undulator beamline at SPring-8 to be used for soft X-ray spectroscopy focused on radioactive materials. Photoemission spectroscopy experiments are carried out in a radioisotope (RI)-controlled area where actinide compounds as well as unsealed radioactive materials are usable. Intrusion of the radioactive materials into the electron storage ring or to the outside of the evacuated beamline components can be avoided by a specially devised RI protection/inspection mechanism. The combination of a variably polarizing undulator and a varied-line-spacing plane-grating monochromator provides linearly or circularly polarized soft X-rays with a high resolving power in the energy range 0.28-1.5 keV. The beamline will become operational in December 1997.

Porphyria cutanea tarda with constrictive pericarditis in a family

Two cases of familial porphyria cutanea tarda (PCT) with constrictive pericarditis are described. A 50-year-old woman and her 48-year-old younger brother were admitted because of right ventricular heart failure. Constrictive pericarditis was diagnosed by RV pressure waveform and echocardiogram. The patients were diagnosed as PCT based on clinical symptoms, histologic findings and elevated urinary excretion levels of uroporphyrin. Even to this day, over 40% of the etiology of constrictive pericarditis remains unknown. There is a possibility of overlooking porphyria cutanea tarda in constrictive pericarditis patients. This report describes the first documented cases of familial PCT with constrictive pericarditis.

Iodine-123 metaiodobenzylguanidine myocardial imaging in patients with pulmonary hypertension

Iodine-123-metaiodobenzylguanidine [123I-MIBG] has been used to evaluate the cardiac sympathetic nervous system. We evaluated the effect of pulmonary hypertension on the sympathetic neuronal function of the left ventricle in patients with pulmonary hypertension. We studied 20 patients with either chronic lung disease or pulmonary vascular disease. The patients were divided into a pulmonary hypertensive group and a control group. Single photon emission tomography was performed in the resting state 15 min and 4 h after administration of 123I-MIBG. Regions of interest (ROI) were set in the left ventricular (LV) free wall, the interventricular septum (IVS) and outside the LV free wall on short-axis images. The washout rate and the ROI/LV uptake ratio were calculated in each ROI. The IVS:LV uptake ratio was significantly lower in the pulmonary hypertensive group than in the control group. Our results suggest that left heart sympathetic neuronal dysfunction initially occurs in the IVS before it involves the LV free wall subsequently.

An abnormal sodium metabolism in Japanese patients with essential hypertension, judged by serum sodium distribution, renal function and the renin-aldosterone system

OBJECTIVE

The role of the renin-aldosterone system and the ability of renal sodium reabsorption to facilitate pressure natriuresis were analyzed by using a sufficient number of Japanese patients with essential hypertension.

METHODS

We studied 3222 normal Japanese subjects (610 in Kashiwa City Hospital and 2612 in Shinshu University Hospital), 741 Japanese patients with essential hypertension (256 in Kashiwa City Hospital and 485 in Shinshu University Hospital), 20 patients with aldosterone-producing adenomas and 11 patients with idiopathic hyperaldosteronism to determine the possible roles of sodium, renal function, and plasma aldosterone concentration (PAC) on blood pressure elevation. Inappropriate elevation of aldosterone levels [elevation of the aldosterone:plasma renin activity (PRA) ratio] was used to assess aldosterone action.

RESULTS

The peak of the serum sodium distribution curve was approximately 2 mmol/l higher in the patients with essential hypertension than it was in controls. The prevalence of higher serum sodium concentrations (> or = 147 mmol/l) also was increased significantly hypertensive patients. Age-related deterioration of renal function did not explain the hypertension and abnormal sodium metabolism in the hypertensive patients. In stepwise regression analysis, the serum sodium concentration was related inversely to the PRA and positively to the PAC:PRA ratio. Although there was an inverse relationship between urinary sodium excretion (representing sodium intake) and the PRA, urinary sodium excretion proved not to be significant as a source of variation in the PAC or in the PAC:PRA ratio in the hypertensive patients. Although the PAC was within the normal range in patients with serum sodium concentrations of 147 mmol/l or more and an elevated PAC:PRA ratio, it was inappropriately high for the stimulus applied, as indicated by the PRA; this is similar to the situation with aldosterone-producing adenomas or idiopathic hyperaldosteronism.

CONCLUSION

Serum sodium distribution patterns differed between normal subjects and patients with essential hypertension in this Japanese population. The deterioration of renal function and increased sodium intake did not explain this abnormal sodium metabolism. A higher serum sodium concentration is related to an elevated blood pressure, and, in some patients, an inappropriate elevation of plasma aldosterone levels. Of the Japanese hypertensive patients, 10-14% exhibited serum sodium concentrations of 147 mmol/l or more and inappropriate elevations of aldosterone level (suppressed PRA and normal aldosterone level). The defect in these patients presumably lies in the inappropriately high secretion of aldosterone.

Production of intense low-energy positron beams with synchrotron radiation

A low-energy positron beam is a unique probe of Fermi surfaces, defects, surfaces and interfaces. In high-energy electron and positron storage rings (E > 6 GeV) it is possible to generate intense synchrotron radiation with 1-3 MeV photons by installing a high-field superconducting wiggler. The strength of the wiggler should be ~8-12 T. High-energy photons are emitted from the wiggler and converted to low-energy positrons by using a suitable target-moderator system. For an 8 GeV electron storage ring at a beam current of 100 mA, final yields are estimated to be ~10(10)-10(12) (slow-e(+) s(-1)) with the size of positron source ~10(2)-10(3) cm(2). The possibility of increasing the brightness of the low-energy positron beam is discussed. Advantages of using synchrotron radiation for producing positrons are pointed out. The effect of a superconducting wiggler on the stored electron beam is also discussed.

Phase shift and radiation spectrum of a straight series of undulators

In constructing a very long undulator it is convenient to separate the undulator into a number of sections with a constant gap distance between the sections. The properties of the radiation spectrum expected in such an undulator were investigated assuming ideal short undulators for each section. It is shown that the peak height and width of the spectrum do not deteriorate if the radiation phases of the sections are matched to each other, even with a large gap distance. This can be realized by adjusting the field strength of the three-pole wigglers installed in each gap.

Coronary angiographic finding of thrombus in the left atrial appendage

PURPOSE

The value of coronary angiography in the diagnosis of thrombus in the left atrial appendage (LAA) was retrospectively analyzed.

MATERIAL AND METHODS

The study covers 34 patients in whom coronary angiography showed coronary neovascularity in LAA with coronary artery-left atrial fistula indicating LAA thrombus. All 34 patients underwent transthoracic echocardiography within one week of coronary angiography. Open-heart surgery was undertaken 2-31 months after angiography in 28 patients.

RESULTS

Coronary neovascularity and coronary artery-left atrial fistula arose from the left circumflex artery in 28 patients, and from the left circumflex artery and the right coronary artery in the remaining 6 patients. By echocardiography, LAA thrombus was detected in only one of the 34 patients. In 18 of the 28 patients who underwent open-heart surgery, LAA thrombus was found at surgery to have resolved.

CONCLUSION

Coronary angiography is useful in the diagnosis of LAA thrombus, and coronary neovascularity and fistula formation may indicate that the thrombus can spontaneously resolve.

The left ventriculographic pattern and serial electrocardiographic changes in hypertrophic cardiomyopathy patients with giant negative T waves

The configuration of the left ventriculogram (LVG) was classified in 64 patients with hypertrophic cardiomyopathy (HCM) observed in ECG, and characteristics of the configuration and serial changes in SV1+RV5 and giant negative T (GNT) waves were studied. The LVG configuration was classified into the spade (15 patients), papillary-muscle hypertrophy (PMH; n = 23), oval (n = 24) and banana types (n = 2). The spade, PMH and oval types were observed for mean periods of 66, 90 and 91 months, respectively. Serial changes in ECG were as follows: GNT decreased from 16.7 +/- 3.3 to 13.3 +/- 5.1 mm in the spade type and decreased significantly from 16.9 +/- 5.9 to 9.8 +/- 6.9 mm in PMH but showed no changes in the oval type. SV1+RV5 decreased significantly from 69.0 +/- 14.9 to 58.2 +/- 14.7 mm in PMH but showed no significant changes in the spade or oval types. Thus GNT decreased progressively in many patients with the exception of a few with the oval type. From these findings, we consider that apical hypertrophy had been established at the time of the initial LVG and changed over time thereafter in the spade and PMH types but that hypertrophy was still in progress in some patients with the oval type.

Iodine-123-metaiodobenzylguanidine myocardial imaging in patients with right ventricular pressure overload

Iodine-123-metaiodobenzylguanidine ([123I]MIBG) has been used to evaluate the cardiac sympathetic nervous system, particularly that of the left heart. To clarify whether the right ventricular (RV) sympathetic neuronal function could be evaluated by [123I]MIBG myocardial imaging, we applied the technique in patients with pulmonary hypertension that was associated with either chronic pulmonary diseases or pulmonary vascular diseases.

METHODS

All patients underwent right heart catheterization, and right heart hemodynamics were determined during a clinically stable state. SPECT was performed in the resting state 15 min (early imaging) and 4 hr (delayed imaging) postadministration of [123I]MIBG. Seven regions of interest (ROI) were selected on the delayed short-axis images on the RV free wall, left ventricular (LV) free wall and interventricular septum (IVS). We calculated the IVS-to-LV uptake ratio from the scintillation counts of the ROI. Thallium-201 myocardial imaging was also performed within 1 wk after [123I]MIBG imaging.

RESULTS

Images obtained with these techniques were analyzed for the RV-to-LV uptake ratio. The IVS-to-LV ratio on [123I]MIBG correlated negatively and significantly with the mean pulmonary arterial pressure (PAm). The RV-to-LV uptake ratio on 201Tl images correlated significantly with PAm.

CONCLUSION

Our results suggest that the uptake ratio of [123I]MIBG in the IVS is a useful index for evaluating the severity of pulmonary hypertension, and that chronic RV pressure overload contributes to disturbances of the cardiac sympathetic nervous system.

Thymus-related liposarcoma: report of a case and review of the literature

We report herein the case of a 77-year-old woman who was admitted to our hospital for further evaluation of an abnormal shadow in the right upper mediastinum that had been revealed by a routine chest X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed the presence of a thymic tumor, but did not show any evidence of invasion into the central vessels or adjacent structures. Thus, an extended thymectomy with resection of the tumor was performed. Microscopically, normal thymic tissue was found among the tumor cells, and a pathological diagnosis of well-differentiated liposarcoma was established. From the operative and microscopic findings, it is apparent that the tumor was related to the thymus. Postoperative irradiation of 60 Gy was delivered to the operative site and the patient has remained free of disease for 29 months since the operation.

Noninvasive assessment of right heart function by 81mKr equilibrium radionuclide ventriculography in chronic pulmonary diseases

Noninvasive multigated equilibrium radionuclide ventriculography with krypton-81m (81mKr) was used to assess right heart relaxation in patients with chronic pulmonary diseases (CPD). The subjects consisted of 30 patients with CPD and 8 patients free of cardiopulmonary diseases admitted to our department. A region of interest (ROI) was selected on both the right atrium (RA) and right ventricle (RV). A time activity curve was obtained for each ROI. As a diastolic index of the right heart performance, the right atrial early emptying rate (RAER) was obtained from the right atrial time activity curve, while the right ventricular rapid filling rate (RVRFR) was obtained from the right ventricular time activity curve. The mean RAER was significantly lower in CPD patients compared with the control (CPD, 9.5 +/- 4.5; control, 16 +/- 3.4%/100 ms). Similarly, the mean RVRFR was significantly lower in CPD patients compared with the control (CPD, 27.3 +/- 9.9; control, 34 +/- 8.5%/100 ms). A strong negative correlation was noted between the mean pulmonary arterial pressure (mPAP) and RAER (r = -0.77; p < 0.001) and between the mPAP and the RVRFR (r = -0.63; p < 0.001). Our results suggest that RAER and RVRFR measured by 81mKr are clinically useful in the noninvasive assessment of right heart relaxation in patients with CPD.

Pulsed Doppler echocardiographic assessment of changes in pulmonary artery pressure during oxygen breathing

To validate the use of pulsed Doppler echocardiography in detecting changes in pulmonary artery pressure (PAP), several parameters of flow velocity profiles of the right ventricular outflow tract were compared with changes in PAP and pulmonary vascular resistance measured directly by cardiac catheterization. The study was performed in 33 patients with chronic pulmonary disease (chronic obstructive pulmonary disease or pulmonary fibrosis) or pulmonary thromboembolism, during room air and 100% oxygen breathing. Inhalation of 100% oxygen for 15 min significantly reduced PAP in patients with mild pulmonary hypertension (20 < or = mean PAP < or = 24 mm Hg; control: 21.3 +/- 1.3, O2: 17.9 +/- 2.2 mm Hg, p < 0.05) and those with severe pulmonary hypertension (mean PAP > or = 25 mm Hg; control 44.9 +/- 16.8, O2: 35.4 +/- 13.5 mm Hg, p < 0.05). It also significantly reduced the pulmonary vascular resistance and cardiac output in both groups. The ratio of acceleration time to right ventricular ejection time (AT/RVET), a parameter measured by Doppler echocardiography, correlated significantly with mean PAP during room air (r = 0.73, p < 0.0001) and oxygen breathing (r = 0.64, p < 0.0001). Furthermore, AT/RVET increased significantly in patients with mild pulmonary hypertension and those with severe pulmonary hypertension. Our results suggest that the Doppler technique provides a clinically useful, noninvasive index for assessing changes in PAP during oxygen breathing in patients with pulmonary hypertension complicating chronic pulmonary disease or pulmonary thromboembolism.

Effects of nicorandil on kinetics of oxygen uptake at the onset of exercise in patients with coronary artery disease

The beneficial effects of coronary vasodilators on exercise capacity in patients with angina pectoris are well known. However, their effects on oxygen uptake (VO2) kinetics at the onset of exercise have not been elucidated. The present study was undertaken to determine the acute effects of nicorandil, a newer coronary vasodilator, on the kinetics of VO2 at the onset of exercise in patients with ischemic heart disease. Ten patients with significant coronary stenosis performed constant mild-intensity cycle exercise (32 +/- 3 W) for 6 minutes after oral administration of 10 mg of nicorandil or an identical placebo in a double-blind, crossover manner. Nicorandil had no effect on resting heart rate, blood pressure, or VO2. However, the time constant for the increase in VO2 during constant work rate exercise was significantly shorter (the kinetics of VO2 were faster) after administration of nicorandil than after placebo (46.5 +/- 13.3 vs 51.1 +/- 11.9 seconds; p = 0.039). The increase in VO2 at 6 minutes compared with 3 minutes of constant work, which reflects the VO2 kinetics, also was reduced with nicorandil (3.8 +/- 37.9 vs 27.5 +/- 27.1 ml/min; p = 0.022). Nicorandil was found to increase the rate of VO2, increase during the onset of constant work rate exercise, probably as a result of an improved response in cardiac output. Analysis of VO2 kinetics provides new and useful parameters for the evaluation of circulatory adjustments at the onset of exercise in patients with ischemic heart disease.

[Evaluation of the pulmonary vascular bed by digital subtraction angiography]

We studied the usefulness of digital subtraction angiography for evaluating the pulmonary capillary bed. Four individuals underwent the procedure. One was a healthy volunteer and the others were patients with chronic pulmonary emphysema. During catheterization, an 8 F balloon catheter was manipulated into the right pulmonary artery. A total of 20 ml of contrast material was injected at a rate of 10 ml/sec at full inspiration. In the normal subject, the capillary bed filled homogeneously and no defect was seen. In the patients, the pulmonary artery was nearly normal, but severe defects were observed in the pulmonary capillaries. Contrast resolvability was greater with digital subtraction pulmonary angiography than with pulmonary perfusion scintigraphy or pulmonary arteriography. This technique makes possible the visual evaluation of the pulmonary capillary bed.

Interpretation of extravascular thermal volume of the lung in patients with chronic pulmonary diseases

To understand the significance of measured extravascular thermal volume of the lung (ETVL) in chronic pulmonary diseases, we measured ETVL using the double-indicator dilution technique in 17 emphysematous patients and 15 patients with pulmonary fibrosis. The level of ETVL in emphysema is significantly correlated with parameters reflecting the severity of the disease, including FEV1.0% (r = 0.54, p < 0.05), DLCO/VA (r = 0.54, p < 0.05), PaO2 (r = 0.61, p < 0.01), and mean pulmonary artery pressure (r = -0.61, p < 0.01). In pulmonary fibrosis, a significant inverse correlation was found between ETVL and PaO2 (r = -0.64, p < 0.02), DLCO/VA (r = -0.58, p < 0.05), and %VC (r = -0.61, p < 0.02). The mean level of ETVL in both groups of patients was lower than previously reported normal values. These results suggest that ETVL may reflect the decrease in pulmonary vasculature in emphysematous patients, while it may signify a decrease of pulmonary vasculature and increased volume of pulmonary interstitial tissue surrounding the pulmonary vasculature in pulmonary fibrosis. We conclude that ETVL may represent a good estimate of the condition of the pulmonary vasculature and interstitial tissue volume in patients with chronic pulmonary diseases.

Monitoring of nocturnal oxygen desaturation using pulse oximeter and apnomonitor in patients with chronic pulmonary disease

The relationship between the degree of nocturnal oxygen desaturation (NOD) and pulmonary hemodynamics, pulmonary function tests, and resting awake blood gases was evaluated in patients with chronic pulmonary diseases (CPD). The severity of NOD correlated with the degree of impairment of pulmonary hemodynamics, but not with pulmonary function tests or resting awake blood gases. NOD was markedly alleviated by oxygen inhalation in CPD patients who did not develop sleep apnea.

Assessment of right ventricular diastolic function by pulsed Doppler echocardiography in chronic pulmonary disease and pulmonary thromboembolism

We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

Ventilatory and pulmonary vascular responses to acute hypoxia are nonuniform in healthy man

The present study was undertaken to examine the pulmonary vascular and ventilatory responses to acute hypoxia in healthy individuals. Pulmonary hemodynamics and minute ventilation (VE) were serially measured during inhalation of 13% O2 for 15 min. There was a wide variability in the pulmonary vascular response to acute hypoxia, and a significant negative correlation between the initial increase in VE after the start of hypoxia (delta VE) and the percent increase in mean pulmonary arterial pressure (r = -0.646; p < 0.01). The fall in arterial oxygen tension significantly decreased in response to an increase in delta VE. These results support the view that a blunted ventilatory response to acute hypoxic stimulation enhances alveolar hypoxia, thereby favoring the constriction of pulmonary vasculature. Thus, our results suggest that the ventilatory response to acute hypoxia plays a significant role in the pulmonary vascular response to acute hypoxia.

Immunohistochemical study of human advanced glycosylation end-products (AGE) in chronic renal failure

In patients with diabetic renal failure plasma advanced glycosylation end-products (AGE) levels are reported to be elevated and dialyzer of continuous ambulatory peritoneal dialysis (CAPD) is usually used with a high glucose concentration. Here, an immunohistochemical study on human AGE accumulation in vascular beds and peritonea of patients with chronic renal failure (CRF) or those on CAPD was undertaken. Further, the influence of aging was studied using AGE-specific monoclonal antibody. 1. AGE accumulation was observed in radial arterial walls (from vascular intima to smooth muscle layer) of diabetic patients with CRF. Even in some non-diabetic patients with CRF (n = 3/6), especially in those with a long history of CRF and dialysis treatment, similar positive staining was seen in vascular walls. No AGE staining was observed in any renal tissue of age-matched control subjects including tissue from patients with acute renal failure. 2. Although AGE accumulation was not seen in the peritonea of CRF patients with no prior CAPD therapy, it was seen in the mesothelial layers and in adjacent coarse connective tissues of peritonea from patients on CAPD (n = 6), even from as early as only 3 months of CAPD therapy. 3. AGE accumulation was observed in the vascular bed of the non-diabetic aged kidney with normal function, but not in that of the young kidney. Thus, AGE accumulation in the vascular bed may depend on the degree and term of renal impairment and on aging in addition to diabetes. AGE accumulation in the peritonea became positive following CAPD treatment, indicating that it might affect the efficiency of CAPD.

In vitro and in vivo growth of B16F10 melanoma cells transfected with interleukin-4 cDNA and gene therapy with the transfectant

In an attempt to develop the most effective cytokine gene therapy, we transfected mouse interleukin(IL)-2, mouse IL-4, and human IL-6 cDNAs into mouse melanoma cells, B16F10. Transfection with IL-4 cDNA decreased the tumorigenicity of B16F10 most strongly. We investigated whether gene therapy with IL-4-transfected B16F10 cells was possible. Flow-cytometric analysis showed that major histocompatibility complex class I and II expression in B16F10 and IL-4-cDNA-transfected B16F10 (B16F10-IL4) cells did not differ. Doubling times of B16F10 and B16F10-IL4 were 20.1 and 21.1 h respectively. The growth of B16F10 cells was retarded if C57BL/6 mice were inoculated with B16F10-IL4 at the contralateral sides. When 5 x 10(5) B16F10 cells were transplanted subcutaneously into the flanks of C57BL/6 mice, they all developed a tumor mass, whereas no tumor masses formed in those transplanted with B16F10-IL4 cells within 60 days. No nude, severe combined immunodeficient or beige mice were able to reject parental B16F10 or B16F10-IL4 cells, although, B16F10-IL4 tumor growth in all these immunodeficient mice was slower than that of B16F10. Therefore, we concluded that T and natural killer cells are necessary for rejection of B16F10-IL4 tumor cells.

[A case of intracranial glioma which demonstrated extramedullary growth]

An unusual case of an intracranial glioma which demonstrated extramedullary growth is reported. The patient was a 39-year-old woman who had experienced headache, nausea and vomiting for about 1 month. On admission she showed slight disturbance of consciousness and bilateral papilloedema. CT scan and MR imaging disclosed a mass approximately 5 cm in diameter in the right frontal region, with clear demarcation from the neighboring gyri. Right external carotid angiogram revealed A-V shunts in the mass, but by right internal carotid angiogram, no abnormal findings were disclosed except for the deviation of normal intracranial vessels due to the existence of the mass. Therefore, a preoperative diagnosis of extramedullary tumor such as meningioma and epidermoid was made. Right frontal craniotomy was performed, and the tumor was proven to exist in subdural space. The boundary of the tumor to the brain surface was distinct except for one part. Histopathologically, the tumor cells had abundant eosinophillic cytoplasms, with eccentric-distribution of their nuclei. Furthermore, they were positive for staining for GFAP and S-100 protein. Therefore, a final diagnosis of gemistocytic astrocytoma was made. Reviewing some references the authors discuss here the form of development and progression of intracranial gliomas which demonstrate extramedullary growth such as this case.