Comparative effects of oral acebutolol and propranolol at rest and during exercise in ischemic heart disease: double-blind placebo crossover study utilizing radionuclide ventriculography

Acebutolol is a new investigational beta-antagonist which has intrinsic sympathomimetic and cardioselective properties. In this study its effects on the ischemic consequences following supine bicycle exercise were compared to those of propranolol in 16 patients with chronic stable coronary artery disease (CAD) using a double-blind placebo crossover protocol and equilibrium radionuclide ventriculography. In eight patients (group I), the left ventricular ejection fraction (LVEF) at peak exercise fell under control conditions. During chronic acebutolol therapy (400 mg thrice daily), the exercise-induced LVEF (means +/- 1 SD) was significantly higher (37.1 +/- 15.5% versus 42.2 +/- 14.3%; p less than 0.05). The corresponding values during placebo and during propranolol (80 mg thrice daily) were 39.2 +/- 12.3% versus 43.4 +/- 14.8% (p = 0.07). In eight patients (group II) in whom supine bicycle exercise produced increases in LVEF, both acebutolol (58.8 +/- 5.4% versus 53.8 +/- 4.4%) and propranolol (57.8 +/- 5.7% versus 54.1 +/- 4.9%) attenuated the increases. In neither group was the resting LVEF reduced by acebutolol or propranolol. The data show that acebutolol and propranolol are approximately equipotent in minimizing the radionuclide left ventriculographic manifestations of myocardial ischemia induced by supine bicycle exercise.

Preparation of monoclonal antibodies against DNA-cytosine-5-methyltransferase from human placenta

Mouse monoclonal antibodies were prepared against DNA-cytosine-5-methyltransferase (EC 2.1.1.37) from human placenta by conventional hybridoma technology. Spleen cells from BALB/c mice immunized with highly purified enzyme were fused to X-63 Ag8.653 mouse myeloma cells. After the hybrid selection in HAT medium individual clones were screened for production of antibodies directed against the enzyme by use of solid-phase ELISA or RIA in which highly purified DNA methyltransferase was either immobilized on microtiter plates or 125I-labeled enzyme was used as a tracer. Positive clones were subcloned, re-screened in the same system and the presence of antibodies directed against DNA methyltransferase was definitively proved in a test system in which the enzyme activity was removed from the solution in immune complexes precipitated by anti mouse immunoglobulin antibodies. From more than 3800 constructed clones 8 were selected which produced antibodies against DNA methyltransferase from human placenta. These antibodies may serve as a useful tool for analysis of DNA methyltransferase structure, intracellular localization and molecular heterogeneity of this enzyme.

Quantitation of myocardial infarct size from thallium-201 images: validation of a new approach in an experimental model

A new computer-based method has been developed to quantitate myocardial infarct size from the size of the regional thallium-201 deficit. The operator outlines the left ventricular myocardial activity with an ellipse. The program then plots the background-corrected activities of the highest mean value in a 3 pixel myocardial band perpendicular to and within the ellipse. The approach uses a new interpolative background correction. To determine the accuracy of this approach in assessing regional thallium deficit size, acute myocardial infarction was produced in six dogs by 24 hour occlusion of the proximal left anterior descending coronary artery. Infarct size was assessed from planar thallium images of the dog heart in three views, each with the chest opened and closed and with the heart excised and placed in a cradle. Before removal of the heart, triphenyltetrazolium chloride was infused to delineate normal from infarct tissue. Transverse slices of left ventricle were made and thallium images of the slices acquired. Infarct size delineated by triphenyltetrazolium chloride staining was expressed as a percent of the total left ventricular slice surface area (planimetric infarct size). Infarct size from whole heart and left ventricular slice thallium images was expressed as a percent of the total length of the left ventricular perimeter (perimetric infarct size). This was determined from points below a certain percent of normalized peak thallium activity in the computer-generated thallium activity curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of right ventricular function using two-dimensional echocardiography

With the use of two-dimensional echocardiography (2DE), we analyzed apical and subcostal four-chamber views for evaluation of right ventricular (RV) function in 30 individuals as compared to RV ejection fraction (RVEF) obtained by radionuclide angiography. In addition to previously reported parameters of changes in areas and chords, a new simple measurement of tricuspid annular excursion was correlated with RVEF. A close correlation was noted between tricuspid annular plane systolic excursion (TAPSE) and RVEF (r = 0.92). The RV end-diastolic area (RVEDA) and percentage of systolic change in area in the apical four-chamber view also showed close correlation with RVEF (r = -0.76 and 0.81); however, the entire RV endocardium could only be traced in about half of our patients. The end-diastolic transverse chord length and the percentage of systolic change in chord length in the apical view showed a poor correlation with RVEF. The correlation between RVEF and both areas and chords measured in the subcostal view was poor. It is concluded that the measurement of TAPSE offers a simple echocardiographic parameter which reflects RVEF. This measurement is not dependent on either geometric assumptions or traceable endocardial edges. When the endocardial outlines could be traced, the apical four-chamber view was superior to the subcostal view in assessment of RV function.

Sources of variability in the radionuclide angiographic assessment of ejection fraction: a comparison of first-pass and gated equilibrium techniques

Measurements of ejection fractions (EF) determined by first-pass and gated equilibrium radionuclide angiography are widely believed to be equivalent. To compare these measurements in a large group of patients over a wide range of EF values, left ventricular (LV) and right ventricular (RV) EFs at rest were measured in 135 consecutive patients who underwent the 2 methods of radionuclide angiography within 1 hour: first-pass upright with a multi-crystal camera in the anterior projection and gated equilibrium supine with a single-crystal camera in the left anterior oblique projection. The population included 18 normal patients and 117 patients with various cardiac and pulmonary disorders. First-pass and gated equilibrium LVEF correlated well (r = 0.83, p less than 0.001), but the slope of the regression line was different from unity, with the first-pass values lower than the gated equilibrium values (0.51 +/- 0.16 vs 0.56 +/- 0.15, p less than 0.05 [mean +/- standard deviation] ). Among the 45 patients with a gated equilibrium LVEF of less than or equal to 0.50, the correlation (r = 0.84) was better than that for the 90 patients with a LVEF greater than 0.50 (r = 0.44, p less than 0.05). However, in the latter group, the correlation remained good in the 15 patients with cardiomegaly due to aortic or mitral regurgitation (r = 0.80). Inter- and intraobserver error was similar for both methods. In contrast, there was a poor correlation between first-pass and gated equilibrium RVEF, with the first-pass values higher than the gated equilibrium values (0.51 +/- 0.11 vs 0.43 +/- 0.11, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Atypical echocardiographic and angiographic presentation of a postoperative pseudoaneurysm of the left ventricle after repair of a true aneurysm

Subsequent to the repair of a true aneurysm from the posteromedial-basal aspect of the left ventricle, a 58 year old man developed a draining wound at the site of the sternotomy. Two-dimensional echocardiography revealed recurrence of the aneurysm at the site of the previous aneurysm repair. This aneurysm had a wide neck and looked similar in appearance to the previous true aneurysm. However, at surgery the patient was found to have a ventricular pseudoaneurysm with a cardiocutaneous fistula.

Chronic effects of myocardial infarction on right ventricular function: a noninvasive assessment

To assess the chronic effects of myocardial infarction on right ventricular function, 48 subjects were studied utilizing radionuclide angiography and two-dimensional echocardiography. Ten were normal subjects (group I), 11 had previous inferior wall myocardial infarction (group II), 10 had previous anteroseptal infarction (group III), 11 had combined anteroseptal and inferior infarction (group IV) and 6 had extensive anterolateral infarction (group V). The mean (+/- standard deviation) left ventricular ejection fraction was 0.66 +/- 0.03 in group I, 0.58 +/- 0.02 in group II, 0.52 +/- 0.02 in group III, 0.33 +/- 0.03 in group IV and 0.33 +/- 0.01 in group V. No systematic correlation between left and right ventricular ejection fraction was observed among the groups. The mean right ventricular ejection fraction was significantly reduced in the presence of inferior myocardial infarction (0.30 +/- 0.03 in group II and 0.29 +/- 0.03 in group IV compared with 0.43 +/- 0.02 in group I [p less than 0.001]). The group II and IV patients also had increased (p less than 0.001) right ventricular end-diastolic area and decreased (p less than 0.001) right ventricular free wall motion by two-dimensional echocardiography. In the presence of anteroseptal infarction (group III), right ventricular free wall motion was increased (p less than 0.05) compared with normal subjects (group I). Thus, the effects of prior myocardial infarction on right ventricular function depend more on the location of infarction than on the extent of left ventricular dysfunction. Inferior infarction was commonly associated with reduced right ventricular ejection fraction and increased right ventricular end-diastolic area. The right ventricular free wall excursion was increased in the presence of anteroseptal infarction, suggested loss of contribution of interventricular septal contraction to right ventricular ejection.

Interventricular septal and free wall dynamics in hypertrophic cardiomyopathy

Two-dimensional echocardiography was used to analyze interventricular septal and free wall dynamics in eight normal subjects and eight patients with hypertrophic cardiomyopathy. Upper, middle and lower septal and corresponding free wall motion and thickening were analyzed using both fixed and floating reference systems. The lower and midseptal dynamics did not seem to differ significantly between the two groups and the lower septum seemed to move more than the corresponding free wall (probability [p] less than 0.05). The upper septum moved and thickened less than the rest of the septum in both groups (p less than 0.05), but was less dynamic in patients with hypertrophic cardiomyopathy than in normal subjects when the fixed reference system was used (p less than 0.05). It is concluded that the interventricular septum in hypertrophic cardiomyopathy is not akinetic. Previously reported hypokinesia of the septum in hypertrophic cardiomyopathy may be due to sampling of the upper septum by M-mode echocardiography and to the fixed system of reference used by M-mode echocardiography.

Enzymatic hypermethylation of DNA in mouse-mouse somatic cell hybrids

Somatic cell hybrids between mouse L fibroblasts (A9 cells) and Ehrlich ascites tumour cells were constructed by use of poly(ethyleneglycol). The hybrids were selected in hypoxanthine/aminopterin/thymidine medium and morphologically different syncaryons were isolated by a micromanipulation. They were simultaneously analysed for their tumourogeneity, a release of certain proteins into the culture medium, the activity of pyrimidine salvage pathways, and the extent of enzymatic DNA methylation. None of these hybrids gave a rise of tumours if transplanted into DBA/2 mice. Two of the hybrids released a protein immunologically cross-reacting with antibody against C-peptide of human proinsulin. Activities of pyrimidine salvage pathways as measured by incorporation of [14C]deoxycytidine into DNA cytosine and thymine, respectively, are different in the analyzed cells. Enzymatic DNA methylation in somatic cell hybrids was significantly elevated as compared to the parental cell lines.

Ventriculitis, aqueductal stenosis and hydrocephalus in neonatal meningitis: diagnose and treatment

Five newborns are presented who had meningitis and developed aqueductal stenosis. The diagnosis of obstruction was made by ventriculography during the course of meningitis. A variety of therapeutic measures (use of intraventricular antibiotics, use of reliably diffusible antibiotics, drainage of ventricles) led to varying results. Protocols should be established to assess each modality or combination thereof to help reduce the extremely high morbidity and mortality of this disease.

Nutritive role of different carbohydrates for the growth and survial of Oryzaephilus mercator Fauvel (Coleoptera)

Recent investigations on the nutritive role of different carbohydrates for the survival and growth of Oryzaephilus mercator show that fructose, glucose, dextrin and glycogen are of high nutritive value, fructose being even better than natural control diet (wheat + 5% yeast). Maltose, soluble starch, mannitol and sorbitol, although support some growth, are not of as good nutritive value as control diet. All pentoses, sorbose, galactose, lactose, raffinose, potato starch, inulin and dulcitol are of no nutritive value.

Beneficial effects of L-methionine in choline deficient diets of Oryzaephilus mercator (Fauvel) (Coleoptera)

Choline is an indispensable vitamin for Oryzaephilus mercator as its ommission in the diet results in slow growth and poor survival. These deficiency symptoms can be overcome by adding L-methionine to the choline-deficient diet. L-methionine however can improve the efficiency of the diet only up to a certain concentration beyond which no beneficial effects are recorded.