Activity in the human primary motor cortex related to arm and finger movements

With the purpose of mapping representations of the finger and proximal arm in the human primary motor cortex (MI), we measured regional cerebral blood flow (rCBF) in eight right-handed normal volunteers during self-paced finger and proximal arm movements. Each movement activated two different fields in MI, one located deep in the anterior lip of the central sulcus and the other relatively close to the surface of the precentral gyrus. Arm fields were located higher than finger fields. A superficial arm field and a deep finger field partially, overlapped. The results indicate that there are two spatially separate motor representations of the finger and proximal arm in the human MI.

A comparative study of 123I-IMP SPET and CT in the investigation of chronic-stage head trauma patients

The aims of this study were (1) to compare N-isopropyl-p-[I-123]-iodoamphetamine (123I-IMP) SPET with computed tomography (CT) in chronic-stage head trauma patients with neurological abnormalities and (2) to quantify regional cerebral blood flow (rCBF) in patients with chronic-stage head trauma. 123I-IMP SPET and CT were performed in 23 patients with chronic-stage head trauma and 12 normal controls. Both types of imaging were evaluated visually. In addition for the SPET images, the rCBF in 12 regions (bilateral frontal cortex, temporal cortex, parietal cortex, occipital cortex, perilolandic area, cerebellum: total 276 regions) was analysed quantitatively using a reference sampling method. In total, 39 focal lesions related to neurological abnormalities were detected. Although 22 (56.4%) lesions were observed using both CT and SPET, another 17 (43.6%) were detected by SPET only. The mean rCBF in the localized lesions of each lobe, which correspond to low-density areas (LDAs), were lower on CT than those of each lobe seen only on SPET. These rCBF values were lower than the mean rCBF values in the lobes of the controls. The mean rCBF values in each lobe with visually normal tracer uptakes were also significantly lower in the 23 patients than in the controls. 123I-IMP SPET is useful for demonstrating brain dysfunction in morphologically intact brain regions and for providing objective evidence to account for the clinical presentation of patients presenting with chronic traumatic brain injury.

Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis

The diameter of the inferior vena cava (IVC) measured by ultrasonography is used as a parameter to estimate right sided cardiac function and central venous pressure. In the current study the IVC diameter during and after hemodialysis (HD) was measured in chronic HD patients to explore the determinant factors of the diameter, and these results were obtained: 1) the maximal diameter of the IVC during quiet expiration (IVCe) can be a marker of circulating blood volume during as well as after HD, because the linear correlation between IVCe and circulating blood volume during and after HD were significant and almost identical; 2) the amount of ultrafiltration is the major determinant of IVCe during HD, because IVCe and circulating blood volume decreased in parallel with the amount of ultrafiltration during HD; and 3) since the recovery of IVCe and circulating blood volume, which correlated with the increase in serum protein concentration during HD, was almost complete while the body weight remained unchanged after HD, plasma refilling rather than body fluid retention was considered important in the recovery of IVCe and circulating blood volume after HD.

Guillain-Barré syndrome following fulminant viral hepatitis A

Guillain-Barré syndrome (GBS) developed soon after the onset of acute viral hepatitis A (HA) in a 62-year-old man. GBS associated with HA is extremely rare, even though HA is common. In a review of case reports the clinical features of GBS following HA could be summarized as follows: 1) Most of the patients are men. 2) GBS develops within 14 days after the onset of HA. 3) Facial nerve palsy is frequently present. 4) Proprioception is likely impaired in addition to superficial sensation. 5) The outcome of neuropathic symptoms is uniformly good, regardless of the degree of liver dysfunction as evaluated on the basis of alanine aminotransferase levels. These findings indicate that GBS following HA essentially does not differ from typical GBS.

[Clinical and experimental studies of septic DIC in surgical patients, in terms of its characteristic features and pathogenesis]

I have experienced 35 cases of DIC in my department during last 8 years. These cases were divided into a septic and non-septic groups based on their back-ground, and compared their clinical symptoms and various laboratory findings. The results showed the septic DIC group could be characterized as follows: (1) impairment of the vital organs was more clearly manifested, while hemorrhagic symptoms were mild, (2) the laboratory tests showed almost no tendency for fibrinogen or alpha 2-PI to be decreased or PIC to be increased, (3) the blood PAF (Platelet Activating Factor) level was clearly higher and showed an inverse relationship with the platelet count. On the basis of these clinical findings, I speculated septic DIC involves suppression of secondary fibrinolysis and participation of PAF. In experiment A, I investigated the effects of endotoxin (Et) on the activity of plasminogen activator (PA) in the rabbit renal cortex. In both in vitro and in vivo systems, I could demonstrate the renal cortex PA activity was significantly suppressed by Et. Then, in experiment B, I could confirm, (1) PAF caused a drop in the blood pressure and a decrease in the platelet count that were similar to those induced by Et, and that Et caused a decrease in the platelet count that was inversely accompanied by an increase in PAF, (2) PAF antagonist showed greater efficacy than a protease inhibitor in suppressing the decrease in the blood platelet count.

[Two cases of malignant effusion treated successfully by loco-regional administration of carboplatin]

We encountered two cases of malignant effusion treated successfully by loco-regional administration of carboplatin (CBDCA). One case was a 60-year-old male showing recurrent non-small cell lung cancer (adenocarcinoma) with pericarditis carcinomatosa. A drainage from the pericardial cavity was performed and a total dose of 600 mg (single dose, 300 mg) of CBDCA was administered into the cavity. Malignant effusion disappeared and radiographic improvement was also observed. No pericardial effusion was observed for about 4 months after the loco-regional treatment, till he died of lung cancer. Another case was a 58-year-old male having invasive thymoma (mixed cell type) with pleuritis carcinomatosa. He received palliative radiation therapy and systemic cancer chemotherapy concurrently. As a loco-regional therapy, drainage from the pleural cavity was performed, and 300 mg of CBDCA and 10 KE of OK-432 were administered into the cavity. A remarkable reduction of pleural effusion was observed after the therapy. No increase of pleural effusion has been observed radiographically for about 18 months, and the patient is still alive with the tumor. The side effects due to loco-regional administration of CBDCA were quite tolerable in both cases.

Subtype- and species-selectivity of a tachykinin receptor antagonist, FK888, for cloned rat and human tachykinin receptors

We investigated the receptor-binding properties and potencies of FK888 (N2-[(4R)-4-hydroxy-1-(1-methyl-1H-indol-3-yl)carbonyl-L-prolyl]-N- phenylmethyl-3-(2-naphthyl)-L-alaninamide), a tachykinin receptor antagonist, for the rat and human tachykinin receptor subtypes (NK1, NK2 and NK3) expressed in transfected mammalian cells. In displacement analyses, using membrane preparations derived from monkey kidney COS-7 cells transiently expressing tachykinin receptor subtypes, FK888 showed a subtype selectivity for NK1 receptor and its affinity for the human NK1 receptor was 320-fold higher than that for the rat NK1 receptor, demonstrating species difference in its binding affinity. This was in marked contrast to FK224 (N-[N2-[N-[N-[N-[2,3-didehydro-N-methyl-N-[N-[3-(2-pentylphenyl )- propionyl]-L-threonyl]tyrosyl-L-leucynyl]-D-phenylalanyl]-L- allothreonyl]-L-asparaginyl]-L-serine-n-lactone) that was selective for NK1 and NK2 receptors with similar affinities for the rat and human receptors. In Chinese hamster ovary cells permanently expressing the human NK1 receptor, FK888 inhibited the substance P-induced phosphatidylinositol hydrolysis and produced a parallel shift in the dose-response curve for substance P. Schild analysis of the antagonism of phosphatidylinositol hydrolysis by FK888 yielded a pA2 value of 8.9 and a slope of 0.97 of the regression line. FK888 itself showed no stimulatory effect on phosphatidylinositol hydrolysis in Chinese hamster ovary cells expressing the human NK1 receptor. Thus, FK888 is a potent, competitive and selective antagonist for human NK1 receptor.

Functional anatomy of taste perception in the human brain studied with positron emission tomography

Regional cerebral blood flow (rCBF) was measured with positron emission tomography (PET) in 10 normal volunteers with the purpose of measuring rCBF changes related to taste physiology. Discrimination of 0.18% saline from pure water was associated with significantly increased rCBF values in the thalamus, the insular cortex, the anterior cingulate gyrus, the parahippocampal gyrus, the lingual gyrus, the caudate nucleus, and the temporal gyri. The results indicate that rCBF changes in these structures may reflect oral exposure to salt.

ATP and calcium modulation of nonselective cation channels in IMCD cells

The mIMCD-3 cell line, developed from simian virus 40 transformed mice, was grown on coverslips for single-channel analysis of the apical membrane. An amiloride-sensitive nonselective cation channel (NCATP) was demonstrated that occurred predominantly in excised patches. The selectivity sequence for NCATP was NH4+ = Na+ = K+ = Li+ = Rb+ > Cl-. The single-channel conductance was 24 pS and nonrectifying in 140 mM KCl or NaCl solutions. NCATP was not permeable to barium from the extracellular side. NCATP was not voltage gated but was activated spontaneously upon patch excision or after applying negative pressure (20-40 mmHg) to an excised patch in bath solutions containing 1 microM Ca2+ [mean number of open channels (NPl) = 1.45]. NCATP was not activated when excised into a bath solution in which Ca2+ was reduced to 100 nM. The open probability of NCATP was reduced by 68% when 2 mM ATP was added to the intracellular side of an excised patch but was unaffected when 0.1 mM 8-bromoguanosine 3',5'-cyclic monophosphate was added to the intracellular side. In cell-attached patches, NCATP was activated upon response to a hyposmotic (210 mosmol/kgH2O) bathing solution containing 0.5 mM Ca2+ (NPo = 0.35). These results show that the mIMCD-3 cell line contains a volume-sensitive nonselective cation channel that is modulated by ATP and calcium but not guanosine 3',5'-cyclic monophosphate. It is postulated that NCATP may act to initiate the volume regulatory response in IMCD cells.

Peripheral neuropathy associated with dialysis amyloidosis

Images

[A simple method for measurement of cerebral blood flow using 123I-IMP SPECT with calibrated standard input function by one point blood sampling; validation of calibration by one point venous blood sampling as a substitute for arterial blood sampling]

In a simplified method for measurement of cerebral blood flow using one 123I-IMP SPECT scan and one point arterial blood sampling (Autoradiography method), input function is obtained by calibrating a standard input function by one point arterial blood sampling. A purpose of this study is validation of calibration by one point venous blood sampling as a substitute for one point arterial blood sampling. After intravenous infusion of 123I-IMP, frequent arterial and venous blood sampling were simultaneously performed on 12 patients of CNS disease without any heart and lung disease and 5 normal volunteers. The radioactivity ratio of venous whole blood which obtained from cutaneous cubital vein to arterial whole blood were 0.76 +/- 0.08, 0.80 +/- 0.05, 0.81 +/- 0.06, 0.83 +/- 0.11 at 10, 20, 30, 50 min after 123I-IMP infusion, respectively. The venous blood radioactivities were always 20% lower than those of arterial blood radioactivity during 50 min. However, the ratio which obtained from cutaneous dorsal hand vein to artery were 0.93 +/- 0.02, 0.94 +/- 0.05, 0.98 +/- 0.04, 0.98 +/- 0.03, at 10, 20, 30, 50 min after 123I-IMP infusion, respectively. The venous blood radioactivity was consistent with artery. These indicate that arterio-venous difference of radioactivity in a peripheral cutaneous vein like a dorsal hand vein is minimal due to arteriovenous shunt in palm. Therefore, a substitution by blood sampling from cutaneous dorsal hand vein for artery will be possible. Optimized time for venous blood sampling evaluated by error analysis was 20 min after 123I-IMP infusion, which is 10 min later than that of arterial blood sampling.

ATP-sensitive K(+)-selective channels of inner medullary collecting duct cells

The inner medullary collecting duct (IMCD) in vivo has the capacity to either secrete or reabsorb K+. However, a selective K+ conductance has not been described previously in the IMCD. In the present study, the patch-clamp method was used to determine the presence and properties of K(+)-selective channels in the apical membrane of the inner medullary collecting duct cell line, mIMCD-3. Two types of K(+)-selective channels were observed in both cell-attached and excised patches. The most predominant K+ channel, a smaller conductance K+ channel (SK), was present in cell-attached patches with 140 mM KCl (high bath K+) but not with 135 mM NaCl plus 5 mM KCl (low bath K+) in the bathing solution. The single-channel conductance of SK was 36 pS with inward currents and 29 pS with outward currents in symmetrical 140 mM KCl. SK was insensitive to both voltage and Ca2+. However, SK was inhibited significantly by millimolar concentrations of ATP in excised patches. A second K(+)-selective channel [a larger K+ channel (BK)] displayed a single-channel conductance equal to 132 pS with inward currents and 90 pS with outward currents in symmetrical 140 mM KCl solutions. BK was intermittently activated in excised inside-out patches by Mg(2+)-ATP in concentrations from 1 to 5 mM. With complete removal of Mg2+, BK was insensitive to ATP. BK was also insensitive to potential and Ca2+ and was observed in cell-attached patches with 140 mM KCl in the bath solution. Both channels were blocked reversibly by 1 mM Ba2+ from the intracellular surface but not by external Ba2+.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of exercise-induced silent ischemia and the sequence of ischemic events in coronary artery disease by radionuclide ambulatory ventricular function monitoring

Twenty-seven patients with stable coronary artery disease were continuously monitored with an ambulatory radionuclide ventricular function monitor (VEST) during exercise to determine the prevalence of silent ischemia and the temporal sequence of events during ischemic episodes. Exercise-induced ejection fraction abnormality was considered a < 6% increase in the control value lasting for more than 60 sec. Patients performed exercise for 424 +/- 111 sec during VEST recording. Seventeen exercise-induced ejection fraction abnormalities were observed in 17 patients, of which eight (47%) were silent electrocardiographically and 12 (71%) were silent symptomatically. In all of the patients, exercise-induced ischemia occurred in a temporal sequence of ejection fraction abnormalities, ST depressions and then symptoms. In nine patients with ejection fraction and ST abnormalities, ejection fraction abnormalities occurred earlier (199 +/- 87 sec) than ST depressions (321 +/- 117 sec; p < 0.01). In five patients with symptoms (399 +/- 151 sec), the sequence was ejection fraction abnormalities (205 +/- 64 sec; P < 0.05) followed by ST depressions (266 +/- 101 sec; P < 0.05) and symptoms (399 +/- 151 sec; P < 0.01). After termination of exercise, ejection fraction (49 +/- 12 sec) recovered sooner than symptoms (102 +/- 27 sec; p < 0.01) or ST abnormalities (191 +/- 96 sec; p < 0.01). Thus, hemodynamic monitoring by VEST may be helpful in detecting ischemic episodes in coronary artery disease which remain electrocardiographically or symptomatically silent. Furthermore, exercise-stress induces a cascade of temporal changes in ischemic events which may be helpful in understanding the pathophysiology of ischemia.

[Blalock-Hanlon procedure for mitral atresia with normal aortic valve]

We report two cases of mitral atresia with normal aortic valve. First case was a 16 day-old girl with double outlet right ventricle, and underwent surgical procedure for three times as palliative treatments. The first surgical management involved simultaneous ligation of patent ductus arteriosus and pulmonary artery banding. Then balloon atrioseptostomy (BAS) and Blalock-Taussig shunt were performed after one month of the initial operation, because of severe cyanosis and right pulmonary branch stenosis. Third one was Blalock-Hanlon procedure. Second case was a two month-old boy with pulmonary atresia. Before the admission to our hospital, BAS was performed on this patient. However interatrial communication was not enough, so he underwent Blalock-Hanlon procedure and Blalock-Taussig shunt simultaneously. After these surgical treatments, both patients have done well with minimum interatrial pressure gradient. Early phase surgical maneuver for the atrioseptostomy should have been considered in these two cases.

[Effect of amurinone on human pulmonary artery in vitro]

We studied the effect of amurinone, a phosphodiesterase inhibitor, on human pulmonary arterial smooth muscle in vitro. Amurinone caused dose-dependent relaxation of pulmonary arterial strips precontracted with 60 mM KCl. Preincubation with either meclofenamate (31 microM), a cyclooxygenase inhibitor, or L-NG-nitroarginine (100 microM), an endothelium-derived relaxing factor (EDRF) production inhibitor, failed to inhibit amurinone-induced pulmonary vasodilation. The cyclic AMP (cAMP) levels in the supernatant of the lung vessel homogenates significantly increased after incubation with amurinone. These results indicate that amurinone causes relaxation of human pulmonary artery in vitro, and suggest a role for cAMP in the mechanisms of amurinone-induced pulmonary vasodilation.

Novel potassium-channel openers: preparation and pharmacological evaluation of racemic and optically active N-(6-amino-3-pyridyl)-N'-bicycloalkyl-N"-cyanoguanidine derivatives

The previous paper reported on the synthesis and pharmacological evaluation of N-(6-amino-3-pyridyl)-N'-bicycloalkyl-N"-cyanoguanidine derivatives, from among which three compounds were selected as potent potassium-channel openers. In the present study, selected compounds were tested for antagonism of potassium-induced contraction of rat aorta, hypotensive activity in normotensive rats, and diuretic activity in spontaneously hypertensive rats. This led to further evaluation of compound (+/-)-10 and selection of (+)-N-(6-amino-3-pyridyl)-N'- [(1S,2R,4R)-bicyclo- [2.2.1]hept-2-yl]-N"-cyanoguanidine ((+)-10) (AL0670) for development as an antihypertensive agent. Although AL0670 is regarded as a pinacidil-type K(+)-channel opener, it showed different pharmacological and conformational profiles from pinacidil.

Regional cerebral blood flow in diabetic patients: evaluation by N-isopropyl-123I-IMP with SPECT

Regional cerebral blood flow (rCBF) was measured using N-isopropyl-123I-iodoamphetamine (123I-IMP) with single photon emission computed tomography (SPECT) in 27 patients with diabetes mellitus with an average age of 64.1 years and with an average fasting plasma glucose of 145 mg dl-1. Their data were compared with those of 12 non-diabetic subjects with an average age of 64.6 years. None had cerebral infarction on computed tomographic (CT) studies. There were no significant differences in the physiological or laboratory data between the diabetic and non-diabetic groups except for their fasting plasma glucose and HbA1c levels. A reference sampling method using continuous arterial blood sampling was employed to quantify the rCBF. The average rCBF in each region of the cerebrum and cerebellum was significantly lower in the diabetic group than in the non-diabetic group (P < 0.01). Although a definite cause was obscure, the rCBF of the diabetic patients was reduced even in the absence of findings indicative of cerebral infarction on a CT study.

Characterization of a novel cofilin isoform that is predominantly expressed in mammalian skeletal muscle

Cofilin is an actin-modulating protein of 20 kDa, which is widely distributed throughout muscle and non-muscle cells. By means of immunoblotting combined with two-dimensional gel electrophoresis, we found that two cofilin variants, muscle type (M-type) and non-muscle type (NM-type), exist in mammals, while a single isoform exists in chickens. During in vitro myogenesis of mouse C2 cells, expression of the M-type cofilin was upregulated. To better understand the nature of the M-type cofilin, we cloned cDNAs encoding M-type cofilin from the cDNA library of C2 myotubes and determined the entire sequence. The deduced peptide sequence contained a nuclear localization signal and a putative actin-binding sequence as reported in NM-type cofilin. The sequence showed 81% identity in the amino acid residues with the mouse NM-type cofilin sequence and, interestingly, higher homology (96% identity) with that of chicken cofilin. The mRNA encoding M-type cofilin, though it contains two variants that differ in the size of their 3'-non-coding sequences, was detected predominantly in heart, skeletal muscle, C2 myotubes, and testis by Northern blotting, while the mRNA for NM-type cofilin was seen in a variety of non-muscle tissues. The presence of the muscle type isoform of cofilin strongly suggests that cofilin is deeply involved in the regulation of actin function not only in non-muscle cells but also in muscle cells.

Recovery of antitumor CD4+ T cell responsiveness, suppressed in the tumor-bearing state, by release from tumor burden

The present study investigates the recovery of antitumor CD4+ T cell responsiveness, suppressed in the tumor-bearing state, following release of tumor burden. Spleen cells from BALB/c mice bearing a syngeneic tumor (CSA1M) 1-3 weeks after the inoculation with CSA1M cells produced interleukin-2 (IL-2) and IL-4 upon in vitro cultures without addition of exogenous tumor antigens. This lymphokine production was achieved through collaboration between anti-CSA1M CD4+ T cells and antigen-presenting cells (APC) that has been pulsed with CSA1M tumor antigens in vivo in the tumor-bearing state. The lymphokine-producing capacity gradually decreased as the tumor-bearing period increased, and spleen cells from mice at late (8-10 week) tumor-bearing stages produced reduced levels of lymphokines. Because APC in these cells exhibited enhanced capacities to present tumor antigens, the reduced responsiveness was ascribed to the dysfunction of CD4+ T cells themselves. However, removal of a tumor after 8 weeks resulted in a remarkable recovery of the lymphokine-producing capacities of whole spleen cells. In contrast to the reduction in CSA1M-antigen-presenting activity of APC following tumor resection, CD4+ T cells exhibited a reciprocal increase in their responsiveness to CSA1M antigens. The recovery of antitumor responsiveness was also observed in the in vitro cultures free from tumor burden; when spleen cells from mice at late tumor-bearing stages were pre-incubated for 1-2 days and re-cultured in fresh medium, they produced potent amounts of IL-2 and IL-4. These results indicate that the immunodysfunction of antitumor CD4+ T cells induced in the tumor-bearing state is not irreversible, and release from tumor burden results in almost complete recovery of the potent antitumor responsiveness they previously expressed.

[Lung 3H-thymidine incorporation in monocrotaline (MCT)-treated rats--role of platelet-activating factor (PAF)]

Monocrotaline (MCT) causes chronic pulmonary hypertension associated with pulmonary vascular thickening in rats. Since components of the pulmonary vascular thickening are reflected in increased DNA synthesis in medial smooth muscle cells, and since platelet-activating factor (PAF) has been reported to contribute to the pulmonary hypertension induced by MCT, we examined the effect of WEB 2170, a specific PAF receptor blocker, on MCT-induced pulmonary vascular thickening and in vitro 3H-thymidine incorporation into lung tissue, as an index of stimulation of cell proliferation. In MCT-treated rats, pulmonary hypertension, right ventricular hypertrophy, and pulmonary vascular thickening developed at 3 weeks after injection. Also, in MCT-treated rat lung tissue, there was a significant increase in the in vitro 3H-thymidine incorporation rate. In WEB 2170-treated MCT rats, these changes were significantly less severe than those observed in rats receiving MCT alone. We conclude that PAF plays a role in the inflammatory process that contributes to the development of pulmonary hypertension and vascular remodeling associated with increased lung cell proliferation in MCT-treated rats.

Molecular and physiological alterations in murine ventricular dysfunction

The present study reports the development and characterization of a murine model of right ventricular dysfunction following graded constriction in the pulmonary artery via microsurgical approaches. To analyze in vivo ventricular function, a technique of x-ray contrast microangiography was developed to allow the quantitative analysis of ventricular volumes and of ejection fraction in normal and pressure-overloaded right ventricle. Severe, chronic pulmonary arterial banding for 14 days resulted in right ventricular dilatation and dysfunction, associated with right atrial enlargement, and angiographic evidence of tricuspid regurgitation. These effects were dependent on the extent of hemodynamic overload, since more moderate pulmonary arterial constriction resulted in hypertrophy with maintenance of right ventricular function. With severe pulmonary artery constriction, the murine right ventricle displays a failing heart phenotype including chamber dilation with reduced function that resembles right ventricular dysfunction in man during chronic pulmonary arterial hypertension. Northern and immunoblot analyses demonstrate a marked down-regulation of phospholamban mRNA and its corresponding protein with both levels of constriction, while a less pronounced but significant depression of sarcoplasmic reticulum Ca(2+)-ATPase protein was observed with severe overload, suggesting that this pattern is an early genetic marker of ventricular dysfunction. By coupling mouse genetics with this murine model and the ability to assess cardiac function in vivo, one should be able to test the role of the down-regulation of phospholamban and other defined alterations in the cardiac muscle gene program in the onset of the failing heart phenotype.

Amorphous material of the skin in amyotrophic lateral sclerosis: a morphologic and biochemical study

We performed morphologic studies on skin from seven patients with ALS and seven control subjects. By light microscopy, the wide spaces that separated collagen bundles reacted strongly with colloidal iron and alcian blue in ALS patients. Electron microscopy revealed markedly increased amorphous material that was positive for ruthenium red in the ground substance. These findings were not present in controls. Quantitative amino acid analysis showed that the amount of total amino acids (nmoles per mg dry weight) was significantly decreased (p < 0.01) in ALS patients compared with that of controls, and there was a significant negative correlation between skin amino acid content and duration of illness in ALS patients (r = -0.83, p < 0.001). These morphologic findings and biochemical data indicate that the amorphous material, which is markedly increased in ALS skin, includes glycosaminoglycans.

[Comparative study of 201Tl-scintigraphic image and endomyocardial biopsy findings in patients with dilated cardiomyopathy]

201Tl-SPECT image was compared with the findings of endomyocardial biopsy in patients with dilated cardiomyopathies (DCM), and diagnostic value of 201Tl patchy pattern image for fibrosis with DCM was evaluated. Serial 22 patients diagnosed as DCM with endomyocardial biopsy findings were selected for this study (age: 50 +/- 17 y.o., Male/Female = 17/5). Patchy pattern of 201Tl-SPECT image was visually classified to 4 stage according to the severity of inhomogeneous defect, and pathologic findings of fibrosis was also classified into 4 according to the severity of fibrosis (0: none, 1: mild, 2: moderate, 3: severe). Ejection fraction calculated from left ventriculography and end-diastolic dimension by echocardiography were also compared with 201Tl-SPECT image. Out of 22 patients, 21 patients (95%) showed fibrosis, and 18 patients (82%) showed patchy pattern with 201Tl-SPECT. Severity of patchy pattern was not in good relation to that of fibrosis (r = 0.374). 201Tl image was not related to the function nor dimension. Four autopsy studies revealed a good relation of macroscopic severity, spatial distribution of fibrosis and inhomogeneous 201Tl-defect pattern before death. Patchy pattern of 201Tl-SPECT image will show the myocardial fibrosis in patients with DCM, and is independent of the function. 201Tl-SPECT may show more clinically useful findings of spatial distribution and severity of fibrosis with focal myocardial biopsy.