Delayed recovery of postexercise blood pressure in patients with chronic heart failure

Thirty-four patients with idiopathic dilated and ischemic cardiomyopathy underwent a symptom-limited cardiopulmonary exercise testing to evaluate the significance of postexercise blood pressure (BP) response. The postexercise BP response was useful in assessing the impaired exercise capacity and increased sympathetic activity in patients with heart failure.

[Prognosis for medically treated elderly patients with coronary artery disease: analysis by the Cox model]

The prognostic importance of age among well-known prognostic factors such as extent of coronary artery lesions, cardiac function, and myocardial ischemia was evaluated in 147 elderly patients with coronary artery disease aged 65 years or older who underwent dipyridamole perfusion scintigraphy and coronary angiography. After excluding 32 patients who initially underwent percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG), 115 patients who were initially treated medically were analysed by the Cox model for cardiac events during a mean follow-up period of 29 +/- 22 months. Among the 114 patients who were available for follow-up, nine patients (7.9%) had cardiac events, including five cardiac deaths and four non-fatal cardiac events (requiring PTCA or CABG). When the 114 patients were divided into three age-groups; 53 patients aged 65-69 years, 42 aged 70-74 years and 19 aged 75 years or older, the incidence of cardiac death was highest in those aged 75 years or older. Univariate analysis showed that age of 70 years or older (hazards ratio 15.15, p = 0.004), scintigraphic diffuse slow washout (hazards ratio 8.77, p = 0.002), and triple-vessel or left main trunk disease (hazards ratio 6.36, p = 0.05) were important prognostic factors. Multivariate analysis showed that scintigraphic diffuse slow washout (hazards ratio 6.33, p = 0.05), and triple-vessel or left main trunk disease (hazards ratio 11.94, p = 0.05) were statistically significant as independent prognostic factors. However, when age of 70 years or older was included in the analysis, it showed higher hazards ratio (21.21, p = 0.03) than that of scintigraphic diffuse slow washout (7.36) or triple-vessel or left main trunk disease (5.30). Age of 70 years or older may be a significant prognostic factor in elderly patients with coronary artery disease which has an equivalent importance to the extent of coronary lesions.

[Magnetic resonance imaging of Kernohan's notch in chronic subdural hematoma]

Compression of the crus cerebri against the free edge of the tentorium contralateral to a supratentorial mass, the so-called Kernohan's notch, can be a cause of false localizing sign. Kernohan's notch has been thoroughly studied clinically and pathologically, but not radiographically. The authors describe a case of left chronic subdural hematoma, which resulted in left hemiparesis caused by Kernohan's notch. Injury to the contralateral cerebral peduncle was clearly shown by magnetic resonance imaging (MRI) performed in the postoperative period. A 43-year-old man was transferred to our hospital in deep coma with dilated pupils, unreactive to light. Computed tomography (CT) scans obtained on admission revealed a left chronic subdural hematoma and a midline shift to the right. After drainage and irrigation of the left chronic subdural hematoma through a single burr hole, his clinical condition improved gradually. But 1 month after the operation, mild left hemiparesis still persisted. MRI T2-weighted images demonstrated an abnormally increased signal area in the right cerebral peduncle. T1-weighted coronal images showed the anatomical relationship between the hypointense lesion in the right cerebral peduncle and tentorial edge. Three-dimensional-MRI (3D-MRI) clearly demonstrated the surface image of Kernohan's notch. We emphasize the utility of 3D-MRI for detecting evidence of brain stem injury, such as Kerno han's notch.

[Mechanism of silent myocardial ischemia in elderly patients with coronary artery disease--assessment by dipyridamole thallium scintigraphy]

To evaluate the clinical significance of silent myocardial ischemia in elderly patients with coronary artery disease, 147 patients (aged 65 years and older) underwent coronary angiography and dipyridamole thallium scintigraphy. Seventy-four patients (44 men, 30 women) who showed reversible defects (RD) and ischemic ST depression during scintigraphy were divided into two groups: 13 with silent RD (18%, 12 men, 1 woman), and 61 with painful RD (82%, 32 men, 29 women). Most patients with silent RD were men. The prevalence of myocardial infarction was similar in patients with silent RD (62%) and in patients with painful RD (49%). The prevalence of multivessel disease was also similar in the two groups: 85% in patients with silent RD and 82% in patients with painful RD. Among 38 patients with infarction, 8 had silent RD and 30 had painful RD. The prevalence of RD in the area of infarction was greater in patients with silent RD (63%) than in patients with painful RD (47%), but the difference was not statistically significant. The prevalence of extensive infarction (fixed defects) was greater in patients with silent RD (75%) than in patients with painful RD (30%, p < 0.05). Among 36 patients without infarction, there was no scintigraphic parameter which showed significant difference. Bypass grafting and angioplasty were initially performed in 23% of the patients with silent RD and in 36% of the patients with painful RD (ns). When the two groups were treated medically during the follow-up period of 29 +/- 22 months, the incidences of cardiac events were similar: 10% in patients with silent RD and 13% in patients with painful RD. The prevalence of silent RD is not high in elderly patients with significant coronary artery disease. Compared with the patients with painful RD, those with silent RD were more likely to have an old and extensive myocardial infarction, and they tended to have RD in the area of the infarct.

Effects of amino acid replacements on cadmium binding of metallothionein alpha-fragment

To evaluate whether only 20 cysteine residues at invariant positions are needed to bind and coordinate the metals in metallothioneins (MTs), and whether changing the positions of cysteine residues in the sequence affects the metal-binding capacity and the coordination of MTs, we examined the cadmium-binding affinities of seven mutant MT alpha s using an Escherichia coli expression system. Five mutant MT alpha s in which the constitutive amino acid residues other than cysteines of the alpha-fragment were replaced with glycine residues, and the remaining two mutant MT alpha s in which the invariant positions of the cysteine residues of the alpha-fragment were shifted, were analysed for their ability to be expressed as cadmium-binding forms and for their biochemical properties. The results showed that extreme alteration of the constitutive amino acid residues other than cysteines in the MT alpha-fragment leads to disruption of their cadmium-binding abilities and of their structure. However, mutant MT alpha s containing changes of the invariant positions of the cysteine residues were expressed in a cadmium-binding form in Escherichia coli, although the invariant positions of 20 cysteine residues in the MTs are thought to be important for their metal-binding abilities. These results suggest that the position of cysteine residues and the chemical nature of the other amino acids in the amino acid sequence of MTs are less critical than expected.

Telomerase activity in gynecologic tumors

The standard telomeric repeat assay protocol (TRAP) was used to examine telomerase activity in 16 ovarian tumors, 16 cervical carcinomas, 4 uterine tumors, and 3 vaginal tumors. Telomerase activity was detected in 95% of these tumors, 88% of ovarian malignancies, and 100% of cervical, endometrial, and vaginal malignancies. In contrast, telomerase activity was not evident in normal tissues or in benign proliferative lesions, such as leiomyomas, condyloma acuminata, and simple endometrial hyperplasia. These results suggest that telomerase activation is associated with immortalization or malignant transformation of gynecologic tumors.

Cytoprotective effect of ulinastatin on LLC-PK1 cells treated with antimycin A, gentamicin, and cisplatin

The cytoprotective effect of ulinastatin was studied in LLC-PK1 cells treated with antimycin A, gentamicin, or cisplatin. All of the three agents induced a concentration-dependent increase in the release of lactate dehydrogenase and a decrease in the amount of remaining protein. In the cell injury models treated with 1.5 microM antimycin A, 10 mM gentamicin, and 0.3 mM cisplatin, ulinastatin tended to show a cytoprotective effect at a concentration of 3,000 U/ml and provided a significant protective effect at 10,000 U/ml. LLC-PK1 cells treated with 0.3 mM cisplatin, bovine serum albumin, and alpha1-acid glycoprotein at a concentration of 3.54 mg/ml, which is a comparable protein concentration to that of 10,000 U/ml ulinastatin, showed no protective effect but rather enhanced cell injury. These results suggest that ulinastatin exerts a direct protective effect on LLC-PK1 cells against various renal toxicities.

[A case of infected subdural hematoma complicating chronic subdural hematoma in a healthy adult man]

The authors report a case of so-called "infected subdural hematoma" as a complication of chronic subdural hematoma. The patient was a 55-year-old man who had sustained a small laceration of the forehead in a traffic accident on March 29, 1995. No fractures were detected on skull roentgenograms, and general and neurological examinations failed to reveal any abnormal findings. In early August 1995, the patient began to experience headaches, and on August 5 he developed a fever of 38 degrees C. On August 8 he suffered a left motor seizure and was admitted to our hospital. Laboratory studies revealed a peripheral leukocyte count of 10,800/mm3 and a C-reactive protein level of 18.1 mg/dl. Computed tomography scans showed a thick right fronto-parietal subdural low density mass and a thin left frontal subdural low density mass. An emergency operation was performed via a single right fronto-parietal burr hole. A chronic subdural hematoma containing slightly yellowish, bloody, purulent fluid was found beneath an outer membrane. The hematoma was irrigated with physiological saline containing antibiotics, and a drain was inserted into the subdural space. A subdural membrane was also present on the left but it contained no pus. Aggressive antibiotic therapy was performed, and the patient was discharged without any neurological deficit. Histologically the membrane was determined to be the outer membrane of a typical chronic subdural hematoma. Enterococcus faecalis, which has rarely been reported to cause infection of the central nervous system, was detected in a bacterial culture of the pus. Systemic investigation showed no evidence of otorhinologic or other focal infection. The above clinical findings suggested that hematogenous seeding of a chronic subdural hematoma had occurred in this patient. Subdural empyema arising from hematogenous seeding to a pre-existing subdural hematoma by an infection is very rare, but this type of complication must be kept in mind not only in the elderly, infants, and compromised hosts, but in patients without complications as well.

Independent self-assembly of cadmium-binding alpha-fragment of metallothionein in Escherichia coli without participation of beta-fragment

We examined the independent self-assembly of the alpha- and beta-fragments of human metallothionein (MT) into cadmium-binding conformation in an Escherichia coli expression system, in addition to wild-type MT expression. The expressed alpha-fragment formed independently the structure of a metal-binding cluster without the aid of the beta-fragment. The alpha-fragment and wild-type MT expressed in E.coli were purified and analyzed for their biochemical and spectroscopic properties. The apparent cadmium binding of the alpha-fragment was approximately 12-fold greater than that for the wild-type MT, whereas in other respects the studied biochemical properties were similar. In contrast, we were unable to obtain any independently expressed beta-fragment as the cadmium-binding form in this study. Possible explanations for this phenomenon are discussed.

Uptake of human urinary trypsin inhibitor by the kidney epithelial cell line, LLC-PK1

We investigated the uptake of human urinary trypsin inhibitor (UTI) by the kidney epithelial cells, LLC-PK1. Indirect immunogold techniques with an electron microscope demonstrated the localization of UTI within the cells after an incubation during which UTI was added to the apical side. Immunoreactivities were found in endocytic vesicles, vacuoles and lysosomes. Subsequently, we tried to characterize the property of the uptake of UTI using the fluorescein isothiocyanate-labelled UTI (FITC-UTI). FITC-UTI uptake was decreased by an incubation with an excess of unlabelled UTI and showed concentration-dependent saturation. This process was markedly suppressed during the incubation at 4 degrees C. The uptake was significantly lessened with 2,4-dinitrophenol and antimycin A, inhibitors of oxidative phosphorylation, and colchicine, a microtubule-depolymerizing agent. These results indicate that exogenous UTI is internalized by LLC-PK1 cells through an endocytic pathway. From uptake studies, it is suggested that an adsorptive process is partially involved in the mechanisms of endocytosis.

Direct visualization of copper-metallothionein in LEC rat kidneys: application of autofluorescence signal of copper-thiolate cluster

We report on the histochemistry of copper-metallothionein (Cu-MT) in the kidneys of Long Evans Cinnamon (LEC) rats. We used the visualization principle of histochemistry based on the autofluorescence emission from the fluorophore of Cu(+)-thiolate clusters in proteins. Intense autofluorescence signals were observed with a ring at the outer stripe of the outer medulla. Orange fluorescence signals were observed in the nuclei and cytoplasm of proximal straight tubular (PST) cells of segment 3 (S3) at the outer stripe of the outer medulla, and yellow-orange signals were detected in lysosome-like organelles in the proximal convoluted tubule (PCT) cells of segments 1 and 2 (S1 and S2) adjacent to the glomeruli in the cortex. These fluorescent materials were identified as Cu-MT because both signals were quenched by withdrawing Cu+ or by blocking cysteine residues, the distributions of cysteine residues and immunoreactive MT showed identical patterns to the localization of the fluorescence signals, and the fluorescent proteins containing Cu were eluted at the same Kd value of purified Cu-MT by gel filtration chromatography. However, a high level of MT mRNA was detected only in the outer stripe of the outer medulla where the orange fluorescence signals were detected, but not in the cortex. This difference in localization between the protein and the mRNA suggested that synthesis of renal MT occurs do novo in the outer stripe of the outer medulla. The yellow-orange fluorescent Cu-MT located in the lysosomal organelles at S1 and S2 of the PCT cells in the cortex could be Cu-MT of nonrenal origin, i.e., Cu-MT transported from other organs.

[Adherent reaction among activated platelets, polymorphonuclear cells and vascular endothelial cells under thrombin stimulation or shear stress]

Platelet activation in addition to blood coagulation abnormality is regarded as a primary factor of thrombosis by atherosclerotic obstruction. Therefore, the platelet activation on atherosclerosis is considered to correlate with shear stress generated between blood cells and endothelial cells in blood flow. P-selectin on the surface of the platelet membrane is measured by flowcytometry as a marker of platelet activation. Herein, we examined the phenomena of platelet activation and adherent platelets with leukocytes (ad-P.L) on stored platelet concentration (PC) and chronic rheumatoid arthritis (RA), moreover, of the adherent platelets or polymorphonuclear cells (PMN) with endothelial cells (EC) in shear stress by using an apparatus we devised. The rate of platelet activation and ad-P.L increased in PC with storage, and the sensitivity of platelets to thrombin decreased. The rate of platelet activation and ad-P.L increased in RA in vivo. Many adherent platelets with EC were found at a low shear rate on normal EC but at a high shear rate on denatured EC without any specific adherent property. Adherent PMN with EC had several hundred times more denatured EC than normal EC and the relationship with shear rate disappeared on denatured EC. The platelet activation and relationship between platelets or leukocytes and EC as to the cause of thrombosis are important subjects for future studies.

[Adult-onset aqueductal stenosis caused by membranous occlusion in the aqueduct: a case report]

The authors report a case of adult-onset aqueductal stenosis caused by membranous occlusion of the aqueduct. The patient was a 35-year-old man, who suffered from progressive headache. On admission, computed tomography (CT) scan showed marked dilatations of the lateral and third ventricles. Midsagittal T1-weighted magnetic resonance imaging (MRI) scan showed a membranous occlusion at the lower end of the aqueduct, with dilatation of the proximal aqueduct and elevation of the tectum. Midsagittal cine-MRI demonstrated the cerebrospinal fluid flow in the aqueduct. The patient was diagnosed as having hydrocephalus resulting from membranous stenosis of the aqueduct by MRI. A ventriculo-peritoneal shunt operation was performed and his symptoms improved markedly. The membranous occlusion of the aqueduct is a rare cause of hydrocephalus. The etiology and therapy of aqueductal stenosis are discussed.

Roles of the conserved serines of metallothionein in cadmium binding

The sequence of six amino acid residues -Ser-Cys-Cys-Ser-Cys-Cys- is present in all mammalian metallothionein sequences and has been highly conserved during evolution, although the metallothioneins have divergent primary sequences. To determine whether two serines in the sequence play a crucial role in metal-binding of metallothioneins, a mutant metallothionein with these two serines replaced by leucines was obtained using an Escherichia coli expression system. The expressed protein was analyzed for its chemical and spectroscopic properties. It was confirmed that the mutant metallothionein (MT) bound cadmium through a metal-thiolate complex and that there was no strong difference between the mutant and the wild-type MTs in retaining the metal-binding cluster. However, the metal-binding cluster of the mutant metallothionein was more unstable than that of the wild-type metallothionein. The two conservative serines could play a role in the stability of metal-binding ligands.

Copper replacement of cadmium-binding alpha-fragment of metallothionein expressed in Escherichia coli

Titration studies of Cd-binding alpha-fragment, the carboxyl-terminal half of human metallothionein-2, which was independently expressed in Escherichia coli as a Cd-binding form, with Cu were performed. The Cu saturated alpha-fragment was not obtained when the alpha-fragment incubated with Cu (I), although completely saturated MT with Cu (I) was successfully obtained in the same conditions. The stoichiometry of the alpha-fragment replaced with Cu (I) was Cu 4 and Cd 1. It is considered that the Cu-binding alpha-fragment required the presence of Cd (II) to form a stable structure. Our results could suggest that each fragment was independent in the metal binding processes, e.g. alpha-fragment for Cd-binding.

[A case of cranial hypertrophic pachymeningitis with intracranial hemorrhage]

A case of cranial hypertrophic pachymeningitis of unknown etiology in a patient with 15-year history of headaches, cranial nerve palsies, and gait disturbance is reported. A 77-year-old woman was brought to our institute in a coma. CT revealed intracerebral hemorrhage in the right temporal lobe and thickening of the falx and tentorium. Fifteen years previously the patient had undergone CT scanning because of headaches, cranial nerve palsies, and progressive gait disturbance and a thickened tentorium, mild hydrocephalus and edematous change in the right temporal lobe had been reported. Since the etiology of her symptoms was unclear at the time, she did not receive adequate treatment. Her symptoms gradually progressed thereafter, and her visual acuity and hearing deteriorated. MR imaging in 1994 showed the thickened tentorium as a hypointense area with hyperintense edges on Gd-DTPA enhanced images. Angiography revealed narrowing of posterior portion of the superior sagittal sinus. The patient's condition rapidly deteriorated due to the intracranial hypertension and she subsequently died. Autopsy revealed a thickened tentorium with xanthochromic surface. This hypertrophic change was also seen in the dura mater of the posterior and middle cranial fossa. Microscopic examination of the thickened tentorium revealed extensive fibrous tissue with a chronic inflammatory infiltrate, predominantly of lymphocytes. No specific lesions were revealed by staining with hematoxylin-eosin, PAS, Gram's or Ziehl-Neelsen stains. The patient had no inflammatory or infectious diseases of other organs, and a diagnosis of idiopathic cranial hypertrophic pachymeningitis of unknown etiology was made. Considering the above findings, the thickened tentorium depicted as a hypointense area on the T1- and T2-weighted images and the Gd-enhanced edges of the tentorium are thought to be represent fibrous tissue and inflammatory regions, respectively.

Protective action of ulinastatin against cisplatin nephrotoxicity in mice and its effect on the lysosomal fragility

The development of azotemia after cisplatin injection in mice was inhibited by ulinastatin treatment in a dose-dependent manner. Reduction in creatinine clearance and elevation in fractional excretion of sodium in mice receiving cisplatin was ameliorated by ulinastatin administration. Epithelial necrosis and hyaline cast formation in the proximal tubule were also suppressed. Ulinastatin showed no influence on the kidney platinum level after cisplatin injection. In LLC-PK1 cells, addition of ulinastatin to the incubation medium markedly reduced the release of N-acetyl-beta-D-glucosaminidase, on of the lysosomal enzymes, during hypotonic treatment only when cells were damaged with cisplatin. On the other hand, ulinastatin showed no effect on the elevation of malondialdehyde concentration in the murine kidney cortical slices after the treatment with cisplatin. These results indicate that ulinastatin has a protective effect against cisplatin nephrotoxicity, and its prevention of the increase in lysosomal fragility is a probable mechanism involved in the renal protection.

Protective effect of human ulinastatin against gentamicin-induced acute renal failure in rats

We investigated the protective effect of human ulinastatin against gentamicin-induced acute renal failure in rats. Gentamicin sulfate was subcutaneously injected at a dose of 200 mg/kg for 5 consecutive days. After 3 days administration of gentamicin, a slight decrease in renal function was observed, as well as granulovascular degeneration in the proximal tubular cells as a change in the renal histology. After 5 days administration of gentamicin, a remarkable increase in plasma concentration of creatinine (from 0.27 +/- 0.02 to 1.17 +/- 0.18 mg/dL) and urea nitrogen (from 17.8 +/- 0.6 to 48.8 +/- 5.1 mg/dL) and a significant decrease in creatinine clearance (from 0.64 +/- 0.08 to 0.20 +/- 0.03 mL.100 g-1.min-1) were observed. In addition, an apparent increase in urinary excretion of N-acetyl-beta-D-glucosaminidase and albumin was detected. In the renal histology, proximal tubular necrosis and desquamation of the epithelial cells in the cortex were observed. Furthermore, hyaline cast formation was frequently observed in the outer stripe of the outer medulla. Ulinastatin at doses of 100,000 or 300,000 U/kg was coadministered intraperitoneally just after each gentamicin injection. Ulinastatin treatment showed a dose-dependent suppression of gentamicin-induced biochemical alterations and histological changes. After 5 days treatment with 300,000 U.kg-1.day-1 of ulinastatin, the magnitude of gentamicin-induced changes in renal function was significantly lessened, by 45-80%. The score for proximal tubular injuries and the rate of hyaline cast formation were also significantly lower in the same group of animals than those in the group treated with gentamicin alone. In the in vitro study, ulinastatin at 10-300 U/mL showed a concentration-dependent suppression on the fragility of the lysosomal membrane isolated from rat kidney cortex during hypotonic treatment. These results indicate that human ulinastatin has a prominent protective effect on gentamicin-induced acute renal failure in rats, and the lysosomal membrane stabilizing effect is possibly involved as a mechanism of this action.

[An elderly patient with Leriche syndrome complicated by congestive heart failure and rhabdomyolysis]

A 64-year-old man, who had had bilateral intermittent claudication and leg pain for five years, was admitted because of sudden onset of severe leg pain, and acute respiratory failure. Laboratory data showed markedly elevated serum CK of 73,050 IU/L, and urinary myoglobin of 430,000 ng/ml. A diagnosis of rhabdomyolysis was made. Renal dialysis was required for the next two days because of acute renal failure. The aortogram was performed on the 32nd day and disclosed complete obstruction of the abdominal aorta immediately distal to the bilateral renal arteries. Good collateral flow was noted to the popliteal arteries. On the 49th day, the patient successfully underwent extra-anatomical bypass surgery (axillo-bifemoral bypass). The mechanism of rhabdomyolysis in this elderly patient was discussed.

Sympathetic hyperactivity in patients with vasospastic angina--assessment by spectral analysis of heart rate and arterial pressure variabilities

The autonomic nervous system may play an important role in regulating coronary arterial tone. To evaluate the role of autonomic nervous activity in patients with vasospastic angina (VSA), we studied 10 VSA patients with patent coronary artery (mean; 56 yr, range; 44-66 yr) and 8 normal subjects (mean; 58 yr, range; 35-71 yr). ECG and arterial pressure were continuously recorded for 4 min in a supine position at 7:30 am, 10:30 am, and 4:30 pm. Low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.20 Hz) components of the beat-to-beat variabilities of the R-R interval (RRI) and systolic arterial pressure (SAP) were then estimated by autoregressive power spectral analysis. The LF-Normalized Power (LF-NP; [LF Power]/[Total Power]-[Direct Current Power]) of both the RRI and SAP variabilities were greater in VSA patients than in normal subjects (RRI: 0.51 +/- 0.07, 0.51 +/- 0.07, 0.53 +/- 0.06, vs 0.25 +/- 0.04, 0.31 +/- 0.05, 0.31 +/- 0.06, at 7:30 am, 10:30 am, and 4:30 pm respectively: p = 0.010, 0.044, 0.018. SAP: 0.62 +/- 0.06, 0.53 +/- 0.06, 0.57 +/- 0.06 vs 0.37 +/- 0.04, 0.30 +/- 0.06, 0.26 +/- 0.07, respectively: p = 0.006, 0.017, 0.003.). The LF-power of SAP variability also tended to be greater in VSA patients. There was no difference in the HF-component coefficient of variance (CCV (%) = 100 x (component power) (1/2)/ mean RR intervals) of the RRI variabilities between the 2 groups. These results indicate that increased sympathetic vasomotor tone and cardiac sympathetic predominance may play an important role in patients with VSA.

Expression of human metallothionein-2 in Escherichia coli: cadmium tolerance of transformed cells

A genetic approach was undertaken to investigate the physiological roles of human metallothionein-2. A constructed expression plasmid, pEXPMTII, in which human metallothionein-IIA cDNA was inserted downstream of a tryptophan-lactose promoter, was used to transform Escherichia coli JM105 strain. Cadmium-binding metallothionein was successfully expressed in E. coli in the medium containing cadmium, while copper and zinc-metallothioneins were scarcely observed in copper- or zinc-containing medium. The amino acid composition and sequence of the biosynthesized cadmium-metallothionein were analyzed. The selectivity of metals bound to metallothionein and the stability of metal-binding forms of metallothionein in E. coli were discussed. In addition, cadmium, zinc, or copper resistance of the cells expressing metallothionein was examined. Cells transformed with the plasmid pEXPMTII and cultured in a medium containing cadmium exhibited tolerance only to cadmium. It was demonstrated that human metallothionein-2 functioned for cadmium detoxification in E. coli.

[Prognosis of patients with triple vessel disease and old myocardial infarction: relationship to the number of total coronary occlusions]

Patients with myocardial infarction (MI) and triple vessel coronary disease generally have poor prognoses. However, it is not known whether there are particular angiographic variables associated with the poor prognosis in MI patients with triple vessel disease. The angiographic variables for poor prognosis were investigated in 43 MI patients with triple vessel disease (32 men and 11 women, mean age 63 +/- 9 years) who were followed medically for a mean of 32 +/- 28 months. There were 13 cardiac deaths (30%) and 10 late-coronary artery bypass grafting (23%). Twenty patients were alive and well. The patients who died of cardiac causes had lower ejection fractions (42 +/- 18% vs 49 +/- 15%, p < 0.05), a higher prevalence of two vessel occlusion (77% vs 40%, p < 0.05), and a higher prevalence of coronary occlusion opposite the MI site (69% vs 25%, p < 0.01) when compared to survivors, although there were no significant differences in age, MI sites, or the prevalence of occlusion in the infarct-related artery. Multivariate analysis with the Cox proportional hazards model revealed that coronary occlusion opposite the MI site (hazards ratio 16.36) and an age of > or = 65 years (4.46) indicated a significantly high ratio. The hazard ratio of the ejection fraction and two vessel coronary occlusion were not significant. The poor prognosis of MI patients with triple vessel coronary disease may be related to impaired left ventricular function and to coronary occlusion opposite the MI site and greater age. This may have important clinical implications in the initial decision for interventional therapy.

Choroid plexus carcinoma in the lateral ventricle--case report

A 68-year-old male presented with choroid plexus carcinoma in the left lateral ventricle manifesting as dysarthria and gait disturbance. Magnetic resonance imaging showed a homogeneously enhanced mass in the trigone of the left lateral ventricle. Selective left posterior cerebral arteriography showed the tumor was fed by the left medial posterior choroidal artery. Detailed examinations found no evidence of an extraneural primary focus. He underwent partial removal of the tumor followed by local Lineac irradiation (50 Gy). After irradiation, the serum level of carcinoembryonic antigen decreased and the size of the residual tumor was reduced.

[Diagnosis and prognosis of elderly patients with coronary artery disease: assessment with dipyridamole thallium imaging]

Noninvasive evaluation of coronary artery disease is difficult in elderly patients because of their limited exercise-capacity. The diagnostic and prognostic value of dipyridamole perfusion scintigraphy was assessed in 147 patients aged 65 years and older. All patients underwent coronary angiography. Initially, 32 patients had percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The other 115 patients were first treated medically and followed for a mean of 29 +/- 22 months. Nine patients (7.9%) had cardiac events including cardiac death and coronary intervention (PTCA or CABG) during the follow-up. Dipyridamole perfusion scintigraphy was performed safely in all patients, whereas treadmill exercise testing could not be adequately performed in 24 patients, 18 of whom had multivessel disease. Multiple regression analysis showed that: fixed defect and reversible defect were powerful detectors of coronary lesions (p = 0.0001, p = 0.0027, respectively), all patients with fixed disease and 94% of patients with only reversible defect had significant coronary lesion; Diffuse slow washout and ST depression were statistically significant for detecting multivessel coronary lesions in patients with fixed disease (p = 0.0001, p = 0.017, respectively), the sensitivity and specificity of diffuse slow washout and/or ST depression for detecting multivessel coronary lesions ware 85% and 74%, respectively, and ST depression was statistically significant for detecting multivessel coronary lesions (p = 0.0002) in patients with only reversible defect, the sensitivity and specificity of ST depression were 88% and 64%, respectively. Cox survival analysis identified diffuse slow washout as the best predictor of future cardiac events among the scintigraphic variables.(ABSTRACT TRUNCATED AT 250 WORDS)