[Role of systemic and pulmonary hemodynamics in genesis pleural effusion in congestive heart failure]

We tried to make an estimate of how pleural effusion occur in congestive heart failure, using right atrial pressure (RA) and pulmonary arterial wedge pressure (PAW) as variables. We calculated the following equation by quoting the data in the past. RA greater than -0.02 x PAW + 13.3. We speculated that when this relationship is satisfied, pleural effusion will appear. We also studied the patients with severe congestive heart failure, dividing them into 2 groups, ie the pleural effusion group (EF) and pulmonary edema group (ED). Compared with ED, EF has a significantly higher RA (RA = 6.1 +/- 1.33 mmHg in EF and 13.3 +/- 2.21 mmHg in ED, mean +/- SE, p less than 0.02) and a significantly lower cardiac index (3.17 +/- 0.26 l/min/m2 vs 2.23 +/- 0.16 l/min/m2, mean +/- SE, p less than 0.01). Therefore, we thought that it was adequate to treat RA and PAW as independent variables. These equations appear to be useful in predicting the development of pleural effusion that's based in the plots of our patients on RA-PAW plane and their relationship to our equations.

[Pure red cell aplasia induced by B19 parvovirus during allogeneic bone marrow transplantation]

We report a patient who had abrupt onset of pure red cell aplasia (PRCA) induced by B19 parvovirus during allogeneic bone marrow transplantation (BMT). A 14-year-old girl with APL in complete remission was admitted in February 1988, for the purpose of BMT. She was received marrow from HLA identical sister on March 17, 1988 (day 0). She received 120 mg/kg cyclophosphamide and 12 Gy total body irradiation for conditioning of BMT. For graft-versus-host disease (GVHD) prophylaxis she was given cyclosporine and short term methotrexate. She did not develop acute GVHD after BMT, but on the day 28 a bone-marrow aspirate revealed findings of PRCA. During this course the number of white blood cell and platelet favorably recovered. B 19 parvovirus DNA was detected in the serum of the day 30 and day 42. Antihuman B 19 parvovirus (HPV) antibody titers were increased: the values of anti-HPV IgM were suddenly elevated and those of anti-HPV IgG were elevated. Serum on the day 42 inhibited erythroid progenitors (CFU-E, BFU-E) but not inhibited myeloid progenitors (CFU-C). A reticulocyte count recovered on the day 50. As the patient was HPV-IgG negative prior to BMT and the donor was HPV-IgG seronegative, the source of infection may be platelet transfusion (day 7 through 14).

Serum tumor necrosis factor-alpha levels in allogeneic bone marrow transplant recipients with acute leukemia

We determined the serum levels of tumor necrosis factor-alpha (TNF) in allogeneic bone marrow transplant recipients in order to evaluate the relationship between TNF and graft-versus-host disease (GVHD). Eight patients with acute leukemia receiving an HLA-identical marrow graft were studied. Samples from healthy subjects and pretransplant recipients were all negative for TNF. Six of eight patients had detectable levels of TNF in serum after transplantation. All three patients with acute GVHD, and three of five patients without acute GVHD had elevated TNF levels in serum. Among the patients with increased TNF levels, documented infection was demonstrated in only one patient, with a clinical diagnosis of B19 parvovirus infection. Serum TNF levels were elevated when the WBC counts were more than 2,000/microliters. However, serum concentrations of TNF significantly correlated with body temperature. Although we could not conclude definitely that serum TNF levels correlated with severity of GVHD, it was suggested that TNF may be produced as a result of latent infections or immunological reaction against non-HLA allogeneic antigens.

[Response of cardiac patients to dynamic exercise: analysis with "systolic" pressure-volume area]

In the present study, we constructed a left ventricular pressure-volume loop from catheterization data and RN-angiocardiography. By connecting the point of origin of the plane, not the point of Vd, with the end-systolic point of the loop, we calculated a "systolic" pressure-volume area (PVA), elastic potential energy (EPE), and stroke work (SW). A cardiac output (CO)-pulmonary artery wedge (PAW) pressure plot was constructed at rest and during exercise, using a bicycle ergometer, to evaluate cardiac pump function. End-systolic volume (ESV) was obtained from the left ventricular P-V loop, and the response of ESV to exercise was investigated. Thirty-five patients with various cardiac diseases were categorized in two groups according to the delta CO/delta PAW obtained from the shift of the CO-PAW plot during exercise; group I (n = 28) with the properly functioning hearts having the ratio greater than 0.12 l/min/mmHg and group II (n = 7) with the poorly functioning hearts having the ratio less than or equal to 0.12 l/min/mmHg. Group I was subdivided further into two subsets according to the changing pattern of ESV during exercise; group I-A with decreased or unchanged ESV (n = 20) and group I-B with increased ESV in which end-diastolic volume (EDV) was increased during exercise (n = 8). During exercise, PVA and SW were unchanged but SW/PVA increased in group I-A, suggesting improvement of external mechanical efficiency. SW/PVA was unchanged in group I-B, despite the increase in PVA and SW. This suggested that external mechanical work increased as a result of increased cardiac oxygen consumption. In group II, PVA increased, SW was unchanged and SW/PVA decreased, which could be explained by the mechanism that external mechanical work during exercise decreased as compared with that at rest. It was suggested that a different mechanism may have been responsible for the production of external mechanical work among patients in group I-A and in group I-B with properly functioning hearts judged from the CO-PAW plot. Therefore, it seems useful to calculate PVA, SW and SW/PVA during exercise using the left ventricular pressure-volume loop for evaluating cardiac function.

Lymphokine activity production in graft-versus-host reactions across minor histocompatibility antigen barriers

Activated T cells responding to murine minor histocompatibility antigens (HA) were characterized according to the patterns of lymphokine activity production. Although B10.D2/nSN and BALB/c are mutually non-reactive in mixed lymphocyte reaction (MLR), graft-versus-host reaction (GVHR) can be induced by the injection of a large amount of B10.D2/nSN lymphoid cells into irradiated BALB/c recipient mice. Spleen cells from such GVHR mice spontaneously produced interleukin 3 (IL-3)-dependent cell-stimulating activity in cultures, but did not produce interleukin 2 (IL-2). Normal B10.D2/nSN spleen cells also produced IL-3-like activity, but not IL-2 in MLR supernatants, in response to irradiated BALB/c splenocytes. In addition, B-cell stimulatory factor-1 (BSF-1)/interleukin 4 (IL-4) and colony-stimulating factor (CSF) activity were detected in MLR supernatants. The properties of the produced lymphokine activities were similar to those produced in syngeneic transplant mice and syngeneic MLR, but a difference in the time course of lymphokine production existed between GVHR and syngeneic transplant mice. These results indicate that T cells may be activated in vivo in allogeneic transplantation when the donor and the recipient are matched for major HA, and are non-reactive in MLR. Also, the character of lymphokine-producing T cells activated by minor HA may not be qualitatively different from those responding to irradiated syngeneic cells.

[Recovery of marrow myeloid progenitors (CFU-GM) after bone marrow transplantation, especially associated with chronic graft-versus-host disease (GVHD)]

Six patients underwent allogeneic bone marrow transplantation (BMT) for treatment of acute non-lymphocytic leukemia. Hemopoietic reconstitution after BMT was monitored by peripheral blood counts, counts of bone marrow cellularity, bone marrow pictures, and clonal assays for myeloid progenitors (CFU-GM). Although bone marrow samples were markedly hypocellular on day 7 posttransplant, myeloid and erythroid elements were seen in 5 of 6 patients. Peripheral blood recovery of these 5 patients was achieved by third weeks posttransplant. The values of (CFU-GM) per 1 X 10(5) marrow mononuclear cells reached normal values on day 7 in two patients and significantly increased by day 28 in a patient. After day 84 the values of (CFU-GM) were remained almost normal and they had no relation to the occurrence of chronic graft-versus-host disease (GVHD). But in patients with chronic GVHD, marrow (CFU-GM) values were significantly increased on day 7 and day 14. These results suggest that marrow (CFU-GM) values by day 28 may predict the occurrence of chronic GVHD.

Quantitative estimation of compliance of human systemic veins by occlusion plethysmography with radionuclide--methodology and the effect of nitroglycerin

Volume-pressure relationship and compliance of human systemic veins were estimated quantitatively and noninvasively using radionuclide. The effect of nitroglycerin (NTG) on these parameters was examined. Plethysmography with radionuclide (RN) was performed using the occlusion method on the forearm in 56 patients with various cardiac diseases after RN angiocardiography with 99mTc-RBC. The RN counts-venous pressure curve was constructed from (1) the changes in radioactivity from region of interest on the forearm that were considered to reflect the changes in the blood volume of the forearm, and (2) the changes in the pressure of the forearm vein (fv) due to venous occlusion. The specific compliance of the forearm veins (Csp.fv; (1/V).(delta V/delta P] was obtained graphically from this curve at each patient's venous pressure (Pv). Csp.fv was 0.044 +/- 0.012 mmHg-1 in class I (mean +/- SD; n = 13), 0.033 +/- 0.007 mmHg-1 in class II (n = 30), and 0.019 +/- 0.007 mmHg-1 in class III (n = 13), of the previous NYHA classification of work tolerance. There were significant differences in Csp.fv among the three classes. The systemic venous blood volume (Vsv) was determined by subtracting the central blood volume, measured by RN-angiocardiography, from total blood volume, measured by the indicator dilution method utilizing 131I-human serum albumin. Systemic venous compliance (Csv) was calculated from Csv = Csp.fv.Vsv. The Csv was 127.2 +/- 24.8 ml.mmHg-1 (mean +/- SD) in class I, 101.1 +/- 24.1 ml.mmHg-1 in class II and 62.2 +/- 28.1 ml.mmHg-1 in class III. There were significant differences in Csv among the three classes. The class I Csv value was calculated to be 127.2 +/- 24.8 ml.mmHg-1 and the Csv/body weight was calculated to be 2.3 +/- 0.7 ml.mmHg-1.kg-1 of body weight, which was very close to the values for Csv reported previously by other investigators in animal experiments. The administration of NTG caused the RN counts - venous pressure curve to become steeper and shift upward. It increased Csv significantly in all cases.

Evidence for the in vivo production of interleukin-3 in lethally irradiated mice transplanted with syngeneic murine splenocytes

We wish to demonstrate new evidence for the in vivo production of interleukin-3 (IL-3). Syngeneic murine splenocytes were transplanted into lethally irradiated mice. The spleen cells in these transplant mice spontaneously produced IL-3 in cultures, and IL-3-like activity was detected in the serum. Chronological changes of the Thy-1 antigen expression on the bone marrow cells, and the number of myeloid progenitors in the bone marrow from post-transplant mice correlated with the amount of IL-3 produced in vivo. These results suggest that IL-3 may be produced by activated T cells during the syngeneic mixed lymphocyte reaction induced in vivo.

Volume-pressure relations of the human pulmonary "venous" system studied by radionuclide angiocardiography and passive leg elevation, with special reference to the effect of nitroglycerin

In an attempt to clarify the effect of nitroglycerin (NTG) on the human pulmonary "venous" (P"V") system, short segments of volume-pressure (V-P) curves in the P"V" system were estimated in 50 patients before and after the sublingual administration of NTG. The pulmonary "venous" volume (P"V"V) was estimated with our own method, using radionuclide (RN) angiocardiography. The mean pulmonary artery wedge pressure (PAW) was measured using a Swan-Ganz catheter. The increments of P"V"V and PAW that occurred during passive elevation of the legs were clues to the estimation of V-P "curves" in this system before and after NTG. In order to calculate a short segment of a V-P curve, the P"V"V was plotted on the ordinate and the PAW on the abscissa. In addition, we presented the effective unstressed volume graphically by extrapolating each short segment of V-P curves towards the volume axis (ordinate). We obtained the following results from the present study; The sublingual administration of NTG caused the P"V"V-PAW-plots to shift to the left (-5.2 +/- 3.6 mmHg, mean +/- SD) and downwards (-19 +/- 11 ml, mean +/- SD). The V-P curves appeared to shift to the left and become steeper after NTG. The average slope (delta V/delta P) was steeper after NTG (19.2 +/- 11.3 ml/mmHg, mean +/- SD) than before NTG (12.4 +/- 7.9 ml/mmHg). The graphically-obtained effective unstressed volume was unchanged with NTG, at least within the operating range of PAW. It is highly probable that NTG causes the tone of the P"V" system to be decreased by way of a relaxation of the vascular beds of the P"V" system.

[Clinical efficacy of a quadruple combination chemotherapy with ACNU, adriamycin, methotrexate, and prednisolone for patients with non-Hodgkin's lymphoma, who were refractory to VEPA (P) treatment]

A quadruple combination chemotherapy with ACNU, adriamycin, methotrexate and prednisolone (AAAP), was performed on 9 patients with non-Hodgkin's lymphoma, who had been previously treated with a VEPA (P) regimen. Complete remission rate was 44% (4/9) and, in four other patients, the tumor was decreased in size. Complete remission duration was from 30 days to over 390 days. Median survival time was 105 days. Myelosuppressive toxicity was severe. In eight patients, WBC counts were less than 3,000/mm3. In six patients, platelet counts were less than 100,000/mm3. An AAAP regimen is useful in relapse or for resistant forms of non-Hodgkin's lymphoma.