ICRF-193 modifies etoposide-induced apoptosis in thymocytes

Etoposide (VP-16), one of the topoisomerase II (TopoII) inhibitors, interferes with TopoII by inducing the formation of and stabilizing a cleavable enzyme-DNA complex. VP-16 has been demonstrated to induce apoptosis in murine thymocytes. To clarify the mechanism of action of VP-16, we examined the in vitro effect of a non-cleavable-complex-forming type TopoII inhibitor, ICRF-193 which inhibits the DNA strand breakage induced by VP-16, on murine thymocytes in which apoptosis had been induced with VP-16. DNA fragmentation is characteristic of apoptosis. In the early stages, ICRF-193 decreased DNA fragmentation induced by VP-16, although this inhibitory effect decreased in the later. These data suggest that TopoII inhibitors induce apoptosis in murine thymocytes in two ways: with DNA-strand breaks in the early stage or without them. ICRF-193 itself induced apoptosis in murine thymocytes. The time course of DNA fragmentation caused by ICRF-193 was different from that of VP-16.

Modulation of noradrenaline release through presynaptic alpha 2-adrenoceptors in congestive heart failure

Stimulation of presynaptic alpha 2-adrenoceptors inhibits the release of noradrenaline from sympathetic nerve endings; however, the extent to which it operates in patients with congestive heart failure is still unknown. To investigate the degree of negative feedback to the release of noradrenaline via presynaptic alpha 2-adrenoceptors at sympathetic nerve endings, we measured plasma noradrenaline levels before and after the injection of phentolamine (i.e., plasma noradrenaline concentration at rest, plasma noradrenaline concentration after phentolamine injection [NAph], and the phentolamine-induced increase in plasma noradrenaline [delta NAph]). Plasma noradrenaline concentration at rest, NAph, and delta NAph increased in a stepwise manner from New York Heart Association class I to class III. A positive correlation was found between the plasma noradrenaline at rest and delta Naph (n = 123, r = 0.697, p < 0.001). These results suggest that the enhanced release of plasma noradrenaline is substantially buffered by the mechanism of noradrenaline release-inhibitory presynaptic alpha 2-adrenoceptors in patients with congestive heart failure, and this buffer serves to protect organs such as the heart from excess sympathetic stimulation.

Alternations in atrial natriuretic peptide release after DC cardioversion of non-valvular chronic atrial fibrillation

The response of atrial natriuretic peptide (ANP) release to haemodynamic influences after cardioversion of atrial fibrillation has not been fully examined. We measured plasma concentrations of ANP and assessed haemodynamic changes 60-120 min after DC cardioversion in 22 patients with non-valvular chronic atrial fibrillation. Passive leg elevation to enhance volume expansion was performed 60 min after DC cardioversion. Sinus rhythm was restored in 18 of the 22 patients (successful DC cardioversion group). The control group consisted of seven patients with non-valvular chronic atrial fibrillation who did not undergo DC cardioversion (atrial fibrillation control group). In the successful DC cardioversion group, the mean pulmonary artery wedge pressure decreased significantly 15 min after cardioversion (P < 0.05) and then remained unchanged. Plasma concentrations of ANP also decreased significantly 15 min after cardioversion (P < 0.05). Furthermore, there was an additional significant decrease in ANP levels for up to 60 min after cardioversion (P < 0.05 from 15 min). Passive leg elevation for 15 min led to an increase in the mean pulmonary artery wedge pressure (P < 0.01) and right atrial pressure (P < 0.05), but did not result in increased plasma concentrations of ANP (47.1 +/- 27.6 vs 43.9 +/- 34.4 pg.ml-1, mean +/- SD, P = ns). In the atrial fibrillation control group, passive leg elevation increased the mean pulmonary artery wedge pressure (P < 0.01), the mean right atrial pressure (P < 0.05) and plasma concentrations of ANP (139.9 +/- 85.8 vs 168.1 +/- 108.2, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Apoptosis in thyroid diseases: a histochemical study

Recent studies demonstrate that apoptosis is an important process in physiological and pathological cell death. We examined the apoptotic phenomena in thyroid tissues by two methods: immunohistological and in situ end-labeling of fragmented DNA (ISEL). In thyroid tissues from patients with Hashimoto's thyroiditis and thyroid cancer, fragmented nuclear DNA and LeY (apoptosis associated antigen) were observed. In tissues from patients with Graves' disease, LeY and bcl-2 oncoprotein were expressed, but no ISEL positive cells were observed. In contrast, thyrocytes in normal thyroid tissues were not stained with ISEL or anti-LeY antibodies (Abs). Fas antigen (Ag) was expressed in various thyroid tissues, including normal subjects. The clinical meaning of this was not determined. These results suggest that the apoptotic process takes place in Hashimoto's thyroiditis and thyroid cancer, and is overcome in Graves' disease by bcl-2 expression.

Plasma adrenaline modulates alpha 1-adrenoceptor mediated pressor responses and the baroreflex control in patients with borderline hypertension

Plasma level of adrenaline has been reported to be elevated in borderline hypertension. However, its role in developing and maintaining hypertension is still not completely understood. This study aimed to estimate the role of plasma adrenaline in developing hypertension. Ten patients with borderline hypertension (BHT) and 10 age-matched normotensive subjects were included. We infused at least three graded doses of phenylephrine, an alpha-adrenoceptor agonist, into the antecubital vein of subjects lying quietly in a supine position. Mean blood pressure was measured continuously through the right radial artery. Cardiac output was measured by the thermodilution method before and after the administration of each dose of phenylephrine infusion. We obtained dose-response curves for mean blood pressure and total peripheral resistance to phenylephrine. Baroreflex sensitivity was calculated by plotting the longest R-R intervals against the elevated peak mean blood pressure after the infusion of each dose of phenylephrine. Plasma noradrenaline and adrenaline concentrations at rest were measured by high performance liquid chromatography coupled with trihydroxyindole fluorimetric detection. The plasma adrenaline level at rest was higher in patients with BHT than in normotensive subjects. With graded infusion of phenylephrine, both the pressor responses and the changes in total peripheral resistance were greater in patients with BHT than in normotensive subjects. The plasma adrenaline level was positively correlated with the slope of dose response curves for the increments of mean blood pressure to phenylephrine (r = 0.60, p < 0.01). Baroreflex sensitivity was reduced in patients with BHT as compared with normotensive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Thrombotic thrombocytopenic purpura and myoglobinuric acute renal failure following radiation therapy in a patient with polymyositis and cervical cancer

A 73-year-old woman was admitted to receive radiation treatment for uterine cervical cancer, however a complex series of events ensued, leading to death. She developed an acute exacerbation of polymyositis complicated by thrombotic thrombocytopenic purpura, rhabdomyolysis and acute renal failure. Radiation therapy may have produced an immune disturbance leading to the acute exacerbation of polymyositis. Auto-immune-mediated endothelial damage might have triggered a series of events leading to thrombotic thrombocytopenic purpura. Rhabdomyolysis seemed to be the main cause of acute renal failure.

Human pulmonary vascular and venous compliances are reduced before and during left-sided heart failure

Human pulmonary vascular and venous compliances were measured in 41 patients with or without left-sided heart failure. Two methods were used. Method 1 was based on analysis of pulmonary capillary wedge (PCW) pressure tracings according to Cv,PCW = (SF/100)(0.075PCW + 0.90)SV/[(v - d)PCW + 1], where Cv,PCW is compliance of pulmonary venous system, SF is systolic fraction of pulmonary venous flow [related to pulmonary capillary wedge pressure (PCW) as SF = 82 - 2.01PCW], (v - d)PCW is pulse pressure in PCW position, and SV is stroke volume. The (0.075PCW + 0.90) term equals k", i.e., systolic run-off ratio. Method 2 was used to measure to pulmonary vascular volume-pressure (V-P) relationship and pulmonary vascular compliance (Cvasc) and is based on measurement of pulmonary blood volume (PBV) and its increase with passive elevation of the legs to calculate Cvasc. Assuming the proportion of blood entering pulmonary venous system (in increase of PBV) during passive leg elevation to be 0.8, pulmonary venous compliance (Cv,PBV) was calculated as Cv,PBV = 0.8Cvasc. Cv,PCW correlated fairly closely with Cv,PBV (r = 0.81, coefficient of variation = 31%). This fair agreement between two independent methods suggests strongly that both methods may be valid, although other interpretations are possible. Cv,PCW, Cvasc, and Cv,PBV decreased going from New York Heart Association class I to classes II and III. When PBV was plotted vs. PCW, average V-P line for class II patients was flatter and shifted downward to the right compared with that for class I. This suggests pulmonary vasoconstriction as well as other factors. Average V-P line for class III patients is flatter but not displaced compared with that for class II. Another previously reported series of 50 patients, most of whom had ischemic heart disease, are included in this study.

Remission of nephrotic syndrome in a patient with renal amyloidosis associated with Takayasu's arteritis after treatment with dimethylsulphoxide

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Prenatal diagnosis of Duchenne muscular dystrophy by polymerase chain reaction analysis

The efficacy of the polymerase chain reaction (PCR) in the first-trimester prenatal diagnosis of Duchenne muscular dystrophy (DMD) was examined. Twenty-seven fetuses from 26 Japanese pedigrees at risk for DMD were analyzed. PCR-restriction fragment length polymorphism analysis, multiplex PCR, and dinucleotide repeat polymorphism analysis were used. Of 16 males, 11 were determined to be unaffected, 4 were affected, and the remaining 1 was undetermined. Of the 11 female fetuses, 1 was diagnosed as a noncarrier, 4 were carriers, and the carrier status of the remaining 6 was not determined at the option of the patients, although DNA polymorphisms could be detected in those patients. Prenatal diagnosis by PCR analysis was possible in 96% of the fetuses tested (26 of 27).

Stimulation of the biosynthesis of interleukin 8 by interleukin 1 and tumor necrosis factor alpha in cultured human chorionic cells

Human chorion, but not amnion, tissue explants produced substantial quantities of neutrophil chemoattractant in response to interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF alpha). This suggested that chorion is one of the chemoattractant producing tissues. Therefore, the biochemical properties and the regulation of a chemoattractant in human chorionic cells were examined. IL-1 alpha and TNF alpha stimulated human chorionic cells to produce neutrophil chemotactic factor in both a dose- and time-dependent manner. This chemotactic factor was a heat-stable and trypsin-sensitive protein with an apparent molecular weight of 10000, and it was also immunologically identified as a chemotactic cytokine of the human IL-8 family. Immunohistochemical observations with IL-1 alpha- and TNF alpha-treated chorion explants indicated that trophoblasts and stromal cells, including fibroblast-like and macrophage-like cells, but not endothelial cells, were characterized as IL-8-producing cells. From these observations, it is very likely that both IL-1 and TNF alpha may participate in the production of chemotactic factor/IL-8 in pre-term parturition, accompanied by an intraamniotic infection, along with their known promotive effect on the production of matrix metalloproteinases, which is connected with the destruction of matrix components of fetal membranes.

The role of combined pelvic floor stimulation and biofeedback in female urinary incontinence: early experience

A series of 109 female patients with urinary incontinence were treated by pelvic floor stimulation and biofeedback. Eighty-one patients received the full course of treatment and 28 patients dropped out. Among the 81 patients who completed the treatment, the improvement and cure rates (completely dry) shortly after treatment were 70.4% and 12.3%, respectively. The improvement and cure rates for more than one year after treatment were 47.6% and 14.3% respectively. Seven patients returned for further pelvic floor stimulation and biofeedback and only three patients underwent bladder neck suspension operations after completing treatment. Of the patients who dropped out, 53.6% had shown improvement with pelvic floor stimulation and biofeedback. Side effects were rare with three patients complaining of abdominal pain. These findings suggest that pelvic floor stimulation and biofeedback are useful, safe and conservative treatment modalities for female patients with urinary incontinence.

Usefulness of the pulmonary vein flow velocity-time profile as an estimate of left atrial storage fraction

During ventricular systole, the left atrium (LA) stores a certain amount of ventricular stroke volume; this is defined as an LA storage volume. From cineangiocardiograms, an LA storage fraction is obtained as the ratio of the LA storage volume to left ventricular stroke volume. From the pulmonary vein (PV) flow velocity-time profile, the LA storage fraction may be estimated as a ratio of the PV flow velocity-time integral during systole (Sa) to a sum of that during systole and diastole (Sa+Da), namely, Sa/(Sa+Da), provided that the PV cross-sectional area remains relatively unchanged during one cardiac cycle and that the PV flow velocity-time profile is similar in any of the PVs draining to the LA. To evaluate usefulness of Doppler echocardiographic method of estimating the LA storage fraction, the authors measured the LA storage fraction from the left upper PV flow velocity-time profile by transesophageal Doppler echocardiography and compared it with the LA storage fraction from conventional cineangiocardiographic volumes. Subjects were 23 patients with a variety of cardiac diseases in normal sinus rhythm, ranging from eighteen to seventy-four years of age. The LA storage fraction was 0.58 +/- 0.12 (mean +/- SD) from cineangiocardiography and 0.64 +/- 0.08 from Doppler echocardiography larger than that from cineangiocardiography (P < 0.01), the correlation was good (r = 0.643). The authors conclude that the left upper PV flow velocity-time profile appears to provide a better correlation with that by cineangiography and may be used as a reliable quantitative estimate of the LA storage fraction.

[Left atrial function during left ventricular diastole evaluated by left atrial angiography and left ventriculography]

The left atrium (LA) stores part of the right ventricular stroke volume during ventricular systole for passive release into the left ventricle (LV) during ventricular early diastole and active release during ventricular late diastole (passive and active contraction). The rest of the right ventricular stroke volume flows through the LA from the pulmonary vascular bed to the LV (LA conduit function). The factors affecting these LA functions were evaluated during ventricular diastole by left atrial angiography and left ventriculography in 21 patients with normal LV ejection fraction (0.53-0.76), but without coronary artery disease and valvular heart disease, aged 40-70 years. LV stroke volume was calculated from left ventriculograms. The maximal LA volume, minimal LA volume, and LA volume at the beginning of the left atrial active contraction were calculated from the left atrial angiograms, and further corrected by a regression equation (true volume = 0.91 x calculated volume -1.1). The LA reservoir volume, LA passive contraction volume, LA active contraction volume, and LA conduit volume were obtained. LA conduit volume correlated significantly with LV stroke volume (r = 0.97), but not with maximal LA volume and LA reservoir volume. LA active contraction volume correlated significantly with LA reservoir volume, LA volume at the beginning of LA active contraction, and maximal LA volume (r = 0.85, 0.60, 0.54, respectively). LA passive contraction volume did not correlate with any factor, and was grossly independent of LV stroke volume. LA conduit volume may be associated with LV diastolic function, and LA active contraction volume appears to increase with increased LA volume.

The change of membrane complement regulatory protein in chorion of early pregnancy

Research on membrane complement inhibitors (DAF, MCP, and CD59) has led to understanding of the regulation of complement system; however, their precise role and distribution remain speculative. In this study, we used an indirect fluorescent immunostaining to investigate the distribution of complements, MCP, DAF, and CD59, in the villi before the 10th week of pregnancy in 18 women. DAF and MCP were observed at the surface of syncytiotrophoblasts (ST) and extravillous trophoblast (EVT) in all subjects. They were observed in villous cytotrophoblast (VCT) in the subjects before the 8th week of pregnancy but were not observed in any subject after the 9th week. However, CD59 appeared in ST but never in VCT. MCP, DAF, and CD59 were observed in EVT. These findings indicated that these complement inhibitors played an important role in early pregnancy, and that CD59 continued to appear in early pregnancy, whereas the expression of MCP and DAF depended on the stage of pregnancy.

[Separation of glycoproteins from cyst fluids of human ovarian cystomas in benign and their some chemical and serological properties]

Perchloric acid-soluble fractions (PASFs 1-3) which were obtained from cyst fluids of two patients [(Nos. 1 (blood group B) and 2 (blood group A))] with ovarian mucinous cystadenoma and one patient (No. 3 (blood group A)) with ovarian dermoid cyst in benign, were identified as glycoproteins by their chemical composition analyses, respectively. Reactivities of PASFs 1-3 against blood group anti-sera and lectins suggest that these PASFs did not contain MN blood group substances, Vgu glycoproteins and T-active glycoproteins. PASF 1 was separated into 11 fractions by Sephacryl S-500 gel filtration. From chemical composition, SDS-PAGE and serological property of the main fraction (Fr. 5), other one fraction (Fr. 7) and mild acid hydrolysates of these two fractions, it is possible to presume that PASF 1 consisted of a large number of AB-active and fucose-rich glycoproteins with high molecular weights and some of these glycoproteins bear either NeuNAc alpha 2-->6GalNAc (sialyl Tn) group or both sialyl Tn and sialylated T groups.

A study on cross-reactivity of anti-DNA antibody with glycosaminoglycans

To study the pathogenesis of lupus nephritis, the cross reactivity between anti-DNA antibody and glycosaminoglycans (GAGs) was investigated. Monoclonal anti-DNA antibodies were obtained from hybridomas by the fusion of MRL/lpr/lpr splenocytes with murine myeloma cells. Some of these monoclonal anti-DNA antibodies showed cross reactivity with GAGs, such as hyaluronic acid, chondroitin sulfate and heparan sulfate. To elucidate the mechanism of cross reactivity, inhibition assays with propanol and polyethylenimine (PEI), a cationic agent, were carried out. Increase of the concentration of PEI (0.6-2.0% vol/vol) resulted in a dose dependent decrease in the binding ability of anti-DNA antibody to GAGs. Propanol, an organic reagent which disrupts the van der Waals bonds between epitopes and paratopes, showed little inhibitory effect on the binding activity of monoclonal anti-DNA antibody to GAGs. These results indicate that the binding of anti-DNA antibody to GAGs is due to a charge interaction rather than van der Waals forces. Anti-DNA antibody which can react with GAGs in the glomerular basement membrane seems to play an important role in the pathogenesis of lupus nephritis.

[Serological property of perchloric acid-soluble glycoprotein fractions of human meconium]

Perchloric acid-soluble fractions (PASFs) were separated, in yields of 87.0-151.9 mg per 1.0 g of wet meconium sample, from six samples of human meconium, and identified as glycoproteins having 41.2-74.1% carbohydrate by chemical composition analysis. Six PASFs reacted with anti-A, -B, -Lea and -Leb sera, but did not react with anti-M and -N sera. These PASFs alos reacted with many lectins such as DBA, UEA-I, Vicia graminea lectin (VGA), Vicia unijuga lectin (VUA), Con A, WGA, RCA-I, PHA-E, SBA, SJA, and influenza A and B viruses. The serological results show that six PASFs contained VGA or VUA-binding (Vgu) glycoproteins as new oncofetal substances, but did not contain M and N blood group substances.

Right atrial contractile performance in patients with myocardial infarction

To evaluate right atrial (RA) contractile performance in patients with myocardial infarction, we validated a cineangiographic method of RA volume measurement, and investigated RA volume change in 'normal' individuals and patients with a previous myocardial infarction. Sixteen silicone rubber RA casts made from human cadavers were filmed in the postero-anterior and left lateral projections. The cast volumes calculated following Simpson's rule were in good agreement with those measured by water replacement (r = 0.992, P < 0.01). At cardiac catheterization, biplane RA cineangiography was performed in 19 'normal' individuals (N group), in 14 patients with a previous antero-septal infarction (AMI group) and in seven patients with a previous inferior infarction (IMI group). The RA volume-time curve was constructed at 20-40 ms intervals for one cardiac cycle. RA volume at the beginning of the atrial contraction (RAVd), which was defined as the 'preload' of the RA, tended to be larger in both the AMI and IMI groups compared with 'normal' individuals. The RA ejection volume was significantly larger in both the AMI (18.4 +/- 2.1 ml.m-2, P < 0.01) and IMI groups (19.4 +/- 2.8, P < 0.01) than in the N group (14.5 +/- 1.9), even for a comparable level of RAVd (range from 26 to 36 ml.m-2) (18.6 +/- 2.1, P < 0.01, 18.2 +/- 2.0, P < 0.01, 14.7 +/- 1.9, respectively). These results suggest that RA contraction increases in patients with myocardial infarction by increasing both the 'preload' and 'contractility' of the RA.

Time-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillation

We aimed to study the time-course of recovery of atrial contraction after cardioversion of chronic atrial fibrillation (duration of more than 3 months) to sinus rhythm. Using M-mode, two-dimensional and pulsed Doppler echocardiography, we determined left atrial (LA) and ventricular (LV) dimensions, peak velocities, and velocity-time integrals of early and atrial filling velocity-time profiles in both LV and right ventricular (RV) inflows (peak E and peak A, Ea and Aa). Results of the LA and LV functions in seven elderly patients (an initial study group) were as follows. The extent of the LA dimensional reduction resulting from atrial contraction was significantly increased up to 5-8 weeks compared with values 0-1 day after cardioversion [from 1.3 +/- 0.8 (mean +/- SD) mm to 3.9 +/- 1.1, P < 0.01]. In conjunction with the progressive increase in peak A, the ratio of peak E to peak A (peak E/A) was significantly decreased and reached a plateau at 5-8 weeks (from 1.93 +/- 0.59 to 0.67 +/- 0.11, P < 0.01). LV fractional shortening was increased significantly 5-8 weeks after cardioversion (from 0.20 +/- 0.06 to 0.29 +/- 0.05, P < 0.01). Since a large part of the improvement in LA contraction was expected to occur in an early stage after cardioversion, we studied eight additional patients more frequently in the early stage (an additional study group). Furthermore, we studied the time course of LA and right atrial (RA) contractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Deletion detection for diagnosis of Duchenne muscular dystrophy in the Japanese population--comparison between the polymerase chain reaction and the Southern blot analysis

We compared the efficacy of the multiplex PCR with that of the cDNA analysis for detection of deletions of the DMD gene in the Japanese patients. Thirty males with DMD from 27 Japanese families were studied by the multiplex PCR, and 24 of them were also investigated by Southern blot analysis. We used five dystrophin cDNA probes for deletion analysis. A total of 19 regions were amplified by the PCR to detect deletions, 9 regions by the method of Chamberlain et al. and another 10 regions by the method of Beggs et al. Deletions were detected in 14 (52%) out of 27 DMD families by the PCR. Southern blot analysis detected deletions in 14 (64%) out of 22 families. Thirteen (93%) of the 14 DMD families with deletions detected by Southern blotting were also confirmed by the multiplex PCR. Provided care is taken in cases where the deletion is limited to a single exon, the multiplex PCR appears to be an efficient and useful alternative to conventional Southern blot analysis for detecting deletions during the prenatal and postnatal diagnosis of DMD.

Acute effects of conventional oral dose of disopyramide on left atrial and ventricular functions

Disopyramide, an antiarrhythmic drug, is known to impair cardiac function, but acute cardiac effects of conventional oral dose of disopyramide are not well known. To examine the extent of acute cardiac effects of daily oral dose of disopyramide, we gave 150 mg of disopyramide to thirteen patients with normal or impaired cardiac function, and observed cardiac function on an hourly basis for 3 hours after baseline period. The serum level of disopyramide reached a therapeutic level (2.0-5.0 micrograms/ml) mostly 1 hour after administration. Doppler-echocardiographically determined left ventricular ejection fraction, and the ratio of the peak early filling velocity to the peak atrial filling velocity in left ventricular inflow velocity remained unchanged throughout the experimental period. Other hemodynamic variables, such as blood pressure and heart rate remained unchanged. We conclude that daily oral dose of disopyramide appears to have no significant effects on cardiac function after administration. Disopyramide seems to be safe and may not be necessarily withheld from patients who need it, when hemodynamic variables are to be measured.

Usefulness of resting thallium-201 delayed imaging for detecting myocardial viability in patients with previous myocardial infarction

To test the feasibility of resting thallium-201 (201Tl) initial and delayed scintigraphy for detecting the area of viable myocardium, we performed single photon emission computed tomography (SPECT) in 57 patients with previous myocardial infarction (MI). All had received coronary arteriography (CAG) and left ventriculography (LVG). Initial and delayed myocardial imagings were carried out 10 min and 2 hours, respectively, after the injection of 201Tl at rest. Redistribution was judged by visual interpretation and/or the circumferential profile curve, and found in the infarcted or its adjacent area in 40 of the 57 cases (70.2%). A negative washout (net increase of 201Tl uptake in delayed image) was detected in 17 of these 40 cases. In 10 of the 57 patients, both exercise and rest-injected 201Tl myocardial images were obtained at exercise and rest, and compared visually. The areas of abnormal perfusion were smaller in the resting delayed images than those seen after exercise in 9 of the 10 cases, and were equal in one case. Thus, resting 201Tl delayed myocardial scintigraphy appears to reduce the underestimation of the size of the viable myocardium by the usual 201Tl images obtained after exercise or by single initial images obtained at rest in patients with previous MI.

Prognostic significance of posturally induced crackles. Long-term follow-up of patients after recovery from acute myocardial infarction

We found that on pulmonary auscultation, fine crackles could be induced by changing the posture from sitting to supine and/or from supine to supine with passive leg elevation in patients without obvious congestive heart failure. We named these crackles "posturally induced crackles (PIC)." To investigate the relationship between PIC and long-term prognosis after myocardial infarction, we followed up 262 patients who recovered from acute myocardial infarction for a mean period of six years. Cardiac death occurred in three of 78 PIC-negative patients and in 28 of 143 PIC-positive patients. PIC-negative patients had a significantly better long-term prognosis than PIC-positive patients according to the Kaplan-Meier survival curves for cardiac death (p < 0.01). In a multilogistic model based on 70 appropriate cases, PIC was the third most important prognosticator after recovery from myocardial infarction and the number of diseased coronary vessels and the pulmonary capillary wedge pressure ranked first and second, respectively.

Modulation of noradrenaline release via activation of presynaptic beta-adrenoceptors in rabbits with adriamycin-induced cardiomyopathy

We investigated the role of beta-adrenoceptors at postganglionic sympathetic nerve endings in noradrenaline release in rabbits with cardiomyopathic congestive heart failure produced by adriamycin (1 mg/kg, I.V., twice a week for 8 weeks). Plasma noradrenaline levels were measured before, 30 min after, and 60 min after the start of continuous intravenous administration of adrenaline (0.06 micrograms/kg/min) in adriamycin-treated and vehicle-treated rabbits in anesthetized condition and pithed condition with electrically stimulated sympathetic outflow (3 Hz, 1 ms square wave pulse, 90 V). In both the anesthetized and pithed conditions, adrenaline increased plasma noradrenaline levels in vehicle-treated rabbits. However, in the adriamycin-treated rabbits, adrenaline had no effect on the plasma noradrenaline level. Pretreatment with propranolol (0.2 mg/kg, bolus I.V. + 0.1 mg/kg/hr, continuous infusion) almost completely abolished the rise in plasma noradrenaline associated with adrenaline infusion in vehicle-treated rabbits. These results suggest that in rabbits with adriamycin-induced cardiomyopathy, the noradrenaline release from the sympathetic nerve endings via the activation of presynaptic beta-adrenoceptors is reduced. This might be due to down-regulation of presynaptic beta-adrenoceptors caused by the elevated plasma noradrenaline due to cardiac failure. However, other possibilities such as reduced affinity or impaired signal transduction cannot be excluded.