Oxygen uptake kinetics are determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction

BACKGROUND

Resting cardiac function does not necessarily affect exercise capacity. However, to determine whether it affects early dynamics of oxygen uptake (VO2) during exercise, we measured VO2 during a constant work rate and during incremental exercise testing in patients with a history of myocardial infarction. VO2 kinetics and exercise capacity were compared between patients with relatively high left ventricular ejection fractions (LVEF > or = 35%, group 1) and those with lower ejection fractions (LVEF < 35%, group 2).

METHODS AND RESULTS

Forty patients with a history of prior myocardial infarction (age, 57 +/- 10 years) were monitored during 6 minutes of moderate constant work rate testing (40 +/- 8 W) and during symptom-limited incremental exercise testing with a cycle ergometer. VO2 was calculated from respired gas analysis on a breath-by-breath basis. Cardiac output determinations were made with a computerized cadmium telluride detector every 10 seconds during exercise. The VO2 time constant during constant work rate exercise was slower in group 2 (58.0 +/- 7.6 seconds) compared with group 1 (45.8 +/- 10.5 seconds, P = .0002), indicating slower kinetics in group 2. The time constant for the rise in cardiac output during exercise was also slower in patients with lower EFs (63.0 +/- 12.8 versus 50.0 +/- 12.2 seconds). However, there were no differences in exercise capacity parameters, such as the VO2 or cardiac output at peak exercise, obtained during incremental exercise testing among the two groups.

CONCLUSIONS

The prolonged time constant of VO2, which is primarily determined during early parts of exercise, reflects delayed cardiac output response in patients with severely impaired LV function. The time constant of VO2 during submaximal constant work rate exercise can be used as a sensitive and discriminant measure of impaired cardiac reserve in these patients.

Gene therapy for Lewis lung carcinoma with tumor necrosis factor and interleukin 2 cDNAs co-transfected subline

Gene therapy with cytokine cDNA will provide a new tool for cancer treatment. We have already reported that immunization with interleukin-2 (IL2) cDNA transfected Lewis lung carcinoma (LLC) cells induced anti-tumor immunity, which, however, was not strong enough to eradicate an established tumor. In an attempt to develop more effective gene therapy methods, we have used tumor cells co-transfected with IL-2 and tumor necrosis factor (TNF) cDNAs. These cDNAs were introduced into pBMG-Neo and pcDV-X819 vectors, respectively, and then co-transfected into LLC cells. The co-transfectants were selected by incubating them in a medium containing G418 followed by the limiting dilution method twice to obtain IL2 and TNF cDNA co-transfected LLC (LLC-TNF-IL2) cells. When 5 x 10(5)/ml LLC-TNF-IL2 cells were incubated for 48 h, they secreted 7.56 U/ml TNF and 527.0 U/ml IL2 into the culture supernatant. When C57BL/6 mice were transplanted with 1 x 10(6) LLC-TNF-IL2 cells, all the tumors were rejected. The growth of transplanted LLC, but not B16F10 melanoma cells, was retarded in mice inoculated with LLC-TNF-IL2 on their contralateral sides, which suggests specific immunity was induced. The immunization effect by the co-transfectant was superior to that of the IL2- and TNF-transfectants alone.

Mechanism of periodic breathing in patients with cardiovascular disease

Although periodic breathing consisting of alternating hyperpnea and hypopnea has been recognized in heart failure patients, its mechanism has not been clarified. We hypothesized that heart failure patients who have oscillations in ventilation will also be found to have oscillations in pulmonary blood flow, as reflected in left ventricular ejection fraction. To test this hypothesis, we analyzed continuously gas exchange and left ventricular ejection fraction during exercise in cardiac patients who exhibited periodic breathing. Out of 48 consecutive patients with reduced left ventricular function who performed a symptom-limited incremental exercise test using an upright cycle ergometer, we selected 5 patients who exhibited clear ventilatory oscillations during exercise. These patients repeated the same exercise test on another day for measuring gas exchange and left ventricular ejection fraction continuously. Oscillatory changes were noted both in left ventricular ejection fraction and in ventilation in these patients. These observations offer support for the hypothesis that fluctuations in pulmonary blood flow are primarily responsible for the periodic breathing seen in heart failure patients.

The pulmonary vascular response to acute hypoxia in chronic pulmonary disease: morphological assessment with magnified pulmonary wedge angiography

To detect hypoxic pulmonary vasoconstriction (HPV) morphologically, we investigated the pulmonary vascular response to acute hypoxia in 27 patients with chronic pulmonary disease (CPD) and 8 healthy subjects. Pulmonary hemodynamic measurements and magnified pulmonary wedge angiography (MPWA) were carried out before and after inhalation of 13% oxygen in nitrogen for 15 min. The diameters of central arteries (A) and muscular arteries (B) were measured using a densitometric method. Vasoconstriction was detected in the muscular arteries than in the central arteries by MPWA. There was a significant correlation between delta P (changes of mean PA pressure) and delta B/A (changes in diameters of B/A) in the CPD group. A significant correlation was found between delta SvO2 and delta B/A in the control group. We conclude that MPWA was a very useful method for the simple detection of HPV in patients with CPDs and we detected one site of HPV on the ninth generation of the pulmonary arterial tree by MPWA.

[A case of obstructive sleep apnea syndrome with increased lung water during sleep]

A 22-year-old man was admitted to the department of plastic surgery in our university with diagnosis of ankylosis and microgeniea. His complaints were snoring and somnolence in the daytime, so we performed a Respigraph (Chest) that showed obstructive apnea during sleep. We diagnosed obstructive sleep apnea syndrome. So we observed pulmonary circulation and measured lung water using the double indicator dilution method (Nihon Koden, MTV-1100) during sleep. During the period of apnea, arterial oxygen pressure and mixed venous saturation decreased, reversely, mean pulmonary arterial pressure rose, lung water (ETV) and central blood volume increased. We considered that the increase of lung water during sleep apnea is caused by hemodynamic change due to hypoxia and increase of venous return. After operation, the value of blood gas assay and apnea index were improved.

Effects of organic and inorganic Ca(2+)-antagonists on acetylcholine-induced contraction in molluscan (Mytilus edulis) smooth muscle

1. Effect of Ca(2+)-antagonist on the contractile response to acetylcholine (ACh) in molluscan (Mytilus edulis) smooth muscle was investigated. 2. ACh-induced contraction was remarkably reduced by exposure to Ca(2+)-deprived medium. 3. The organic Ca(2+)-blockers, verapamil, diltiazem and nicardipine, reduced the concentration-response curve for ACh in a concentration-dependent manner. 4. The inorganic Ca(2+)-blockers, MnCl2, NiCl2, CoCl2 and CdCl2, also reduced the concentration-response curve for ACh concentration-dependently. 5. ACh significantly increased the amounts of inositol 1,4,5-trisphosphate (IP3) in the ABRM. 6. ACh-induced contraction in the ABRM might therefore be mediated through an influx of extracellular Ca2+ and Ca(2+)-release from IP3 sensitive intracellular pools.

Cis-diamminedichloroplatinum(II) inhibits p34cdc2 protein kinase in human lung-cancer cells

cis-Diamminedichloroplatinum(II) (CDDP) induced G2-phase arrest in PC-9 human cancer cells. To elucidate how CDDP acts on cell-cycle regulation, we analyzed the effect of CDDP on cell-cycle regulators such as p34cdc2 protein kinase. p34cdc2 protein kinase activity was maximum in G2 phase and decreased after G2/M transition in synchronized PC-9 human lung cancer cells. Evidence for a phosphorylated p34cdc2 protein kinase complexed with cyclin B was obtained from cells in G2 phase and the p34cdc2 protein kinase appeared to be dephosphorylated at M phase. After exposure to CDDP in G1 phase, PC-9 cells were arrested in G2 phase. The activation of p34cdc2 protein kinase was inhibited by CDDP. Cyclin A and wee-I kinase were not affected by the exposure to CDDP. Cyclin B was degraded in M phase in PC-9 cells. Exposure to CDDP did not affect the degradation of cyclin B. Our data suggest that the effect of CDDP on cell-cycle phase might be regulated by the dephosphorylation of p34cdc2 protein kinase. To determine whether the p34cdc2 protein kinase is a primary target for CDDP, we examined the direct effect of CDDP on tyrosine dephosphorylation of p34cdc2 protein kinase in cellular extracts. Cell lysates from synchronized PC-9 in G2 phase were immunoprecipitated with p13-Sepharose beads. In vitro dephosphorylation of phosphotyrosine of p34cdc2 protein kinase was observed after exposure to okadaic acid in a concentration-dependent manner. The dephosphorylation of p34cdc2 protein kinase by okadaic acid was inhibited by CDDP. We hypothesize that inhibition of p34cdc2 dephorphorylation by CDDP is important for its growth-inhibiting properties.

[Coronary artery bypass surgery in patients with poor left ventricular function]

As the indications for coronary artery bypass grafting (CABG) among patients with poor left ventricular function remain incompletely defined, We undertook the study to assess the results of CABG surgery for a group of such patients. We retrospectively reviewed the clinical features and outcome for 7 patients with poor left ventricular function defined as an ejection fraction below 0.3 who underwent CABG. The mean age of the patients was 63 years (range, 38 to 78 years), and 4 were 70 years of age or older. All patients had history of previous myocardial infarction, and all had left main trunk stenosis or left main equivalent stenosis. The patients underwent CABG with three to six distal anastomoses (mean, 4.3/patient), the internal thoracic artery could be used in all patients, for one or two distal anastomoses (mean, 1.6/patient). Combined coronary endarterectomy was performed in 2 patients. With the exception of one 78-year-old patient with renal failure who died during the early postoperative period, all patients showed marked postoperative improvement in cardiac function. Cardiac catheterization and exercise stress test studies revealed significant improvement in left ventricular function and exercise tolerance in these six patients. These results suggest that excellent results can be obtained with CABG surgery in patients with poor left ventricular function when the viability of the myocardium in the bypassed area has been confirmed.

Interleukin-6 cDNA transfected Lewis lung carcinoma cells show unaltered net tumour growth rate but cause weight loss and shortened survival in syngeneic mice

HuIL-6 cDNA, cloned into a neomycin resistant conferring expression vector, BMGNeo, was transfected into Lewis Lung Carcinoma (LLC) cells. LLC cells (5 x 10(6) ml-1) transfected with IL-6 cDNA (LLC-IL6) secreted IL-6 into the culture supernatant at a concentration of 9.9 ng ml-1 within 48 h. When 1,000,000 of untransfected LLC, BMGNeo vector transfected LLC (LLC-Neo) or LLC-IL6 cells were transplanted into C57BL/6 mice subcutaneously, the mean +/- s.d. of survival times of these mice were 33.3 +/- 9.7, 34.3 +/- 7.1 and 17.0 +/- 3.1 days, respectively. The survival time of LLC-IL6 cells transplanted mice was significantly shorter than that of LLC (P < 0.01) or LLC-Neo (P < 0.01) cells transplanted mice without a measurable difference of tumour size. Plasma concentration of IL-6 steadily increased in LLC-IL6 transplanted mice. Body weight and serum albumin were significantly lower in LLC-IL6 transplanted mice than in LLC transplanted mice. Mouse IL-1 alpha and mouse TNF-alpha were not detected in the plasma of LLC-IL6 transplanted mice. These data suggested that secretion of IL-6 from LLC cells was unable to alter net tumour growth rate but rather caused a state similar to cachexia without detectable increase of IL-1 alpha and TNF-alpha in the plasma. This state may be responsible for the shortened survival of LLC-IL6 tumour-bearing mice.

Apoptosis of lung cancer cells caused by some anti-cancer agents (MMC, CPT-11, ADM) is inhibited by bcl-2

To determine whether the apoptotic cell death induced by anti-cancer agents could be inhibited by bcl-2, we established a bcl-2-transfected human small cell lung cancer cell line, SBC-3/Bcl2. SBC-3/Bcl2 showed higher resistance to ADM, CPT-11 and MMC compared with the parental line SBC-3, with relative resistance values of 3.4, 7.6 and 5.7, respectively. However, there was no difference in sensitivity to CDDP, VP-16, ACNU, MTX and taxol between SBC-3 and SBC-3/Bcl2. Agarose gel electrophoresis showed typical DNA fragmentation of SBC-3 following treatment with CPT-11 or MMC, in a concentration-dependent manner. In contrast, the same concentration of the drugs did not induce DNA fragmentation in SBC-3/Bcl2. Treatment with CDDP resulted in the same degree of DNA fragmentation in SBC-3 and SBC-3/Bcl2. These studies indicate that bcl-2 can modulate the cytotoxicity of some anti-cancer agents by inhibiting the process of apoptosis.

Combination effect of vaccination with IL2 and IL4 cDNA transfected cells on the induction of a therapeutic immune response against Lewis lung carcinoma cells

In order to develop a more effective method of immunotherapy we have transfected mouse interleukin-2 (IL2) or mouse interleukin-4 (IL4) cDNA into a spontaneous non-immunogenic murine lung cancer. Lewis lung carcinoma (LLC). IL2 cDNA transfection more strongly decreases tumorigenicity of LLC than IL4 cDNA transfection. Recombinant-human-IL2 treatment of mice that were transplanted with untransfected LLC could not prolong their survival. In contrast, vaccination with IL2-cDNA-transfected LLC (LLC-IL2) and LLC-IL2 mixed with IL4-cDNA-transfected LLC (LLC-IL4) could significantly suppress tumor growth of LLC in a tumor-specific manner. The vaccination with LLC-IL2 mixed with the same number of LLC-IL4 cells was more suppressive to the growth of LLC than that with LLC-IL2 cells alone, while LLC-IL4 vaccination alone was ineffective. Nude, severe-combined-immune-deficient (SCID) and beige mice were unable to reject LLC-IL2 cells. However, immunodeficient mice responded to LLC-IL2, but not to LLC, since their survival times after transplantation with LLC-IL2 cells were significantly longer than the survival time of normal or immunodeficient mice transplanted with untransfected LLC cells. We conclude that vaccination with IL2-producing tumors and, with more pronounced effect, in combination with IL4-producing tumors, is able to induce an immune response to this normally non-immunogenic tumor. Tumor rejection appears to be achieved by the combined activity of CTL and NK cells. This strategy has potential for new immunotherapeutic interventions in cancer patients.

Treatment of sleep apnea with prosthetic mandibular advancement (PMA)

Nine males with sleep apnea DOES syndrome and three males with sleep apnea DIMS syndrome were treated with prosthetic mandibular advancement (PMA). The method uses a prosthesis, which is designed to advance the mandible 3-5 mm to prevent upper airway occlusion during sleep. The apnea index in the obstructive-type apnea and the percentage of time spent in obstructive apnea decreased significantly with PMA. Although the apnea index showed merely a tendency to decrease in central apnea (p < 0.1), the percentage of time spent in central apnea decreased significantly with PMA. A marked improvement in sleep structures was observed with PMA; a significant increase was seen in total sleep time, percent slow wave sleep (SWS) and percent rapid eye movement (REM) sleep, and the time spent in intra-sleep awakening decreased remarkably. PMA had excellent effects on snoring, and daytime hypersomnolence was reduced in almost all patients. Moreover, a survey on the therapeutic effects of PMA on sleep apnea syndrome and problems associated with wearing PMA was performed with a questionnaire for the sample of nine DOES patients and an additional 22 patients who were treated over a long time. The therapeutic effects could be maintained without any problems in about 2/3 of these patients. The therapeutic mechanisms of PMA in its reduction of both obstructive and central apnea are discussed.

Hibernating myocardium associated with coronary artery dissection and vasospastic angina

Hibernating myocardium is an uncommon clinical state involving persistently impaired myocardial function. A 61-year-old man was admitted because of vasospastic angina. Coronary angiography revealed coronary artery dissection in the midportion of the right coronary artery, and segmental vasoconstriction was evoked by acetylcholine. In this patient, hibernating myocardium in the dissected region was clearly demonstrated by dipyridamole thallium-201 imaging. This report describes the first documented case of hibernating myocardium associated with coronary artery dissection, and the usefulness of dipyridamole thallium-201 imaging in the assessment of this state. Coronary artery spasm might be relevant to the etiology of coronary artery dissection.

Beta(+)-thalassemia with hemochromatosis

A 64-year-old man was admitted due to ascites. Laboratory data showed hemoglobin 6.7 g/dl, mean corpuscular volume 82 fl, and ferritin 2,360 ng/ml. Liver biopsy showed hemochromatosis. The diagnosis of beta-thalassemia was suggested by a decreased ratio of beta/alpha-globin synthesis in vitro (0.26). Cloning of the beta-globin gene showed A-to-G mutation in the first base of the ATA box. He was confirmed to be homozygous for this specific allele by beta-gene complex analysis and analysis of Southern blot hybridization of the alpha- and beta-globin genes. His two sons were confirmed to be heterozygous for this allele.

A new variant of alpha-1-antitrypsin deficiency (Siiyama) associated with pulmonary emphysema

A 38-year-old male with pulmonary emphysema due to severely reduced serum alpha-1-antitrypsin (AAT) level (14.5 mg/dl) was found to have an inherited new AAT deficient variant Siiyama. Chest roentgenogram and CT scanning revealed advanced emphysema, and severe obstructive ventilatory impairment was observed. During the 4-year follow-up period, the annual rate of decline of FEV 1.0 showed approximately 10-fold greater than the normal decline in FEV 1.0 (-380 ml/yr). Treatment with tamoxifen in order to raise the serum AAT level only resulted in an insufficient increase. Augmentation therapy of human AAT should be considered in the future.

Sequence analysis of the large (L) protein of simian virus 5

The complete nucleotide sequence of the large (L) protein gene of simian virus 5 (SV5) was determined from cDNA of the genomic RNA and mRNA, and found to be 6804 bases in length, exclusive of a poly(A) tract. The sequence contained an open reading frame of 6765 nucleotides encoding 2255 amino acids. Results of dot matrix comparisons of the L protein of SV5 with those of human parainfluenza type 3 virus and Sendai virus indicated that there are five conserved domains, and that each domain contains characteristic sequence(s). The L protein of SV5 was detected in purified virions using antiserum directed against an oligopeptide corresponding to the N-terminal region.

A partial defect in technetium-99m pyrophosphate image suggesting cardiac rupture following acute myocardial infarction

We present the case of a 70-year-old woman with acute myocardial infarction who died of cardiac rupture on the 2nd hospital day. Dual isotope single photon emission computed tomography (SPECT) using thallium-201 chloride and technetium-99m pyrophosphate (PYP) performed on the 2nd hospital day showed a large perfusion defect in the anteroseptal wall on 201Tl image and a increased accumulation on 99mTc-PYP image in the anterior area consistent with a partial defect. Autopsy performed 1 h after death revealed a tear in the left ventricular anterior wall consistent with the defect on the 99mTc-PYP image. We propose that the finding of a partial defect in 99mTc-PYP is an interesting finding which may be associated with cardiac rupture following acute myocardial infarction.

Molecular relationships between human parainfluenza virus type 2, and simian viruses 41 and 5: determination of nucleoprotein gene sequences of simian viruses 41 and 5

The nucleotide sequences of cDNAs of the simian virus 5 (SV5) nucleoprotein (NP) gene, and the 3' end of the genome and NP gene of SV41 were determined. The open reading frames of the SV5 and SV41 NP genes encode polypeptides with Mrs of 56,582 and 60,575, respectively, values which are consistent with those estimated by SDS-PAGE. The NP of human parainfluenza virus type 2 (hPIV-2) was more closely related to that of SV41 (amino acid sequence identity 70.5%) than that of SV5 (57.0%); the amino acid sequence identity between the NPs of SV41 and SV5 was 63.3%. The sequence of the 3' end of the genome of SV41 showed a high level of similarity to that of hPIV-2, the terminal 18 nucleotides being identical. It is concluded from these findings that SV41 is related most closely to hPIV-2, even though SV5 had been thought to be an animal type of hPIV-2.

[Psychological states and personality as factors in the morbidity of head and neck malignant tumors]

Many publications have repeatedly indicated that there seems to be a correlation between neoplastic disease and certain types of psychological situations. However, such studies subjected malignant tumors in head and neck region are scanty so far. We applied Cornell Medical Index Health Questionnaire (CMI) and Maudsley Personality Inventory (MPI) to collect medical and psychiatric data from 86 patients (56 males and 30 females) with head and neck malignant tumors and 115 control patients (73 males and 42 females) with head and neck diseases other than malignant tumors. Analysis of CMI data using Diagnostic Sheet, Fukamachi's method and Modification of Abe's method, and analysis of each of Extroversion-Introversion scale scores, Neuroticism scale scores and Lie scale scores of MPI led the following conclusion. 1) Both male and female patients with head and neck malignant tumors showed to be more depressive than their control patients were. Especially, between the two patient groups in males, there was a statistically significant (p less than 0.05) difference. 2) Regarding neurosis, autonomic nerve dysfunctioning and extroversion-introversion, none of these factors seemed to be related with the morbidity of head and neck malignant tumors. Further exploration of this issue, with a special attention to the relationship between depression and head and neck malignancy should be conducted, if possibly, from a prospective point of view.

[A case of inflammatory pseudotumor of the lung that extended to involve the mediastinum]

A 17-year-old woman was referred to our hospital because of cough and fever. The chest X-ray films revealed an anterior mediastinal mass shadow. Steroid drugs and antibiotics were administered and the shadow diminished slightly. To confirm diagnosis, open thoracotomy was performed. The tumor was extended to the mediastinum, thymus and heart as well as the right middle lobe and right lower lobe. Microscopic findings of the resected tumor showed proliferation of histiocytes with infiltration by inflammatory cells, lymphocytes and fibrous tissue.

Comparison of body temperature rhythms between healthy elderly and healthy young adults

The fact that the elderly are usually aware of early sleep onset and early morning awakening shows that the phase of sleep-wake rhythms in the elderly is more advanced than that in young adults. Since it has been suggested that human sleep onset, morning awakening, sleep period and depth of sleep are highly influenced by body temperature rhythms, rectal temperature rhythms were analyzed in 7 healthy elderly and 7 healthy young adults under the condition with time cue. Although a significant 24-hour period was found in the rhythms for all subjects, the phase of the rhythms in the elderly was more advanced than in the young adults. Moreover, a significant inverse correlation was observed between age and acrophase time in the elderly.

[Right ventricular infarction following acute inferior myocardial infarction confirmed by dual isotope single photon emission computed tomography (SPECT) of [99mTc] pyrophosphate and [201Tl] chloride]

A 56-year-old man, complaining of severe substernal chest pain, was admitted. In this patient, right ventricular infarction following by acute inferior myocardial infarction was suggested by serial enzymes, electrocardiogram, echocardiogram, and hemodynamic data, but it was not confirmed. A dual isotope SPECT with 99mTc-pyrophosphate and 201Tl-Cl was performed and color-coded tomograms were obtained. It showed a characteristic image of right ventricular infarction, especially in the short axis view right ventricular infarction looked like shape of a tongue which protruded from left ventricle. We concluded that though the diagnosis of right ventricular infarction is difficult, a dual isotope SPECT is a useful method because it shows a characteristic image.

[A case of lung cancer with mediastinal tumor]

A 72-year-old female underwent surgical resection of lung cancer and mediastinal tumor. Abnormal shadows on the chest roentgenogram were incidentally detected by the regular health screening. The lung cancer existed in the left upper lobe, and the mediastinal tumor existed in the posterior mediastinum along left side of the spines. Serum CEA level was 299 ng/ml by enzyme immunoassay method. We judged the lung cancer as being in Stage I (T2 N0 M0), and the mediastinal tumor as benign neurogenic tumor unrelated to the lung cancer through detailed examination. Surgical resection of both tumors was performed through left thoracotomy, and the surgical procedure was curative operation. Pathological examination revealed the lung cancer was moderately differentiated adenocarcinoma and the mediastinal tumor was Schwannoma. Eight months after surgery, serum CEA level is 1.1 ng/ml without evidence of recurrence. This experience suggested us that a mediastinal tumor accompanied by lung cancer is not necessarily metastatic tumor, and that curative operation may be possible in these cases.

Regression of left ventricular hypertrophy in patients with essential hypertension: outcome of 12 years antihypertensive treatment

To assess the regression of cardiac hypertrophy during long-term (12 years) antihypertensive treatment, the following parameters were determined in 93 patients with essential hypertension: SV1 + RV5 by electrocardiography (ECG), and septal wall (SW) and posterior wall (PW) thickness by echocardiography (UCG). The patients were treated with a thiazide diuretic alone (group 1), thiazide + beta-blocker (group 2), thiazide + methyldopa or nifedipine (group 3) or nifedipine or methyldopa alone (group 4). The blood pressure decreased gradually within 6 months of treatment. According to ECG, regression of left ventricular hypertrophy occurred during the initial 7 years in all groups, whereas in the subsequent 5 years, statistically significant regression was found only in the patients treated with thiazide + other drugs (group 3). By UCG, which was taken only at the 7th and 12th year, regression was detectable during the last 5 years in all groups. The apparent incidence of regression of hypertrophy was lower in the thiazide-alone group (group 1) than in the thiazide + beta-blocker group (group 2), most likely due to mild hypertension in group 1. A cardiovascular accident (nonfatal myocardial infarction) occurred only in 1 patient. We conclude that during long-term antihypertensive treatment, persistent, progressive reversal of cardiac hypertrophy takes place.

Echocardiographic studies on the relationship between atrial fibrillation and atrial enlargement in patients with hyperthyroidism of Graves' disease

In order to study the relationship between the left atrial size and atrial fibrillation (AF) in patients with thyrotoxicosis, 92 patients with Graves' disease were examined. Out of 92 patients (23 men and 69 women, age 7-71 years), 21% had AF: 31% of the patients older than 40 years had AF whereas none of the patients younger than 40 years had AF. Echocardiography revealed that the left atrial enlargement (more than 40 mm) exist in 7% of patients younger than 40 years, in 2% of those older than 40 years without AF and 94% of those older than 40 years with AF. Serum T3 and T4 were higher in the patients with AF than in those without AF when patients older than 40 years were analyzed.

Cerebral atrophy and slow wave sleep of abstinent chronic alcoholics

Although a considerable decrease of slow wave sleep (SWS) has been observed in abstinent chronic alcoholics, the under-lying mechanism is still obscure. In the present study CT scans and polysomnographic recording were repeatedly conducted in nine chronic alcoholics. SWS was remarkably reduced in all the patients, but it was slightly restored in six patients on the 6th month after abstinence. On the other hand, enlargement was observed in the cortical sulci, cerebral fissures and ventricles in these patients. The enlargement of the cortical sulci was improved in five patients, and four of the patients showed increase of SWS. Although enlargement of the cerebral fissures and ventricles was improved in a few patients, in most of the patients who showed improvement in the cortical sulci SWS was increased. The results indicate that the decrease in SWS in abstinent alcoholics may have resulted from the atrophy of the cerebral cortex.

[A randomized controlled study of adjuvant immunotherapy with N-CWS for head and neck malignancies]

The nonspecific adjuvant immunotherapeutic effectiveness of the cell wall skeleton of Nocardia rubra (N-CWS) was studied in patients with head-and-neck malignancies. This study involved 390 patients seen from March 1980 to July 1982. The patients qualifying for statistical analysis were limited to 276 with squamous cell carcinoma without a vestige of tumor after four months of radical therapy. They were divided into two background-factors matched groups of 132 immunotherapy and 144 control patients. The overall two-year nonrecurrence rate was 70.4% for the immunotherapy group and 67.1% for the control. This difference, however, was amplified, when the patients' stages were limited to III and IV: 66.6% for the immunotherapy group and 55.3% for the control.

[Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck]

Thirty-seven previously untreated cases of primary non-Hodgkin's lymphoma in the head and neck were treated at our department from September 1977 through January 1983. The survival rate at three years by stage was 84% in stage I, 44% in stage II and 0% in stage III and IV. Stage, T- and B-cell markers, initial primary site, the level of lymph node involvement (UICC, 1978) and number were important prognostic factors. Chemotherapy in the pre- or post-radiation period was essential, especially in stage II. It was proved that adequacy of radiation portals with special reference to anatomical considerations was necessary.

Characteristic findings of metrizamide CT cisternography in epidermoids

The characteristic findings of metrizamide CT cisternography in two cases of epidermoid are reported. The main finding was a "cauliflower-like" appearance and was thought to be caused by the irregular interstices of epidermoids. Metrizamide CT cisternography may be helpful in making a diagnosis of an epidermoid.

Intracerebellar hemorrhage due to rupture of angiomatous malformations in the cerebellum

Two infants were reported with intracerebellar hemorrhage due to rupture of angiomatous malformations in the cerebellum. There have been only a few reports on intracerebellar hemorrhage under 6 years of age, which was due to angiomatous malformation in all cases. The results of operations for intracerebellar hemorrhage in infants were more favorable than those in adults, so even if the infant patient shows severe neurological symptoms preoperatively, an operation should be performed.

[Contrast echocardiographic evaluation of right ventricular filling profiles in patients with right ventricular volume or pressure overload]

Contrast echocardiographic examinations were performed to evaluate hemodynamic filling profiles in patients with right ventricular overload as well as in normal adults. The subjects were 15 cases of atrial septal defect (ASD) as a representative of right ventricular volume overload, 13 cases of mitral stenosis (MS) as a condition with right ventricular pressure overload and 15 cases of normal adults. M-mode contrast echocardiograms were recorded through the ultrasonic beam direction determined by two-dimensional echocardiograms as shown in Fig. 1.

RESULTS

1) In diastole, continuous rapid linear flow through the tricuspid valve orifice was observed in 11 patients with ASD, while biphasic rapid linear flow was noted in normal adults (control) and in patient with MS. 2) Maximum flow velocity (MFV) in early diastole and flow velocity in atrial contraction phase (AFV) were larger in cases with ASD than that of the control subjects. However, there was no difference in rapid filling time (RFT) between patients with ASD and MS. 3) The characteristic findings of tricuspid valve echoes in cases of ASD included increased valve opening velocity (TOV), decreased diastolic descent rate (TDDR), and high F point. These findings were correlated well with increased MFV and prolonged RFT. 4) MFV was decreased secondarily to the increment of pulmonary artery pressure. 5) Turbulent flow in the right-sided chamber was observed in patients with pulmonary hypertension. These results suggest that linear contrast echoes in the M-mode echocardiograms may be useful for the evaluation of flow velocity and flow profiles across the tricuspid valve orifice in patients with right ventricular volume or pressure overload.