TNF-stimulated arginine transport by human vascular endothelium requires activation of protein kinase C

OBJECTIVE

The authors determined the endothelial arginine transport mechanism and the potential role of a tumor necrosis factor (TNF)-alpha-mediated signal transduction pathway involving protein kinase C (PKC) in regulating this transport in cultured endothelial cells.

SUMMARY BACKGROUND DATA

The vascular endothelium metabolizes arginine to generate nitric oxide (NO), and an increase in NO production can be stimulated by several cytokines. The mechanism(s) responsible for the accelerated arginine transport are poorly understood.

METHODS

Arginine transport was assayed in confluent human umbilical vein endothelial cells in the presence of TNF +/- the PKC inhibitor chelerythrine chloride.

RESULTS

Carrier-mediated arginine transport was accomplished by two Na(+)-independent transporters, System y+ (80% of total transport) and System b0,+ (20% of transport). Tumor necrosis factor (0.1-2 ng/mL) increased System y(+)-mediated arginine transport in a time- and dose-dependent manner by augmenting System y+ transport maximal capacity (control Vmax = 1325 +/- 60 pmol/mg protein/minute vs. TNF Vmax = 3015 +/- 110 pmol/mg protein/minute, p < 0.01) without affecting transporter affinity (control Km = 30 +/- 1.4 microM vs. 34 +/- 1.3 microM arginine, p = NS). Stimulation was maximal at the 8-hour time point and was inhibited by both actinomycin D and cycloheximide. In addition, inhibition of PKC with chelerythrine abrogated the TNF-augmented arginine transport. Similarly, incubation of cells with the direct PKC activator TPA (phorbol ester 12-myristate 13-acetate) stimulated System y(+)-mediated arginine transport nearly fivefold, secondary to an increase in transporter Vmax (TPA Vmax = 5349 +/- 310 pmol/mg protein/minute, p < 0.001 vs. control), with no change in Km. This TPA-induced stimulation of arginine transport also was blocked by chelerythrine CI, actinomycin D, and cycloheximide. Incubation of TNF-stimulated cells with two NO synthase inhibitors did not reduce transport activity, suggesting that the arginine transporter and the NO synthase enzyme may, in part, be independently regulated.

Balloon-expandable stent repair of severe coarctation of aorta

Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. This study evaluates the feasibility and immediate results of balloon-expandable stent implantation in 10 patients with severe coarctation of aorta. The ages of the patients ranged from 1 month to 43 years; 1 was an infant, 8 were children (mean age 5.3 +/- 4 years), and 1 was an adult. All had an unfavorable anatomy for balloon angioplasty; 9 had isthmus hypoplasia. Balloon predilation was first performed and its immediate effect evaluated. Then a balloon-expandable stent that was 30 mm long and covered the isthmus and coarctation levels was deployed, and it was further expanded to the preselected final diameter (12 +/- 4 mm). A final hemodynamic and angiographic evaluation was then obtained. Full deployment of an incompletely expanded and distally displaced stent in the infant led to aortic disruption that was controlled by a second stent covering the disrupted zone and the isthmus. After balloon angioplasty alone was done, the mean gradient (43 +/- 12 vs 31 +/- 10 mm Hg) and the percentage stenosis (72% +/- 11% vs 54% +/- 11%) had an insufficient decrease. However, after stent implantation was done, the gradient almost disappeared (mean 2 +/- 3 mm Hg). The angiographic stenosis disappeared in 7 patients and was markedly reduced in 3. The ratio of isthmus/descending aorta changed from 0.65 +/- 0.14 to 1 +/- 0.08 (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of system y+ arginine transport capacity in differentiating human intestinal Caco-2 cells

This study describes the ability of passaged human intestinal Caco-2 cells to regulate transport of L-arginine via system y+. Subconfluent and confluent cells possessed system y+ activity, as determined by the sodium independence of uptake and the pattern of inhibition by amino acid analogues or N-ethylmaleimide. Initial rates of arginine uptake via system y+ decreased as the cells advanced from the undifferentiated to the differentiated state following culture passaging. Furthermore, kinetic analysis of the leucine-insensitive portion of uptake indicated that the Caco-2 system y+ transport capacity decreased with cell age, dropping from a maximal velocity (Vmax) = 1,094 pmol.mg-1.min-1 [Michaelis constant (Km) = 41 microM] in undifferentiated cells 2 days postseeding to Vmax = 320 pmol.mg-1.min-1 (Km = 37 microM) in confluent cells 9 days postseeding (from cells of the same passage). Northern analysis indicated that the levels of a single 7.9-kb mCAT-1 mRNA species were relatively constant over the course of Caco-2 differentiation and therefore were unsynchronized with the system y+ relative transport activities. It is concluded that the Caco-2 capacity to transport arginine via system y+ may be downregulated by posttransitional modifications in confluent cells compared with newly passaged undifferentiated cells. These data serve as a well-defined in vitro model for further studies regarding regulation of arginine transport in epithelial cells.

Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent

To assess the risk of late side branch occlusion after Palmaz-Schatz stent deployment, we analyzed the angiographic evolution of 62 patients treated by successful stent implantation who had a total of 85 side branches starting from the stented segment. Side branches were considered minor (n = 39) when the diameter was < 1 mm and intermediate (n = 46) when the vessel had > or = 1 mm diameter. One angiographic follow-up study was available in all patients at 8 +/- 5 months. Eight minor branches presented some degree of stenosis at origin before stent deployment (4 totally occluded). After stent deployment, 32 (82%) of 39 remained unchanged and 3 became occluded. Late progression at origin occurred in 4 of 34 (3 occluded). Before stent deployment, 48% of the intermediate branches had some compromise degree at their starting point (1 totally occluded). Eight of 45 intermediate branches became occluded after stent implantation. Late progression at origin happened in 5 of 32 branches (2 occluded). Some degree of follow-up stenosis regression at the origin was observed in 22 (26%) of 85 arteries. Neither clinical nor angiographic factors could be identified as predictors of late side branch occlusion or stenosis progression at its origin. Later occlusion or progression at origin of a side branch covered by a Palmaz-Schatz stent seems to be an uncommon occurrence (7% and 12% respectively) that cannot be predicted by angiographic or clinical factors. On the contrary, regression at follow-up of a side branch-origin stenosis can also come about.

Differentiation- and protein kinase C-dependent regulation of alanine transport via system B

The regulation of sodium-dependent L-alanine transport is described for the first time in intestinal cells. Substrate analogue inhibition patterns and Dixon analyses indicated that uptake occurred via transport system B, an epithelial cell variant of systems B0,+ and ASC. System B served > 95% of the Na(+)-dependent alanine uptake in both undifferentiated (2 days postpassaging) and differentiated (> 9 days postpassaging) states of the human Caco-2 cultured intestinal cell line. (Methylamino)isobutyric acid-inhibitable system A transport accounted for < 5% of total alanine uptake. System B activity was greater in undifferentiated cells compared with the differentiated state, and activity at any differentiation state was stimulated by 12-O-tetradecanoylphorbol-13-acetate (TPA). The maximal stimulation, determined by TPA dose-response/exposure time data, was attributable to a change in cell transport capacity (Vmax), with Km unaffected. The Vmax of system B was greater in 2-day-old cells (2.79 +/- 0.21 nmol min-1 mg of protein-1; Km = 164 +/- 26 microM alanine), decreasing to Vmax = 0.51 +/- 0.03 nmol min-1 mg of protein-1 (Km = 159 +/- 14 microM) in 9-day-old cells. Regardless of differentiation status, the sodium-activation Hill coefficient was 1.06 +/- 0.10, and the alanine passive diffusion permeability coefficient was 0.53 +/- 0.08 microliter min-1 mg of protein-1. Phorbol ester up-regulated the Vmax of system B in 2-day-old cells to Vmax = 6.32 +/- 0.37 nmol min-1 mg of protein-1 (Km = 169 +/- 18 microM), and in 9-day-old cells to Vmax = 1.42 +/- 0.05 nmole min-1 mg of protein-1 (Km = 180 +/- 10 microM). Phorbol ester stimulation of transport occurred after at least 6 h of continual exposure, and was blocked by the protein kinase C inhibitors chelerythrine or photoactivated calphostin C. Protein synthesis inhibitors cycloheximide and actinomycin D each blocked the phorbol ester up-regulation of system B activity. It is concluded that Caco-2 cells regulate carrier-mediated sodium-dependent transport of L-alanine by changing the membrane capacity to transport alanine via system B and that this regulation involves de novo protein synthesis under the control of protein kinase C.

[Registry of activities of the Hemodynamics and Interventional Cardiology Section in 1993]

Results of the Spanish Registry for Interventional Cardiology 1993 are presented, as previous years, by the Section of Haemodinamics and Interventional Cardiology of Sociedad Española de Cardiología. There are 72 participating cardiac catheterization laboratories. That represents 100% of those laboratories who had activity in 1993, Public medicine (51 centers) and Private practice (21 centers). From those, 8 laboratories exclusively performed pediatric cases. There have been performed 47353 diagnostic procedures and 2647 endomiocardial biopsies. In diagnostic cases greater proportion corresponds to coronariography (37591, 75.2%). Therapeutic interventionalism is also accomplished in 61 laboratories, on which 7807 balloon PTCA, 535 coronary atherectomies, 825 mitral valvotomies were performed, and 503 endocoronary prostheses were implanted. Mean rate of coronary interventionalism was 222 procedures by a million of inhabitants. This activity represents approximately a 17% increase from 1992, in diagnostic as well interventional procedures. Results of therapeutic cases did not show any significant changes, balloon PTCA primary success rate is 91.5%, with an incidence of 4.2% of complications that includes 0.7% mortality rate.

SSZ-26 and SSZ-33: Two Molecular Sieves with Intersecting 10- and 12-Ring Pores

The framework structures of two closely related molecular sieves, SSZ-26 and SSZ-33, are described. These materials possess a previously missing but desired structural feature in a group of industrially significant zeolites. They contain a three-dimensional pore system that provides access to the crystal interior through both 10- and 12-rings. This property is a consequence of the organic structure-directing agents used in the synthesis of these materials. These materials are examples of the purposeful design of a micropore architecture. Both SSZ-26 and SSZ-33 contain the 4=4-1 building unit that had been previously found only in natural zeolites.

Factors determining late success after mitral balloon valvulotomy

Mitral balloon valvulotomy (MBV) has proved to be an effective method in the treatment of patients with mitral stenosis. Although several factors determining an optimal immediate result have been described, there is little information regarding long-term follow-up, as well as factors influencing late success after MBV. This study analyzes 350 patients (mean age 46 +/- 12 years) treated by MBV who were clinically followed up between 6 months and 6 years. At least 1 echo-Doppler follow-up study was obtained in 298 patients 28 +/- 14 months after MBV; hemodynamic reevaluations were performed in 66 patients after 23 +/- months. Late success was considered if the patient was in functional class I to II and free of major events (death, restenosis and valve surgery). Restenosis was defined as a 50% loss of initial gain with regard to valve area by echocardiography, which was confirmed hemodynamically. After a mean follow-up of 38 +/- 15 months, 296 patients (84%) remained in functional class I to II, without surgery or the need for an increase in medical treatment. The 5-year Kaplan-Meier survival rate was 94 +/- 1%, whereas restenosis, valve surgery and major event-free probability were 90 +/- 3%, 91 +/- 2% and 85 +/- 2%, respectively. Multivariate study (Cox regression model) identified the presence of sinus rhythm (p < 0.001) and the absence of calcium at fluoroscopy (p < 0.003) as the only independent factors of late success.(ABSTRACT TRUNCATED AT 250 WORDS)

Serial angiographic observations after successful directional coronary atherectomy

This study focuses on the early and late angiographic evolution observed in 82 patients with coronary artery disease who were successfully treated by directional coronary atherectomy (DCA) without adjunctive balloon angioplasty. Qualitative inspections and quantitative measurements were obtained from a selected angled-view projection in the following conditions: (1) before treatment; (2) immediately after treatment; (3) the day after atherectomy; (4) 1 month after; and (5) 6 months after. The appearance of the treated segment 24 hours after the procedure did not differ in 79 patients from that observed immediately after DCA; silent total occlusion occurred in two patients, and one had an aneurysm at the site of resection (all three patients were excluded from the analysis). At the 1-month study restenosis developed in 3 (3.6%) patients; the remaining 76 had identical appearances, with no evidence of renarrowing of the lumen. However, from 1 to 6 months after the procedure restenosis developed in 35 of the remaining 76 (46%) patients, and 41 patients were free of restenosis and symptoms. These findings, which show that early elastic recoil does not occur after successful DCA, are different from the changes observed after balloon angioplasty. At the 1-month observation restenosis is an infrequent but possible phenomenon (3.8%). From this point the healing of the arterial wall leads to no or mild renarrowing (late success); an exaggerated proliferative response produces restenosis.

Intracoronary ultrasound assessment of directional coronary atherectomy: immediate and follow-up findings

OBJECTIVES

This study was conducted to assess the relations among intracoronary ultrasound, angiographic and histologic data obtained from patients with coronary artery disease successfully treated by directional coronary atherectomy. In addition, it was designed to elucidate whether some aspects of intravascular ultrasound or pathologic findings could predict a propensity to restenosis.

BACKGROUND

Intracoronary ultrasound is a useful technique in guiding and assessing atherectomy. However, there is little information about the characterization of the different types of coronary plaques and the changes observed in them after resection. Furthermore, the follow-up ultrasound appearance of previously treated lesions remains undepicted.

METHODS

Fifty-two patients (54 +/- 10 years old) were studied. All were successfully treated by atherectomy with the aid of intracoronary ultrasound guidance. Qualitative and quantitative ultrasound and angiographic variables were derived before and after resection. Quantitative histologic morphometric information was also obtained from the specimens. In 22 patients, a follow-up echoangiographic reevaluation was performed 6 +/- 4 months later.

RESULTS

Echogenic plaques had a higher collagen and calcium content, whereas echolucent plaques had an increased level of fibrin, nuclei and lipids. Ultrasound plaque reduction after atherectomy was greater in echolucent (76 +/- 21%) than in echogenic plaques (60 +/- 18%; p < 0.05). That reduction correlated with the weight of the resected material (r = 0.62; p < 0.01). At follow-up study, 13 of 22 patients had angiographic and ultrasound evidence of restenosis. Most recurrent lesions had a stenotic three-layer appearance. The incidence of restenosis of primary lesions treated with atherectomy was higher in echolucent (100%) than in echogenic (33%) plaques. Similarly, a higher proportion of nuclear content in the resected material was observed in patients who developed restenosis (2.1 +/- 0.7%) than in patients who had late success after atherectomy (1.2 +/- 0.6%).

CONCLUSIONS

Our findings suggest that echolucent plaques are easier to resect than are echogenic plaques but frequently develop restenosis. In contrast, the resection of echogenic plaques, although often incomplete, is associated with better long-term results.

Peripheral stent recovery after failed intracoronary delivery

The Palmaz-Schatz stent can be successfully deployed in most patients. However, in a small percentage of instances a systemic embolism of the stent has been reported. In the present article we describe an easy and fast method of stent capture when detachment from the balloon has happened (pulling back the stent-loaded balloon into the guiding catheter or femoral sheath). In this situation we propose the use of the coronary guide-wire "as a guide" to capture coaxially the lost stent. This method allows for continuing the procedure without removal of the femoral sheath.

Kinetics of the sodium-dependent glutamine transporter in human intestinal cell confluent monolayers

The intestinal epithelium metabolism of glutamine plays a critical role in inter-organ nitrogen flow. Although it is known that glutamine is the primary oxidative energy source and nucleotide precursor in intestinal cells, the luminal uptake of glutamine by the apical surface of enterocytes is poorly understood. In this study we have uncovered the sodium-dependent transporter system responsible for L-glutamine uptake by the apical membrane of a human intestinal epithelial cell line. The sodium-dependent Michaelis constant (Km) = 247 +/- 45 microM glutamine, and Jmax = 4.44 +/- 0.65 x 10(-9) mole min-1(mg protein)-1 (37 degrees C). Glutamine shares the transporter with alanine, as demonstrated by unlabeled glutamine inhibition of [3H]alanine uptake kinetics with a purely competitive-type inhibition pattern, and glutamine inhibition Ki = 205 +/- 18 microM by Dixon analysis. The inhibition pattern for a series of amino acid analogs indicated that this intestinal apical membrane sodium-dependent transporter for glutamine is distinct from any other transport system found in membranes of non-intestinal cells.

Divided Palmaz-Schatz stent for discrete coronary stenosis

This article shows the findings observed in a group of 7 patients with short coronary lesions who were treated by a divided (7 mm length) coronary Palmaz-Schatz stent, in trying to match the length of the stent to that of the treated segment. All of the patients were male and had a mean age of 59 +/- 5 years; 6 had unstable and 1 stable angina. The angiographic length of the lesion was 4.3 +/- 1 mm. The divided stent was successfully deployed in all cases and remained in place without complications. The clinical condition stabilized and all 7 patients were symptom-free 6 months post-hospital discharge. At angiographic follow-up studies, performed before discharge and at 2 and 6 months later, there were no significant changes in the resultant minimal lumen diameter. The stented segment and surrounding areas remained smooth and without intraluminal defects. These observations suggest that a 7 mm length stent is effective in avoiding elastic recoil of discrete coronary lesions. This reduced length could be helpful in: 1) decreasing exposed metallic surface, 2) increasing deliverability and 3) preventing the origin of nearby side-branches to be covered by a standard 15 mm length stent.

[Follow-up study after percutaneous mitral valvuloplasty. The COR-PAL experience]

Mitral balloon valvulotomy has proven to be an effective method for the treatment of patients with mitral stenosis. Although several factors determining an optimal immediate result have been described, there is few information regarding the longterm follow-up as well as factors influencing late success after the procedure. In this article, we analyzed our series of 311 patients treated by mitral balloon valvulotomy who were clinically followed between 3 months and 5 years (mean 23 +/- 11 months). At least, one echo-Doppler follow-up study was obtained in 260 patients, 20 +/- 10 months after. Hemodynamic re-evaluations were performed in 63 patients after 20 +/- 11 months. Late success was defined as the patient being in functional class I-II and free of major events (death, restenosis or valve surgery). Restenosis was defined as the loss of 50% of initial gain in terms of valve area, confirmed always hemodynamically. Major events during follow-up period occurred in 19 patients (10 deaths, 8 restenosis and 11 mitral valve surgery). We performed a multivariate study using the Cox-regression model. In the analysis, all variables with or near statistic significance in the univariate analysis (Mantel-Haezel) were included. The only significant independent predictors of late success were the presence of sinus rhythm (p < 0.04) and the absence of calcium at the valve (p < 0.001). In conclusion, the best results 5 years after mitral balloon valvulotomy are observed in patients with non calcified valve and sinus rhythm.

[Thin layer chromatography for identification of 9 species of traditional Chinese medicine in baihe gujin tang granules]

Baihe Gujin Tang granules are mainly composed of nine species of traditional Chinese medicine and other admixtures, so the composition is very complex. In order to confirm the presence of each traditional Chinese medicine in the preparation, a thin layer chromatographic method was developed successfully for analysis of Scrophulariae, Platycodon, Paeoniae and Glycyrrhizae.

Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis

This study presents the findings in 33 patients with discrete subaortic stenosis who were treated by percutaneous balloon dilation and were followed up for 2 months to 6.2 years (mean 34 +/- 21 months). The mean age was 13 +/- 11 years; 10 (30%) were female and 23 (70%) male. Associated malformations were observed in nine patients (27%). All patients underwent noninvasive studies and cardiac catheterization. The mean value to membrane distance was 4.5 +/- 2 mm/m2. After balloon dilation, the pressure gradient from the left ventricle to the aorta decreased from 68 +/- 30 to 20 +/- 13 mm Hg (p less than 0.00001); there were no significant changes in the degree of aortic regurgitation. A fluttering and widely mobile remaining membrane was clearly visualized after dilation. Better immediate results were obtained in patients with a smaller baseline gradient, a larger aortic anulus and a longer valve to membrane distance. Serial follow-up echographic studies were available in 30 patients, and 18 hemodynamic reevaluations were performed in 13 patients. However, seven patients who demonstrated restenosis underwent redilation at a mean of 29 +/- 17 months after the first dilation. Redilation in six of the seven patients obtained benefits similar to those observed at the first dilation. Only one patient with unsuccessful redilation required surgery. The mean value of the last explored residual gradient (on hemodynamic or Doppler study) in the remaining 32 patients was 21 +/- 10 mm Hg. No significant changes were observed in the angiographic evolution of aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon valvuloplasty for mild mitral stenosis

Of a total number of 288 patients with mitral stenosis treated by percutaneous balloon valvuloplasty, 21 patients had a basal mitral area equal to or greater than 1.5 cm2, as measured hemodynamically. The immediate hemodynamic results of this particular group of patients with mild mitral stenosis are described, as well as the clinical and echo doppler findings at follow-up (22 +/- 12 mo). Patients with mild mitral stenosis (group I) had more pliable valves (p less than 0.01), as assessed by echo, and higher incidence of sinus rhythm (p less than 0.02) than that observed in the remaining 267 patients (group II). After valvuloplasty the valve area increased in group I from 1.7 +/- 0.2 to 3.1 +/- 0.7 cm2 (p less than 0.0001). This mean final area was significantly different (p less than 0.0001) than that observed in group II (1.98 +/- 0.6 cm2). No patients with mild mitral stenosis developed progression of mitral regurgitation, and none had any other major complications. Most of them reached a grade I final functional status. At echo doppler follow-up studies we did not observe significant changes in the mean mitral gradient as compared with the immediate hemodynamic results. These findings suggest that early mitral balloon valvuloplasty could be an alternative in trying to favorably influence the natural course of the rheumatic mitral disease in selected patients.

[Coronary permeability and left ventricular function following thrombolytic therapy]

We study 40 patients, 55 +/- 7 years old with acute myocardial infarction treated early by thrombolytic therapy (20 STK and 20 rt-PA). All patients were angiographically studied in the following conditions: 1) baseline, before initiating therapy. 2) Three hours after treatment. 3) Twenty four hours later. 4) Before discharge. The infarct related artery was patent 24 hours after treatment in 31 patients (78%); five of them were patent before treatment, and we observed an early reperfusion in 20 patients (57%) and late reperfusion in 6 patients (17%). The number of patients with angiographic evidence of intraluminal thrombus decreased progressively through conditions while the grade TIMI of coronary perfusion increased in the absence of reocclusion. Final regional wall motion of infarct related myocardial zones and their degree of recovery were significantly higher in recanalized patients, as compared with non-reperfused patients. Similarly, left ventricular functional recovery was higher in patients with antegrade of collateral flow to the infarct area, as compared with totally occluded patients.

[Valvulopathies (XIV). The role of percutaneous valvuloplasty in congenital valvular diseases]

The present article describes the cooperative experience Córdoba-Las Palmas since 1983 in 123 patients with congenital right or left ventricular outflow obstructions who were treated by percutaneous balloon dilatation. Seventy of them had pulmonary stenosis (63 valvular and seven supravalvular types); two had pulmonary atresia, 25 valvular aortic stenosis and 27 discrete subaortic stenosis. In patients with valvular pulmonic stenosis the gradient and the right ventricular pressure decreased significantly. No significant changes were observed in the degree of pulmonary regurgitation. One neonate died. No other major complications occurred. After a mean follow up of 3 +/- 2 years, we did not observe significant changes in the degree of pressure relief. The mean residual gradient is 26 +/- 19 mmHg. In our 21 patients out of the neonatal period with valvular aortic stenosis the gradient and the left ventricular pressure dropped significantly. Progression of aortic regurgitation in more than I grade was observed in 4 patients (19%), although only one (5%) progressed to grade III. There were no major complications in this group. After a mean follow up period of 24 +/- 17 months they persist with the obtained pressure relief and same degree of valvular competence. All 4 neonates with critical aortic stenosis had unsuccessful dilations and they died, wether after ulterior surgery or without it. In 27 patients with discrete subaortic stenosis the gradient and the left ventricular pressure decreased markedly, without significant changes in valve competence. There were no related major complications. After dilation, a broken and mobile membrane was frequently seen. At follow up (24 +/- 18 months), 6 patients (22%) had restenosis; five of them were successfully redilated. The remaining 21 patients persist with a reduced residual gradient (24 +/- 7 mmHg) and without significant changes in valve competence.

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study]

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors influencing progression of mitral regurgitation after transarterial balloon valvuloplasty for mitral stenosis

This study analyzes the clinical, echocardiographic and hemodynamic factors affecting progression of mitral regurgitation (MR) after transarterial balloon valvuloplasty in 200 consecutive patients with rheumatic mitral stenosis. After valvuloplasty, the mitral valve area increased in all patients, from 1.03 +/- 0.36 to 2.06 +/- 0.71 cm2 (p less than 0.0001). With regard to the basal stage, the mitral valve was competent in 139 patients and there was mild MR in 61 (grade I in 53, and grade II in 8). Three patients had progression of MR induced by a technical deficiency and they were excluded from analysis. Patients were classified into 2 groups on the basis of the degree of MR before and after valvuloplasty: group A--no progression of MR (n = 167; 85%) when the degree of MR did not change, disappeared after valvuloplasty, or increased from grade 0 to I; group B--progression of MR (n = 30; 15%) when the degree of MR increased to greater than or equal to grade II. Progression of MR was observed more frequently in older patients with presence of chronic atrial fibrillation, larger left atrial size and left ventricular volumes, baseline MR, more severe stenosis and a lower ejection fraction. Multivariate analysis selected age, left ventricular volumes and ejection fraction as independent predictors of progression of MR. All these factors suggest that progression of MR after balloon valvuloplasty could be related to a more advanced degree of disease.

Balloon valvuloplasty for mitral restenosis after previous surgery: a comparative study

We studied 203 patients with mitral stenosis treated by transarterial valvuloplasty. Forty two (group A) had undergone closed (n = 30) or open n = 12) surgical commissurotomy 15 +/- 5 years before. The remaining 161 had not undergone previous surgery (group B). There were no significant differences between both groups in terms of age, sex, functional class, left atrial size, two-dimensional anatomic features of the valve, incidence of mild basal mitral regurgitation, or ejection fraction. A comparative analysis of both groups showed no significant differences in terms of changes in the mean gradient, mitral valve area, and incidence of severe postvalvuloplasty mitral regurgitation (9.5% versus 5.5%). Echo-Doppler follow-up studies (11 +/- 7 months) showed persistent gradient relief in either group. We conclude that the immediate and short-term results of balloon valvuloplasty in patients who had undergone previous surgery are similar to those observed in patients who had not had commissurotomy.

Characterization of gamma/delta T cell clones isolated from human fetal liver and thymus

The origin and development of T cells bearing gamma/delta T cells receptors (TcR) has been extensively studied in the mouse. By contrast, little is known about development patterns and diversity of the human gamma/delta T cell lineage. To study the repertoire of human gamma/delta+ T cells during T cell ontogeny, we have isolated clonal populations of gamma/delta+ T cells from 14-week fetal thymus and liver and characterized the molecular composition of their TcR. The technique of in situ hybridization was used to identify cells expressing TcR genes in fetal liver and thymus. A panel of clones representative of developing T cell populations found in vivo was subsequently isolated from both tissues and clones expressing cell surface gamma/delta receptors were identified. Although both the liver-derived gamma/delta+ T cell clone, L2, and the thymus-derived gamma/delta+ T cell clone, T6, had similar cell surface phenotypes, namely CD3+, CD7+, CD45+ and CD8-, their reactivity with anti-CD2 and -CD4 antibodies was different. L2 was CD2high, CD4- whereas T6 was CD2low, CD4low. Both clones possessed effector functions similar to those of adult T cells as demonstrated by the synthesis and secretion of cytokines in response to stimulation through the CD3/TcR complex. Analysis of the TcR composition of the fetal clones showed both clones to possess similar or identical gamma chain components, C gamma 1, J gamma 1/2, V gamma 8, and both utilize V delta gene segments other than V delta 1. This TcR genotype has not been previously reported in the analysis of adult gamma/delta+ T cells. Our studies have identified a unique population of human gamma/delta+ T cells that may be derived extrathymically and appear to be preferentially and perhaps transiently expressed during fetal life.

[Infarct size determination using enzymatic methods in patients with early coronary recanalization]

To evaluate the usefulness of the infarct size determined by serial creatine kinase (CPK) measurements in patients with early reperfusion, we have studied 189 patients meaning in age 59.2 +/- 8.6 years, with acute myocardial infarction treated with streptokinase (STK); 81 of them by intracoronary route (group A), and 108 by intravenous administration (group B). In the group A we performed serial angiographic studies in the following conditions: baseline, immediately after STK infusion and before hospital discharge. In group B we performed only one angiographic control 5 +/- 3 days after. In patients with reperfusion, the parameters of left ventricular function correlated with cumulative creatine kinase release (MAX-CPKr) by linear regression in both groups. We observed a tendency to closer correlations in patients with left anterior descending or circumflex artery as the infarct related artery, in patients without previous infarction and in those who did not receive electrical shock for ventricular arrhythmias. In patients with unsuccessful reperfusion (n = 11), we also obtain a significant correlation (r = 0.72) between ejection fraction and MAX-CPKr. The slope of the regression line (b = 7.7 X 10(-5) was steeper (p less than 0.05) than that observed in recanalized patients, who were evaluated within the first 3 days (b = 2.2 X 10(-5), after 8 +/- 5 days (b = 2.7 X 10(-5), or before discharge, at 22 +/- 9 days (b = 2.6 X 10(-5).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of lipoxygenase inhibitors on Ca2(+)-induced constriction of the rabbit ear artery

1. The effects of nafazatrom, nordihydroguaiaretic acid (NDGA) and quercetin on Ca2(+)-induced vasoconstriction were studied in isolated rabbit ear arteries. 2. The arteries were perfused with Ca2(+)-free and high K+ (75 mM) Krebs bicarbonate buffer. Constriction of the artery was induced by addition of Ca2+ (1.5 mM) to the perfusion fluid. 3. Indomethacin (1 microM) did not alter the response to Ca2+. 4. Nafazatrom (2 or 5 microM) produced a concentration-dependent inhibition of the constrictor response to Ca2+ ranging from 4 to 23% after 1 hr of perfusion and 26 to 62% after 3 hr. 5. Similar effects were obtained with NDGA and quercetin (0.5 and 1 microM). 6. The inhibitory effects of nafazatrom and quercetin were antagonized by Ca2+ (2.5 mM) or Bay K 8644 (1 microM), a calcium channel activator. 7. Ca2(+)-induced contractions recovered within 30 min after discontinuation of perfusion with quercetin, whereas nafazatrom and NDGA had longer durations of action. 8. These results suggest that inhibitors of lipoxygenase antagonized Ca2(+)-induced vasoconstriction and that products of lipoxygenase metabolism may facilitate Ca2+ entry into vascular smooth muscle cells.

In vivo administration of interleukin 1 elicits increased Ia antigen expression on B cells through the induction of interleukin 4

The effects of the in vivo administration of interleukin 1 (IL 1) on lymphocytes from lymph node and spleen were analyzed. Mice received five daily subcutaneous (s.c.) injections of various doses of human recombinant IL 1 beta. Either 1 or 7 days after IL 1 treatment, spleens, popliteal and inguinal lymph nodes were collected. Lymphadenosis and splenomegaly were observed in the IL 1-treated animals. Lymph nodes from IL 1-treated mice contained a higher percentage of B cells than controls, and B cells from IL 1-treated mice expressed dramatically increased levels of Ia antigen. Lymphadenosis and splenomegaly, as well as the changes in subset distributions and Ia expression were transient. Concomitant treatment of mice with IL 1 and anti-IL 4 monoclonal antibody suppressed IL 1 effects on B cell Ia expression, but not on the B/T cell ratio. In situ hybridization analyses revealed that IL 1 treatment induced the expression of mRNA for IL 4, interferon-gamma, and IL 2 in lymph node and spleen cells. The distribution of cells expressing the various cytokine mRNA was markedly different between the spleens and lymph nodes.

Abrupt homeostatic responses to transient intracardiac occlusion during balloon valvuloplasty

The present study analyzes the hemodynamics of intracardiac occlusive periods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 +/- 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p less than 0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p less than 0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed.

Angiographic follow-up after balloon angioplasty for coarctation of the aorta

Balloon angioplasty for coarctation of the aorta was performed in 45 patients; 17 (Group 1) were infants (mean age 34 +/- 43 days). This study focuses on the remaining 28 patients (Group 2), children and adults ranging in age from 2 to 31 years (mean 13 +/- 8). Two patients had had previous surgery for coarctation; in the remaining 26 the coarctation had not been surgically treated. Twenty patients (71%) had a discrete type of coarctation; the remaining eight had a diffuse or eccentric stenosis. Angiographic studies of the aorta were performed before and immediately after angioplasty in all 28 patients; 16 (57%) of them also underwent angiographic reevaluation 10 +/- 2 months later. The pressure gradient decreased immediately after angioplasty and was unchanged at follow-up. Residual gradient at follow-up ranged from 0 to 40 mm Hg (mean 11 +/- 13). Patients with a discrete type of coarctation had a lesser residual gradient than did patients with other anatomic types of coarctation. Angiographically, the stenosis also decreased after angioplasty (68 +/- 10% versus 24 +/- 17%; p less than 0.01); a new small, but significant decrease was observed at follow-up (9 +/- 18%; p less than 0.05). A quantitative analysis of the aorta at different levels revealed no significant changes proximal and distal to the coarctation segment; however, at the level of coarctation, a significant (p less than 0.01) and homogeneous increment was observed after dilation that was unchanged at follow-up. One (6%) of 16 reevaluated patients had a clear aneurysm at the site of dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiopathology of transient ventricular occlusion during balloon valvuloplasty for pulmonic or aortic stenosis

Hemodynamic observations were made at different cardiac levels during transient balloon occlusion at the time of aortic or pulmonary valvuloplasty in 37 patients (mean age 8 +/- 9 years); 22 had pulmonary stenosis and 15 had aortic stenosis (6 valvular and 9 discrete subvalvular types). Eighty-two tentative dilatations were performed in patients with pulmonary stenosis and 61 in patients with aortic stenosis. The hemodynamics of the right and left heart were monitored during inflation-deflation time. From selected tracings mean beat-to-beat pressures curves were constructed during occlusion-recovery time. The cycle length (RR interval) did not change significantly during occlusion, except for patients with pulmonary occlusion and patent foramen ovale, where a significant increase in cycle length (p less than 0.01) was observed during recovery time. The mean maximal increase in ventricular pressure reached 95% of basal values for the right ventricle and 58% for the left ventricle. The hypertension was retrogradely transmitted to all cardiac chambers. Angiographic observations during occlusion suggest that the atrioventricular valves and the foramen ovale, when patent, become escape orifices during occlusion, for adapting and relieving intracavitary pressures. The ventricle seems to adapt to sudden occlusion by generating hypertensive and hypokinetic contractions, with atrioventricular regurgitation.

Effects of BAY K 8644 on the responses of rabbit ear artery to electrical stimulation

BAY K 8644 at 6.25 nM to 1 microM enhanced, in a concentration-dependent manner, both phases of the vasoconstrictor response of the isolated perfused rabbit ear artery to electrical stimulation. At 1 microM, BAY K 8644 enhanced the constrictor response by more than 250%. To study possible involvement of neurotransmitter release in the enhancement of the vasoconstrictor response by BAY K 8644, rabbit ear arteries were preincubated with [3H]norepinephrine and stimulated either electrically (for 1 or 5 min) or by 60 mM K+. BAY K 8644 (1 microM) had no effect on tritium release caused by 1-min periods of electrical stimulation. However, tritium release caused by 5-min periods of electrical stimulation or by 60 mM K+ was enhanced in the presence of BAY K 8644. It was concluded that BAY K 8644 enhances vasoconstrictor effects of electrical stimulation of rabbit ear artery by primarily a direct agonist action on Ca2+ channels in vascular smooth muscle cells. Following sustained depolarization, however, the drug may also enhance the release of neurotransmitter from sympathetic nerve endings. Under certain conditions, this release may contribute to the overall action of BAY K 8644.