Antigen selectivity characteristic of polyclonal antibodies against omega-conotoxin GVIA and N-type voltage-dependent calcium channels

The antibodies against omega-conotoxin GVIA (omega-CTX GVIA; N-type voltage-dependent calcium channel [VDCC] blocker) and B1Nt (N-terminal segment [residues 1-13] of BI alpha1 subunits of VDCCs) were prepared, and the selectivity for each antigen omega-CTX GVIA and B1Nt was investigated. For the antigen selectivity of anti-omega-CTX GVIA antibody against omega-CTX GVIA, ELISA, and immunoprecipitation were used. The reactions for ELISA and immunoprecipitation were observed except when antibody IgG purified by Protein A-Sepharose CL-4B from nonimmunized serum (purified NI-Ab) was used. The specific reactions were inhibited by 10 nM omega-CTX GVIA, but not by omega-CTX SVIB (N-type VDCC blocker), omega-CTX MVIIC (N- and P-type VDCC blocker), or omega-Aga IVA (P-type VDCC blocker). For the antigen selectivity of the anti-B1Nt antibody, analyses by ELISA, immunoprecipitation, and Western blotting were conducted. The reactions were observed except when NI-Ab was used. The ELISA and immunoprecipitation reactions were inhibited by the antigen peptide B1Nt, and the IC50 values were about 1.2 x 10(-8) and 1.3 x 10(-8) M, respectively. The bands of 210 and 190 kD by Western blotting of crude membranes from chick brain were also inhibited by 1 microM B1Nt. These results suggest that the antibodies prepared against omega-CTX GVIA and B1Nt in this work have high selectivity for their antigen. Therefore we assume that the antibodies against omega-CTX GVIA and B1Nt are useful tools for the analyses of the function and distribution of N-type VDCCs. The anti omega-CTX GVIA antibody must also be useful for the radioimmunoassay of omega-CTX GVIA.

Dosimetric evaluation and clinical application of virtual mini-multileaf collimator

One of the major concerns with multileaf collimators (MLC) is the jagged field edge that produces a larger penumbra compared with that produced by a Cerrobend block. The dosimetric undulation of the MLC can be minimized by replacing an existing MLC with a mini-MLC, an expensive replacement, or by software implementation, which essentially converts a regular MLC into a virtual mini-MLC. In this study, the dosimetry in the penumbra region of a virtual mini-MLC replacing the Cerrobend block is investigated for clinical applications. HD270, a software program implemented by Siemens (Concord, CA), combines the use of an MLC and a table translation perpendicular to the leaf plane to produce a smooth field edge, thus reducing isodose undulation. Three different step resolutions are available: 5 mm, 3 mm, and 2 mm. Using film dosimetry, the penumbra regions are studied at two different depths for clinical blocks and corresponding MLC setup, as well as HD270 with different resolutions for both 6-MV and 15-MV x-ray beams. The dose delivery time for HD270 on auto-sequencing mode is compared with the use of Cerrobend blocks. The clinical applications of HD270 in head-and-neck (head and neck) and prostate treatments are investigated. For single-field irradiation, the 80-20% penumbra widths for both the 45 degrees block and the circular block are reduced with HD270 compared with MLC for both 6 and 15 MV at different depths. At 2-mm resolution, the scalloping isodose lines (IDLs) with MLC completely disappear, although the penumbra is still larger than the Cerrobend block. On the other hand, the difference in dose undulations between 2-mm and 3-mm resolution is small. In the head and neck irradiation, the 80-20% widths with HD270 are 1 to 2 mm less than MLC, but they are still 2 mm wider than with a Cerrobend block. The 50% IDL is reduced by 2 mm with HD270 compared with MLC, which provides safety near spinal cord. Dose-volume histogram (DVH) calculations for the different shielding techniques indicate that the HD270 improves the spinal cord dose distribution significantly compared with MLC. A similar improvement in dose undulation is observed for the prostate case. In the dose region, >60% of the prescribed dose, there is approximately 10% less irradiated volume for the rectum when HD270 (3 mm resolution) is employed compared with MLC. The treatment time was compared with that from the Cerrobend block, and it was found that even at 3-mm resolution, there is a 20% reduction in treatment time in a head and neck treatment; with a 2-mm resolution, there is a 15% increase in time. The isodose undulation due to MLC can be significantly reduced with the HD270. Clinical application with HD270 for head and neck and prostate irradiation provides a smaller penumbra region compared with MLC, although it still gives a larger one compared with the Cerrobend block. In the clinical cases presented in this study, the 3-mm resolution is the most effective in improving the penumbra and delivery time. The HD270 implementation is a versatile and cost-effective solution for reducing MLC undulation.

Computed tomography localization of radiation treatment delivery versus conventional localization with bony landmarks

A computed tomography (CT) scanner was installed in the linear accelerator room (Primatom) at Morristown. Since June 2000, we have been providing prostate, lung, and liver cancer patients with fusion of CT and linac radiation treatment. This paper describes our registration methods between planning and treatment CT images, and compares treatment localization by CT versus conventional localization by bony landmarks such as portal imaging. For image registration, we printed out beforehand the beam's eye view of the treatment fields. Prostate tumor volume from each Primatom CT slice was mapped on the printouts, and the necessary isocenter shift relative to the skin marks was deduced. No port film was necessary for our Primatom patients. For ten patients we generated digitally-reconstructed radiographs (DRRs) with bone contrast from the CT scans, and deduced the required shift as the difference between the DRRs of the Primatom CT versus the planning CT. This represented the best observable shift should portal imaging be employed. Shift from bony landmark significantly correlated with the Primatom CT shift. Positioning adjustment based on bony anatomy was generally in the same direction as the CT shift for individual patient, but frequently did not go far enough. Our study confirmed that prostate organ motion relative to the bones has an average length of 4.7 mm (with standard deviation of 2.7 mm), and indicated the superiority of CT versus conventional bony structure (such as portal imaging) localization.

Oral beraprost sodium improves exercise capacity and ventilatory efficiency in patients with primary or thromboembolic pulmonary hypertension

OBJECTIVE

To investigate the effect of beraprost sodium, an orally active prostacyclin analogue, on exercise capacity and ventilatory efficiency in patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension.

PATIENTS AND DESIGN

Symptom limited cardiopulmonary exercise testing was performed before and 3 (1) months (mean (SEM)) after beraprost treatment in 30 patients with precapillary pulmonary hypertension (14 with primary pulmonary hypertension and 16 with chronic thromboembolic pulmonary hypertension).

RESULTS

Long term treatment with beraprost resulted in significant increases (mean (SEM)) in peak workload (87 (4) W to 97 (5) W, p < 0.001) and peak oxygen consumption (peak VO2, 14.9 (0.7) ml/kg/min to 16.8 (0.7) ml/kg/min, p < 0.001). Beraprost decreased the ventilatory response to carbon dioxide production during exercise (VE-VCO2 slope, 42 (2) to 37 (1), p < 0.001). No significant difference in the responses of these variables to beraprost treatment was observed between patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension.

CONCLUSIONS

Oral administration of beraprost sodium may improve exercise capacity and ventilatory efficiency in patients with both primary and chronic thromboembolic pulmonary hypertension.

Severe complications after hypofractionated high dose rate intracavitary brachytherapy following external beam irradiation for oesophageal carcinoma

The purpose of this study was to evaluate severe complications that developed after high dose rate (HDR) intracavitary brachytherapy for oesophageal carcinoma. Six consecutive patients with oesophageal carcinoma were treated by external beam irradiation (60 Gy in 30 fractions over 6 weeks) followed by hypofractionated intracavitary HDR brachytherapy (10 Gy in 2 fractions). Two of the six patients were alive and well for more than 2-3 years following therapy, but three of the six patients developed treatment-related oesophageal fistulae and died. HDR intracavitary brachytherapy following external beam irradiation is an effective method for radical treatment of oesophageal carcinoma. However, hypofractionated HDR brachytherapy should be used with care.

Hemodynamic, renal, and hormonal effects of ghrelin infusion in patients with chronic heart failure

Ghrelin is a novel GH-releasing peptide that may also induce vasodilation and a positive energy balance through GH-independent mechanisms. However, the hemodynamic, renal, and hormonal effects of ghrelin in patients with chronic heart failure (CHF) remain unknown. Accordingly, 12 patients with CHF were given an iv infusion of human ghrelin (0.1 microg/kg.min) or placebo. Ghrelin significantly decreased mean arterial pressure (-9 mm Hg, P < 0.05) without a significant change in heart rate. Ghrelin significantly increased cardiac index (+25%, P < 0.05) and stroke volume index (+30%, P < 0.05), although it did not significantly alter mean pulmonary arterial pressure or pulmonary capillary wedge pressure. Infusion of ghrelin induced a marked increase in serum GH level (15-fold), associated with slight increases in circulating epinephrine, ACTH, cortisol, and PRL. Infusion of ghrelin did not significantly alter urine volume, urinary sodium excretion, or creatinine clearance. These hemodynamic, renal and hormonal parameters remained unchanged during placebo infusion. In summary, iv infusion of ghrelin, a potent GH-releasing peptide, had beneficial hemodynamic effects in patients with CHF in the absence of renal effects.

Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience

PURPOSE

Stereotactic radiotherapy (SRT) is highly effective for brain metastases from non-small-cell lung cancers (NSCLCs). As such, primary lesions of NSCLC may also be treated effectively by similar focal high-dose SRT.

METHODS AND MATERIALS

Between October 1994 and June 1999, 50 patients with pathologically proven T1-2N0 M0 NSCLC were treated by CT-guided frameless SRT. Of these, 21 patients were medically inoperable and the remainder were medically operable but refused surgery. In most patients, SRT was 50-60 Gy in 5-10 fractions for 1-2 weeks. Eighteen patients also received conventional radiotherapy of 40-60 Gy in 20-33 fractions before SRT.

RESULTS

With a median follow-up period of 36 months (range 22-66), 30 patients were alive and disease free, 3 were alive with disease, 6 had died of disease, and 11 had died intercurrently. Local progression was not observed on follow-up CT scans in 47 (94%) of 50 patients. The 3-year overall survival rate was 66% in all 50 patients and 86% in the 29 medically operable patients. The 3-year cause-specific survival rate of all 50 patients was 88%. No definite adverse effects related to SRT were noted, except for 2 patients with a minor bone fracture and 6 patients with temporary pleural pain.

CONCLUSIONS

SRT is a very safe and effective treatment for Stage I NSCLC. Additional studies involving a larger patient population and longer follow-up periods are warranted to assess this new treatment for early-stage lung cancer.

Sentinel lymph node identification for patients with breast cancer using large-size radiotracer particles: technetium-99m-labeled tin colloids produced excellent results

Sentinel lymph node (SLN) biopsies using radioactive tracers have been reported to detect the metastatic status of the axillary lymph nodes in breast cancer patients. However, the optimal radioactive tracer particle sizes remain to be determined. In this study, identification of SLNs with large radiolabeled tin colloid particles was evaluated. Seventy-five patients with T1-2, N0 breast cancer were enrolled. Two hours prior to surgery, 1 to 2.5 mL technetium-99m-labeled tin colloid particles were injected around the tumor under ultrasonographic guidance. Immediately before the operation, dye fluids were also injected around the tumor to increase the interstitial pressure. After axillary dissection, lymph nodes with x100 or more uptake of radioactivity than the mean of the other lymph nodes are considered to be SLN. All lymph nodes from the axillary dissections were pathologically investigated, and the characteristics of SLNs were evaluated. SLNs were clearly identified in 74 of 75 patients (98.7%). Of 37 patients without SLN metastasis, pathological investigation revealed no further involvement of the remaining non-SLNs. The SLNs tended to be larger in size, and more than 50% were located in the lower medial site of the axilla. This is the first study to show that SLNs could successfully be identified with radiolabeled tin colloid particles. When SLNs were negative for metastases, non-SLNs were always negative.

Elevated circulating level of ghrelin in cachexia associated with chronic heart failure: relationships between ghrelin and anabolic/catabolic factors

BACKGROUND

Ghrelin is a novel growth hormone (GH)-releasing peptide, isolated from the stomach, that may also cause a positive energy balance by stimulating food intake and inducing adiposity. We sought to investigate the pathophysiology of ghrelin in the cachexia associated with chronic heart failure (CHF).

METHODS AND RESULTS

Plasma ghrelin was measured in 74 patients with CHF and 12 control subjects, together with potentially important anabolic and catabolic factors, such as GH and tumor necrosis factor (TNF-alpha). Patients with CHF were divided into two groups, those with cachexia (n=28) and those without cachexia (n=46). Plasma ghrelin did not significantly differ between all CHF patients and controls (181+/-10 versus 140+/-14 fmol/mL, P=NS). However, plasma ghrelin was significantly higher in CHF patients with cachexia than in those without cachexia (237+/-18 versus 147+/-10 fmol/mL, P<0.001). Circulating GH, TNF-alpha, norepinephrine, and angiotensin II were also significantly higher in CHF patients with cachexia than in those without cachexia. Interestingly, plasma ghrelin correlated positively with GH (r=0.28, P<0.05) and TNF-alpha (r=0.31, P<0.05) and negatively with body mass index (r=-0.35, P<0.01).

CONCLUSIONS

Plasma ghrelin was elevated in cachectic patients with CHF, associated with increases in GH and TNF-alpha and a decrease in body mass index. Considering ghrelin-induced positive energy effects, increased ghrelin may represent a compensatory mechanism under catabolic-anabolic imbalance in cachectic patients with CHF.

Chronic administration of ghrelin improves left ventricular dysfunction and attenuates development of cardiac cachexia in rats with heart failure

BACKGROUND

Ghrelin is a novel growth hormone (GH)-releasing peptide that may also induce vasodilation and stimulate feeding through GH-independent mechanisms. We investigated whether ghrelin improves left ventricular (LV) dysfunction and attenuates cardiac cachexia in rats with chronic heart failure (CHF).

METHODS AND RESULTS

Ligation of the left coronary artery or sham operation was performed; 4 weeks after surgery, rat ghrelin (100 microg/kg SC BID) or saline was administered for 3 weeks. Echocardiography and cardiac catheterization were performed. Serum GH and insulin-like growth factor-1 were significantly higher in both CHF and sham rats treated with ghrelin than in those given placebo (P<0.05 for both). CHF rats given placebo showed an impaired increase in body weight compared with sham rats given placebo (P<0.05). CHF rats treated with ghrelin, however, showed a significantly greater increase in body weight than those given placebo (+10% versus +3%, P<0.05). They showed significantly higher cardiac output (315+/-49 versus 266+/-31 mL. min(-1). kg(-1), P<0.05) and LV dP/dt(max) (5738+/-908 versus 4363+/-973 mm Hg/s, P<0.05) than CHF rats given placebo. Ghrelin increased diastolic thickness of the noninfarcted posterior wall, inhibited LV enlargement, and increased LV fractional shortening in CHF rats (from 15+/-3% to 19+/-3%, P<0.05).

CONCLUSIONS

Chronic subcutaneous administration of ghrelin improved LV dysfunction and attenuated the development of LV remodeling and cardiac cachexia in rats with CHF.

Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension

OBJECTIVE

To assess acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

DESIGN

Cardiopulmonary exercise testing was performed in 20 patients with CTEPH before thromboendarterectomy (baseline), one month after (early phase), and four months after (late phase). Peak oxygen uptake (peak VO(2)) and the ventilatory response to carbon dioxide production (VE-VCO(2) slope) were measured for assessment of exercise capacity and ventilatory efficiency. Right heart catheterisation was performed in all patients before and one month after surgery.

RESULTS

Baseline peak VO(2) decreased and VE-VCO(2) slope increased along with the increase in pulmonary vascular resistance in patients with CTEPH. After thromboendarterectomy, the VE-VCO(2) slope decreased greatly from baseline to the early phase (mean (SD), 50 (9) to 37 (7), p < 0.05) and reached a steady level thereafter. In contrast, a continued increase in peak VO(2) was noted from the early to the late phase (16.9 (4.1) to 21.1 (5.0) ml/kg/min, p < 0.05). The decrease in the VE-VCO(2) slope from baseline to the early phase, but not the increase in peak VO(2), correlated strongly with the decrease in pulmonary vascular resistance after surgery (r = 0.75, p < 0.01).

CONCLUSIONS

Thromboendarterectomy may cause an immediate improvement in ventilatory efficiency, possibly through its beneficial haemodynamic effects. In contrast, exercise capacity may continue to improve towards the late phase, reflecting peripheral adaptation to exercise.

Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension

OBJECTIVE

To assess acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

DESIGN

Cardiopulmonary exercise testing was performed in 20 patients with CTEPH before thromboendarterectomy (baseline), one month after (early phase), and four months after (late phase). Peak oxygen uptake (peakV˙o2) and the ventilatory response to carbon dioxide production (V˙e-V˙co2 slope) were measured for assessment of exercise capacity and ventilatory efficiency. Right heart catheterisation was performed in all patients before and one month after surgery.

RESULTS

Baseline peakV˙o2 decreased andV˙e-V˙co2 slope increased along with the increase in pulmonary vascular resistance in patients with CTEPH. After thromboendarterectomy, theV˙e-V˙co2 slope decreased greatly from baseline to the early phase (mean (SD), 50 (9) to 37 (7), p < 0.05) and reached a steady level thereafter. In contrast, a continued increase in peak V˙o2 was noted from the early to the late phase (16.9 (4.1) to 21.1 (5.0) ml/kg/min, p < 0.05). The decrease in theV˙e-V˙co2 slope from baseline to the early phase, but not the increase in peakV˙o2, correlated strongly with the decrease in pulmonary vascular resistance after surgery (r = 0.75, p < 0.01).

CONCLUSIONS

Thromboendarterectomy may cause an immediate improvement in ventilatory efficiency, possibly through its beneficial haemodynamic effects. In contrast, exercise capacity may continue to improve towards the late phase, reflecting peripheral adaptation to exercise.

Multiple venous aneurysm of a basilic vein

An uncommon case of multiple venous aneurysm of the basilic vein was diagnosed in a 61-year-old woman who presented with a left arm mass. The lesion was successfully resected with day surgery. Clinical features, including the complications, treatment, and etiology of these exceedingly uncommon lesions, are discussed.

Differences in prolonged ischemia length using ischemic preconditioning in the rabbit heart. Tolerable limitation time for surgically induced myocardial ischemia during normothermic cardiac operation

BACKGROUND

To determine the effect of the tolerable limitation time of prolonged ischemia after ischemic preconditioning on postischemic functional recovery and infarct size reduction in the rabbit heart.

METHODS

White rabbits (n=30) were used for Langendorff perfusion. Control hearts were perfused at 37 degrees C for 180 min; 30 min global ischemia hearts (30GI) received 30 min global ischemia and 120 min reperfusion; IPC+30GI hearts received 5 min zero flow global ischemia and 5 min reperfusion prior to 30 min global ischemia; 20 min global ischemia hearts (20GI) received 20 min global ischemia and 120 min reperfusion; IPC+20GI hearts received 5 min zero flow global ischemia and 5 min reperfusion prior to 20 min global ischemia.

RESULTS

Infarct size in the 30GI hearts was 33.5+/-4.0% and 1.7+/-0.5% in the control hearts. The 20GI hearts and IPC+30GI hearts decreased infarct size, as compared with the 30GI hearts (13.0+/-1.8% and 16.6+/-1.7%, respectively; p<0.001, 20GI vs 30GI; p<0.01, IPC+30GI vs 30GI; p>0.05, 20GI vs IPC+30GI) but did not enhance postischemic functional recovery. The IPC+20GI hearts (3.5+/-0.6%) significantly decreased infarct size as compared with the 20GI hearts (p<0.05, IPC+20GI vs 20GI), and there was no significant difference between the IPC+20GI and the control hearts (p>0.05), but the IPC+20GI hearts did not enhance postischemic functional recovery.

CONCLUSIONS

A 20 min ischemia may be the tolerable limitation time of prolonged ischemia after ischemic preconditioning in an isolated rabbit heart model.

Hemodynamic and hormonal effects of human ghrelin in healthy volunteers

To investigate hemodynamic and hormonal effects of ghrelin, a novel growth hormone (GH)-releasing peptide, we gave six healthy men an intravenous bolus of human ghrelin (10 microg/kg) or placebo and vice versa 1-2 wk apart in a randomized fashion. Ghrelin elicited a marked increase in circulating GH (15-fold). The elevation of GH lasted longer than 60 min after the bolus injection. Injection of ghrelin significantly decreased mean arterial pressure (-12 mmHg, P < 0.05) without a significant change in heart rate (-4 beats/min, P = 0.39). Ghrelin significantly increased cardiac index (+16%, P < 0.05) and stroke volume index (+22%, P < 0.05). We also examined ghrelin receptor [GH secretagogues receptor (GHS-R)] gene expression in the aortas, the left ventricles, and the left atria of rats by RT-PCR. GHS-R mRNA was detectable in the rat aortas, left ventricles, and left atria, suggesting that ghrelin may cause cardiovascular effects through GH-independent mechanisms. In summary, human ghrelin elicited a potent, long-lasting GH release and had beneficial hemodynamic effects via reducing cardiac afterload and increasing cardiac output without an increase in heart rate.

Sex ratio in the offspring of male radiologists

RATIONALE AND OBJECTIVES

The purpose of this study was to determine if male radiologists predominantly father daughters and, if so, to investigate the association between this skewed sex ratio of offspring and radiation exposure.

MATERIALS AND METHODS

Questionnaires completed by 586 male radiologists in Japan provided data regarding the radiologist's age, length of employment in radiology, if he had ever received radiation doses higher than that recommended by the International Commission on Radiological Protection, the sex of each child fathered, and the birth date of each child.

RESULTS

As a group, male radiologists tended to father a lower proportion of boys (48.47%) compared with the control group (51.46%), and the relative risk was 1.13 (95% confidence interval [CI]: 1.00, 1.27). Offspring of highly irradiated radiologists, however, had a reduced proportion of males (34.48%), with a significantly (P = .002) increased relative risk of 2.01 (95% CI: 1.29, 3.13).

CONCLUSION

X-ray exposure may explain the reduced percentage of sons in the offspring of male radiologists.

Carcinoma of the uterine cervix: twice- versus once-weekly high-dose-rate brachytherapy

PURPOSE

To compare the effectiveness and safety of once- versus twice-weekly high-dose-rate (HDR) brachytherapy for cervical cancer.

MATERIALS AND METHODS

From 1980 to 1997, 124 consecutive previously untreated patients with cervical cancer were treated with external-beam irradiation (50 Gy) and HDR brachytherapy. Clinical stages were I, 4 (3%) patients; II, 51 (41%); III, 64 (52%); and IV, 5 (4%). From 1980 to 1992, 74 patients (group A) were treated with HDR brachytherapy once weekly (about three fractions of 7 Gy each to point A [2 cm superior and 2 cm lateral to the inferior end of the intrauterine radioactive source]), while from 1992 to 1997, 50 patients (group B) were treated twice weekly (about six fractions of 4.5 Gy each to point A).

RESULTS

Overall survival rate at 5 years was 65.2% in group A and 65.3% in group B (P=.96). Local recurrence-free survival rate at 5 years was 69% (51 of 74 patients) in group A and 90% (45 of 50 patients) in group B (P<.001). The rate of grade 2 (moderate) and grade 3 (severe) complications was significantly lower in group B (6% vs. 32% in group A, P<.001). At multivariate analysis, the variables significantly associated with increased local-regional recurrence rates were having stage III-IV lesions (P=.04) and with fewer than six sessions of HDR brachytherapy (P=.02).

CONCLUSION

The twice-weekly HDR regimen may improve the local control rate with fewer complications.

Prevention of secondary osteoporosis postmenopause in hemiplegia

OBJECTIVES

To study secondary osteoporosis postmenopause in women with hemiplegia and to show the therapeutic effects of etidronate and how osteoporotic conditions relate to the activities of daily living (ADL).

DESIGN

Eighty-one postmenopausal women with hemiplegia were admitted within 6 mo of their first cerebrovascular accident. The bone mineral density (BMD) and biochemical markers of bone turnover were measured at the time of admission. Forty women (treatment group) received a 2-wk administration of etidronate. Forty-one women (control group) were not administered etidronate.

RESULTS

After completing a 3-mo rehabilitation program, BMD levels were remeasured. ADL was evaluated by FIM. The low ADL group had a larger decrease in BMD than the high ADL group. For the control group, the BMD rate of change on the paretic side of the femoral neck was -9.6%/3 mo for the low ADL group. BMD loss was reduced significantly by the administration of etidronate for the low ADL group.

CONCLUSIONS

Results indicate that ADL corresponds to the progression of osteoporosis in postmenopausal women with hemiplegia and that increasing the level of ADL will reduce the progression of osteoporosis. Use of etidronate has also been proven to have a suppressive effect on the BMD decrease in women.

Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension

We sought to assess the effects of oral supplementation of L-arginine, the precursor of nitric oxide (NO), on hemodynamics and exercise capacity in patients with pulmonary hypertension. Acute hemodynamic responses to oral L-arginine (0.5 g/10 kg body weight) or placebo were examined in 19 patients with primary or precapillary secondary pulmonary hypertension. Cardiopulmonary exercise tests were performed to measure peak oxygen consumption (peak V O(2)) and the ventilatory response to carbon dioxide production (V E-V CO(2) slope) before and 1 wk after treatment with L-arginine (1.5 g/10 kg body weight/d) or placebo. Oral supplementation of L-arginine significantly increased plasma L-citrulline, which indicated enhancement of NO production. Supplemental L-arginine produced a 9% decrease in mean pulmonary arterial pressure (53 +/- 4 to 48 +/- 4 mm Hg, p < 0.05) and a 16% decrease in pulmonary vascular resistance (14.8 +/- 1.5 to 12.4 +/- 1.4 Wood units, p < 0.05). L-arginine modestly decreased mean systemic arterial pressure (92 +/- 4 to 87 +/- 3 mm Hg, p < 0.05). A 1-wk supplementation of L-arginine resulted in a slight increase in peak V O(2) (831 +/- 88 to 896 +/- 92 ml/min, p < 0.05) and a significant decrease in the V E- V CO(2) slope (43 +/- 4 to 37 +/- 3, p < 0.05) without significant systemic hypotension. Hemodynamics and exercise capacity remained unchanged during placebo administration. These results suggest that oral supplementation of L-arginine may have beneficial effects on hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension.

Usefulness of the subendocardial myocardial velocity gradient in low-dose dobutamine stress echocardiography

The subendocardial side of myocardium makes a major contribution to left ventricular (LV) contraction and is very susceptible to ischemia. In this study we sought to quantify regional wall motion during low-dose dobutamine stress echocardiography (DSE) by using the myocardial velocity gradient (MVG) derived from tissue Doppler imaging (TDI). We then compared the usefulness of subendocardial MVG with that of transmural MVG in detecting subtle wall motion abnormalities. Fourteen patients (single vessel disease = 6; normal coronary arteries = 8) underwent low-dose DSE (10 microg/ kg per min). M-Mode TDI of the LV posterior wall was recorded using a Toshiba SSA-380A combined with custom computer software, and analyzed for both subendocardial and transmural MVG. Visual estimation and transmural MVG failed to clearly demonstrate the differing responses between the nonischemic (systole: 3.0 +/- 0.8/s to 4.9 +/- 1.9/s, not significant; diastole: -4.3 +/- 1.3/s to -5.7 +/- 1.4/s, not significant; mean +/- SD, P versus ischemic segments) and ischemic (systole: 3.3 +/- 1.2/s to 3.8 +/- 1.0/s; diastole: -5.4 +/- 2.0/s to -5.3 +/- 1.1/s) segments during low-dose DSE. Subendocardial MVG demonstrated a significant change in the nonischemic segments (systole: 4.1 +/- 1.0/s to 7.7 +/- 2.2/s, P = 0.012; diastole: -6.5 +/-1.8/s to -11.3 +/- 2.2/s, P = 0.001), whereas the response remained unchanged in the ischemic segments (systole: 4.6 +/-2.4/s to 4.8 +/- 1.2/s; diastole: -7.0 +/- 1.9/s to -7.3 +/- 1.1/s). Subendocardial MVG, particularly diastolic subendocardial MVG, may serve as a useful indicator of subtle ischemic changes in wall motion induced by low-dose DSE.

CD3+, CD4-, CD8-, TCR alpha beta-, TCR gamma delta+ granular lymphocyte proliferative disorder without lymphocytosis and clinical symptoms

Granular lymphocyte-proliferative disorder is characterized by a proliferation of large granular lymphocytes (LGLs). It is often associated with neutropenia, rheumatoid arthritis (RA), and pure red cell aplasia (PRCA). Phenotypic analysis has demonstrated that in most cases, the LGLs show a clonal rearrangement of the TCR alpha beta rearrangement. We are reporting a patient with TCR gamma delta LGL proliferation without clinical findings and lymphocytosis. The patient showed an expansion of the CD3+, CD16+, CD56+, and CD57+ LGL populations which involved coexpression of TCR gamma delta with TCR J gamma and J delta 1 gene rearrangement. Autoimmune manifestations, including RA and PRCA, have not appeared and the results of laboratory examinations have not changed for 1 year after the diagnosis.