Sexually dimorphic expression of pituitary growth hormone-releasing factor receptor in the rat

Secretion of growth hormone (GH) exhibits marked sexual dimorphism in the rat. To examine the underlying mechanism that involves hypothalamic GH-releasing factor (GRF), we determined pituitary GRF receptor mRNA levels in male and female rats and compared their in vitro abilities to release GRF, an endogenous ligand for GRF receptor. Female rats expressed GRF receptor mRNA at a level of only 15% (P < 0.001) of that of male rats. Female rats also showed a 33% lower (P < 0.01) ability to release GRF than male rats. These results indicate that the GRF secretion and action system of female rats is characterized by the combined reduction in GRF receptor expression and GRF-releasing capacity compared with that of male rats. This could explain the in vivo finding that spontaneous, GRF-triggered GH pulses are of much lower amplitude in the female than in the male rat.

[Prognosis of patients with triple vessel disease and old myocardial infarction: relationship to the number of total coronary occlusions]

Patients with myocardial infarction (MI) and triple vessel coronary disease generally have poor prognoses. However, it is not known whether there are particular angiographic variables associated with the poor prognosis in MI patients with triple vessel disease. The angiographic variables for poor prognosis were investigated in 43 MI patients with triple vessel disease (32 men and 11 women, mean age 63 +/- 9 years) who were followed medically for a mean of 32 +/- 28 months. There were 13 cardiac deaths (30%) and 10 late-coronary artery bypass grafting (23%). Twenty patients were alive and well. The patients who died of cardiac causes had lower ejection fractions (42 +/- 18% vs 49 +/- 15%, p < 0.05), a higher prevalence of two vessel occlusion (77% vs 40%, p < 0.05), and a higher prevalence of coronary occlusion opposite the MI site (69% vs 25%, p < 0.01) when compared to survivors, although there were no significant differences in age, MI sites, or the prevalence of occlusion in the infarct-related artery. Multivariate analysis with the Cox proportional hazards model revealed that coronary occlusion opposite the MI site (hazards ratio 16.36) and an age of > or = 65 years (4.46) indicated a significantly high ratio. The hazard ratio of the ejection fraction and two vessel coronary occlusion were not significant. The poor prognosis of MI patients with triple vessel coronary disease may be related to impaired left ventricular function and to coronary occlusion opposite the MI site and greater age. This may have important clinical implications in the initial decision for interventional therapy.

Infectious retrovirus is inactivated by serum but not by cerebrospinal fluid or fluid from tumor bed in patients with malignant glioma

Intravenous gene transfer using recombinant retroviruses tends to suffer from a low infectious viral titer when conducted in vivo. This is, in part, caused by complement-mediated proteolytic inactivation of the retrovirus in human serum. However, if the retroviruses were directly injected into the brain, they might not be inactivated. Supernatant from amphotropic retrovirus-producing cells harboring the BAG vectors was incubated with sera or cerebrospinal fluid (CSF) of patients with gliomas or unrelated disorders. The retroviruses were severely inactivated in sera. However, no such inactivation was noted in CSF or fluid from the tumor bed of glioma patients. These data suggest that gene transfer using recombinant retroviruses could be done into the cavity after removal of the tumor in glioma patients.

Indications and options of nutritional treatment for Crohn's disease. A comparison of elemental and polymeric diets

Several studies on enteral nutrition undertaken by our group led to the following findings: (1) A semielemental diet was as effective as an elemental diet in inducing remission. (2) A low-residue diet was useful for the maintenance of remission, with the effect depending upon the quantity given. (3) Intractability to enteral nutrition was found in patients with long-standing disease, in those with severe activity, and in those with colonic disease. Currently there is insufficient evidence to make specific recommendations for altering accepted indications for nutritional therapy.

[A study of acquisition time using compartment analysis with 99mTc-GSA liver scintigraphy]

99mTc-galactosyl human serum albumin (99mTc-GSA) is a newly developed receptor-binding agent specific for the asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. Liver scintigraphy using 99mTc-GSA was performed on 13 patients with liver disease. Dynamic data were obtained by gamma camera during 40 min after the intravenous injection of 3 mg (185 MBq) of 99mTc-GSA. Heart and liver time activity curves with acquisition times of 40,30 and 20 min were created, and two different compartment analyses were examined. One was a nonlinear five-compartment model adopting the Michaelis-Menten type for the transfer of 99mTc-GSA from hepatic blood to receptor, and the other was a linear five-compartment model assuming a linear rate constant (P(2)*) for the transfer of 99mTc-GSA. The maximum removal rate obtained by the nonlinear model, P(2), was found to be independent of the change in acquisition time, while the maximum removal rate obtained by the linear model, P(2)*.Km, which was given by the product of P(2)* and the Michaelis constant Km, increased with shortening acquisition times from 40 to 20 min. For both models, the liver blood flow rate decreased with shortening acquisition time. The maximum removal rate and liver blood flow rate obtained by the linear model were significantly correlated with those obtained by the nonlinear model. It was concluded that linear model with an acquisition time of 20 min was applicable to liver scintigraphy with 99mTc-GSA.

A ColE1-encoded gene directs entry exclusion of the plasmid

To detect entry exclusion of the ColE1 plasmid, we established an assay system that was not influenced by incompatibility of extant plasmids in the recipient cells or by the viability of the cells due to the killing action of colicin E1 protein. The assay revealed that exc1 and exc2, assigned as genes directing entry exclusion, had no exclusion activity. Instead, mbeD, which had been characterized as a gene for plasmid mobilization, directed the exclusion activity. MbeD was overexpressed and identified as a 35S-labeled protein, which was recovered in both the soluble and membrane fractions, particularly in the inner membrane fraction. An amphipathic helical structure was predicted in the N-terminal region of MbeD as well as in the corresponding homologous proteins of ColA and ColK. These proteins may bind to the inner membrane via the N-terminal amphipathic helix and function in entry exclusion.

[Sisters with early onset hereditary dentatorubral-pallidoluysian atrophy of childhood--DNA analysis and clinicopathological findings]

Two sisters were presented, 16 years old and 12 years old, who showed similar clinical courses. They had had mental retardation since early childhood, and then ataxia began. They suffered from astatic and tonic seizures from early school age, which gradually evolved to intractable epilepsies. Spasticity progressed, and they deteriorated both physically and mentally. They revealed photo-sensitivity; convulsions were induced by the flickering of light. They were attacked by myoclonic seizures as well as choreoathetosis, and became bedridden by the latter part of the elementary school age. There were no fruitful results of any kind from the laboratory examinations for metabolic disorders. EEG showed that the epileptic seizure discharges were induced by photic stimulation; there were frequent 3-4 Hz diffuse spike-and-wave short bursts during waking and sleep periods. MRI findings of the elder sister at the age of 16 revealed remarkable diffuse brain atrophy. Gene analysis showed abnormally enlarged DNA fragments localized on the short arm of chromosome 12. This meant expanded CAG trinucleotide repeats. The younger sister died at the age of 12 years. Autopsy findings revealed degeneration of both dentatorubral and pallidoluysian pathways. There were especially remarkable gliosis and neuronal cell loss in the outer segment of globus pallidus, and moderate neuronal cell loss and typical grumose degeneration in the dentate nucleus. The diagnosis of juvenile-type hereditary dentatorubral-pallidoluysian atrophy was compatible with the pathologic findings. This diagnosis will be made possible before death through the understanding of the clinical symptoms and molecular genetics.

[Development of new in vitro chemosensitivity test using collagen gel droplet embedded culture and its clinical usefulness]

We developed a new in vitro assay for chemosensitivity test using collagen gel droplet embedded culture and image analysis. In this in vitro assay, we successfully minimized the cancer cell number required for culture to approximately 3-10 x 10(3) cells for each 30 microliters collagen gel droplet, obtained the sufficient growth of cancer cells using serum-free medium while suppressing the growth of fibroblastic cells, and measured the volume of cancer cells by eliminating the contaminating fibroblastic cells by an image processing technique. Anticancer effects of the in vitro assay showed a very good correlation with those of in vivo nude mouse assay using human cancer cell lines. The success rates of the in vitro assay for 141 surgical specimens of primary lung cancers and for 65 of primary breast cancers were 89 and 80%, respectively. The accumulated in vitro assay response rates of MMC, CDDP, VDS and VP-16 for primary lung cancers and of MMC, 5-FU and ADR for primary breast cancers were similar to the respective clinical response rates. These results suggest that this in vitro chemosensitivity test may be practically useful for clinical applications.

Regulation of neurotensin receptor mRNA expression by the receptor antagonist SR 48692 in the rat midbrain dopaminergic neurons

In this study, we demonstrated that the tyrosine hydroxylase-like immuno-reactive (possibly dopaminergic) neurons express neurotensin receptor mRNA in the rat substantia nigra and in the ventral tegmental area. Additionally, 2 weeks treatment with the neurotensin receptor antagonist SR 48692 increased mRNA levels in the substantia nigra. These data suggest that neurotensin receptor expression in the perikarya and in the terminal regions of dopaminergic neurons is regulated by its endogenous agonist in vivo.

A novel analog of TRH, YM14673, causes a decrease in brain TRH receptors in vitro

Biochemical mechanisms by which analogs of thyrotropin-releasing hormone (TRH) produce their potent neuropharmacological actions on the brain remain ill-defined. We tested effects of YM14673, a novel analog of TRH, on TRH receptors in rat brains in vitro. No significant binding of [3H]YM14673 to brain plasma membranes occurred. In contrast, preincubation of membranes with YM14673 caused dose-dependent decreases in TRH binding. This was not due to competition for TRH binding sites or existence of metabolites of YM14673. Preincubation with DN1417 (an another TRH analog), cyclo(His-Pro) or methionine-enkephalin did not affect the binding. Affections of YM14673 on TRH binding were observed when cerebral cortical membranes were studied; those were not seen in membranes prepared from hypothalamus, striatum, midbrain, hippocampus, or pons-medulla. The present data indicate that YM14673 exerts its characteristic neuro-pharmacological functions through interacting with TRH binding sites in the brain.

Normal age-related conversion of bone marrow in the mandible: MR imaging findings

OBJECTIVE

The mandible is one of the most common sites for osteomyelitis and other marrow-based diseases. Therefore, knowledge of the normal patterns of marrow distribution could help evaluate marrow-based diseases. The purpose of this study was to assess the age-related normal sequence of conversion from hematopoietic to fatty marrow in the mandible as depicted on MR images.

SUBJECTS AND METHODS

We prospectively reviewed T1-weighted MR images of the mandible for the distribution of hematopoietic and fatty marrow. Forty-five subjects 4 months to 25 years old with no known marrow abnormality were examined with the spin-echo technique. Marrow conversion was assessed in the condyle, ramus, angle, and body of the mandible using visual grading based on homogeneity, signal intensity, and a signal-intensity ratio determined by the intensities of the surrounding subcutaneous fat and air.

RESULTS

Conversion of hematopoietic to fatty marrow occurred first in the mandibular body, followed by the angle, ramus, and finally the condyle. The marrow in the region distal to the ramus had almost fully converted to fatty marrow by the third decade of life, but the remaining regions contained some hematopoietic marrow. Further substantiating these results, the signal-intensity ratio increased up to about 90% in the angle and 70% in the ramus by the age of 10 years and then leveled off. On the other hand, the signal-intensity ratio in the condyle reached 60% by age 15 and remained unchanged for the following 10 years.

CONCLUSION

The normal age-related conversion from hematopoietic to fatty marrow in the mandible follows a well-defined sequence, first seen in the mental region early in childhood, then in the body, the ramus, and finally the condyle.

Neuronal localization of CD38 antigen in the human brain

CD38 is a lymphocyte differentiation antigen which is involved in the cyclic ADP-ribose-mediated second messenger system. We provide immunochemical and immunohistochemical evidence for the expression of CD38 in the adult human brain. We used six polyclonal antibodies against synthetic CD38 polypeptides, in addition to four monoclonal antibodies already available. Brain CD38 was detectable by Western blotting after immunoaffinity purification of the brain extracts. Immunoperoxidase staining localized CD38 immunoreactivity to the perikarya and dendrites of many neurons, such as the cerebellar Purkinje cells, implying that CD38 is involved in the signal transduction within the central nervous system neurons.

Alteration of cataleptic responses induced by dopamine receptor antagonists after chronic cocaine administration in mice

The influence of chronic treatment of mice with cocaine, an indirect dopamine receptor agonist, on the cataleptic effects of R-(+)-chloro-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-3-benzazepin- 7ol hydrochloride (SCH23390), a dopamine D1 receptor antagonist, or haloperidol, mainly a dopamine D2 receptor antagonist, was investigated. Mice were given cocaine (10 mg/kg s.c.) once every other day for 7 (4 injections), 15 (8 injections) or 21 (11 injections) days. The cataleptic effects of SCH23390 (0.3 mg/kg i.p.) were significantly reduced when it was given 1-7 days after the last dose of a 7- or 15-day pretreatment course of cocaine. When SCH23390 was given 14-21 days after the cocaine the cataleptic effect was increased in the 15-day, but not the 7-day, cocaine-pretreated mice. However, after a 21-day treatment with cocaine, a challenge dose of SCH 23390 given 1-3 days thereafter produced a decreased cataleptic response, but an increased response after 7-21 days. The cataleptic effects of haloperidol (o.3 mg/kg i.p.) were reduced when it was given 1-7 days after the last dose of a 7-day pretreatment, but increased 1-3 days after that of a 15-day pretreatment with cocaine (10 mg/kg s.c.) The pretreatment with cocaine for 21 days did not affect the haloperidol catalepsy during a 1- to 3-day withdrawal period. However, haloperidol catalepsy was decreased only 7 days, then reversed 14 days and gradually increased 21 days after the last injection of a 15- or 21-day pretreatment course of cocaine. These results suggest that chronic treatment with the indirect dopamine receptor agonist, cocaine, caused supersensitivity of dopamine D1 receptors (a decrease in SCH23390 catalepsy) during the early withdrawal period and subsensitivity (an increase in SCH23390 catalepsy) after a longer period of withdrawal. It was apparent that the longer the period and the higher the dose of pretreatment with cocaine, the less were the alterations in initial responses and the greater were the alterations in subsequent responses to the dopamine D1 receptor antagonists.

Pharmacological characterization of SR 48692 sensitive neurotensin receptor in human pancreatic cancer cells, MIA PaCa-2

Previously, one type of human neurotensin receptor has been molecularly cloned. Recently, it has been proposed that a subtype of neurotensin receptor exists, which is not sensitive to newly synthesized neurotensin receptor antagonist SR 48692. In this study, we characterize the pharmacological properties of neurotensin receptor expressed in human pancreatic cancer cells, MIA PaCa-2. In binding studies with [3H]neurotensin, the data fit a model for a single population of high-affinity binding sites that are competitively antagonized by SR 48692. The rank order of the equilibrium dissociation rate constants for neurotensin(8-13), neurotensin, neuromedin N, [Ala11] neurotensin(8-13), and SR 48692 were similar to those found with the molecularly cloned human neurotensin receptors. Additionally, the intracellular calcium mobilization and the growth of MIA PaCa-2 cells induced by neurotensin receptor agonist were completely inhibited by SR 48692. In conclusion, our results showed that MIA PaCa-2 cells express functional and SR 48692-sensitive-type neurotensin receptors. It is suggested that the neurotensin receptor antagonist SR 48692 may be useful in the treatment of pancreatic cancers that possess this type of neurotensin receptor.

[A case of sudden death during postoperative Holter ECG examination in a patient who experienced intraoperative cardiac arrest]

We report a case of postoperative sudden death during Holter-ECG examination in a 62-yr-old male, who experienced intraoperative cardiac arrest possibly due to myocardial ischemia. Although the patient recovered from intraoperative event without any neurological sequelae, he suffered from spontaneous ventricular tachycardia following mild ST segment depression that led to cardiac arrest on the 58th postoperative day. Precise mechanism of sudden death was not clear because coronary angiography or autopsy was not performed. However, the postoperative Holter-ECG revealed frequent episodes of silent 0.5-1.0 mm ST segment depression during tachycardia which had not been observed in the preoperative 12-lead ECG. Thus a likely explanation would be that the patient had the undetected coronary artery disease with frequent episodes of silent ischemia and finally was led to the fatal arrhythmia. In this case, so called "stunned myocardium" following repeated silent ischemia may have also contributed to the life-threatening arrhythmias. This case suggests that even mild ST depression might lead to life-threatening arrhythmias in the patients with silent ischemia. Adequate preoperative evaluation and careful perioperative observation are necessary for these patients.

[A case of inspiratory unidirectional value malfunction detected by an abnormal capnogram pattern]

We report a case of substantial rebreathing which occurred during the thoracoscopic bulla resection despite a normal FICO2 reading on capnogram. Early detection of inspiratory unidirectional valve malfunction as the cause of the rebreathing was only possible by careful observation of the capnogram pattern. During the course of one lung anesthesia, a rising end-tidal CO2 concentration (FETCO2) and a change in the pattern of the capnogram were observed. However, the lowest FICO2 value in the late phase of inspiration stayed below the alarm limit setting of rebreathing. For this reason, the capnograph failed to identify the beginning of inspiration and perceived the high FICO2 value in early inspiration as part of expiratory plateau. In case of the inspiratory valve malfunction, it is possible that analysis of the capnogram reveals underestimated FICO2.

Epidermal growth factor prevents oxygen-triggered apoptosis and induces sustained signalling in cultured rat cerebral cortical neurons

Epidermal growth factor (EGF), a conventional mitogenic factor, acts as a neurotrophic factor on several types of neurons in the central nervous system. We found that EGF prevented the death of rat cerebral cortical neurons cultured in a 50% oxygen atmosphere. This high-oxygen-triggered cell death showed features of apoptotic cell death, which was blocked by inhibitors of RNA or protein synthesis. EGF prevented the oxygen-induced death of the cultured cortical neurons in a dose-dependent manner. Basic fibroblast growth factor (bFGF) also prevented this cell death, although there was no apparent additive effect of EGF and bFGF. Among the cultured cortical neurons, we observed neurons possessing the EGF receptor and cells expressing c-Fos protein in response to EGF. The cortical neurons were cultured in the presence of cytosine arabinoside, and the number of glial fibrillary acidic protein-positive astroglial cells was < 0.5% of that of the corresponding microtubule-associated protein 2-positive neurons. Therefore, the effect of EGF on the cultured cortical neurons is thought to be due to a direct action. We also examined EGF-induced signalling in the cultured cortical neurons. We found that EGF induced the sustained tyrosine phosphorylation of the EGF receptor and sustained the activation of mitogen-activated protein kinase in the cultured cortical neurons. We suggest that EGF may exert the survival effect through the prolonged activation of the EGF signalling.

Lissencephaly gene product. Localization in the central nervous system and loss of immunoreactivity in Miller-Dieker syndrome

The Miller-Dieker syndrome, a disorder of neuronal migration, is caused by deletions of chromosome 17p13.3. Recently, a gene on 17p13.3, named LIS-1, was identified as the causative gene for this cerebral anomaly. Here we immunochemically and immunohistochemically localized the gene product, LIS-1 protein, among control normal subjects and patients with Miller-Dieker syndrome, using specific antibodies raised against synthetic peptide fragments of LIS-1 protein. Western blot analyses identified LIS-1 protein as a 45-kd, heparin-binding protein abundant in the cytosolic fraction. The protein was restricted to the central nervous system and detectable in brains of controls of all ages, from the early fetal to adult period. Immunostaining demonstrated the widespread distribution of LIS-1 protein in the brain and spinal cord of controls and a loss of immunoreactivity in individuals with Miller-Dieker syndrome. These results are consistent with the notion that a deficiency of LIS-1 protein is the direct cause of the brain malformation and that the protein plays a critical role in neuronal migration.

Cysteine protease of the nematode Nippostrongylus brasiliensis preferentially evokes an IgE/IgG1 antibody response in rats

Some cysteine proteases such as papain and those of mites and schistosomes have potent allergenic properties. To clarify the allergenicity of nematode cysteine proteases, the enzyme was purified from the intestinal nematode Nippostrongylus brasiliensis using cation exchange chromatography and gel filtration chromatography. The purified protease, of 16 kD and pI 8.5, showed maximum enzyme activity at pH 5.5 and substrate preference for Z-Phe-Arg-MCA. The specific inhibitors of cysteine protease leupeptin, iodoacetic acid, and E-64, completely suppressed the activity, indicating that the purified enzyme belongs to the cysteine protease family. Cysteine protease activity was found not only in somatic extract, but also in the excretory-secretory (ES) product of the nematode. When anti-cysteine protease immunoglobulin isotypes were examined in sera from rats infected with N. brasiliensis, a high level of IgG1 and a lower level of IgE antibody were detected. Depletion of IgG antibodies from the sera using protein G affinity columns resulted in a marked increase in reactivity of anti-cysteine protease IgE with the antigen, possibly due to the removal of competing IgG antibodies. In contrast to IgE and IgG1, production of anti-cysteine protease IgG2a was negligible. These results indicate that the nematode cysteine protease preferentially evokes an IgE/IgG1 antibody response.

Enhancement by cyclo-oxygenase inhibitors of platelet-activating factor production in thapsigargin-stimulated macrophages

1. Thapsigargin stimulated the accumulation of cell-associated platelet-activating factor (PAF) and extracellular prostaglandin E2 (PGE2) in rat peritoneal macrophages. PAF in the conditioned medium was less than the detectable amount. To obtain further insight into the mechanism of PAF accumulation, the role of PGE2 in PAF accumulation was investigated. 2. When macrophages were incubated in medium containing thapsigargin (30 ng ml(-1), 46.1 nM) and cyclo-oxygenase inhibitors such as indomethacin, naproxen or ibuprofen, the PAF content of the cells at 10 min was increased in a concentration-dependent manner in accordance with inhibition of PGE2 production. The stimulation by thapsigargin, cyclo-oxygenase inhibitors did not increase PAF accumulation. 3. In thapsigargin-stimulated macrophages, when PGE2(10(-7) M) was added to the medium, the cyclo-oxygenase inhibitor-induced stimulation of PAF accumulation at 10 min was markedly inhibited. 4. The accumulation of PAF induced by thapsigargin alone at 10 min was inhibited by exogenous PGE2 (10(-8) and 10(-7) M), or arachidonic acid (10(-6) and 10(-5) M) in accordance with the increase in PGE2 production. 5. The accumulation of PAF induced by thapsigargin alone or by thapsigargin and indomethacin (10(-6) M) was inhibited by dibutyryl cyclic AMP. 6. These results indicate that the concurrently produced PGE2 in thapsigargin-stimulated macrophages down-regulates PAF accumulation by increasing intracellular cyclic AMP levels, and that cyclo-oxygenase inhibitors increase PAF accumulation by inhibiting PGE2 production.

Spastic tetraplegia as an initial manifestation of familial Alzheimer's disease

Two sisters with familial Alzheimer's disease developed spastic gait disturbance as an initial manifestation. Their gait disturbance progressed gradually, followed by dementia a few years later. Post-mortem examination of one of the patients disclosed degeneration of the thalamus and corticospinal tract in addition to numerous senile plaques and neurofibrillary tangles in the neocortex, both of which were confirmed by immunohistochemistry. This is the first report in which clinicopathological evaluation is sufficient to establish a new variant of Alzheimer's disease presenting initially as spastic tetraplegia.

[Diagnosis and prognosis of elderly patients with coronary artery disease: assessment with dipyridamole thallium imaging]

Noninvasive evaluation of coronary artery disease is difficult in elderly patients because of their limited exercise-capacity. The diagnostic and prognostic value of dipyridamole perfusion scintigraphy was assessed in 147 patients aged 65 years and older. All patients underwent coronary angiography. Initially, 32 patients had percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The other 115 patients were first treated medically and followed for a mean of 29 +/- 22 months. Nine patients (7.9%) had cardiac events including cardiac death and coronary intervention (PTCA or CABG) during the follow-up. Dipyridamole perfusion scintigraphy was performed safely in all patients, whereas treadmill exercise testing could not be adequately performed in 24 patients, 18 of whom had multivessel disease. Multiple regression analysis showed that: fixed defect and reversible defect were powerful detectors of coronary lesions (p = 0.0001, p = 0.0027, respectively), all patients with fixed disease and 94% of patients with only reversible defect had significant coronary lesion; Diffuse slow washout and ST depression were statistically significant for detecting multivessel coronary lesions in patients with fixed disease (p = 0.0001, p = 0.017, respectively), the sensitivity and specificity of diffuse slow washout and/or ST depression for detecting multivessel coronary lesions ware 85% and 74%, respectively, and ST depression was statistically significant for detecting multivessel coronary lesions (p = 0.0002) in patients with only reversible defect, the sensitivity and specificity of ST depression were 88% and 64%, respectively. Cox survival analysis identified diffuse slow washout as the best predictor of future cardiac events among the scintigraphic variables.(ABSTRACT TRUNCATED AT 250 WORDS)