Interaction between cadmium and copper on ossification of embryonic chick bone in tissue culture

To investigate the interaction between cadmium and copper in ossification, femurs from 9-day-old chick embryos were cultured for 6 days in the presence of 2 microM cadmium and/or 1 microM copper. It was found that cadmium + copper treatment caused interactively severe damage to osteogenic mesenchymal cells in the periosteum and a severe degenerative change in osteoblasts around the trabecula, resulting in severe impairment of ossification in the diaphysis. Cadmium content was increased by copper; however, copper content was unaffected by cadmium in the diaphysis. It was therefore considered that the copper-induced increase in cadmium content was a primary factor in the interactive toxic effect of the cadmium + copper treatment in ossification.

Effects of enoxacin and its combination with 4-biphenylacetate, an active metabolite of fenbufen, on population spikes in rat hippocampal slices

The effects of enoxacin, a new quinolone antibacterial agent, and its combination with 4-biphenylacetate (BPA), an active metabolite of the non-steroidal antiinflammatory agent fenbufen, were examined on population spikes induced by electrical stimulation of the stratum radiatum in the CA1 pyramidal cell layer in rat hippocampal slices. Enoxacin (10(-4) M) and bicuculline (10(-6) M) increased the amplitude of the population spikes and anew elicited the second spikes (latency: 10 msec.), while BPA (10(-5) M) decreased the amplitude of the population spikes. However, the combination of enoxacin (10(-6), 10(-5) M) with BPA (10(-5) M) elicited the second spikes or epileptiform bursts with an increase of the population spike amplitude. The dose-response relationships showed that the effect of enoxacin was 100 times potentiated in the presence of BPA (10(-5) M). The second spikes induced by enoxacin (10(-4) M) were suppressed by muscimol (10(-6) M) and baclofen (10(-6) M), but not by clorazepate (5 x 10(-5) M) and pentobarbital (5 x 10(-5) M). The second spikes induced by bicuculline (10(-6) M) were suppressed by these four drugs. The second spikes by the combination of enoxacin (10(-6) M) with BPA (10(-5) M) were suppressed by muscimol (5 x 10(-6) M), but not by clorazepate (5 x 10(-5) M). These results suggest that the combination of enoxacin with BPA exerts a drug interaction to elicit the second spikes or epileptiform bursts with its mode of action different from that of bicuculline.

Dynamic exercise-induced elevation in plasma levels of atrial natriuretic peptide in patients with effort angina pectoris

We investigated the relationship between plasma atrial natriuretic polypeptide (ANP) levels and hemodynamic indices during dynamic exercise testing in 15 patients with effort angina pectoris. Patients exercised on an angina-limited, supine, multistage bicycle ergometer, and plasma ANP levels and hemodynamic indices were measured at rest, at peak exercise, and 6 minutes after exercise. Plasma ANP levels increased significantly at peak exercise. Pulmonary artery wedge pressure (PAWP) and coronary sinus blood flow (CSBF) were significantly correlated with plasma ANP levels before and at peak exercise (PAWP: r = 0.69, p less than 0.001; CSBF; r = 0.45, p less than 0.05). In six of eight patients whose PAWP exceeded 20 mm Hg at peak exercise, plasma ANP levels were increased at 6 minutes after exercise, whereas PAWP had decreased relative to the values obtained at peak exercise. Plasma ANP concentrations at 6 minutes after exercise were not correlated with PAWP at the same time. However, PAWP at peak exercise was correlated with the plasma ANP levels at 6 minutes after exercise (r = 0.80, p less than 0.001). These results suggest that in patients with effort angina pectoris left ventricular dysfunction resulting from exercise-induced myocardial ischemia may increase preload excessively and may contribute to the excess secretion of ANP after dynamic exercise.

Clinical significance of simple heart rate-adjusted ST segment depression in supine leg exercise in the diagnosis of coronary artery disease

To evaluate the clinical significance of simple heart rate-adjusted ST segment depression (delta ST/delta HR) in the diagnosis of coronary artery disease, 42 patients with stable exertional angina underwent supine leg exercise testing and cardiac catheterization. During exercise, heart rate, a multilead electrocardiogram, and pulmonary artery wedge pressure were recorded. The sensitivity and accuracy of the delta ST/delta HR criteria (greater than or equal to 3.0 microV/beat/min) were significantly greater than the conventional analysis of ST segment depression criteria (greater than or equal to 0.2 mV) for detecting three-vessel coronary artery disease at a matched specificity of 72% (100% versus 46%, 81% versus 64%, p less than 0.01). A significant linear correlation was found between maximum pulmonary artery wedge pressure increments during exercise (delta PAWP) or Gensini score and the delta ST/delta HR (delta PAWP: r = 0.51, p less than 0.001; Gensini score: r = 0.47, p less than 0.001). There were no statistically significant differences in the delta PAWP or Gensini score between patients with three-vessel disease who had delta ST/delta HR greater than or equal to 3.0 microV/beat/min and those with one- or two-vessel disease who had delta ST/delta HR greater than or equal to 3.0 microV/beat/min (delta PAWP: 18.1 +/- 2.0 versus 21.9 +/- 3.3, p = NS; Gensini score: 68.5 +/- 6.6 versus 66.3 +/- 11.3, p = NS). These findings demonstrate that delta ST/delta HR is more useful than a conventional analysis of ST segment depression for identifying not only anatomically severe coronary artery disease but also functionally severe coronary artery disease.

[Induction of Cd and Zn-thionein in a clonal osteogenic cell, MC3T3-E1]

Clone MC3T3-E1 cells at various differentiation stages were exposed to 0.44-13.3 microM Cd or 50-175 microM Zn in culture medium. After a 2-h culture period, the amount of Zn accumulated in the cells was shown to be larger than that for Cd, but the production of Zn-thionein was much less compared with that of Cd-thionein. After a 24-h incubation period, the synthesis of Zn-thionein increased markedly at levels of 150 microM Zn or greater, Cd induced metallothionein (MT) synthesis in a dose-dependent manner at 0.44 microM Cd or greater. Since calcified cells differentiated into osteoblastic cells also produced MT, osteoblasts were confirmed to have an ability to induce MT synthesis. Initiation of production of Cd-or Zn-thionein in the cells occurred at an accumulation of about 0.4 nmol Cd and 2.5 nmol Zn/mg cytosol protein. The ratios of thionein-binding Cd/Cd accumulated in the cytosol and thionein-binding Zn/Zn accumulated in the cytosol were 0.11 mol/mol and 0.067 mol/mol, respectively. These results show that the concentration of accumulated Zn necessary for initiating production of MT is about six times that of Cd and one molecule of Cd induces thionein about 1.6 times as effectively as one molecule of Zn does.

[Effects of antacids on absorption, excretion and metabolism of cefteram pivoxil]

Effects of various antacids (sodium bicarbonate, aluminium hydroxide gel) and an H2-blocker (cimetidine) on the absorption and excretion of a new cephem drug for oral use, cefteram pivoxil (CFTM-PI), were studied in healthy adult volunteers. 1. No significant differences were found in serum levels of CFTM and CFTM-A (an inactive isomer of cefteram (CFTM)) or their urinary excretion levels (concentration, recovery rate) between the group given CFTM-PI in combination with sodium bicarbonate and that given CFTM-PI alone. 2. There were no significant differences in serum levels of CFTM and CFTM-A or their urinary excretion levels (concentration, recovery rate) between the group given CFTM-PI in combination with aluminium hydroxide gel and that given CFTM-PI alone. 3. In contrast, serum levels of CFTM and its urinary recovery rate were significantly less in the group given the drug in combination with cimetidine than in that given a single administration 2-3.5 hours and 2-4 hours after administration, respectively. Clinical considerations remain.

Prediction of left ventricular function during supine bicycle ergometer exercise in angina-free patients with old myocardial infarction

We investigated whether or not left ventricular function during dynamic exercise in angina-free patients with old myocardial infarction could be estimated using resting left ventricular function and noninvasive parameters determined during exercise. We studied 70 patients with old myocardial infarction by measuring hemodynamic parameters during supine multistage bicycle ergometer exercise. Coronary arteriography and left ventriculography were performed: then the left ventricular ejection fraction and left ventricular end-diastolic volume were measured. The parametric changes (delta) between rest and peak exercise were determined. Significant positive correlations were observed between cardiac index (CI) at rest and at peak exercise (r = 0.62, p less than 0.001), as well as between pulmonary artery wedge pressure (PAWP) at rest and at peak exercise (r = 0.72, p less than 0.001). Multiple regression analysis indicated that CI and PAWP at peak exercise as dependent variables were best described by the equations: CI at peak exercise = 1.074 [CIrest] +0.031 [delta HR] + 0.004 [ExD] + 0.018 [LVEF] - 1.560 (r = 0.79, p less than 0.001), PAWP at peak exercise = 0.994 [PAWPrest] - 0.181 [LVEF] + 0.203 [delta DBP] -0.076 [delta HR] -21.488 (r = 0.80, p less than 0.001). These data suggested that CI and PAWP during dynamic exercise in angina-free patients with old myocardial infarction could be predicted using noninvasive parameters, such as increments of blood pressure and heart rate as well as exercise duration, together with data on resting left ventricular function, such as resting CI, resting PAWP, and resting left ventricular ejection fraction (LVEF).

Unresponsiveness of insulinoma cells to secretin: significance of the secretin test in patients with insulinoma

It is well known that B cells in the pancreas release insulin when stimulated by secretin, but there have been few reports on the response of insulinoma cells to secretin. In five patients with insulinoma, changes in serum immunoreactive insulin (IRI) concentration were measured after the intravenous injection of secretin into the peripheral vein before and after extirpation of the insulinoma. The extirpated insulinomas were cultured and tested for their response to secretin. The rise in serum IRI in response to secretin in patients with insulinoma was significantly slower and smaller than in normal volunteers. After removal of the insulinoma, the response to secretin became prompt and increased with time. Cultured insulinoma cells did not release insulin when stimulated by secretin. Therefore, it is concluded that the response of insulinoma cells to secretin is quite different from that of normal beta cells, and that the function of beta cells in the insulinoma-bearing pancreas is suppressed by the autonomous hypersecretion of insulin by the insulinoma. The extent of the decrease in function of the beta cells in patients with insulinoma can be estimated by the intravenous secretin test. Thus, the secretin test is sometimes useful in the differentiation of hypoglycemia due to insulinoma from that due to beta cell hyperplasia or alimentary hyperinsulinemia.

Mechanism of abnormal postexercise systolic blood pressure response and its diagnostic value in patients with coronary artery disease

To define the factors that affect an abnormal postexercise systolic blood pressure (SBP) response and to verify the diagnostic value of that response in patients with coronary artery disease (CAD), we studied 33 normal subjects, eight patients with hypertension who had no CAD, and 42 patients with documented CAD who underwent supine leg exercise testing. SBP recovery ratios were derived by dividing the values obtained 1 and 3 minutes after exercise by the peak value. The upper normal limit of the SBP ratio was defined by two standard deviations from the mean for 33 normal subjects. The specificity of this criterion for identifying patients with CAD was 97% and the sensitivity was 60%. None of the eight patients with hypertension showed an abnormal postexercise SBP response. At peak exercise the pulmonary artery wedge pressure was significantly greater in the patients with CAD having an abnormal response. In multiple regression analysis the exercise pulmonary artery wedge pressure, the exercise SBP, and the systemic vascular resistance after exercise were determining factors for an abnormal SBP response. Three-vessel disease was more common in patients with an abnormal response. Results of this study indicate that an abnormal postexercise SBP response appears to be determined by (1) the extent of exercise-induced impairment of left ventricular function and (2) peripheral vascular tone during recovery. This study also suggests that this criterion can increase the specificity of supine exercise testing in patients with CAD including those with hypertension and might provide a marker for the severity of impaired left ventricular function by exercise in CAD.

Isolation of urinary p-hydroxylated metabolites of mephentermine and phentermine in male Wistar rats

1. p-Hydroxymephentermine (p-hydroxy-MP) and p-hydroxyphentermine (p-hydroxy-Ph) were isolated as hydrochlorides from urine of male Wistar rats repeatedly dosed with mephentermine (MP). In addition, p-hydroxy-Ph was isolated as the hydrochloride from urine of the rats dosed with phentermine (Ph). 2. These results substantiate previous indications that p-hydroxylation of MP and Ph was a primary metabolic reaction in the rat.

Hemodynamic mechanisms of antianginal action of calcium channel blocker nisoldipine in dynamic exercise-induced angina

To investigate the mechanism of antianginal action of the calcium channel blocker nisoldipine and to determine the reproducibility of the clinical and hemodynamic events induced by supine leg exercise, 30 patients with stable effort angina pectoris were studied. They were divided into two groups; one group of 19 patients received a single 10-mg dose of nisoldipine orally, and the other group of 11 patients received a single dose of placebo orally. Chest pain was induced in all of 30 patients during the control exercise test. After nisoldipine administration, chest pain was not induced in 13 of 19 patients and was of lessened severity in five patients with the same work load as those performing control exercise. ST segment at peak exercise showed less severe depression after nisoldipine. Systemic vascular resistance was reduced by 38% (p less than 0.001) at rest and 22% (p less than 0.001) at peak exercise, and coronary vascular resistance was reduced by 31% (p less than 0.01) at rest and 18% (p less than 0.01) at peak exercise. Pulmonary artery wedge pressure fell from 6 +/- 1 to 3 +/- 1 mm Hg (p less than 0.001) at rest and from 28 +/- 3 to 11 +/- 2 mm Hg (p less than 0.001) at peak exercise. Coronary sinus flow at rest and myocardial oxygen uptake both at rest and during exercise was not modified by nisoldipine. However, coronary sinus flow at peak exercise increased significantly from 219 +/- 24 to 249 +/- 31 ml/min (p less than 0.01) after nisoldipine, and myocardial oxygen uptake was not significantly changed despite decreased coronary vascular resistance. The clinical and hemodynamic events induced by the exercise during invasive studies (except pulmonary artery wedge pressure at rest) were reproducible after placebo administration. Our data demonstrate that increased coronary blood flow could be the major mechanism of the antianginal action of nisoldipine in supine leg exercise-induced angina.

A suitable culture medium for ossification of embryonic chick femur in organ culture

To establish a culture medium which allows ossification in organ culture, 9-day-old embryonic chick femurs were cultured in variously supplemented BGJb-HW2 media. Changes of Ca and Pi concentrations in the BGJb-HW2 medium or the 10% addition of chick embryo extract (CEE) did not induce ossification. Furthermore, combinations of the 10% CEE with a high Ca x Pi product or with 5 mM beta-glycerophosphate (beta-GP) or with 10% horse serum plus a high Ca x Pi product often caused pathological abnormalities in the periosteum. On the other hand, BGJb-HW2 medium supplemented with 5 mM beta-GP induced development of ossification. The Ca content of femurs and the diaphysial hydroxyproline content were markedly increased. Histological observation showed a formation of a thick and active periosteum, numerous osteoblastic cells, a sufficient amount of osteoid tissue and well developed calcified trabeculae without any pathological changes. Thus, the organ culture system using this medium was considered to be an appropriate one for studies on osteogenesis in vitro.

Safety and pharmacokinetics of single oral and intravenous doses of fluconazole in healthy subjects

At intervals of two to four weeks, eight subjects received 25 mg of fluconazole orally; 50 mg orally; 25 mg intravenously; 50 mg intravenously; and then 100 mg orally (six subjects). Physical examinations and laboratory tests performed before and after each drug administration revealed no side effects or significant changes in test results. After oral administration, plasma fluconazole levels rose rapidly in a dose-dependent manner, maximum levels being reached in 0.7 hours after 25 mg, in 1.4 hours after 50 mg, and in 1.7 hours after 100 mg. After intravenous administration, mean plasma drug levels were higher than after oral administration for 30 minutes and then declined rapidly; at one hour after injection, plasma levels were similar to those seen after oral administration. During 120 hours after oral administration, 69% of the 25-mg dose, 66% of the 50-mg dose, and 75% of the 100-mg dose were recovered unchanged in urine; after intravenous injection, 74% of the 25-mg dose and 72% of the 50-mg dose were recovered. The half-life of fluconazole was 31 to 37 hours after oral and intravenous administration. Calculations of the areas under the plasma fluconazole time curves showed a clear dose-dependent response. The results indicate that fluconazole is a safe and effective antifungal agent.

[An analysis of the cellular DNA contents in lung-metastasized stomach cancers]

A study has been conducted of the cellular DNA contents in the primary and metastatic lesions of 30 cases of lung-metastasized stomach cancers, in which each DNA Index (DI) was calculated and analysed comparatively. As a consequence, the rate of the diploid type in the nodular lung metastases was found to be higher than the rate of the others. Further, the DI's of 22 out of 30 (73%) metastatic lymph nodes corresponded with those of the primary lesions. Four lung metastatic lesions out of five differed from their primary lesions, but all five lesions simulated their metastatic lymph nodes. Thus understanding of the properties of the metastatic lymph nodes, rather than their primary lesions, would seen to be helpful in planning the therapy to combat recurrent cancers.

[Clinical courses and pathological findings in two gay male patients with acquired immunodeficiency syndrome infected in Japan]

This is a report on the clinical courses and pathological findings in two gay male patients with acquired immunodeficiency syndrome (AIDS) infected in Japan. Case 1. A 39 year-old Japanese homosexual male was diagnosed as amebic dysentery complicated with liver abscess on admission. He was placed on Metronidazole with complete relief. Serological tests was positive for AIDS. On second admission, he was found to have pneumocystis carinii pneumonia (PCP) and cytomegalo-viral uveitis. Administration of Pentamidine was partially effective, however the therapy with Azidothimidine was discontinued by bone marrow suppression. On his third admission, he suffered from cryptococcal meningitis and therapy-resistant fungusemia. Finally he died of recurrent pneumonia regardless of appropriate therapies. Autopsy proved extended cryptococcal infection in the brain, meninx, lungs, liver and kidney, and cytomegalo-infection in the lungs, liver and kidney. Furthermore, atypical mycobacteriosis was found in the lymph nodes. There was no active findings compatible with PCP. Case 2. A 44 year-old Japanese homosexual male was admitted with oral candidiasis and diagnosed as AIDS related complex. He suffered from pneumonia with marked improvement on sulfamethoxazole-Trimethoprim. On his second admission, he developed diarrhea and was found to be infected with Giardia lambia. In addition, cytomegalo-viral infection damaged his eye sight. He died of pneumonia and meningitis shortly there after. Autopsy proved a cytomegalo-viral infection in the lung and colon, old lesions possibly caused by PCP in the lungs, and suppurative meningitis in the meninx. These experiences confirm that AIDS patients can be exposed to several opportunistic infections at the same time in the multiple organs. Furthermore, it is suggested that homosexual patients with AIDS may have unique opportunistic infections such as amebic dysentery or Giardia lamblia unlike other AIDS patients related to hemophilia.

Two cases of Reiter's syndrome

Two characteristic cases of Reiter's syndrome are reported. One (case T.M) was a 64-year-old female with ulcerative colitis and the other (case O.M) was a 20-year-old male with serum antistreptococcal lysine O (ASLO) and antistreptokinase (ASK) titers of 480x and 2560x, respectively. These cases were both histocompatibility antigen HLA-B27 positive. The ulcerative colitis and iritis were inactive in case T.M. However, case O.M required aggressive treatment for fever and arthralgia. These patients have recently shown no evidence of Reiter's syndrome; however, case T.M has had recurrent bowel hemorrhages due to ulcerative colitis.

Renal handling of fleroxacin in rabbits, dogs, and humans

The renal handling of fleroxacin was studied by renal clearance and stop-flow techniques in rabbits and dogs and by analyzing the pharmacokinetics with and without probenecid in humans. In rabbits the excretion ratios (fleroxacin intrinsic renal clearance/glomerular filtration rate) were greater than unity (2.01) without probenecid and were decreased to a value below unity (0.680) with probenecid. In dogs, on the other hand, the excretion ratios were less than unity (0.608 and 0.456) both without and with probenecid, and so were not affected by probenecid. This fact suggested that fleroxacin was excreted into urine by both glomerular filtration and renal tubular secretion in rabbits, but only by glomerular filtration in dogs, accompanied by partial renal tubular reabsorption in both species; these mechanisms were also supported by stop-flow experiments. In humans probenecid treatment induced increases in the elimination half-life and area under the serum concentration-time curve and decreases in apparent serum clearance, renal clearance, and urinary recovery of fleroxacin. The excretion ratio without probenecid was 1.13, which was significantly decreased to 0.750 with probenecid. These results indicated that both renal tubular secretion and reabsorption contributed to renal excretion of fleroxacin in humans. The contribution of tubular secretion was species dependent and was extensive in rabbits, minimal in dogs, and moderate in humans. Renal tubular reabsorption was commonly found in every species. The long elimination half-life of fleroxacin in humans might be explained by its small total serum clearance and small renal clearance, which are attributed to less tubular secretion and more tubular reabsorption.

Urinary N-acetyl-beta-D-glucosaminidase isoenzyme activity as measured by fast protein liquid chromatography in patients with nephrotic syndrome

Exactly why N-acetyl-beta-D-glucosaminidase (NAG) excretion is increased in patients with nephrotic syndrome with glomerular lesions is poorly understood. Glomeruli contain less NAG than do proximal tubules. In this study, we have tried to measure the NAG isoenzymes automatically by use of the recently developed fast protein liquid chromatography (FPLC) system, followed by column chromatography on DEAE cellulose (Mono Q). Three isoenzyme peaks--B, I + II, and A--were observed for urine from both healthy subjects and nephrotic patients. The B isoenzyme usually constituted about 10% of the total NAG in healthy controls, 30% in nephrotic patients. In contrast, the proportion of the A isoenzyme was inversely related to that of the B isoenzyme when healthy controls and nephrotic patients were compared. Our system for measuring NAG isoenzymes is reproducible and fast, and it should be useful in further studies.

Urinary N-acetyl-beta-D-glucosaminidase isoenzyme activity as measured by fast protein liquid chromatography in patients with nephrotic syndrome

Exactly why N-acetyl-beta-D-glucosaminidase (NAG) excretion is increased in patients with nephrotic syndrome with glomerular lesions is poorly understood. Glomeruli contain less NAG than do proximal tubules. In this study, we have tried to measure the NAG isoenzymes automatically by use of the recently developed fast protein liquid chromatography (FPLC) system, followed by column chromatography on DEAE cellulose (Mono Q). Three isoenzyme peaks--B, I + II, and A--were observed for urine from both healthy subjects and nephrotic patients. The B isoenzyme usually constituted about 10% of the total NAG in healthy controls, 30% in nephrotic patients. In contrast, the proportion of the A isoenzyme was inversely related to that of the B isoenzyme when healthy controls and nephrotic patients were compared. Our system for measuring NAG isoenzymes is reproducible and fast, and it should be useful in further studies.

Heterogeneous response of cytoplasmic free Ca2+ in proximal convoluted and straight tubule cells in primary culture

Cytoplasmic free calcium [( Ca2+]c) plays an important role in cellular signal transduction in response to hormones. The development of microfluorometric digital image analysis makes it possible to obtain an image of a calcium-indicator dye, fura-2, in a single living cell. Subconfluent primary cultured cells from isolated proximal convoluted and straight tubules were analyzed for [Ca2+]c. The basal level of [Ca2+]c was 92.0 +/- 0.82 nM in convoluted and 75.0 +/- 4.7 nM in straight tubule cells. Exposure of convoluted tubule cells to parathyroid hormone (10(-7) M) elicited a 1.4-fold transient rise in [Ca2+]c. Treatment of straight tubule cells with calcitonin (0.1 U/ml), on the other hand, evoked a 1.6-fold transient increase in [Ca2+]c. [Ca2+]c in proximal straight tubule cells did not respond to parathyroid hormone, nor did that in convoluted tubule cells to calcitonin. [Ca2+]c peaks were diminished in straight tubule cells by repeated additions of calcitonin at 5-min intervals. These hormonal responses were abolished by perfusing the cells with calcium-free solution and were not mimicked by perfusion with adenosine 3',5'-cyclic monophosphate (10(-4) M) or with forskolin (5 X 10(-5) M). The results suggest that the [Ca2+]c response to the selected peptide hormones is different in proximal convoluted and straight tubule cells in primary culture.

[A case of gastric carcinoid with transient features of tubular adenocarcinoma]

A 51-year-old male sought a medical advice because of gastric lesion that had been detected by a mass screening though the man felt no symptoms. Gastrofiberscopy revealed a superficially elevated, depressed lesion on the lesser curvature of the antrum. Biopsy specimens showed a moderately differentiated adenocarcinoma, and surgically obtained material, about 1.5 cm in diameter, revealed a carcinoid and tubular adenocarcinoma. The tumor consisted mainly of carcinoid tissue while the surface of the tumor manifested, histologically, an adenocarcinoma, though the margins of the two histologies were unclear. The carcinoid tissue revealed a positive Grimerius-staining and a negative Fontana-Silver staining. Fifteen patients having a gastric lesion containing a carcinoid and a carcinoma have been reported in Japan. Five of these 15 cases were pointed out as having existing transient features between the cancer and carcinoid.

Noninvasive detection of exercise-induced markedly elevated left ventricular filling pressure by pulsed Doppler echocardiography in patients with coronary artery disease

To assess the accuracy of the exercise-induced decrease in the ratio of peak flow velocity in atrial systole to that in early diastole (A/E) for predicting an elevation of left ventricular filling pressure, supine bicycle ergometer exercise testing was performed in 27 consecutive patients with coronary artery disease. Doppler-derived transmitral flow velocities were recorded at rest and immediately after exercise. A/E decreased during exercise in 16 patients (group A) and increased in 11 (group B). Pulmonary artery wedge pressure (PAWP) increased notably from 7 mm Hg at rest to 26 mm Hg at peak exercise in group A (p less than 0.001). In contrast, PAWP increased slightly from 6 mm Hg to 10 mm Hg in group B (p less than 0.05). The cardiac index at peak exercise in group A was significantly lower than that in group B (p less than 0.05). These findings suggest that patients with an exercise-induced decrease in A/E might not increase their cardiac output. A significant negative correlation between PAWP and A/E was observed in patients with PAWP over 20 mm Hg (r = -0.74; p less than 0.005). The exercise-induced decrease in A/E showed a sensitivity of 100%, a specificity of 73%, and a predictive accuracy of 85% in detecting patients with PAWP over 20 mm Hg. These findings show that Doppler recordings of transmitral flow velocities during dynamic exercise can provide useful information concerning exercise-induced left ventricular dysfunction associated with markedly elevated filling pressures.

[Uric acid metabolism in patients with chronic glomerulonephritis]

Serum uric acid (SUA), creatinine clearance (Ccr), urinary excretion of uric acid (UUAV) and uric acid clearance (CUA) were determined in 357 patients with IgA nephritis (IgAN) and 81 patients with membranous nephropathy (MGN) in an attempt to clarify uric acid metabolism in patients with chronic glomerulonephritis, and UUAV/Ccr and CUA/Ccr levels were measured to investigate their correlations. As a result, hyperuricemia that could hardly be explained with a decline of Ccr alone was recognized in many cases, since the patients with hyperuricemia exceeding 7.0 mg/100 ml of SUA registered even as high as 25.5% in IgAN and 33.3% in MGN, whereas those with the Ccr levels higher than 80 ml/min registered 22.3% in IgAN and 38.0% in MGN. Although the SUA level increased and the UUAV and CUA levels decreased along with a decline of Ccr in IgAN, no similar trends were recognized in MGN. When the distribution of UUAV was studied in the patients with the Ccr levels higher than 80 ml/min, the patients whose UUAV levels higher than 800 mg/24 hrs that suggested excessive uric acid production were markedly as low as 3.9% in IgAN and 3.7% in MGN. Thus, the cause of hyperuricemia could not be attributed to an amount in the uric acid production. On the other hand, the patients whose CUA levels lower than 6.0 ml/min in the distribution of CUA that suggested a decrease of uric acid excretion registered 47.4% in IgAN and 63.0% in MGN, respectively, which equally appeared to be a type of lowered excretion in a majority of patients whose hyperuricemia was recognized in IgAN and MGN. The mechanism of the lowered excretion of uric acids from the kidney despite the normal level of Ccr has yet to be clarified.