[Long-term follow-up of pulmonary hypertension of unknown etiology]

Since 1967, 166 patients with primary pulmonary hypertension of unknown etiology have been followed-up at the Department of Cardiology at the University of Vienna. Although an exact etiopathogenetic differentiation was not possible, three groups of patients were identified clinically: patients with so-called primary pulmonary hypertension (PPH)--group 1; patients with pulmonary hypertension induced by anorexipens (aminorex fumarate)--group 2; and patients with pulmonary hypertension due to emboli in the large pulmonary vessels--group 3. In addition to non-invasive echocardiographic assessment of pulmonary pressures, regular cardiac catheterizations were carried out, which revealed right atrial mean pressure, cardiac output, and mixed venous saturation to be prognostic predictive factors. Patients with anorexigen-induced pulmonary hypertension have a clearly better life expectancy than those with PPH. Owing to the temporally limited effect of the pulmonary hypertension-inducing agent, aminorex fumarate (Menocil), patients with anorexigen-induced pulmonary hypertension may be considered a model group for drug-induced vascular pathology.

Plasminogen activator inhibitor-1 levels in patients with chronic angina pectoris with or without angiographic evidence of coronary sclerosis

Increased plasma levels of plasminogen activator inhibitor-1 (PAI-1) have been shown to exist in 40 to 60% of patients with stable coronary artery disease and have been suggested to be responsible for the development of coronary thrombotic complications. However, it is also discussed whether PAI-1 elevation might mainly be due to variables like increased age or to reactive mechanisms caused e.g. by the chest pain itself. To exclude age dependent or pain related influences, age-matched patients with stable angina pectoris (NHYA II) and angiographically proven coronary artery disease (CAD, n = 16) or without evidence for coronary sclerosis (variant angina, n = 10; angina-like syndrome with normal coronary angiogram, n = 5; non-CAD, n = 15) have been investigated for their plasma PAI-1 activity and t-PA antigen levels. The mean PAI activity in CAD patients (17.5 U/ml) was significantly higher than in non-CAD patients (9.6 U/ml) (p less than 0.0001). In the CAD patients no significant variation in plasma PAI-1 values could be demonstrated when related to the extent of the disease or to a history of previous myocardial infarction. t-PA antigen was also elevated in CAD patients as compared to the non-CAD group (p less than 0.02). The results suggest therefore a strong correlation between coronary artery disease itself and elevated levels of components of the plasma fibrinolytic system.

Four year follow-up of the Duromedics Edwards bileaflet valve prostheses

The Duromedics Edwards (DE) bileaflet valve prosthesis was withdrawn from the market after 12 leaflet escapes had been reported in 20,000 implants. Effort is necessary to identify the failure mode to improve valve design or production, but the rate of other valve related complications will tell if it is worthwhile reintroducing this prosthesis. Five-hundred and sixty-four DE valves have been implanted in 508 patients between September 1983 and May 1988. Two-hundred and sixty-eight had aortic valve replacement (AVR), 183 mitral valve replacement (MVR) and 56 double valve replacement (DVR); the perioperative mortality was 6.9%. Follow-up has been 98.7% complete for a total of 1064 patient years and a mean follow-up of 26 months (range 3 to 54 months). Late mortality was 3.7%/yr and actuarial survival was 85 +/- 3% without and 78 +/- 3% including operative mortality after 54 months. Event free actuarial rates (linearized rates in parenthesis) were 93 +/- 2% (1.5%/yr) for thromboembolism, 91.7 +/- 1.9% (2.3%/yr) for anticoagulant related hemorrhage, 89 +/- 4.8% (2.3%/yr) for valve failure, 93 +/- 2% (1.8%/yr) for valve related mortality, 72 +/- 4.8% (6.3%/yr) for all valve related morbidity and mortality and 83 +/- 4.4% (3%/yr) for treatment failure. Two leaflet escapes occurred in the study group (0.18%/yr), both patients survived reoperation. The concept of reducing thrombus formation by a specially designed irrigating hinge mechanism was proven by a low rate of thromboembolism in our clinical follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of age on human pancreatic growth hormone releasing hormone stimulated growth hormone secretion

63 non-obese healthy subjects aged 18 to 95 years were investigated for age-dependence of GHRH-stimulated GH-secretion. In addition, priming of GH-secretion with three oral doses of propranolol (3 x 80 mg, the last dose 2 hours prior to the second GHRH-bolus) was carried out in 15 subjects below 40 years and 13 subjects older than 70 years. We found that mean maximal incremental GH-levels were inversely correlated with chronological age (r = -0.44, P = 0.001) of the probands. Propranolol premedication caused a significant rise of both basal and peak GHRH-induced relative increases in all subjects tested, whereas GHRH-induced relative increases of GH remained unchanged. In a well selected group of non-obese healthy subjects stimulated GH-secretion is found to undergo an aging process that is supposed to be of pituitary and suprapituitary origin. Priming GH-secretion with a beta-Blocker is possible both in young and very old healthy subjects and is likely to affect the basal GH secretory tone and not GHRH-stimulated GH-secretion.

Recurrent paradoxical embolism complicating severe thromboembolic pulmonary hypertension

A patient with a three-year history of recurrent pulmonary embolism is presented. Thromboembolic pulmonary hypertension was proven in the final stage of disease in the presence of repeated episodes of systemic embolic events. Paradoxical embolism was assumed to be present on the basis of blood-gas analysis and contrast echocardiography that demonstrated a right-to-left shunt at atrial level. Autopsy revealed a patent foramen ovale and provided strong evidence for the accuracy of the clinical diagnosis.

Pulmonary veno-occlusive disease in a patient with unilateral absence of right pulmonary artery

A 25-year-old patient had unilateral absence of the right pulmonary artery (UARPA) and severe left pulmonary artery hypertension. After death from congestive right heart failure, autopsy revealed histologic signs of pulmonary veno-occlusive disease (PVOD) and pulmonary hypertension (PH). An accessory arterial vessel that was thrombotically occluded was found connecting the ascending aorta and the right pulmonary hilum. There was also histologic evidence of arterial thrombi within the right lung arterial vascular bed. The PH in UARPA usually occurs very early during the course of disease. From histologic findings and medical history, it is likely that in this case, late-onset elevation of pulmonary pressures was triggered by the occurrence of PVOD. This is the first case of UARPA and PVOD--a congenital unilateral arterial malformation in the presence of bilateral involvement in a possibly acquired venous obliterative disease.

[Penicillin-induced acute renal failure as a rare severe complication of erysipelas treatment]

Penicillins are the most commonly used antibiotics in dermatology owing to their bacteriocidal effect and the high responsiveness of most bacterial dermatoses to penicillin treatment. Although there is a wide range of adverse reactions to penicillins, severe complications are seen very rarely. We report on two cases of penicillin-induced acute interstitial nephritis and summarize the characteristic features of this serious adverse reaction to penicillin administration.

[Successful treatment of antimony-resistant cutaneous leishmaniasis]

We report the case of a patient who acquired cutaneous leishmaniasis in Israel, with multiple lesions on the face and wrists. The diagnosis was made several months after the onset of disease. We observed large multiple ulcers, which at first responded to sodium stibogluconate (600 mg daily for 2 weeks). After initially decreasing in size, the lesions remained unchanged. Several weeks later clinical exacerbation of the cutaneous leishmaniasis was observed. Fearing late complications on the upper eyelid, we administered two 2-week courses of ketoconazole, 800 mg daily. The early and rapid improvement achieved indicates that ketoconazole was successful in this case of cutaneous leishmaniasis.

Effects of sex and age on growth hormone response to growth hormone-releasing hormone in healthy individuals

The influence of age and sex on human GH secretion is controversial. In previous studies, serum GH responses to arginine and insulin-induced hypoglycemia were significantly higher in pre- and postovulatory women than in men. In contrast, recent studies suggest that GH responsiveness to GHRH is higher in normal young men than in age-matched women. To clarify the question of sex and age influence on GHRH-(1-44)-stimulated GH secretion, we studied 116 normal women and men (with body mass indexes of 18-25 and 19-26, respectively) between the ages of 18 and 95 yr. The peak serum GH increments after GHRH administration were significantly higher in premenopausal women than in age-matched men (P less than 0.003 for the age group 18-30 yr and P less than 0.03 for the age group 30-50 yr, as assessed by analysis of variance). The responses were not different in postmenopausal women and age-matched men. Multiple regression analysis revealed a significant negative correlation between GHRH-induced GH responses (integrated area under the curve) and age in both women (P less than 0.002) and men (P less than 0.001). In addition, we determined basal serum testosterone, estradiol, cortisol, and PRL levels in all subjects. Multivariate regression analysis of the GH responses to GHRH administration revealed a significant positive correlation (P less than 0.01) between serum estradiol and both GH increase and the area under the GH response curve. No correlation was found between GHRH-stimulated GH secretion and basal serum cortisol, testosterone, or PRL concentrations. Our data clearly demonstrate a marked influence of both sex and age on GHRH-stimulated GH secretion. We found a higher GH increase in premenopausal women compared with age matched-men and an age-dependent decrease in GHRH-stimulated GH secretion in both sexes. Furthermore, in women a significant influence of estradiol on GH secretion after GHRH administration could be demonstrated.

[Isolated agenesis of the right pulmonary artery with late manifestation of pulmonary artery hypertension]

The case of a woman patient of 25 years of age with acute cardiac decompensation is presented. The chest x-ray as well as the lung scan showed the typical features of absence of the right pulmonary artery. The diagnosis was confirmed angiographically. The sudden and late onset of symptoms of pulmonary hypertension is a remarkable feature.

Abnormalities in the hypothalamic-pituitary-adrenocortical axis in patients with chronic renal failure

The recently described human corticotropin-releasing factor was administered to eight patients with chronic renal failure in order to assess hypothalamic-pituitary-adrenocortical (HPA) function. Acute administration of corticotropin-releasing factor lead to a diminished increase of the basally elevated levels of ACTH and beta-endorphin immunoreactivity in patients on chronic hemodialysis. Basal plasma cortisol concentration was normal in end-stage renal disease; however, considering the corresponding elevated ACTH concentrations, cortisol levels were inadequately low. Thus, the hypothalamus as well as the adrenal gland seems to contribute to the alterations in HPA function observed in patients with chronic renal failure; involvement of the pituitary gland and effects of metabolic alterations cannot be ruled out.

[The spectrum of transient acantholytic dermatoses]

In reviewing the literature, we made an attempt to expand the term "transient acantholytic dermatosis" (TAD) beyond the criteria of classical Grover's disease to a broader spectrum of diseases and to systematically categorize the variety of reported clinical pictures. Moreover, we endeavoured to separate these conditions from Darier's and Hailey-Hailey's disease and from immunofluorescence-positive acantholytic dermatoses. Three patients of our own are presented with a heretofore undescribed bullous exanthematic variant.

Molecular mobility and nucleocytoplasmic flux in hepatoma cells

Fluorescence microphotolysis (photobleaching) was used to measure, in single polyethylene glycol-induced polykaryons of hepatoma tissue culture cells, nucleocytoplasmic flux and intracellular mobility for a series of dextrans ranging in molecular mass from 3 to 150 kD and for bovine serum albumin. For the dextrans, the cytoplasmic and the nucleoplasmic translational diffusion coefficients amounted to approximately 9 and approximately 15%, respectively, of the value in dilute buffer. The diffusion coefficients depended inversely on molecular radius, suggesting that diffusion was dominated by viscosity effects. By application of the Stokes-Einstein equation, cytoplasmic and nucleoplasmic viscosities were derived to be 6.6 and 8.1 cP, respectively, at 23 degrees C. Between 10 and 37 degrees C nucleoplasmic diffusion coefficients increased by approximately 45-85%, whereas cytoplasmic diffusion coefficients were virtually independent of temperature. In contrast to that of the dextrans, diffusion of bovine serum albumin was more restricted. In the cytoplasm the diffusion coefficient was approximately 1.5% of the value in dilute buffer; in the nucleus albumin was largely immobile. This indicated that albumin mobility is dominated by association with immobile cellular structures. Nucleocytoplasmic flux of dextrans depended inversely on molecular mass with an exclusion limit between 17 and 41 kD. This agrees with previous measurements on primary hepatocytes (Peters, R., 1984, EMBO [Eur. Mol. Biol. Organ.] J. 3:1831-1836), suggesting that in both cell types the nuclear envelope has properties of a molecular sieve with a functional pore radius of approximately 55 A.

Functional evaluation of murine allogeneic T lymphoblasts separated by Vicia villosa lectin positivity

Mixed-lymphocyte culture-stimulated cells have been fractionated by their ability to bind the lectin Vicia villosa (Vv) and assessed for their cytolytic and suppressor activity in vitro. Vv positive and negative cells were separated either by cell affinity chromatography using Vv-Sepharose 6MB chromatography or by electronic cell sorting with FITC-Vv. Both populations expressed marked cytolytic and suppressor cell activity. Thus this lectin cannot be used to discriminate between these and other functional lymphoid cell population of blastoid cells binding the FITC-Vv appears following allogeneic stimulation; treatment with the immunosuppressive drug cyclosporin A, which affects cytotoxic cells preferentially, results in a considerable reduction of the Vv positive blastoid cells.

Effect of in vitro cyclosporin. A treatment on human natural and antibody-dependent cell-mediated cytotoxicity

Concentrations of 0.1 to 10.0 micrograms of cyclosporin A (Cy A) per ml do not directly inhibit the lysis of 51Cr-labeled K562 target cells by human peripheral blood natural killer (NK) cells nor of antibody-coated chicken red blood cells by antibody-dependent cellular cytotoxicity (ADCC) effector cells. Pretreatment of effector cells with Cy A for 18 hr still failed to affect NK or ADCC effector function. However, induction of NK cell activity by overnight pretreatment of effector cells by polyinosinate-polycytidylate (PolyIC) is inhibited by as little as 1 micrograms of Cy A per ml. The mechanism of inhibition may involve a direct effect of Cy A on "induced" or "activated" NK cells or inhibition of the release of Poly IC-induced interferon from lymphocytes.

Direct staining of mouse T lymphoblasts with fluoresceinated Vicia villosa lectin

Fluorescein conjugated Vicia villosa (Vv) lectin was used for direct staining of the surface of viable cells of various mouse lymphocyte populations. A varying proportion of polyclonally-activated T cells expressed Vv receptor although less strongly than cells of an influenza virus-specific cytotoxic T lymphocyte (CTL) clone and blasts generated in the mixed lymphocyte reaction. Cyclosporin A (CyA) treatment markedly reduced the expression of Vv receptor following concanavalin A (Con A) stimulation by between 66% and 93% with a concurrent inhibition of blastogenesis and complete abrogation of cytolytic function. Resting mouse lymphocytes and B-cell blasts were always Vv-negative. However, non-specific suppressor factor producing non-cytotoxic T-cell lines also expressed Vv receptor as shown by the weak, but specific, surface fluorescence of EL4 and BW5147 cells stained with Vv. Vv-positive cells were not restricted to a particular Ly phenotype, Vv-positive cells being found among both Lyt 1+ and Lyt2+ MLC stimulated lymphocytes. Our data suggest that the receptor for Vv lectin cannot be regarded as an exclusive differential marker for CTL.

Electron microscopic and histochemical investigations of the atretic oocyte of Perca fluviatilis L. (Teleostei)

The regression of atretic oocytes in Perca fluviatilis was studied by histochemical, light and electron microscopic methods. The course of regression can be divided into three stages, the first two comprising the dissolution of the atretic oocyte and its phagocytosis by the granulosa cells of the follicular epithelium, and the third stage consisting of the dissolution of the granulosa cells themselves. The ultrastructure in all three stages shows only features related to phagocytosis and lysosome formation. In particular, there is no agranular endoplasmic reticulum formed within the phagocytically active granulosa cells, nor is there any 3 beta-hydroxysteroid dehydrogenase activity (3 beta-HSD). Large yellow-orange pigments, formed during the third stage of regression, are ascribed to a relative deficiency of lysosomes in lipid digestion, and do not result from a preceeding steroid-synthesising phase in mammalian corpora lutea. Thus, the atretic oocyte of P. fluviatilis is considered not to give rise to a corpus luteum formation with endocrine function, but merely represents a degenerative structure.

[Changes in cellular immunity during peritoneal dialysis]

In 8 patients with chronic peritoneal dialysis before and after 24-hour peritoneal dialysis examinations on the cellular immunity were performed (lymphocyte blast transformation with PHA and Con A, ADCC). There was no difference to the normal findings in healthy control persons. Blast transformation decreased during peritoneal dialysis, no changes were visible with ADCC. Compared with reports in literature concerning regular hemodialysis therapy the state of cellular immunity in chronic peritoneal dialysis seemed to be superior.