Propagation-based x-ray phase-contrast tomography of mastectomy samples using synchrotron radiation

PURPOSE

Propagation-based phase-contrast computed tomography (PB-CT) is a method for three-dimensional x-ray imaging that utilizes refraction, as well as absorption, of x rays in the tissues to increase the signal-to-noise ratio (SNR) in the resultant images, in comparison with equivalent conventional absorption-only x-ray tomography (CT). Importantly, the higher SNR is achieved without sacrificing spatial resolution or increasing the radiation dose delivered to the imaged tissues. The present work has been carried out in the context of the current development of a breast CT imaging facility at the Australian Synchrotron.

METHODS

Seven unfixed complete mastectomy samples with and without breast cancer lesions have been imaged using absorption-only CT and PB-CT techniques under controlled experimental conditions. The radiation doses delivered to the mastectomy samples during the scans were comparable to those approved for mammographic screening. Physical characteristics of the reconstructed images, such as spatial resolution and SNR, have been measured and compared with the results of the radiological quality assessment of the complete absorption CT and PB-CT image stacks.

RESULTS

Despite the presence of some image artefacts, the PB-CT images have outperformed comparable absorption CT images collected at the same radiation dose, in terms of both the measured objective image characteristics and the radiological image scores. The outcomes of these experiments are shown to be consistent with predictions of the theory of PB-CT imaging and previous reported experimental studies of this imaging modality.

CONCLUSIONS

The results presented in this paper demonstrate that PB-CT holds a high potential for improving on the quality and diagnostic value of images obtained using existing medical x-ray technologies, such as mammography and digital breast tomosynthesis (DBT). If implemented at suitable synchrotron imaging facilities, PB-CT can be used to complement existing imaging modalities, leading to more accurate breast cancer diagnosis.

The classification of lung cancers and their degree of malignancy by FTIR, PCA-LDA analysis, and a physics-based computational model

Lung cancer has the highest mortality rate of all malignant tumours. The current effects of cancer treatment, as well as its diagnostics, are unsatisfactory. Therefore it is very important to introduce modern diagnostic tools, which will allow for rapid classification of lung cancers and their degree of malignancy. For this purpose, the authors propose the use of Fourier Transform InfraRed (FTIR) spectroscopy combined with Principal Component Analysis-Linear Discriminant Analysis (PCA-LDA) and a physics-based computational model. The results obtained for lung cancer tissues, adenocarcinoma and squamous cell carcinoma FTIR spectra, show a shift in wavenumbers compared to control tissue FTIR spectra. Furthermore, in the FTIR spectra of adenocarcinoma there are no peaks corresponding to glutamate or phospholipid functional groups. Moreover, in the case of G2 and G3 malignancy of adenocarcinoma lung cancer, the absence of an OH groups peak was noticed. Thus, it seems that FTIR spectroscopy is a valuable tool to classify lung cancer and to determine the degree of its malignancy.

[The assessment of the value of ultrasound and magnetic resonance imaging in diagnosing hand joint arthritis]

The main imaging investigation used in diagnosing rheumatoid arthritis is radiography of the hands and feet. It allows visualisation of bone erosions--typical of the disease. However, bone erosions occur during the later stages of the rheumatoid arthritis and are preceded by synovitis. The aims of the study were to use ultrasound (US) and magnetic resonance imaging (MRI) in examining joints in patients suffering from chronic arthritis, and also to assess the value of these methods in diagnostics. In 61 patients with chronic arthritis (39 with rheumatoid arthritis--RA, and 22 with another etiology arthritis), plain radiography, US and MRI of the hands was performed. MRI and US were more sensitivity in visualisation of bone erosions than plain radiography. Both methods showed synovitis in all patients with RA. In detecting bone erosions in the hand joints MRI and US are more sensitive methods than plain radiography. Both methods detect synovitis and tenosynovitis. Inflammatory changes shown using the MRI and US are more intensive in RA than in patients suffering from another etiology arthritis.

Permeability, cytotoxicity, and genotoxicity of Cr(III) complexes and some Cr(V) analogues in V79 Chinese hamster lung cells

The permeabilities and genotoxicities of the Cr(III) complexes [Cr(en)(3)](3+), mer-[Cr(glygly)(2)](-), cis-[Cr(phen)(2)(OH(2))(2)](3+), and trans-[Cr(salen)(OH(2))(2)](+) and the Cr(V) analogues of cis-[Cr(phen)(2)(OH(2))(2)](3+) and trans-[Cr(salen)(OH(2))(2)](+) [en being 1,2-ethanediamine, glygly being glycylglycine, phen being 1,10-phenanthroline, and salen being N,N'-ethylenebis(salicylideneiminato)] have been studied in V79 Chinese hamster lung cells. Following exposure of approximately 10(6) cells to 0.4 mM Cr(III) for 4 h, the Cr uptake by single cells was less than 10(-)(14) g/cell (as determined by GFAAS analysis and as confirmed by PIXE analysis where the Cr concentration was below the limit of detection). Importantly, the Cr(V) analogue of cis-[Cr(phen)(2)(OH(2))(2)] was significantly more permeable than the Cr(III) complex. The cytotoxicity of the Cr(III) complexes increased in the following order: mer-[Cr(glygly)(2)](-) < [Cr(en)(3)](3+) approximately cis-[Cr(phen)(2)(OH(2))(2)](3+) < trans-[Cr(salen)(OH(2))(2)](+). No genotoxic effects were observed following exposure to mer-[Cr(glygly)(2)](-) or [Cr(en)(3)](3+) at concentrations up to 6 mM. The Cr(III) imine complexes trans-[Cr(salen)(OH(2))(2)](+) and cis-[Cr(phen)(2)(OH(2))(2)](3+), which could be oxidized to Cr(V) complexes, induced MN in vitro at rates of 13.6 and 3.3 MN/1000 BN cells/micromol of Cr, respectively. The comparative permeabilities and genotoxicities of trans-[Cr(salen)(OH(2))(2)](+) and [CrO(salen)](+) were similar due to the instability of the Cr(V) complex at physiological pH values (7.4). There was a substantial increase in the permeability of [Cr(O)(2)(phen)(2)](+), compared to that of the Cr(III) analogue, which was accompanied by a highly genotoxic response. Consequently, any Cr(III) complex that is absorbed by cells and can be oxidized to Cr(V) must be considered as a potential carcinogen. This has potential implications for the increased use of Cr(III) complexes as dietary supplements and highlights the need to consider the genotoxicities of a variety of Cr(III) complexes when determining the carcinogenic potential of Cr(III) particularly when "high" deliberately administered doses are concerned.

Absolute value of the difference of Tl-201 uptake between redistribution and rest is a specific marker of myocardial viability

Although Tl-201 rest redistribution SPECT is widely used to assess myocardial viability, there is no agreement on the best prognostic marker of left ventricle contraction improvement after revascularization. More recent data suggest that not only rest or redistribution uptake but also reverse redistribution patterns may serve to indicate the viability of myocardium. The aim of this study was to define criteria (which include reversibility and reverse redistribution) for viability testing and prediction of functional outcome in Tl-201 rest redistribution SPECT. Twenty-five patients with left ventricle dyssynergy were studied before and after revascularization with Tl-201 SPECT and echocardiography. Perfusion and contractility was assessed in a 16-segment model of the left ventricle. Out of 400 left ventricular segments, contraction disturbances of various degree of intensity (hypokinesis, akinesis and dyskinesis) were found by echocardiography in 107 segments. Revascularization was performed in 97 segments. In 57% of the segments, improvement of contraction was observed after PTCA or CABG. Perfusion was analysed in the segments between segments with and without contraction improvement. In discriminant analysis, only the modulus of difference between rest and redistribution study > or = 10% was the common parameter for hypo-, a- and dyskinetic segments to predict the functional recovery of left ventricle (LV) with the specificity of 93% and sensitivity of 78%. The modulus of segmental quantitative difference between redistribution and rest image is a new parameter adding specificity to Tl-201 rest redistribution SPECT in prediction of recovery of left ventricle function.

[Permanent heart pacing in treatment of cardioinhibitory vasovagal syncope (case report)]

Vasovagal syncope is a complex syndrome in which specific methods of treatment rarely are related to clinical success. Since it turned out that some patients with neurocardiogenic syncope were resistant to offered pharmacotherapy, cardiac pacing has been used as the alternative way of long-term therapy. Successive studies, which have estimated clinical efficacy of permanent cardiac pacing, indicate that such method of treatment may reduce symptoms revealed by vasovagal reflex. Nevertheless the optimal pacing mode has not been established yet. It is known that single chamber VVI pacing is not a good and effective method whereas dual chamber DDI pacing with rate hysteresis seems to be very promising in treatment of people suffering from malignant cardioinhibitory vasovagal syncope. DDD pacing with rate drop response, search and scan functions recently has been available to these patients. The results of the North American Vasovagal Pacemaker Study, as well as some casuistic observations referring to patients with vasovagal syndrome, show very high clinical efficacy of dual chamber pacing with mentioned new functions. We present a case of patient with cardioinhibitory vasovagal syncope who was successfully treated by permanent DDD pacing with search and scan hysteresis.

[The prolonged asystole during head down tilt test: prognostic significance and therapy]

The head up tilt test is a worthy of acknowledgment and widely accepted tool used in diagnosing patients with syncope of unknown origin. In some cases tilting provokes asystole lasting even several tens of seconds. Not long ago this kind of vasovagal reaction was being associated with appearance of syncope combined with body injures. The prognostic significance of asystole during head-up tilt test and the safe and efficacious way of therapy in such cases hasn't been established yet. There were three cases of vasovagal reaction, resulting in asystole, described in order to show a large number of diagnostic and therapeutic problems related to the discussed syndrome. The presentation of actual views on diagnosing and therapy of patients with vasovagal syndrome, as a matter of fact is a synthesis of published results of clinical studies and its aim is to be more objective about so many obliging theories.

[Norms of arterial blood pressure for 24 hours based on biological activity]

So far there is no unambiguous universally accepted standards for 24 ABPM. Aim of this study was to establish standard values of systolic and diastolic blood pressures, taking into account minimal night values, corresponding with basic biological activity. 1204 patients were tested. In 707 of them, (mean age 42.5 +/- 14.7 years), arterial hypertension was recognized. Basic on our results we determined borderline values (112/69 mmHg) which are diagnostic for arterial hypertension. Those norms eliminate influence of environmental factors on values of blood pressure. They correspond with homeostasis in hypertensive patients.

[Examination of skin microcirculation with laser-Doppler flowmetry in patients with essential hypertension]

The estimation of microcirculatory parameters in patients with essential hypertension and in normotensic control group was the aim of this study. The study group consisted of 14 patients with essential hypertension confirmed by 24-hours ABP. 10 healthy patients served as control group. The flow in the skin microcirculation was measured by laser-Doppler flowmeter (PF-3, PERIMED) on dorsal part of the palm. Microcirculatory indices were registered in resting conditions, during one-minute occlusion reaction and during reactive hyperemia. The following indices were calculated: resting flow, biological zero, maximal flow, time to maximal flow, ratio of maximal to resting flow, ratio of resting flow to biological zero and ratio of maximal flow to biological zero. Skin microcirculation was highly disturbed in patients with essential hypertension. It was expressed by significantly higher biological zero and longer time to maximal flow.

[Analysis of some exercise test parameters in patients 12 months after myocardial infarction]

This study comprised 102 patients (70 men--32 women) in mean age 57 +/- 7.8 year after noncomplicated myocardial infarction. Thirty five patients were after anterior infarction (group I), 36 after inferior infarction (group II) and 31 after subendocardial infarction (non Q wave) (group III). Exercise tests were performed always in morning, on ergometer Medicor. This study was continued until restriction symptoms appeared or until the limit of 85% of the pulse rate adequate to the age. Assessment of effort and load tolerance as well as ST segment depression on ECG and the kind of effort pain, was performed. The minimal tolerance of effort in patients after non Q infarction has been found. Coronary efficiency was the worst in patients after inferior and non Q myocardial infarction.

[Late cellular potentials in patients after myocardial infarction--a result of left ventricular diastolic disfunction?]

The link between left ventricular dysfunction and arrhythmogenesis is commonly known. However, so far, only the systolic left ventricular dysfunction has been evaluated. Because of the controversial results of those studies, we decided to assess if is there a link between late potentials (LP) and left ventricular diastolic dysfunction. Our material consisted of 56 patients: 11 women and 45 men, mean age was 61.12 +/- 10.07 years. Signal averaged ECG and ECHO were performed in each patient, 2-3 months after myocardial infarction. For high pass filter of 40 Hz, LP were defined as 2 or 3 abnormal SAECG variables (the averaged QRS > 114 ms, the low amplitude signal duration LAS > 38 ms and root mean square voltage of the terminal 40 ms RMS40 < 20 microV). During ECHO study, we assessed E and A waves E/A ratio, left ventricular end-diastolic volume (LVEDV), ejection fraction (EF), acceleration (AT) and deceleration times (DT). The patients were divided into 2 groups: group I-30 patients LP positive and group II-26 patients LP negative. There were no significant differences between the groups in terms of age, EF, and heart rate. We presented significant differences between group I and II in terms of E wave velocity (0.75 +/- 0.19 vs 0.64 +/- 0.19 p < 0.03) E/A ratio (2.13 +/- 1.56 vs 1.0 +/- 0.5 p < 0.05) respectively. We did not confirm significant differences as regards A wave velocity, AT, isovolumetric time (IVRT) and LVEDV between both tested groups. In group I we revealed a significant correlation between E wave (r = 0.45), E/A ratio (r = 0.62), AT (r = -0.42) E/A ratio (r = 0.56), DT (r = 0.55) and QRS, as well as DT and LPD (r = 0.40) and between IVRT and RMS40 (r = -0.43). The results of our study suggest that in patients after myocardial infarction: 1/incidence of LP depends on the degree of left ventricular filling pattern like in impaired relaxion, quite well correlated with filtered QRS time 3/in LP positive patients there was predominance of restrictive left ventricular filling pattern, quite well correlation with RMS40 amplitude.

Permeability, cytotoxicity, and genotoxicity of chromium (V) and chromium (VI) complexes in V79 Chinese hamster lung cells

The genotoxicity of Cr(V) complexes in mammalian cells (V79 Chinese hamster lung cells) has been studied for the first time using the in vitro micronucleus assay. Two complexes were investigated, [CrO(ehba)2]-, which undergoes ligand-exchange and disproportionation reactions in the cell growth medium, and [CrO(mampa)]-, which is chemically inert in the medium for the duration of the exposure period. Results of in vitro micronucleus assays show that both complexes are genotoxic and exhibit similar potencies to that of [Cr2O7]2-. The permeabilities of the Cr(V) complexes were also investigated for the first time using particle-induced X-ray emission (PIXE) analysis of individual cells. The Cr uptake increased in the order: [Cr(phen)2-(H2O)2]3+ < [CrO(ehba)2]- < [CrO(mampa)]- < [Cr2O7]2-. Clonal assays showed that Cr(VI) exhibits an expectedly higher cytotoxicity than the Cr(V) complexes. While the genotoxicities of the Cr(V) and Cr(VI) complexes increase according to their permeabilities, the genotoxicities of the Cr(V) complexes are equal to, if not greater than, that of Cr(VI) in terms of the amount of Cr entering the cell. This supports other evidence that Cr(V), produced as a metabolic intermediate from the intracellular reduction of Cr(VI), may be important in Cr-induced cancers.

[Frequency of paroxysmal atrial fibrillation and parameters of averaged atrial signal]

The aim of the study was to evaluate the importance of time and frequency domain analysis of P-wave signal averaging, left atrium size measured echocardiographically and time of P.-wave assessed in II lead of standard ECG in patients with different frequency of atrial fibrillation events. The material consisted of 110 pts (81 men and 29 women), mean age 60.44 +/- 10.73 with atrial fibrillation events concomitant coronary heart disease and/or primary hypertension documented in standard ECG or Holter monitoring. The positive correlation, statistically significant between the frequency of atrial fibrillation events and the time of filtered P-wave vector, the time of filtered P-wave in X, Y, Z leads and differences between times of filtered P-wave vector and times of P-wave in II ECG lead was confirmed. Additionally the negative correlation, statistically significant between frequency of atrial fibrillation events and RMS10, RMS20 and RMS30 was confirmed. There was no correlation between frequency analysis of P-wave averaging or left size and frequency of atrial fibrillation events.

[Perindopril in monotherapy of primary hypertension--6 month observation]

We evaluated effects of perindopril (Prestarium-SERVIER) in the treatment of the primary hypertension in 41 patients (mean age 41.6) in the I or II degrees WHO using 24 ambulatory blood pressure measurement and echocardiography. Investigation were performed before and after 3 and 6 months of the treatment. Initially 4 mg of perindopril was given and individually was increased after 3 months to 8 mg according to 24 ambulatory blood pressure measurement results. We obtained significant decrease of blood pressure in 3 (134.6/86.6 mm Hg) and in 6 (135/88, 9 mm Hg) months of treatment in comparison to baseline values (141.8/91.1 mm Hg), decrease of left ventricular mass to 244.4 g in 3 and 248.8 g after 6 months (baseline 258.5 g), as well as index of left ventricular mass, wall thickness and left ventricular end diastolic volume. There was no significant differences in: ejection, heart rate, left ventricular inflow on the successive investigations. Good effect of perindopril we observed in 31 patients (75.6%) after 6 months of treatment. We did not observe any serious side effects of perindopril.

CONCLUSION

Perindopril in treatment hypertension effectively reduces the level of blood pressure (systolic, diastolic and mean) without any effect on heart rate. Prestarium reduces left ventricular mass, intraseptal wall thickness and left ventricular end diastolic volume. There is no influence on inflow to the left ventricle as well as on ejection fraction.

Microprobe X-ray absorption spectroscopic determination of the oxidation state of intracellular chromium following exposure of V79 Chinese hamster lung cells to genotoxic chromium complexes

The oxidation state of intracellular chromium has been determined directly in mammalian lung cells exposed to mutagenic and carcinogenic chromium compounds. Microprobe X-ray absorption spectroscopy (XAS) experiments on single V79 Chinese hamster lung cells showed that Cr(VI) and Cr(V) complexes were reduced completely (>90%) to Cr(III) within 4 h of exposure of the cells. This result provides direct evidence for the hypothesis that these genotoxic oxidants react rapidly with intracellular reductants.

[Echocardiographic evaluation of cardiac structures in patients with rheumatoid arthritis]

Since heart lesions were found at autopsy in 55-60% of rheumatoid arthritis patients, we decided to assess echocardiographically their clinical significance. The study comprised 100 consecutive patients with rheumatoid arthritis (77 females and 23 males) of the mean age 55.7 +/- 12.5 yrs (range 18-83 yrs) and the disease duration of 8.3 +/- 8.0 yrs (range 1-35 yrs). The control group consisted of 100 consecutive age and sex matched patients admitted to university hospital. All the patients underwent echocardiographic examinations in apical and parasternal projections. The activity of the rheumatoid process, the severity of articular lesions, the presence of extraarticular sings as well as HLA DR and DQ antigens were determined clinically and with laboratory tests. Twenty six patients with rheumatoid arthritis had pericardial effusion, 10 revealed the sings of chronic pericarditis, in the control group 4 and 0 respectively (p = 0.001 and p = 0.025). No difference was shown in the wall contractions disturbances, size of the cardiac cavity, or thicknesses of the interventricular septum or posterior wall. In 3 rheumatoid arthritis patients, a valvular heart disease was diagnosed, this number was not significantly different from that in the control group (2 patients). There was no correlation between the lesions observed in the heart and the rheumatoid process activity estimated with clinical and laboratory indices.

[Guillain-Barre syndrome with an especially severe course]

A case of polyradiculoneuritis in a 51-year-old man is reported. Symptoms occurred suddenly. Our serologic tests failed to explain the cause of the illness. Physical examination showed tetraplegia and respiratory muscles paralysis which required continuous use of respirator during six weeks. In the treatment were used: steroid hormones, antibiotics, anabolics, plasmapheresis. In physical treatment: kinesitherapy, massage, electrotherapy, hydrotherapy. After three years of intensive physical treatment patient was cured.

[Changes in the quality of life influenced by treatment of primary arterial hypertension]

The quality of life (QL) in 90 male patients (age 41.2 +/- 41) suffering from Ist IInd hemodynamic WHO-stage of essential arterial hypertension has been studied during 3 months therapy. The patients have been divided into 3 groups treated with enalapril, atenolol and verapamil respectively. The Sickness Impact Profile, Bulpitt's test and Spitzer's test were used for evaluation of QL. Significant reduction in diastolic arterial blood pressure has been achieved during the treatment period. In the same time improvement in QL indices was observed, most evident in group of enalapril, moderate in group of verapamil and the minor in atenolol group. It is concluded that these three QL test (SIP, Bulpit, Spitzer) are very useful in monitoring of treatment of the essential arterial hypertension.

Investigation of the uptake of drugs by individual cells using a scanning proton microprobe (SPM)

In this paper we demonstrate the use of micro-PIXE (proton induced X-ray emission) for measuring the quantitative uptake of anti-AIDS drugs, containing metal atoms, by individual Vero cells (African green monkey kidney cell line). Hetero-polytungstates, which are assessed to present an activity against the HIV virus, were studied using Vero cells. It was found that unlike other techniques, SPM offers both the sensitivity and the spatial resolution to carry out these programs of investigations. The use of elemental analysis in single cells of cultured cell lines has shown to have distinct advantages over peripheral blood lymphocytes.

The use of a scanning proton microprobe to observe anti-HIV drugs within cells

A series of inorganic polyanions (viz. heteropolytungstates) has been shown to have antiviral activity but there was no evidence to indicate that the drugs reached their site of antiviral (HIV) activity intact. We have shown that with a scanning proton microprobe it is possible to analyse the metal content of individual cells (PBLs) treated with such a polyoxometalate drug and to determine the atomic ratio of the metals within the cell. This was found to be near that in the drug. The distribution of the metals (tungsten and cobalt) within the cell was measured and it was shown that both metals were located in the same region within the cell. These findings would suggest that the drug had entered the cells intact.

[Effect of treatment with vasodilators on physical exercise tolerance in patients with chronic congestive heart failure]

The studies were performed in 46 patients with chronic congestive heart failure (CCHF), III and IV NYHA classes. During the first two weeks all patients received digoxin (D) and furosemide (F) in optimal doses (stage O). Then, patients were randomly divided into two groups. During the stage A group I (n = 26) received digoxin, furosemide and nifedipine (N), while in the stage B captopril (K) was added to that treatment and it was continued for 4 weeks. During the following two weeks (stage C) patients were treated the same as in stage A. During the same stages group II (n = 20) received D, F and isosorbide dinitrate (S), then, D, F, S and K followed by D, F and S, respectively. After the termination of each stage of the treatment all patients performed physical exercise on bicycle ergometer, until limiting symptoms have occurred. Power (M) and duration (t) of exercise, systolic (ps) and diastolic (Pd) arterial blood pressures, heart rate (HR) at the peak load, and HR x Ps and HR/M indices were determined. It was found that N did not significantly affect the investigated ergometric parameters. Combined treatment with D, F, N and K induced an increase in M, t and HR, and a decrease in. This effect persisted through the stage C. Following the treatment with D, F and S, a significant increase in M and decrease in HR/M were observed. Addition of K to D, F, and S did not induce further improvement in the physical exercise tolerance of these patients.

[Results of conventional treatment of severe congestive heart failure with vasodilators]

In 61 patients with NYHA IV class chronic congestive heart failure, treated in succession with digoxin (D) and furosemide (F) for two weeks, with D+F and isosorbide dinitrate (S) or nifedipine (N) for two weeks, with D+F+S or N without C for two weeks, clinical status, chest X-ray picture and two dimensional echocardiography were evaluated at the end of each stage of the treatment. There were analyzed heart rate (HR), arterial systolic (Ps) and diastolic (Pd) blood pressure, body weight (Mc), 24-hour urinary output (Dd), cardio-thoracic index (CTI), cardiac volume index (CVI) and dimensions of the left ventricle: systolic (LVIDs), and diastolic (LVIDd). The mean daily doses of the drugs were as follows: D-0.290 +/- 0.108 mg, F-13.0 +/- 4.1 mg, S-44.5 +/- 9.8 mg, N-42.0 +/- 12.2 mg, and C-75.1 +/- 24.4 mg. The treatment with vasodilators (Vd) induced decreases in Mc, CVI, LVIIDs and LVIDd in comparison with the treatment with D and F. The largest lowerings in HR, Ps, Pd and Mc were observed during the treatment with D and F. The most beneficial effects with regard to CVI, LVIDs and LVIDd were obtained during four-week treatment with captopril.

Electrophysiologic effects of blocking and stimulating the opioid system in patients with unexplained heart palpitations

The opioid system plays a role in the regulation of the cardiovascular system. Endogenic as well as egzogenic administration of opioids influences the heart rhythm. This work was undertaken in order to assess the influence of crossover activity of the heart opioid system on the heart conduction system in patients with various disturbances of rhythm having an efficient circulatory system and a normal 12-lead stationary ECG. Subjects were 20 patients (9 men and 11 women of mean age of 38.7 years) reporting sudden heart palpitations. They were subjected to invasive programmable electrophysiological studies (PES). Naloxone was administered intravenously to 10 patients. Pentazocine was administered in the same way. In the remaining 10 patients the order of drug administration was reversed. PES was done in the basic state and after the administration of each drug. Study results were subjected to statistical analysis with no-parameter Wilcoxon test assuming differences to be significant at p less than 0.05. Blocking of the opioid system resulted in significant lengthening of the sinoatrial (SACT), intra-atrial (PA), and atrioventricular node (AH) conduction times, while no changes were induced in conduction in the His-Purkinje system (HV) and automation of the sinus node. Naloxone lengthened the atrial (ERPA) and atrioventricular node (ERPA AVN) effective refractory periods. Stimulation of the opioid system resulted in decreases of the following values: SACT, PA, AH, ERPA, ERPA AVN, while no effect was exerted on the SNRT, HV, ERPV. Neither drug influenced the QRS time, although naloxone lengthened QTc period significantly. Opioids did not influence the time of conduction in concealed extranodal atrioventricular pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of treatment for severe congestive heart failure with digoxin, furosemide and vasodilating agents]

In 61 patients with class IV (NYHA) of chronic congestive cardiac failure treated for 2 weeks with digoxin (0.290 +/- 0.108 mg/d) and furosemide (13.0 +/- 4.1 mg/d), for 2 weeks with digoxin, furosemide and isosorbide dinitrate (44.5 +/- 9.8 mg/d) or nifedipine (42.0 +/- 12.2 mg/d), for 4 weeks with digoxin, furosemide, isosorbide or nifedipine and captopril (angiotensin converting enzyme inhibitor) (75.1 +/- 24.4 mg/d), and for the last 2 weeks with digoxin, furosemide, isosorbide or nifedipine without captopril, after each stage the clinical state, exercise tolerance and haemodynamic parameters determined echocardiographically were assessed. Ten weeks of treatment by this method caused regression of pulmonary congestion in 80%, oedema in 63.3% and hepatomegaly in 33.3% of the patients. Moreover, 60.7% of the patients returned to class III, 13.1% to class II, and 26.2% remained in class IV (NYHA). In the group treated with digoxin, furosemide, nifedipine with captopril (n = 30) a significant rise was observed of the value of the ejection fraction and cardiac index in relation to the treatment with digoxin and furosemide and the treatment with digoxin, furosemide, nifedipine (p less than 0.05). No drug improved significantly the tolerance of submaximal exercise. During the treatment with captopril no clinical improvement was achieved in 4 cases, and worsening occurred in 3 cases of severe cardiac failure (7 of 61 patients, 11.5%). The obtained results showed that vasodilating drugs are safe in congestive cardiac failure and in many cases of severe failure captopril contributed to rapid clinical and haemodynamic improvement.

[Effect of using nifedipine by patients with chronic congestive heart failure treated with digoxin and furosemide]

Nifedipine was administrated to 25 patients with chronic congestive heart failure treated with digoxin and furosemide++, nifedipine (NF) in a daily dose of 30-80 mg for 14 days. Before and after the treatment with nifedipine chest X-ray, blood biochemical investigations, echocardiographic evaluation of the left ventricular function and submaximal exercise test were performed. Nifedipine induced significant decreases in the left ventricular systolic dimension, heart volume, blood serum potassium and uric acid concentrations and hematocrit . Resting and exertional heart rate, blood pressure, exercise power and duration, watt-pulse, myocardial oxygen demand index, ejection fraction, cardiac output, body weight, 24-hour urinary output, blood serum concentrations of urea, creatinine, sodium and chloride changed insignificantly following nifedipine administration. The obtained results suggest that long-term nifedipine treatment of patients who were already given digoxin and furosemide neither improve nor worsen their clinical status.

[Effect of nitrates on left ventricular function and exercise tolerance in patients with mild circulatory failure caused by ischemic heart disease]

In 26 patients with ischaemic heart disease with symptoms of mild chronic circulatory failure (NYHA grade II) aged 56.2 +/- 14.4 years the left ventricular function was tested by two-dimensional echocardiography, the exercise tolerance was determined on cycle ergometer at submaximal workloads, the cardiothoracic index (CTI) and cardiac volume index (CVI) were calculated from chest radiograms. The tests were done before and after 2 and 6 weeks of treatment with isosorbide dinitrate in doses of 49.6 +/- 15.2 mg/day. Isosorbide was found to increase somewhat the ejection fraction (EF), and to raise statistically significantly (p less than 0.05) the velocity of shortening of the circumferential fibres in left ventricular myocardium (mVCF), and to reduce the internal dimensions of the left ventricle (LVIDd and LVIDs), without changing the values of the ejection index (SVI) and cardiac index (CI). Decreased transverse dimensions of the left ventricle was correlated with a significant decrease of the CVI index. No statistically significant effect of isosorbide was noted on the parameters characterizing exercise tolerance but the quotient of the exercise-induced heart rate by the workload (HR/Wat) and the index of myocardial oxygen requirement (HRx Ps) were decreased in a demonstrable way.

[Effect of vasodilator agents on the character and incidence of cardiac arrhythmia in chronic heart failure]

In 50 patients with chronic congestive heart failure (CCHF, III or IV class), aged 62.8 +/- 9.1 years, who were treated with digoxin (Dx) and furosemide (F) (investigation A), continuous 24-hour ecg registration was performed according to Holter. Next, this treatment was extended by two-week administration of nifedipine (N) or isosorbide dinitrate (S) (investigation B), followed by one-month addition of captopril (Cp) (investigation C). During the last two weeks Dx, F, N or Dx, F, S were administered with Cp being withdrawn (investigation D). At the end of each stage of the treatment ecg registration was repeated according to Holter. At the same time, during the investigation A there were performed determinations of blood serum sodium, potassium and digoxin concentrations, two-dimensional echocardiography and evaluation of submaximal exercise tolerance. In 96 per cent of patients with CCHF, treated with Dx and F, cardiac rhythm disturbances were found. In 53.3 per cent life-threatening ventricular arrhythmias occurred, including unstable ventricular tachycardia in 11.1 per cent of patients. Addition of N or S to the classical treatment did not decrease either patient number or amounts of cardiac rhythm disturbances in individual classes according to Lown. Also Cp did not affect numbers of patients with cardiac rhythm disturbances, but it decreased numbers of patients with life-threatening ventricular arrhythmias from 53.3 per cent to 28.9 per cent (from 24/45 to 13/45). At the same time, Cp significantly decreased numbers of ventricular arrhythmias in class 3 and 4a (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in left-ventricular function in chronic congestive heart failure treated with digoxin, furosemide and vasodilators]

48 patients (62.8 +/- 9.1 yrs) with III or IV NYHa class congestive heart failure after 2-week therapy with digoxin (D) and furosemide (F) underwent two-dimensional echocardiographic examination to assess left ventricular function. Then in 25 patients (group I) DF and nifedipine (N) were given within 2 weeks, D, F, N and captopril (C) within 4 weeks and again D, F, N within 2 weeks. In 23 patients (group II) isosorbide dinitrate (S) was administered instead of nifedipine. 2-DE examination had been performed at the end of the each study stage. Optimal daily drug dose were: D-0.34 +/- 0.07 mg, F-40.7 +/- 12.5 mg, S-44.3 +/- 10.4 mg and 75.8 +/- 26.4 mg. Nifedipine and isosorbide dinitrate administrated with digoxin and furosemide did not improve left ventricular function in comparison with a standard therapy (DF). The best positive changes were observed in both groups during treatment with captopril. Ejection fraction by Teichholz increased from 42.9 +/- 15.0% during DF stage to 45.2 +/- 11.5% (DFNK stage) in group I (p less than 0.001) and from 35.3 +/- 10.5% to 36.4 +/- 10.4% in group II respectively (p greater than 0.01). Left ventricular systolic and diastolic internal diameters significantly decreased (p less than 0.05) whereas stroke volume and cardiac indices nonsignificantly increased (p greater than 0.05). Captopril with digoxine, furosemide and nifedipine caused significant hemodynamic improvement. Effect of captopril with nifedipine was greater that of captopril with isosorbide dinitrate.

[Significance of 2-dimensional echocardiography for the diagnosis of dipyridamole-induced myocardial ischemia in patients with coronary heart disease]

In 24 patients with coronary heart disease (group 1) and in 16 control patients (group 2) dipyridamole test was performed in combination with two-dimensional echocardiography. The studies were aimed at the comparison of sensitivity, specificity and predictive values calculated during analysis of segmental contractility of the left ventricular wall and LVEDVI, LVESVI, SVI, CI and EF in relation to ecg examination. During analysis of changes in ST segment, dipyridamole test sensitivity was 0.37, specificity--0.94, predictive confirmatory value--0.90, and predictive excluding value--0.50. During analysis of LVEDVI, SVI and CI diagnostic value of the dipyridamole test did not change (p greater than 0.05). During analysis of LVESVI and EF dipyridamole test sensitivity increased to 0.75 and 0.83, respectively (p less than 0.05). Also during analysis of segmental contractility of the left ventricular wall sensitivity of the test increased to 0.75 (p less than 0.01), while its specificity and predictive value did not change (p greater than 0.05). Two-dimensional echocardiography augments diagnostic value of the dipyridamole test.

[The importance of two-dimensional echocardiography in conjunction with trans-esophageal stimulation of the left atrium for the diagnosis of myocardial ischemia]

In 27 patients with coronary heart disease (group 1) and in 15 persons of ontrol group (group 2) transoesophageal left atrial pacing was performed. 12-lead ECG and two-dimensional echocardiography were done before and on the peak of the pacing. Changes of ST-segment (ST) and R-wave amplitude of V5 in the ECG (RV5) were analyzed. Left ventricular wall motion in the 11 segments and left ventricular enddiastolic volume index (LVEDVI), left ventrivular endsystolic volume index (LVESVI), stroke volume index (SVI), cardiac index (CI) and ejection fraction were studied by echocardiography. Sensitivity, specifity and predictive value confirming and excluding of coronary heart disease of the analyzed parameters were determined. During the analysis of ST-segment these values were 0.81, 0.67, 0.81 and 0.67 respectively. Diagnostic values of the analysis of the left ventricular wall motion and the ejection fraction were not statistically different (p greater than 0.05) from the analysis of ST-segment. During the analysis of LVEDVI, LVESVI, CI sensitivity of the transoesophageal atrial pacing was decreased and specifity was increased (p less than 0.05). The greatest value in the diagnosis of myocardial ischaemia during the two-dimensional echocardiography combined with transoesophageal left atrial pacing has the finding of the segmental asynergy of systole, diminution of EF and augmentation of LVESVI.

[Evaluation of nifedipine and captopril as adjuvant drugs in the standard treatment of chronic heart failure]

A group of 25 patients in III-IV haemodynamic period of chronic stagnant circulatory failure (pzns) in clinical conditions for two weeks were administered digoxin and furosemide (DF), then for the following two weeks DF therapy was combined with nifedipine (N), in the following 4 weeks the DFN therapy was combined with captopril (DFNK), in the last two weeks DFN therapy was applied again. The authors used the following doses per 24 h: D--0.29 +/- 0.96 mg, F--13.5 +/- 4.8 mg, N--40.8 +/- 12.8 mg and K 75.0 +/- 28.8 mg. Each cycle of the therapy was followed by a precise clinical evaluation, analysis of the function of the left ventricle by means of two-dimensional echocardiography, the evaluation of the tolerance of physical effort and the evaluation of chest radiograms. Besides, blood was studied for the concentrations of potassium, sodium, chloride, urea, creatinine, uric acid, haematocrit value and pH value. The addition of nifedipine to the classical therapy did not give significant improvement in the clinical condition, haemodynamic parameters and the tolerance of physical effort in patients with pzns. In comparison to DF period, the use of captopryl brought about a statistically significant increase (p less than 0.05) in ejection fraction (EF) from 43.0 +/- 15.3% up to 45.2 +/- 11.7%, in effort power from 36.5 +/- 16.4W up to 47.1 +/- 17.5W, in effort duration from 3.5 +/- 1.6 min. up to 4.5 +/- 1.8 min. and a significant decrease (p less than 0.05) in body weight from 68.1 +/- 13.8 down to 66.9 +/- 13.0 kg and heart volume from 1175.5 +/- 487.3 cm3 down do 1074.6 +/- 380.9 cm3. One could notice, though statistically not significantly (p greater than 0.05) an increase in stroke volume index and cardiae index. Besides, the authors noticed a tendency to an increase in potassium concentration in blood serum. Eliminating captopryl caused fast regression of positive haemodynamic effects, decrease in physical effort tolerance, and clinical condition resumed the condition observed in the period of DFN therapy.

Electrophysiologic effects of intravenous dipyridamole

We evaluated the electrophysiologic effects of dipyridamole given intravenously to 24 patients during intracardiac electrophysiologic study. Electrophysiologic parameters were measured before and 5 minutes following infusion of 0.5 mg/kg of dipyridamole. The drug significantly shortened the sinus cycle length by 26 per cent (P less than 0.001), sinuatrial conduction time by 15 per cent (P less than 0.01), maximal sinus node recovery time by 21 per cent (P less than 0.001), atrial and atrioventricular nodal effective refractory period by 8 and by 11 per cent, respectively (both P less than 0.01), ventricular effective refractory period by 4 per cent (P less than 0.001), paced cycle length to atrioventricular nodal Mobitz type II block by 5 per cent (P = 0.046), and QT interval during sinus rhythm by 10 per cent (P less than 0.01). After dipyridamole, the PA interval increased by 16 per cent (P less than 0.001), the AH interval by 11 per cent (P less than 0.01), and the corrected QT interval by 5 per cent (P less than 0.01). During retrograde conduction we observed a shortening of the ventriculoatrial interval by 6 per cent (P = 0.036), retrograde atrioventricular nodal effective refractory period by 5 per cent (P less than 0.001), paced cycle length to atrioventricular nodal Wenckebach and atrioventricular nodal Mobitz type II block both by 8 per cent (P less than 0.01). We conclude that intravenous dipyridamole increases sinus node automaticity and reduces atrial, atrioventricular nodal and ventricular refractory periods, prolongs intra-atrial and atrioventricular nodal conduction, but does not produce any changes in His-Purkinje system conduction times.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of ergonovine and the cold stress test on time intervals of left ventricular systole and their significance for the diagnosis of coronary heart disease]

In 20 healthy test persons and 44 patients with a coronary heart disease without stenocardia at rest the ergonovine and the cold pressure test were performed. During the tests the ECG in 12 standard leads and the mechanocardiogrammes were registered, from which the time intervals of the left-ventricular systole were calculated. From the analysis of the pectanginous complaints and/or from the changes of the ST segment for the diagnosis of the coronary heart disease a sensitiveness of the ergonovine test of 40% was obtained, whereas the sensitiveness of the cold tolerance test was only 10%. In healthy test persons during the ergonovine test a shortening of Q-1, a decrease of the quotient PEP/LVET and a prolongation of LVETI were established. Apart from this, in patients with coronary heart disease also shortenings of ICT and PEP and an increase of the quotient LVET/S1S2 were made evident. During the cold tolerance test in healthy test persons, besides the prolongation of LVETI, no other changes were stated. On the other hand, in the patients a decrease of the quotient PEP/LVET and a shortening of PEP were existing. The diagnostic value of the analysis of the left-ventricular time intervals was insignificantly higher during the ergonovine test than at rest. However, during the cold pressure tests no differences were stated. The application of the analysis of the left-ventricular time intervals does not essentially enlarge the sensitiveness of the two tests in comparison to the analysis of the changes of the ST segment in the ECG.

[The significance of systolic time intervals in the dipyridamole test for the diagnosis of coronary disease]

The investigations concerning the significance of the systolic time intervals in the dipyridamole test for the diagnosis of the coronary heart disease were carried out in 15 healthy test persons and 40 patients with coronary heart disease. Apart from the systolic time intervals calculated according to Weissler and co-workers also the behaviour of the ST segment, the R wave in lead V5 (RV5) and the sum of the amplitudes of the R waves (sigma R) were estimated concerning sensitivity, specifity and predictive value. At a sensitivity of 65% for the behaviour of the ST segment under influence of the dipyridamole test this was smaller for RV 5, sigma R, ICT and LVET/S1S2, on the other hand greater for PEPI and OS2I (p less than 0.05). The other time intervals did not differ in their sensitivity to the ST segment. The specifity and the predictive confirming value were 100% for the changes of the ST segment. In the analysis of the other parameters no differences were stated (p greater than 0.05). The predictive value, excluding a coronary heart disease, was 51.7% for the ST segment and still higher for PEPI and OS2I (p less than 0.05). By the analysis of the systolic time intervals the diagnosis value of the dipyridamole test continues to increase.

Localization of vanadium-containing particles in the lungs of uranium/vanadium miners

Several geological formations of the Utah-Colorado mining region mined for uranium ore during and after World War II had been mined earlier for vanadium. Therefore, most miners and millers from that region were exposed to those metals' ores or tailings at one time or another. Preliminary investigation to determine uranium and vanadium retained in the lungs of a former uranium miner and miller from this region, who died of lung cancer (mesothelioma), showed a high nonuniform distribution of vanadium. This observation led to the hypothesis that the vanadium content in the lungs could be associated with inhaled particles. Further examination of spectra of characteristic X-rays obtained by scanning particle-induced X-ray emission (microPIXE) of an autopsy sample of this lung indicated that vanadium was indeed present in localized sites within the 20-μm spatial resolution of the proton beam. This work points out that the microPIXE-RBS (Rutherford backscattering) test for vanadium can be used for site localization of inhaled particles retained in the lungs. Further studies are in progress to: (i) locate uranium-bearing particles in lung tissues of former uranium miners and millers; and (ii) evaluate the local doses of alpha radiation received from these particles.