Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.

A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. Electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.

Determination of percent body fat by the newly developed sulfur hexafluoride dilution method and air displacement plethysmography.

The reliability and validity of two newly developed densitometric methods for determining the human body volume and percent body fat (%FAT), the sulfur hexafluoride dilution method (SHF) and air displacement plethysmography (ADP), were evaluated in comparison with the underwater weighing method (UWW). Seven healthy male volunteers (age 31 to 44, mean height 166.0 cm, weight 61.4 kg) participated in this study. The same-day test-retest coefficients of variation (CVs) for body volume and %FAT measurements were not significantly different among the three methods. SHF and UWW showed a strong correlation in terms of body volume and %FAT, with the correlation coefficients (r) being 0.9997 and 0.986, respectively. The correlation between ADP and UWW was slightly weaker (r = 0.9997 for body volume and 0.907 for %FAT). However, body volumes measured by SHF and ADP were significantly different from that by UWW when compared by mean values. Such differences were also found for %FAT measurements. The regression lines of body volume measured by SHF and ADP on that by UWW were almost equivalent to the line of identity. However, those of %FAT measured by SHF and ADP on that by UWW were significantly different from the line of identity. Because the reliability of SHF and ADP appeared to be high, further validation and improvement are required and worth doing.

Purification and characterization of alkaline phosphatase containing phosphotyrosyl phosphatase activity from the bacterium Prevotella intermedia.

A novel alkaline phosphatase, designated PiALP, has been purified and characterized from Prevotella intermedia ATCC 25611, an anaerobe implicated in progressive periodontal disease. The enzyme was a homodimer of apparently identical subunits of Mr 54 kDa. Thiol-reducing agents completely inhibited the purified enzyme. The enzyme was highly stable even at 80 degrees C. It exhibited substantial activity against tyrosine-phosphate-containing Raytide. The phosphatase activity was sensitive to orthovanadate and Zn2+ but highly resistant to okadaic acid. The amino acid sequence of peptides derived from PiALP showed a high degree of identity (65%) with alkaline phosphatases from Zymomonas mobilis and Synechococcus. The present results imply that PiALP might represent a new family of alkaline phosphotyrosyl phosphatases which has not been described previously.

Characteristics of energy metabolism in males with mental retardation.

To characterize the energy metabolism in individuals with mental retardation (MRs), we measured energy cost at several physical activity levels (basal, supine, sitting, standing, and walking at 30, 50 and 70 m/min), maximal oxygen consumption (Vo2max), and body composition in 23 male MRs and the same number of volunteer male controls. Both groups were individually matched for age, body height, and body weight. Energy cost was measured by the Douglas bag technique. The recently developed sulfur hexafluoride (SF6) dilution technique was employed for measuring body composition. In addition, 3-dimensional accelerometry was used for evaluating body movements, and plasma indices of macronutrients were also measured. The energy cost of MRs, when sitting, standing, and walking at 30 and 50 m/min, was significantly higher than that of controls (p < 0.05), while the basal and resting metabolic rates were similar in both groups. Vo2max was significantly lower (p < 0.05) in MRs than controls. Accelerometry demonstrated excessive movement by MRs, which may explain their higher energy cost of exercise. In contrast, no significant difference was observed in percent body fat or lean body mass. Concentrations of plasma total cholesterol, triacylglycerols and albumin were significantly lower in MRs as compared with the controls. Our findings suggest that MRs are burdened with an energy metabolism less economical than non-MRs. Limited physical activity in their daily life may be the cause. These characteristics of MRs' energy metabolism should be considered for planning their proper dietary schedules and physical activity programs.

A 23-year-old patient with neurofibromatosis associated with acute myocardial infarction, vasospasm and a coronary artery ectasis.

We treated a 23-year-old male with neurofibromatosis with acute myocardial infarction. Cardiac catheterization revealed severe organic stenosis in the left anterior descending artery, an ectasic left circumflex artery and a small right coronary artery. Percutaneous transluminal coronary angioplasty (PTCA) was performed on the stenosis. In follow-up catheterizations, intracoronary administration of ergometrine induced vasospasm of the left coronary artery including at the PTCA site. An I 123 metaiodobenzylguanidine (MIBG) scintigram showed defects in the septum, inferior wall and apex. These findings suggest abnormality of the cardiac sympathetic nerve in neurofibromatosis.

Pravastatin reduces restenosis after coronary angioplasty of high grade stenotic lesions: results of SHIPS (SHIga Pravastatin Study).

We conducted a multicenter prospective, randomized, double-blind, placebo-controlled trial to test whether pravastatin, a hydroxymethyl glutaryl coenzyme A reductase inhibitor, can decrease restenosis after percutaneous transluminal coronary angioplasty (PTCA). Pravastatin 10 mg twice daily was begun at least 10 days prior to elective PTCA in patients with total cholesterol less than 280 mg/dl. The end-point was a between-group comparison of the frequency of restenosis defined as a more than 50% loss of the initial gain in diameter stenosis at the PTCA site at 3 months during follow-up by automated quantitative coronary arteriography. Of 207 patients randomly assigned to study groups, 139 patients underwent PTCA; 133 procedures were successful, and 124 patients underwent follow-up angiography at 3 months, and 179 lesions (85 pravastatin, 94 placebo) in 124 patients (62 pravastatin, 62 placebo) were analyzed. The two groups were comparable for baseline characteristics. Total cholesterol decreased by 19.6% in the pravastatin group (p < 0.001) but not in the placebo group. Although the restenosis rate was not different in the two groups (29.4% in pravastatin vs. 39.4% in placebo, p = 0.215) as a whole, it was reduced to about one fifth (8.8%) in the pravastatin group compared with 44.8% in the placebo group (p = 0.0011) when the comparison was restricted to high grade lesions (> or = 75% diameter stenosis, 34 lesions in pravastatin, 29 lesions in placebo). Pravastatin thus reduces restenosis after PTCA of high grade lesions.

Microdialysis of rat skeletal muscle and adipose tissue: dynamics of the interstitial glucose pool.

Microdialysis was evaluated as a method for studying glucose metabolism in skeletal muscle. Dialysis probes (0.5 x 10 mm) were perfused at 0.5 or 1.0 microliter min-1. Based upon perfusion with glucose, the muscle interstitial glucose concentration was estimated to be 6.9 +/- 0.3 mM (n = 14), which was not significantly different from the blood glucose level. With insulin infusion (1200 mU kg-1 body wt i.v.), the insulin-induced change in the glucose concentration of the interstitial space of muscle was of equal magnitude to that of blood and adipose tissue. In spite of this, when the perfusion medium was not supplemented with glucose, the glucose concentration decreased more in skeletal muscle dialysates (to 36.7 +/- 4.9% of the initial level) than in blood (to 29.7 +/- 5.0%) but less than in adipose tissue (to 17.7 +/- 4.9% of the initial level) (P < 0.05). The results indicate that these differences are due to tissue-specific differences in the dynamic balance between the supply to, and removal from, the interstitial glucose pool. This balance is revealed as a result of the constant glucose drainage by the microdialysis probe. The present results show that, in skeletal muscle, increases in glucose uptake occur with a concomitant increase in tissue blood flow as revealed by the microdialysis ethanol technique, whereas in adipose tissue the glucose uptake increases in the absence of a corresponding increase in blood flow.

[Relation of habitual exercise to basal metabolic rate and energy expenditure during exercise in older people].

The relation between habitual exercise and the basal metabolic rate, energy expenditure during exercise (lactic threshold and maximal oxygen uptake) was examined in 291 older people. Metabolic rate was highest in old players of gatebowl (a form of croquet) (male; 23.3 +/- 2.3, female; 22.7 +/- 3.0 kcal/kg/day), higher in old untrained people (male; 21.9 +/- 2.5, female; 20.8 +/- 2.4 kcal/kg/day), and lower in old people in a home for the aged (male; 20.6 +/- 3.5, female; 20.8 +/- 3.7 kcal/kg/day). Energy expenditure while walking at a speed of less than 100 m/min was similar in trained and untrained old people aged 60-69 years. However, lactic threshold was higher in trained (30.2 +/- 4.8 ml/kg/min) than in untrained (20.9 +/- 2.8 ml/kg/min) females aged 60-69 years. Maximal oxygen uptake was higher in trained (male; 50.4 +/- 4.1, female; 36.6 +/- 3.9) than in untrained (male; 30.9 +/- 3.7, female; 26.8 +/- 2.8) old people aged 60-69 years. It was suggested that a higher basal metabolic rate, lactic threshold and maximal oxygen uptake resulted in higher daily physical activity and larger daily energy consumption in trained old people.

Relation of running distance to plasma HDL-cholesterol level in middle-aged male runners.

This study examined the relation of training distance to plasma high density lipoprotein cholesterol (HDLC) concentration in runners. Forty-eight male endurance runners, aged from 30 to 57 years, were classified into three groups according to training distance (Grade I: n = 12, 30 km/week; Grade II: n = 22, 60 km/week; Grade III: n = 14, 100 km/week in average running distance), with 12 non-lean and 12 lean subjects as age-matched untrained controls. There were no significant differences in plasma total cholesterol among the groups (194-208 mg/dl on average). HDLC level was significantly higher in the untrained, lean group than in the untrained, non-lean men (63 +/- 13 vs. 46 +/- 8 mg/dl, mean +/- SD). HDLC levels in all the runner groups were significantly higher than in untrained, lean subjects, and no differences were observed among Grade I, II and III runner groups (76 +/- 15, 76 +/- 13, 77 +/- 11 mg/dl, respectively). This study suggests that further increases in HDLC could not occur in response to further elevation of training distance in well-trained runners.

Cardiovascular changes associated with decreased aerobic capacity and aging in long-distance runners.

Fifty-five male runners aged between 30 to 80 years were examined to determine the relative roles of various cardiovascular parameters which may account for the decrease in maximal oxygen uptake (VO2max) with aging. All subjects had similar body fat composition and trained for a similar mileage each week. The parameters tested were VO2max, maximal heart rate (HRmax), cardiac output (Q), and arteriovenous difference in oxygen concentration (Ca-Cv)O2 during graded, maximal treadmill running. Average body fat and training mileage were roughly 12% and 50 km.week-1, respectively. The average 10-km run-time slowed significantly by 6.0%.decade-1 [( 10-km run-time (min) = 0.323 x age (years) + 24.4] (n = 49, r = 0.692, p less than 0.001]. A strong correlation was found between age and VO2max [( VO2max (ml.kg-1.min-1) = -0.439 x age + 76.5] (n = 55, r = -0.768, p less than 0.001]. Thus, VO2max decreased by 6.9%.decade-1 along with reductions of HRmax (3.2%.decade-1, p less than 0.001) and Q (5.8%.decade-1, p less than 0.001), while no significant change with age was observed in estimated (Ca-Cv)O2. It was concluded that the decline of VO2max with aging in runners was mainly explained by the central factors (represented by the decline of HR and Q in this study), rather than by the peripheral factor (represented by (Ca-Cv)O2).

Blood lactate accumulation during exercise in older endurance runners.

To delineate the possible age-related differences in blood lactate response during exercise and its relations to endurance performance, 34 male runners (aged 21 to 69 years) performed an incremental treadmill running test. There were no significant differences in training distance and relative body fat among younger runners (YR), middle-aged runners (MR), and older runners (OR). The 5-km run time slowed with age, but was ranked at relatively the same level in each age group. OR had a 23% (P less than 0.001) and 12% (P less than 0.01) lower maximal oxygen uptake (VO2max) and a 22% (P less than 0.001) and 11% (P less than 0.001) slower 5-km run time than YR and MR, respectively. However, mean VO2 corresponding to 4 mM of blood lactate (OBLA VO2) was the same among the groups when expressed as %VO2max (YR; 84.3%, MR; 85.9%, OR; 85.9%). Significant correlations were found between OBLA VO2 (ml.kg-1.min-1) and 5-km run time in each group (YR; r = -0.648, P less than 0.05; MR; r = -0.658, P less than 0.01; OR; r = -0.680, P less than 0.05). These results suggest that OR attain a given blood lactate level at almost similar %VO2max to YR and MR and that OBLA VO2 in OR is useful for evaluating an endurance performance as well as in YR and in MR.

Plasma lipid and lipoprotein profile in elderly male long-distance runners.

The purpose of this study was to evaluate plasma lipid and lipoprotein profiles in 30 elderly male long-distance runners (aged 66 +/- 5 years, body fat 12 +/- 2%, mean +/- SD) by comparing them with 30 middle-aged untrained men (43 +/- 8 years, 17 +/- 3%), 30 middle-aged endurance-trained men (45 +/- 8 years, 12 +/- 2%) who were matched for training distance to the elderly runners, and 15 elderly sedentary persons (65 +/- 4 years, 16 +/- 4%). Both elderly and middle-aged runners averaged 43 km/week in the latest year. Maximal oxygen uptake in the elderly runners (48 +/- 5 ml/kg/min) was 60% higher than in age-matched untrained men, but 15% lower than in middle-aged runners. Plasma high-density lipoprotein cholesterol (HDLC) was significantly higher in the elderly runners than in their age-matched counterparts (77 vs. 59 mg/dl), but not different from the middle-aged runners. The middle-aged runners had lower plasma low-density lipoprotein cholesterol (LDLC) concentrations than their untrained counterparts (114 vs. 129 mg/dl), whereas LDLC level in the elderly runners was almost identical to that of the age-matched untrained men (127 vs. 119 mg/dl). Total cholesterol concentration in the elderly runners (219 mg/dl) was 11% higher than in the age-matched untrained men, whereas there was no difference between the middle-aged trained and untrained men. The remarkable reduction of the LDLC/HDLC ratio in the elderly runners, therefore, is attributable to the elevated HDLC rather than lowered LDLC compared with the age-matched sedentary men (1.7 vs. 2.2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Monitoring of follicles by ultrasonography during induction with HMG-HCG treatment--especially on the prevention of side effects].

Estrogen levels are a useful indicator to use in predicting of ovarian hyperstimulation syndrome (OHSS) which is one of the side effects of HMG-HCG therapy. However, the quantitative assay of estrogens entails cumbersome time-consuming procedures. The present study represents our attempt to establish criteria for predicting the occurrence of OHSS by the use of ultrasonography (USG), a diagnostic procedure that can be performed quickly and conveniently. The subjects were 40 anovulatory women (79 cycles) receiving HMG-HCG therapy. Each patient had USG performed at the time of switching to HCG in a regimen of sequentially administered gonadotropins and was measured for maximum follicular diameter (FD) and total of vertical follicular area (FA) to correlate measurements of these parameters with simultaneously determined serum estradiol (E2) levels. A study was also made of relationships of FD and FA with ovulation and OHSS. The results are summarized as follows: No distinct correlation was observed between FD and E2 (r = 0.3794). It should be noted, however, that the therapy was successful in inducing ovulation in those cases in which the patient was switched to HCG from HMG when FD was 18mm or above. There was a significant correlation between FA and E2 (r = 0.8113, p less than 0.001). FA was thus proven to well reflect E2 levels and hence to be a parameter of the predictive value for OHSS. All but one (with moderate OHSS) of 26 cases showing evidence of OHSS had FA values of more than 6.0cm2, while those developing severe OHSS invariably.(ABSTRACT TRUNCATED AT 250 WORDS)