Effect of ageing on post-lesion oestradiol treatment on mouse cholinergic neurones in vivo.

A single 17ß-oestradiol (E(2)) treatment reduces the loss in cholinergic fibre density in the cortex after NMDA lesion into the nucleus basalis magnocellularis (NBM) of the basal forebrain (BF) in young female mice. In the present study, we examined whether age influences this protective effect of E(2) on cholinergic neurones in male and female mice. Gonad-intact young and aged animals of both sexes were treated with E(2) after unilateral NMDA lesion into the NBM. NMDA lesion elicited ipsilateral cholinergic cell loss in the NBM and ipsilateral fibre loss in the somatosensory cortex to the same extent, irrespective of age or sex. A single E(2) injection performed 1 h post-lesion did not affect the cholinergic cell loss but reduced the loss of fibres in the ipsilateral cortex in young male and female mice. By contrast, E(2) did not have an effect on the NMDA-induced cholinergic cell and fibre loss in aged male or female mice. The oestrous stage of young female mice did not alter the number of cholinergic cells/fibres or the protective effect of E(2) on cholinergic fibres after NMDA injection. Our results show that E(2) has a protective action on BF cholinergic fibres in young males and females, although the treatment potential of E(2) declines with age.

[Coronary angioplasty over 70 years of age]. / Koszorúér-angioplasztika 70 éves kor felett.

In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 male and 73 female) aged 70 years or more, with the 57 (20.1%) 6 months redo procedures performed out to June 1999, totally 247 interventions. The dilatations were done in 230 vessels (218 natives and 12 grafts) and in 254 stenoses, as of 1996 in 73 cases with stent deployment, too. PTCA was clinically successful in 178 (90.8%) pts, suboptimal result and/or MACE (AMI, emergency PTCA or CABG, fatal outcome) occurred in 18 (9.2%) cases. Due to unsuccessful PTCA-s, 3 (1.5%) pts underwent acute, 3 elective bypass surgery, in 1 (0.5%) case thoracal sympathectomy without revascularisation, in 1 no further intervention was done. The in-hospital as well as the 30 days mortality was 5 (2.6%). Taking into consideration the higher risk of CABG surgery at an old age, in the case of indication for coronary revascularisation the possibility of angioplasty should be considered first.

[Improvement of myocardial perfusion following left ventricular resection]. / A myocardialis perfusio javulása bal kamrai resectiót követóen.

Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardial infarction in association with progressive ventricular dilatation and symptoms of heart failure. Coronary angiogram revealed a serious lesion in the proximal segment of the left anterior descending coronary branch with a poor run off tract. 18FDG-PET and 99mTc-MIBI-SPECT investigation were performed in order to differentiate the scarred regions from the viable myocardial segments. Taking into consideration the results an aneurysm resection was performed without revascularisation procedure. After the surgery not only the ejection fraction and the left ventricular dilatation had improved but the tissue perfusion in the segments surrounding the resected aneurysm had also showed a significant increase at the follow up MIBI-SPECT imaging.

Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability.

BACKGROUND: The functional significance of the anterograde and retrograde filling of coronaries on angiography is controversial. METHODS AND RESULTS: Eighteen patients with 27 severe lesions (> 85% diameter stenosis) after previous extensive myocardial infarction were selected. The left ventricle was divided into 33 segments for regional comparison of epicardial flow (as assessed by angiography) and tissue perfusion as well as metabolism (as measured by 13NH3- and 18FDG-PET). Viability was defined as normal perfusion (> 80% relative of maximum 13NH3 activity) or mismatch defect (> 1.2 metabolism/flow ratio). A method has been developed to register the 'lesion predicted region', determined on the basis of angiography, in the same polar map as derived from the positron emission tomography data. Distal to the lesion, the anterograde epicardial flow was evaluated by Thrombolysis in Myocardial Infarction (TIMI) criteria (TIMI flow 0-3), and retrograde filling was graded on a 0-3 scale (collateral grade 0-3). TIMI flow grade and retrograde collateral grade in every lesion predicted region segment were summed to indicate the total segmental epicardial flow. Out of the 594 segments, 369 were associated with a severe lesion. Among them, significantly higher average perfusion and metabolic activities were found in segments of good epicardial filling (summed epicardial flow > or = 3) than in the territories of limited epicardial flow (summed score < 3): 65.4 +/- 17% vs 45.6 +/- 10 (P = 0.001%) and 68.6 +/- 16% vs 47.4 +/- 11% (P = 0.0004), respectively. However, when we analysed the predictive value of angiographically detectable good epicardial flow for positron emission tomography viability criteria then the positive predictive value was found to be as low as 0.5, while the negative predictive value was considerably higher (0.82). CONCLUSION: After myocardial infarction, angiographically detectable limited epicardial flow reveals scarred segments while good epicardial contrast filling does not necessarily indicate maintenance of nutritive function.

[Prediction of the result of high-risk coronary bypass surgery by positron emission tomography]. / Nagy kockázatú koszorúér bypass mütét eredményességének elörejelzése pozitron emissziós tomográfiával.

Coronary angiography revealed three-vessel disease in a 56-year-old male with two previous myocardial infarctions. Coronary bypass surgery was initially ruled out by cardiac surgeon because of the poor left ventricular function (EF: 23%), despite moderate viability signs during conventional isotope techniques. Positron emission tomography with 18FDG indicated a large periinfarction area of hibernating myocardium. Accordingly, coronary bypass grafting was performed. Postoperatively, the symptoms disappeared, the left ventricular wall motion abnormalities (with the exception of the scarred region demonstrated by PET) improved, and the global left ventricular function increased significantly. This case and the role of cardiac PET study for prediction of the result of revascularization are discussed.

[First Hungarian experiences with positron emission tomography (PET) studies. Members of the PET working group]. / Elsö hazai tapasztalatok pozitron emissziós tomográfiás (PET) vizsgálatokkal. PET munkacsoport tagjai.

Diagnostic investigations commenced on the 28th of June 1994 in Hungary's and Central Europe's first PET Centre at the University Medical School of Debrecen. The Centre is equipped with a GE 4096 Plus whole body PET scanner. A metabolic tracer, 18F-deoxy-D-glucose (FDG), was used in the investigations. During the first 15 months 249 PET investigations were made in the Centre of which 242 were diagnostic and 7 normal subjects served as control for the patient studies with brain scans. The number of oncological indications (intra- and extracranial tumours, Hodgkin's lymphomas) was n = 105 (43.4% of the 242 diagnostic examinations), neurological investigations (without intracranial tumours) formed the dominant group (n = 117; 48.3%), whereas the number of cardiological indications was 20 (8.3%). The oncological studies included those of intracranial tumours (n = 76; 31.4%); thyroid tumours (n = 9; 3.7%); Hodgkin's lymphomas (n = 7; 2.9%) and other extracranial tumours (n = 13; 5.4%). The distribution of different neurological and psychiatric investigations was as follows: localization of focal epileptogen zone (n = 60; 24.8%); differential diagnosis of dementias (n = 30; 12.4%); exploration of cerebrovascular diseases (n = 10; 4.1%); and other neurological diseases (n = 17; 7.0%). The main objective of the cardiological PET investigations was the exploration of viable myocardium. The present paper overviews both the procedures (including administrative issues, as well) and the results of the first 249 FDG-PET investigations.