Impact of Subnormothermic Machine Perfusion Preservation in Severely Steatotic Rat Livers: A Detailed Assessment in an Isolated Setting.

The current drastic shortage of donor organs has led to acceptance of extended-criteria donors for transplantation, despite higher risk of primary nonfunction. Here, we report the impact of subnormothermic machine perfusion (SMP) preservation on the protection of >50% macrosteatotic livers. Dietary hepatic steatosis was induced in Wistar rats via 2-day fasting and subsequent 3-day re-feeding with a fat-free, carbohydrate-rich diet. This protocol induces 50-60% macrovesicular steatosis, which should be discarded when preserved via cold storage (CS). The fatty livers were retrieved and preserved for 4 h using either CS in histidine-tryptophan-ketoglutarate or SMP in polysol solution. Graft functional integrity was evaluated via oxygenated ex vivo reperfusion for 2 h at 37°C. SMP resulted in significant reductions in not only parenchymal alanine aminotransferase (p < 0.001), but also mitochondrial glutamate dehydrogenase (p < 0.001) enzyme release. Moreover, portal venous pressure (p = 0.047), tissue adenosine triphosphate (p = 0.001), bile production (p < 0.001), high-mobility group box protein-1 (p < 0.001), lipid peroxidation, and tissue glutathione were all significantly improved by SMP. Electron microscopy revealed that SMP alleviated deleterious alterations of sinusoidal microvasculature and hepatocellular mitochondria, both of which are characteristic disadvantages associated with steatosis. SMP could protect 50-60% macrosteatotic livers from preservation/reperfusion injury, and may thus represent a new means for expanding available donor pools.

The combined associations of social participation and support with self-rated health and dietary satisfaction in men with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine the association between social participation (SP) and social support (SS) with self-rated health and dietary satisfaction and (2) to explore the joint association and interactions of SP and SS with self-rated health and dietary satisfaction in community-dwelling adult men with spinal cord injury. SETTING: Members of the Spinal Injuries Japan organization. METHODS: We sent questionnaires to 2731 registered members of Spinal Injuries Japan via mail. Responses from 625 men aged ⩾40 years were analyzed. Respondents were categorized into four groups: SP/sufficient SS, SP/insufficient SS, no SP/sufficient SS and no SP/insufficient SS. Logistic regression analysis was used to examine the odds ratios for self-rated health and dietary satisfaction according to the SP/SS categories. RESULTS: Relative to participants in the no SP/insufficient SS category, those in the SP/sufficient SS group demonstrated significantly better self-rated health and dietary satisfaction after adjusting for sociodemographic variables. There was no interaction between SP and SS in self-rated health or dietary satisfaction. SP was associated with high self-rated health without SS, and sufficient SS was associated with high dietary satisfaction without SP. CONCLUSIONS: Relative to other groups, participants with SP/sufficient SS demonstrated higher self-rated health and dietary satisfaction. Sufficient SS was associated with high dietary satisfaction without SP. This study suggested the importance of addressing aspects of both SP and SS using self-rated health and dietary satisfaction as outcome measures in health promotion programs.

Perception of dry mouth in a sample of community-dwelling older adults in Japan.

The purpose of this study was to examine the prevalence of perceived dry mouth among a group of independently-living elderly persons in Japan, and to determine its association with general disease, medication, and dental status, as well as its effect on oral function. The study population consisted of participants of the Senior Citizens' College. The subjective sensations of oral dryness on waking and while eating a meal were measured by a questionnaire. The number of usable questionnaires was 1003 or 77.9%. The mean age of the subjects was 66.3 +/- 4.2 years, and 53.0% were male. More than one-third (37.8%) of the subjects reported oral dryness on waking. Only 9.1% of them noticed a subjective feeling of dry mouth during eating. Persons who had at least one of these symptoms made up 41.0%. A multiple stepwise logistic regression analysis indicated the following results: Perception of dry mouth on waking was more frequent among males (p < 0.001), persons who had a low BMI (p < 0.05), and those taking two or more prescribed drugs (p < 0.01). Sensation of dry mouth when eating was more frequent among subjects with a low BMI (p < 0.001) and those who wore a denture in the maxillary arch (p < 0.05). Perception of dry mouth when eating was associated with self-assessed chewing ability (p < 0.01) and dissatisfaction with speaking clearly (p < 0.05), as well as dental status. However, dissatisfaction with tasting a meal had a significant relationship with the reports of mouth dryness on waking (p < 0.01). Our findings suggest that a substantially higher percentage of persons have the perception of dry mouth on waking than when eating, which was associated with medications, being male, and having a low BMI. This perception may influence oral function, especially the reported dissatisfaction with tasting foods.

Preoperative assessment of vascularity by color Doppler ultrasonography in human rectal carcinoma.

PURPOSE: Although angiogenesis assessed by immunostaining endothelial cells (microvessel density) is a well-known prognostic factor in a wide variety of human solid tumors, preoperative determination of microvessel density seems to be difficult in rectal carcinoma. Thus, we performed transanal color Doppler ultrasonography in 46 patients with rectal carcinoma to assess preoperative angiogenic status and compare it with microvessel density in surgical specimens. METHODS: Time-averaged maximal velocity, peak systolic velocity, number of vascular points, and vascular point index were conducted by color Doppler ultrasonography in 46 patients with rectal carcinoma. Number of vascular points was defined as the number of vessels with pulsation in the section of tumor. Vascular point index was defined as the average number of vascular points divided by the area assessed by color Doppler ultrasonography in the section of tumor. The profiles of number of vascular points were similar to those assessed by microangiography in five rectal carcinomas. RESULTS: Vascular point index significantly correlated with microvessel density (P < 0.0001). No significant correlation was found between microvessel density and time-averaged maximal velocity or peak systolic velocity. Vascular point index was also a better indicator of lymph node metastasis and venous invasion than microvessel density. In addition, 11 of 46 cases with postoperative hematogenous metastasis (23.9 percent) were observed prospectively. Vascular point index may be a best predictor for hematogenous metastasis from rectal carcinoma compared with peak systolic velocity, time-averaged maximal velocity, and microvessel density by receiver operating characteristic analysis. CONCLUSION: These results suggest that preoperative quantification of angiogenesis using color Doppler ultrasonography will provide quick and useful information in the management of rectal carcinoma.

Negative inotropism of hyperthermia increases oxygen cost of contractility in canine hearts.

Heart temperature affects left ventricular (LV) function and myocardial metabolism. However, how and whether increasing heart temperature affects LV mechanoenergetics remain unclear. We designed the present study to investigate effects of increased temperature by 5 degrees C from 36 degrees C on LV contractility and energetics. We analyzed the LV contractility index (E(max)) and the relation between the myocardial oxygen consumption (MVO(2)) and the pressure-volume area (PVA; a measure of LV total mechanical energy) in isovolumically contracting isolated canine hearts during normothermia (NT) and hyperthermia (HT). HT reduced E(max) by 38% (P < 0.01) and shortened time to E(max) by 20% (P < 0.05). HT, however, altered neither the slope nor the unloaded MVO(2) of the MVO(2)-PVA relation. HT increased the oxygen cost of contractility (the incremental ratio of unloaded MVO(2) to E(max)) by 49%. When Ca(2+) infusion restored the reduced LV contractility during HT to the NT baseline level, the unloaded MVO(2) in HT exceeded the NT value by 36%. We conclude that HT-induced negative inotropism accompanies an increase in the oxygen cost of contractility.

Three-dimensional ultrasonographic assessment of the umbilical cord during the 2nd and 3rd trimesters of pregnancy.

OBJECTIVE: To evaluate the umbilical cord and its abnormalities by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. PATIENTS AND METHODS: Ninety-five pregnancies (92 normal, 2 with hydrops fetalis, and 1 with omphalocele) from 14 to 40 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. A proportion of the umbilical cords (coiled or noncoiled free loop, abdominal insertion, and placental insertion) visualized at each gestational age interval is presented. RESULTS: The proportion of the umbilical cords visualized during pregnancy except for between 24 and 27 weeks of gestation was about 70% (range 64-83%). Optimal visualization of the umbilical cord was achieved between 24 and 27 weeks of gestation. During this period it was possible to adequately depict the umbilical cord in 93% of the cases. The proportions of the noncoiled umbilical cord depicted during pregnancy ranged from 8 to 45%. The detection rate of abdominal insertion of the umbilical cord visualized at 14-19 weeks was 44%; the detection rate decreased thereafter. Placental insertion of the umbilical cord could not be identified after 28 weeks of gestation. In 2 cases with hydrops fetalis, edematous umbilical cord was evident. In 1 fetus, omphalocele was clearly depicted. CONCLUSIONS: The new three-dimensional ultrasound technology generates within seconds high-quality three-dimensional images of the umbilical cord, although limitation of viewing direction exists. These results suggest that the new three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and might be useful in identifying abnormal umbilical cords in utero.

Assessment of embryonic anatomy at 6-8 weeks of gestation by intrauterine and transvaginal sonography.

Our purpose was to compare the ultrasound visualization of the early first-trimester embryo using transvaginal and intrauterine sonography. In all, 32 women about to undergo therapeutic abortion at 6-8.9 weeks gestation were studied using a specially developed catheter-based, high-resolution, real-time miniature (2.4 mm outer diameter) ultrasonography transducer (20 MHz). Before the intrauterine sonographic procedure was performed, transvaginal sonographic assessment of the embryo was conducted. The parameters evaluated included the ability to visualize anatomical structures and a subjective assessment of the overall image clarity. The ability to view most organs was better with intrauterine sonography compared to transvaginal sonography, and this was especially true for the brain, spine, heart, liver, midgut herniation, extremities, and sacral tail. Moreover, it was possible to obtain finer image quality of very small embryonic structures with intrauterine sonography than with transvaginal sonography. Stomach, spleen, kidney, and bladder could not be depicted with both techniques. One cystic hygroma was diagnosed at 7 weeks 6 days using intrauterine sonography, but not with transvaginal sonography. Intrauterine sonography may provide additional information on the visualization of anatomical structures of the embryo in the early first trimester of pregnancy. In this limited series, one case of cystic hygroma was demonstrated and, thus, there is a potential for its use in the early detection of embryonic malformation. These results suggest that intrauterine sonography may be a valuable tool in imaging the early first-trimester embryo, complementing and not replacing transvaginal sonography in high-risk pregnancies.

Negative chronotropic effect of beta-blockade therapy reduces myocardial oxygen expenditure for nonmechanical work.

BACKGROUND: The negative chronotropic effect of beta-blocking agents is likely to provide hemodynamic and energetic advantages. However, the negative chronotropic effect on cardiac energetics observed on the initiation of beta-blockade therapy has not been fully elucidated. METHODS AND RESULTS: In 18 patients with heart failure, left ventricular pressure and volume, external work (EW), myocardial oxygen consumption per beat (total Vo2), mechanical efficiency (EW/total Vo2), and Vo2 for nonmechanical work (total Vo2-2.EW) were measured with the use of conductance catheter and Webster catheter at the following three states: under control conditions and after beta-blockade (0.15 +/- 0.07 mg/kg propranolol IV) with and without atrial pacing to keep the heart rate at control levels. Heart rate decreased after atrial pacing was stopped. EW decreased during beta-blockade with pacing and returned to the control level after pacing was stopped. Total Vo2 did not change during beta-blockade with or without pacing, whereas Vo2 for nonmechanical work increased with pacing and returned to the control level after pacing was stopped. As a result, mechanical efficiency decreased during beta-blockade with pacing and returned to the control level after pacing was stopped. CONCLUSIONS: The negative chronotropic effect of a beta-blocking agent may offset the mechanoenergetical deterioration resulting from its negative inotropic effect through a reduction in oxygen expenditure for nonmechanical work. These findings suggest that the negative chronotropic effect is an important aspect of beta-blockade therapy.

Alteration in energetics in patients with left ventricular dysfunction after myocardial infarction: increased oxygen cost of contractility.

BACKGROUND: Although the use of inotropic agents to treat congestive heart failure (CHF) in patients with coronary artery disease has yielded short-term hemodynamic improvement, long-term mortality has shown less improvement. The loss of cardiac muscle as a result of infarction not only decreases the pumping ability of the heart but also leads to some dramatic changes in myocardial energetics. However, little is known about the mechanoenergetics of the heart in patients with left ventricular (LV) dysfunction after myocardial infarction. METHODS AND RESULTS: The present study was designed to compare by means of the Vo2-pressure-volume area relation (PVA, a measure of total mechanical energy) and Emax (LV contractility index), the incremental oxygen cost of contractility measured as nonmechanical energy per unit increment in contractility in patients with various kinds of LV dysfunction. We assessed Emax, Vo2, and PVA using conductance and Webster catheters under control conditions and during different rates of dobutamine infusion (3 and 6 micrograms x kg-1 x min-1) in 30 patients with coronary artery disease. Patients were divided into three groups according to LV ejection fraction (EF): 10 without LV dysfunction (EF>/= 60%), 10 with mild LV dysfunction (40%

On the right track. The integrated IEC campaign succeeds in recruiting many acceptors in a fishing commune.

PIP: The Population and Family Planning Committee of Quangnam Danang Province's integrated information, education, and communication (IEC) campaign promotes late marriage, having two children, and spacing births from 3 to 5 years. The total fertility rate (TFR) in the province is 3.4. One urgent priority of the committee is to tackle poverty by reducing the rapid rate of natural population increase in rural areas. Xa Cam Ha is a poor, rice-producing commune of population 11,114 in which family planning used to be widely unaccepted among families. TFR in the commune is now slightly less than 3. The steady promotion of the Population and Family Planning Program has encouraged couples to accept and practice family planning such that the rate of natural increase fell from 2.0% in 1985 to 1.8% in 1994. Financial incentives are also offered to family planning acceptors; poor acceptors are eligible for loans from the People's Committee to start income-generating activities. More and more couples are accepting family planning.^ieng

[Assessment of serum estrogen levels by RIA with HPLC during hormone replacement therapy].

We studied the serum estradiol and estrone levels in 146 peri and postmenopausal women, and in 38 women who had complained of various climacteric disturbance symptoms during daily hormone replacement therapy (HRT) with conjugated equine estrogen (CEE) 0.625 mg and medroxyprogesterone acetate (MPA) 2.5 mg. Serum estradiol and estrone were measured before treatment, and at 6 months, and after one year of the HRT therapy by HPLC-radioimmunoassay. In 146 peri and postmenopausal women, the serum level of estradiol was from 3 to 6pg/ml. The serum level of estradiol in 38 women after HRT significantly increased (p < 0.01) from 3.34 to 23.6 pg/ml at 6 months, and 21.5 pg/ml at 12 months. The serum level of estrone significantly increased (p < 0.01) from 26.6pg/ml to 156.7pg/ml at 6 months, and 137.2pg/ml at 12 month. These results are very useful for deciding on the doses of hormones and the expected serum estradiol level in HRT for Japanese women.

Men should take part in family planning. An interview with the Grand Mufti.

PIP: For Muslims the Koran provides the infallible rules of conduct fundamental to their way of life. In the past, conservative religious leaders represented a force opposing changes in the traditional status of women and large family norms in Egypt. However, the Grand Mufti has openly expressed his support for responsible parenthood and family planning. The total fertility rate would not have dropped to 3.9 in Egypt without his strong support for family planning. The Grand Mufti expressed his views on family planning in an interview. Family planning is compatible with the teaching of the Koran. There is no problem in promoting family planning according to the Koran. Family planning is the independent and voluntary decision and right of each couple. The Grand Mufti encourages practice family planning through TV, radio, and newspapers. Among Islamic countries, Egypt is one of the few countries where family planning has been well accepted. Religious leaders, medical doctors, and mass media people recognize that the Koran's teachings harmonize with family planning, therefore the promotion of family planning has been successful. More and more people in other Islamic countries will come to practice family planning as they comprehend the Koran's teachings accurately. However, it will take some time before people in these countries will be able to benefit from family planning, since many countries face economic problems thwarting the development of family planning services. The fact that most of the family planning users are women is immaterial, as family planning is the joint responsibility of the married couple. Men should definitely participate in family planning. Men's participation in family planning fits in with the Koran. At the International Conference on Population and Development to be held in the September, 1994, the Grand Mufti is going to speak on men's responsibility for family planning.^ieng

Having its own strength.

PIP: More than 100 million couples throughout the world want to stop or postpone childbearing, but they have neither the quality family planning information nor services that they need. This situation has arisen because demand for fertility control has grown more rapidly than the supply of affordable family planning services. The number of women aged 15-49 will increase by 140 million over the period 1994-2000, while the contraceptive prevalence rate increases concurrently, causing the number of women protected from unintended pregnancy to increase from 489 million to 685 million by 2000. This additional growth in demand will only make it more difficult to provide quality family planning information and services to people in need, especially in developing countries. Home governments and consumers bear most of the costs for family planning, paying 78.8% in 1990, with foreign donors paying the rest. Many family planning programs in developing countries, however, are seriously underfunded. Traditional donors have been asked to increase the quantity of population and family planning assistance they render, but the economic slump in the industrialized countries may preclude the receipt of additional funds. One of the most promising and practical plans is to promote South-South cooperation advocated by the Non-Aligned Movement countries. Developing countries have the appropriate technical knowhow and can share their program-relevant experiences in developing and implementing programs. Efforts are already being made to transfer the related technology and to provide technical assistance, with the Japanese government already providing US$700,000 to Indonesia for cooperation in family planning.^ieng

Stunned myocardium after rapid correction of acidosis. Increased oxygen cost of contractility and the role of the Na(+)-H+ exchange system.

Left ventricular (LV) contractile dysfunction during acidosis has been reported to be almost reversible in crystalloid-perfused hearts after correction of acidosis. In contrast, we have found that, in blood-perfused hearts, contractile function is paradoxically depressed after correction of acidosis with a transient overshoot of contractility during the recovery of pH. To clarify the mechanism of this phenomenon, we measured the LV contractility index (Emax) and the relation between myocardial oxygen consumption (VO2) and systolic pressure-volume area (PVA, a measure of the LV total mechanical energy) before and after induction and rapid correction of acidosis by CO2 loading (pH 7.00) and unloading in 13 excised cross-circulated canine hearts. During the rapid correction of acidosis in six control hearts, a severe transient overshoot of Emax (404% of acidosis) occurred. However, after correction of acidosis, Emax and PVA were lower than the preacidosis values by 46% (P < .01) and 44% (P < .01) at the same LV volume. When the preacidosis Emax level was restored by Ca2+ infusion, the VO2 intercept (PVA-independent VO2) of the linear VO2-PVA relation exceeded the control value by 18% (P < .05) with an unchanged slope. In addition, the oxygen cost of contractility, defined as the slope of the relation between PVA-independent VO2 and Emax, increased by 83% (P < .01) after correction of acidosis, indicating that postacidosis myocardium requires higher VO2 for nonmechanical activities for a unit increase in Emax. Then, we hypothesized that these mechanoenergetic disorders after rapid correction of acidosis would result from Ca2+ overload via accelerated Na(+)-Ca2+ exchange due to the heavily operating Na(+)-H+ exchange system at the time of rapid pH recovery. To examine this hypothesis, dimethylamiloride, a selective Na(+)-H+ exchange inhibitor, was administered just before the correction of acidosis in the other seven hearts. The administration of dimethylamiloride completely prevented both the mechanical and energetic disorders after correction of acidosis. We conclude that rapid recovery of pH paradoxically depresses myocardial contractility and increases the oxygen cost of contractility through an activation of the Na(+)-H+ exchange system.

Hypercapnic acidosis increases oxygen cost of contractility in the dog left ventricle.

The effect of acidosis on left ventricular (LV) mechanoenergetics was assessed in seven excised, cross-circulated dog hearts with the use of the frameworks of the contractility index (Emax) and the relationship between myocardial oxygen consumption (VO2) and pressure-volume area (PVA; a measure of the LV total mechanical energy). Acidosis was stably maintained without hypoxia by appropriately mixing CO2 and air in a membrane oxygenator in the coronary arterial perfusion circuit. Acidosis [pH: 6.98 +/- 0.09 (SD), PCO2: 91 +/- 25 mmHg in the coronary arterial blood] decreased Emax by 45 +/- 12% (P < 0.01) and PVA by 47 +/- 12% (P < 0.01) at a fixed LV volume. When the preacidosis Emax level was restored by Ca2+ infusion during acidosis, unloaded VO2 (the VO2 intercept of the VO2-PVA relation) exceeded the control value by 19 +/- 17% (P < 0.05), indicating that acidosis required higher VO2 for nonmechanical activities at a matched Emax. Moreover, the oxygen cost of enhanced contractility (the incremental ratio of unloaded VO2 to Emax) was 1.53 +/- 0.40 times higher (P < 0.01) during acidosis than preacidosis. We conclude that acidosis results in LV contractile dysfunction accompanied by an increased oxygen cost of contractility. This increased energy cost of the excitation-contraction coupling can be accounted for by a decreased Ca2+ sensitivity of the contractile proteins during acidosis.

"Our staff like to serve clients in a good and friendly way". An interview with YKB Executive Director Firman Lubis.

PIP: Yayasan Kusuma Buana (YKB) was established in Indonesia in 1980 to help promote an urban family planning program. Firman Lubis, Executive Director of the organization, responds to questions on the type of program originally planned; why fee-charging family planning services were introduced; the factors of successfully promoting fee-charging services; his views on the important ingredients of fee-charging service; his expectations of the staff who provide client-oriented service; why fees were charged for parasite control services; whether the control project was self-reliant; and why it has not been replicated in other municipalities. Lubis also discusses whether YKB plans to move toward other preventive health services; if the Tokyo Health Service Association will serve as a model for the YKB; public relations; staffing; training; salaries; popularity of the YKB family clinic; key issues for YKB; international donors; and the future of the organization.^ieng

Moral recovery. Couples should be more responsible in bringing up the number of children that they can support and educate.

PIP: The remarks of Filipino Senator Leticia Ramos Shahani are summarized from her speech delivered in the Philippine Senate chambers on August 19, 1992. She also responds to 17 questions on family planning issues. In addition to her high-level international background with the UN, she also was Deputy Minister for Foreign Affairs in 1986 and has been an active proponent of family planning. A number of bills have been introduced by her for an AIDS center, protecting spouses from sexually transmitted diseases, provision of benefits for single parents and their children, prohibiting teenagers from appearing in advertisements for liquor and cigarettes, and other bills which enhance women's status. Over the next 6 years, she plans to continue to go to selected provinces to ensure the cooperation and commitment of local executives to family planning (FP). The country will be helped because there is a President and a Health Secretary who are strong supporters of FP. Although her background is in policy making, she was aware that deficiencies exist in training FP workers, assuring adequate supplies of contraceptives, and providing sufficient information and education. FP should be directed to spacing and limiting births and helping with infertility in a friendly atmosphere. Postponing marriage to an older age should be encouraged. Working before having children, to ensure economic support, needs to be encouraged. FP must be voluntary and without coercion. People have a basic right to information on FP and human sexuality. Support for FP does not mean support for abortion, which is illegal and prohibited by the Catholic Church. Hopefully, knowledge about FP method will prevent the high number of illegal abortions. There is more support now in the legislature for FP. The Senator continues to promote her "moral recovery program." The program emphasizes that people must have the right values concerning discipline, hard work, love of country, and sense of common good. FP is a moral decision of couples to limit the number of children, which affects the destiny of the nation.^ieng

Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates.

Echocardiographic assessments of fetal and neonatal systolic time intervals were made to determine differences in circulatory changes in 40 neonates delivered vaginally and 30 delivered by elective cesarean section. Left preejection period (LPEP), left ventricular ejection time (LVET), LPEP/LVET, right preejection period (RPEP), right ventricular ejection time (RVET), RPEP/RVET, and heart rate were determined at various time points from antenatal to 120 hours after delivery. There were no significant changes in left systolic time intervals between the two groups at any various time points. However, RPEP and RPEP/RVET values were significantly higher in the cesarean section group than in those in normal vaginal delivery group within 12 hours after delivery. These results suggest that the transient pulmonary hypertension after delivery is prolonged in babies delivered by elective cesarean section.

Transvaginal Doppler ultrasound assessment of intratumoral hemodynamic change before and during hypertensive intra-arterial chemotherapy for uterine cancer.

OBJECTIVE: To evaluate blood flow in malignant uterine tumors during hypertensive intra-arterial chemotherapy. METHODS: Hypertensive intra-arterial chemotherapy (angiotensin II, cisplatin 100 mg, doxorubicin 40 mg) was given to two women with cervical cancer (stage IVA) and seven with endometrial cancer (three stage IA, one stage IB, two stage II, and one stage III). The intratumoral blood flow velocity waveforms were imaged by transvaginal Doppler ultrasound before and during the chemotherapy in six patients. RESULTS: The mean peak systolic velocity during hypertensive intra-arterial chemotherapy (58.9 +/- 29.3 cm/second) was significantly higher than that before chemotherapy (16.0 +/- 6.3 cm/second) (P < .05). There was a significant difference between the end-diastolic velocity before (5.2 +/- 1.8 cm/second) and during chemotherapy (21.2 +/- 6.8 cm/second) (P < .05). The resistance index value during hypertensive intra-arterial chemotherapy (0.607 +/- 0.094) fell significantly from that before therapy (0.644 +/- 0.119) (P < .05). Blood flow velocity waveforms in normal myometrial tissue could be recorded in three cases; in all, the diastolic flow noted before hypertensive intra-arterial chemotherapy disappeared during chemotherapy. CONCLUSION: These results suggest that hypertensive intra-arterial chemotherapy induces a selective marked increase of blood flow in uterine cancer.