Cardioprotective effect of edaravone against ischaemia-reperfusion injury in the rabbit heart before, during and after reperfusion treatment.

The free radical scavenger edaravone is able to stimulate prostacyclin release and inhibit the lipoxygenase pathway in the arachidonic acid cascade. The effect of edaravone administration on myocardial damage in rabbit hearts subjected to ischaemia-reperfusion was examined at different times relative to reperfusion. All rabbits underwent sustained coronary artery occlusion for 30 min followed by 3 h of reperfusion. Rabbits were divided into the following groups: control; early (3 mg/kg edaravone IV 10 min before reperfusion); immediate (3 mg/kg edaravone IV immediately after the start of reperfusion); and late (3, 6 or 10 mg/kg edaravone IV 5 min after the start of reperfusion). Single bolus administration of edaravone 10 min before reperfusion or immediately upon initiation of reperfusion appears to be associated with reductions in infarction size and the percentage of apoptotic cells, but treatment with edaravone 5 min after initiation of reperfusion does not appear to have this protective effect.

[Preoperative antifungal agent for pulmonary aspergilloma].

A 52-year-old man with a 6-month history of bloody sputum was admitted to our hospital. Chest X-ray on admission showed a pulmonary cavity with liquid content in the left upper field and consolidation at the circumference of the lesion. Chest computed tomography (CT) on the 13th hospital day revealed a typical fungus ball in the cavity, which we diagnosed as pulmonary aspergilloma. We administered him micafungin sodium for 1 month. Voriconazole was administered subsequently, but side effects developed. Therefore, itraconazole was administered as a substitute. Chest high-resolution CT (HRCT) clearly showed a reduction in size of the aspergilloma, thus confirming the effectiveness of antifungal agent administration in this case. However, since hemoptysis occurred for the case, left upper lobectomy was performed and postoperative course was excellent.

[Castleman disease in the posterior mediastinum showing atypical feature in computed tomography; report of a case].

A 41-year-old man was referred to our hospital because of an abnormal mass on a chest X-ray. An enhanced computed tomography (CT) showed a well-defined round mass (30 x 45 x 66 mm in diameter) that was heterogeneously enhanced owing to central necrotic or cystic change. A 3-dimensional CT demonstrated a couple of feeding arteries to the mass. The mass was completely resected through thoracotomy. Dissection of tight adhesion between the hypervascular mass and the surrounding tissues caused relative amount of hemorrhage during the surgery. The cystic lesion of the mass was fulfilled with brown liquid. The pathological examination revealed the mass as Castleman disease, and scattered cells in the cystic lesion.

First-third ejection fraction: is the first-pass radionuclide method accurate?

Previous reports have suggested that left ventricular first-third ejection fraction (EF) can be obtained from the left ventricular time-activity curve derived from first-pass radionuclide angiography based on Anger camera data. The validity of this technique was assessed by: a study of beat-to-beat variations in data from 15 patients in which electrocardiographic data were simultaneously recorded, and a computer simulation incorporating the application of Poisson statistics to appropriate count rate data. The results of patients studies showed no consistent trend in any first-third parameter obtained from consecutive beats in individual subjects, and unacceptably high statistical uncertainty in the calculation of the first-third ejection fraction. The weighted standard deviation of the first-third ejection fraction in each of 15 patients studied averaged 7.5 EF units, while first-third ejection fraction averaged 22.9 EF units. The relative error averaged 32%. The computer simulation indicated a high relative error of 47% associated with the first-third ejection fraction at typical end-diastolic count rates of 200 per frame from 1,000 computer Poisson randomizations of an appropriate analog volume curve. The results render the first-pass radiocardiographic method invalid for determining first-third ejection fraction.

Progressive cardiac dysfunction in adriamycin-induced cardiomyopathy rats.

Cardiotoxicity is a limiting factor in the treatment of cancer with adriamycin. We administered adriamycin by a method which minimizes the risk of peritonitis in an adriamycin-induced cardiomyopathy rat model. Sixty male Wistar rats were given 1 mg/kg of adriamycin intraperitoneally 15 times over a 3-week period (total dose, 15 mg/kg) to induce the cardiomyopathy model. Fifteen control rats received 10 ml/kg body wt. saline 15 times over 3 weeks. The animals were observed for 12 weeks and assessed for mortality, and cardiac volume and function was analyzed by echocardiography at 4, 8, and 12 weeks. In rats treated with adriamycin, the cumulative mortality was 35.8% while in the controls, none of the rats died. Left ventricular diameter of the systole (LVDs) was significantly increased at 4 weeks (4.5 vs. 3.3 mm; P<0.001). Left ventricular diameter of the diastole (LVDd) was significantly increased at 12 weeks (7.9 vs. 7.0 mm; P<0.01) and the % fractional shortening (FS) was significantly decreased at 8 weeks (33.4% vs. 50.0%; P<0.01) in the adriamycin-treated rats. This administration method appears to be useful for investigating the cardiac effect of adriamycin while avoiding the influence of peritonitis typically caused by an intraperitoneal injection of higher single doses of adriamycin.

The influence of the peripheral reflection wave on left ventricular hypertrophy in patients with essential hypertension.

The objective of this study was to clarify the relationship between afterload, which consists mainly of the vascular reflection wave, and left ventricular hypertrophy in patients with untreated essential hypertension using the fingertip photoplethysmogram (PTG) and second derivative wave (SDPTG) methods, the simplest and most convenient tools for pulse wave analysis. The augmentation index (AI) is defined as the ratio of the height of the late systolic peak, augmented by the peripheral reflection wave, to that of the early systolic peak caused mainly by left ventricular ejection in the pulse. Increased AI of the PTG and negative d/a, obtained by multiplying the ratio of the late re-decreasing wave (d wave) to the initial positive wave (a wave) of the SDPTG by -1, have the same meaning as increased ascending aortic AI. The left brachial artery blood pressure was measured in 60 patients. The PTG and SDPTG of the right second finger were recorded by a digital photoplethysmograph. The left ventricular mass index (LVMI) was investigated by ultrasonography. Subjects were assigned to one of two groups: a low AI (AI of PTG<1.6; group 1) or a high AI (AI of PTG> or =1.6; group 2) group. LVMI was significantly higher in group 2 than in group 1. In the study group as a whole, the LVMI was positively correlated with both the AI of PTG (r=0.60, p<0.0001) and negative d/a (r=0.63, p<0.0001). An increase in the LVMI was seen in subjects with an augmented late systolic component in the waveform. It was concluded that an increase in the peripheral reflection wave on the left ventricle is one of the important factors causing cardiac hypertrophy in patients with hypertension.

Graphical comparison of coronary arterial culprit lesions in acute myocardial infarction and unstable angina pectoris.

OBJECTIVE: The culprit lesion morphology at acute myocardial infarction (AMI) and unstable angina pectoris (UAP) was investigated by observing the responsible vessels through intravascular ultrasound (IVUS) during the acute stage. METHODS: As the subjects of study, 54 lesions of 54 ACS patients (26 in AMI patients, 28 in UAP patients) were enrolled prospectively from June 1994 to June 1998. The appearance of plaque in the lesion, the distal and proximal sites, extent of calcification, eccentricity, remodeling and shrinkage were observed through IVUS before the intervention. RESULTS: At lesion and distal site, significantly more soft plaques were observed in AMI than UAP. As to the extent of calcification in the former, mild calcification was noted significantly more in distal site as well as a tendency of more mild calcification in the lesion and proximal site. CONCLUSION: These results suggested that the condition of responsible coronary artery is involved in the onset mechanism of AMI and UAP.

[Acquisition of Philadelphia chromosome with bcr rearrangement concomitant with transformation of refractory anemia with excess of blasts with 8 trisomy into acute myelogenous leukemia].

A case of Philadelphia (Ph1) chromosome positive acute myelogeneous leukemia (AML) following a refractory anemia with excess of blasts (RAEB) with 8 trisomy is reported. The 80-year-old man developed pancytopenia during the course of follow-up after the surgical operation of the carcinoma of the sigmoid colon and the rectum for which no irradiation therapy nor chemotherapy had been applied. The diagnosis of RAEB was made according to the diagnostic criteria proposed by FAB co-operative group. Chromosomal analysis revealed 8 trisomy in 54% of the metaphases of bone marrow cells. The remainders showed normal karyotype without Ph1 chromosome. He was on androgenic steroid and activated Vitamin D3 without significant changes in the clinical and the hematological features until 3 months later when many atypical blasts appeared in the peripheral blood. The diagnosis of AML (M2) was made. Chromosomal analysis revealed Ph1 chromosome with the typical 9;22 translocation in 100% of the examined cells. 8 trisomy was not detected any more. Southern blot analysis using bcr probe showed bcr rearrangement. He was treated with a small doses of Ara-C. There was some reduction in the number of blasts in the peripheral blood. However, he died of septicemia 2 months later. The present case indicates that Ph1 positive acute leukemia with bcr rearrangement is not necessarily considered as a blastic transformation of chronic myelogeneous leukemia and such a cytogenic abnormality can appear in a leukemic transformation of myelodysplastic syndrome.

[Detection of culprit lesion in patients with unstable angina pectoris by using ATP thallium-201 myocardial SPECT].

The purpose of this study is to determine the diagnostic accuracy for detection of culprit lesions in patients with unstable angina. Both ATP 201Tl SPECT and coronary angiography were performed in 51 patients with unstable angina pectoris within a week since the last attack. SPECT images were divided into 17 segments and the regional uptakes were scored semiquantitatively (0 = normal to 3 = no activity) and compared with the coronary angiographic findings. ATP 201Tl SPECT revealed decreased uptakes in 54 of 56 culprit lesions. The sensitivity, specificity and accuracy for detection of culprit lesions were 96.4%, 89.5% and 92.4%, respectively. Although adverse effects during ATP administration were complicated in 28 (54.9%) patients, all the complications were mild and resolved within two minutes. ATP 201Tl SPECT is sensitive and reliable method for detecting culprit lesions and can be performed safely even at acute phase in patients with unstable angina pectoris.

[Studies on evaluation of the oxygen transport system function with multistage treadmill stress testing: comparison between normal control subjects and patients with coronary heart disease].

The oxygen transport system (OTS) function was evaluated with multistage treadmill stress testing on 171 normal control subjects and 80 patients with coronary heart disease (CHD). After Bruce's definition, OTS function was expressed with functional aerobic impairment (FAI), left ventricular impairment (LVI) or myocardial aerobic impairment (MAI), heart rate impairment (HRI) or chronotropic reserve impairment (CRI) and peripheral circulatory impairment (PCI). All subjects were monitored on heart rate, blood pressure, electrocardiogram and endtidal O2 and CO2 before and every one minute during the symptom limited maximal stress testing. Seventy three of 80 coronary patients were subjected to the coronary arteriography and were classified into four groups; 31 with single vessel disease (SVD), 20 with double vessel disease (DVD), 15 with triple vessel disease (TVD) and 7 with A-C bypass surgery. Comparison between normal control subjects and the CHD patients with regard to the relation of age and VO2max derived from the linear regression analysis disclosed the identical age-related decrease in VO2max in both groups. The age corrected VO2max in the CHD patients, however, was 2.2 METS less than that of normal control subjects. Therefore, the level of VO2max in CHD patients was determined not only by disease, but also by ageing process itself. Comparisons among three CHD groups with regard to FAI, LVI, HRI and PCI clearly demonstrated different functional impairments paralleling to the severity of the disease process. On the other hand, the patients with A-C bypass surgery revealed almost identical functional impairment to the patients with SVD. In conclusion, these simple and noninvasive evaluations of the oxygen transport system could give us valuable informations reasonably differentiating the clinical status of the patients with CHD.

The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT.

OBJECTIVES: To evaluate the reliability of cone beam CT (CBCT) values and dimensional measurements of oropharyngeal air spaces as compared with those of multidetector row CT (MDCT). METHODS: A soft tissue equivalent phantom with different sized holes was used. The phantom was scanned using CBCT and MDCT. In addition, a volunteer was examined using both methods for clinical comparison. The CT data were retrieved to a personal computer and treated using image processing software for three-dimensional rendering and dimensional measurements. The CT values of air, water and soft tissues were measured experimentally and the CT values of air, fat and muscle were measured in a clinical case. The diameter of each hole drilled in the phantom was measured on CBCT and MDCT images using the software tool and digimatic callipers. RESULTS: The CBCT values were quite different from the Hounsfield units obtained with a typical MDCT system. The standard deviations were almost ten times larger with CBCT. In vivo assessment showed that the CBCT values for fat had a wide range that partially overlapped the values for muscle. The measurement of distances greater than 4 mm was consistent for all methods. The difference for holes was less than 0.2 mm. CONCLUSIONS: The phantom study showed that CBCT provides limited quantitative CT values for each pixel on sliced images for differentiating air, water and soft tissues. However, the measurement of air spaces with CBCT was quite accurate.

Link between obstructive sleep apnea and increased bone resorption in men.

UNLABELLED: The bone metabolic abnormalities in patients with obstructive sleep apnea (OSA) were examined. Severity-dependent increases in the serum/urinary levels of bone resorption markers and their attenuation following continuous positive airway pressure therapy in subjects with OSA provide the first evidence of a link between OSA and abnormal bone metabolism. INTRODUCTION: Hypoxia, microinflammation and oxidative stress, well-known pathophysiological features of obstructive sleep apnea (OSA), are also known to affect bone metabolism. We examined the bone metabolic abnormalities in patients with OSA and also the effects of continuous positive airway pressure (CPAP) therapy on these abnormalities. METHODS: A cross-sectional and prospective study was conducted in 50 consecutive male subjects visiting a sleep clinic and 15 age-matched control subjects without OSA. Plasma concentrations of IL-1beta, IL-6, TNF-alfa, 3-nitrotyrosine, osteocalcin, bone-specific alkaline phosphatase (BAP), and urinary concentrations of cross-linked C-terminal telopeptide of type I collagen (CTX) were examined before and after 3 months' CPAP in subjects with OSA. RESULTS: The plasma levels of the cytokines as well as the urinary CTX levels were higher in subjects with severe OSA than in those with mild OSA or control subjects. Significant decrease of the urinary excretion of CTX (before: 211+/-107 vs. after: 128+/-59 microg/mmol/creatinine; p<0.01) as well as of the plasma levels of the cytokines was observed following 3 months' CPAP. CONCLUSIONS: Severity-dependent increases in the serum/urinary levels of bone resorption markers and their reversal following CPAP in subjects with OSA provide the first evidence of a link between OSA and abnormal bone metabolism.

Hexose and hexosamine concentrations in human pancreatic juice.

Hexose and hexosamine contents were measured in 117 samples of either duodenal or pancreatic juice from 49 subjects. The specimens were obtained by three methods: firstly, through a Dreiling's double lumen tube and with a pancreozymin secretin test performed simultaneously; secondly, by fiber duodenoscopy after an intravenous injection of secretin; thirdly, through a postoperative cannula without stimulation. The hexose content measured by phenol-sulfuric acid reaction correlated well with the hexosamine content measured by the Elson-Morgan method (r = 0.63, p less than 0.005). Since determination of hexose is not as complicated as that of hexosamine, the measurement of hexose content in the pancreatic juice seems to be more useful than measuring hexosamine for obtaining valuable information on pancreatic abnormalities.

[Placement of the inferior vena cava filter proximal to the renal vein in a patient with left-sided inferior vena cava complicated by pulmonary embolism: a case report].

A 55-year-old man was admitted to our hospital complaining of dyspnea and chest pain. Transthoracic echocardiography showed dilation of the right ventricle. Chest computed tomography with contrast medium showed multiple emboli in the pulmonary arteries. Venography of the lower extremities showed multiple thrombi in the right popliteal vein and the presence of left-sided vena cava. This unusual case of left-sided vena cava was complicated by deep vein thrombosis due to hemostasis. A Greenfield filter was placed in the vena cava proximal to the right renal vein in a right internal jugular vein approach.

Repeated postpericardiotomy syndrome following a temporary transvenous pacemaker insertion, a permanent transvenous pacemaker insertion and surgical pericardiotomy.

The postpericardiotomy syndrome is a well-known complication of opening and manipulating the pericardium. The occurrence of this syndrome following transvenous pacemaker insertion is very rare, and only 5 cases have been reported to date. The present patient repeated this syndrome 3 times in a short period following 3 different interventional techniques: a temporary transvenous pacemaker, a permanent transvenous pacemaker and surgical pericardiotomy.

Involvement of TRAIL/TRAIL-R interaction in IFN-alpha-induced apoptosis of Daudi B lymphoma cells.

Interferon-alpha (IFN-alpha) exerts the anti-tumour effect on various tumours at least partly through induction of apoptosis. Apoptosis is induced by members of the tumour necrosis factor (TNF) family, including Fas (CD95) and TNF-related apoptosis-inducing ligand (TRAIL). In the present study, we examined whether the TRAIL/TRAIL-R system is involved in IFN-alpha-induced apoptosis using Daudi B lymphoma cells. IFN-alpha upregulated the expression of TRAIL within 12 h, as assessed by flow cytometry and RT-PCR, and the level increased with time until 72 h. The levels of both TRAIL-R1 and TRAIL-R2, low in Daudi cells, were enhanced by IFN-alpha. The enhanced TRAIL-R1/-R2 appeared to function as a death-inducing molecule since IFN-alpha-stimulated cells were more susceptible to TRAIL-induced cell death. The IFN-alpha-stimulated Daudi cells or their derived culture supernatants displayed cytotoxicity against TRAIL-sensitive, but not resistant lines. Moreover, the IFN-alpha-induced reduction in mitochondrial membrane potential preceding the induction of apoptosis was substantially prevented by neutralizing anti-TRAIL monoclonal antibody. Taken together, IFN-alpha-induced apoptosis appears to be mediated by the autocrine and/or paracrine loop involving TRAIL/TRAIL-R.

The effects of vitamin E on the indicator enzymes of organella membranes in the injured liver.

Acute and chronic liver damage was caused by the administration of either galactosamine or carbon tetrachloride. Consequently, the rats with damaged livers were killed after vitamin E was administered. The livers were removed and were homogenated. Indicator enzymes (5'-nucleotidase, arylsulfatase, cytochrome C oxidase and glucose-6-phosphatase) of organella membranes were measured in the homogenates of the normal and damaged livers. The effects of vitamin E resulted in the stabilizing of the impaired membranes of plasma, lysosome, mitochondria and microsome; (1) the abnormal decrease of 5'-nucleotidase activity and glucose-6-phosphatase activity, and the abnormal increase of arylsulfatase activity, which induced galactosamine or carbon tetrachloride, and (2) the abnormal decrease of cytochrome C oxidase activity induced by galactosamine- HCl, were normalized.