99mTc-MIBI (RP-30) to define the extent of myocardial ischemia and evaluate ventricular function

99mTc-MIBI, a new myocardial perfusion agent, is a technetium labeled isonitrile derivative. We have taken advantage of the physical characteristics of 99mTc to combine at rest, post infarction, ventricular function studies with analysis of perfusion. We have studied at rest and at stress, 22 patients with coronary artery disease selected on the basis of an abnormal coronary angiogram or on the basis of a positive exercise ECG stress test for symptomatic angina. We have also studied, at rest only, 20 patients with a previous myocardial infarction. A comparative thallium planar scintigraphy was obtained for all patients. The sensitivity of 99mTc-MIBI scintigraphy for detecting individual vessel lesions at stress was 88% as compared with 83% for 201Tl. Sensitivity was higher in patients with previous myocardial infarction (93% for the 2 isotopes) than in patients without (85% for 99mTc-MIBI versus 81% for 201Tl). Segmental myocardial correspondence between 99mTc-MIBI and 201Tl was very close (92%). The overall sensitivity for the detection of acute myocardial infarction reached respectively 91% for 99mTc MIBI and 87% for 201Tl. The specificity in the regions corresponding to arteries not involved was excellent for both tracers as we did not observe any false positive result. This is important information but it does not correspond to the specificity to detect coronary artery disease in the overall patient population. The correlation between first pass left ventricular ejection fraction obtained with 99mTc-MIBI and equilibrium left ventricular ejection fraction obtained with 99mTc red cells was excellent (r = 0.96). It was not as good but was still satisfactory for the right ventricle (r = 0.75).(ABSTRACT TRUNCATED AT 250 WORDS)     

Absence of inhibition by lipoprotein (a) inhibition of tPA induced thrombolysis in a patient's plasma milieu

The increase in Lp(a) is strongly correlated with premature coronary artery disease. The Apo(a) has striking homology to plasminogen. It was found in an in vitro purified system that Lp(a) competes with both plasminogen and tissue-type plasminogen activator (tPA) for fibrin binding sites, thus resulting in a decrease in fibrin-dependent plasminogen activation. In this study, plasma fibrinolysis was studied in a young patient who had a consistently high level of Lp(a) (198 mg/dl) and had suffered from cerebral thrombophlebitis 12 months previously. The patient had normal levels of plasma plasminogen and fibrinogen. The euglobulin lysis time before and after venous occlusion was not prolonged, and after the addition of tPA to the patient's plasma or whole blood, the clot lysis time was normal. The same result was obtained when the patient's plasma was depleted of Lp(a) before clotting. When the patient's plasma serpins were inhibited, plasminogen activation by tPA in the presence of several fibrin concentrations was normal, suggesting that the formation of the ternary complex tPA - plasminogen - fibrin was not inhibited by the presence of high levels of Lp(a). It is concluded that a consistently high level of Lp(a) in this patient did not inhibit tPA-dependent fibrinolysis, and the thrombotic episode was not therefore related to deficient thrombolysis.     

Isolation and characterization of an abnormal alpha slow-moving high-density lipoprotein subfraction in serum from children with long-standing cholestasis

An abnormal high-density lipoprotein (HDL) subfraction, detected during periods of mild jaundice in the serum of seven children with chronic cholestasis from birth, was isolated and characterized. This fraction, identified by its slow alpha electrophoretic migration, is present in addition to normal HDL and differs from the abnormal HDL previously described in cholestatic syndromes. It is devoid of apolipoprotein B but is precipitated by phosphotungstate-MgCl2. These properties allowed its isolation by double selective precipitation. This subfraction is undetectable with this procedure in the serum of healthy subjects, is rich in cholesterol, and contains a large amount of apolipoprotein E, which may explain its precipitation by phosphotungstate-MgCl2. These apo E-containing HDL may play a major role in the lipid metabolism of patients with long-standing cholestasis during periods of mild jaundice.     

Predicting the carcinogenicity of the aromatic amine derivatives tested in the second UKEMS collaborative study

The carcinogenicity prediction and battery selection (CPBS)procedure was used to analyze the short-term in vitro and invivo genotoxicity results obtained during the Second UKEMS CollaborativeStudy. In accordance with preliminary animal bioassay results,CPBS predicted correctly the carcinogenicity of benzidine, 4,4'-diaminoterphenyland 4-dimethylaminoazobenzene. CPBS predicted the non-carcino-genkityof 4-cyanodimethylaniline, a chemical of as yet unknown carcinogenicity.Moreover, CPBS indicated that for the chemicals included inthe UKEMS study, highly predictive as well as cost-effectivebatteries consisting of three short-term assays could be identified.     

Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction.

OBJECTIVE: The present study evaluated whether dental patient anxiety has an effect on the cardiovascular response to the delivery of anesthetic to achieve mandibular anesthesia. STUDY DESIGN: One hundred eighty adult patients scheduled to receive routine dental extraction under local anesthesia were enrolled in this prospective study. Anxiety was measured at 15 minutes before local anesthetic delivery using Corah's Dental Anxiety Scale (Corah's DAS). Anesthetic was delivered using a standard technique for mandibular nerve block with the same dose (2 cartridges) given to all patients. Cardiovascular response data including blood pressure, heart rate, O(2) saturation, and electrocardiographic changes were measured at 5 time points from 5 minutes before to 15 minutes after the administration of anesthetic. RESULTS: The mean anxiety scale score before administration of anesthetic was 9.3 (SD +/- 2.5) with a range from 4 to 20. Women had a significantly higher mean dental anxiety level than men (P < .05). Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (Corah's DAS >12) was associated with significantly increased heart rate during administration of anesthetic. Patients with severe anxiety also had a significantly greater increase in heart rate during anesthetic administration (P < .001). Younger age was associated with increased likelihood of high dental anxiety and associated cardiovascular response to dental anesthesia (P = .001). Pain on injection was also associated with increased heart rate during anesthetic administration. CONCLUSION: This study showed that Corah's dental anxiety scale is a useful tool for estimating the impact of anxiety on the heart rate during local anesthetic delivery to achieve mandibular block for dental extraction. Younger patients undergoing tooth extraction were more likely to have high anxiety levels, and younger patients with high anxiety were more likely to report a traumatic dental history. High anxiety, younger age, and traumatic dental history were correlated with greater increases in heart rate during the administration of local dental anesthesia.     

L’hypercalciurieHypercalciuria.

Hypercalciuria is a biological syndrome defined as excretion in the urine of more than 0.1 mmol/kg/24 hours of calcium in the absence of dietary restrictions. A number of endocrine, renal, and bone diseases can cause hypercalciuria. Urinary calcium excretion is substantially influenced by the intakes of calcium, sodium, protein, carbohydrates, alcohol, and potassium, so that a poorly balanced diet can result in hypercalciuria. Recently, there has been a burst of interest in molecular studies of rare lithiasis syndromes, all of which are due to mutations in the ClCN5 chlorine channel gene. Mutations affecting the calcium-sensitive receptor (CaSR) have been identified in other forms of hypercalciuria. Idiopathic hypercalciuria is defined as hypercalciuria that persists after correction of dietary imbalances and has no detectable cause. The classification suggested by Pak (class I, class II, class III, and “renal” hypercalciuria) is controversial and of little assistance in clinical practice. Three mechanisms can be incriminated in idiopathic hypercalciuria: increased intestinal absorption of calcium, defective reabsorption of calcium by the renal tubule, and increased bone resorption. Overexpression of the vitamin D receptor and a deficiency in renal tubule enzymes may be involved also. Bone mineral density is moderately decreased in idiopathic hypercalciuria, particularly of the renal type. The risk of vertebral fracture seems increased, however. Overproduction of calcitriol and of cytokines that stimulate bone resorption have been incriminated in the bone loss. Treatment of the cause is essential in secondary hypercalciuria (dietary advice, treatment of an underlying disease…). A diet low in sodium and meat and containing no more than 800 mg of calcium per day has been advocated in idiopathic hypercalciuria. Hydrochlorothiaide therapy is warranted in patients with osteopenia and an inadequate response to dietary therapy.     

Über die Lipoidablagerung (Lipoidose) und die Anhäufung von Eiweißmassen in den Sehnen

Ohne ZusammenfassungUnterabteilung für Pathomorphologie des StoffwechselsMit 5 Abbildungen im Text.