Measurement of right ventricular dP/dt. A simultaneous/comparative hemodynamic and Doppler echocardiographic study]

Right ventricular systolic function is difficult to assess by Doppler echocardiography. We studied 14 patients with tricuspid regurgitation on Doppler echocardiographic examination with the object of determining an index of right ventricular contractility based on the continuous Doppler signal of the regurgitant jet. The rate of increase in right ventricular pressure was calculated between 2 points, V1 and V2, situated on the ascending limb of the velocity profile of the tricuspid regurgitation and compared with the dP/dt max measured simultaneously at right heart catheterisation. The different values of V1 and V2 were: 0 and 1 m/s, 0 and 2 m/s, 0.5 and 1.5 m/s, 1 and 2 m/s and 0.5 and 2 m/s. An excellent correlation was observed between the catheter dP/dt max and the rate of increase in pressure measured by Doppler between 0 and 2 m/s (r = 0.93; p = 0.0001) and between 0.5 and 2 m/s (r = 0.93; p = 0.0001). The correlation was not as close between 0 and 1 m/s (r = 0.69; p = 0.048) and there was no correlation with the measurements between 0.5 and 1.5 m/s and between 1 and 2 m/s. Doppler echocardiography could therefore be used for non-invasive assessment of right ventricular systolic function in clinical practice.     

Old pulmonary embolism causing intrabronchial bleeding

A 51-year-old man was admitted because of hemoptysis. Physical examinations and chest XP revealed no abnormal findings. Fiberoptic bronchoscopy showed pulsatile bleeding at the orifice of right B6. Right bronchial arteriography showed a markedly dilated and tortous bronchial artery and shunting to the pulmonary arterial system in the middle and lower lobes. Pulmonary arteriography showed complete obstruction of the right middle lobar and lower lobe segmental arteries (A6, 9, 10). The hemoptysis was thought to be due to increased blood flow of the right bronchial artery, which compensated for reduced right pulmonary arterial flow. Right middle and lower lobe resection was done to prevent further hemoptysis. The resected specimen revealed old thromboemboli in the right middle and lower lobe pulmonary arteries. In this case old pulmonary embolism should be considered as a cause of intrabronchial bleeding.     

A case of follicular bronchiolitis with broncho-pleural fistula in rheumatoid arthritis]

A 67-year-old male diagnosed clinically as having rheumatoid pleuritis and bronchiolitis was treated with adrenocorticosteroid. His clinical findings improved, but following the tapering of the steroid dose, exacerbation occurred. After the steroid dose was increased, serological findings improved, but chest X-ray findings revealed no improvement. To re-evaluate the etiology of the bronchiolar lesion, open lung biopsy was performed. The biopsy specimen showed lymphocytic infiltration and formation of lymphoid follicles in and around the bronchioles. The pulmonary lesion was diagnosed as follicular bronchiolitis.     

Cellular models and tissue equivalent systems for evaluating the structures and significance of age-modified proteins

The accumulation of modified proteins in aging is well documented in many aging models. For example, the deamidated isoforms of triosephosphate isomerase accumulate in: (a) old erythrocytes, (b) fibroblasts from old donors, (c) fibroblasts aged in vitro, (d) premature-aging syndromes and (e) old cells in the eye lens. However, a fundamental remaining question is: 'Do such modified proteins interfere with cellular function?' It has been difficult to assess this question at the molecular level using whole-organism models and equally frustrating to evaluate the physiological significance of such changes using classical cellular models. Tissue equivalent systems (TES) provide an opportunity for examining the molecular basis and physiological consequences of modified proteins during aging. TES are composed of differentiating and proliferating heterogeneous cell types with symbiotic cell-cell and cell-matrix interactions. They closely resemble, both morphologically and functionally, the tissues from which they were derived. Aging studies utilizing TES can provide information on modifications of protein structures, isozyme patterns, enzymes of the cellular environmental protection system and metabolic parameters which may regulate protein synthesis and degradation.     

MRI and ultrasonography of atherosclerosis of the thoracic aorta and carotid arteries in elderly hypercholesterolemic patients]

In 53 elderly participants aged more than 60 the thoracic aorta and bilateral carotid arteries were observed with noninvasive techniques, MRI and ultra-sonography, in order to elucidate the relationship between hypercholesterolemia and atherosclerosis in the elderly. Hypercholesterolemic subjects were classified as group H (serum total cholesterol (TC) greater than 220 mg/dl), group H-I (220 mg/dl less than TC less than 250 mg/dl) and group H-II (TC greater than or equal to 250 mg/dl). Atherosclerotic changes of the thoracic aorta were observed in 46% of group H, 27% of group H-I, 60% of group H-II and 37% of normolipidemic subjects (group NL). Carotid atherosclerotic changes were observed in 19% of group H, 9% of group H-I, 27% of group H-II and 18% of group NL. In group H-I, the percentages of atherosclerotic changes in both thoracic aorta and carotid arteries were lower than those in group NL. However, atherosclerotic changes of thoracic aorta and carotid arteries were detected in 43% and 29% of the subjects showing higher apo B/Apo Al ratio than 1.0 among group H-I + NL (TC less than 250 mg/dl). These changes occurred in 32% and 13% of the subjects showing lower apo B/Apo Al ratio than 1.0 among the same groups. Namely, atherosclerotic changes of the thoracic aorta and carotid arteries were observed more frequently in the subjects showing a higher apo B/Apo Al ratio than 1.0 even if their serum cholesterol values were not higher than 250 mg/dl. We should use not only the serum cholesterol value but also the apo B/Apo Al ratio as an indicator to evaluate the roles of lipids in the development of atherosclerosis.     

Recombinant forms of Gerbich blood group antigens: expression and purification.

Recombinant forms of normal glycophorin C (GPC), carrying the high frequency Gerbich blood group antigens, and its natural deletion mutants of Yus and Ge type (all combined with oligohistidyl tag) were expressed in CHO and COS 7 cells. The stable expression of all recombinant forms of GPC in CHO cells was obtained, but the level of expression was low and detectable only by flow cytometry. The high level of transient expression of GPC recombinant forms in COS 7 cells allowed their purification on Ni-NTA-agarose. The purified recombinant GPC and mutants of Yus and Ge type behaved in SDS-PAGE similarly to normal GPC forms from RBC membranes. The recombinant GPC.Yus and GPC.Ge mutants appeared as diffuse bands, suggesting the similar heterogeneity of glycosylation that was observed in natural GPC.Yus and GPC.Ge glycoproteins. The flow cytometry analysis of the transfected CHO and COS 7 cells showed that binding of anti-GPC monoclonal antibodies to GPC variants was accordant with the known fine specificity of these antibodies. The obtained recombinant forms of GPC carrying common Gerbich antigens may be useful in serology, and also as model molecules for structure-function studies.     

Covered metal stent for tumor obstruction of efferent loop recurrence after gastrectomy

Reports the case of a 60-year-old woman who underwent R2 total gastrectomy, and subsequent palliation of painful symptom recurrence via a membrane-covered metal stent. Received: 13 June 1996/Accepted: 31 July 1996     

Brucellosis of the spine with a synchronous Staphylococcus aureus pyogenic elbow infection

Staphylococcus aureus osteomyelitis and pyogenic arthritis has a different pattern in the elderly than in the young. The axial skeleton is the most frequent site of infection and treatment is usually by intravenous antibiotics. We report a case ofStaph. aureus septic arthritis of the elbow with concomitant osteomyelitis of the spine that was thought to be due toStaph. aureus, but culture of debrided material from the lesion grewBrucella in culture. We suggest that in the elderly it is advisable to obtain a tissue culture diagnosis and not to instigate therapy based on positive blood cultures or a concomitant infection.     

A study on plasma norepinephrine and epinephrine levels in TCM liver syndromes.

The levels of plasma norepinephrine (NE) and epinephrine (E) were determined by HPLC in 220 patients with various TCM liver syndromes, and in 96 healthy subjects as controls. The plasma NE and E contents were higher in patients with liver excess syndromes, including Ganqi Yujie (GQYJ [symbol: see text]) syndrome, Ganyang Shangkang (GYSK [symbol: see text]) syndrome, Ganhuo Shangyan (GHSY [symbol: see text]) syndrome, and Ganyang Huafeng (GYHF [symbol: see text]) syndrome; while they were lower in patients with liver deficiency syndromes, including Ganqixu (GQX [symbol: see text]) syndrome, Ganxuexu (GXX [symbol: see text]) syndrome, and Ganyinxu (GYX [symbol: see text]) syndrome. Futhermore, when Ganshen Yinxu (GSYX [symbol: see text]) syndrome was turned into GYSK and then into GYHF, the plasma NE and E contents increased in order of precedence; while when GQYJ was turned into Ganyu Pixu (GYPX [symbol: see text]) syndrome, both NE and E contents decreased. The results suggest that the plasma NE and E contents are reliable objective parameters for the study of pathophysiological basis of the liver excess and liver deficiency syndromes, and the liver-kidney and liver-spleen interrelated syndromes.