Evaluation of ischemia by exercise stress Tl-201 myocardial SPECT in silent and symptomatic ischemia

Forty patients with ischemic heart disease confirmed by coronary arteriography were performed Tl-201 stress myocardial scintigraphy using SPECT. Fifteen patients had anginal attack during exercise Tl-201 myocardial perfusion study (symptomatic group), and 25 patients had horizontal or downsloping ST segment depression more than 0.1 mV without angina (asymptomatic group). The washout maps were derived from circumferential profile analyses of tomographic short-axis slices, and the data were plotted as a bull's eye map. The patient's washout map was compared with the lower limit of normal (mean--2 SD), and the extent and severity scores were calculated. On visual analysis 87% (13/15) of symptomatic patients showed redistribution, while only 56% (14/25) of asymptomatic patients showed redistribution (p less than 0.05). The extent score was significantly higher in the symptomatic group than in asymptomatic group (37.2 + 23.6 vs. 19.6 + 20.8, p less than 0.05), but severity score was slightly higher in symptomatic group (56.1 + 59.4 vs. 30.0 + 54.8, NS). In conclusion, symptomatic ischemia may be more severe than asymptomatic one and the degree of ischemia may be one of the factors that determine the presence of angina during ischemia.     

201Tl SPECT in the detection of mediastinal lymph node metastases from lung cancer

201Tl SPECT was performed to detect mediastinal involvement in 80 patients with lung cancer who underwent surgery within a week after the SPECT study. Out of 29 patients with mediastinal involvement 16 (55%) were positive on the 201Tl early scan at 15 min postinjection and 22 (76%) were positive on the delayed scan at 3 h. These metastatic lymph nodes tended to be visualized much better on the delayed scan. In all patients with true positive results on the delayed scan, the mediastinal lymph nodes were plural, with a lesion of more than 14 mm in size. Seven false negative cases were found to have metastatic lesions less than 12 mm in size. Both the early and delayed scans showed false positive accumulation in six of 51 patients without mediastinal involvement (specificity 88%). Thus the overall accuracy for the delayed scan was 84%. The 201Tl delayed SPECT is thought to be a good noninvasive method for assessing mediastinal lymph node metastases from lung cancer.     

A combined treatment of interferon-alpha, 8 MHz radiofrequency hyperthermia and/or irradiation in a patient with advanced renal cancer

A combined treatment of alpha interferon (INF), 8 MHz radiofrequency (RF) hyperthermia using Thermotron-RF Model 8 and/or irradiation was performed on a patient with advanced renal cancer. The patient was a 52-year-old male, who had received arterial embolization with a gelatin sponge and 60 mg of adriamycin for the right renal tumor in January, 1985. He was referred to our clinic in April, 1985. Computed tomography showed a right renal tumor, 120 x 105 x 80 mm. Histological examination revealed clear cell carcinoma of the right kidney. The tumor was unresectable because of the huge tumor size, invasion into the right lobe of the liver, multiple pulmonary metastases and severe dysproteinemia. From the beginning of May, 1985, administration of 3 x 10(6) units interferon-alpha (INF) daily and radiofrequency (RF)hyperthermia for one hour twice a week were started. By June 11, 1985, 10 sessions of RF-hyperthermia were performed. Thereafter, hyperthermia for the renal tumor was maintained once a week until June, 1986. From the middle of June, 1985, a gradual improvement of dysproteinemia and appetite loss, and a decrease of the right renal tumor size as well as disappearance of febrile attacks were attained. In November, 1985, mediastinal lymph node swelling developed. A combined therapy of RF-hyperthermia twice a week and irradiation with 2.0 Gy daily 5 times a week was started. A total of 14 sessions of RF-hyperthermia and 30 Gy of irradiation were delivered until January, 1986. Intratumoral temperature of the renal tumor reached 44.0 degrees C during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)     

Auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap

A technique to take an auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap is described. Not only can this procedure remove the composite graft without auricular deformity, but it is also useful for covering small auricular defects after trauma or tumor excision.     

Homozygous C3 deficiency associated with IgA nephropathy

A 23-year-old male patient with homozygous C3 deficiency who developed asymptomatic proteinuria and hematuria was reported. Renal biopsy disclosed typical IgA nephropathy with deposition of early- and late-complement components except for C3 deposition. C9 and membrane attack complex were detected in the glomeruli despite the absence of C3. It was suggested that there might be some unknown complement activation mechanism which does not require C3 component.     

Lack of evidence for existence of vitamin D and 25-hydroxyvitamin D sulfates in human breast and cow's milk

The presence of water-soluble vitamin D and 25-OH-D sulfates in human breast and cow's milk was studied. We first confirmed that synthetic vitamin D2 and D3 sulfates could not be hydrolyzed by alkali but by acid. Breast or cow's milk was separated into milk whey containing water-soluble components and milk curd containing crude proteins and lipophilic components. The separated milk whey and curd were hydrolyzed by acid or alkali and each lipid extract was subjected to HPLC analysis. Neither peak due to vitamin D and 25-OH-D was observed in the chromatograms of acid- and alkali-hydrolyzed milk whey, whereas the peaks due to vitamin D3 and 25-OH-D3 were found in the chromatograms of both acid- and alkali-hydrolyzed milk curd and there was no significant difference between the respective peak heights. The eluates corresponding to the respective peaks observed on the latter's chromatograms were collected and subjected to UV, HPLC, GC-MS and GLC to identify the existence of vitamin D3 and 25-OH-D3, respectively. We concluded from these results that neither breast nor cow's milk contained water-soluble vitamin D and 25-OH-D sulfates, whereas they contained fat-soluble vitamin D3 and 25-OH-D3. The concentrations of vitamin D3 and 25-OH-D3 in breast milk were about 125 and 350 ng/liter, while those in cow's milk were about 420 and 270 ng/liter, respectively. The experiments on the transfer of 3H-D3 and 3H-25-OH-D3 perorally dosed to lactating rats into suckling pups through their milk also supported the above conclusion.     

Cardiovascular effects of the new positive inotropic agent denopamine with special reference to species difference and the effect on failing heart

Cardiovascular effects of (-)-(R)-1-(p-hydroxyphenyl)-2-[(3,4-dimethoxyphenethyl)amino]ethanol (denopamine, TA-064) were investigated in various experimental animals. An intravenous bolus injection of denopamine dose-dependently increased the contractile force or the maximum rate of rise of left ventricular pressure (LV dp/dtmax in cynomolgus monkeys, miniature pigs, cats and rats. In these animals, the doses of denopamine which increased the contractile force by 30% of the control (ED30) were found to be 2-3 micrograms/kg. On the other hand, ED30 values for dl-isoprenaline ranged from 0.005 to 0.04 micrograms/kg. Thus, the potency of denopamine for increasing the contractility was approximately 1/60-1/300 that of dl-isoprenaline. It is noteworthy that the positive inotropic effect of denopamine was more pronounced than the positive chronotropic effect compared with those of isoprenaline, as estimated at ED30 for positive inotropy. In general, denopamine produced little effect on the blood pressure, and only a slight increase or an increasing tendency was observed in all of these animals. An intravenous continuous infusion of denopamine to monkeys or pigs produced qualitatively similar cardiovascular effects to those following intravenous bolus injection. When examined with monkeys, the positive inotropic effect and plasma levels of denopamine were closely related. Denopamine increased cardiac output, and reduced total peripheral resistance in pigs and dogs. In dogs, common carotid, superior mesenteric and femoral arterial blood flow were increased concomitant with the increase in cardiac output, while the vascular resistance of the corresponding vascular bed was reduced. Denopamine had no significant influence on central venous pressure in monkeys and pulmonary arterial pressure in dogs.(ABSTRACT TRUNCATED AT 250 WORDS)