Prediction of functional recovery of the left ventricle after coronary revascularization in patients with prior anterior myocardial infarction: a myocardial integrated backscatter study.

Cyclic variation (CV) of myocardial integrated backscatter (IBS), which reflects intrinsic contractile performance, can predict myocardial viability in patients with a reperfused acute myocardial infarction (MI), but the use of this method has not been validated for chronic left ventricular (LV) dysfunction. The aim of this study was to examine whether myocardial IBS was useful for predicting LV functional recovery after coronary revascularization in 17 patients with prior anterior MI and LV dysfunction (ejection fraction <50%). Within 24 h of the revascularization procedure (percutaneous transluminal coronary angioplasty or coronary stenting), IBS curves were obtained by placing the region of interest on the anterior wall on the short-axis IBS image. The patients had repeat left heart catheterization at 3 or 6 months after the revascularization procedure, and were grouped according to the patterns of the IBS curve within the anterior wall. In 8 patients (group A), the IBS curve had a synchronized pattern with the magnitude of CV > or = 3.5, and in the remaining 9 patients (group B), the curve had either an asynchronized pattern or the magnitude of CV was less than 3.5 dB even in the case of synchronized pattern, or both. At baseline, there were no significant differences in LV functional indices between the 2 groups. After the follow-up period, the LV end-systolic volume decreased (75 +/- 21 ml to 56 +/- 20ml, p = 0.05), LV ejection fraction increased (35 +/- 12% to 50 +/- 14%, p = 0.014), and LV end-diastolic pressure decreased (19 +/- 10 mmHg to 13 +/- 6 mmHg, p = 0.02) in group A, whereas only the LV ejection fraction increased (34 +/- 9% to 40 +/- 11%, p = 0.03) in group B; LV end-systolic volume (72 +/- 19 ml to 66 +/- 16 ml, p = 0.126) and LV end-diastolic pressure (18 +/- 12 mmHg to 14 +/- 8 mmHg, p = 0.184) showed no significant changes. In conclusion, IBS is valuable for predicting LV functional recovery after coronary revascularization in patients with LV dysfunction caused by a remote anterior MI. A large-scale study is be needed to establish these data.     

Projection of nucleus tractus solitarius units influenced by hepatoportal afferent signal to parabrachial nucleus

In urethan-chloralose anesthetized rats, units in the nucleus tractus solitarius (NTS) which antidromically responded to electrical stimulation of the parabrachial nucleus (PB) were investigated for their responses to hepatic-vagal afferent signals. Among 63 NTS units examined, 25 (40%) were excited, 17 (27%) inhibited and the remaining 21 (33%) unaffected by single shock electrical stimulation of the hepatic branch of the vagus nerve. Topical application of Na+ produced an increase in discharge rate of 9 units and a decrease in 5 units. Portal infusion of hypertonic saline produced an increase in discharge rate of 3 units and a decrease in 5 units. Furthermore, 3 units responded to both topical application of Na+ and portal infusion of hypertonic saline.     

Successful chemotherapy with adriamycin and methotrexate in a case of advanced transitional cell carcinoma of the ureter--a clinical application of subrenal capsule assay

A case of advanced transitional cell carcinoma of the left ureter was treated with a combination of adriamycin and methotrexate. These drugs were selected using the subrenal capsule assay for which tumor tissues were obtained from a biopsy specimen of the left supraclavicular lymph node. Complete regression of left supraclavicular lymph node metastasis and 90% regression of para-aortic lymph node metastasis were obtained after four courses of the combination therapy. Subsequently, left total nephro-uretrectomy and retroperitoneal lymph node dissection were carried out. Pathological examination revealed the remains of tumor cells in the primary lesion and in the para-aortic lymph node. The tumor tissues obtained from the para-aortic lymph node were not susceptible to adriamycin and methotrexate. However, the tendency of the regression rates in the drug-treated groups was the same as that apparent before chemotherapy. Three courses of the same regimen as that given before surgery were then prescribed. The patient is currently alive with no evidence of disease. We therefore suggest the usefulness of the subrenal capsule assay for predictive chemosensitivity testing.     

Vaginal repair of large cystoceles

Repair of cystoceles requires a complete understanding of the pelvic anatomy. While smaller defects are relatively straightforward, greater degrees of prolapse can be among the most challenging surgeries in pelvic floor reconstruc-tion. This article reviews current transvaginal techniques used for repair of large cystoceles.     

Solifenacin: as effective in mixed urinary incontinence as in urge urinary incontinence

Patients with mixed urinary incontinence (MUI) are frequently treated with antimuscarinic therapy, despite little data being previously published for this patient group. We present a subgroup analysis of patients with overactive bladder syndrome, assessing the efficacy of once-daily solifenacin succinate in patients with MUI (n=1041) or urge urinary incontinence (UUI; n=1648) only. A greater proportion of patients receiving solifenacin achieved resolution of incontinence in both the MUI and UUI groups (MUI: 5 mg=43%, 10 mg=49%; UUI: 5 mg=55%, 10 mg=54%) compared with patients receiving placebo (MUI 33%, UUI 35%). Baseline to endpoint improvements in all other symptoms were statistically significant vs placebo for both solifenacin doses in both cohorts. The incidence of adverse events was comparable between the MUI and UUI cohorts. This analysis shows that once-daily solifenacin was as effective and well tolerated in patients with MUI as in patients with UUI.     

25-Hydroxyvitamin D-24-hydroxylase in phytohemagglutinin-stimulated lymphocytes: intermediate bioresponse to 1,25-dihydroxyvitamin D3 of cells from parents of patients with vitamin D-dependent rickets type II

A method for assay of 25-hydroxyvitamin D-24-hydroxylase (24-hydroxylase) activity in phytohemagglutinin (PHA)-stimulated lymphocytes was applied to determine whether vitamin D-dependent rickets type II (VDDR II) is hereditary. In normal lymphocytes incubated with PHA for 3 days, maximal and half-maximal responses of 24-hydroxylase were observed after exposure to 10(-8) mol/L and (1.3 +/- 0.4) x 10(-9) mol/L 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3], respectively. These responses were similar to those of cultured skin fibroblasts. In contrast, after exposure to 10(-8), 10(-7), and 10(-6) mol/L 1,25-(OH)2D3, no 24-hydroxylase activity was detected in cells from patients with VDDR II, and intermediate activity was observed in cells from their parents. These findings indicated the presence of an intracellular receptor-effector system for 1,25-(OH)2D3 in peripheral lymphocytes. Heterozygotes of VDDR II could be identified, and autosomal recessive inheritance of the disease was demonstrated. Detection of heterozygotes of this disease was not possible by assay of inhibition of thymidine incorporation, another marker of the function of 1,25-(OH)2D3 in PHA-stimulated lymphocytes. Therefore, assay of 24-hydroxylase induction reflected the receptor status more closely than assay of inhibition of DNA biosynthesis. The assay of 24-hydroxylase activity in PHA-stimulated lymphocytes described here will be useful for diagnosis of VDDR II and study of families of patients with this disease.     

Pharmacokinetics of carboplatin (CBDCA) and tissue concentration of platinum in gynecologic organs

A pharmacokinetics and platinum concentration in the gynecologic organs were measured following the intravenous drip infusion of 375 mg/m2 of CBDCA. Total platinum (TP) in plasma decreased biphasically and free platinum (FP) was almost monophasically eliminated. The t 1/2 of FP was about 51 min. and the percentage of FP out of TP at four hours after administration was more than 92%, which was much higher proportion compared with that of cisplatin (CDDP). A cumulative excretion of platinum in the urine within 24 hours was 69%. The platinum concentration in the benign part of portio and endocervix were higher than that of malignant portion, although there were no significant differences in other pelvic organs such as ovary and tubes. However, pelvic lymph-nodes showed less platinum concentration both in metastatic and non-metastatic tissues. Platinum concentration in the tissue did not change significantly with lapse of time. Bone marrow suppression was observed especially in the patients who had received chemotherapy or radiotherapy. No renal toxicity was observed even without any hydration and gastro-intestinal toxicity was much milder than that of CDDP.     

Prevention of infected urinary stones by urease inhibitor. IV. Treatment of infection stones in rats by a new hydroxamic acid and cefalexin

We investigated the combined effectiveness of a new urease inhibitor, N-( pivaroyl ) glycinohydroxamic acid, with Cefalexin in the treatment of infection stones in rats. Combination therapy with the hydroxamic acid and Cefalexin inhibited bladder stone formation, and dissolved the stone dose dependently, while separate therapy was not significantly effective against stone formation or bacterial growth. This compound may become a useful medicine for the treatment of infection stones.