Comparative results of coronary intervention in patients with variant angina versus those with non-variant angina.

Coronary angioplasty is reported to be feasible and safe in patients with coronary spasm and fixed stenosis. However, the long-term results are not positive. We compared the results of coronary angioplasty in 20 patients with variant angina versus 17 patients with non-variant angina among 231 consecutive patients with vasospastic angina. Coronary angioplasty was performed successfully in all 37 patients without any complications. Stenting for coronary dissection or recoil was performed in 8 patients, directional coronary atherectomy was selected for ostial lesion of left anterior descending coronary artery stenosis in 2 patients, and standard balloon angioplasty was performed in 27 patients. There were no clinical differences between the two groups. The restensois rate in patients with variant angina was similar to that in patients with non-variant angina (30% vs 29%, ns). There was no relationship between the provoked spasm and restenosis. During the follow-up period, no major complications were observed in patients with variant angina or those with non-variant angina. In conclusion, full medication with calcium channel antagonists and isosorbide dinitrate, and treatment by coronary angioplasty including the use of new devices, were useful treatments for patients with coronary vasospasm and significant organic stenosis. There was no difference concerning the results of coronary intervention between the patients with variant angina and those with non-variant angina.

Major complications during spasm provocation tests with an intracoronary injection of acetylcholine.

This study sought to clarify major complications associated with acetylcholine testing. Serious major complications, such as sustained ventricular tachycardia, shock, and cardiac tamponade were determined in 4 of 715 patients (0.56%), but no cases of death or irreversible complications occurred. The spasm provocation test using acetylcholine should be performed carefully, although it is considered a safe and reliable method.

New combined spasm provocation test in patients with rest angina: intracoronary injection of acetylcholine after intracoronary administration of ergonovine.

The incidence of provoked coronary spasm with the standard single spasm provocation test has been relatively low in patients with rest angina. The present study examined the clinical usefulness of a newly designed spasm provocation test, an intracoronary injection of acetylcholine (ACh) following an ergonovine (ER) test, in patients with rest angina who demonstrated low disease activity and atypical chest pain. Triple sequential spasm provocation tests were performed in 24 patients with atypical chest pain who had no ischemia and in 40 patients with rest angina who had distinct ischemia. Initially, an ACh test (20-100 microg) and then an ER test (40-64 microg) were performed and then, if no spasm was provoked, an intracoronary injection of ACh was given after the ER test to evaluate coronary spasm. Coronary spasm was defined as total or subtotal occlusion. In the 24 patients with atypical chest pain, no spasm was provoked by intracoronary injection of either ACh or ER, but coronary spasms were induced in 2 patients using the new method, with the remaining 22 not experiencing spasm (specificity of new method, 92%). In the 40 patients with rest angina, intracoronary injection of ACh induced coronary spasm in 22 patients (group I) and 6 (group II) demonstrated spasm with intracoronary injection of ER. Coronary spasm was not induced by either the ACh test or the ER test in 12 patients (group III). The intracoronary administration of ACh after the ER test provoked spasm in 11 of 12 patients. Diffuse spasms were provoked in 10 of 11 patients. In patients with rest angina, the frequency of chest pain attacks in 1 month experienced by patients in group III (0.8+/-0.8) was significantly lower than that of patients in group I (7.0+/-5.3, p<0.01) or II (3.5+/-2.3, p<0.05). No serious or irreversible complications related to this new combined method were observed. In conclusion, this method was safe and reliable for the induction of coronary spasm in patients with rest angina who may have low disease activity.

Clinical characteristics of female patients with coronary spastic angina: comparison with male patients.

There are many patients with vasospastic angina who have minor atherosclerosis, and in Japan the majority of them are male. No data exist concerning sex differences in patients with coronary spastic angina, so the present study sought to clarify the clinical characteristics between male and female patients with vasospastic angina. Between April 1991 and June 1998, 204 consecutive patients were diagnosed with vasospastic angina and of these, 26 (12.7%) were female. An acetylcholine test was performed with incremental doses of 20, 50, and 80 microg injected into the right coronary artery and 20, 50, and 100 microg into the left coronary artery. Ergonovine was injected in a total dose of 40 microg into the right coronary artery and 64 microg into the left coronary artery. Coronary spasm was defined as 99% or more luminal narrowing accompanied by ischemic changes on ECG. Compared with male patients, female patients had less organic stenosis (12 vs 33%, p<0.05), less history of smoking (15 vs 85%, p<0.01), and fewer focal spasms (31 vs 64%, p<0.01). There were no other differences between the 2 groups. In conclusion, Japanese female patients with vasospastic angina had the characteristics of diffuse provoked spasm, less organic stenosis, and less history of smoking, but only 1 in 10 of all patients with vasospastic angina are female.

A case of variant angina pectoris with similar findings on both rest and matched exercise thallium-201 studies.

A patient with variant angina showed similar findings on both the rest and matched exercise 201Thallium (201Tl) myocardial perfusion scintigrams. The 65-year old man was admitted to hospital because of rest angina. His electrocardiogram during the attack disclosed ST segment elevation on inferior leads. However, emergency coronary arteriogram showed no fixed stenosis. Intracoronary injection of acetylcholine induced a spasm on the distal right coronary artery, but not in the left coronary artery. In the rest 201Tl study, septal perfusion was low on the early image, although partial redistribution of this site was observed on the delayed image without the appearance of chest pain or electrocardiographic ischemic change. Similary, in the 201Tl exercise study undergone 2 weeks later, septal redistribution was diagnosed because the early image had decreased septal perfusion. Both the exercise 123I-metaiodobenzylguanidine study and the rest 123I-betamethyl-p-iodophenyl-pentadecanoic acid study showed inferior abnormalities on the early and delayed images. Although a coronary spasm was not induced in the left anterior descending artery with the acetylcholine test, septal redistribution was observed on the delayed image of both the rest and exercise 201Tl studies. The mechanism of the redistribution on the rest 201Tl study was unclear.

A patient with non-A, non-B, non-C hepatitis-associated aplastic anemia recovered promptly following immuno-suppressive therapy, including antithymocyte globulin.

A 21-year-old male patient with non-A, non-B, non-C acute hepatitis was complicated by hepatitis-associated severe aplastic anemia during hospitalization for active hepatitis. He was promptly diagnosed and treated with methylprednisolone, anabolic steroids, cyclosporin A, granulocyte colony-stimulating factor (G-CSF), and antithymocyte globulin (ATG). He responded quickly to the immuno-suppressive therapy and was transfusion independent after 25 days and granulocyte colony-stimulating factor independent at 57 days after ATG therapy. Although the etiology of hepatitis-associated aplastic anemia is still controversial, the authors emphasized the importance to carefully follow non-A, non-B, non-C hepatitis patients without aplastic anemia for more than three months after hepatitis episodes in order to improve outcome of this lethal disease.

[Usefulness of thallium-201 myocardial scintigraphy during hyperventilation and accelerated exercise test in patients with vasospastic angina and nearly normal coronary artery].

The usefulness of thallium-201 (201Tl) myocardial scintigraphy was studied in 109 patients with vasospastic angina who had nearly normal coronary arteries (degree of stenosis < 50%). Coronary spasm was confirmed by pharmacologic agents in all 109 patients from January 1991 to June 1996. The appearance rate of visual redistribution on 201Tl myocardial scintigraphy was compared between four groups, 34 patients performing graded bicycle ergometer exercise starting at a work load of 50 W with increments of 25 W every 3 min [Ergo (3) group], 14 patients performing hyperventilation for 5 min [HV (5) group], 31 patients performing bicycle ergometer exercise with increments of 25 W every 1 min after 5 min hyperventilation [HV (5) + Ergo (1) group], and 30 patients at rest (Rest group). The value of the visual redistribution rate on 201Tl myocardial scintigrams in the HV(5) + Ergo (1) group (65%) was higher than that in the patients of other groups [Ergo (3) 41%, HV (5) 43%, Rest 33%]. However, there were no significant differences between the four groups. Stress 201Tl imaging after hyperventilation and accelerated exercise is useful to disclose ischemic evidence in about two thirds of patients with vasospastic angina and nearly normal coronary arteries, whereas about 40% of patients had visual redistribution on 201Tl myocardial scintigrams by performing standard procedures.

[Study on the surgical treatment for pulmonary metastasis from renal cell carcinoma].

BACKGROUND: Pulmonary resection for metastatic renal cell carcinoma were studied to assess the indication of surgical management. METHODS: Between January, 1981 and December 1994, 17 consecutive patients (14 men and 3 women) underwent complete pulmonary resection for metastatic renal carcinoma. Median age was 61 years (range, 45 to 73 years). Eleven were appeared lung metastasis after resection of primary tumor. Median time between nephrectomy and pulmonary resection was 32 months (range, 0 to 127 months). RESULTS: There were no operative deaths. One patient had solitary metastasis, 4 had two, 2 had three, 2 had four, one had seven, one had eight and 6 had more than twenty-two. Segmental resection was performed in 12 patients, lobectomy in 2, lobectomy and segmentectomy in 3 and segmentectomy for total lobes in 3. Four patients had another site operation of renal metastasis, brain tumor resection, chest wall and ribs resection, contra-lateral adrenalectomy and contralateral partial nephrectomy. Median follow-up was 44 months (range, 10 to 129 months). The cause specific survival rate and disease free survival after pulmonary resection was 55 and 48 percent at 5 years and 27 and 14 percent at 10 years, respectively. CONCLUSION: Pulmonary resection for metastatic renal cell carcinoma was considered effective in some selected slow-growing cases. Multiple and both lungs metastases is not contraindication and the patients under 10 metastatic focuses had good prognosis.

[Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1991)].

Isolated bacteria from respiratory tract infections were collected since 1981 in cooperation with institutions located throughout Japan, and have been investigated for their sensitivities to various antibacterial agents and antibiotics and reported by IKEMOTO, et al. Relationships between these isolates and backgrounds of the patients were also studied each year. These results are discussed in detail in this report. In 20 institutions around the entire Japan from October 1991 to September 1992, 631 strains of bacteria were isolated mainly from sputa of 529 patients with respiratory tract infections and tentatively determined to be etiological agents. MICs of various antibacterial agents and antibiotics against 96 strains of Staphylococcus aureus, 112 strains of Streptococcus pneumoniae, 111 strains of Haemophilus influenzae, 114 strains of Pseudomonas aeruginosa (non-mucoid), 41 strains of Moraxella subgenus Branhamella catarrhalis, 39 strains of Pseudomonas aeruginosa (mucoid), Klebsiella pneumoniae and some others, were determined, and the drug sensitivities of these strains were determined except for the strains that had been killed during transportation: 1. S. aureus. S. aureus strains for which MICs of methicillin were higher than 4 micrograms/ml (methicillin-resistant S. aureus) accounted for 58.3% and the frequency of the drug resistant bacteria increased over previous year's 42.5%. As shown by the MICs, arbekacin was active as vancomycin against all the strains on S. aureus. 2. S. pneumoniae: Benzylpenicillin among the penicillins showed a potent activity against S. pneumoniae. Cefuzonam, cefmenoxime, cefozopran and cefotaxime among the cephems showed excellent antimicrobial activities against S. pneumoniae. Imipenem; a penem antibiotic, showed the most potent activity with MIC80 of 0.03 micrograms/ml. 3. H. influenzae: Activities of all drugs were excellent against H. influenzae strains tested. Ampicillin showed MIC80 of 1 micrograms/ml against H. influenzae. Cefuzonam showed the most potent activity among cephems, it completely killed all bacteria at MIC 0.06 micrograms/ml. Cefotaxime and cefmenoxime showed next most potent activities with MIC80s of 0.06 micrograms/ml. The antimicrobial activity of ofloxacin was equivalent to those of cephems. 4. P. aeruginosa (mucoid). Ciprofloxacin and tobramycin showed the most potent activities against P. aeruginosa (mucoid), and their MIC80s were 4 micrograms/ml. 5. P. aeruginosa (non-mucoid): Similarly, ciprofloxacin and tobramycin showed the most potent activities against P. aeruginosa (non-mucoid) with MIC80 of 2 micrograms/ml. Comparing to activities against P. aeruginosa (mucoid), all the drugs tested showed lower activities against P. aeruginosa (non-mucoid). 6. K. pneumoniae: The activities of all drugs except for penicillins were very high against K. pneumoniae.(ABSTRACT TRUNCATED AT 400 WORDS)

[Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1990)].

These investigations have been continued since 1981. In this year the isolation frequencies and sensitivities to antibiotics were investigated for 654 bacterial strains isolated from respiratory tract infections in 20 institutions during the period of October 1990 to September 1991. Among Staphylococcus aureus isolated from inpatients, many were methicillin-resistant S. aureus (MRSA), and the frequency of their isolation was 56.3% for inpatients and 4.3% for outpatients. Of the relation to antibiotic administration, the isolation frequency of MRSA before administration of antibiotics was 19.6% (10/51), and after administration was 75.0% (27/36). The sensitivities of S. aureus to imipenem and clindamycin (MIC80) decreased from 0.2 microgram/ml to 64 micrograms/ml and from 0.2 micrograms/ml to 128 micrograms/ml, respectively. We investigated year to year changes in the backgrounds of patients with respiratory tract infections. Bacterial pneumonia was 31.6% among respiratory tract infections in the period of the study, this trend has increase from 1989. Frequencies of different etiological bacteria in respiratory tract infections did not change appreciably from year to year, and S. aureus, Streptococcus pneumoniae and Pseudomonas aeruginosa were the most showing some frequent pathogens.

Transient forebrain ischemia induces increased expression and specific localization of cathepsins E and D in rat hippocampus and neostriatum.

The accumulation and localization of cathepsins E and D in the rat hippocampus and neostriatum during the neurodegenerating process induced by transient forebrain ischemia were investigated by immunoprecipitation and by immunohistochemistry using discriminative antibodies specific for each enzyme. While significant amounts of cathepsin D were found in both the hippocampus and the neostriatum of normal rats, cathepsin E was barely detectable in these tissues. No significant change in their levels was found in these tissues of postischemic rats for up to 3 days after transient forebrain ischemia. After 7 days of the treatment, cathepsin E was markedly increased in both tissues. Although the cathepsin D content in these tissues was also increased at this stage, the rate of increase was much less than that of cathepsin E. At the light microscopic level, the increased immunoreactivity for each enzyme was mainly found in reactive glial cells and degenerating neurons in the hippocampal CA1 subfield at 7 days postischemia. In the neostriatal dorsolateral portion, cathepsin D immunoreactivity was also increased in both reactive glial cells and degenerating neurons, whereas increased immunoreactivity of cathepsin E was only identified in reactive glial cells at 7 days postischemia. It was also found by double-immunostaining technique that the cathepsin E-positive glial cells were largely reactive microglial cells, whereas the cathepsin D-positive glial cells were associated mainly with reactive astrocytes. These results suggest that the accumulation of both cathepsins E and D in the regions of selective neuronal vulnerability may be associated with the postischemic development of intense gliosis and also probably neurodegenerative responses.

Dependence of the thymidylate synthase inhibition rate on the interval after the last administration of tegafur in sigmoid colon cancer patients.

The thymidylate synthase (TS) inhibition rate was measured after tegafur (FT) administration (1.5 g/day, at least 10 days) in 7 sigmoid colon cancer patients. The TS inhibition rate decreased as the interval between the time of the last administration and the time of the tumor resection increased longer. This study provides basic data for considering methods of drug administration and assessment of modification, for example, by leucovorin.

Serum fluoride concentration after sevoflurane anesthesia in ethanol treated rats: special reference to cytochrome P-450 in the liver.

The relationship between serum concentration of inorganic fluoride (F(-)) and cytochrome P-450 content after sevoflurane anesthesia was investigated in ethanol treated rats. Twenty male Wistar rats were randomly divided into 2 isocaloric diet groups of 10 rats each: one group receiving a standard diet and the other an ethanol diet. After 28 days on the diets the animals were administered 2.5% sevoflurane for 2 hr with 30% oxygen and 70% nitrous oxide. Cytochrome P-450 and cytochrome b(5) were induced by the ethanol diet. In the ethanol diet group serum concentration of F(-) was significantly higher than that of the standard diet group after sevoflurane anesthesia. These results suggest that cytochrome P-450 and b(5), which were induced by ethanol, enhanced sevoflurane defluorination.

[Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1988)].

Isolated bacteria from respiratory infectious diseases were collected in cooperation with institutions located throughout Japan, since 1981, and Ikemoto et al. have been examining sensitivities of the isolates to various antibacterial agents and antibiotics, relationships between the isolates and the backgrounds of the patients and so forth each year. We report here the research results for the year 1988. In 18 institutions around the entire Japan from October 1988 to September 1989, 554 strains of bacteria were isolated mainly from the sputa of 439 patients with respiratory infectious diseases and assumed to be the etiologic bacteria. MICs of various antibacterial agents and antibiotics against 68 strains of Staphylococcus aureus, 102 strains of Streptococcus pneumoniae, 120 strains of Haemophilus influenzae, 86 strains of Pseudomonas aeruginosa, 65 strains of Branhamella catarrhalis, 18 strains of Klebsiella pneumoniae and so forth, were determined, and the drug sensitivities of these strains were examined except for the strains which died during transportation. The drug sensitivities of the main strains were almost the same as those determined last year for each drug. However, S. aureus strains for which MICs of methicillin were higher than 12.5 micrograms/ml (methicillin-resistant S. aureus) accounted for 38.2%, and the frequency of drug resistant bacteria increased over last year's 18.2%. Also, we examined changes in the backgrounds of patients, the infectious diseases, and the etiologic bacteria and so forth. As to patient backgrounds, there were many infectious diseases found in a high age bracket, and the patients over age 60 accounted for 57.2% of the diseases. In the distribution by disease, bacterial pneumonia and chronic bronchitis accounted for greatest numbers of cases 32.1% and 31.4%, respectively, followed by bronchiectasis and bronchial asthma. As for frequencies of etiologic bacteria by disease, S. aureus (22.5%) and S. pneumoniae (15.4%) in pneumonia, S. pneumoniae (25.7%) and H. influenzae (24.1%) in chronic bronchitis, H. influenzae (32.5%) and P. aeruginosa (23.8%) in bronchiectasis, and H. influenzae (31.4%), S. pneumoniae and B. catarrhalis (20.0%) in bronchial asthma were the most frequent. Regarding effects of administration of antibiotics and isolates obtained on each day after infection, those bacteria which were isolated before antibiotic administration and which decreased after administration included S. pneumoniae, H. influenzae, and B. catarrhalis. Frequencies of S. aureus and P. aeruginosa, however, increased after antibiotic administration. Also, when dosing continued for more than 15 days, the frequency of P. aeruginosa increased rapidly.

[The influence of the time activity variation on dynamic SPECT images in camera based SPECT].

Image quality of dynamic single photon emission computed tomography (SPECT) using a rotating gamma camera is dependent on the time activity variation of the tracer such as accumulation and excretion in the object's organ. Especially at the early time after injection of radionuclide, artifacts may occur strongly in the SPECT images. Simulated and experimental projection data of line sources and Jaszczak phantom were altered by sequentially weighting the projections with a function that varied linearly with time. With a variation of object activity given by linearly decaying functions, the main effect observed on the SPECT images obtained from simulated line sources was an elliptical deformation on the object. If the changing rate (R (t + 1)-R(t))/R(t) x 100 remained within 20% during acquisition, this deformation of SPECT images of line sources was not noticeable visually and resolution (FWHM) of line sources scarcely was degraded. In renal dynamic SPECT study using 99mTc-DTPA, the image quality of the first scan (30 sec) was considerably degraded. However, the changing rates after the third scan were less than 20% on the mean of 10 kidneys and the image quality was not noticeable visually.

[Treatment of invasive thymoma with myasthenia gravis: a case report responsive to azathioprine and methylprednisolone].

The treatment of invasive thymomas associated with autoimmune diseases, such as myasthenia gravis (MG) and pure red cell aplasia, has not been established. In this paper, we report a 37-year-old patient with post thymectomy myasthenia gravis, who underwent subtotal resection of invasive thymoma with residual lesions of intrathoracic implants. He was treated with azathioprine (AZP) and methylprednisolone (MP). During two months from the start of this therapy, the clinical symptom was improved apparently and the recurrent tumor was reduced. Lasting 18 months of the treatment, he had to stop it because of the renal failure, but now he has no sign of the recurrence. Further studies with this combined regiments are warranted in the treatment of the invasive thymomas associated with autoimmune disease.

[Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1987)].

Since 1981, in cooperation with research institutions across the nation, Ikemoto, et al. have been collecting clinical isolates from patients with respiratory tract infections and conducting an annual retrospective survey of patients' background factors and of isolated strains and their sensitivities to various antibacterial agents and antibiotics. In the period from October, 1987 to September, 1988, 17 institutions participated in the survey and a total of 706 strains which were demonstrated to be causative organisms were isolated from 562 patients with respiratory tract infections. Strains were mostly isolated from the sputum. The taxonomic breakdown of these strains was: Staphylococcus aureus (69 strains), Streptococcus pneumoniae (120), Haemophilus influenzae (170), Mucoid-producing Pseudomonas aeruginosa (42), Non-mucoid-producing P. aeruginosa (87), Escherichia coli (11), Klebsiella pneumoniae (35), Brahamella catarrharis (72), etc. Of these strains, 629 were used to determine MICs of various antibacterial agents and antibiotics for susceptibility analyses. Relationships between patient backgrounds and diagnoses and between infections diseases and causative organisms were also investigated. Most of the major causative organisms, such as H. influenzae and P. aeruginosa, showed no substantial changes from previous years, with regard to their sensitivities to antibiotic agent, but S. aureus, particularly methicillin/cephem-resistant strains of S. aureus (MCRSA) showed somewhat lower sensitivity to beta-lactams, and as in recent years, to ofloxacin, a new quinolone drug, as well. Regarding background factors of patients, the age distribution was heavily concentrated in age brackets of 50 years and older, thus patients in these age group accounted for 75.2% of all the patients, which was comparable to 73.5% in 1985 and 77.9% in 1986. Among infections encountered, bacterial pneumonia was most frequent at 28.3%, followed by chronic bronchitis (27.2%) and bronchiectasis (16.0%). Bacterial pneumonia was actually the most frequent, throughout the entire age groups accounting for 34.3% of patients up to 29 years, 26.6% in the group of 30-69 years and 30.7% in patients aged 70 years and older. Chronic bronchitis was next most frequent and accounted for 20.0%, 26.4% and 30.7% among the three age groups, respectively. Breaking down clinical isolates by diagnosis, H. influenzae, S. pneumoniae and P. aeruginosa were isolated frequently from most of the infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS)