Quinapril with high affinity to tissue angiotensin-converting enzyme reduces restenosis after percutaneous transcatheter coronary intervention.

Experimental studies have demonstrated that vascular injury resulted in an induction of vascular angiotensin-converting enzyme (ACE), and have suggested that inhibition of vascular ACE might be important in the prevention of restenosis. The present study aimed to determine the effect of quinapril, an ACE inhibitor with high affinity to tissue ACE, on restenosis following coronary intervention. The design of this study was a prospective, randomized, open, and non-placebo controlled trial. Patients with ischemic heart disease were enrolled after successful percutaneous transluminal coronary angioplasty or stent implantation at 7 participating institutions. Two hundred and fifty-three patients with 294 lesions were randomly assigned to the quinapril (10-20 mg per day) group or control group. Administration of quinapril was continued for 3-6 months of the follow-up. Quantitative coronary angiography was performed before and after angioplasty and at follow-up. Core laboratory measurements were performed independently and blinded. Follow-up angiography was performed in 108 patients with 124 lesions in the quinapril group and in 107 patients with 130 lesions in the control group. The baseline characteristics and findings of angioplasty showed no significant differences between the two groups. However, in the quinapril group, restenosis per patient and per lesion was significantly lower (34.3% vs. 47.7%, p < 0.05 and 30.6% vs. 43.8%, p < 0.05). Multivariable analysis revealed that administration of quinapril independently contributed to reducing the restenosis per patient and per lesion (odds ratio, 0.73; 95% confidence interval, 0.54-0.99 and odds ratio, 0.75; 95% confidence interval, 0.57-0.99). In conclusion, quinapril significantly reduces restenosis following coronary intervention.

[Clinical evaluation of gallium-67 scintigraphy in comparison with autopsy findings in the elderly, with particular reference to histological findings and classification of pulmonary cancer].

A correlative study of autopsy findings and retrospective review of gallium scintigrams were performed in 106 elderly patients. Of the cases studied, 57% demonstrated positive gallium study in the present series. Histological correlation was undertaken in cases of lung cancer. Among them, squamous cell carcinoma showed the highest incidence of positive results (83%), whereas adenocarcinoma was the lowest (35%). There is no apparent correlation between subtypes of histological classification of adenocarcinoma and abnormal accumulation of gallium. However, abnormal accumulation of the nuclide seems to be rather related with interstitial reactions, namely fibrotic changes, lymphocyte infiltration and vascularization.

Scanning electron microscopic studies on microvascular architecture of human coronary vessels by corrosion casts: normal and focal necrosis.

Microvascular architecture of the normal human heart and myocardial focal necrosis were studied by scanning electron microscopy of corrosion casts. Casts macroscopically identical in form to the left ventricular posterior wall were prepared. The following results were obtained in the normal human heart. Most of the arterioles communicated with capillary plexuses smoothly and straightforwardly in the left ventricular posterior free wall. Arterioles which branched from the arteries ran in various directions and continued into capillaries either at right angles or obliquely in the trabeculae carneae. Capillaries running parallel with the cardiac muscle fibers ran in different directions to cross over with each other in different layers of myocardium. Capillaries in the myocardium formed a continuous and coarse net-like architecture with many bifurcations and anastomoses. Capillaries were about 5-7 micron in diameter. Some veins gathering capillaries in the epicardium ran into the myocardium and the others ran in the epicardium. Veins connecting with capillaries in the myocardium ran in the myocardial layer and communicated with larger veins. An arterio-venous anastomosis and two different types of venous-venous anastomoses were observed in the left ventricular posterior wall. At the site of focal necrosis, cross sections of dilated vessels were observed in large numbers by light microscopy and scanning electron microscopy. At the site of focal necrosis, dilated capillaries running with tortuosity were seen in large numbers by scanning electron microscopy of corrosion casts. When compared with vessels in the normal myocardium, small arterial branches were dilated and run tortuously. These dilated capillary plexuses were observed in the area which communicated with twigs branching off at the right angle from the arterial branch.

Microvascular architecture of the rabbit ventricular walls: a scanning electron microscopic study of corrosion casts.

Microvascular architecture of the rabbit heart was studied with scanning electron microscopy of corrosion casts. Arterioles divide into several finer branches and form a capillary plexus. Capillaries of the plexus run generally in parallel with cardiac muscle fibers and converge into venules and veins. Most of the veins run towards the epicardium, while some of them run towards the endocardium. The subendocardial veins sometimes open into the right ventricular cavity. Arterial branches of the right ventricular free wall and the right ventricular side of the septum open into the ventricular cavity. Arteriovenous anastomoses are observed in the left ventricular free wall and in the right ventricular side of the septum.