We developed a method to evaluate the severity of chronic cardiac failure by Doppler image analysis. Doppler images of the whole arterial lumen were consecutively recorded on video tape and the power spectrum (sum of intensity multiplied by frequency) of each frame was considered as an index of the blood flow volume (VI). The right brachial artery was occluded for 15-60 seconds by a occluding cuff, and was released quickly. The VI was determined until the VI returned to the level at rest and total VI was calculated as an O2 repayment. The O2 repayment rate (R-Rate) was calculated as a ratio of the O2 repayment divided by total VI during interruption. The cardiac function was evaluated by sub-maximal exercise using bicycle ergometer and was compared with the R-Rate. The subjects were 22 patients (18 males and 4 females) with chronic cardiac failure of NYHA class I (9), class II (6), class III (4), class IV (3) and 12 healthy controls. R-Rate was almost unchanged by the duration of occlusion and showed positive correlation with exercise capacity. R-Rate decreased as the class of NYHA advanced. In conclusion, determination of reactive hyperemia can be used for objectively evaluating the severity of cardiac failure.
A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.
The aim of the present study is to clarify in situ expression of platelet-derived growth factor (PDGF) and its receptors in different phases of inflammatory bowel disease (IBD). Tissues samples were obtained from 20 patients with ulcerative colitis (UC) and 29 with Crohn's disease (CD) at surgery. In situ hybridization and immunohistochemistry on frozen sections were performed for PDGF-A and -B and its α and β receptors (αR and βR). The area of active inflammation was infiltrated by abundant polymorphonuclear and mononuclear leukocytes, of which the latter expressed mRNA and proteins of PDGF-A, -B, and -αR and mRNA for PDGF-βR. The area of active fibrosis, characterized by activated fibroblasts/myofibroblasts, was juxtaposed to ulceration, which is induced as a repair process to tissue destruction. In these areas, activated fibroblasts/myofibroblasts were positive for mRNA and protein of PDGF-A, -B, -αR, and -βR. The expression of PDGF-A, -B, and -αR declined significantly in the scar area. Our results suggest that PDGF is not only important as an inducer of fibrosis in the repair phase but also it is involved in the active inflammatory phase possibly as a chemoattractant for mononuclear inflammatory cells.
Hyaluronan is known to play an important role in the healing of degenerative osteoarthritis. But there is no clear consensus how it effects on osteoarthritis compare to cortisone. The purpose of the research was to determine the comparative effects of hyaluronan and cortisone on the healing of degenerative osteoarthritis. A rabbit model used in which a degenerative osteoarthritis were created in the articular cartilage by the inoculation of Staphylococcus Aureus (S. Aureus). The rabbits divided into two groups namely injected with hyaluronan (group A) and cortisone (group B) at days 20, 23 and 26. After hyaluronan and cortisone injections for treatment of osteoarthritis at day of 25 and 35 six rabbits (each of three injected with hyaluronan and cortisone) and at day 50 (six of injected with hyaluronan and five of cortisone) were sacrified. In biopsies obtained from these knees both articular cartilage degeneration and inflammation around the joint were examined by light microscopy. It was seen that the histopathologic findings were consistent with active chronic inflammation at day 10, followed by chronic inflammation. At day 5 of treatment the degeneration decreased (60%) in group A, and clinical findings disappeared after day 9 of treatment. At day 15 of hyaluronan treatment the degeneration degree regressed and at day 30 absolutely healed (all except one). In group B, at day 5 of treatment, the clinical findings disappeared and the healing rate was 72%. At day 15 of cortisone treatment, the degeneration slightly increased and at day 30 the degeneration degree increased more than that day of 15. The results showed that cortisone is effective in the treatment of cartilage degeneration and inflammation early in the course of the septic arthritis whereas the therapeutic effect of hyaluronan is higher late in the course of the disease. Further studies are required in order to understand the effectiveness of the combined or consecutive use of these drugs in degenerative osteoarthritis.
Vascular endothelial growth factor (VEGF) is known to maintain endothelial cells of immature vessels and is constitutively expressed in the kidney from the embryo to adult. We tested the hypothesis that VEGF activity is needed to maintain glomerular endothelial cells in the adult. Neutralizing antibody to VEGF165 was intraperitoneally administered to mice for 3 days to strongly suppress its intrinsic activity. On the fourth day, mice were sacrificed and tissues were examined by light and electron microscopies. Vascular casts of renal vessels were observed by a scanning electron microscopy. Distribution of the administered antibody and expressions of VEGF and Flk-1 were examined immunohistochemically. The suppression of endogenous VEGF activity caused swelling and vacuolation of endothelial cells and obstruction of capillaries in the glomerulus. Other tissues were not impaired significantly. The administered antibody was specifically localized to the glomerulus, and was found more predominantly in the juxta-medullary than in the cortical glomerulus. This pattern of antibody deposition was similar to that of Flk-1. VEGF expression in the glomerulus was compensatively elevated by the antibody treatment. These results show that demand for VEGF signaling in the glomerulus is much higher than in other tissues, probably to protect its endothelial cells against high tension for blood filtration. This demand may be fulfilled by enriched signaling through the Flk-1 in the glomerulus.
Hindquarter compensator tone (HCT) is referred to as the sympathetic vasoconstrictor tone to the hindquarters of the rat induced by such hypotensive interventions as pentobarbital anesthesia, nitrate administration and blood loss. The aim of this study is to observe whether chlorpromazine (CPZ) injected intravenously in rats (0.5 mg/kg) inhibits the following two different kinds of vasoconstrictor tone: HCT induced by pentobarbital and the renal tone which is normally present in the conscious state. Rats were implanted with an electromagnetic flow probe around the terminal aorta or the left renal artery. The right common carotid was cannulated for mean arterial pressure (AP). Regional peripheral resistance (hindquarter resistance [HQR] or renal resistance [RR]) was calculated as AP divided by regional flow. In rats under pentobarbital anesthesia, after CPZ, ganglionic blockade with hexamethonium bromide (25 mg/kg) did not decrease HQR. However, in conscious rats after CPZ, blockade decreased RR significantly. These findings indicate that CPZ inhibits HCT almost completely but scarcely decreases the renal tone and further suggest that HCT and the renal tone are generated by different mechanisms.
The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.