So Yabuki

Distal coronary flow velocity immediately after direct angioplasty for acute myocardial infarction

To evaluate coronary flow dynamics after direct angioplasty and to define the determinants of flow-velocity variables in the infarct artery, we measured coronary flow velocity in 36 infarct arteries and 64 normal coronary arteries by using a Doppler guide wire. Flow-velocity variables in the infarct arteries did not return to normal even after successful direct angioplasty, and phasic coronary flow in infarct arteries varied considerably. Normal phasic flow was calculated as the ratio of diastolic to systolic flow ratio (DSVR) of greater than or equal to mean DSVR - 1 SD in normal coronary arteries. Infarct-related arteries were divided into two groups: normal DSVR (n = 28) and low DSVR (n = 8). Reduced diastolic peak velocity with a relative preservation of systolic velocity contributed to a low DSVR flow. Angiographic slow flow and late recanalization were significantly related to low DSVR flow. Thus the extent of disturbed microcirculation can be evaluated by assessing phasic flow after direct angioplasty for acute infarction.

Beneficial Effects of the Urinary Trypsin Inhibitor Urinastatin on Renal Insults Induced by Gentamicin and Mercuric Chloride (HgCl2) Poisoning

The authors investigated the protective effects of the urinary trypsin inhibitor urinastatin on acute renal failure induced in rats by gentamicin (240 mg/kg body weight i.p. for 3 days) and by mercuric chloride (3 mg/kg s.c.). In rats injected with gentamicin, glomerular filtration rate (GFR), renal plasma flow (RPF), and percent fractional sodium excretion (%FENa) were 151 +/- 51 microliters/min/100 g body weight, 0.69 +/- 0.31 ml/min/100 g and 0.73 +/- 0.32, respectively, whereas in rats given 100,000 U of urinastatin the renal function was significantly ameliorated (GFR 318 +/- 43 microliters/min/100 g RPF 1.41 +/- 0.35 ml/min/100 g), although the %FENa (0.46 +/- 0.26) was not significantly improved. A 50,000-unit dose of urinastatin prevented the deterioration of renal function to some extent following administration of gentamicin: GFR 219 +/- 66 microliters/min/100 g and RPF 0.93 +/- 0.43 ml/min/100 g. In the study using mercuric chloride, treatment with 75,000 U of urinastatin protected the kidney from HgCl2 poisoning, yielding values of 294 +/- 93 microliters/min/100 g (GFR), 1.03 +/- 0.41 ml/min/100 g (RPF), and 1.44 +/- 0.72 microliters/min/100 g (%FENa) as compared with respective values of 169 +/- 48 microliters/min/100 g, 0.7 +/- 0.18 ml/min/100 g, and 2.22 +/- 1.35 in the untreated rats. Renal histology revealed mild to moderate tubular epithelial changes in untreated rats, but preservation of an almost normal tubular structure in urinastatin-treated rats in both studies.

Safety and feasibility of continuous monitoring of coronary flow velocity in acute myocardial infarction by Doppler guide wire

We investigated the safety and limitations of the Doppler guide wire for continuous monitoring of coronary flow velocity outside the catheterization laboratory in 17 patients with acute myocardial infarction. After direct angioplasty, patients were taken to the coronary care unit with the Doppler guide wire positioned within the artery. Flow velocity was continuously monitored. Heparin was titrated to an active clotting time > 200 seconds. Clinical outcome and angiographic analyses were evaluated. Flow velocity monitoring was conducted with an 88.2% success rate and lasted for 16 +/- 5 hours. Monitoring failed in 2 of the 4 right coronary artery cases. Small amounts of thrombus were seen to adhere to the Doppler guide wire at the end of monitoring. No complications were related to the procedure. No deterioration of angiographic findings was observed. This preliminary study confirmed the safety of the Doppler guide wire for continuous monitoring of coronary flow in patients with acute myocardial infarction.

Kidneys of Chronic Alcoholic Rats Are More Vulnerable to Ischemic Insult

The effects of chronic ethanol ingestion on the rat kidney were studied. Rats were fed a liquid diet containing ethanol for 5 weeks to induce chronic alcoholism. Renal ischemia was introduced by clamping the renal artery and vein either for 10 or 20 min. The glomerular filtration rate (GFR) and the renal blood flow (RBF) were determined by using I125-iothalamate and I131-iodohippurate. In the absence of renal ischemia, there were no significant differences in the renal function between nonalcoholic rats (n = 5) and alcoholic rats (n = 5): 380 +/- 30 vs. 403 +/- 27 microliters/min/100 g body weight (BW) in GFR, and 3.1 +/- 0.1 vs. 3.1 +/- 0.2 ml/min/100 g BW in RBF. The recovery of GFR measured 2 h following 10-min renal ischemia in both groups was not significantly different; the values returned to 340 +/- 40 microliters/min/100 g BW (nonalcoholic rats) and 246 +/- 22 microliters/min/100 g BW (alcoholic rats), respectively. The changes of RBF following 10 min ischemia were also similar in both groups. However, the effects of alcoholism on the renal function became apparent when animals were subjected to more prolonged renal ischemia. In nonalcoholic rats (n = 5), GFR and RBF measured 2 h following 20 min renal ischemia were 245 +/- 51 microliters/min/100 g BW and 2.5 +/- 0.4 ml/min/100 g BW, whereas in alcoholic rats (n = 5) the GFR and RBF were significantly decreased to 93 +/- 15 microliters/min/100 g BW and 1.1 +/- 0.2 ml/min/100 g BW, respectively (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of recombinant human erythropoietin on cardiac function, peripheral circulatory function and life activity in patients with chronic hemodialysis.

慢性血液透析患者の運動耐容能, 左心機能および末梢循環機能におよぼすrecombinant human erythropoietin (rEPO) の影響を評価するとともに, 日常運動量の変化に関して検討した. 約3か月間のrEPO治療によって, ヘモグロビン濃度は7.9±0.8g/dlから10.5±1.1g/dlへ, ヘマトクリット値は24.2±2.3%から32.0±2.3%へと有意 (p<0.01) な上昇を示したが, 白血球数や血小板数は変化しなかった. このような腎性貧血の改善に伴い, functional aerobic impairment (FAI) は31.7±19.3%から11.6±18.9% (p<0.01) へ, PCIは16.7±20.4%から-4.2±12.3% (p<0.05) へと有意な低下を示したが, MAI (5.6±15.1% vs 5.2±6.7%) とHRI (8.3±8.7% vs 7.3±7.3%) は有意な変化を示さなかった. また, 透析間隔中の歩行数 (6,716±3,468歩vs 6,986±3,125歩) にも有意な変化を認めなかった. 以上の結果より, rEPO治療による腎性貧血の改善によって得られる運動耐容能の増加は, 主として末梢循環機能が改善するためと考えられた. しかし, このような運動耐容能の増加は直接日常運動量を変化させることはなく, 社会復帰の目的のためには, よりactiveな生活指導や積極的な運動療法の併用が必要であろうと考えられた.