Immunohistochemical demonstration of nerve fibers in the synovial fold of the human cervical facet joint

The role of the intra-articular synovial fold as a source of facet joint pain is unclear, because the nature of nociceptive innervation in lumbar synovial folds is controversial, and there have been no such studies in cervical synovial folds. The present study aimed to demonstrate the presence of nerve fibers including nociceptive fibers in synovial folds of human cervical facet joints using immunohistochemistry. Synovial folds of cervical facet joints removed from patients undergoing cervical spine laminoplasty were analyzed immunohistochemically using antibodies to protein gene product 9.5, beta III-tubulin, substance P and calcitonin gene-related peptide. Many nerve fibers immunoreactive for protein gene product 9.5 and beta III-tubulin were demonstrated both around blood vessels and as free fibers in the stroma of the synovial fold. Also. immunostaining showed the presence of free nerve fibers immunoreactive for substance P and calcitonin gene-related peptide in the stroma. The presence of putative nociceptive fibers in cervical synovial folds supports a possible role for these structures as a source of cervical facet joint pain.

Alterations in autonomic nervous control of heart rate among tourists at 2700 and 3700 m above sea level

OBJECTIVES

Many travelers who are not specially trained for activities at high altitude are at risk of physical problems, including cardiovascular disorders, when exposed to high-altitude environments. In the present study, we investigated how actual acute exposure to altitudes of 2700 and 3700 m affected the autonomic nervous control of heart rate in untrained office workers.

METHODS

Physiological parameters (heart rate, respiratory rate, arterial blood oxygen saturation, and end-expiratory carbon dioxide tension) were measured at sea level, 2700 m, and 3700 m. The power of heart rate variability was quantified by determining the areas of the spectrum in 2 component widths: low frequency (LF; 0.04-0.15 Hz) and high frequency (HF; 0.15-0.5 Hz). The ratio of LF power to HF power (LF:HF), which is considered to be an index of cardiac sympathetic tone, was also assessed.

RESULTS

Both HF and LF heart rate variability decreased according to the elevation of altitude. High- and low-frequency powers at 3700 m were significantly lower than those at sea level (P < .01 for HF, P < .05 for LF). The LF:HF ratio at 2700 m was not significantly different from that at sea level. However, it was significantly increased at 3700 m (P < .01).

CONCLUSIONS

At 2700 and 3700 m, the activity of the autonomic nervous system measured by heart rate variability was decreased in untrained office workers. The sympathetic nervous system was dominant to the parasympathetic at 3700 m. These alterations in the autonomic nervous system might play some role in physical fitness at high altitudes.

The effects of diltiazem on hemodynamics and seizure duration during electroconvulsive therapy

Electroconvulsive therapy (ECT) is often associated with acute hyperdynamic responses, and we hypothesize that diltiazem can blunt this response. We measured the effect of a 10-mg dose of diltiazem on heart rate and mean arterial pressure during ECT. Furthermore, we assessed seizure duration by using both the cuff method and two-lead electroencephalogram. We studied 18 patients with a randomized, double-blinded, placebo-controlled cross-over study design. Diltiazem significantly reduced heart rate and mean arterial pressure just after medication, and it also significantly reduced the increases in these variables after ECT, as compared with the placebo. The use of diltiazem was, however, associated with a shortened seizure duration, possibly making ECT less effective. Because of the reduction in seizure duration, the routine administration of diltiazem may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT. However, diltiazem medication for ECT is potentially useful for reducing tachycardia and hypertension in high-risk patients.

IMPLICATIONS

Diltiazem can blunt acute hyperdynamic responses after electroconvulsive therapy, but seizure duration is also significantly reduced, possibly making this therapy less effective.

Plasma brain natriuretic peptide as a parameter to assess efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) to treat severe primary pulmonary hypertension: a case report

Continuous intravenous infusion of prostacyclin (epoprostenol) as a treatment for primary pulmonary hypertension (PPH) definitely improves the patient's quality of life, but few accurate parameters have been found to evaluate the efficacy of the treatment. We observed a patient with severe PPH whose plasma brain natriuretic peptide (BNP) level changed significantly as her condition and symptoms changed. Plasma BNP may be considered as one of the parameters for assessing the efficacy of prostacyclin treatment.

Perinuclear-antineutrophil cytoplasmic antibodies are associated with vasculitis

We describe a 62-year-old man with perinuclear-antineutrophil cytoplasmic antibodies-associated vasculitis, which involved the heart, lung, and kidneys. The patient's care was complicated by total occlusions of the brachiocephalic and right renal arteries and a stenosis of the left renal artery. Involvement of large-sized vessels has not been reported in patients with perinuclear-antineutrophil cytoplasmic antibodies-associated vasculitis.

Clinical advantages of interictal SPECT coregistered to magnetic resonance imaging in patients with epilepsy

PURPOSE

The aim of this study was to investigate the clinical value of coregistration of interictal SPECT and magnetic resonance imaging (MRI) in patients with partial epilepsy.

MATERIALS AND METHODS

Seventeen patients with partial epilepsy were examined with I-123 IMP or Tc-99m ethyl cysteinate dimer SPECT during the interictal phase. The SPECT images were automatically coregistered to axial T1 weighted MRIs. Asymmetry indexes (AIs) were calculated in both nonregistered images and coregistered images.

RESULTS

SPECT images showed areas of decreased tracer uptake in 12 patients. In two patients, the relation between the tumor and the extent of decreased uptake became more accurate in the coregistered images. In five cases, the coregistered images clearly showed that the decreased uptake was located in the sulcus. The AIs were significantly reduced from 14.29 +/- 7.23 to 5.86 +/- 3.48 (P < 0.001) after the images were coregistered in these cases. In five cases, the coregistered images indicated that the decreased areas were in agreement with the cortical findings. No significant differences in the AIs were observed in these cases (16.50 +/- 6.19 versus 17.83 +/- 4.45). Thus, the coregistered images were useful not only to differentiate actual hypoperfusion from artificial hypoperfusion resulting from partial volume effects but also to improve the accuracy of AIs.

CONCLUSION

The coregistration of interictal perfusion SPECT and MRI is useful not only to provide precise functional and anatomic mapping but also to improve the accuracy of calculations of the semiquantitative analysis of regional cerebral blood flow parameters during the interictal state of epilepsy.

Comparison of (18)F-FDG, (131)I-Na, and (201)Tl in diagnosis of recurrent or metastatic thyroid carcinoma

There are several reports about the usefulness of (18)F-FDG PET in thyroid cancer. However, few studies have compared FDG PET with (131)I and (201)Tl scintigraphy. The aim of this study was to evaluate the clinical significance of whole-body FDG PET in differentiated thyroid cancer and to compare the results with those obtained from (131)I and (201)Tl scintigraphy.

METHODS

Whole-body FDG PET was performed on 32 patients (10 men, 22 women; age range, 30-77 y; mean age, 54 y) with differentiated thyroid cancer (5 cases of follicular cancer and 27 of papillary cancer) after total thyroidectomy. An overall clinical evaluation was performed, including cytology, thyroglobulin level, sonography, MRI, and CT, to allow a comparison with functional imaging results for each patient. Metastatic regions were divided into five areas: neck, lung, mediastinum, bone, and other. Multiple lesions in one area were defined as one lesion. The tumor-to-background ratio (TBR) was measured for the lesions that were positive for both (201)Tl uptake and FDG PET uptake.

RESULTS

The number of lesions totaled 47. Forty-one (87%) were detected by all scintigraphic methods. FDG uptake was concordant with (131)I uptake in only 18 lesions (38%). FDG uptake was concordant with (201)Tl uptake in 44 lesions (94%). Only one lesion was negative for FDG uptake and positive for (201)Tl uptake, and two lesions were positive for FDG uptake and negative for (201)Tl uptake. A significant correlation was seen between the TBR of (201)Tl and that of FDG (r = 0.69; P<0.05).

CONCLUSION

These data indicate that for detecting metastatic lesions, FDG PET and (131)I scintigraphy may provide complementary information, whereas FDG PET may provide results similar to those of (201)Tl scintigraphy. Thus, the combination of (131)I scintigraphy and FDG PET (or (201)Tl scintigraphy) is the method of choice for detecting metastatic thyroid cancer after total thyroidectomy.

Thalamic asymmetry on interictal SPECT in patients with frontal lobe epilepsy

BACKGROUND

Interictal brain single photon emission computed tomography (SPECT) is useful for the detection of seizure focus. Recent reports indicate a hypoperfusion in the ipsilateral thalamus as a seizure focus on interictal SPECT in temporal lobe epilepsy. In frontal lobe epilepsy (FLE), however, the alteration of perfusion in the thalamus has not been well documented. This study aimed to assess whether perfusion analysis on the thalamus may add useful information for the detection of epileptic foci in patients with FLE.

METHODS

Interictal brain SPECT was performed in 11 patients with FLE. The asymmetry index for the thalamus and frontal area in the SPECT image was calculated in order to compare the laterality of the seizure foci.

RESULTS

Thalamic asymmetry was seen in seven patients (64%), while cortial asymmetry was seen in six patients (55%). The concordance with the lateralization of the seizure foci was 6/7 (86%) in the thalamus, and 4/6 (67%) in the frontal area. Four patients showed only thalamic asymmetry. Concordance with the lateralization of the seizure focus was found in all of them.

CONCLUSION

These preliminary results suggest that hypoperfusion in the thalamus may have a complementary role to lateralize the epileptic foci in patients with FLE.

Influence of a fat on muscle oxygenation measurement using near-IR spectroscopy: quantitative analysis based on two-layered phantom experiments and Monte Carlo simulation

The influence of a subcutaneous fat layer on measurement of muscle oxygenation using near-IR spectroscopy was quantitatively investigated by two-layered phantom experiments and Monte Carlo simulations, with the aim of developing an algorithm that can correct this influence. The phantom consisted of a fat-like layer, which was a mixture of agar and titanium dioxide powder, and a muscle-like layer, which was suspension of washed bovine blood in Intralipid solution. An LED with 760 and 840 nm elements was used as an optical source, and the backscattered light was detected by photodiodes at source-detector distances of 20, 30 and 40 mm. The relationships between changes in optical density and blood concentrations were obtained at fat-like layer thicknesses of 0.5,10 and 15 mm under fully oxygenated and fully deoxygenated states. It was experimentally found that the change in optical density is significantly decreased and the linearity of measurement characteristics is clearly distorted by the presence of a fat layer. In the simulations, normalized light reflectance and mean optical pathlength in a muscle layer were calculated. The simulation results of the light reflectance agreed well with the experimental results. When the absorption in a muscle layer was relatively high, the mean optical pathlength in the muscle layer, or the measurement sensitivity, was not so dependent on the absorption. Therefore, the modified Beer-Lambert law can still be applied to estimate changes in muscle absorption from changes in optical density, even when a fat layer is involved. The results of simulation also suggested that the influence of a fat layer can be eliminated by correcting the measurement sensitivity using the fat layer thickness.

Serotonin 2A receptor-like immunoreactivity is detected in astrocytes but not in oligodendrocytes of rat spinal cord

The distribution of the serotonin 2A (5-HT2A) receptor in glial cells in the white matter of rat spinal cord was immunohistochemically examined with specific antibodies against the 5-HT2A receptor. 5-HT2A receptor-like immunoreactivity was detected in astrocytes that were identified by an antibody against the glial fibrillary acidic protein. In contrast, 5-HT2A receptor-like immunoreactivity was not observed in oligodendrocytes.

Reverse use-dependent QT prolongation during infusion of nifekalant in a case of recurrent ventricular tachycardia with old myocardial infarction

Pure class III antiarrhythmic agents cause reverse use-dependent QT prolongation. Nifekalant is a new class III antiarrhythmic agent and blocks rapid component of the delayed rectifier K+ current (Ikr) selectively. To prevent recurrent ventricular tachycardia in a patient with old myocardial infarction, nifekalant was administered by continuous intravenous infusion. There was little variation in the blood level of nifekalant during the 1-day period, but the QTc interval became shorter with an increase of the heart rate early in the morning. It is therefore considered advisable to monitor the heart rate and QTc interval during administration of nifekalant by continuous intravenous infusion.

Immunolocalization of p38 MAP kinase in mouse brain

p38 has been implicated to play a critical role in regulating apoptosis in PC12 and cerebellar granule cells, and is inactivated in cultured fetal neurons in response to insulin. Though p38 is activated in microglia after ischemia, the physiological functions of p38 in the brain are not well understood. As a first step to elucidate the physiological functions of p38 in the central nervous system, we raised a polyclonal antibody against p38 and performed immunohistochemical examination to demonstrate the localization of p38 in mouse brain. Strong p38 immunoreactivity was apparent in fiber bundles including the olfactory tract, anterior commissure, corpus callosum, cingulum, internal capsule, stria terminalis, fimbria and alveus hippocampi, fornix, stria medullaris, optic chiasm and optic tract. Although similar regions were stained with both anti-p38 and anti-neurofilament antibodies, intense p38 immunoreactivity was often observed in myelin sheath-like structures but not in axons. This is the first demonstration of the localization of p38 in the central nervous system and provides an anatomical basis for understanding physiological roles of p38.

Long term depletion of serotonin leads to selective changes in glutamate receptor subunits

The present study was carried out to clarify possible modulation mechanism of serotonin (5-HT) on glutamatergic neurotransmission in the rat cerebral cortex. 5-HT was depleted by a 5-HT metabolite blocker (para-chlorophenylalanine; pCPA) for a week. Receptor binding experiments using (S)-[(3)H]alpha-amino-3-hydroxy-5-methylisoxazol-4-propionic acid (AMPA) showed a considerable increase in B(max) value of the membrane samples prepared from the cerebral cortex of rats compared with that of control animals received saline. In contrast, B(max) value of the [(3)H]MK-801 binding experiments for NMDA receptor was not changed by pCPA-treatment. Changes in the density of each AMPA receptor subtype were examined in the cerebral cortex by immunoblot analyses using antibodies against AMPA receptor subunits. The density of immunoreactive bands with receptor subtype specific antibodies against GluR2/3 and GluR2 receptors was increased, whereas that of GluR1 receptors was decreased. Considering GluR2 receptor subtype inhibits Ca(2+) influx into neurons, the present study suggests that 5-HT appears to modulate synaptic plasticity by regulating the density of each AMPA receptor subtype.

Longitudinal elongation of primary afferent axons in the dorsal funiculus of the chick embryo spinal cord

The longitudinal elongation of primary afferent axons (PAAs) in the dorsal funiculus of chick embryo spinal cord was examined using a lipophilic tracer, DiI and immunohistochemistry. The earliest developing PAAs in the brachial segments invaded the spinal cord around embryonic day (E) 3.5. Thereafter, they elongated both rostrally and caudally in the presumptive dorsal funiculus, with frequent contacts between pre-existing axons and later arriving growth cones. By E4, the PAAs had elongated 3 segments both rostrally and caudally. In the course of their longitudinal elongation, the PAAs shifted their trajectory dorsally within the dorsal funiculus. By E6-6.5, the PAAs had extended as far as 10 segments rostrally and 6 segments caudally in the dorsal funiculus, and collaterals began to enter the dorsal horn. By E9, the PAAs extended up to 13 segments rostrally and 7 segments caudally, and collaterals reached the ventral spinal cord. During their longitudinal course, the PAAs shifted their trajectory medially within the dorsal funiculus.

Vitamin B6 phototoxicity induced by UVA radiation

We have previously reported that pyridoxine shows UVA-induced cytotoxicity. Four other vitamin B6 compounds (pyridoxal, pyridoxamine, pyridoxal phosphate, and pyridoxamine phosphate) are metabolically more important in vivo than pyridoxine. These compounds were examined for UVA phototoxicity to cultured human fibroblasts. The cytotoxicity was measured by post-UVA irradiation colony-forming ability. All the B6 compounds except pyridoxal phosphate showed cytotoxicity. Pyridoxamine phosphate, which is the most important form of vitamin B6 in vivo, had the strongest cytotoxic effect. To examine the involvement of reactive oxygen species in the phototoxicity, we performed an electron spin resonance study using the spin trapping agent, 5,5-dimethyl-1-pyrroline N-oxide, and diethylenetriaminepentaacetic acid. We failed to detect radicals derived from vitamin B6. The cytotoxic effect remained in UVA-irradiated solutions for at least 30 min after the end of UVA irradiation. Hydrogen peroxide was produced in the solution, but the amount was not enough to cause cytotoxicity. In addition, the cells from xeroderma pigmentosum patients who belong to group A or C showed survival curves similar to those of normal fibroblasts. This suggests that cyclobutane pyrimidine dimers or 6-4 photoproducts of DNA were not involved in this damage. These findings suggest that UVA-induced vitamin B6 cytotoxicity is caused by toxic photoproducts resulting from irradiated vitamin B6.

Developmental changes in the localization of activated C-JUN N-terminal kinase (JNK/SAPK) in the chick spinal cord

To examine the role of c-Jun N-terminal kinase (JNK/SAPK) in the developing nervous system of vertebrates, the localization of an active form of JNK, phosphorylated JNK (p-JNK), was studied in the lumbosacral spinal cord of the chick embryo. We also examined the localization of phosphorylated neurofilaments (NFs, potential targets of p-JNK) and cyclin-dependent kinase 5 (Cdk5), which is known to phosphorylate cytoskeletal proteins, including NFs, and compared their expression with that of p-JNK. Additionally, the localization of phosphorylated forms of c-Jun and ATF-2 was compared with that of p-JNK. On embryonic day 3 (E3), the expression of p-JNK was observed in regions containing early-projecting axons. Axons in these regions also expressed phosphorylated NFs. Subsequently, on E5 and E8, the expression of both p-JNK and phosphorylated NFs increased concomitantly in the axonal tracts in the spinal white matter. Thus, white matter expressed both p-JNK and phosphorylated NFs, whereas there was only weak expression of Cdk5. By E13, the spinal cord expression pattern of p-JNK and phosphorylated NFs had changed compared to earlier ages. Although phosphorylated NFs were still expressed in the white matter, the expression of p-JNK was decreased in axons in the white matter, whereas strong p-JNK expression appeared in cell nuclei in the gray matter. In summary, the present study revealed that the localization of p-JNK in the spinal cord changes dramatically from axons to cell nuclei during development, suggesting multiple roles of p-JNK, depending on the developmental age.

A new dynamic myocardial phantom for the assessment of left ventricular function by gated single-photon emission tomography

Gated myocardial perfusion single-photon emission tomography (SPET) has been used for the measurement of left ventricular (LV) function and validated by means of comparison with other imaging modalities. We have designed a new dynamic myocardial phantom in order to validate the LV function as assessed by the use of gated myocardial perfusion SPET. The phantom consists of two half-ellipsoids (an endocardial surface and an epicardial surface) and a thorax. The myocardial space is filled with a radioactive solution. The endocardial surface moves continuously towards and away from the epicardial surface in the longitudinal axis to vary the LV volume [143 ml at end-diastole (ED), 107 ml at end-systole (ES)] and thickness (apex 8 mm at ED and 26 mm at ES, midplane 8 mm). The mean values of wall motion (WM) for the apical midplane region and the basal midplane region were 5 mm and 2 mm, respectively. Gated myocardial SPET was performed during 8 and 16 intervals. These projection data sets were processed using a Butterworth filter with an order of 5 and a critical frequency of 0.34 cycles/cm. LV function was calculated using the quantitative gated SPET (QGS) algorithm. The LV function values estimated by gated SPET during 16 intervals [22% for ejection fraction (EF), 3.7 mm for WM of the apical midplane, 1.7 mm for WM of the basal midplane] closely resembled actual LV functions [25% for EF, 5 mm for WM of the apical midplane, 2 mm for WM of the basal midplane]. However, the estimated values during 8 intervals were smaller than those during 16 intervals (19% for EF, 3.3 mm for WM of the apical-midplane, 1.1 mm for WM of the basal-midplane). The estimated LV volumes closely correlated with the actual volumes (r=0.99 for 16 intervals, r=0.95 for 8 intervals). Utilizing this phantom, LV function estimated using gated myocardial SPET can be compared with actual values.

The involvement of axonin-1/SC2 in mediating notochord-derived chemorepulsive activities for dorsal root ganglion neurites

Previous studies have suggested that the developing notochord secretes diffusible axon guidance molecules that repel dorsal root ganglion (DRG) neurites (R. Keynes et al., 1997, Neuron 18, 889-897; K. Nakamoto and T. Shiga, 1998, Dev. Biol. 202, 304-314). Neither notochord-derived chemorepellents nor their receptors on DRG neurites are, however, known. Here we investigated whether cell adhesion molecules (CAMs) of the immunoglobulin/fibronectin type III subfamily present on DRG neurites, including axonin-1/SC2, N-CAM, Ng-CAM, and Nr-CAM, are required for mediating the notochord-derived chemorepulsion. Using collagen gel cocultures of DRGs and notochord explants, we found that an antibody against axonin-1/SC2 diminished the effects of the chemorepulsive activity from the notochord, whereas antibodies against N-CAM, Ng-CAM, and Nr-CAM had no effect. We further showed that the removal of glycosylphosphatidylinositol-anchored cell surface molecules, including axonin-1/SC2, from DRG neurites diminished the effects of the notochord-derived chemorepulsive activity to an extent similar to that of treatment with the anti-axonin-1/SC2 antibody. These results suggest that axonin-1/SC2 expressed on DRG neurites may be involved in mediating the notochord-derived chemorepulsive activity.

Delayed hypotensive effect of the thromboxane A2/prostaglandin H2 receptor antagonist S-1452 in spontaneously hypertensive rats

1. Several lines of evidence indicate that thromboxane (Tx) A2 may contribute to the development and maintenance of hypertension. The present study was undertaken to evaluate the role of TxA2 in the development of hypertension in spontaneously hypertensive rats (SHR) by using an orally active, highly specific TxA2/prostaglandin H2 receptor antagonist S-1452. 2. Vehicle (1% arabic gum solution) alone was given orally to Wistar-Kyoto (WKY) rats (n = 15) and SHR (n = 14), while S-1452 (10 mg/kg per day, twice daily) was administered orally to SHR (n = 16) for 18 weeks (from 5 to 23 weeks of age). 3. No significant difference was observed in tail-cuff blood pressure (BP) between vehicle- and S-1452-treated SHR before and at 5 and 11 weeks after treatment. Thereafter, BP was further elevated in vehicle-treated SHR, but was significantly blunted in SHR treated with S-1452 at 15 (224+/-8 vs 211+/-13 mmHg; P < 0.01) and 18 weeks (227+/-9 vs 206+/-10 mmHg; P < 0.001); this was associated with reduced proteinuria. 4. Urinary TxB2 in vehicle-treated SHR, especially during the early period, was significantly greater than that in WKY rats, while no significant difference was observed in urinary 6-ketoprostaglandin F1alpha (6-keto-PGF1alpha) between the two groups. Treatment with S-1452 reduced urinary excretion of TxB2 at 18 weeks. 5. The present study shows that S-1452, at the dose used, does not reduce BP during the early period of the development of hypertension. These results suggest that the role of enhanced TxA2 production in the development of hypertension is small, if any, in SHR. Delayed response of BP may be independent of the direct pharmacological effects of S-1452.

Experimental use of a transportable hyperbaric chamber durable for 15 psi at 3700 meters above sea level

A transportable hyperbaric chamber durable for 15 psi of pressure was used to treat a patient suffering from moderate acute mountain sickness at 3700 m above sea level. The symptoms were ameliorated a few minutes after pressurization in the chamber. After a 20-minute stay in the chamber, the patient was completely free of symptoms. Since the chamber can be inflated by using compressed air from a cylinder, no strenuous work was required of the operators. This transportable chamber seems to be useful for the treatment of high-altitude disorders at around 3000 m above sea level.

Minor cardiac troponin T release in patients undergoing coronary artery bypass graft surgery on a beating heart

OBJECTIVES

To determine whether and to what extent coronary artery bypass graft (CABG) surgery without extracorporeal circulation is associated with cardiac troponin T (TnT) release.

DESIGN

Prospective study.

SETTING

A single university hospital.

PARTICIPANTS

Twenty-three patients scheduled for minimally invasive CABG surgery. Sixteen patients received one coronary anastomosis, and seven received two.

INTERVENTIONS

TnT and creatine kinase-MB (CK-MB) levels were determined immediately before induction of anesthesia (baseline) and at 0, 12, and 24 hours after surgery. Hemodynamic measurements were made, and 5-lead electrocardiograms with continuous automated ST-segment trends were analyzed.

MEASUREMENTS AND MAIN RESULTS

All patients had a good cardiac outcome. Median cumulative coronary artery occlusion time was 27 minutes (range, 10 to 49 minutes). TnT levels were undetectable in 91.3% of patients at baseline when a detection limit of 0.01 ng/mL was employed. TnT and CK-MB showed significant elevations at 12 and 24 hours versus baseline. Postoperatively, TnT was detectable in 91.3% of patients, and 17.4% suffered minor myocardial damage, as evidenced by an abnormal increase in TnT greater than 0.2 ng/mL, excluding those exhibiting myocardial infarction. ST segment changes developed in seven patients, persisting for 13.0 minutes (range, 9.5 to 15.8 minutes) and disappearing immediately after coronary artery clamp release. There were no significant correlations between cumulative coronary occlusion time and peak TnT or CK-MB levels.

CONCLUSIONS

TnT was detected after surgery in most patients, and significant TnT levels indicative of myocardial injury (>0.2 ng/mL) were detected in only 17% of patients, probably as a result of brief periods of coronary artery occlusion.

Comparison of muscle oxygen consumption measured by near infrared continuous wave spectroscopy during supramaximal and intermittent pedalling exercise

The two purposes of the present study were 1) to determine the oxygen consumption in working skeletal muscle from the oxygenation measured by near-infrared continuous-wave spectroscopy (NIRcws) with the arterial occlusion method during the resting condition, INT(VT), and INT(MAX) and 2) to examine whether the decline rate of oxygenation is related to maximal oxygen uptake. Eight healthy males (aged 19.8 +/- 0.4 yr, height 166.9 +/- 17.4 cm, weight 62.1 +/- 2.5 kg, and maximal oxygen uptake [VO2max] 55.9 +/- 1.9 ml/kg x min(-1)) took part in this study. The oxygenation was measured by NIRcws during the Wingate anaerobic test (WAnT) and two intermittent pedalling exercises of VT (INT(VT)) and maximal (INT(MAX)) work intensity. The decline rates of oxygenation obtained during the resting condition, INT(VT), and INT(MAX) with arterial occlusion were 0.43 +/- 0.05%/sec, 4.94 +/- 0.31%/sec, and 8.16 +/- 0.38%/sec, respectively, and that during the WAnT without arterial occlusion was 8.73 +/- 0.49%/sec. The decline rate of oxygenation during the WAnTwas significantly (p < 0.0001) related to maximal oxygen uptake (VO2max). These findings indicate that O2 is utilized from the early phase, even during a supramaximal pedalling exercise, and that the oxidative metabolic capacity may be a factor contributing to supramaximal exercises. Therefore the arterial occlusion method with NIRcws is suitable for the evaluation of the muscle O2 consumption during exercise noninvasively.

Effect of cimetidine and probenecid on pilsicainide renal clearance in humans

OBJECTIVE

To investigate the effect of cimetidine and probenecid on the renal clearance of pilsicainide in healthy subjects.

METHODS

Nine healthy men (age range, 21 to 38 years) were given oral doses of 50 mg pilsicainide hydrochloride alone, with coadministration of 800 mg oral cimetidine, or with coadministration of 1,500 mg oral probenecid on three occasions in a Latin-square order. Urine and venous blood samples were collected on a timely basis. The concentration of pilsicainide in plasma and urine were determined by an HPLC method.

RESULTS

Concomitant administration of cimetidine significantly increased the area under the plasma concentration-time curve of pilsicainide by a mean of 33%, prolonged elimination half-life by a mean of 24% (from 5 to 6.2 hours), reduced apparent oral clearance by a mean of 26% (from 14.7 +/- 0.1 to 10.8 +/- 0.8 L/h) and reduced renal clearance by a mean of 28% (from 196.8 +/- 53.9 to 141.8 +/- 25.9 mL/min). The net renal clearance by tubular secretion was significantly reduced by a mean value of 38%, from 151.4 +/- 62.9 to 93.0 +/- 31.1 mL/min. Coadministration of probenecid did not show any changes in plasma concentrations of pilsicainide, pharmacokinetics, or the net renal clearance by tubular secretion of pilsicainide.

CONCLUSIONS

Pilsicainide appeared to be secreted by the active transport system for organic bases in the proximal tubule, and the excretion of pilsicainide was inhibited by cimetidine.