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Effects of thrombotic coronary occlusion followed by thrombolytic reperfusion with recombinant tissue-type plasminogen activator (rt-PA) on infarct size and left ventricular function were studied in anesthetized closed chest dogs. After thrombotic occlusion of the left anterior descending coronary artery was produced by a copper coil technique, 74 dogs were randomly allotted to three groups; dogs treated with rt-PA at 90 min (n = 23) (group I) and at 180 min (n = 25) (group II) of the thrombotic occlusion, and 26 dogs treated with saline solution (permanent thrombotic occlusion, group III). The loading dose of intravenous rt-PA was 8,160 IU/kg body weight per min at the initial 60 min and the maintenance dose was 2,450 IU/kg per min continuously infused far 24 h.Thrombolytic recanalization was achieved at 15 ± 4 and 18 ±6 min after rt-PA infusion in groups I and II, respectively. Infarct size and area at risk were determined by triphenyltetrazolium chloride staining and postmortem angiography; infarct size/area at risk ratio was 10 ± 3% (n = 10), 33 ± 7% (n = 9) and 63 ± 3% (n = 10) in groups I, II and III, respectively (difference significant among groups). To examine whether infarct size and left ventricular function after thrombolytic reperfusion differ from those after mechanical reperfusion, 39 other dogs (group IV) underwent mechanical coronary occlusion for 106 ± 1 min (occlusion period comparable with that of group I) and reperfusion using a balloon catheter. Infarct size/area at risk ratio in group IV was 27 ± 5% (n = 12), which was smaller than that in group III (p < 0.01) and larger than that in group I (p < 0.05). The abnormally contracting area within the left ventricle in groups I and IV was 33 ± 5% and 38 ± 3%, respectively, at 90 min, and 9 ± 4% and 33 ± 4% (p < 0.01) at 24 h of coronary occlusion.The results suggest that thrombolylic reperfusion with timely administration of rt-PA had more beneficial effects on infarct size and left ventricular function than did mechanical occlusion and reperfusion.

Using an intracellularly trapped dye, quin 2, effects of adenosine on intracellular free calcium concentrations ([Ca2+]i) were recorded, microfluorometrically, using rat aortic medial vascular smooth muscle cells (VSMCs) in primary culture. Regardless of whether cells were at rest (in 5 mM K+), at K+-depolarization (in 55 mM K+) or at Ca2+ depletion (in Ca2+-free media), adenosine induced a rapid reduction of [Ca2+]i, following which there was a gradual increase to pre-exposure levels, in cells at rest and in the case of Ca2+ depletion. Only when the cells were depolarized (55 mM K+) did adenosine induce a new steady [Ca2+]i level, lower than the pre-exposure value. These findings indicate that decrease in [Ca2+]i by adenosine is one possible mechanism involved in the adenosine-mediated vasodilatation, and that adenosine decreases [Ca2+]i by direct extrusion, by sequestration, or by inhibiting the influx of Ca2+ into VSMCs.

The mechanisms of epicardial coronary artery dilation after reactive hyperemia were studied in instrumented conscious dogs. A pair of ultrasonic crystals, an electromagnetic flow probe and a cuff occluder were placed on the left circumflex coronary artery in 12 mongrel dogs under sterile conditions. Reactive hyperemia after 20 s of coronary occlusion dilated the epicardial coronary artery by 120 +/- 14 micron (3.8 +/- 0.6%, p less than 0.01) from 3.167 +/- 0.345 mm. This reactive dilation was abolished by flow-limiting coronary stenosis. However, vasodilation after nitroglycerin was 168 +/- 26 micron (5.1 +/- 0.5%) and 162 +/- 27 micron (4.9 +/- 0.6%), respectively, before and after flow limitation. After removal of the endothelium by a balloon catheter, dilation of the epicardial coronary artery after reactive hyperemia was markedly attenuated to 7 +/- 4 micron (p less than 0.01 versus before denudation), despite the presence of a similar degree of reactive hyperemia. The extent of coronary dilation after nitroglycerin was unchanged before and after de-endothelialization. Thus, the endothelium contributed to reactive dilation but not to the nitroglycerin-induced dilation. The negative feedback control of coronary diameter to changes in flow velocity may relate to the regulation of coronary artery tone.

Since indomethacin may be effective in the treatment of orthostatic hypotension, the ability of this drug to increase reflex vasoconstriction was studied in six patients with orthostatic hypotension and in five normal subjects. Reflex forearm vasoconstriction during lower body negative pressure at 20-40 mm Hg was measured before and after indomethacin 50 mg by mouth. In patients with orthostatic hypotension and central nervous system involvement indomethacin increased recumbent blood pressure, resting forearm vascular resistance, and reflex forearm vasoconstriction during lower body negative pressure. The fall in blood pressure with lower body negative pressure was not significantly inhibited by indomethacin, but mean blood pressure during lower body negative pressure was higher after than before indomethacin. Indomethacin did not alter these responses in normal subjects. The increase in reflex vasoconstriction with indomethacin may contribute to its therapeutic effects in the treatment of orthostatic hypotension.

In order to define the subcellular localization and characters of substances in the rat kidney which increase vascular permeability and produce angionecrosis, the following investigations have been undertaken: (1) subcellular fractionation by use of differential centrifugation and osmotic shock treatment with enzyme profile determination; (2) chromatographic separation of lysosomal contents with concanavalin A affinity column. Lysomal contents contained substances that induced an increase of vascular permeability of the rabbit skin and angionecrosis in the pancreas of the bilaterally nephrectomized rats and the spontaneously hypertensive rats. Lysosomal contents treated at 60 degrees for 30 min showed no renin activity and yet produced angionecrosis. Non-affinity fraction from concanavalin A column chromatography showed no renin activity but produced angionecrosis and an increase of vascular permeability of rabbit skin.

An unusual patient is described in whom electrophysiological studies strongly suggest the occurrence of Mahaim conduction. The patient whose electrocardiogram previously showed a left anterior hemiblock pattern then developed advanced atrioventricular (AV) block (AH block). Beats conducted through the atrioventricular node always had a short HV interval (20 ms) and QRS complexes of left anterior hemiblock pattern. Junctional escape beats always had a normal HV interval (50 ms) with normal intraventricular conduction. His bundle pacing showed the StV interval and QRS contour of escape beats. These findings suggest the existence of an accessory pathway (Mahaim fibres) passing from the area of block, presumably the uppermost portion of the His bundle, to the posteroinferior division of the left bundle-branch. The surface electrocardiogram did not show the characteristic delta wave of the Wolff-Parkinson-White syndrome. Our observations suggest that patients in whom there is conduction along Mahaim fibres may show only the pattern of intraventricular conduction defect without a delta wave.