Two technologically diverse functional measures of stenosis severity--Doppler-derived poststenotic hyperemic intracoronary flow reserve and vasodilator stress 99mTc-sestamibi myocardial perfusion imaging--are highly (89%) correlated. The physiological assessment of coronary stenoses of angiographically intermediate severity may be improved by the use of these techniques.

to effect their critical functions. Certain myeloid growth factors, including G-CSF, inhibit random migration of neutrophils in vitro and theoretically may alter neutrophil G-CSF administration to normal donors results in granulocyte apheresis yields generally greater than those migration to these sites in vivo. 11 To assess the distribution of G-CSF-mobilized neutrophils in vivo, LA products col-observed with other neutrophil mobilizing agents. In vitro, neutrophils cultured with G-CSF exhibit pro-lected from normal donors receiving G-CSF were labeled with indium-111 and infused into neutropenic allogeneic longed survival; however, the random migration of neutrophils exposed to this agent is inhibited. Although BMT recipients. Serial scintigraphic images were obtained post-infusion. Results of this pilot study of five patients transfused neutrophils mobilized with agents other than G-CSF migrate to sites of inflammation or infection in support the hypothesis that G-CSF-mobilized neutrophil products retain their ability to localize to sites of inflam-vivo, this has yet to be demonstrated with infusion of G-CSF-mobilized neutrophils into neutropenic human mation in vivo. subjects. Five neutropenic allogeneic bone marrow transplant (BMT) patients each received a fresh infusion of G-CSF-mobilized indium-labeled irradiated Methods white blood cells (WBC) apheresed from HLA-matched normal donors on day +5 post-transplant. Localization In all cases, the donor of the granulocyte apheresis products was also the donor of the bone marrow product for each of activity on delayed scintigraphic images of indiumlabeled WBC scans to sites of tissue damage recipient. The protocol was approved by the Institutional Review Board and accrued five donor/recipient pairs. Eligi-(oral/nasopharynx in two patients with mucositis and terminal ileum/cecum in one with diarrhea) occurred, bility criteria for donors included age у15 and р70 years, WBC у4000/l, ANC у1500/l, platelet count and supports the hypothesis that G-CSF-mobilized HLA-matched donor neutrophils which have been у100 000/l, hematocrit (Hct) у30%. All donors were HLA-A, B, DR six antigen serologic matched and ABO irradiated are functional after infusion into neutropenic recipients. compatible with the recipients. Otherwise, donors satisfied standard blood donation criteria as determined by the Food Keywords: granulocyte transfusions; G-CSF; indium labeled and Drug Administration (FDA) and as interpreted by the Blood Bank Director. Recipients between the ages of 15 and 55 years undergoing related donor allogeneic BMT for malignant disease were eligible. Alloimmunization, as G-CSF is a safe and effective agent for mobilization of defined by unresponsiveness to platelet transfusions, 12 was neutrophils in normal donors, consistently resulting in cell not evident in the study recipients. Antileukocyte antibodies yields of 4-10 × 10 10 per leukapheresis (LA) procedure 1,2 were not measured. Informed consent for entry of recipients as opposed to Ͻ3 × 10 10 cells/LA procedure with ot...

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The noninvasive diagnosis of coronary artery disease in the elderly can occasionally be difficult. Intravenous dipyridamole-thallium imaging is a potentially useful diagnostic test to determine presence and severity of coronary disease; however, the safety of the procedure has not been determined in an older population. The side effect profile and frequency of severe ischemic responses after 0.56 mg/kg of intravenous dipyridamole were compared in 101 patients greater than or equal to 70 years old and 236 patients less than 70 years old. There were no side effects in 64% and 62% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). Among the 337 patients tested, there were no complications of myocardial infarction or death. The most common cardiac side effect was chest pain, which occurred in 21 (21%) of the 101 patients aged greater than or equal to 70 years and in 64 (27%) of the 236 patients less than 70 years (p = NS). Aminophylline was required to reverse cardiac or noncardiac side effects in 15 (15%) and 36 (15%) of the patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). A severe ischemic response occurred in 2% and 2.5% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). The sensitivity of intravenous dipyridamole-thallium imaging for obstructive coronary artery disease was 86% (25 of 29) and 83% (68 of 82) in older and younger patients, respectively (p = NS); the specificity was 75% (6 of 8) and 70% (16 of 23), respectively (p = NS). Thus, intravenous dipyridamole-thallium imaging is a safe noninvasive method for assessment of older patients with obstructive coronary disease; its side effect profile and diagnostic accuracy are similar to those seen in younger patients. The technique is associated with severe ischemic responses in only a small minority of patients.