Laboratory diagnosis of 24 cases of human cytomegalovirus (HCMV) infection in patients with the acquired immunodeficiency syndrome, renal transplant recipients and premature infants was achieved. These results were obtained by a rapid, sensitive and versatile HCMV-antigen detection method, which combined cell culture and immunoperoxidase staining with a monoclonal antibody to an HCMV "early" nuclear protein. The results were compared with HCMV isolation by the conventional cell culture method. While some of these immunocompromised patients lacked a significant antibody response, infective HCMV could be detected in the patients' urine and bronchial lavage fluid. The diagnostic procedure took no longer than 24 h. The usefulness of this antigen test for an effective diagnosis in immunocompromised individuals was demonstrated. We recommend routine analysis of various specimens, since recent developments in chemotherapy of HCMV infection and the risks of long-term damage demand immediate management of the patients concerned.

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Endothelium-dependent and endothelium-independent vasodilation of the epicardial conduit vessels and the microcirculatory coronary vessels was investigated with cumulative doses of acetylcholine (ACh 50 micrograms and 100 micrograms i.c.), nitroglycerin (0.3 mg i.c.) and dipyridamole (0.56 mg.kg-1 i.v.) in 17 patients (3 female/14 male; age: 47 +/- 3.6 years) with angiographically normal coronary arteries 40 +/- 5.1 months after cardiac transplantation. The effect of ACh on large conduit arteries was evaluated angiographically. Coronary blood flow velocity changes were measured utilizing an 8F Judkins style 20 MHz Doppler catheter positioned in the left main coronary artery. A coronary flow index was calculated from the mean Doppler flow velocity and the computed cross-sectional vascular area. After 50 micrograms of ACh the diameter of proximal, middle and distal segments of the left anterior descending coronary artery decreased significantly by 7.6 +/- 2.06% (P < 0.05), 10.6 +/- 3.5% (P < 0.01) and 12.6 +/- 3.29% (P < 0.01) and after 100 micrograms ACh by 10.5 +/- 2.4% (P < 0.05), 13.0 +/- 3.7% (P < 0.01) and 15.3 +/- 3.9% (P < 0.01). The endothelium-independent vasodilator nitroglycerin (0.3 mg i.c.) induced an increase in vascular diameter of 14.4 +/- 3.1% (P < 0.01), 18.6 +/- 4.1% (P < 0.01) and 20.8 +/- 2.9% (P < 0.01) in proximal, mid and distal segments of the left anterior descending coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

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Upright tilting leads to pooling of blood in the legs. One of the normal compensatory responses is a reflex tachycardia which our patient did not show as a sign of an afferent defect. Patients with orthostatic hypotension as a prominent symptom should be investigated with a standardized tilt test. In special patients, additional neurological investigations are necessary.