On the role of Ca++ binding proteins as possible targets for Ca++ sensitizing agents. We describe the effects of various cardioactive compounds on the Ca++ activation of force production and ATPase activity in isolated contractile structures from mammalian heart and, in some cases, skeletal muscle. We show that: 1) the Ca++ sensitizing activity of APP 201-533 does not discriminate between cardiac and skeletal muscle and is, therefore, not based on interaction with cardiac troponin I phosphorylation at serine 20. 2) compounds like trifluoperazine or bepridil, both known to interact with calmodulin, increase the Ca++ sensitivity of the contractile structures of the heart, in high concentrations, as expected from the high natural abundance of troponin C. 3) DPI 201-106 interacts with calmodulin (and presumably with the structurally closely related troponin C) in the microM concentration range. Its high Ca(++)-sensitizing potency in skinned cardiac muscle and a certain sensitivity of this effect to the detergent Triton X-100 suggest accumulation of the hydrophobic compound in the myofibrillar protein lattice.


[New cardiotonic/inodilator agents: energetic aspects]. Inotropic agents alter myocardial oxygen consumption by influencing heart rate, by influencing preload and afterload due to vasodilation, and by direct effects on the myocardium. The latter critically depend on the pharmacologic mode of action. Inotropic agents which act by increasing cyclic AMP in the failing human myocardium increase myocardial energy turnover by their effects on excitation-contraction coupling, resulting in a considerable increase in the amount of calcium cycling. Glycosides, which increase contractile force independent of cyclic AMP, increase calcium cycling moderately and do not influence myocardial energy turnover significantly. Calcium-sensitizers, by increasing calcium-affinity of contractile proteins, may increase contractile force and decrease myocardial energy turnover. Peripheral vasodilation following the application of inotropic agents decreases myocardial oxygen consumption due to a decrease in systolic stress-time integral. The energy-saving effect of reduced preload and afterload may counterbalance a direct myocardial energy-wasting effect of some inotropic agents. An increase in heart rate due to inotropic interventions is unfavorable since 1) oxygen consumption increases in proportion to heart rate, and 2) contractile force of the failing human myocardium decreases. The latter was obvious from experimental and clinical studies showing that increasing heart rate increases contractile force and cardiac output in nonfailing human myocardium, but decreases cardiac performance in the failing human heart. In light of the inverse force-frequency relation in failing human myocardium, negative chronotropic drugs may represent a new class of "positive inotropic" agents. Agents reducing heart rate may be beneficial from an energetic point of view by reducing myocardial oxygen consumption and by improving myocardial perfusion due to a prolongation of diastole.


[The value of ACE inhibitors in heart failure (mechanism of action)]. ACE-inhibitors improve symptoms and prognosis in patients with heart failure. The V-Heft II trial has demonstrated that the beneficial effect of these agents is superior to unspecific vasodilators. Besides sustained arterial and venous vasodilation the inhibition of the neurohumoral axis is thought to play an important role. Angiotensin II and catecholamines not only exert vasoconstrictor effects, but might also contribute to vascular and myocardial growth. Thus, it may not be surprising that the beneficial effects of ACE inhibitors in heart failure only emerge during long-term therapy rather than after short-term administration. It has been shown that these agents improve blood flow to skeletal muscle during exercise after chronic therapy (not acutely), and there is some preliminary evidence that improvement of endothelial function might be involved in this effect, i.e., by reducing the degradation of bradykinin, an endothelial vasodilator. ACE inhibitors reduce LV hypertrophy, an important risk factor for cardiovascular disease and prognosis. Moreover, there is experimental evidence that ACE inhibitors can prevent and even reverse interstitial fibrosis in the left ventricle. Although the plasma renin activity may be normal in patients with chronic heart failure, recent data using polymerase chain reaction indicate that the tissue cardiac renin angiotensin system is activated in the failing human heart as assessed by measurements of angiotensin converting enzyme mRNA and angiotensinogen mRNA which may be an important target for ACE-inhibition.


[Value of ACE inhibitors in heart failure (clinical aspects)]. The use of ACE-inhibitors in patients with severe congestive heart failure is established on the basis of the results of the CONSENSUS I-study, which has shown that ACE-inhibitors in patients in NYHA class IV not only have improved functional parameters, but also improved survival. Recently published controlled data from studies including patients with mild to moderate heart failure (SOLVD-study) show a significant improvement of mortality in this subgroup. Comparing placebo and ACE-inhibitors, the effect of ACE-inhibitors on mortality is due to a reduction of progression of pump failure. Comparing vasodilator-therapy (hydralazine/isosorbide dinitrate) and ACE-inhibition in the V-HeFT II-trial showed, despite a transient increase in ejection fraction and exercise capacity during the vasodilator-therapy, a significant improvement in survival in the patients treated with an ACE-inhibitor. This was achieved by a reduction of the incidence of sudden cardiac death. From these recent data it can be concluded that ACE-inhibition is the therapy of choice in patients with mild to severe heart failure.


[Clinical aspects of differential drug therapy of chronic heart failure]. Treatment of chronic heart failure with ACE-inhibitors has greatly improved the prognosis. In addition to ACE-inhibitors, diuretics seem to be necessary to decrease mortality, whereas the importance of cardiac glycosides has not been demonstrated unequivocally. Nevertheless, modern treatment of chronic heart failure in all stages should be a combination of diuretics, digitalis, and ACE-inhibitors rather than a stepwise addition of drugs depending on the severity of the disease. An increased heart rate leads to increased myocardial O2-consumption, decreased O2-supply, ischemia, and reduced contractility. Betablocker-induced reduction of heart rate does, however, not necessarily improve symptoms or hemodynamic conditions. The optimal heart rate in large failing hearts is not known yet. Probably, it is dependent on the type and severity of myocardial disease or impairment. In this respect, the sarcoplasmatic release and uptake of Ca2+ plays the most important role in the disordered force-frequency-relation in chronic heart failure.


Time course of serum lipid and lipoprotein levels after coronary bypass surgery: modification by pravastatin. The time course of the changes in serum lipid and lipoprotein levels have been studied in 100 patients undergoing coronary artery bypass surgery. Marked decreases occur in the levels of cholesterol (-45%), HDL-cholesterol (-35%), LDL-cholesterol (-53%), Apo A1 (-43%) and Apo B (-43%) on the third day after the operation. In the control group the values gradually returned to preoperative levels which are reached after three months. Three months after the intervention, in the pravastatin-treated group (20 mg/day) the values of total cholesterol (-20%), LDL-cholesterol (-28%) and Apo B (-22%), remained significantly lower than in the control group (p 0.0001) and were lower over the whole duration of the study. The postoperative time course of HDL-cholesterol and Apo A1, however, was not significantly influenced by the administration of pravastatin.


Time course of serum Lp(a) in men after coronary artery bypass grafting. The serum Lp(a) time course was studied in 100 male patients who underwent coronary artery bypass grafting (CABG). The patients were randomized in a placebo (N = 50) and pravastatin treated (N = 50) group. The pravastatin regimen was 10 mg daily from the third postoperative day on and 20 mg daily after 1 week during 11 weeks. Lp(a) levels and serum lipids were analyzed at baseline, at 3 and 10 days, and at 4 and 12 weeks post-CABG. A decrease of serum Lp(a) levels at the third postoperative day was seen which parallels the changes noted with the other serum lipids when using extracorporeal circulation. In contrast with the other serum lipids, a slight but significant Lp(a) overshooting was noticed at day 10 followed by a decrease of the serum Lp(a) levels to preoperative levels 1 month after the acute event. The study clearly depicts that there is a significant time-dependent effect on the serum Lp(a) levels post-CABG and that there is no effect of treatment (pravastatin). The data also reveal that reliable postoperative Lp(a) measurements can be made at earliest 1 month post-CABG.


The diet and moderate exercise trial (DAMET): results after 24 weeks. W.H.O. and U.S. Dept. of Health and Human Services advocate a fat-modified, fruits and vegetable-enriched diet in conjunction with mode-rate physical activity for fitness and health. The Diet and Moderate Exercise Trial (DAMET) is a randomized and controlled study and has provided scientific proof, possibly for the first time, to the above hypothesis (based on epidemiologic studies, short clinical trials and experimental studies) that the new approach can cause modulation of risk factors of coronary heart disease (CHD) as well as improve fitness. In the DAMET, 231 group A and 232 group B patients with risk factors of CHD were administered a prudent diet for 4 weeks, group A patients in addition were also given at least 400 g/day of fruits and vegetables that are rich in dietary fibre and antioxidants such as vitamins A, C, E, carotene and copper, selenium and magnesium. Fruits and vegetables were administered in a foods-to-eat approach by asking the patients to eat these foods before meals when they were hungry to allow better nutrient adequacy. After 4 weeks, group A patients also did moderate exercise such as brisk walking and spot running compared to no such advice to group B for another 20 weeks. After a follow-up period of 24 weeks, adding exercise to diet was associated with a significant decrease in blood total cholesterol (8.9%) and LDL-cholesterol (6.7%) and triglycerides (11.9%) and a marked increase in HDL-cholesterol (16.5%). Mean blood pressures, fasting blood glucose, body weight, body mass index, waist-to-hip ratio and subcutaneous fat also showed a significant decrease in group A, leading to a significant decrease in 12-year CHD risk. A long-term follow-up may be necessary to demonstrate the role of this new approach in decreasing cardiovascular morbidity and mortality.


[Hypoglycemia in diabetes mellitus].

[Hypoglycemia in diabetes mellitus]. Type 1 diabetic patients experience symptomatic hypoglycemia once or twice a week. 30% of insulin-treated patients suffer from hypoglycemic coma at least once during their life, 10% at least once a year. 3% are incapacitated by frequent and severe attacks, 3 to 4% die from hypoglycemia. In contrast the incidence of symptomatic hypoglycemia in sulfonylurea-treated patients is about 0.2 per 1000 patients' years, the mortality of severe attacks being about 8%. The cause of hypoglycemia is always an excess of insulin, in absolute or relative terms. Additional precipitating factors are defective counterregulation after longer duration of diabetes, as well as a lowered threshold for counterregulation and/or for perception of warning symptoms, as seen under strict glycemic control. Considering the risks associated with hypoglycemia, preventive measures must be emphasized.


[Is the patient with respiratory failure adequately cared for these days?]. Pulmonary function studies in 20,000 non-clinical probands throughout Austria showed abnormal findings in 20%. This is further evidence that chronic obstructive pulmonary disease (COPD) is epidemiologically similar to coronary heart disease. A staging classification of COPD has been proposed to facilitate a strategy for the prevention of the disease and to permit coordination among general practitioners, specialists and pulmonary function laboratories. This initiative aims to reduce the prevalence of advanced (stage IV) COPD. In the meantime long-term oxygen therapy and respirator therapy should be used increasingly to improve the quality of life of patients with advanced COPD.


[Functional and clinical differentiation of chronic respiratory failure]. Respiratory insufficiency is defined as hypoxemia due to bronchopulmonary disorders. The site of the underlying disease can be exclusively in the parenchyma and vessels of the lung, but also in the pumping mechanisms with resulting CO2-retention. A combination of these phenomena is usually seen in patients of the predominant bronchitic Type B of chronic obstructive lung disease. Vascular and parenchymatous lesions cause hypoxemia by decrease of diffusion capacity, distribution inequality of blood flow and ventilation, and also shunting mechanisms. CO2-retention is not to be expected in these cases. The therapeutic approach is based on the individual predominance of functional findings in a given patient, and include medication to relieve bronchial obstruction, substitution of oxygen and measures for mechanical support of breathing. Especially bronchial obstruction should be identified as early as possible in the course of the disease in order to prevent inevitable and irreversible morphological changes.


[Conventional therapy exemplified by COPD]. Conventional therapies are those, that are generally agreed on and applied. With COPD these are strongly anti-inflammatory corticosteroids, bronchodilatant betamimetics, vagolytics and theophyllines, within certain indications antibiotics, secretolytics and secretomotorics, physical therapy and therapy of secondary effects. At present those measures, that might mitigate the status of patients importantly, e.g. patient training and beyond this early diagnosis and therapy to improve the prognosis are still unconventional. Prophylactic measures, importantly influencing pathogenesis and progression of the disease, would be of special importance. Prevention of cigarette smoking would show the greatest benefit. It would be desirable, that these unconventional measures would be more widespread in use than is presently the case.


Intravenous therapy of chronic obstructive pulmonary disease with sodium glycinate theophylline monitored by a new bed side theophylline assay. Although the therapy of airway obstruction with theophylline is well established, unwanted side effects can occur: overdosage and reactions to ethylendiamine, an additive to increase the solubility of theophylline. Frequent measurements of the theophylline blood levels and the use of ethylendiamine free preparations can avoid such problems. Therefore, we studied the validity of a new immunochromatographic bed side assay (Acculevel) prior and after infusion of sodiumglycinate-theophylline (Theospirex) in 13 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Although theophylline levels increased above the therapeutic range (20 mg/L) in half of the patients after the infusion of 400 mg Theospirex in 1 hour, no toxic effects could be denoted. In addition, no influence on blood pressure and heart rate were found. We observed good correlations between this new immunochromatographic assay and theophylline levels measured with 2 well established reference methods (HPLC and turbidimetry, r = 0.87 and 0.91, respectively), although Acculevel revealed slightly higher values. Thus, the use of sodium-glycinate-theophylline and the new, fast bed side test system seems of practical importance in the therapy of COPD by potentially avoiding undesirable side effects.


[Genetic principles of malignant transformation]. Genetic alterations such as translocations, deletions or point mutations often result in a loss of function. Such alterations may contribute to oncogenesis by interference with mechanisms restraining cellular growth. However, mutations of protooncogenes can also result in abnormal positive signals for cell proliferation. Some concepts resulting from genetic approaches to identify the genes that may be involved in the regulation of cell multiplications are discussed.


[Insulin resistance].

[Insulin resistance]. Insulin sensitivity of insulin dependent tissues (muscle, adipose tissue, liver) is subject to a variety of influences. Any change in insulin sensitivity is compensated in healthy subjects by a dynamic change in insulin secretion, which will decrease following a rise in insulin sensitivity and increase if insulin sensitivity is impaired (i.e. during insulin resistance induced by obesity, pregnancy, oral contraceptives, dehydration, saturated fatty acids, fever, drugs, etc.). In contrast to secondary insulin resistance idiopathic insulin resistance in type 2 diabetic individuals is associated with impaired insulin secretion, which thus is unable to overcome impaired insulin sensitivity. Idiopathic insulin resistance in type 2 diabetes is additionally characterized by reduced glucose storage, the basis of which may reside in an insulin receptor defect, in the presence of insulin receptor antibodies, in a postreceptor defect or in the synthesis of abnormal insulin molecules.


Correlation between mitochondrial enlargement in renal proximal tubules and microalbuminuria in rats with early streptozotocin-induced diabetes. To clarify the ultrastructural changes in renal proximal tubules causing microalbuminuria in the early stage of diabetic nephropathy, three different groups of rats were prepared: rats with streptozotocin (STZ)-induced diabetes given no treatment (DMut; n = 7), rats with STZ-induced diabetes treated with insulin (DMt; n = 7), and non-diabetic rats injected with citrate buffer (control; n = 7). In each group, the laboratory findings, ATP content of the renal cortex, and the size of proximal tubule cells and their nuclei and mitochondria (MT) were determined. In two weeks after the start of the study, MT in renal proximal tubules showed diffuse enlargement in the DMut group as compared with those in the control group. Renal cortical ATP content, fractional sodium excretion (FENa), urinary excretion of beta 2-microglobulin and albumin were also increased significantly in the DMut group relative to the controls. In the DMt group, most of the examined parameters returned almost to normal. There were positive correlations between each of the following parameters: hyperglycemia and MT enlargement, MT enlargement and increased cortical ATP content, increased cortical ATP content and increased FENa, increased FENa and increased urinary excretion of beta 2-microglobulin and albumin. On the basis of these results, we conclude that mitochondrial enlargement, resulting from disturbed metabolism of ATP, may reduce active transport in renal proximal tubules, which, in turn, may impair reabsorption in the tubules. This would cause urinary excretion of low-molecular-weight proteins and microalbumin in the early stage of diabetic nephropathy.


Changes in spermatozoa due to large doses of pyridoxine (vitamin B6). To investigate the changes of spermatozoa by high doses of vitamin B6 (B6), the alterations in spermatozoa and testis of rats after the administration of high doses of B6 were evaluated quantitatively and morphometrically. Wistar rats of 11 weeks of age were intraperitoneally injected with 63, 125, 250 and 500 mg/kg of B6 daily 5 times per week for 6 weeks. Using the spermatozoa taken from the epididymis and ductus deferens, the number, motility and nuclear morphology of spermatozoa were examined. After preparing 7 parameters for the nuclear morphology, the morphometry was performed by an IBAS version 2 (Zeiss) image analysis system. The number of spermatocytes and spermatids in representative stages of spermatogenesis was counted per Sertoli cell histologically. Mild deformation of spermatozoa nuclei occurred in the 63 mg or more exposure groups. In the 125 and 250 mg groups, the decrease in number as well as motility of spermatozoa together with slight decrease of spermatids in late maturation phase (mature spermatids) and the delay in spermiation appeared. Phagocytosis of mature spermatids by Sertoli cells was clearly increased in the 250 mg group. The alteration and the decreased number of spermatozoa are suggested to have mainly resulted from alteration of mature spermatids and the increased phagocytosis of mature spermatids by Sertoli cells. Computer-assisted morphometry of spermatozoa nuclei was useful not only to evaluate morphological changes objectively but also to discern them early.


Pancreatic islet abnormalities in sudden infant death syndrome. Qualitative and quantitative analyses of 15 cases. The pancreata of 15 autopsy cases of sudden infant death syndrome (SIDS) and those of 14 age-matched controls were examined qualitatively and quantitatively to re-evaluate the relationship between pancreatic islet abnormalities and sudden death in infancy. Histopathologically, a diffuse or focal form of nesidioblastosis and septal islets were frequently observed in the pancreata of both groups. Endocrine cell dysplasia was found only in 2 infants who had died of SIDS. Quantitatively, there was little difference of islet cell composition between the SIDS cases and the controls. A relatively high proportion of islet cell area to total pancreatic tissue area was demonstrated in the SIDS group (8.46 +/- 4.90% in the pancreatic head; 8.66 +/- 4.23% in the pancreatic body to tail) in comparison with the controls (5.32 +/- 1.77%; 5.63 +/- 1.60%). Although nesidioblastosis and septal islets were considered to be within the limits of normal variation during pancreatic development, endocrine cell dysplasia and quantitatively unusual proliferation of the pancreatic endocrine tissue suggest the possibility that abnormalities in the endocrine pancreas may be causally related to sudden death in infancy.


Pulmonary blastoma. Comparison between its epithelial components and fetal bronchial epithelium. Three cases of pulmonary blastoma exhibiting biphasic epithelial and stromal patterns, and a case of fetal lung-type adenocarcinoma, were examined by immunohistochemistry and electron microscopy (EM) and compared with fetal bronchial epithelium in order to explore the multidirectional differentiation of their epithelial components. The glandular cells of all four tumors resembled fetal bronchial epithelial cells in the pseudoglandular stage. Neuroendocrine (NE) cells were also present; they were argyrophilic and expressed pan-NE markers, neurosecretory granules and peptide hormones. The neural cell adhesion molecule (NCAM) was strongly expressed on the cell membranes of glandular cells, as in the case of proximal bronchial epithelial cells at the pseudoglandular stage in fetal lung. Sialosylated Lewis X was also expressed, indicating that the epithelial cells were possibly of endodermal origin. Two of the four cases showed considerable immunoreactivity for alpha-fetoprotein (AFP). The epithelial cells of pulmonary blastomas may occasionally de-differentiate into cells functionally resembling fetal hepatic, foregut and yolk sac cells expressing AFP. Tumor examination by immunohistochemistry and EM suggested that the glandular cells of the tumors may differentiate to some extent like those of fetal large bronchi at the pseudoglandular stage, but there was concordance and discordance in the expression of neuroendocrine and oncofetal markers between blastomatous tumors and fetal bronchial epithelium.


Multinodular deposition of AA-type amyloid localized in the adrenal glands of an old man. Multinodular amyloid deposits localized in non-neoplastic adrenal glands were found incidentally at autopsy in an 83-year-old Japanese man. Clinically, the patient lacked evident deficiency of adrenal hormones. The nodules of the stromal amyloid deposits were scattered in the adrenal cortex, where the parenchymal cells were compressed and atrophic. The deposits were confirmed to be amyloid by Congo red staining and polarization microscopy. Amyloid fibrils were also demonstrated in the deposits by electron microscopy. The amyloid deposits were permanganate-sensitive and showed immunohistochemical staining for serum amyloid P component and serum amyloid A protein (SAA), implying that they were AA amyloid. There have been no reports describing localized amyloid deposits of the AA type in non-neoplastic adrenal glands. The pathogenesis and clinical significance of the amyloid deposition in the present case remain only speculative.


A case of intramural uterine stromal tumor with epithelial differentiation. A case of intrauterine tumor in a 62-year-old Japanese woman is presented. It was thought initially that this was a case of uterine tumor resembling an ovarian sex cord tumor. To examine the cytological features of the tumor cells, electron microscopical and immunohistochemical studies were done, and a hormone assay of the tumor tissue was performed. The tumor cells were rich in rough endoplasmic reticulum (rER), mitochondria and microfilaments. Some tumor cells tended to form glandular patterns, but these epithelial elements were frequently scattered among fibrous stromal elements. Though many tumor cells with an epithelial appearance possessed a large quantity of cytokeratin and vimentin, they did not secrete estradiol, progesterone, testosterone or human chorionic gonadotropin. This case was finally diagnosed as an intramural uterine stromal tumor with epithelial differentiation after taking all the available data into consideration. This would be classified as an endometrial stromal tumor with epithelial elements, recently proposed and named by Clement and Scully.


Evaluation of the performance of the copper T380A IUD up to ten years. Is this IUD a reversible but potentially permanent method? The clinical experience of a cohort of 340 women using a TCu380A IUD for up to 10 years at the Family Planning Clinic of the State University of Campinas, Brazil was evaluated by life-table analysis. Removals for medical reasons were more frequent during the first year of use, while from the third year on, removals for personal reasons were more frequent. Expulsions were concentrated in the first two years of use, and none were detected after the fourth. Gross pregnancy rate accumulated to 2.0, 2.8 and 5.3 and continuation rate was 64.2, 43.4 and 27.8 per 100 women at three, six and ten years of use, respectively. The effectiveness of the device did not decrease significantly after the eighth year of use and it could be considered a reversible but potentially permanent method.


Immediate postpartum intrauterine device insertion--a report on the Chinese experience. Immediate postplacental insertion (IPPI) of the intrauterine device (IUD) has been practiced in China for at least 17 years. This presentation reviews and integrates the clinical experiences of IPPIs at five Chinese centers. The stainless-steel ring IUD was the most commonly used device for this procedure. Our review indicates that: (a) IPPIs-both after vaginal delivery and at cesarean section-are medically safe and effective in preventing accidental pregnancies (given careful patient selection), and (b) the one-year life-table expulsion rates of IUDs inserted at cesarean section are lower than the rates for vaginal insertions after normal delivery. This review also discusses other issues, such as factors influencing expulsion rates. Generally, IPPIs, whether performed via vagina or cesarean section, seem to be a method of choice for postpartum contraception. Some findings are, however, tentative; thus, further studies are needed.


Comparative assessment of two low-dose oral contraceptives, Lo-Femenal and Lo-Estrin, in Mexican women. This trial was designed to determine the differences in effectiveness, clinical acceptability, and one-year discontinuation rates of two low-dose oral contraceptives: Lo-Estrin (norethindrone acetate 1.5 mg plus ethinyl estradiol 0.030 mg) and Lo-Femenal (norgestrel 0.30 mg plus ethinyl estradiol 0.030 mg) in 148 Mexican women. In addition, the effects of both oral contraceptive preparations on blood lipids were prospectively evaluated in a subgroup of 41 women. The results indicated that there were no differences in pregnancy rates, discontinuation or clinical acceptability between the two groups. The lipid changes observed were minimal for the Lo-Femenal subgroup and somewhat greater for the Lo-Estrin group, mainly an increase in serum triglycerides. These changes were interpreted as estrogen induced effects of norethindrone-containing oral contraceptives. Overall, the data indicate that both Lo-Femenal and Lo-Estrin are effective and safe combined oral contraceptives.


An evaluation of IUD insertion by a non-clinical delivery system. To evaluate the safety, effectiveness, side-effects, and continuation rate associated with non-clinical IUD insertion compared to IUD insertion in routine clinical facilities, a cohort comparative study was done on two groups of IUD users self-selected for either the non-clinical or clinical delivery system in Yogyakarta Special Area Province. During the months of January to March 1985, 454 non-clinical and 625 clinical acceptors were recruited into this study. However, only 414 non-clinical and 605 clinical acceptors fulfilled the inclusion criteria and were included in the analysis. Bleeding and pain were the most common side-effects reported by acceptors. The frequency of bleeding was higher in the non-clinical group than in the clinical group. However, the difference was a not statistically significant relative risk (RR) of 1.09 (0.8-1.4) to 1.2 (0.9-1.5). Severe menstrual blood loss mostly occurred in the first three months after insertion and then declined in the rest of the year in both groups. The frequency of pain was not clearly different between the two groups during the whole year, with RR 0.8 (0.5-1.3) to 1.3 (0.8-2.0). The actual number of pregnancies was very small and the difference was not statistically significant (p = 0.375). The 12-month expulsion rates were 7.22 per 100 IUD users for the non-clinical group and 7.00 for the clinical group. The difference was not statistically significant (p = 0.660). The cumulative probability of women who were still using IUDs at 12 months was 89.7% and 89.1% for the non-clinical and clinical groups, respectively. The non-clinical delivery system seemed to be responsive to an unmet demand for family planning among women with lower educational background compared with those in the clinical setting service. While the characteristics of a population obviously influence the contraceptive behavior, this study shows that the non-clinical delivery system family planning method provides a similarly efficacious and safe service to the usual clinical system.


The possible relationship between menorrhagia and occult hypothyroidism in IUD-wearing women. A high incidence of occult hypothyroidism in menorrhagic women has been reported and emphasized in recent studies. In order to verify this statement, we have evaluated the functional status of the thyroid gland in intrauterine device (IUD) wearers suffering from increased menstrual bleeding. The study group consisted of 40 IUD-wearing women, aged 26-46 years, suffering from metrorrhagia. The control group consisted of 38 IUD-fitted women, 22-44 years old, in whom menstrual bleeding was not significantly increased. Menorrhagia was defined as excessive vaginal bleeding lasting for 6 days or more, and/or containing a significant amount of blood clots. Free thyroxine (FT) and thyroid-stimulating hormone (TSH) levels were assessed. FT levels were identical in both groups and within the normal range (1.31 +/- 0.28 ng/dl). TSH levels were significantly higher in the study group than in the controls, although they remained within the normal range (2.75 +/- 2.06 vs. 1.45 +/- 0.45 microU/ml, p < 0.01). A thyrotropin-releasing hormone (TRH) test was performed in 10 women having the highest TSH levels. All the results of TRH tests were consistent with occult hypothyroidism. These women were treated with L-thyroxine and all had a significant improvement in their bleeding within 3 months of treatment. We concluded that any IUD-wearing woman suffering from menorrhagia may have occult hypothyroidism. Should FT and TSH be within normal limits, a TRH test should be performed as the definitive diagnostic test. A frequent side-effect of intrauterine contraception is menometrorrhagia. The intrauterine device (IUD) has to be removed in 5-15% of cases to prevent iron deficiency anemia.


A multicenter clinical trial in Nigeria with Multiload-Cu250 (MLCu250) and Multiload-Cu375 (MLCu375) intrauterine devices. A multicenter study was conducted in Nigeria, comparing the Multiload-Cu250 (MLCu250) with the Multiload-Cu375 (MLCu375). The two intrauterine devices were studied on aspects of effectiveness and acceptability. Parameters were observed and analyzed, using the life-table method of Tietze and Lewit. Continuation rates were excellent. Overall results were in line with studies done elsewhere in the world with Multiload devices, showing a slight superiority of the MLCu375 over the MLCu250.


Early pregnancy termination: an improved technique for 'menstrual regulation' with ultrasound assistance. We performed aspiration of early pregnancy on 100 women requesting termination, using a low caliber angled catheter under sonographic guidance, without analgesia or anesthesia. The sonographic inclusion criteria for the study were: (1) mean gestational sac diameter less than 30 mm, or (2) crown rump length less than 10 mm when an embryo was visualized. The uterine content was successfully evacuated in all cases and none needed an additional curettage. Two women developed mild endometritis which responded to antibiotic therapy. This refinement of this 'menstrual regulation' technique seems to be safer when compared with the reported results of the original technique.


Interrupted extra-ovular infusion may not be reversible. Late abortion ensued 9 days after discontinuation of extra-ovular PGE2 infusion for mid-trimester termination of pregnancy in a 15-year-old unmarried primigravida. This observation, which has no precedent in the literature, may suggest that once extra-ovular PG infusion has been started, its discontinuation may not be considered reversible.


A review of cognitive outcome after hemidecortication in humans. This review of the effects of hemidecortication in humans has been limited to studies of cognitive outcome published during the last 20 years. More directly than in the case of split-brain patients, the patients reviewed here attest to the remarkable ability of a single hemisphere, whether left or right, to support at least at modest levels a wide range of cognitive functions--from visual perception, through memory and intellectual processes, to language and even speech. In some cases, as has been indicated, the surgical removal of a diseased hemisphere has resulted in improvement of cognitive function. This positive outcome has occurred more frequently in patients with early (i.e. congenital or perinatal) onset of seizure disorders than in those with late onset (e.g. Rasmussen's disease). But even for the latter patients, the cognitive costs of the surgery per se have rarely been severe. And in both types of case, the incidence of either complete or substantial postoperative relief from intractable seizures has been high, ranging around 80-90%. Although the therapeutic efficacy and small cognitive costs of the surgery are now quite well established, little is known yet regarding the specific cognitive defects that arise from the loss of one as opposed to the other cerebral hemisphere. Intelligence levels have been found to be equally low, averaging in the mid-60s and almost never rising above 100 in patients with either left or right hemidecortications, and memory quotients have most often appeared to fall in line with the IQ scores, again without clear evidence of any difference in the effects of left and right removals. Even in the case of visual spatial perception, considered to be a hallmark of right hemisphere function, the evidence is unclear, one study reporting selective impairment on difficult visuospatial tasks in right hemispherectomised patients, but another not. Only in regard to language processes is there a consensus regarding the differential effects of left and right hemidecortication, and here the differences are apparent only in the relatively subtler aspects of language. Thus, the isolated right hemisphere is at a significant disadvantage compared with the left in the comprehension of abstract, low frequency words, in phonetic feature analysis, and in the subtleties of grammar, such as the comprehension of passive negative constructions and the correct use of morphological markers in unfamiliar contexts (e.g. application of comparative and superlative forms of an adjective to nonwords.(ABSTRACT TRUNCATED AT 400 WORDS)


[Mathematical model of oblique three-dimensional intertrochanteric detorsion varus-forming osteotomy of the femur by the Bernbeck method in surgical treatment of congenital hip dysplasia in children]. Whenever the conservative procedure fails to bring about congruence of the dysplastic hip joint, an operative procedure becomes indispensable. In Orthopaedic Clinic of the Pomeranian Medical Academy in Szczecin we implement the oblique three-dimensional intertrochanteric detorsion and varus forming osteotomy after Bernbeck in order to correct the proximal end of the femoral bone. Precise determination of the plane to be cut, prior to the operative procedure, simplifies and shortens the operation itself and facilitates the achieving of the planned angular values in all three planes. Mathematical model of osteotomy according to Bernbeck considering required angles of correction as well as angles determining the plane of osteotomy was worked out. In collaboration of the Szczecin Technical University, a simple computer program was elaborated which allowed the presentation of the results in the form of tables. With the help of tables the optimal cutting plane was chosen and created correct biomechanical and anatomical conditions as well as optimal conditions for stable osteosynthesis of dissected fragments of the femoral bone. That type of osteotomy is useful in most operative correcrions of the dysplastic hip joint (not great varus formation connected with relatively extensive detorsion). The achieved congruence in the 22 dysplastic hip joints operated on was the most important condition for their later physiological development. Short post-operative observations confirm the value of described mathematic model.


[Control of the quality of radioimmunological methods of determining plasma levels of atrial natriuretic peptide (ANP) and the evaluation of their usefulness in clinical studies]. The radioimmunologic assays appeared to be the most convenient methods for determination of atrial natriuretic peptide (ANP) concentration in blood plasma. The purpose of this work was to compare the control quality parameters of two radioimmunologic methods for the ANP determination in human plasma: the methods described by Pruszczyński et al. and the method with the use of Amersham ready-made set (kit). The comparison of the two methods was performed by analyzing 10 series of ANP determinations carried out by Pruszczyński method, and 15 series by means of the kit. Both methods appeared to fulfil the criteria of satisfactory quality for RIA determinations. The second purpose of this study was to define the utility of the RIA method for the determination of ANP in clinical practice, taking into the consideration some factors influencing or modifying plasma ANP levels. Three groups of persons of were studied: 15 healthy subjects, 16 patients with acromegaly and 47 patients with the impairment of renal function. The ANP level in plasma was determined in these 3 groups of persons. It has been demonstrated that the change of body position from upright to supine caused the increase of the ANP concentration in plasma. It has also been found that the decrease in the intravascular fluid volume induced by furosemide administration resulted in the reduction of ANP concentration in plasma. The enlarged intravascular fluid volume, accompanying acromegaly and probably present in persons with the impairment of kidneys, was associated with the increased ANP concentrations in plasma.


[Evaluation of immunological studies in patients with rheumatoid arthritis]. Immunological studies are widely applicable at a clinic in rheumatoid patients, despite the fact that their clinical value is still a disputable subject. Many authors are of opinion that the determination of individual immunological tests does not provide the estimation of immunological state in patients, and should be evaluated critically. The aim of the actual paper was to evaluate the immunological state of patients with rheumatoid arthritis by means of immunological profile index, which consists in performing concurrently many immunological tests involving both humoral immunology and cellular one. The results were referred to the duration of the disease, pathological process activity, the presence of rheumatoid factor, the advancement of osseous changes. The studies were carried out in patients, aged 16-69 years, 63 of them had RA and 9 were affected by ankylosing spondylitis. The control group comprised 16 normal subjects aged 28-61 years. It has been disclosed that the values of the immunological profile index in patients were statistically significantly lower than in the control group. The lowest values of immunological profile index were recorded in patients with extra-articular symptoms with recurrent infections of urinary and respiratory tracts, as well as in patients with active form of RA, and the presence of rheumatois factor. The patients with ankylosing spondylitis were found to reveal immunological disorders, but they were expressed less markedly than in RA patients. With the help of immunological profile it was possible to show that multifunctional immunological disorders appeared in patients with rheumatoid arthritis. The most sensitive immunological tests were: levels of immunoglobulins in blood serum, and the count of lymphocytes T and B. The immunological profile study in patients with rheumatoid inflammation of joints is an objective method of evaluating their immunological state.


[Electrophysiological characteristics of the heart with special reference to the sinoatrial node function in patients with disorders of the atrioventricular and intraventricular conduction]. Sinus node function and other electrophysiologic properties of the heart in patients with atrioventricular or intraventricular blocks are not well documented. I therefore performed electrophysiological studies in 35 patients with chronic high degree atrioventricular block (AVB--group I), 20 patients with bifascicular block (BFB--group II) and in 24 control subjects (group III). Multilevel conduction disturbances were found in 51.5% of patients with AVB and in only 10% of patients with BFB. Sinus node dysfunction was disclosed in 3 patients (8.6%) with AVB (in 1 it was functional) and in 3 patients (15%) with BFB. A new modified method for recording sinus node electrogram (SNE) was described. By applying this method, SNE was recorded successfully in 80% of cases. The results are comparable to those of other methods. Retrograde conduction was observed in 34% of patients with AVB, 75% of patients with BFB and in 38% of control subjects. It plays an important role in the pathogenesis of the "pacemaker syndrome" in patients with VVI pacemakers. Atrial hyperexcitability was observed in 5.7% of patients in gr. I, 10% in gr. II and 4.2% in control group only. Rare occurrence of atrial arrhythmias provoked by electrical stimulation provides the possibility to use DDD or VDD pacing systems in patients with AVB or BFB. Inadequate rate of response to exercise (chronotropic incompetence) was observed in most patients with sinus node dysfunction, but it occurred also in patients with normal sinus function. 1) Sinus node dysfunction is uncommon in patients with atrioventricular or intraventricular blocks. 2) Persistence of abnormal sinus node function and atrioventricular or intraventricular conduction disturbances after autonomic inhibition is an argument for organic disseminated injury of the conduction system (binodal disease). 3) Electrophysiological evaluation of sinus node function, retrograde conduction, artial hyperexcitability and chronotropic response to exercise permit suitable choice of physiological pacing mode (VDD, DDD, DDR, VVIR) in patients with AVB or BFB.


[Analysis of disorders of adolescent behavior at the Diagnostic- Referral Family Center in Szczecin]. As many as 120 subjects, directed in 1984-1988 to the Diagnostic-Consultative Family Centre in Szczecin, were studied due to behaviour disorders or penal acts. Thirteen (10.8%) juveniles were exempted from further studies, since they were diagnosed to have mental deficiency or encephalopathy. The rest was studied by means of diagnostic criteria for behaviour disorders according to DSM-III-R. Those complying with the criteria made up a group with Behaviour Distemper Syndrome (BDS)--74 persons (55 boys and 19 girls), while the others formed a group holding Single Behaviour Distemper (SBD)--33 persons (21 boys and 12 girls). Two age subgroups, 7-14 and 15-17 years, were isolated from each of the groups. Use was made of own questionnaire to collect data concerning factors that might induce the revealed behaviour disorders. Groups BDS and SBD were compared with regard to the type and incidence rate of respective signs of behaviour disorders, according to criteria DSM-III-R, and also the age, sex as well as social background, living environment, and hereditary encumberance, course of pregnancy and delivery, former psychophysical development, use of condiments, somatic disorders actually evidenced, parental and school environmental atmosphere and that of peers of the studied group.


[Evaluation of temporo-mandibular myoarthropathies, the status of the masticatory system and patients' personality based on the tests and clinical studies]. Resorting to commonly applied methods and clinical indices, the masticatory organ state was evaluated in 64 patients with symptoms of myoarthropathy (studied group)) and in 61 patients without the symptoms of the disease (control group). The assumption laid down in the work was that the studied group and the control one do differ with regard to the incidence rate and the intensity of the investigated local parameters and the level of neuroticism as well as extraversion. The aim of the paper was to show the mutual correlation between the parameters studied, and to determine their effect on the inception of the temporal jaw dysfunction. It has been revealed that the advancement of age is accompanied by statistically significant increase in the incidence rate and intensity of local diseases as well as by malfunctions, a rise in the level of neuroticism and a drop of the extraversion level. In consequence of the former findings, severe forms of dysfunction of the mandibular articulation arose in 89% of patients within the highest age group. Comparing the parameters between the studied group and the controls provided the possibility to isolate the features that make the both groups differ, thus facilitating the determination of the influence the individual factors exert on the origination of dysfunction of the mandibular articulation. The most essential differences affected five factors: unilateral mode of mastication, parafunction, teeth deficit, abnormal occlusion and high neuroticism. The lack of statistically significant differences between the studied and control groups with respect to periodontal diseases, looseness of teeth, dental abrasion do not authorize us to exclude their influence on the formation of temporal jaw myoarthropathy, since these factors are responsible for the loss of teeth, occlusal articulation disorders, and in an indirect way they, undoubtedly, exert destructive influence on the organ of mastication.


[Selected etiological factors in dental caries among 18-year-old high-school students in Poland in the light of the results of the questionnaire and epidemiological studies]. The performed studies covered 1100 subjects being 18 years old (both girls and boys) representing large and small towns as well as villages situated in 13 provinces. The material and methods were based on the instruction provided by "WHO Basic Methods 1986". Answers given to questionnaire inquiries in the area of nutrition and oral cavity hygiene furnished an image of health consciousness and behaviours of 18-agers in Poland. Dental state and stomatologic treatment requirement jointly with the effects of stomatologic care were evaluated on the basis of the results established by epidemiological studies. The accomplished analysis encompassed the influence of sex, living environment, type of schools and variable content of fluoride in water, exerted on the pattern of the investigated epidemiological parameters. No correlation was recorded between health consciousness and behaviours in 18-year-old youth on the one hand, and the dental state as well as the therapeutic requirements on the other. The questionnaire responses and the epidemiologic studies made it possible to disclose some drawbacks in transmitting and introducing the education-health principles, which was reflected by not the best results concerning the health consciousness and behaviours particularly in male youth and in rural inhabitants. The dental condition is unsatisfactory in the studied population, despite being provided, in most instances, with permanent stomatological care. This indicates that optimization of adequate stomatological service is indispensable. A low percentage of youth with dentition does not predict good prognosis for them to achieve 3-rd health objective set up by WHO for the year 2000. The studies have confirmed the influence of big urban environment, with complete profile of stomatological care and water fluoridation, being exerted on the state of dental therapeutic requirements in 18-year-old youth. Difficult as it appeared was the detection of the sugars consumption role and that of oral cavity hygiene, in the course of one-stage investigation.


[Molecular-genetic evaluation of translocation of bcl-2 gene and locus bcl-1 in selected lymphoproliferative changes]. In the work it has been decided to evaluate the occurrence of locus bcl-1 rearrangement in type B chronic lymphatic leukemia and that of gene bcl-2 in non-Hodgkin's lymphoma with diffuse morphology, as well as in reactive lymph nodes. The study material comprised DNA isolated from fragments of lymph nodes sent for routine diagnostic examinations at the Institute of Pathology--Pomeranian Medical Academy. Southern's method was used to examine DNA having been cut with restrictive enzymes, estimating the distribution of gene bcl-2 and locus bcl-1. Resorting to Polymerase Chain Reaction (PCR) translocation t (14;18) was assessed by means of short nucleotides hybridizing with 14 and 18 chromosome sequences restricting this translocation. The amplification product was subsequently studied by Southern's method with probe bcl-2. In 1 out of 18 examined cases of type B chronic lymphocyte leukemia it was disclosed that locus bcl-1 had been rearranged. In 45 cases of non-Hodgkin's lymphoma with diffuse morphology the gen bcl-2 was found to display germline arrangement. Germline position of gen bcl-2 was also revealed in 60 cases of reactive lymph nodes.


[Serum C-reactive protein monitoring in children after injuries of closed body cavities]. Serum CRP-level monitoring was performed in 101 children after trauma of occlude body cavities to determine its applicability in diagnostic procedure, treatment and prognosis. Case history of a patient, clinical status, type and course of treatment provide the basis for establishing clinical punctation in each group of injury for statistical purposes. As many as 87 children with head trauma, 5 having abdominal trauma, 8 with traumatized heads and abdomens, and 1 with chest injury were investigated. All the studied groups revealed similar graph of CRP levels. Until the third day after injury, dynamic rise was being observed followed by slower elimination phase proceeding to the initial level on the seventh day after the injury. Dynamics of CRP outputs and their positive correlation with the area under the curve in all groups investigated shows that CRP monitoring is useful for clinical purpose.


[Effect of pollen extract (Cernitin) on the course of poisoning with organic solvents (biochemical analysis)]. The aim of the study has been to experimentally estimate the chronic exposure of selected biochemical parameters of serum and microsomal level fraction in animals to a mixture of organic solvents. An attempt was made to alleviate the eventual changes by applying Cernitin preparation. The experiment was performed on male rats, Wistar strain. The rats were exposed to the organic solvents in a toxicological chamber with controlled parameters. Cernitin preparation was added to standard diet, being given to the animals in the form of balls. The biochemical investigations were carried out after a lapse of 3 and 6 month exposition. The range of the accomplished studies included: activity of enzymes (AspAT, AlAT, AP, ChE) bilirubin level and lipids content in blood serum. Lipids content was determined in liver homogenate. The content of protein, cholesterol, phospholipids and free fatty acids, was studied in liver microsomes. It has been shown that protracted exposure to the mixture of organic solvents elicits an increase in the activity of the studied aminotransferases and alkaline++ phosphatase, as well as a decrease in the activity of cholesterase. The changes in activity are accompanied by a rise in the content of lipids. Cernitin preparation used prophylactically normalizes impairments affecting the studied enzymatic and lipid parameters.


[Biomechanical aspects of surgical treatment of secondary stenosis of the spinal canal in the lumbosacral region]. In experimental studies and on clinical material, behaviour was checked of intervertebral discs and vertebrae under the axial pressure: which is the being exerted by the trunk weight, as well as the behaviour of the adjacent mobile segments after "diskoplasty" operation or vertebral interbody stiffening. The material pertaining to the experimental part comprises 6 undamaged spine preparations of the lumbosacral segment, while the clinical part consists of 60 patients out of 143 subjects having been operated on by "diskoplasty" or vertebral interbody stiffening from the approach through fenestration, hemilaminectomy, or plastic laminectomy. The results of performed experimental studies and spodylometric analysis of radiograms in patients treated operatively by decompressing the vertebral canal and by "diskoplastic" stabilization of the vertebrae, or vertebral interbody stiffening permit the following observations. The most favourable localization of the transplant is the medial and posterior parts of the vertebral interbody space, since in both segments L4/L5 and L3/L4 it reproduces the height of the vertebral interbody space, the height and width of intervertebral foramen, widens the intervertebral foraminis, and reduces the lumbar lordosis, which advantageously changes the biomechanic relations, transferring loads of the posterior to the anterior vertebral column. The localization of the transplant in the anterior part of the vertebral interbody space, in fact, increases the anterior vertebral interbody space, but decreases the height of posterior interbody space, the vertebral interbody angle alpha as well as the height and width of the intervertebral foramen. The retroshifting of vertebral L4 indicates mobile segment instability. By implementing a transplant of matching height and appropriate localization in vertebral interbody space, it is possible to increase or reduce the angle between the vertebral bodies at the operative level, widening the vertebral interbody space in anterior and posterior parts. The localization of the bony transplant in the anterior part of vertebral interbody space, involving the clinical material, caused in 65% constriction of intervertebral foraminis, retroshifting of vertebrae L4 and L3, and recurrence of algesic complaints, which may be elucidated by instability of the operated on or adjacent mobile segments.


[Current approaches in the treatment of gastrinoma metastases]. In the last years the therapeutic behaviour with regard to gastrinomas, has deeply changed becoming more and more aggressive. Nowadays, almost all authors recommend, after a serious treatment of the hypersecretion with omeprazole, an explorative laparatomy in all patients affected by gastrinoma even without a preoperative tumor localization. The multiple endocrine syndrome (MEN I) and the metastatic disease are excluded from the above practice. A careful examination of the most recent data available today in literature accompanied with our experience, even if limited, shows that only the surgical treatment allows a better survival also in metastatic disease. The surgical treatment is surely recommended in gastrinoma with pancreatic and duodenal lynphonodal metastasis. For hepatic metastasis all types of hepatic resection, the "wedge resection" included, can be suggested. After the first positive experiences, the hepatic transplantation can find a place among the therapeutic means against this kind of tumors.


[Antonio Pacchioni (1665-1726): pioneer studies on the dura mater]. Clustering of arachnoid villi along the sagittal sinus gives rise to the so-called "Pacchionian Granulations". These structures were originally described in 1705 by Antonio Pacchioni, an Italian scientist. Born in Reggio Emilia in 1665, he graduated in Medicine in his hometown and later moved to Rome were he built up a successful career by dedicating to medical practice as well as to research and teaching. He became friend and often collaborated with some of the leading scientists of his age: Lancisi, Malpighi and Morgagni among the others. Moreover he carefully followed research developments in Europe as testified by frequent quoting of foreign authors in his works. He devoted himself to the elucidation of structure and function of Dura Mater, often by using new techniques of maceration of anatomic specimens in various fluids. Among Pacchioni's works, the "Dissertatio epistolaris de glandulis conglobatis Durae Meningis humanae" (1705) is particularly well known and contains the first description of arachnoidal granulations. He compared Dura to cardiac muscle and attributed to its "glandulae" (glands) the faculty of secreting lymph for lubrification of the sliding movements between meninges and brain during contractions. He died in Rome in 1726. Three centuries after Pacchioni's death fine structure of arachnoid villi hasn't been fully elucidated; moreover many questions on mechanisms underlying CSF absorption remain unanswered.


[Heart complications in general surgery: results of a multicenter study]. Cardiac events are the most dangerous postoperative complications since they may be easily followed by the death of the patient. The related risk factors were prospectively evaluated in a study of 1182 patients. Stepwise regression logistic model was employed for statistical analysis. Preoperative cardiac and respiratory failure, ventricular arrhytmias, compromission of the nutritional status, presence of neoplastic disease and prolonged anesthesia over two hours were the only significative factors related to postoperative cardiac complications. Advanced age was not a major risk factor. The results of the study require a prospective validation. They are however comparable to those observed in the literature Preoperative cardiac evaluation is of utmost importance for cardiac prognosis and various instrumental, sometimes invasive diagnostic procedures have been proposed. The Authors provide a usefull, simple and widely employable system of general and cardiac assessment for the determination of cardiac risk.


[Therapeutic problems in euthyroid multinodular goiter]. Now therapeutic different possibilities of goitre pathology seem well defined, in front of limit of suppressive therapeutic range in initial stages, prevalently diffuse, that interest young people and arise in jodic want lands; it's possible that medic theraphy ends can't be obtained because of not responders patient, or even for possibilities of controindications. Local presence of suspicious nodules and the need of goitre volumetric reduction for aesthetical and compressory ends, with the possibility in course of time of functional changes are sure reasons to surgery. Certainly main problems exist about surgery definition of multinodular disease with bilobar involvement where there is comparing between total and subtotal thyroid exeresis. Now by literature analysis and our School experience we think that surgery choice, considered before operation, must find absolute assurance after preoperative morphotopographic careful exploration of thyroid. We think that total thyroidectomy must be done when it's certain a total gland involvement, reserving subtotal thyroidectomy in the other cases; always employing a careful surgery technique, keeping operative field interely bloodless to identify important structures and dissection plan narrowly close by capsule.


[Ectopic parathyroid glands in primary hyperparathyroidism]. The incidence of the ectopic parathyroid glands seems to be different between normal subjects and patients affected by primary hyperparathyroidism. We reviewed a serie of patients operated on for primary hyperparathyroidism in our Institute between 1985 and 1991, and the reports from literature about this mean; the frequence of ectopies is = 31% (10.3% in the upper- anterior mediastinum). These findings are similar to those reported in the literature. The higher incidence of ectopies in the hyperparathyroid group respect to the normal one and the surgical problems that it could cause represent a reinforcement of the concept that parathyroid surgery should be done only by an experienced, technically and theoretically prepared surgeon, and may justify the use of non invasive, non expensive imaging techniques at the first cervical exploration for suspected hyperparathyroidism, in order to ameliorate the results and in particular to solve suddenly some dramatical cases due to major parathyroid ectopies.


[Esophago-gastric lesions caused by caustics]. A wide range of lesions may occurs after accidental or voluntary ingestion of caustic substances including mild epithelial injury to whole thickness necrosis of the involved organs. The type of management varies according to the severity of the damage, medical therapy being indicated in the less severe cases while surgery is required in life threatering lesins or alternatively as elective treatment of trighly desabling sequelae last complications such as. From 1981 to 1989 we observed 20 patients with acute hastro-oesophageal lesions due to ingestion caustic substances 19 of then were successfully treated with medical therapy. Only 1 patient underwent surgery and died of oesophagus cardiac fistula with right atrium perforation (24 days following total gastrectomy). Based on either our own experience and the data reported in the literature we believe that the most adequate management of patients with lesions of the E.G. due to caustic agents tract must include: vital functions control maintenance intensive care treatment of shock endoscopic monitoring of E.G. lesions emergency surgical treatment where needed.


[Our experience with early gastric cancer]. Authors assert that, in Early gastric cancer diagnosis, anatomicomedical characteristics expressed on the basis of canons formulated by Endoscopy Japanese Society and by Lauren's unexipered classification are of particular interest. After having referred on characteristics observed on a group of patients, in the light of data given from medical Literature, they try to extrapolate aetiopathogenetic factors. These, together with anatomicopathological characteristics of the lesion, are the premises for a wise radical therapeutic choice.


[Anatomo-clinical considerations on early gastric cancer]. After having asserted the still rising interest for an as early as possible diagnosis of gastric cancer, authors refer on a group of patients who are carriers of Early gastric cancer. After having touched upon localization and histological characteristics of neoplasms, linger on the rules that leaded their therapeutic choice and they report the results of a follow-up dragged ten years long. They terminate affirming only a timeliness diagnosis can consent a really decisive therapeutic approach.


[The finger fracture technique in hepatic resection]. The main complementary techniques for "finger fracture" in liver resections are evaluated. It is retained that transparenchymal resections should be limited to segmental resections (uni-, bi- or trisegmentectomies), while in case of extensive resections (lobectomy or extensive lobectomy) an operation with extraparenchymal preparation of the hepatic pedicle and possibly of the suprahepatic vein is preferable. Lastly a casuistry of 24 hepatic resections for primary or metastatic tumours is presented.


[Spontaneous perforations of the large intestine]. Spontaneous perforation of colon is a rare disease and physiopathologic basis are actually unknown. Surgical treatment is standardized and post-operative survival is over 60%, morbidity and mortality rate depends on peritoneal contamination. In 1984 J.A. Berry classified spontaneous perforations into "stercoral" and "idiopathic" perforations on the basis of etiopathogenetical causes of lesions. Anatomopathologically stercoral and idiopathic perforations present different characteristics. Macroscopically stercoral perforation origines from an ulcerative lesion often situated on the sigmoid colon or rectum. Microscopical characteristic is represented by a superficial ischemic necrosis of mucosa (caused by fecalomas) followed by an extension to sub-mucosa and muscular tissues of the colonic wall. On the contrary, "idiopathic perforation", frequently situated on the sigma, is a linear laceration of anti-mesenteric side of the colon without pathologic modifications of the colon. Physiopathologic basis of spontaneous perforations of the colon were also discussed. Stercoral perforation is often a consequence of chronic constipation. Instead, two hypoteses are advanced as regards idiopathic perforations. S.V. Kessing e coll. (1962) hypotized a parietal suffering caused by ischemia of anti-mesenteric side of the colon, depending on ipoperfusion of colonic tissues; they also hypotized a constitutional weakness of colonic wall as a cause of idiopathic perforation. Others hypotized an intraluminal hypertension caused by intestinal hernias (J.W. Eadie, 1955; K. Cronin, 1959), rectal prolapse or abnormal depth of Douglas cavity (D.C. Lyon, 1969). In these cases, lesion is caused by contraction of abdominal muscles during defecation, which presses colonic wall during distension.(ABSTRACT TRUNCATED AT 250 WORDS)


[Treatment of postoperative entero-cutaneous fistula: personal experience]. The authors present their experience on surgical treatment of intestinal fistulas based on personal cases treated from 1981 to 1990. The cases are divided into two groups: the first: the first group of patients was treated only surgically (1981-1984); the second group was treated with surgery and artificial nutrition (1984-1990). The mortality rates are much lower in the second group. The conclusion is that is always necessary to associate a form of artificial nutrition to surgery because the percentage of healing is statistically higher.


[Carcinoid neoplasms: report of 5 personal cases]. The authors report 5 cases of carcinoid tumor differently located. The typical carcinoid syndrome has been observed only in one case, presenting with high levels of urinary serotonin and 5-OH-HIAA. The remnant patients were completely asymptomatic and the correct diagnosis was obtained only by histologic examination of the surgical specimen. On the basis of their experience and of the literature, the authors evaluate the current diagnostic and therapeutic options for these neoplasms. The indication for surgical treatment, even in cases with local or distant metastases, is emphasized.


[Biological cycle of Paralibyostrongylus hebrenicutus (Nematoda: Trichostrongylidae)]. Paralibyostrongylus hebrenicutus accomplishes its life cycle spontaneously in captive Atherurus africanus, its natural host, and in experimentally infected guinea pigs and rabbits. Morphogenesis and larval morphology were studied in the guinea pig and described herein. Host infection were achieved either by subcutaneous or by oral inoculation. The entsheathed infective larvae moult soon after penetration in the vertebrate host. Following subcutaneous inoculation, they reach the lungs very probably through the lymphatic vessels and the right heart at H8, and the stomach as soon as D2. However, a possible direct migration by the mesenteric lymphatic vessels and crossing of the digestive wall cannot be excluded as a few larvae were found in the peristomachal mesentery. Following ingestion, L3 larvae reached the stomach directly. 24 hours post-ingestion, they were localized deep inside the gastric mucosa crypts lumen. The same larval localization was observed at D3 after a subcutaneous inoculation. At D5, regardless of the inoculation route, larvae reached their definitive position, embedded in the gastric mucosa mucus lining, where they underwent the 3rd moulting (L3-L4) followed by the 4th moulting (L4-Ad) at D19. Eggs appeared at D28. Except for the inflammatory granuloma seen in the lungs and the mesentery from H24 to D3, the nematode induced no tissue lesion. The genus Paralibyostrongylus is one of the most primitive in the Libyostrongylinae-Cooperiinae line. The double transmission route, may have made possible the transition from primitive cycles by cutaneous penetration to more specialized cycles by the oral route, the latter being responsible for the evolutionary success of the group in large herbivores.


[Comparison of color duplex and phlebography in the diagnosis of deep venous thrombosis of the legs]. The aim of this prospective study was to evaluate the efficacy of color duplex scanning in comparison with plebography in patients with clinically suspected deep vein thrombosis of the legs. The group was of sixty patients. The tests were both positive in 51 limbs and negative in 8 limbs. In a case of below-knee thrombosis, color-duplex was negative while phlebography was able to show small localized thrombosis. The sensitivity of color-duplex was 98%, its specificity and positive predictive value 100% and its negative predictive value 88.8%. In conclusion, color-duplex is as effective as phlebography in detecting deep vein thrombosis above knee.


An account of the ticks of the northeastern of Spain (Acarina: Ixodidae). The tick species commonly collected at the Northeast of Spain are reported in this paper. Data on hosts, temperature and humidity requirements, vegetation relationships, altitudinal distribution, and seasonal activity are included. R. sanguineus is commonly collected in areas with Mediterranean vegetation, esteppe, and semi-desertic esteppe, ranging from 190 to 1,000 meters above the sea level. R. sanguineus is related with sparse vegetal areas, and it is absent from areas with dense shrub or forests of every kind; sometimes, small populations may be collected in ecotones between Pinus spp. and esteppe formations. R. pusillus is closely related to areas of Mesomediterranean vegetation, sometimes subordinate to Pinus spp. and Quercus spp. The climate to which the species ally is always of continental type, with a hot and dry summer, and cold winter; although the species is commonly restricted to its main host, Oryctolagus cuniculus, several specimens have been collected from V. vulpes. Our data display the clear affinity of I. ricinus to the Supramediterranean vegetation (Aceri-Quercion faginae), places of Quercetum-Buxetum, as well as the Iberian Oromediterranean vegetation (Pinus sylvestris-Buxus sempervirens). Captures are scarce in forest of Fagus sylvatica, but data suggest that the species may be locally common on such places. Climate for the zones of collection of I. ricinus is Atlantic attenuated, with mild summers and humid winters. D. marginatus is strongly related to the xerophilic vegetation, widely spread through the Mediterranean, Supramediterranean, and hill levels, but does not colonize the true Oromediterranean vegetation. In our captures, the species is commonly collected in pubescent oak formations, but it does not penetrate in true forest associations.(ABSTRACT TRUNCATED AT 250 WORDS)


Vaccination of cattle against Rhipicephalus appendiculatus with detergent solubilized tick tissue proteins and purified 20 kDa protein. Three groups of 4 cattle have been vaccinated with either detergent solubilized tick tissue proteins (SMP) of male and female Rhipicephalus appendiculatus, a 20 kDa soluble integumental antigen, a mixture of both SMP and 20 kDa. Two weeks after one booster injection all cattle were challenged by infestation with adult ticks. Treatment had no influence on tick attachment but on cattle vaccinated by the 20 kDa 32.5% fed ticks died (p < 0.001). Moreover, the mean weight of ticks fed on 7 out of 12 vaccinated cattle was significantly lower (p < 0.05 to p < 0.001). Individual differences could be seen where the mean weight reduction was up to 30%. Moreover, ticks fed on 1 (group SMP) or 2 cattle (group 20 kDa) had some difficulties in converting their blood meal into eggs (p < 0.05 to p < 0.001).


[Leishmania major MON-117, an agent of cutaneous leishmaniasis in Mauritania]. The causative agent of cutaneous leishmaniasis in Mauritania is identified for the first time as Leishmania major MON-117, a new zymodeme closely related to MON-26. The authors point out the need to study this previously unknown focus.


Larval stages of medically important flukes (Trematoda) from Vientiane province, Laos. Part II. Cercariae. The cercariae of five flukes, which are potential human parasites, Opisthorchis viverrini (family Opisthorchiidae), Haplorchis taichui (Heterophyidae), Schistosoma spindale (Schistosomatidae), Fasciolopsis buski, and Fasciola gigantica (Fasciolidae) were found in freshwater snails from Laos. The cercariae of the above species, recorded in Laos for the first time, are illustrated and their morphology is briefly described. The snail Helicorbis umbilicalis represents a new intermediate host of F. buski. The occurrence of medically important snails in the Vientiane province will also be discussed.


Study on the surface morphology of the developmental stages of the liver fluke, Opisthorchis viverrini (Trematoda: Opisthorchiidae). The external morphology of some developmental stages of the fluke Opisthorchis viverrini (Trematoda: Opisthorchiidae), parasitizing humans in Southeast Asia was studied for the first time using electron microscopy. The surface structure of the egg, as well as the rediae, cercaria, metacercaria, and adult found in naturally infected hosts from Laos are described herein and their morphological characteristics discussed.


Haemaphysalis juxtakochi, Ixodes pararicinus (Ixodidae) and Otobius megnini (Argasidae) in relation to the phytogeography of Argentina. The phytogeographical distributions of Haemaphysalis juxtakochi, Ixodes pararicinus and Otobius megnini in Argentina are described from material collected mainly from 1978 to the present. H. juxtakochi was found in the northwestern area of the Amazonian domain and in the Chaco, Espinal and Pampean provinces of the Chaco domain. It was detected on Mazama spp., Tapirus terrestris, dog, cattle and on the vegetation. Most findings of I. pararicinus were from mountain rangeland, where it was found on cattle and in a lesser extent on horses. Ticks from Argentina classified as Ixodes ricinus were probably I. pararicinus. O. megnini was detected on cattle an sheep in the Andean Patagonian domain and in the Monte, Chaco and Espinal provinces of the Chaco domain. This tick is considered typical of arid and semiarid conditions, however the findings from the Espinal province where from areas with an annual rainfall over 900 mm.


Angiostrongylus costaricensis natural infection in Vaginulus plebeius in Nicaragua. A study of 94 slugs, collected from urban and rural areas in and around Léon, Nicaragua, was carried out in order to confirm the role of Vaginulus plebeius as an intermediate host of Angiostronglylus costaricensis. Third-stage larvae of A. costaricensis were obtained from these molluscs. Some of these larvae were then orally inoculated into two laboratory-bred rats Sigmodon hispidus and adult worms of A. costaricensis were recovered two months later. The infection rate of these slugs ranged from 4% in urban areas to 85% in rural areas. These data suggest that contamination to man is a major risk especially in rural areas and that abdominal angiostrongyliasis could be a health problem in Nicaragua.


[Thrombosis and thrombin].

[Thrombosis and thrombin]. Thrombosis, either venous and arterial, is the most important cause of death in our society. Thrombin formation is a pivotal step in the pathogenesis of both forms of thrombosis. Drugs like heparin and vitamin K antagonists act because they inhibit thrombin formation. Better drugs than conventional heparin and oral anticoagulants are however urgently needed. They can be found on basis of a better understanding of thrombin formation. The mechanism of thrombin formation is explained. The mode in which conventional heparin and the newer, low molecular weight heparins inhibit this process is discussed. It is shown that, contrary to current belief, low molecular weight heparins inhibit primarily via their action on thrombin and that the inhibition of factor Xa is of less importance. Thrombin inhibition has a direct action but also acts indirectly via its influence on thrombin mediated feedback loops. It is argued that rather than anti-factor Xa activity or prolongation of some type of coagulation time, the time-concentration integral of thrombin (thrombin potential) in clotting plasma should be used as a yardstick for the efficiency of a thrombin inhibiting drug.


[Lyme disease].

[Lyme disease]. After a short historical review of the Lyme disease, the author describes the responsible bacteria, a Spirochete called Borrelia. Epidemiology, physiopathology and clinical manifestations are studied, as well as the different phases of the disease (primary secondary and tertiary) and the various possible symptoms (dermatological, cardiovascular, rheumatical, neurological syndrome). The biological part includes isolation of the Bacteria and detection of antibodies (IFI, ELISA, passive hemagglutination and Western Blot). Prophylaxy and treatments are also presented.


[Aromatic and polyphenolic composition of infused peppermint, Mentha x piperita L]. The qualitative and quantitative composition of the main aromatic and polyphenolic constituents of Mitcham type peppermint (Mentha x piperita L.) tisane, were examined and compared with those of leaves before and after infusion. The original peppermint leaves contained 2.4% essential oil of which menthol was 0.99%, total polyphenolic compounds 19% and total flavonoid compounds 12% comprising eriocitrin 7%, luteolin-7-rutinoside 1.5%, hesperidoside 0.6% and total hydroxycinnamic compounds 7% (rosmarinic acid 1.4%). The tisane contained 21% of the original essential oil corresponding to 25 mg/l, with increased alcohol and ketone contents and lower contents of hydrophobic terpenecarbons, oxides and esters. It contained also a high proportion of the polyphenolic compounds (about 750 mg/l) corresponding to an extraction yield of 75%. In consequence the monograph "Peppermint leaf" of the Pharmacopoeia should be amended.


[Campaign against allergenic moulds in dwellings. Inhibitor properties of essential oil of Geranium 'Bourbon', citronellol, geraniol and citral]. Many fungal airborne spora show allergenic effects. Indoor (dwelling, work rooms, hospital chambers) can be disinfected by elimination of living particles. We have undertaken experiments in more and more spacious bulks for evaluation of the antifungal effects of vapours of essential oils and some volatiles compounds. Results show that the Mucorales and Geotrichum resist strongly. On the contrary, the Cladosporium strains, some Aspergillus and Penicillium, Trichothecium roseum are the most sensitive, specially towards the citral vapours. Experiments in hospital can be undertaken.


[HPLC used in the validation of simple methods for research of degradation products in essential drug tablets]. HPLC have been used to validate simple methods to be employed in developing countries (DC) for the quality control of drugs. As the important lack of analytical material in DC, colorimetric methods have been used. These are subjected to visual appreciation of the color intensity. Two essential drugs have been selected: aspirin, hydrochlorothiazide. For each compound, standardization of concentration's degradation product by colorimetry and HPLC have been achieved in proximity of the restricted norms of pharmacopoeia. These results have been applied to tablets exposed to stressed conditions (t(0) = 60 and humidity = 75%). The results obtained by colorimetric method were similar to HPLC's ones.


[Measurement of pacemaker effect: incidences on the choice of pacing mode? A prospective and statistical study of 396 patients]. Single ventricular stimulation induces haemodynamic disturbances, the best known of which is the pacemaker syndrome. In order to assess the prevalence and severity of these abnormalities, invasive blood pressure monitoring was performed in 396 consecutive patients undergoing endocavitary electrophysiological investigations: a decrease in systolic blood pressure at a rate near to that of the spontaneous rhythm defines the pacemaker syndrome. It is maximal after 3 to 5 beats of equivalent intensity with or without retrograde conduction. The pacemaker syndrome is greater in hypertensive and coronary patients than in subjects with healthy hearts (-44.2 mmHg and -37.2 mmHg versus -33 mmHg, p < 0.001 and p < 0.04). It is less pronounced in cases of cardiac failure (-31.8 mmHg). The pacemaker syndrome increases in intensity with age (-44.3 mmHg after 80 years of age versus -23.1 mmHg in subjects under 50 years of age; p < 0.001). Two electrophysiological abnormalities are associated with an increased pacemaker syndrome even in apparently normal hearts: sustained induced supraventricular tachycardia (-34.2 mmHg versus -26 mmHg, p < 0.002), mixed carotid sinus syndromes (-38 mmHg) and pure vasodepressive syndromes (-48.5 mmHg, p < 0.001). The study of the pacemaker syndrome is useful for three reasons: the detection of another cardiac abnormality in cases of sustained induced supraventricular tachycardia, even in an apparently healthy heart; to assess the presence of a second haemodynamic abnormality independent of the vagal effect in cases of carotid sinus syndrome with vasodepression; finally, to identify the patients at high risk of a pacemaker syndrome.


[Evaluation of non invasive methods for the diagnosis of atherosclerosis of the graft after orthotopic cardiac transplantation]. The frequency and severity of atherosclerosis of the cardiac transplant make it an essential complication of cardiac transplantation. Coronary angiography is the usual diagnostic method but it has severe limitations. In order to evaluate other diagnostic methods coronary angiography and non-invasive techniques: echocardiography, exercise stress ECG, exercise radionuclide ejection fraction, stress Thallium scintigraphy, were performed practically simultaneously in 60 patients after cardiac transplantation. These non-invasive methods were said to be positive in the presence of, respectively, a segmental wall motion abnormality, ischaemic ST segment depression, absence of increased ejection fraction on exercise, reversible or irreversible myocardial hypofixation. Coronary angiography was considered as the reference procedure for distinction between "normal coronary circulation" (no angiographically detectable lesion) and "graft atherosclerosis" (at least one coronary stenosis irrespective of the severity and extension). None of the non-invasive methods had an adequate sensibility when compared with coronary angiography (echocardiography 0.27, exercise stress ECG 0.28, exercise radionuclide ejection fraction 0.64, myocardial scintigraphy 0.62) or negative predictive value (echocardiography 0.56, exercise stress ECG 0.58, exercise radionuclide ejection fraction 0.68, myocardial scintigraphy 0.66). This inadequacy of the non-invasive technique may be explained by the fact that they are more adapted to the diagnosis of myocardial ischaemia than that of coronary studies. In addition, the extent of the coronary lesions may have masked discordance between 2 segments by the global hypovascularisation. The results of this study indicate that the non-invasive methods studied cannot be recommended for diagnosis of atherosclerosis of cardiac transplants.


[Characteristics and prognosis of ventricular tachycardia induced by atrial fibrillation]. The aim of this study was to evaluate the clinical significance of ventricular tachycardia (VT) induced by atrial pacing. A group of 145 patients with spontaneous and induced VT was studied. Twenty-four VTs were induced by atrial stimulation (Group I) and 121 by ventricular stimulation (Group II). The underlying cardiac disease was comparable in the two groups (ejection fraction 32 +/- 14% versus 34 +/- 17%). Spontaneous bi-tachycardias, syncope and VT induced by exercise testing were more common in Group I. The prognosis was worse with 7 cardiac deaths in Group I versus 23 in Group II; recurrences of VT were commoner in group I. In this group, an electrophysiological (branch to branch or fascicular reentry) or clinical mechanism (ischaemia or poor haemodynamic status) could usually be demonstrated. Some cases of idiopathic VT were also observed in young patients. These results suggest that atrial stimulation should be performed routinely during electrophysiological studies of VT because the induction of VT by this method is not uncommon (16%). In addition, these cases of VT usually have a precise mechanism and a poor prognosis and, therefore, an appropriate treatment should be given.


[Value of early systematic postoperative transesophageal echocardiography in mitral valve replacements. A prospective study of 50 patients]. The aim of this study was to assess the value of routine transoesophageal echocardiography in the early postoperative period after mitral valve replacement. The authors report their experience in 50 consecutive operated patients (43 mechanical and 7 bioprostheses) investigated routinely by this method in the postoperative period in the surgical unit. Abnormal findings were observed in 36% of cases (18 patients): trans-prosthetic leaks (8 cases) and thrombosis (10 cases) in 2 bioprostheses and 8 mechanical prostheses; in 3 cases this led to haemodynamic dysfunction but in 7 cases the thrombus had no influence on the trans-prosthetic pressure gradient. No predisposing factor could be identified (spontaneous contrast, left atrial volume, left ventricular function, poor anticoagulation, blood clotting abnormalities). No abnormality of the mobile components of the prosthesis was observed at radioscopy. The outcome with heparin therapy was favourable with disappearance of the thrombi in 6 cases; the thrombi did not regress in 4 patients on heparin: 2 patients underwent thrombolytic therapy with a complete cure in 1 case and a severe embolic complication in the other; in 2 cases, the thrombus was so big that the patients were reoperated. Systematic early postoperative transoesophageal echocardiography before discharge from the surgical unit would seem to be necessary after early mitral valve replacement: it allows diagnosis of asymptomatic thrombosis which has an important emboligenic potential. The management of these thromboses remains controversial, but the poor natural outcome in cases of large thromboses should lead to referral for early reoperation.


[Relationship between right ventricular ejection fraction and pulmonary pressure in man]. This clinical study analysed the changes in right ventricular ejection fraction induced by changes in right ventricular afterload using a new thermodilution catheter linked to a rapid response computer which allowed instantaneous measurements of the right ventricular ejection fraction. The first group comprised 16 patients referred for coronary angioplasty with single vessel disease (isolated proximal stenosis of one of the two main branches of the left coronary artery) and a normal left ventricular ejection fraction (> or = 55%) and mean pulmonary artery pressure of < 25 mmHg: right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after 60 seconds' coronary occlusion with the balloon catheter in order to assess the effects of the reactional increase in afterload on the right ventricular ejection fraction. The second group comprised 11 patients with dilated primary cardiomyopathy with decreased left ventricular ejection fraction (< 50%) and mean pulmonary artery pressure > or = 25 mmHg: the right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after intravenous trinitrin (performed to evaluate the pulmonary reaction to vasodilators) in order to analyse the effects of the reduction of afterload on right ventricular ejection fraction. Negative linear correlations were observed between the right ventricular ejection fraction and mean pulmonary artery pressure under basal conditions (r = -0.72; p < 0.005) and between the right ventricular ejection fraction and mean pulmonary artery pressure after changing the conditions of afterload (r = -0.82; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)


[Comparative effects of anti-arrhythmia agents on ventricular refractory period and prevention of ventricular tachycardia induced by stimulation]. The efficacy of antiarrhythmic drugs is attributed to their actions on the refractory periods or conduction velocity in the reentry circuit. The aim of this study was to determine the relationship between these factors and the prevention of electrically inducible ventricular tachycardia (VT). Twenty-seven patients with sustained monomorphic postinfarction VT underwent programmed stimulation under basal conditions and after administration of oral Class I antiarrhythmic drugs. The protocol of stimulation consisted of delivering one to three extrastimuli to the right ventricular apex on two basic cycle lengths. Sustained VT was induced in all patients. After the same protocol under antiarrhythmic therapy (1 to 5 tests, average 2.9 +/- 1) sustained VT could not be induced in 12 patients (44%). The effective right ventricular refractory period was significantly increased in patients without inducible VT under treatment (247 +/- 18 versus 302 +/- 26 ms). The increase in the right ventricular effective refractory period in patients with persistence of inducible VT was much less (from 270 +/- 28 to 287 +/- 30 ms). In all patients in whom several antiarrhythmic drugs were tested the right ventricular effective refractory period was higher when the treatment was judged to be effective (299 +/- 27 ms) than ineffective (272 +/- 27, p < 0.02). The prevention of inducible VT by class I antiarrhythmic agents seems therefore to be related to their effect on the ventricular refractory period.


[Measurement of right ventricular dP/dt. A simultaneous/comparative hemodynamic and Doppler echocardiographic study]. Right ventricular systolic function is difficult to assess by Doppler echocardiography. We studied 14 patients with tricuspid regurgitation on Doppler echocardiographic examination with the object of determining an index of right ventricular contractility based on the continuous Doppler signal of the regurgitant jet. The rate of increase in right ventricular pressure was calculated between 2 points, V1 and V2, situated on the ascending limb of the velocity profile of the tricuspid regurgitation and compared with the dP/dt max measured simultaneously at right heart catheterisation. The different values of V1 and V2 were: 0 and 1 m/s, 0 and 2 m/s, 0.5 and 1.5 m/s, 1 and 2 m/s and 0.5 and 2 m/s. An excellent correlation was observed between the catheter dP/dt max and the rate of increase in pressure measured by Doppler between 0 and 2 m/s (r = 0.93; p = 0.0001) and between 0.5 and 2 m/s (r = 0.93; p = 0.0001). The correlation was not as close between 0 and 1 m/s (r = 0.69; p = 0.048) and there was no correlation with the measurements between 0.5 and 1.5 m/s and between 1 and 2 m/s. Doppler echocardiography could therefore be used for non-invasive assessment of right ventricular systolic function in clinical practice.


[Effects of electrocautery on the threshold values of permanent pacing. An experimental study]. One of the hazards of high frequency electrical interference (electrocautery) with cardiac pacing is thought to be related to an increase in the threshold values leading to loss of pacing. This hypothesis was examined in an experimental study performed on 5 dogs. A pacing catheter was introduced via the right jugular vein and positioned at the apex of the right ventricle and connected successively to several stimulators implanted in a latero-cervical subcutaneous pocket. A Bovie 400 CT generator was used to deliver a high frequency 1.75 MHz current between a probe applied near to the pacemaker pocket and an electrode placed under the right leg. One or two 5 second bursts were applied for each make of pacemaker, making a total of 3 to 6 applications per animal. A detecting circuit enabled the measurement of the currents in the catheter during the application. The thresholds of pacing were measured before and after each manipulation for several pacing impulse durations. At the maximal output of the generator, the highest recorded current was 117 mA (modulated) and 141 mA (unmodulated). The thresholds of stimulation did not change significantly and the pacing catheter impedance was also stable. This study suggests that high frequency current does not modify the threshold of stimulation in cardiac pacemaker patients. The loss of pacing sometimes observed after the use of electrocautery is probably related to pacemaker dysfunction.


[Financial management of clinical cardiovascular research in France from 1985 to 1990]. From 1985 to 1990, 31.5 MF were distributed for clinical cardiovascular research in France by: the Institut national de la santé et de la recherche médicale (INSERM): 7.7 MF (25%); the Société Française de cardiologie (SFC): 4.6 MF (15%) comprising 3.4 MF from its own resources (74%) and 1.2 MF from the pharmaceutical industry (26%); the Fédération Française de cardiologie (FFC): 9.4 MF (30%) comprising 6.4 MF (68%) from its own resources and 3 MF from the pharmaceutical industry (32%); the pharmaceutical industry directly: the Searle Foundation; 4.8 MF (15%); and the Bank Crédit Lyonnais: 5 MF (15%). The pharmaceutical industry therefore donated directly or indirectly via the SFC or the FFC, 9 MF or one third of the total sum attributed for cardiovascular research. Globally, over the period 1985-1990, the sums invested in cardiovascular research have doubled. The largest increase was related to the efforts of cardiologists themselves and their professional institutes: the SFC (by a factor of 3.7) and the FFC (by a factor of 2.5). On the other hand, independent donations and grants received from the pharmaceutical industry, the bank and Inserm have remained at the same level.


[Parkinson syndrome, a possible adverse effect of calcium inhibitors]. The effects of calcium inhibitors are not limited to the muscles and may affect other systems and cause varied side effects. Two cases of Parkinsonian syndrome occurring after starting therapy with calcium inhibitors (verapamil in one case and diltiazem in the other) are reported. Complete regression of the symptoms after withdrawing the drugs was strongly in favour of a causal relationship. The condition could be due to inhibition of the calcium channels in the central nervous system disturbing neurotransmission. This seems to be a rare side effect as there have only been three other reported cases of secondary extrapyramidal syndromes in the literature. However, a Parkinsonian syndrome is very invalidating and clinicians using this family of drugs should be aware of this possible complication.


[Early constrictive pericarditis after coronary revascularization. Apropos of a case]. The authors report a case of severe constrictive pericarditis occurring 6 weeks after coronary bypass surgery and in the absence of any other predisposing factor. The diagnosis was confirmed by CT scan and cardiac catheterisation which showed signs of a diastole. The patient died despite early surgical reoperation because of the severity of the pericardial fibrosis.


[Tamponade without cardiac rupture after repetitive thrombolysis in acute myocardial infarction]. The authors report the case of tamponade without cardiac rupture 48 hours after a second course of intravenous thrombolytic therapy undertaken for unstable angina in laterobasal infarction in a 72 year old woman. The outcome after ultrasonic guided pericardiocentesis and surgical drainage (700 cc) was favourable. This is a rare complication of thrombolytic therapy (10 cases) and usually observed after anterior myocardial infarction.