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7787730
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Barium studies in esophageal cicatricial pemphigoid.
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Cicatricial pemphigoid (CP) (benign mucous membrane pemphigoid) is a rare, blistering disease of skin and mucous membrane. The disease rarely extends to involve the esophagus, and there are only a few cases reported in the radiological literature. The aims of this study were to document the frequency of esophageal involvement and to describe the findings on upper GI barium studies. A total of 197 patients with CP were seen at our institution from 1981 to 1991. The clinical and radiological findings of these patients were reviewed and compared with findings reported in the literature. Esophageal involvement was documented in seven patients. Cervical esophageal webs were found in five of the seven patients. Two patients had single esophageal webs while three had multiple webs. Frank strictures of the esophagus were also seen in five patients. These were most common in the cervical esophagus, but strictures were also found in the mid and lower esophagus. Two of the strictures resulted in significant dysphagia and required multiple endoscopic dilatations. One of the dilatations was complicated by mucosal injury, and follow-up barium examination showed dissection of the esophageal mucosa from the cervical esophagus to the esophagogastric junction. One patient demonstrated intramural pseudodiverticulosis in the cervical esophagus. Functional disturbances demonstrated on barium studies included tracheal aspiration in two patients and nasopharyngeal reflux in three. CP involves the esophagus in approximately 5% of cases. The hypopharynx and cervical esophagus are most commonly involved, but any portion of the esophagus may be involved, and multiple levels of involvement may be seen. Cervical esophageal webs, often multiple or complex, are the most common appearance on barium studies, but frank strictures are also found. Secondary manifestations of esophageal involvement include nasopharyngeal reflux, tracheal aspiration, and intramural pseudodiverticulosis.
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7787727
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MRI of pelvic neurofibromatosis.
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Pelvic neurofibromatosis is a rare disease and rarely involves the prostate. A 19-year-old male presented with irritative and obstructive voiding symptoms. Magnetic resonance imaging showed a large mass extending from the sacral promontory to the perirectal and perivesical spaces and to the proximal root of the penis. The mass also involved the prostate. The characteristics of the mass were highly suggestive for neurofibroma. Prostate biopsy showed neurofibroma, and the immunohistochemistry stain for S-100 protein was positive.
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7787726
|
Ureteral lymphoma: MRI demonstration.
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A case of ureteral lymphoma with no other areas of involvement was incidentally discovered on MRI examination. Bilateral ureteral soft tissue infiltration, asymmetrical hydronephrosis, and abnormal enhancement of lymphomatous tissue were noted. A follow-up MRI after chemotherapy demonstrated significant decrease in the size of the periureteral disease and improvement in the extent of hydronephrosis.
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7787725
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Emphysematous pyelonephritis with resultant emphysematous cholecystitis secondary to hematogenous dissemination.
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Both emphysematous pyelonephritis and emphysematous cholecystitis are uncommon, but potentially fatal, clinical entities. The simultaneous diagnosis of these two entities in the same patient has not previously been reported. In this paper, we describe a 68-year-old diabetic male who presented acutely with emphysematous pyelonephritis and emphysematous cholecystitis. This case demonstrates several important diagnostic and treatment considerations. Additionally, the unique circumstances of this case offer support for the proposal that emphysematous cholecystitis may often be secondary to hematogenous seeding/embolic phenomena rather than obstruction of the cystic duct. Prompt diagnosis is essential, as prompt intervention can minimize mortality and morbidity.
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7787723
|
Herniation of small bowel through the falciform ligament: CT demonstration.
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A case of intestinal obstruction with strangulation due to a hernia through a rent in the falciform ligament is presented to emphasize the diagnostic role of CT imaging in patients without previous surgery.
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7787724
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Multilocular cystic renal cell carcinoma presenting as a solid mass: radiologic evaluation.
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Multilocular cystic renal cell carcinomas (MCRCCs) are a recently described variety of renal cell carcinoma with characteristic pathological and clinical features. We found that the radiologic appearances of MCRCCs of smaller size did not fulfill the previously documented criteria of the MCRCCs. This study was conducted to analyze the radiologic characteristics of MCRCCs of smaller sizes. The radiologic findings of 13 multilocular cystic renal cell carcinomas of diameter ranging from 10-32 mm (average 22 mm) seen in nine patients were analyzed in correlation with pathologic findings. On US, the tumors were predominantly hyperechoic (11 of 13 tumors) with or without small anechoic areas. Precontrast CT showed the lesions to be either hypodense or hyperdense depending on the presence of hemorrhage. Degree of contrast enhancement was usually slight. The mean increase in CT attenuation was 28 +/- 19 (mean +/- standard deviation) at dynamic phase and 12 +/- 10 at delayed phase. On MR imaging, signal intensities of the tumors were high both on T1- and T2-weighted images (7 of 9 tumors) due to proteinaceous fluid or hemorrhage. Dynamic enhanced MR imaging revealed irregular contrast enhancement within the tumor (5 of 6 tumors). Angiography failed to reveal neovascularity. Although multiple cysts were seen within the tumors pathologically, MCRCCs of smaller sizes appeared solid on radiologic examinations. However, contrast enhancement or neovascularity was very slight.
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7787722
|
Niemann-Pick disease type C: nodular splenomegaly.
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Niemann-Pick type C disease (NPCD) is an autosomal recessive storage lipidosis due to a disorder of cholesterol esterification leading to the accumulation of sphingomyelin and cholesterol in the brain, liver, and spleen. The disease is usually diagnosed when neurological symptoms appear. We report an unusual presentation of NPCD in a young asymptomatic adult with isolated nodular splenomegaly.
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7787720
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Nonpalpable rectus sheath hematoma clinically masquerading as appendicitis: US and CT diagnosis.
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Within a period of 5 years, we encountered three patients with a small rectus sheath hematoma, presenting with clinical signs of appendicitis. The rectus sheath hematoma was diagnosed by ultrasound (US) in all three cases and confirmed by computed tomography (CT) in two. None of the hematomas was palpable and in two of three cases in which the patient did not receive anticoagulant therapy. In patients who are sonographically examined for suspected appendicitis, the abdominal wall should be studied as well, to exclude a nonpalpable rectus sheath hematoma. In cases in which a hematoma is found, an unnecessary appendectomy can be prevented.
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7787721
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Turcot's syndrome: a new case in the first decade of life.
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A case of Turcot's syndrome is described in an 8-year-old girl. Turcot's syndrome is a rare hereditary disease in which malignant glioma of the central nervous system is associated with colonic polyposis. The patient initially presented with a left parietal glioblastoma diagnosed by computed tomography (CT), and was subsequently found to have nonfamilial colonic polyposis.
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7787719
|
Sonography of acute appendicitis in pregnancy.
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Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women. We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm. The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical followup; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix. Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.
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7787718
|
Direct spread of subperitoneal disease into solid organs: radiologic diagnosis.
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The subperitoneal space is the continuous space interconnecting the peritoneum and retroperitoneum and the abdominal organs. This report expands the concept of direct spread of disease via the subperitoneal space to include direct extension into the solid abdominal viscera (i.e., liver, kidneys, and spleen). Discussion of the anatomy, case presentations, and imaging with computed tomography, ultrasound, and magnetic resonance are presented. This unifying concept provides an understanding for direct spread of disease presenting clinically or being imaged within a solid abdominal organ.
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7787716
|
Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients.
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The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. After chemotherapy, tumor volume decreased by 50-90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.
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7787717
|
Chylous ascites: CT and ultrasound appearance.
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An unusual but pathognomonic appearance of chylous ascites was observed on computed tomographic (CT) and ultrasound examinations of the abdomen in a patient with AIDS and disseminated tuberculosis. The images showed gradual development of fat-fluid level in the peritoneal collection when the patient maintained a recumbent position. The explanation for this phenomenon is provided together with a brief review of pertinent literature.
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7787715
|
Cystic peripheral cholangiocarcinoma: sonography and CT.
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A case of cystic peripheral cholangiocarcinoma is presented. Both sonography and computed tomography (CT) demonstrated a large intrahepatic cystic neoplasm containing an enhancing solid portion. Despite the very rare incidence of this tumor, we believe that cystic degeneration of peripheral cholangiocarcinoma should be considered with these radiologic findings.
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7787714
|
MR imaging of intrahepatic cholangiocarcinoma.
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The purpose of this study was to determine the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma. MR imaging studies of seven cases of pathologically proven intrahepatic cholangiocarcinoma were retrospectively reviewed. On MR images the tumors presented as a single mass (N = 5) or multiple nodules (N = 2), as well-delineated (N = 5) or ill-defined (N = 2), and as nonencapsulated (N = 7). Mean tumor diameter ranged from 6-14 cm (mean, 10 cm). On T1-weighted (TR/TE = 400-600/10-17 msec) images, the tumors were hypointense compared to the liver. The five tumors studied with dynamic MR imaging showed progressive centripetal filling-in after intravenous administration of a gadolinium chelate. On T2-weighted (TR/TE = 2000-2500/80-100 msec) images, all tumors were hyperintense compared to the liver; five were markedly hyperintense and two moderately hyperintense. Vascular encasement, bile duct dilatation within the tumor, and central scar were depicted on MR images in four, three, and two tumors respectively. The typical MR appearance of intrahepatic cholangiocarcinoma is a large well-delineated nonencapsulated tumor associated with intrahepatic venous encasement.
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7787712
|
Bile duct involvement in hepatocellular carcinoma: MR demonstration.
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To determine the magnetic resonance (MR) features of hepatocellular carcinoma (HCC) with associated bile duct involvement. MR examinations of six patients (mean age, 62 years) demonstrating bile duct involvement due to HCC were retrospectively reviewed and compared to surgical and pathologic findings. Three of the tumors were solitary, and three were multifocal. In two patients, MR showed direct biliary duct invasion by tumor. On T1-weighted MR images, four tumors were hypointense compared to the liver and two were isointense. On T2-weighted MR images, four tumors were hyperintense, and two were isointense. The two tumors studied with dynamic T1-weighted MR images obtained after intravenous administration of a gadolinium chelate, displayed enhancement similar to that of the liver. There was no evidence of a tumor capsule on either unenhanced or enhanced MR images. Intrahepatic bile duct dilatation was seen in five patients. The extrahepatic bile duct was normal in all cases. Although rare, HCC should be included when considering the etiology of intrahepatic bile duct obstruction. Imaging features suggestive of the diagnosis by MR include intrabiliary tumor or bile duct obstruction with an associated hepatic mass.
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7787713
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Dynamic contrast-enhanced MR imaging of fibrolamellar hepatocellular carcinoma.
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The magnetic resonance (MR) appearance of fibrolamellar hepatocellular carcinoma (FL-HCC) on T1- and T2-weighted and dynamic serial postgadolinium-DTPA images is reported. Both tumors were large (> 7 cm in shortest dimension) and had central regions of low signal intensity on T1- and T2-weighted images. Diffuse heterogeneous enhancement of the tumors occurred on immediate postcontrast images. Lesions became more homogeneous in enhancement over time, but lack of enhancement of central portions of the tumor persisted. Although persistent lack of enhancement of the tumor scar on late postcontrast MR images may be characteristic of FL-HCC compared with delayed enhancement in focal nodular hyperplasia, the potential similarities between these tumors is stressed.
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7787710
|
Primary sclerosing cholangitis: sonographic findings.
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To determine the value of sonography of the upper abdomen in primary sclerosing cholangitis (PSC). In a prospective study of 23 patients with PSC we performed upper abdominal sonography. Sonographic findings of the bile ducts were correlated with endoscopic retrograde cholangiographic (ERC) findings. Signs of advanced disease and complications were also sought. The major limitation of ultrasound was its inability to exclude intrahepatic duct disease. In six patients with multiple strictures and pruning but without dilatations on ERC, sonography showed no intrahepatic duct abnormalities. Extrapheptic duct disease was adequately demonstrated on ultrasound. Mural thickening of the common bile duct (CBD), the hallmark of PSC in the appropriate clinical setting, was demonstrated in 17 of 18 cases with a stenosis on ERC. Ultrasound confirmed advanced disease manifested by signs of portal hypertension in seven patients. Marked nonsegmental intrahepatic duct dilation and the presence of a mass lesion occurred in two of three cases in which complicating cholangiocarcinoma was found. Despite its inability to exclude intrahepatic duct disease, sonography is useful in diagnosing and following PSC.
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7787711
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Intrahepatic bile duct dilatation secondary to hepatocellular carcinoma: CT features in 10 patients.
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To determine the computed tomographic (CT) features of bile duct obstruction secondary to hepatocellular carcinoma (HCC). CT examinations of 10 patients (mean age, 58 years) with bile duct obstruction secondary to HCC were retrospectively reviewed. All tumors were intrahepatic. Eight tumors were well-delineated and two were ill-defined. The largest diameters of tumor ranged from 1.5-6.0 cm (mean, 3.6 cm). All tumors were hypodense before contrast and did not contain calcification. After contrast, four tumors became hypodense, three were isodense, and three were hyperdense to the liver. No tumor demonstrated encapsulation. Diffuse intrahepatic bile duct dilation was observed in seven patients. One patient had extrahepatic bile duct dilatation. Localized bile duct dilatation was observed in three patients, in the hemi-liver which contained the tumor. No tumor invaded the portal vein. Although rare, HCC should be included in the differential diagnosis of bile duct obstruction. This diagnosis should be suggested in patients with bile duct obstruction when CT shows an associated intra- or extrahepatic mass. Our results suggest that HCC responsible for bile duct obstruction is remarkable for the absence of encapsulation.
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7787708
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Clinical evaluation of gastric fundic gland polyps without familial polyposis coli.
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Assessments were made of 63 cases of fundic gland polyposis (FGP) unassociated with adenomatosis coli. These cases were evaluated by radiological examination over 2 years follow-up. All polyps were pathologically confirmed by endoscopic biopsies. Most cases were asymptomatic when diagnosed during mass radiological surveys of the upper gastrointestinal tract. The majority of patients ranged in age from 40-60 years, and the polyps numbered fewer than 20 in 55 cases (87.3%). Polyps were detected in the fundic glands using the congo red test and by biopsies. All serum gastrin values were within the normal range. During the course of this study, the polyps of 13 cases (20.6%) increased and those of three cases (4.8%) decreased or resolved completely. From these findings it is considered that FGP are observed in stomachs with less atrophy, and that polyps follow courses in which they increase, decrease, disappear, along with atrophy.
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7787709
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Periduodenal panniculitis due to spontaneous rupture of a pancreatic pseudocyst into the duodenum.
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We report a patient with transient periduodenal panniculitis due to spontaneous rupture of a pancreatic pseudocyst into the duodenum. He developed sudden onset of severe epigastric and back pain with jaundice, mimicking the symptoms of acute pancreatitis. However, the serum and urinary amylase levels did not increase. CT scans showed disappearance of his pseudocyst and periduodenal panniculitis without any evidence of acute pancreatitis. The CT findings of periduodenal panniculitis and his symptoms both improved within 3 weeks. A duodenal fistula leading to the remnant pseudocyst and narrowing of the periduodenal portion of the common bile duct were demonstrated by endoscopic retrograde cholangiopancreatography.
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7787702
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[An experimental evaluation of the behavioral characteristics in the formation of a predilection for alcohol].
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A set of correlating indices has been developed to assess alcohol craving in rats who has a free access to it for 24 months. The set includes the estimation of voluntary daily alcohol intake before and after ethanol deprivation and the assessment of rats' behavior in a conflict situation and a plus-maze. The increased intake of alcohol after its deprivation has been established to correlate with a number of punished ethanol lickings in the conflict paradigm and functional locomotor asymmetry in the plus-maze.
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7787701
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[The effect of D-penicillamine on the metabolism of the basic substance of the connective tissue and the indices of the liver parenchyma in experimental cirrhosis in rats].
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While examining the effects of D-penicillamine [correction of D-penicillin] on the formation of hepatic toxic damage in mature male Wistar rats from the stage of developing cirrhosis to that of the developed one, the author revealed a high antifibrotic activity of the drug which significantly normalized the metabolism of the major agent of the hepatic connective tissue; there was a slight improvement of parenchymal metabolism when the agent was taken for 2 months. There were apparently healthy animals in the experimental group following 4-month course of the therapy. Control rats developed hepatic damage, as evidenced by electron microscopic studies.
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7787698
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[The pharmacological correction of the activity of lipid peroxidation processes in the dynamics of craniocerebral trauma].
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Rat experiments have shown that free radical oxidation processes are activated in the cerebral mitochondrial fraction in the dynamics of craniocerebral injury, which appears as accumulation of malonic dialdehyde and disturbed functional interaction of antiradical protection enzymes. These changes are most marked 24 hours after injury. Some GABA-positive drugs and opioid receptor agonists prevent lipid peroxidation activation. The highest efficiency is displayed by piracetam (1 g/kg) and the synthetic enkephalin analogue DSLET (0.1 mg/kg).
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7787700
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[The pharmacokinetics of the new Russian prolonged-action form of diclofenac sodium--Ortopek--in a single oral dose].
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Ortopak tablets, 100 mg, were investigated. The pharmacokinetics of Ortopak was studied in 10 rheumatoid arthritis patients after a single oral dose of 100 mg. Ortophenum and voltaren-retard (Ciba-Geigy) were used for comparison. Diclophenac-sodium was measured in the patient's plasma by using high performance liquid chromatography. Ortopak was shown to be eliminated from the patient's body much slower than Ortophenum. The bioequivalence of Ortopak versus Ortophenum was 62.7%. The pharmacokinetic properties of Ortopak were similar to those of Voltaren-retard, which were close to those of diclophenac-sodium in the blood plasma within the therapeutic range.
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7787699
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[The limitation of glucose catabolism as a factor in protection during hypoxia].
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Violuric acid was first shown to have antihypoxic and antioxidative properties, to exert protective action in sodium nitrite-induced hemic hypoxia. Hepatic glucose and glucogen levels increased, the activity of glucose-6- phosphodihydrogenase enhanced, while that of lactate dehydrogenase and alkaline phosphatase decreased, the content of cAMP restored, whereas cGMP and 2,3-diphosphoglycerate levels decreased to a greater extent. The action of violuric acid was especially evident at the ultrastructural level-the ultrastructure of brush receptor elements in anoxia in the presence of violuric acid's action retained all the features characteristic for intact animals, which was accompanied by a significant accumulation of glycogen in the neuroplasm.
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7787697
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[The cytochrome P-450-dependent mono-oxygenase system of the liver and interleukin-1 production by the macrophages in adjuvant arthritis in rats under the influence of beta-carotene].
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A relationship between the production of interleukin 1 (IL-1) by macrophages from adjuvant-induced arthritic rats and cytochrome P-450-dependent hepatic microsomal monooxygenase was studied. The synthesis of IL-1 by splenic and peritoneal macrophages on day 17 postadjuvant treatment was not altered, but the hepatic cytochrome P-450 levels and monooxygenase activity were significantly decreased. Beta-carotene treatment of arthritic rats reduced hind paw swelling and concurrently stimulated the ability of macrophages to secrete IL-1 and increased the cytochrome P-450 levels and the activity of hepatic monooxygenase. The findings did not establish a definite relationship between the production of IL-1 by systemic macrophages on the one hand, and the hepatic cytochrome P-450 levels a and monooxygenase activity on the other hand. It thus appears that IL1 is unable to play a role of a mediator between the immune system and the hepatic cytochrome P-450-dependent monooxygenase system of rats with adjuvant-induced arthritis.
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7787696
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[The effect of thalicoside on reproductive function in an experiment].
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Talicoside, a triterpene glycoside from Thalictrum minus L., given in an oral dose og 1 mg/kg for 5 days was demonstrated to cause ovulation stimulation induced by intravenously injecting 1.2% solution of copper acetate into the rabbits. The agent enterally administered in a dose of 1 mg/kg to rats for 5 days reduced the levels of luteinizing hormone and elevated serum follicle-stimulating hormone in proestrous and estrous.
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7787695
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[An evaluation of the efficacy of chronotheray with heparin and kurantil in patients with chronic pyelonephritis].
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The effectiveness of traditional therapy (TT) and chronotherapy (CT) with heparin and curantyl was comparatively studied in 80 patients suffering from chronic pyelonephritis. The blood clotting variables were determined every 4 hours before and 2.5-3 weeks after TT and CT in combination with antibacterial therapy. The findings suggest that CT is more effective than TT with heparin and curantyl. With CT, steady-state clinical effects, positive dynamics of laboratory findings and a greater trend to normalization of the circadian organization of hemocoagulation were achieved in earlier periods when lower daily and course doses of the agents were used.
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7787694
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[The interaction of the converting-enzyme inhibitor captopril with cardiac glycosides in the rat kidney].
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Strophanthin (0.1 mg.kg, i.v.) and digoxin (0.1 mg/kg, i.v.) moderately increase blood supply of the renal cortical and medullary layers in unconscious rats and enhance renal excretion of sodium and water. Preadministration of the converting enzyme inhibitor captopril (10 mg/kg/day, per os, for 6 days) promoted vascular dilatation in the inner and outer areas of the medulla, which occurred under the action of these agents and substantially increased their natriuretic and diuretic effects. It is concluded that the renin-angiotension system is directly involved into the mechanism of action of cardiac glycosides in the kidneys, acting as a modulator that prevents their vasodilating and tubular effects.
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7787693
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[The epithelium-dependent mechanism of the bronchodilating action of adrenaline].
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The involvement of the epithelium in the adrenergic reactions of airways smooth muscles was studied. The epithelium-dependent pathway of the bronchodilating action of catecholamines, which played a minor role was found to become decisive in some cases. In that case the epithelial inflammatory lesion could be a cause of reducing the response of the bronchi to catecholamines.
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7787691
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[The principles for creating drug preparations of natural origin that stimulate hematopoiesis].
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The paper outlines the principles in designing hemostimulators by using glycosamineglycans. Hemostimulating properties of the tested agents is likely to be primarily due to the presence of D-glucuronic acid in their structure. The homotypic mechanisms are largely responsible for all agents' effect in stimulating hemopoiesis. Thus, they all virtually activate the function of the hemopoiesis-inducing microenvironment. In addition, they directly or indirectly stimulate the processes of proliferation and differentiation of precursor cells of erythro- and granulomonocytopoiesis.
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7787692
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[A mathematical analysis of the cardiac activity indices in patients with ischemic heart disease undergoing antianginal pharmacotherapy].
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Taking into account various parameters of heart rhythm variability makes it possible to differentiate patients with ischemic heart disease by their response to antianginal pharmacotherapy. The cardiointervalographic method may be used to predict therapeutical effects in making clinical and pharmacological decisions.
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7787690
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[The effect of the mineral composition of the diet on cholesterol metabolic indices and the experimental correction of propranolol-induced atherogenic dyslipoproteinemia].
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Rat experiments have revealed that surplus sodium chloride intake causes dyslipoproteinemia and intensifies the atherogenic action of propranolol. The new antihypertensive and antiedematous table salt substitute, as sanasole exerts its hypocholesterolemic effect. Both dietary salt mixtures eliminates the atherogenic action of beta-adrenoblocker. The application of table salt substitutes may become a convenient and effective agent against risk for atherogenesis.
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7787689
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[The effect of ximedon on cholesterol metabolism and experimental atherosclerosis in rabbits].
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The effects produced by the two pyrimidine derivatives pyridinol carbamate (parmidine) and xymedon on cholesterol metabolism and experimental atherosclerosis were comparatively studied in rabbits. The rabbits were fed either a chow containing cholesterol (200 mg/kg body weight) or the same diet also containing xymedon (30 mg/kg body weight) or pyridinol carbamate (30 mg/kg body weight). Total plasma cholesterol showed 5.5- and 4.7-fold increases in the rabbits receiving only cholesterol or cholesterol + pyridinol carbamate, respectively, as compared with that in the animals on a standard laboratory chow. In the rabbits given cholesterol+xymedon, cholesterol levels were 24% less than that in the animals taking cholesterol alone. In these animals, the aortic atherosclerotic damage index (ADI) was equal to 24.1%, which was 1.8-fold less than that in the cholesterol-fed rabbits. In the rabbits given cholesterol+pyridinol carbamate, ADI was decreased by 1.7 times, but it did not differ from that in the hypocholesterolemic rabbits. At the same time xymidone and pyridinol carbamate reduced the hepatic levels of total and esterified cholesterol. To elucidate the mechanism of action of xymedon, it was studied for effects on cholesterol metabolism in cultured rabbit hepatocytes and murine macrophage J774. Xymedon did not alter the esterification and other parameters of cholesterol metabolism in the cultured hepatocytes. It is suggested that the hypocholesterolemic effect was realized at the level of intestinal rather than hepatic cholesterol metabolic changes. The investigations made on the murine macrophage J744 showed that xymedone reduced cholesterol esterification in macrophages, evidently by inhibiting the activity of the enzyme acyl-CoA: cholesterol acyltransferase. The anti-atherosclerotic effect of xymedon seems to result from reductions in plasma cholesterol levels and cholesterol esterification in blood vascular cells.
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7787688
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[A comparative study of the anticonvulsant action of a new table salt substitute].
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Murine experiments have demonstrated that excess sodium chloride intake has an aggravating effect on the course of convulsions caused by corazolum, thiosemicarbaside and maximum electric shock rather than strychnine. The new sodium chloride substitute hyposol given to animals ad libitum for a fortnight produces an anticonvulsant effect which is more pronounced in corazolum-induced convulsions and potentiates the anticonvulsant effect of diazepam. The official drug sanasol is antagonistic to strychnine and corazolum, but it displays a proconvulsant activity on a thiosemicarbaside model.
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7787687
|
[The effect of clofelin on the pain syndrome in mandibular trauma].
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Oral clopheline (0.000075) noticeably alleviates the pain syndrome and circulatory hyperdynamic state of patients with mandibular fracture. The agent is superior to the conventional combination of 50% analgin (2 ml) and 1% dimedrolum (1 ml) in its efficiency and duration of action.
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7787686
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[The effect of calcium channel blockers on animal behavior in tests to study their anxiolytic activity].
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The anxiolytic activity of calcium channel blockers (verapamil, nifedipine, cinnarizine, fendiline, and diltiazem) versus diazepam (relanium) was tested in experiments on male [correction of female] mice. Only verapamil (1 mg/kg) and nifedipine (5 mg/kg) were found to increase the number of transitions and reduced the animals' stay in the dark compartment. All the agents in the used doses failed to substantially affect the animals' behavior in the plus-maze. It is suggested that conditions for modelling pathological anxiety rather than natural states are required in the experiments where antianxiety properties are studied. The model of pathological anxiety states is possible in the examination of the action of agents on the effects of routine anxiogenic agents.
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7787685
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[Nootropic substances enhance the N-methyl-D-aspartate-induced short-term potentiation of synaptic transmission in rat hippocampal slices].
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The nootropic agents pyracetam, ethymisole, N-5-oxynicotinoyl glutamate and beta-carboline derivative--ambocarb--enhance short-term potentiation of populational EPSP's amplitude of area CA1 pyramidal neurons in the slices of the rat hippocampus, which is evoked by NMDA. The inhibitors of protein kinases diminish the effect of pyracetam and ethymisole (tolbutamide), as well as all the studied nootropic drugs (polymyxin B and trifluoroperazine).
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7787684
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[The prediction of the individual chemosensitivity of human malignant tumors: the biological patterns and clinical results].
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Individual laboratory prediction of the sensitivity of human neoplasms to chemicals is justified on the basis of the authors' own data and those available in the literature. The potentialities and limitations of methods for individual prediction, as well as clinical results are discussed. Data are given on some biological mechanisms responsible for tumor growth which have been obtained in in vitro and in vivo tests with human tumor tissue and carcinoma cells. Further perspectives of this line of studies are discussed.
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7787651
|
Where should health services go: local authorities versus the NHS?
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The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities. One of the fiercest debates at the outset of the NHS was whether the hospitals should be run by local authorities. In the end the minister for health, Aneurin Bevan, decided against local democracy and in favour of a national health service. His arguments included the fact that equality of treatment could not be guaranteed if facilities varied with local finances and that even the largest authorities were not big enough to pool risks and expertise. All these arguments still apply today, and the recent changes in community care provide an insight into how a market model of local authority control might work. The changes have been accompanied by a shift from public to private sector provision and the introduction of charges for services that the NHS once provided free. As important, the willingness and ability of local authorities to raise extra revenue from local taxes and charges affect the service they can provide, so leading to inequalities of provision. Local authorities have yet to make the case that they can preserve the fundamental principles and benefits of the NHS, including its reliance on central taxation and unified funding formulas.
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7787650
|
Integrating undergraduate and postgraduate education in general practice: experience in Tayside.
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Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for change, national developments in education, financial support through funds set aside to cover the additional cost of teaching, and a management structure which concentrates on shared leadership. Forces that hindered the integration included uneasiness about ideas for reforming traditional structures, institutional inertia, the complexity of financial arrangements, and tensions over priorities. The experience of managing institutional changes in Tayside has been invaluable and will lead to a more cohesive approach to undergraduate teaching, postgraduate training, and the provision of services relevant to the development of general practice.
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7787648
|
Extracontractual referrals: safety valve or administrative paperchase?
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To describe the extracontractual referrals of residents of a health authority during a six month period in 1994, identifying the number and cost of emergency and non-emergency referrals, including the number of cases costing more than 20,000 pounds and those cases when payment was refused. Descriptive analysis of all extracontractual referrals submitted to the health authority between 1 April and 30 September 1994. A health authority covering a population of 614,000. Payment of 2,583,693 pounds was made to 263 different providers for 2400 episodes of care, of which 1469 were emergencies and 931 were elective or tertiary referrals. Authorisation was granted for an additional 1376 referrals for future treatment but was refused in 713 instances, mostly for technical reasons. Sixteen extracontractual referrals together accounted for over a fifth of total expenditure during the study period. Handling large numbers of episodes of care on an individual cost per case basis imposes an enormous administrative burden on both purchasers and providers, diverting money away from patient care. Extracontractual referrals also expose health authorities to considerable financial risk and may undermine commissioning strategies. Measures are proposed to limit the number of episodes handled in this way.
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7787645
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Risk factors for acanthamoeba keratitis in contact lens users: a case-control study.
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To investigate reasons for an increase in cases of Acanthamoeba keratitis related to contact lenses. Case-control study. Cases were contact lens related acanthamoeba keratitis patients treated between 1 September 1989 and 31 August 1992. Controls were lens users without lens related disease who presented as new patients to the casualty department from 1 March 1992 to 31 August 1992. All subjects completed a questionnaire detailing lens use and hygiene practices. Eye hospital. 35 cases with acanthamoeba keratitis and 378 controls. Relative risks comparing different contact lens types, socioeconomic classification, age, sex, lens use, lens wearing experience, hygiene compliance, and hygiene systems. The crude relative risk for developing acanthamoeba keratitis with the use of daily wear disposable lenses was 49.45 (95% confidence interval 6.53 to 2227; P < 0.001) compared with conventional soft lenses (the referent). Multivariable analysis showed that this increased risk could be largely attributed to lack of disinfection (relative risk 55.86 (10 to 302); P < 0.001) and use of chlorine based disinfection (14.63 (2.8 to 76); P = 0.001) compared with other chemical systems (the referent). None of the other outcome measures showed a significant association. Both failure to disinfect daily wear soft contact lenses and the use of chlorine release lens disinfection systems, which have little protective effect against the organism, are major risk factors for acanthamoeba keratitis. These risks have been particularly common in disposable lens use. Over 80% of acanthamoeba keratitis could be avoided by the use of lens disinfection systems that are effective against the organism.
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7787644
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Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people.
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To determine whether vitamin C status, as measured by dietary intake and plasma ascorbic acid concentration, is related to mortality from stroke and coronary heart disease in people aged 65 and over. A 20 year follow up study of a cohort of randomly selected elderly people living in the community who had taken part in the 1973-4 Department of Health and Social Security nutritional survey and for whom dietary and other data had been recorded. Eight areas in Britain (five in England, two in Scotland, and one in Wales). 730 men and women who had completed a seven day dietary record and who had no history or symptoms of stroke, cerebral arteriosclerosis, or coronary heart disease when examined by a geriatrician in 1973-4. Mortality from stroke was highest in those with the lowest vitamin C status. Those in the highest third of the distribution of vitamin C intake had a relative risk of 0.5 (95% confidence interval 0.3 to 0.8) compared with those in the lowest third, after adjustment for age, sex, and established cardiovascular risk factors. The relation between vitamin C intake and stroke was independent of social class and other dietary variables. A similar gradient in risk was present for plasma ascorbic acid concentrations. No association was found between vitamin C status and risk of death from coronary heart disease. In elderly people vitamin C concentration, whether measured by dietary intake or plasma concentration of ascorbic acid, is strongly related to subsequent risk of death from stroke but not from coronary heart disease.
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7787643
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Interrelation of vitamin C, infection, haemostatic factors, and cardiovascular disease.
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To examine the hypothesis that the increase in fibrinogen concentration and respiratory infections in winter is related to seasonal variations in vitamin C status (assessed with serum ascorbate concentration). Longitudinal study of individuals seen at intervals of two months over one year. Cambridge. 96 men and women aged 65-74 years living in their own homes. Haemostatic factors fibrinogen and factor VIIC; acute phase proteins; respiratory symptoms; respiratory function. Mean dietary intake of vitamin C varied from about 65 mg/24 h in winter to 90 mg/24 h in summer; mean serum ascorbate concentration ranged from 50 mumol/l in winter to 60 mumol/l in summer. Serum ascorbate concentration was strongly inversely related to haemostatic factors fibrinogen and factor VIIC as well as to acute phase proteins but not to self reported respiratory symptoms or neutrophil count. Serum ascorbate concentration was also related positively to forced expiratory volume in one second. An increase in dietary vitamin C of 60 mg daily (about one orange) was associated with a decrease in fibrinogen concentrations of 0.15 g/l, equivalent (according to prospective studies) to a decline of approximately 10% in risk of ischaemic heart disease. High intake of vitamin C has been suggested as being protective both for respiratory infection and for cardiovascular disease. These findings support the hypothesis that vitamin C may protect against cardiovascular disease through an effect on haemostatic factors at least partly through the response to infection; this may have implications both for our understanding of the pathogenetic mechanisms in respiratory and cardiovascular disease and for the prevention of such conditions.
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7787601
|
Using data from the 1991 census.
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The 1991 census for England and Wales provides a substantial amount of data on demography, ethnicity, housing tenure, employment status, and other social factors for geographical areas ranging in size from enumeration districts upwards. Many in the health service and in the academic community are making use of the data in the 1991 census. However, users of census data need to be aware of the problems and limitations of these data, which include the format of the data, data modification and suppression, sampling error, and underenumeration. An important innovation of the 1991 census was that the census form included a question on the postcode of respondents; this allowed the Office of Population Censuses and Surveys to produce a postcode-enumeration district look up table which overcomes many of the problems previously encountered in trying to assign postcodes to enumeration districts. The new look up table also includes the grid reference of postcodes, and this will improve the geographical referencing of census data.
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7787599
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Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters.
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To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. Comparison study of age and sex matched demented and non-demented elderly people and their supporters. 25 primary health care teams in Dundee. 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person. Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care). Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person. Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.
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7787594
|
Somatostatin v placebo in bleeding oesophageal varices: randomised trial and meta-analysis.
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To study whether somatostatin or its derivative octreotide is more effective than placebo for treating bleeding oesophageal varices. Randomised, double blind trial and meta-analysis with blinded analysis of data and writing of manuscripts. Departments of medical and surgical gastroenterology in Copenhagen. Patients suspected of bleeding from oesophageal varices and of having cirrhosis of the liver. Survival, number of blood transfusions, and use of Sengstaken-Blakemore tube. 86 patients were randomised; in each group 16 died within six weeks (95% confidence interval for difference in mortality--19% to 22%). There were no differences between those treated with somatostatin or placebo in median number of blood transfusions (8 v 5, P = 0.07, 0 to 4 transfusions) or in numbers of patients who needed balloon tamponade (16 v 13, P = 0.54, -11% to 28%). In a meta-analysis of three trials involving 290 patients somatostatin had no effect on survival compared with placebo (P = 0.59, odds ratio 1.16; 0.67 to 2.01). For blood transfusions and use of balloon tamponade there was heterogeneity between the trials with no convincing evidence in favour of somatostatin. No placebo controlled trials have been performed with octreotide. Within the limited power of this study and meta-analysis we were unable to show a clinical benefit of somatostatin in the emergency treatment of bleeding oesophageal varices.
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7787595
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The analgesic effect of sucrose in full term infants: a randomised controlled trial.
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To evaluate the effects of different sucrose concentrations on measures of neonatal pain. Randomised, double blind, placebo controlled trial of sterile water (control) or one of three solutions of sucrose--namely, 12.5%, 25%, and 50% wt/vol. Postnatal ward. 60 healthy infants of gestational age 37-42 weeks and postnatal age 1-6 days randomised to receive 2 ml of one of the four solutions on to the tongue two minutes before heel prick sampling for serum bilirubin concentrations. Duration of crying over the first three minutes after heel prick. There was a significant reduction in overall crying time and heart rate after three minutes in the babies given 50% sucrose as compared with controls. This was maximal one minute after heel prick in the 50% sucrose group and became statistically significant in the 25% sucrose group at two minutes. There was a significant trend for a reduction in crying time with increasing concentrations of sucrose over the first three minutes. Concentrated sucrose solution seems to reduce crying and the autonomic effects of a painful procedure in healthy normal babies. Sucrose may be a useful and safe analgesic for minor procedures in neonates.
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7787593
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Evidence of an association between non-Hodgkin's lymphoma and skin cancer.
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To investigate a possible link between exposure to ultraviolet light and the almost epidemic increase in non-Hodgkin's lymphoma worldwide. Because ultraviolet light is known to cause skin cancers, the association between non-Hodgkin's lymphoma and skin cancer was studied. Secondary occurrence of either malignant melanoma or squamous cell skin cancer in cohorts of patients with a first diagnosis of either non-Hodgkin's lymphoma or chronic lymphocytic leukaemia, and vice versa, were studied. Expected numbers of subsequent cancers were calculated by sex, age, and period specific national incidence rates multiplied by the person years under observation in the cohorts. Denmark (1943-89) and Sweden (1958-89). Four population based cohorts identified in the nationwide cancer registries (34,641 people with non-Hodgkin's lymphoma, 17,400 with chronic lymphocytic leukaemia, 34,989 with malignant melanoma, 25,980 with squamous cell skin cancer). A total of 562,085 person years were accrued for the analysis. The ratios of observed to expected cancers (the standardised incidence ratio) served as a measure of the relative risk. The relative risk for developing squamous cell skin cancer was 5.5 (95% confidence interval 4.6 to 6.6) among patients with non-Hodgkin's lymphoma and 8.6 (7.2 to 10.3) among patients with chronic lymphocytic leukaemia. The relative risks remained high over more than 15 years of follow up. Relative risks for malignant melanoma were 2.4 (1.8 to 3.2) for patients with non-Hodgkin's lymphoma and 3.1 (2.1 to 4.4) for patients with chronic lymphocytic leukaemia. After squamous cell skin cancer had been diagnosed there was a twofold excess risk for non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. By contrast, in each of the cohorts the general cancer risks excluding skin and lymphoproliferative malignancies were close to the expected. The occurrence of non-Hodgkin's lymphoma and skin cancer are strongly associated; this supports the hypothesis that the secular increase in exposure to ultraviolet light may have contributed to the increasing incidence of non-Hodgkin's lymphoma in recent decades.
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7787549
|
Smuggling and cross border shopping of tobacco in Europe.
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Governments have recently become concerned about cross border shopping and smuggling because it can decrease tax revenue. The tobacco industry predicted that, with the removal of border controls in the European Union, price differences between neighbouring countries would lead to a diversion of tobacco trade, legally and illegally, to countries with cheaper cigarettes. According to them this diversion would be through increased cross border shopping for personal consumption or through increased smuggling of cheap cigarettes from countries with low tax to countries with high tax, where cigarettes are more expensive. These arguments have been used to urge governments not to increase tax on tobacco products. The evidence suggests, however, that cross border shopping is not yet a problem in Europe and that smuggling is not of cheap cigarettes to expensive countries. Instead, more expensive "international" brands are smuggled into northern Europe and sold illegally on the streets of the cheaper countries of southern Europe.
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7787548
|
Teleradiology.
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Advances in telecommunications and computer software have led to the development of radiology image transfer systems. Radiologists may now report radiographs at a site distant from that of the examination, in some cases almost instantaneously. Computed tomography, magnetic resonance imaging, and ultrasonography may also be supervised from afar. Developments over the past few decades are reviewed, allowing an understanding of the systems currently available. These include systems that transmit static images and real time video systems that enable interactive supervision from a radiologist at a distant site. The implications for the practice of radiology are discussed and the main areas of development over the next few years explored.
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7787547
|
Telemedicine: lessons remain unheeded.
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Telemedicine, the delivery of health care with the patient and health professional at different locations, has been around for over 30 years. Its driving force has been developments in communications technology, and as new communications systems are developed health applications are proposed such as supporting the delivery of primary health care to geographically remote areas or regions underserved through the maldistribution of professional expertise. Despite rapid technological advances, evaluations of such systems have been largely superficial, and more thorough evaluations have failed to show significant advantages for more advanced and expensive technology over older technology such as the telephone. Methods for evaluating the impact of particular technologies on the health care system need to be developed and clearer benefits shown in terms of improved standards of care.
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7787542
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Need and demand for primary health care: a comparative survey approach.
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To develop general practice profiles of needs and demand for primary health care. Postal survey of a stratified random sample of 3478 people registered with five general practices. Data from a single practice were compared with data from the remaining four to identify areas of comparative need. Five general practices in Lothian. Differences between the single practice and the comparison practices in terms of social and economic circumstances, limiting long term illness, specific ongoing conditions, minor illness or symptoms, psychosocial problems, discussion of lifestyle, associated use of services. Respondents from the single practice reported higher rates than those in the four comparison practices of ongoing mental health and respiratory problems and use of antidepressants, tranquillisers, or sleeping tablets. Although rates of limiting long term illness and other specific ongoing conditions were comparable, the rates of minor illness or symptoms and psychosocial difficulties were higher in the single practice. Respondents from the single practice were more likely to consult frequently, to have contacted the practice out of normal working hours, and to have discussed psychosocial difficulties with a general practitioner. For any specific ongoing condition or "minor" illness, respondents from the single practice were no more likely to consult. A comparative survey approach is a useful method of developing an understanding of patterns of need and demand among general practice populations. It has the potential to inform planning within individual general practices and the process of commissioning among general practices within a given area.
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7787537
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Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial.
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To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection. Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. Large general hospital in Dublin. 541 patients admitted for lower respiratory tract infection during one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection. Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. There were no significant differences between the groups in clinical outcome or mortality (6%). However, patients randomised to oral co-amoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around 176,000 pounds a year. Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intraveous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.
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7787538
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Prevalence and outcome of symptomatic carotid lesions in young adults. National Research Council Study Group.
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To estimate the prevalence and outcome of symptomatic internal carotid artery lesions in young adults. Multicentre hospital based observational study with five year follow up. Seven neurological departments in northern and central Italy. 240 patients (115 men) aged 15-44 with a recent transient ischaemic attack or stroke in the carotid territory. (a) Prevalence of symptomatic internal carotid artery stenosis or occlusion detected by continuous wave Doppler ultrasonography at entry; (b) incidence rates of cerebral, cardiac, and non-vascular death; non-fatal stroke; and non-fatal myocardial infarction. Carotid stenoses of 50-99% and occlusions were found in 38 patients (15.8%). Both conditions were significantly more frequent in patients aged over 35 and in those with hypertension, diabetes mellitus, and stroke at entry. The standardised mortality ratio at five years was 10.5 (95% confidence interval 5.0 to 19.3). Survival of patients with stenoses of 0-49% and occlusions was significantly better than that of patients with stenoses of 50-99%. Carotid stenosis of 50-99% was an independent predictor of death (hazard ratio 7.9; 95% confidence interval 2.2 to 29) and non-fatal stroke (hazard ratio 7.4; 1.5 to 37.4). The prevalence of carotid stenosis or occlusion in young adults after a cerebrovascular event is low. Though patients with high grade symptomatic carotid stenosis are at risk of non-fetal and fetal events, patients with internal artery occlusion apparently have a benign prognosis.
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7787536
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Influence of vitamin D receptor genotype on bone mineral density in postmenopausal women: a twin study in Britain.
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To investigate the possible association between vitamin D receptor genotype and bone mineral density in a large group of postmenopausal twins. Cross sectional twin study. Twin population based in Britain. 95 dizygotic (non-identical) pairs of twins and 87 monozygotic (identical) pairs of twins aged 50-69 years, postmenopausal, and free of diseases affecting bone, recruited from a national register of twins and with a media campaign. Bone mineral density measured at the hip, lumbar spine, forearm, and for the whole body by dual energy x ray absorptiometry in relation to differences in the vitamin D receptor genotype. At all sites the values of bone density among dizygotic twins were more similar in those of the same vitamin D receptor genotype than in those of differing genotype, and the values in the former were closer to the correlations seen in monozygotic twins. Women with the genotype that made them at risk of osteoporotic fracture had an adjusted bone mineral density that was significantly lower by SD 0.5 to 0.6 at the hip, lumbar spine, and for the whole body. The results could not be explained by differences in age, weight, years since menopause, or use of hormone replacement therapy. The findings that in postmenopausal women in Britain bone density-particularly at the hip and spine-is genetically linked and specifically associated with the vitamin D receptor genotypes should lead to novel approaches to the prevention and treatment of osteoporosis.
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7787517
|
[Mechanisms of natural detoxication and antioxidant protection].
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This paper considers the mechanisms of energy-dependent and synchronized detoxication and antioxidative defense (AOD) when synchronized detoxication and antioxidative defense (AOD) when the body is exposed to chemicals. It emphasizes the role of glutathione as a binder of this system involving in the regulation of this activity. It also discusses the mechanisms that define the reliability and efficiency of detoxication and AOD. The paper discusses whether the body's resistance to technogenic toxicants can be enhanced by using metabolic precursors of glutathione and other natural and (or) synthetic agents activating natural detoxication and AOD.
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7787516
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[Methodical approaches to the assessment of population's domestic exposure to chemicals].
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The paper deals with the specific action of biocidal agents of household chemistry as part of population's chemical loading. A concept of evaluation of disinfectants on human health was formulated and its guidelines are substantiated. For this, the author proposes to use criteria for membrane damaging and immunodepressive effect based on the non-invasive test-systems to identify the immunometabolic status of the body. He also defines the ways of searching the approaches to identifying a life-threatening abnormality in either prenosological status.
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7787515
|
[Specific hemosorption, kinetics and physiological effects].
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The paper covers the physicochemical and clinicophysiological aspects of hemosorption. It proposes mathematical models of blood elimination kinetics of substances which have different affinities for plasma proteins and cellular receptors. It also describes the processes occurring onto the surface of hemosorbents on their contact with blood. It is attempted to associate these processes with some immunomodulating effects of hemoperfusion.
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7787513
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[Molecular mechanisms of the effects of sodium hypochlorite on thrombocytes and lipoproteins].
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Hypochlorite seems to inhibit platelet aggregation in the platelet-rich plasma (PRP) by modifying fibrinogen receptors. The hypochlorite-inactivated isolated platelets are completely repaired by native plasma. Platelet aggregation in PRP is suppressed by hypochlorite by its direct interaction with cells and indirectly due to plasma modification. The indirect action of hypochlorite is a reversible reaction between the platelet active groups and the products of plasma modification. The reaction may involve sulphur-containing groups. The spin-probe method shows that hypochlorite penetrates into the lipid phase of human blood lipoproteins. It initiates lipid peroxidation and causes the disturbance of the lipid structure and the protein please.
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7787514
|
[Free and esterified epidermal cholesterol in psoriasis].
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The levels of epidermal total, free and esterified cholesterol were studied in psoriatic patients. Lipids were isolated from the areas of psoriatic lesions and from the normally appearing epidermis by the authors' non-invasive surface extractive method. The quantity of cholesterol was given in microgram per square centimeter. Fifty six and 11 healthy persons were examined. The skin cholesterol levels were twice-four-fold higher in the patients than in the healthy subjects. The same levels were noted from the areas of lesion and from normally appearing epidermis. The proportion of an esterified fraction decreased mainly in the normally appearing epidermis areas, especially in severe psoriasis. The role of the findings was also discussed.
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7787512
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[Interactions of various amino acids, dipeptides and glutathione with hypochlorite anion (CLO-)].
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The specific features of interaction between sodium hypochlorite and various amino compounds were examined. It is shown that in the first reaction munite, methionine and glutathione are the most active in neutralizing hypochlorite anion, while histidine, glycine, alanine, dipeptides and taurine are less active. The chloroamino complexes formed by dipeptides and taurine are the most resistant.
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7787509
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[Effects of chemical agents on the immunity status of workers at Novomoskovsk enterprises].
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A comprehensive study was made of the body's immunological and microbiological responses to industrial health hazards at chemical enterprises. For this, a total of 284 workers from the Novomoskovsk Bytchim and Orgsintez Production Associations were investigated by the conventional procedures. The workers were found to have immunological changes at the cellular and humoral levels as compared with the persons who were not engaged in chemical industry. There are also changes in the structure of the intestinal microflora at the expense of higher quantities of opportunistic microbes. The findings suggest that the workers of chemical enterprises experience great immunological influences of chemical compounds in their working places, despite the existing safety and protection measures. A number of proposals have been introduced to prevent immunological and microbiological changes in this group of persons.
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7787510
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[Probability of health impairment by exposure to chemicals at the level of sanitary standards and the problem of individual sensitivity].
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The paper briefly outlines the problems in estimating the probability of the population's health impairments caused to the individual person's hypersensitivity due do their genetic and their acquired properties when it is chemically exposed at the level of the maximum allowable concentrations. In connection with the environmental situation, it is quite necessary to concentrate everybody's attention on palliative antichemical protective measures.
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7787511
|
[Ecological hygiene--a science of global health].
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The paper defines ecological hygiene, a science that combines a preventive trend and comprehensive ecological analysis of man-made changes occurring in the biosphere. Ecological hygiene may be regarded as a science of global human health in relation to ecological situations, of modes of its maintenance, promotion, and improvement. As for its application, ecological hygiene may be determined as a complex of medical preventive research subjects whose purpose is to maintain and promote health by preventing diseases and premature aging. To apply this approach, ecological hygiene studies the environment and its influence on the human body, reveals unfavourable environmental factors and defines the maximum acceptable levels of their influence, works out recommendation how to eliminate unfavourable factors and how to rationally apply useful ones.
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7787507
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[Health status of dwellers of cities and towns with developed chemical industry].
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Assessing the physical development of children residing in the developed chemical industrial town has revealed that more than a fourth of the children examined are abreast of their biological age and that there is a trend for reducing the number of those who have the level of biological development which corresponds to their age. In the total morbidity pattern among children, respiratory diseases rank first, whose proportion increases in the higher air-polluted areas. A comprehensive assessment shows that the overwhelming majority (88-93%) belong to Health Groups II-IY, which is indicative of the unfavourable environmental factors of the town. The predictive calculation makes it possible to determine possible changes in the morbidity rates due to the identified diseases. The morbidity rate shows 4-6 increases per each unit of changes in the complex indicator of environmental pollution.
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7787506
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[Industrial hygiene and occupational diseases in chemical industry at present].
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The working conditions of workers engaged in chemical industry today make them be at risk of an occupational disease whose early manifestation can be detected by modern techniques of medical investigations, such as electromyography, electron spirometry, allergic, immunological and neuropsychological tests. The preventive trend in occupational medicine should be in progress by developing the system of biological and hygienic monitoring techniques for those getting in contact with noxious chemicals and by improving the legal bases for creating safe working conditions with allowance made for new economic relations.
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7787505
|
A managed care model for home infusion therapy.
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Home infusion therapy began in response to the medical needs of the patients. In the traditional model, products and services were delivered in the home on a physician's prescription. Limitations related to medical quality management and cost were recognized in this model. Because of these limitations, the changes that continue to occur in health care delivery and the increase in number and acuity of patients requiring non-hospital services, a managed care model was conceived and implemented at the University of Minnesota Medical School and Hospital. This model emphasizes physician-based case management, total quality management, a point of contact medical information system, outcomes assessment and management, and research and education activities designed to evaluate and improve home infusion therapies. The model was implemented through a public-private partnership. This application of managed care to home infusion therapies is described in this communication.
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7787504
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Emergency department utilization in a large pediatric group practice.
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The effect of a triage and care system, which employs continued patient education, alternatives to emergency department (ED) care for nonemergent problems, and close cooperation between ED staff and the primary care physician on inappropriate ED use, was analyzed for three groups of patients: (a) Medicaid patients, all of whom had unrestricted access to the ED; (b) group A patients who required prior physician approval and copayments for all ED services; and (c) patients enrolled in group B who were responsible for copayments only and did not require prior physician approval for ED use. Two hundred ninety-nine (299) charts were prospectively reviewed for age, payer status, date, time of visit, diagnosis, outcome of visit, and severity of illness. Medicaid patients utilized the ED much more than expected, compared to either group A or B patients (P < 0.001). Expected rates of utilization were based upon that particular group's representation in a medical associate's patient panel, which was based upon patient billing data. Medicaid patients were significantly younger than group A or B patients (P < 0.001) and had lower severity scores (P = 0.04). Our triage and care system failed to alter patterns of ED utilization for Medicaid patients.
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7787503
|
Use of follow-up services by patients referred from a walk-in unit: how can patient compliance be improved?
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Timely use of necessary follow-up services is an important dimension of ambulatory care quality. Using a hospital-based walk-in center, this study identified patients who were referred for follow-up care and examined factors related to compliance with these referrals. The participants were 696 adults seen in a hospital-based walk-in unit between June 1, 1992, and December 1, 1992. Patients completed a self-administered questionnaire including questions about sociodemographic characteristics, prior use of health services, and the Medical Outcomes Study (MOS) 36-Item Health Survey. Medical findings, follow-up recommendations, insurance status, and compliance with follow-up referrals were ascertained using chart review, the hospital's computing system, and clinic records. Fifty percent of the patients were referred for follow-up medical care; 55% of these complied with follow-up referrals. Factors associated with referral for follow-up care included older age, inability to afford a physician, longer duration of chief complaint, the patient's belief that follow-up care would be needed, and worse MOS pain score. The most important factor associated with compliance with follow-up referral was scheduling appointments while patients were still in the walk-in unit. Patients with such scheduled appointments were almost 10 times more likely than others to receive follow-up (adjusted odds ratio = 9.6, 95% confidence interval = 4.4-21.2). The most important step a provider can take to improve compliance with follow-up referral is to schedule appointments before patients are sent home. This should presumably improve quality of ambulatory care.
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7787502
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Severity-adjusted differences in hospital utilization by gender.
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Gender-based differences in hospital use may result from biological differences or may suggest problems of access to health services and quality of care. We hypothesized that there should be no difference in hospital care between men and women, given the same diagnosis. Hospitalizations were characterized by severity of illness, as this may indicate the timeliness of hospital care. Hospitalizations may be too late (with higher severity of illness) resulting in long stays and high costs, or too early (with lower severity of illness) resulting in care that could be given in alternative treatment settings. Three abdominal conditions were examined which could be misdiagnosed or confused with other diseases involving the female reproductive system: appendicitis, diverticulitis, and cholecystitis. The National Hospital Discharge Survey (NHDS) was used for analysis. Disease staging was used to assign a severity of illness indicator, ranging from stage 1 (conditions with no complications) to stage 3 (multiple site involvement, poor prognosis). For each disease, the percentage of discharges and the age-adjusted discharge rate per 1000 population was examined by stage of illness and gender. For appendectomy, there was a significantly greater percentage of men at stage 1 (lower severity) compared to women (73% versus 67%). For diverticular disease, women had higher proportions of stage 2/3 discharges than men for both medical and surgical hospitalizations. For cholecystitis, women had a greater percentage of hospitalizations at stage 1 than men, notably for surgical treatment (63% compared with 38%), although more men were admitted at stage 2 for both medical and surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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7787501
|
An empirical test of the structure, process, and outcome quality paradigm using resident-based, nursing facility assessment data.
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This study distinguishes between organizational characteristics, regarded as exogenous structural indicators of quality, and those identified as endogenous indicators of structural care (SC), and investigates the degree to which measures of SC vary by ownership mode (defined by four combinations of chain affiliation and profit status) for 142 certified and licensed nursing facilities (NFs) in a southern state. Structural care measures include: licensed and unlicensed staffing, licensed therapists, and case mix-adjusted direct care expenditures. In addition, seven (four process and three outcome) facility-level, risk-adjusted process, and outcome quality scales are developed from 39 resident-level quality indicators. A causal mode of NF quality arranged according to the structure, process and outcome paradigm is specified and estimated using path analysis. Organizational data derive from the 1991 Medicaid Cost Report; process and outcome quality measures were developed from the Minimum Data Set Plus Resident Assessment Instrument. Using the percentage of Medicaid and private pay residents as covariates, there was a significant overall multivariate effect due to ownership mode on the SC measures. Although there were several significant direct effects, the overall path model was unconfirmed. The multivariate results suggest that some organizational characteristics of structure quality may be more appropriately considered exogenous to causal quality models and therefore have indirect (versus direct) effects on process or outcome quality indicators. The path analysis implies that the structure-process-outcome paradigm may not accurately capture the way NF health care is delivered. Research which considers alternate NF quality paradigms needs to be done with samples that are more representative of national proportions of each ownership mode.
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7787499
|
The legal status of clinical practice parameters: an updated annotated bibliography.
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In response to extensive speculation about the probable liability implications for health care providers of the formal creation and dissemination of explicit practice parameters of guidelines, I prepared several years ago an annotated bibliography of emerging literature on that topic (1). Since preparation of that catalogue, little meaningful clarification of these issues has emerged from the courts, legislatures, or regulatory agencies.
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7787498
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A public/private partnership in the quest for quality: development of cerebrovascular disease practice guidelines and review criteria.
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The development of Uniform Clinical Data Set (UCDS) algorithms for cerebrovascular disease can serve as a model for cooperation between government agencies and physician organizations in the development of clinical guidelines and the translation of practice guidelines into review criteria. UCDS is a computerized system of data collection and case finding developed by the Health Care Financing Administration (HCFA) to standardize the Peer Review Organization screening process for potential utilization and quality problems. Input on the cerebrovascular disease algorithms was provided through the American Medical Association UCDS Advisory Panel and the American Academy of Neurology Task Force on Hospital Utilization for Stroke. Physician organizations were successful in identifying problematic areas, improving the original algorithms, suggesting new issues for development, and deleting inappropriate or misdirected algorithms. Since HCFA modified the cerebrovascular disease algorithms in response to feedback, physician organizations have had an important impact on algorithm development. Unfortunately, the process for algorithm review was often complicated, inefficient, and slow. This process is reviewed, problems and constraints are discussed, and specific recommendations are given for improving the process.
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7787496
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Sotalol-induced bradycardia reversed by glucagon.
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Glucagon is considered the drug of choice for treating bradycardia and hypotension encountered during beta-blocker poisoning. Its potential usefulness in reversing adverse effects encountered during therapeutic dosing with beta-blockers has not been well characterized. We present a case of sotalol-induced bradycardia reversed by glucagon.
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7787495
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Cardiopulmonary resuscitation. Not for all terminally ill patients.
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Where there are clear clinical indications that a patient suffering from a terminal illness would not benefit from cardiopulmonary resuscitation, there is no legal or ethical requirement that CPR be discussed with the patient as a treatment option or that CPR be administered if the patient stops breathing or suffers cardiac arrest.
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7787494
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Postpolio syndrome. Unusual disease in rural family practice.
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Postpolio syndrome is a sequela of paralytic poliomyelitis seen in approximately 25% of polio victims. Because the symptoms are nonspecific, it can be difficult to diagnose. Getting information about diagnosis and treatment of unusual conditions in rural and remote regions can be difficult, and physicians sometimes find themselves in the position of being the on-site "expert." Physicians must make difficult decisions with patients and their families about life-giving therapies, advance directives, and the like.
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7787493
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Hypertension in pregnancy.
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Hypertension occurs in 7% to 10% of pregnancies. It is associated with increased risk of maternal and fetal complications. Early diagnosis in the office by careful attention to signs and symptoms could result in adequate management. Delivery provides the only care for this disease process. Recently, low-dose acetylsalicylic acid has been used in high-risk situations to prevent the development of preeclampsia.
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7787492
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Family practice obstetrics in a community hospital.
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To review obstetric care provided by family physicians and to determine why they transfer patients to obstetricians. Retrospective chart review. Obstetrics department of a regional non-academic community hospital Of 683 women booked with family physicians for obstetrical care, 601 were admitted by family physicians and 82 were transferred to obstetricians before admission. Risk score, induction, augmentation, consultation, forceps delivery, cesarean section, episiotomy, epidural anaesthesia, narcotic analgesia, neonatal birth weight and Apgar scores, and maternal complications. Family physicians' patients had good maternal and neonatal outcomes; spontaneous delivery rate was 82%; cesarean section rate was 9%. Women transferred from family physicians to obstetricians before admission for delivery had a cesarean section rate of 63%. Family physicians provided total obstetric care to most women in this community and transferred patients to obstetricians for expected reasons. Community hospitals with family physicians highly involved in providing obstetric care are likely ideal institutions for training future family physicians.
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7787491
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Family practice obstetrics in a teaching hospital. Does a tertiary care environment make a difference?
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To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals. Case series. Retrospective review of hospital records. Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. Five hundred forty-two women admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991. The number and types of obstetrical consultations obtained for the study population. Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections. Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians.
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7787490
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Family medicine in a tertiary care hospital. Obstetrical outcomes and interventions.
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To examine the rates of obstetrical complications and interventions among patients managed or comanaged by family physicians. Case series. Retrospective review of hospital records. Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. Five hundred forty-two women in labour admitted consecutively by family physicians from October 1, 1990, to September 31, 1991. There were no exclusions based on antenatal risk. Degree of risk on admission, and rates of cesarean sections, inductions, epidurals, forceps deliveries, episiotomies, perineal tears, postpartum hemorrhages, and postpartum fever for mothers. For newborns, Apgar scores and rate of need for a pediatric critical care unit or special observation nursery. Except for rates of inductions and episiotomies, which were lower than those reported elsewhere, results were all comparable to those in previous North American studies of low-risk family medicine obstetric patients. Family physicians care for women with a range of antenatal risks. Even when practising in tertiary care environments, family physicians can minimize many obstetrical interventions while maintaining good maternal and neonatal outcomes.
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7787489
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Consultation in family practice obstetrics.
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To examine the types of non-low-risk obstetric patients managed by family physicians in urban teaching hospitals, and to determine indications for consultation for women at low risk when labour began. Retrospective chart review for all patients delivered by family physicians in three downtown Toronto teaching hospitals during 1 year. Of 1710 cases, 595 (34.8%) were classified as non-low risk, with the main indications being postdates (> 42 weeks) (19.9%); pregnancy-induced hypertension (19.3%); and premature labour (< 37 weeks) (14.8%). Of the 1115 low-risk patients, 363 (32.6%) had an intrapartum consultation, usually for failure to progress (50.1%) or fetal distress (12.7%). More than 80% of intrapartum consultations were associated with induction and augmentation of labour. Family physicians can continue to care for many non-low-risk women, usually with the help of obstetricians. Consultations were obtained for many women at low risk. We need to reevaluate whether some mandatory consultations are necessary in family practice obstetrics.
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7787478
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First experience with cardiomyoplasty in Ukraine.
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We have been studying feasible surgical alternatives for treating congestive heart failure, including the use of cardiomyoplasty. In this operation, skeletal muscles are conditioned, through electrical stimulation, to provide active tension on diseased myocardium, which improves left ventricular performance and ultimately increases cardiac output. We performed cardiomyoplasty in a 37-year-old man with severe ischemic cardiomyopathy. He was discharged from the hospital 2.5 months after the operation, and he did not require medical therapy. We believe this to be the 1st cardiomyoplasty performed in Ukraine.
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7787477
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Concomitant cerebral, brachiocephalic trunk, and cardiac revascularization. An unusual case.
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Extensive transthoracic brachiocephalic revascularization is rarely performed. Instances of this operation performed concomitantly with cardiac revascularization and carotid endarterectomy have been reported in fewer than 10 cases in the literature. We report the case of a patient requiring complex brachiocephalic revascularization associated with coronary bypass grafting and a left carotid endarterectomy.
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7787476
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The epidemiology of prosthetic heart valves in the United States.
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The Center for Devices and Radiological Health of the Food and Drug Administration, in collaboration with the National Center for Health Statistics, conducted the Medical Device Implant Supplement to the 1988 National Health Interview Survey, generating the 1st available population-based estimates of the use of prosthetic heart valves in the United States. The 1988 National Health Interview Survey was a massive, nationally representative cross-sectional survey that encompassed 47,485 households and 122,310 individuals. Data from the Medical Device Implant Supplement indicate that an estimated 253,283 persons with 279,175 heart valves were present in the civilian, non-institutionalized US population (population prevalence of 1.1/1,000, 95% CI 0.8-1.3). Prevalence of valve prostheses ranged from 0.2 per 1,000 in those age 44 and under to 5.3 per 1,000 in those 75 years of age and older. Age-adjusted prevalence of valve prostheses did not differ significantly according to sex, race, region of residence, education, or income of recipients. Two thirds of aortic valve recipients identified by the survey were male, compared with only one third of mitral valve recipients. Approximately two thirds of both aortic and mitral valve implants were reported as mechanical. Reported use of anticoagulative agents was significantly more common in recipients of mechanical than of bioprosthetic valves. The single most common reported reason for prosthetic valve implantation was rheumatic heart disease. These data provide useful epidemiologic and public health planning information on prosthetic heart valve use.
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7787475
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Scopulariopsis endocarditis associated with Duran ring valvuloplasty.
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Fungal endocarditis is rare and is usually caused by Aspergillus and Candida species. We present a patient with endocarditis caused by Scopulariopsis brevicaulis. The patient had a history of mitral valve disease and, 1 year earlier, had undergone valvuloplasty with the placement of a prosthetic Duran ring in the mitral valve position. S. brevicaulis was cultured from samples of a large vegetation on the mitral valve apparatus. The mitral valve was replaced with a St. Jude mechanical prosthesis. The patient was treated with amphotericin B but was later switched to oral itraconazole when antibiotic tests indicated susceptibility to that agent. We believe this is the 1st reported case of endocarditis caused by Scopulariopsis.
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7787474
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The Medicare Participating Heart Bypass Demonstration Project in Houston, Texas. The experience of St. Luke's Episcopal Hospital, Texas Heart Institute, and CardioVascular Care Providers, Inc.
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While passage of a health care bill remains uncertain, the structure of health care in the United States is nonetheless changing rapidly. In some cases, physicians and hospitals are working more closely with one another to provide high-quality care at lower costs. Patients, physicians, hospitals, and insurers (including the Federal government) can all benefit from such an arrangement. We review here the experience with a program of bundled-free (physician and hospital) cardiovascular care for Medicare patients at the Texas Heart Institute at St. Luke's Episcopal Hospital in Houston, Texas.
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7787473
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CardioVascular Care Providers. A pioneer in bundled services, shared risk, and single payment.
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In 1984, physicians at the Texas Heart Institute developed CardioVascular Care Providers, Inc., the 1st packaged pricing plan for cardiovascular surgery. Under this arrangement, all services (including physician and hospital charges) are covered by a global payment package (bundled service). The resulting flat fee is lower than the sum of the individual charges. Since November 1984, the plan has been offered to the non-Medicare (< 65-year-old) population through contracts with self-insured corporations, prepaid health plans, union trusts, and foreign governments. In 1993, it was extended to Medicare patients who require coronary artery bypass grafting. Our experience has shown that the plan lowers costs, increases patient access, allows payers to forecast their expenses, and streamlines the billing process, while maintaining a high quality of care and enabling patients to choose their own providers. Our success with this approach is attributed not only to the plan's simplicity but also to the fact that it is physician-directed and organ-specific, involving many related specialties. Equally important keys to success include our hospital's large patient population and extensive database. Similar packaged pricing plans have been adopted by several other cardiovascular centers. The approach is now being evaluated by Medicare in 6 other hospitals nationwide. With time, this approach is likely to become an increasingly popular reimbursement option.
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7787472
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Effect of IgM-positive crossmatches on survival in heart transplant recipients.
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To determine whether an IgM-positive crossmatch adversely affects the results of heart transplantation, we conducted a retrospective study of 125 orthotopic heart transplant recipients. A direct donor-recipient crossmatch was performed retrospectively on sera from all patients by the standard National Institutes of Health (NIH) method and the antihuman globulin (AHG) procedure. The patients were then divided into 3 groups as follows. Group 1 comprised 110 patients with a negative NIH and AHG crossmatch (control group). Group 2 comprised 5 patients with a positive NIH crossmatch and a negative AHG crossmatch. Group 3 comprised 10 patients with positive NIH and AHG crossmatches. All positive crossmatches in group 3 patients converted to negative after treatment of sera with dithioerythritol, indicating that the initial result was due to IgM antibodies. All patients received standard immunosuppressive treatment. An IgM-positive crossmatch did not affect the number or severity of rejection episodes among the 3 groups, nor did it have an effect on the incidence of infection. Whereas coronary artery disease was detected by angiography in 16 of 110 patients (14.6%) in group 1 and in 1 of 10 patients (10%) in group 3 (P = NS), no patient in group 2 was affected. Actuarial survival at 1 and 2 years post-transplant was significantly better for patients with an IgM-positive crossmatch (group 2) (100% survival at 2 years) than for patients with a negative crossmatch (group 1) (73% at 1 year and 71% at 2 years, P < 0.05). Based on our study, the effect of an IgM-positive crossmatch on survival is difficult to interpret because of the small sample size. An IgM-positive crossmatch, however;did not appear to have a deleterious effect on survival. It may be that the IgM antibody has an immunoregulatory role. A larger series of patients with positive crossmatches and longer follow-up will be necessary to evaluate the importance of these results.
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7787469
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Use of amiodarone in the postmyocardial infarction patient.
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Amiodarone appears to be an effective antiarrhythmic agent for reducing mortality in the postmyocardial infarction patient with ventricular ectopic activity. Such activity has long been recognized to have an adverse effect on prognosis after acute myocardial infarction. When a strong correlation between ectopic activity and left ventricular dysfunction was demonstrated, ventricular ectopic activity was thought to be a consequence of underlying myocardial damage. However, ventricular ectopic activity is now considered to be an independent risk factor for mortality after myocardial infarction. Because of the basic premise that a positive correlation existed between arrhythmia suppression and improved survival, it had been common practice to use antiarrhythmic agents to treat asymptomatic ventricular ectopic activity in the postinfarction patient. After the results of the Cardiac Arrhythmia Suppression Trial (CAST) were released, this practice was largely abandoned. In the post-CAST era, however, amiodarone has appeared to improve survival in patients who have sustained myocardial infarctions. In this report, we briefly review the pharmacology of amiodarone and discuss the results of relevant clinical trials. Large, multicenter trials currently under way may clarify some of the unanswered questions surrounding the use of this promising antiarrhythmic agent in postmyocardial infarction patients.
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7787470
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Cardiac rehabilitation, exercise training, and preventive cardiology research at Ochsner Heart and Vascular Institute.
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We review data from our institution demonstrating the benefits of cardiac rehabilitation and exercise training on coronary risk factors, exercise capacity, behavioral characteristics, and quality of life in various subgroups of patients. In addition, we discuss our research in several other areas of preventive cardiology, including lipid disorders, hypertension, left ventricular hypertrophy, fish oils, and antioxidants. We believe that we are now in a very exciting era in which a multifactorial approach to the primary and secondary prevention of coronary artery disease is needed in order to further reduce morbidity and mortality rates.
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7787468
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Dobutamine echocardiography and myocardial contrast echocardiography. Two new techniques for the assessment of myocardial viability.
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As investigators have discovered that cardiac regions displaying resting wall motion abnormalities are not the necessary equivalent of myocardial scar (and therefore of irreversible injury) but are potentially viable regions rendered dysfunctional by stunning or hibernation, a new field of medicine has developed to identify viable myocardium that can improve in function after revascularization. Moreover, improvements in myocardial preservation and perfusion during coronary artery bypass grafting and percutaneous transluminal coronary angioplasty have enabled patients with poor resting ejection fractions to undergo safer revascularization. In this review, we describe briefly the diagnostic techniques most commonly used in identifying dysfunctional but viable myocardium. We give specific attention to the assets and limitations of these techniques and special emphasis to 2 promising new techniques: dobutamine echocardiography and myocardial contrast echocardiography.
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7787467
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Recent advances in the treatment of acute myocardial infarction.
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A number of recent major clinical trials have added substantially to the understanding of what the current "optimal" therapy for acute myocardial infarction may include. This review highlights a number of studies that have been published or presented within the last 2 years. Clearly, there is still room for improvement, but we have made considerable progress in recent years, and the pace of our advances continues to accelerate.
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7787466
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Coronary angioscopy.
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Coronary angioscopy will not replace angiography as the gold standard for imaging atherosclerotic coronary arteries. However, there may well be a clinical niche for a technology that gives accurate information regarding a specific lesion, if that information can be used to improve the acute or chronic outcome of an interventional procedure. Our experience demonstrates that angioscopy indeed provides this information. Using angioscopy, we now have access to information regarding arterial wall disease that heretofore has been available only at necropsy. In addition, whereas angiography has provided only a 2-dimensional, gray-scale image of the coronary vessels, angioscopy offers a full-color, 3-dimensional perspective of the intracoronary surface morphology. These important lesion-specific details, not reliably available from angiography alone, may ultimately be used to improve patient outcome and to assess risk.
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7787465
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Conversion from chronic to acute coronary heart disease syndromes. Role of platelets and platelet products.
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Vascular endothelial injury associated with arterial narrowing leads to platelet adhesion and aggregation at the site of endothelial injury and to the local accumulation of several mediators that promote platelet aggregation and vasoconstriction, including thromboxane A2, serotonin, adenosine diphosphate, platelet activating factor, oxygen-derived free radicals, activated thrombin, and tissue factor. At the same sites of endothelial injury, there is a reduction in absolute or relative amounts of the endogenous inhibitors of platelet aggregation and vasoconstriction, including prostacyclin, endothelium-derived relaxing factor (nitric oxide), and tissue plasminogen activator; the loss of the effects of the endogenous inhibitors preventing platelet aggregation and vasoconstriction helps to create a prothrombotic and vasoconstrictive environment. Endothelial injury occurs as a result of atherosclerotic plaque fissuring or ulceration, flow shear stress, hypertension, diabetes mellitus, immune complex deposition, infection, and mechanical injury in the form of diagnostic and therapeutic catheterization. Endothelial injury and the accumulation of platelet- and other cell-derived mediators promotes neointimal proliferation in an exaggerated wound-healing response, resulting in further anatomic narrowing of artery in the subsequent days and weeks. Future methods that may prove useful in protecting the individual with these vascular problems from acute myocardial infarction and its consequences are inhibition of multiple mediators of platelet aggregation and vasoconstriction, restoration of the presence of the normal endogenous inhibitors of platelet aggregation and vasoconstriction, and/or rapid therapeutic regeneration of the injured endothelium.
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7787461
|
Radiation-induced superior vena cava syndrome.
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A 59-year-old man developed superior vena caval obstruction 20 years after receiving a radiation treatment for primary germinal cell tumor of the mediastinum. Venous decompression was achieved by anastomosing a 10-mm ringed polytetrafluoroethylene graft from the left internal jugular vein to the right atrium, which yielded immediate relief of symptoms. A left internal jugular venogram demonstrated graft patency 11 months post-operatively, and the patient remained free of symptoms of superior vena caval obstruction 29 months postoperatively.
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7787460
|
"Acquired" left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis.
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We present, with echocardiographic and intraoperative findings, a rare case of left ventricular-to-right atrial communication (Gerbode defect) after endocarditis associated with Staphylococcus aureus. (Tex Heart Inst J 1995;22:100-2)
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7787458
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[Extra-pulmonary tuberculosis and dissemination in patients infected by the human immunodeficiency virus in Bujumbura (Burundi)].
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Scattered and extra pulmonary tuberculosis patients coinfected with HIV represent in Bujumbura (Burundi) more than 56% of tuberculosis cases. The high prevalence of these forms could be explained partly by the hospital recruitment, therefore by patients already strongly immunocompromised. Performing further examinations as abdominal echography, ganglionic biopsy (or firstly a puncture sucking procedure) permit to reveal multifocal affections. These examinations provide valuable diagnostic arguments specially among the negative bacteriological forms.
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