Use of in situ detection of histone mRNA in the assessment of epidermal proliferation: comparison with the Ki67 antigen and BrdU incorporation

The labelling index is commonly used as a measure of proliferation. However, the use of tritiated thymidine or BrdU labelling of S-phase cells is limited to prospective samples. We have employed an oligonucleotide cocktail complementary to the mRNA species encoding the replication-dependent histones H2B, H3 and H4 for non-isotopic in situ hybridization (NISH), and have compared the resultant proliferation indices in normal skin with those obtained by bromodeoxyuridine (BrdU) incorporation and by Ki67 immunohistochemistry (IHC) using the monoclonal antibody MIB1. In addition, we compared the staining characteristics of histone NISH and Ki67 IHC in a further 25 samples from a variety of inflammatory dermatoses and neoplastic conditions, as well as from normal skin. In normal skin, S-phase (histone NISH and BrdU) and cycling (Ki67) cells were confined to the basal and low suprabasal layers. The labelling indices determined by histone NISH and BrdU incorporation were similar, whereas that of Ki67 IHC was four times greater. In biopsies from hyperproliferative dermatoses and dysplastic or malignant lesions, the number of histone NISH- and Ki67 IHC-positive cells was generally elevated; in accordance with the differential expression of these two markers during the cell cycle, MIB1 consistently gave higher results. The advantage of histone NISH over Ki67 IHC is that it is a marker of the same part of the cell cycle as BrdU incorporation. However, the combined use of both histone NISH and Ki67 IHC to measure two cell cycle parameters, namely S-phase and the number of cycling cells, allows more detailed retrospective study of epidermal proliferation than has been possible previously.

Elevated serum procalcitonin levels in patients with melioidosis

The prognostic value of serum procalcitonin levels in 43 patients with acute melioidosis, an infection with a wide range of clinical manifestations, was assessed. In eight patients with mild localized infections, the median procalcitonin levels were 0.13 ng/mL (range, 0.02-0.46 ng/mL), which were similar to those in 19 healthy controls (median, 0.07 ng/mL; range, 0.03-0.15 ng/mL). In the patients with severe infections, the initial procalcitonin levels were significantly higher in the patients who died (median, 350 ng/mL; range, 63-3,538 ng/mL) than in the survivors (median, 19 ng/mL; range, 0.55-387 ng/mL) (P < .0001); 16 of 19 patients with procalcitonin levels of > 100 ng/mL died, compared with 2 of 16 patients with levels of < 100 ng/mL (relative risk, 6.7; 95% confidence interval, 1.8-25; P = .0001). In those patients who survived, the subsequent procalcitonin levels reflected closely the clinical course of their infection. The serum concentration of procalcitonin correlates well with the severity of Pseudomonas pseudomallei infection and is comparable with other acute-phase markers. However, this prognostic indicator and marker of continuing disease activity is not specific to melioidosis and could be applied to other severe infections.

Regulatory effects of IL-13 on synovial fluid macrophages and blood monocytes from patients with inflammatory arthritis

Activated macrophages are central to the destructive processes of chronic inflammatory arthritis. In this study, it was hypothesized that IL-13, a product predominantly of 'Th2-type' lymphocytes, may be used therapeutically to down-regulate monocyte/macrophage activities at sites of chronic inflammation. Synovial fluid mononuclear cells were isolated from 12 patients with chronic inflammatory arthritis. Peripheral blood mononuclear cells (PBMC) were isolated at the same time as synovial fluid cells from all 12 patients. IL-13 significantly inhibited lipopolysaccharide (LPS)-induced tumour necrosis factor-alpha (TNF-alpha) production by mononuclear cells from peripheral blood, but not synovial fluid. In contrast, IL-13 inhibited LPS-induced IL-1 beta production by all cells, and as a positive response to IL-13, CD23 expression was increased on both cell populations. Blood monocytes cultured for 7 days with granulocyte-macrophage colony-stimulating factor (GM-CSF) or M-CSF responded to IL-13 in a manner similar to that detected for synovial fluid-derived cells, with suppression of LPS-induced IL-1 beta, but not TNF-alpha, production. In all experiments, the responses to IL-13 were very similar to those detected to IL-4, but differed from those measured with IL-10. Thus, the responses to IL-13 by synovial fluid cells and cultured monocytes are not equal to those of blood monocytes. The similar responses to IL-4 and IL-13 support claims of a common element for signalling from the IL-4 and IL-13 receptors. Furthermore, the activity of a common receptor chain may be altered by monocyte activation and differentiation.

The majority of Fc gamma RIII-positive gamma delta T cells do not express HLA-DR in patients with primary Sjögren's syndrome

The percentages of circulating gamma delta T cells and the proportions of these expressing Fc gamma RIII (CD16) or HLA-DR in patients with primary Sjögren's syndrome (pSS) and controls were determined using monoclonal antibodies and flow cytometry. There was no significant difference in the percentages of gamma delta T cells in the pSS patients compared with controls. There was, however, a significant increase in the proportions of both CD16+ and HLA-DR+ gamma delta T cells in pSS patients. A 3-colour immunofluorescence technique demonstrated that these two markers were mutually exclusive and therefore may identify either subpopulations of gamma delta T cells or different stages of the activation process.

Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta

BACKGROUND

Rupture of the aorta is a major cause of death after motor vehicle accidents. Survival depends on early diagnosis, and emergency aortography is the standard imaging method. Although transesophageal echocardiography is noninvasive and can provide high-resolution images of the aorta, information about its value in patients with trauma is limited. We conducted this study to assess prospectively the value of transesophageal echocardiography in the emergency evaluation of patients at risk for aortic injury.

METHODS

Transesophageal echocardiography of the aorta was attempted in 101 patients admitted to the emergency room with a diagnosis of possible traumatic rupture of the aorta. Echocardiography and aortography personnel were notified simultaneously of the arrival of the patient, and the two tests were performed sequentially by operators who were blinded to the results of the other test. The sensitivity and specificity of transesophageal echocardiography were calculated on the basis of the results of aortography of the arch, surgery, or autopsy.

RESULTS

Transesophageal echocardiography was attempted in 101 patients. The study was successfully performed in 93 patients but could not be completed in 8 because of lack of cooperation on the part of the patient (7 patients) or maxillofacial trauma (1 patient). Despite a high injury-severity score (mean, 29.6), transesophageal echocardiography was performed without complications, and within a mean (+/- SD) of 29 +/- 12 minutes. Eleven of the 93 studies (12 percent) demonstrated rupture of the aorta near the isthmus. The findings were confirmed in 10 of the 11 patients by aortography (9 patients), surgery (9 patients), or autopsy (1 patient), yielding a sensitivity of 100 percent and specificity of 98 percent for the detection of injury to the aorta. There was one false positive echocardiogram.

CONCLUSIONS

Transesophageal echocardiography is a highly sensitive and specific method of detecting injury to the thoracic aorta. This technique can be used safely and quickly in critically injured patients with suspected traumatic rupture of the aorta and compares favorably with arch aortography.

Latex agglutination for rapid detection of Pseudomonas pseudomallei antigen in urine of patients with melioidosis

A latex agglutination test for the detection of Pseudomonas pseudomallei antigen in urine was evaluated for the rapid diagnosis of melioidosis. With unconcentrated urine, antigen was detected in only 18% of patients with melioidosis overall. However, when urine was concentrated 100-fold, antigen was detected in 47% overall and in 67% of patients with septicaemia or disseminated infection, in whom a rapid diagnosis is most important. The specificity of the test was 100%. These results compared favourably with an enzyme immunoassay. This latex agglutination test is a simple, rapid and highly specific method of diagnosing melioidosis, and will be particularly useful in areas with limited laboratory facilities.

Quantification of mitral regurgitant volume by the color Doppler proximal isovelocity surface area method: a clinical study

In vitro studies have demonstrated that regurgitant flow rate can be estimated by the color Doppler "proximal isovelocity surface area" (PISA) method. By applying the PISA method and continuity principle, we developed a formula to calculate mitral regurgitant volume: 2 pi r2.VN.FVI/Vo, where r = distance from the first jet alias to mitral leaflets, VN = aliasing velocity, FVI = flow velocity integral or regurgitant jet, and Vo = peak velocity through the regurgitant orifice. Doppler echocardiography was performed in 20 patients with mitral regurgitation. The mitral regurgitant volume was estimated by PISA and compared to cine ventriculographic grading. The results showed an increase in regurgitant volume by PISA compared with increasing angiographic grades of mitral regurgitation: 19 +/- 0.6, 18 +/- 5, 25 +/- 12, and 44 +/- 4 ml for grades 1+ to 4+, respectively (r = 0.77). Thus a formula developed from PISA is able to identify patients with a severe grade of mitral regurgitation and to provide an alternate approach to the noninvasive quantitation of mitral regurgitation.

Isolation of Pseudomonas pseudomallei from soil in north-eastern Thailand

In order to optimize the recovery from soil of Pseudomonas pseudomallei, the cause of melioidosis, 3 selective broths were compared. A basal salt solution containing L-threonine (TBSS) performed significantly better than trypticase soy broth containing crystal violet and colistin 50 mg/L (CVC50), both in isolation rate and suppression of overgrowth of other organisms, but the addition of colistin to TBSS gave the best results overall. In a survey in north-eastern Thailand, P. pseudomallei was recovered from 114 (68%) of the 167 sites tested. A detailed study of a single rice farm showed that the isolation rate increased with depth of soil sample, and P. pseudomallei could still be isolated during the dry season, although only from moist soil in areas where other crops were cultivated and around the water source.

Reliability of blood pressure, heart rate, and Doppler-derived hemodynamic measurements during exercise

Doppler echocardiography of aortic blood flow, heart rate, and blood pressure represent noninvasive methods for evaluation of the hemodynamic effects of pharmacologic agents or other stimuli during rest and exercise. In this study the reliability of continuous-wave Doppler echocardiography for detecting the effects of various interventions on left ventricular systolic function during exercise was assessed. The reliability of Doppler measurements was compared with that found for measurements of simultaneously obtained heart rate and blood pressure. Exercise treadmill testing was performed at 0, 2, 4, 6, and 8 hours in 18 healthy male subjects. All measurements were performed at rest and during the last half of each exercise stage. Reliability of peak modal velocity, peak aortic blood flow acceleration, heart rate, and blood pressure was measured by the intraclass correlation coefficient (ICC) at each stage. ICC reliability of greater than 0.75 is considered excellent, 0.4 to 0.75 fair to good, and less than 0.4 poor. The reliability of all Doppler-derived parameters, heart rate, and blood pressure improved with increasing stage of exercise. Peak modal velocity, peak acceleration, heart rate, and manually obtained systolic blood pressure had ICCs of 0.75 or greater by stage 3. The reliability of Doppler-derived aortic blood flow parameters was good or excellent at rest and advanced stages of exercise. Continuous-wave Doppler echocardiography is a reliable method for performing studies to assess the effects of interventions on cardiovascular function during exercise.

Absolute and relative involvement in homicide offending: contemporary youth and the baby boom cohorts

Recent concerns have been expressed that youths are an increasingly violent segment of U.S. society. This report explores such claims by presenting alternative dimensions with which trends in youth violence can be interpreted. Using Uniform Crime Reports and U.S. Bureau of the Census data for 1958-1993, rates of arrests for murder, taken to represent absolute levels of involvement in this form of violence, are analyzed for trends among 15-to 19-years-olds. Relative involvement, operationalized as the ratio of arrest rates for those aged 15-19 to those of the remainder of the population, is also analyzed for trends. A pronounced upward trend since the mid-1980s in both rates and ratios of arrests for murder is found for ages 15-19, resulting in this group now having the highest levels of absolute and relative involvement in murder arrests of any age category, a distinct departure from previous years. As a context for interpreting these levels, the involvement of current 15- to 19-year-olds is shown to exceed by a considerable margin the involvement of similarly aged cohorts of baby boomers, a youth group formerly the object of considerable public concern. Research is encouraged that addresses the multifaceted sources contributing to this dramatic societal shift in age-related patterns of arrests for murder and, by assumption, involvement in homicide offending.

Condom availability in schools: the need for improved program evaluations

OBJECTIVES

This article examines the impact of contentious local debates on the design and implementation of school-based condom availability programs.

METHODS

Information about condom availability in schools was reviewed by 50 leading educators and health officials at a 1992 forum held in Menlo Park, Calif.

RESULTS

Few existing condom availability programs were designed to yield definitive data on sexual risk-taking behavior or other measures of program effectiveness.

CONCLUSIONS

In the debate over school-based condom availability programs, as in many aspects of human immunodeficiency virus (HIV) prevention programs, scientific, moral, and political concerns overlap. Behavioral research into the potential effectiveness of such programs can help inform debates about fundamental values concerning sexual decision making and privacy, family integrity and parental autonomy, and public health.

Further experience with transesophageal echocardiography in the evaluation of thoracic aortic injury

This prospective study sought to further define the role of transesophageal echocardiography (TEE) in diagnosing thoracic aortic injury. We performed TEE, aortography, or both on 160 consecutive patients suspected of having blunt thoracic aortic injury: TEE correctly identified 14 aortic injuries, of which five were confirmed by aortography, seven at thoracotomy, and two at autopsy. The TEE results were suggestive of but not diagnostic for injury in two additional patients with proven aortic injury, and TEE was otherwise 100% sensitive and specific for aortic injury. Aortograms yielded one false positive result and four false negative results, for a sensitivity of 73% and a specificity of 99%. We conclude that TEE is a rapid, safe, and accurate bedside method for evaluating the heart and thoracic aorta for blunt trauma. Negative or positive TEE results obviate the need for aortography. We recommend that aortography be used when TEE results are equivocal, when TEE is not tolerated or contraindicated, or when other suspected vascular injuries require evaluation by arteriography.

Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis

An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/[kg.d]) vs. amoxicillin/clavulanate (160 mg/[kg.d]) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand. Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group. The overall mortality rate (47%) was similar for both treatment groups. However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after > or = 72 hours of treatment (P = .004). The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P = .02). Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated. Parenteral amoxicillin/clavulanate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.

Detection of Pseudomonas pseudomallei antigen in urine for the diagnosis of melioidosis

An enzyme-linked immunosorbent assay using a fluorescein isothiocyanate (FITC)-anti-FITC amplification system, has been developed to detect Pseudomonas pseudomallei antigen in urine. The assay was evaluated in 135 patients with acute melioidosis, 194 hospitalized patients with other disorders, and 40 healthy controls. Antigen was detected in the urine of 123 (91%) patients with melioidosis. Urinary antigen was found in 85 (96%) of 89 patients with septicemic melioidosis, all six patients with P. pseudomallei urinary tract infection, and 32 (80%) of 40 patients with other localized infections. Antigen was not detected in the urine of 40 healthy individuals, but the urine of 16 (8%) of 194 hospitalized patients with diagnoses other than melioidosis gave a positive result. Of the false-positive results, 13 of 16 were associated with bacteriuria > or = 10(4) colony-forming units/ml. At a cutoff titer of 1:10, the sensitivity and specificity of the test were 81% and 96%, respectively. Enzyme immunoassay detection of urinary antigen is a valuable and rapid laboratory test for the early diagnosis of acute melioidosis.

The epidemiology of melioidosis in Ubon Ratchatani, northeast Thailand

BACKGROUND

Melioidosis, or infection with Pseudomonas pseudomallei is an important cause of morbidity and mortality in South East Asia and Northern Australia. The epidemiology of melioidosis in Ubon Ratchatani, Northeast Thailand was studied over a 5-year period from 1987 to 1991.

METHODS

Rates and, when possible, the risks of developing melioidosis were calculated. The numerator was the number of culture-proven cases of melioidosis seen in the 1000-bed referral hospital of the province. The denominators were obtained from the population census, a survey of Health, Welfare and Use of Traditional Medicine, and the North Eastern Meterological Centre, Thailand.

RESULTS

The average incidence of human melioidosis was 4.4 (95% confidence interval [CI]: 3.8-5.0) per 100,000. The disease affected all ages with the highest incidence in 40-60 years olds. Melioidosis was 1.4 (95% CI: 0.4-5.3) times more common in males than females. The disease showed a significant seasonal variation in incidence, and a strong linear correlation with rainfall (r = 0.7, 95% CI: 0.5-0.9) Adults exposed to soil and water in their work (most were rice farmers) had an increased risk of melioidosis (in the 40-59 year age group, relative risk = 4.1, 95% CI: 2.4-6.9). Most adult patients had an underlying disease (mainly diabetes mellitus) predisposing them to this infection.

CONCLUSION

Melioidosis may result from either acute exposure to the organism in the soil and water, or 're-activation' of an asymptomatic childhood infection (by an unidentified possibly infective seasonal cofactor). The results from this analysis are consistent with both hypotheses. Further epidemiological studies are needed to identify risk factors so that optimal strategies for control of melioidosis may be developed.

Dissociation of erythema and p53 protein expression in human skin following UVB irradiation, and induction of p53 protein and mRNA following application of skin irritants

The mechanisms mediating the varied effects of ultraviolet radiation (UVR) on human skin are unclear, although a relationship between erythema and DNA damage is suggested by photosensitivity in xeroderma pigmentosum. Increased p53 expression in response to UVR is thought to reflect direct DNA damage, but recent evidence indicates that UVR also activates membrane and cytosolic signal transduction pathways. In this study, we have investigated the relationship between erythema and p53 induction following UVB and whether this p53 response is specific to UVR. p53 protein expression was determined by immunocytochemistry using the monoclonal antibody DO7, and p53 mRNA expression was examined by non-isotopic in situ hybridization. Incremental doses of UVB were administered to the lower back of eight subjects. Immunostaining revealed that p53 positive nuclei were significantly increased 8 h after suberythemogenic doses of UVB (79 +/- 12), compared to normal unirradiated skin (8 +/- 6, p < 0.0005), but no change in p53 mRNA was seen. Higher UVB doses, which resulted in moderate erythema, resulted in a similar or greater induction of p53 protein. Indomethacin (1% w/v), applied immediately after UVB irradiation, significantly inhibited UVB erythema at 8 h in six subjects (p < 0.005), but did not reduce p53 immunostaining. Dithranol (1 microgram/microliter, n = 8), sodium dodecylsulphate (5%, n = 4), and retinoic acid (0.5%, n = 4), applied for 48 h, caused erythema, significantly increased p53 protein levels (p < 0.05), and also increased p53 mRNA. Our results show that in human skin, UVB-induced p53 elevation can be dissociated from erythema and skin irritants can also induce p53 protein. The induction of p53 mRNA by irritants but not UVR suggests different mechanisms of action.

Selective expression of V beta families by T cells in the blood and salivary gland infiltrate of patients with primary Sjögren's syndrome

OBJECTIVE

The T cell infiltration of the salivary gland of patients with Sjögren's syndrome (SS) has been implicated in the pathogenic process of the disease. We examined the representation of V beta subsets in the blood and salivary tissue of patients with SS.

METHODS

Circulating T cells from 12 patients and paired samples of blood and labial salivary glands obtained from 8 patients were studied. A panel of monoclonal antibodies directed against the variable region of the T cell receptor was used to enumerate the cells expressing V beta families in the peripheral blood by flow cytometry, and in tissue sections by immunofluorescence.

RESULTS

We found an increase of cells bearing V beta 2 family gene products in the circulation, and an increase in both V beta 2 and V beta 8 in the salivary gland infiltrate of patients with SS. No significant difference was noted between the 5 DR3+ patients and 7 DR3- patients studied with regard to the V beta families seen.

CONCLUSION

Our data are consistent with a role for specific T cell families in the pathogenesis of SS.

Cirrhosis in patients with rheumatoid arthritis receiving low dose methotrexate

We describe three patients with RA who developed cirrhosis while taking low dose methotrexate (MTX). This report includes a review of the risk factors for cirrhosis occurring in association with MTX. Two of these patients were part of a prospective study to quantify changes in pericellular and total collagen in 76 patients with RA receiving low dose pulse MTX, giving a point prevalence of cirrhosis of 2.63%.

A simplified method for determining regurgitant fraction by Doppler echocardiography in patients with aortic regurgitation

OBJECTIVES

This study attempted to develop and validate a simple method for calculating aortic regurgitant fraction by use of pulsed wave Doppler echocardiography.

BACKGROUND

Although several investigators have been able to determine aortic regurgitant fraction by Doppler echocardiography, the methods used require accurate determination of the cross-sectional areas of intracardiac sites at which the volumetric flow is calculated.

METHODS

Our concept was based on a constant relation that exists between the cross-sectional area of the left ventricular outflow tract and the mitral valve annulus in normal subjects. To verify this, we used Doppler echocardiography to measure the flow velocity integral of the left ventricular outflow tract and the mitral annulus in the apical view in 50 normal subjects (32 men, 18 women, mean age 34 years).

RESULTS

Close correlation (r = 0.95) was observed between the flow velocity integral (FVI) of the outflow tract (OT) and that of the mitral annulus (MA): FVIMA/FVIOT = 0.77. Because mitral flow equals aortic flow in normal subjects, the ratio of the cross-sectional area of the mitral annulus to that of the outflow tract was 1/0.77. In patients with aortic regurgitation, the regurgitant fraction (RF) = (Aortic flow-Mitral flow)/Aortic flow = 1-Mitral flow/Aortic flow. Substituting 0.77 for the area component of flow, RF = 1-(1/0.77).(FVIMA/FVIOT). To evaluate the accuracy of this method, we compared the regurgitant fraction derived by Doppler echocardiography with that from catheterization findings in 20 patients with aortic regurgitation (an isolated lesion was found in 14). The regurgitant fraction by catheterization was the difference between total (angiographic) and forward (thermodilution) stroke volumes as a percent of total flow. Good correlation was observed between catheterization and Doppler regurgitant fraction (r = 0.88, SEE 9%, p < 0.01).

CONCLUSIONS

Thus, regurgitant fraction can be estimated from Doppler echocardiography in patients with aortic regurgitation by a method that requires only measurements of the flow velocity integral from the mitral annulus and left ventricular outflow tract.

Comparison of two- and three-dimensional echocardiography with cineventriculography for measurement of left ventricular volume in patients

OBJECTIVES

We compared two- and three-dimensional echocardiography with cineventriculography for measurement of left ventricular volume in patients.

BACKGROUND

Three-dimensional echocardiography has been shown to be highly accurate and superior to two-dimensional echocardiography in measuring left ventricular volume in vitro. However, there has been little comparison of the two methods in patients.

METHODS

Two- and three-dimensional echocardiography were performed in 35 patients (mean age 48 years) 1 to 3 h before left ventricular cineventriculography. Three-dimensional echocardiography used an acoustic spatial locator to register image position. Volume was computed using a polyhedral surface reconstruction algorithm based on multiple nonparallel, unevenly spaced short-axis cross sections. Two-dimensional echocardiography used the apical biplane summation of disks method. Single-plane cineventriculographic volumes were calculated using the summation of disks algorithm. The methods were compared by linear regression and a limits of agreement analysis. For the latter, systematic error was assessed by the mean of the differences (cineventriculography minus echocardiography), and the limits of agreement were defined as +/- 2 SD from the mean difference.

RESULTS

Three-dimensional echocardiographic volumes demonstrated excellent correlation (end-diastole r = 0.97; end-systole r = 0.98) with cineventriculography. Standard errors of the estimate were approximately half of those of two-dimensional echocardiography (end-diastole +/- 11.0 ml vs. +/- 21.5 ml; end-systole +/- 10.2 ml vs. +/- 17.0 ml). By limits of agreement analysis the end-diastolic mean differences for two- and three-dimensional echocardiography were 21.1 and 12.9 ml, respectively. The limits of agreement (+/- 2 SD) were +/- 54.0 and +/- 24.8 ml, respectively. For end-systole, comparable improvement was obtained by three-dimensional echocardiography. Results for ejection fraction by the two methods were similar.

CONCLUSIONS

Three-dimensional echocardiography correlates highly with cineventriculography for estimation of ventricular volumes in patients and has approximately half the variability of two-dimensional echocardiography for these measurements. On the basis of this study, three-dimensional echocardiography is the preferred echocardiographic technique for measurement of ventricular volume. Three-dimensional echocardiography is equivalent to two-dimensional echocardiography for measuring ejection fraction.

Pharmacodynamics of racemic and S(-)-atenolol in humans

The cardiovascular actions of racemic atenolol (RSATN) have been well characterized in humans, but the actions of S(-)-atenolol (SATN) when administered alone are unknown. In this study, responses of heart rate (HR) and Doppler-derived aortic blood flow profiles to upright treadmill exercise were compared after oral administration of 50 mg SATN and 100 mg RSATN in eight healthy, adult, male volunteers. After a single-blind, placebo run-in period, subjects were randomly allocated in a double-blind, crossover fashion to receive SATN and RSATN. Each study period was separated by a 7-day washout period. Multiple submaximal exercise tests were performed and data were collected over the 24 hours after each treatment. Both SATN and RSATN significantly (P < .05) blunted peak exercise HR by 38 +/- 3 and 37 +/- 3 beats/min, respectively. Aortic blood flow acceleration measured during peak exercise decreased after SATN and RSATN, by 13 +/- 4 and 13 +/- 3 m/sec2, respectively (P < .05). No difference in hemodynamic effect was observed between treatments. Pharmacodynamic parameters derived from plasma S(-)-atenolol concentration-effect (HR) curves after SATN, RSATN, and total atenolol plasma concentrations after RSATN did not differ significantly. Predicted maximum reductions in heart rate (Emax) and EC50 for S(-)-atenolol after SATN were 39.6 +/- 5.8 beats/min and 38.4 +/- 40.9 ng/ml versus 34.5 +/- 8 beats/min and 25.9 +/- 29.9 ng/ml for RSATN, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of ofloxacin and ceftriaxone for short-course treatment of enteric fever

An open, randomized comparison of ofloxacin (200 mg, every 12 h) given orally for 5 days and ceftriaxone (3 g, once daily) given intravenously for 3 days in the treatment of uncomplicated enteric fever was conducted in Ho Chi Minh City, Vietnam. Salmonella paratyphi type A was isolated from six patients. Salmonella typhi was isolated from 41 patients; 63% of these isolates were resistant to multiple antibiotics: ampicillin, chloramphenicol, sulfamethoxazole, trimethoprim, and tetracycline. Of the culture-confirmed cases, treatment with ofloxacin resulted in complete cure of all 22 patients, whereas 18 of 25 patients treated with ceftriaxone were completely cured (P < 0.01). In the ceftriaxone group, there were six acute treatment failures and one relapse. Mean +/- standard deviation fever clearance times were 81 +/- 25 h for ofloxacin and 196 +/- 87 h for ceftriaxone (P < 0.0001). Short-course treatment with oral ofloxacin (5 days) is significantly better than that with ceftriaxone (3 days) and will be of particular benefit in areas where multiresistant strains of S. typhi are encountered.