Short-term and long-term epoprostenol (prostacyclin) therapy in pulmonary hypertension secondary to connective tissue diseases: results of a pilot study

Continuous intravenous epoprostenol improves exercise capacity, haemodynamics, and survival in severe primary pulmonary hypertension. Pulmonary hypertension can also be life-threatening in patients with connective tissue diseases. In a prospective open monocentre uncontrolled study, the effects of epoprostenol were evaluated in patients with severe pulmonary hypertension secondary to connective tissue diseases who were unresponsive to oral vasodilators (including calcium channel blockers) and continued to be in the New York Heart Association (NYHA) functional class III or IV despite conventional medical therapy. Seventeen patients received epoprostenol administered by a portable infusion pump associated with conventional therapy (oral anticoagulants, diuretics, supplemental oxygen). During the first six weeks of therapy, two (12%) patients died, of pulmonary oedema (n = 1) and severe sepsis (n = 1). In the fifteen remaining subjects, clinical and haemodynamic parameters improved significantly at six weeks. These patients were subsequently monitored for 80+/-48 (range 14-154) weeks after initiation of epoprostenol. Five (33%) patients died, of right heart failure (n = 2), severe sepsis (n = 2) or syncope (n = 1) and two patients were successfully transplanted 24 and 52 weeks after initiation of epoprostenol. Seven of the remaining eight patients had a persistent clinical improvement. Short-term epoprostenol therapy is effective in some patients with connective tissue diseases as demonstrated by better clinical status and haemodynamics at six weeks. However, this study reports several cases of early and late major complications including severe sepsis and pulmonary oedema. Additional information is needed to evaluate the benefit: risk ratio of long-term epoprostenol therapy in pulmonary hypertension secondary to connective tissue diseases.

A single-nucleotide polymorphism in the human bone morphogenetic protein-4 (BMP 4) gene

A polymorphic site has been found in the human bone morphogenetic protein-4 (BMP4) gene. To our knowledge, it is the first defined polymorphism in this gene, being present with similar frequencies in Caucasian, Hispanic, and African populations.

Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia

INTRODUCTION

An epicardial site of origin of ventricular tachycardia (VT) may explain unsuccessful endocardial radiofrequency (RF) catheter ablation. A new technique to map the epicardial surface of the heart through pericardial puncture was presented recently and opened the possibility of using epicardial mapping to guide endocardial ablation or epicardial catheter ablation. We report the efficacy and safety of these two approaches to treat 10 consecutive patients with VT and Chagas' disease.

METHODS AND RESULTS

Epicardial mapping was carried out with a regular steerable catheter introduced into the pericardial space. An epicardial circuit was found in 14 of 18 mapable VTs induced in 10 patients. Epicardial mapping was used to guide endocardial ablation in 4 patients and epicardial ablation in 6. The epicardial earliest activation site occurred 107+/-60 msec earlier than the onset of the QRS complex. At the epicardial site used to guide endocardial ablation, earliest activation occurred 75+/-55 msec before the QRS complex. Epicardial mid-diastolic potentials and/or continuous electrical activity were seen in 7 patients. After 4.8+/-2.9 seconds of epicardial RF applications, VT was rendered noninducible. Hemopericardium requiring drainage occurred in 1 patient; 3 others developed pericardial friction without hemopericardium. Patients remain asymptomatic 5 to 9 months after the procedure. Interruption during endocardial pulses occurred after 20.2+/-14 seconds (P = 0.004), but VT was always reinducible and the patients experienced a poor outcome.

CONCLUSION

Epicardial mapping does not enhance the effectiveness of endocardial pulses of RF. Epicardial applications of RF energy can safely and effectively treat patients with VT and Chagas' disease.

Orthotopic heart transplantation for dilated cardiomyopathy in a patient with persistent left superior vena cava and atresia of the right superior vena cava

OBJECTIVE

To describe the surgical procedure of an orthotopic heart transplantation in a recipient with persistent left superior vena cava and atresia of right superior vena cava.

EXPERIMENTAL DESIGN

Case report.

PATIENT

A 43 year old male with persistent left superior vena cava, atresia of the right superior vena cava and dilated cardiomyopathy.

INTERVENTIONS

Orthotopic heart transplantation with selective cannulation of the left superior vena cava via recipient coronary sinus for cardiopulmonary bypass.

RESULTS

No perioperative complications, satisfactory postoperative course. No rejection episodes at 7 months postoperative with non invasive procedure surveillance.

CONCLUSION

Technique described to preserve left superior vena cava is a useful alternative for this patient with no surgical complications.

Description of a redox-controlled sulfidostat for the growth of sulfide-oxidizing phototrophs

This paper describes a novel type of continuous culture for the growth of phototrophic sulfur oxidizers under constant concentrations of hydrogen sulfide. The culture maintains a constant concentration of sulfide despite possible variations in external factors likely to affect photosynthetic activity. Variations in biological activity lead to small departures from the steady-state concentration of hydrogen sulfide which result in variations of the redox potential. These changes in redox, monitored through a redox controller, modulate the rate at which the medium is pumped into the culture and therefore govern the dilution rate. As a result, when changes in external factors such as the light supply occur, the dilution rate of the culture adjusts to the new rate of sulfide oxidation, while maintaining a virtually constant concentration of hydrogen sulfide. The system has been successfully tested for an extended period of several weeks and under conditions of shifting illumination (868 to 113, 113 to 23, and 23 to 7 (mu)E(middot)m(sup-2)(middot)s(sup-1)). After changes in illumination, a transition to a new dilution rate started immediately, reaching a new equilibrium in less than 3 h.

Measurement of light absorption and determination of the specific rate of light uptake in cultures of phototrophic microorganisms

This article describes a novel method for the measurement of light absorption by cultures of phototrophic microorganisms. The rate of light absorption is calculated as the difference between the rate of light output from a culture containing cells and the rate of light output from a culture containing only growth medium. The specific rate of light uptake is calculated by dividing the rate of light absorption by the total biomass present in the culture. Application of the method to several case studies shows that light output from a culture varies widely depending on the absorption and scattering characteristics of the suspension.

Ifosfamide and mesna at high doses for the treatment of cancer of the cervix: a GETLAC study

This study was carried out to assess the efficacy of high-dose ifosfamide/mesna (HDIFM) in the treatment of advanced or recurrent cancer of the cervix. In all, 18/21 evaluable patients with advanced or inoperable cervical cancer were included. The mean age was 42 years (range, 31-58 years); and the International Federation of Gynecology and Obstetrics (FIGO) stage was III in 10 patients and IV in 11. The Karnofsky performance status ranged between 70 and 90, with a median of 77. Ten patients had previously been treated with surgery, radium and cobalt (8) or cobalt alone (2). Therapy consisted of 3.5 g/m2, ifosfamide (IFO) given in an 8-h i.v. infusion on days 1-5 and mesna at 20% of the IFO dose, given i.v. at 0, 2, 4, 6 and 8 h, followed by mesna at 40% of the IFO dose by the oral route at 10 and 12 h on days 1-5. For evaluation purposes, patients received at least two cycles. Toxicity was registered in 137 cycles and was mild to moderate. Three complete (16.6%) and six partial (33.3%) responses were observed (50%), but 66% of them occurred in areas that had not previously been irradiated. The median duration of response was 14 months and the overall median survival was 15+ months (18+ months for responders). The Karnofsky scale after treatment ranged from 90 to 100. The results of this study indicate that HDIFM is well tolerated, giving a high percentage of remission (50%) and significantly improving the quality of life.

Bacterio-pharmacological activity of Saccharomyces boulardii in clindamycin-induced colitis in the hamster

The effect of S. boulardii on experimental colitis induced by the single oral administration of 1 mg/kg of clindamycin in the Syrian hamster was studied. Oral administration of S. boulardii for 13 days, starting 3 days prior to the administration of clindamycin, significantly reduced the mortality rate and inhibited the growth of C. difficile in the caecum and colon. There was a marked improvement in the sub-mucosa and mucosa which showed major inflammatory lesions when clindamycin was administered alone.

A chromosome No. 2 abnormality in a child with a few congenital defects

An abnormal chromosome No2 was found in the case of a child with an imperforate anus, a recto-vaginal fistula, unilateral atresia of the inner canal ,and deformity of the external ear. G-banding studies revealed an insertion of a segment of the short arm into the long arm in one of the chromosomes No. 2 of the proband, the apparent result of a de novo phenomenon of chromosome rearrangement.

Analysis of the human genome by complementary RNA/DNA gradient hybridization and relaxes cesium sulfate-silver ion density centrifugation

3H-Labeled complementary RNA (cRNA) transcribed from total nuclear human DNA was hybridized to homologous DNA and the hybrids formed localized in CsC1 density gradients. Radioactive peaks indicative of cRNA/DNA hybrids identified ten density components. The experimental conditions used indicated that these components correspond to DNA rich in repeated sequences. In addition, cRNAs transcribed from five Cot fractions (31% of total DNA; Cot less than 100) were hybridized to total DNA in CsC1 gradients. The hybrids sedimented at similar densities to those seen in total cRNA but showed a differential distribution along the five fractions. To isolate native double-stranded DNA components containing the various families of repeated sequences observed, nuclear DNA was fractionated using relaxes Cs2SO4/Ag+ density gradient centrifugation. These fractions revealed the presence of seven major components a densities of 1.715, 1.711, 1.708, 1.705, 1.702, 1.700 and 1.698 g/cm3 and three minor components at densities of 1.696, 1.693 and 1.687 g/cm3. The density components corresponded to those observed by cRNA/DNA hybridization, thus suggesting that the bulk of the human genome is made up of ten density-biased components containing sequences of varying degrees of repetitiveness.

Simultaneous G and C banding of human chromosomes

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Trisomy for the distal half of the short arm of chromosome 9. A variant of the trisomy 9p syndrome

Three patients with partial trisomy for the distal one half of the short arm of chromosome 9 were studied. These patients represent a mild clinical variant of the trisomy 9p syndrome.

The G-banded prophase chromosomes of man

Using a simple G-banding technique developed in our laboratory, analysis of late prophases enables the visualization of approximately 1000 bands in the haploid set of human chromosomes. These bands have been classified according to the recommendations of the Paris Conference. The increased resolution offered by this technique is likely to be useful in the study of the structure and molecular organization of chromosomes and in identifying minute chromosome defects in birth defects and neoplasia.