Interpretative reproducibility of two-dimensional echocardiographic images. Analysis of intraobserver, interobserver and beat to beat reproducibility of the mitral valve orifice

The intraobserver, interobserver and beat to beat interpretative reproducibility of two-dimensional echocardiographic images of the mitral valve area has been studied retrospectively in a group of 37 patients affected by rheumatic mitral valve disease. Reproducibility has been expressed either in terms of mean absolute or percent error of duplicate measurements. A group of 11 normal subjects was used for comparison. In our normal group the intraobserver, interobserver and beat to beat reproducibility averaged 1.8 +/- 2.1%, 3.1 +/- 1.4%, 2.7 +/- 2.0% or 0.12 +/- 0.14 cm2, 0.21 +/- 0.10 cm2, 0.17 +/- 0.13 cm2, respectively. In our patient population the intraobserver, interobserver and beat to beat reproducibility averaged 2.7 +/- 2.7% 4.1 +/- 4.9%, 4.6 +/- 3.6% or 0.05 +/- 0.05 cm2, 0.08 +/- 0.10 cm2, 0.08 +/- 0.06 cm2. In both groups there was no statistical difference among intraobserver, interobserver and beat to beat reproducibility either in terms of percent or absolute value. The mean percent error did not significantly differ between normal or stenotic valves or, in this latter group, among valves of different sizes (less than or equal to 1.4 cm2; 1.5-2.4 cm2; greater than or equal to 2.5 cm2). The mean absolute error, on the contrary, statistically differed between the two groups or among valves of different sizes, being larger in normals or in valves greater than or equal to 1.5 cm2. Thus, the interpretative reproducibility for two-dimensional echocardiographic images of the mitral valve area is small and acceptable for most clinical purposes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bacterial, mycotic and protozoal cholangitis in childhood]

The Authors present the cases of cholangitis in childhood observed in the Institute of Infectious diseases of Genoa from 1973 to 1982. Cholangitis rarely starts by alone, whereas it appears usually in association with hepatic underlying disease. In childhood the symptomatological triad (fever, jaundice, pain) is infrequent: only jaundice is a common sign of disease. Polymicrobial aetiology of cholangitis is very usual, but Streptococci and E. coli are the aetiological agents most frequently observed; sometimes also anaerobic organsimee, fungi and protozoa cause cholangitis.

[Granulomatous hepatitis. Apropos of a case with difficult etiological diagnosis]

Hepatic granulomatosis is an anatomo-pathologic feature, rising from the aspecific answer of the liver to various antigenic, toxic and infectious noxae. One of the most frequent symptoms of this disease is a some weeks lasting fever. The most frequent etiology is proved to be infectious, particularly tuberculosis, and sarcoidosis. In this paper an analysis of the various diseases which can produce hepatic granulomas is presented, as well as the clinical case of patient with fever and hepatic disease for whom it has been possible to get to an etioilogic diagnosis of tuberculosis only through an hepatic biopsy and culture of liver tissue.

Naloxone inhibits exercise-induced release of PRL and GH in athletes

Opiate peptides stimulate the release of GH and PRL, and such changes have also been reported following physical exercise. To investigate opiate involvement in the exercise-induced release of these hormones, eight professional athletes were exercised to 80% of their maximal heart rate on a bicycle ergometer. This exercise alone induced an increase in circulating mean GH (basal to maximal level, 3.1 +/- 0.9 ng/ml-27.3 +/- 5.9 ng/ml) and mean PRL level (6.1 +/- 1.1 ng/ml-19.5 +/- 1.9 ng/ml). Infusion of naloxone (0.3 mg/min) antagonized these responses in mean serum GH (5.6 +/- 1.0 ng/ml to 8.6 +/- 1.1 ng/ml) and PRL levels (6.4 +/- 1.1 ng/ml-8.1 +/- 1.2 ng/ml), which were both significantly less than during the control infusions (P less than 0.01). It is suggested that certain forms of stress stimulate the release of PRL and GH via endogenous opiate peptides.

Treatment of benign fibrocystic disease of the breast with 2-bromo-alpha-ergocryptine (CB 154)

A total of 192 patients with benign fibrocystic disease of the breast were studied. Diagnosis was based on the clinical picture, xerography, and/or mammography. Most of the patients were 30-45 years old. Hormonal studies including serum PRL, 17-beta-estradiol, progesterone, and gonadotropins were performed by means of specific and sensitive RIA techniques. Patients were allotted to treatment with 3 x 25 mg p.o. 2-bromo-alpha-ergocryptine (CB 154, Parlodel, Sandoz) continuously for a period of 3 months. In an attempt to establish a possible relationship between PRL levels and the disease, patients were divided into two groups with high or normal levels of PRL. Results indicate an improvement or complete recovery in about 75% of the cases. These results are independent of PRL levels. According to our experience CB 154 seems to be the most effective treatment of this disease.

The analgesic effect of calcitonin in humans: studies on the role of opioid peptides

The possibility that the analgesic action of calcitonin could be due to variations in beta-endorphin levels in both peripheral blood and cerebrospinal fluid was studied. A total of 40 microgram of synthetic salmon calcitonin was injected i. v. in four male volunteers undergoing minor operations under rachianesthesia. Beta-Endorphin was determined in blood and cerebrospinal fluid samples that were collected before and at regular intervals after calcitonin injection. No statistically significant variation in beta-endorphin levels was observed either in peripheral blood or cerebrospinal fluid. Since the injected calcitonin was free of contaminants (demonstrated by both high pressure liquid chromatography and radioimmunoassay of endorphin made on the injected preparation) and since an increase was observed in the immunoreactive calcitonin in cerebrospinal fluid following calcitonin i. v., self-analgesic action may be hypothesized, even though action through prostaglandins or other systems cannot be excluded.

Human milk: relationship of fat content with gestational age

In order to assess the suitability of early human milk as a food for preterm infants, concentrations of fat were analyzed in milk samples representative of complete 24-h expressions, obtained serially over the first 30 days of lactation from 47 mothers delivering at term (FT) and 25 mothers delivering prematurely (PT). During the first postpartum month milk fat increased with progressing lactation both in FT and PT mothers' group. The increase was significant over the first 10 day period. During this stage the fat content was significantly higher in the milk from PT mothers than in FT mothers. A significant inverse correlation of fat content with gestational age was established. On the basis of these results, the higher energy intake obtained with PT milk suggests that is may be reasonable to prefer the use of mothers' own early milk than pooled milk as the more appropriate feeding for premature infants.

[Combination of antifungal chemotherapeutic agents in experimental candidiasis in mice]

For the valuation of therapeutical activity of many new recent antifungal drugs, these were employed in the various possible associations in the experimental candidosis of the mouse. From the results obtained calculated on the survivance percentage, was concluded that the best antifungal is the 5 fluorocytosine + amphotericin B association.