A randomized, double-blind clinical trial using fixed daily doses of 100 or 200 IU of recombinant FSH in ICSI cycles

The effect of 100 and 200 IU per day recombinant FSH (rFSH) on numbers of oocytes retrieved and the total dose used in ovarian stimulation before intracytoplasmic sperm injection was investigated in a double-blind, randomized multicentre trial. A total of 91 women was treated with a low-dose protocol and 88 with a high-dose regimen at five centres. For each started cycle, significantly more oocytes were retrieved in the 200 IU group than in 100 IU group (12.0 versus 5.7, P < 0.001); total rFSH consumption was 1121 and 1875 IU in the low- and high-dose groups respectively. Significant variations were noted between centres with regard to numbers of oocytes collected per started cycle, ranging from 2.8 to 7.2 in the 100 IU group and from 9.0 to 19.1 in the high-dose group. Exploratory analyses of secondary outcomes suggested there were no differences in vital pregnancy rates per started cycle (19.2 versus 16.9%) and per embryo transfer (26.2 versus 19.3%) in the low- and high dose groups respectively. There were four hospitalizations due to ovarian hyperstimulation syndrome, all in the 200 IU group.

Insulin-like growth factor I in the anterior pituitary of the clawed frog Xenopus laevis: immunocytochemical and autoradiographic indication for a paracrine action and corelease with prolactin

Insulin-like growth factor I (IGF-I) and its receptor are present in human and rat anterior pituitary. However, few data exist on the potential presence of IGF-I or its receptor in the non-mammalian pituitary and the cellular sites of IGF-I production have not been identified in any species. Thus, we investigated the anterior pituitary of the clawed frog Xenopus laevis which is widely used to study growth and differentiation. The study was performed with antisera against mammalian insulin-like growth factor I (IGF-I), prolactin (PRL) and growth hormone (GH) using immunohistochemical and immunocytochemical techniques. IGF-I binding was determined by in-vitro receptor autoradiography. The PRL-and GH-immunoreactive cells exhibited distinct distribution patterns. Neither at the light nor the electron microscopical level any colocalization of PRL-and GH-immunoreactivities was apparent. The PRL-immunoreactive cells exhibited round granules of medium electron density (mean diameter: 312 nm) and the GH-immunoreactive cells spherical granules of medium electron density (mean diameter: 165 nm). By the use of serial semithin sections IGF-I-immunoreactivity was exclusively located in PRL-immunoreactive cells. At the ultrastructural level, IGF-I-immunoreactivity was confined to the secretory granules in coexistence with PRL-immunoreactivity using the double labelling immunogold technique. Specific IGF-I binding sites were localized throughout the pituitary. The results provide evidence for a concomitant release of PRL and IGF-I and suggest autocrine/paracrine actions of IGF-I in the anterior pituitary.

[The first sequential transplantation of both lungs in the Czech Republic]

The authors describe the case of the first sequence transplantation of both lungs in the CR. This operation is indicated in all patients suitable for transplantation of the lungs who suffer from chronic pulmonary infection.

Immunohistochemical evidence for the presence, localization and partial coexistence of insulin, insulin-like growth factor I and relaxin in the protochordate Ciona intestinalis

The occurrence and coexistence of peptides of the insulin-like growth factor (IGF)/insulin superfamily were investigated in the ovary and gastro-intestinal tract of the protochordate Ciona intestinalis. Antisera specific for mammalian IGF-I, insulin and relaxin were used in a double-immunofluorescence method on paraffin sections and with an immunogold technique on consecutive semi-thin sections. IGF-I and relaxin immunoreactions but no insulin immunoreactions occurred in the ovary and were confined to medium-sized and mature follicle cells. Two subpopulations of reacting follicular cells were present: those containing only IGF-I immunoreactivity (5%) and those containing IGF-I and relaxin immunoreactivities (95%). In the gastro-intestinal tract, IGF-I and insulin immunoreactions coexisted, whereas no relaxin immunoreactions were obtained. Gel chromatography and radioimmunoassay in Ciona ovary revealed IGF-I immunoreactivity in two peaks with apparent molecular masses of approximately 16 kDa and 3 kDa. The present results indicate that (1) the same IGF-I-related peptide probably occurs in gastro-intestinal tract and ovary, (2) three different members of the insulin/IGF family of peptides are probably present in protochordates, (3) different types of coexistence of these peptides seem to exist in protochordates, i.e. an IGF-I-related peptide and an insulin-related peptide in the digestive tract and, as shown previously, in central nervous system, and the IGF-I-related peptide and relaxin in the ovary, (4) an IGF-I-related peptide and relaxin may be involved in oocyte maturation in the protochordate ovary.

[Thromboelastography--an instrument for the researcher or clinician?]

Thromboelastography is a method which is used experimentally since 1948. Since the end of the eighties it is experiencing a certain revival also in clinical medicine. The submitted case-record presents this technique as a very useful aid in the differential diagnosis of postoperative haemorrhagic conditions in cardiosurgery. Its application can facilitate aimed treatment of some typical disorders of haemocoagulation.

The early phase of glucose-stimulated insulin secretion requires nitric oxide

Nitric oxide (nitrogen monoxide, NO) acts as a signal transducer in a variety of cells. In the present study rat pancreatic islets were perifused with physiologically relevant glucose concentrations in the presence or absence of various NO-modulating agents. Perifusion in the presence of 0.1-1 mmol/l of the NO synthase inhibitor, NG-monomethyl-L-arginine or of 10 micromol/l of the NO-scavenger, 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO), resulted in an inhibition of the early phase of glucose-stimulated insulin secretion by 60-65% and 46%, respectively. Light- and electron-microscopic studies revealed that pancreatic islets constitutively express NO-synthase in alpha and delta cells, where it is confined to the secretory granules. Therefore, these data indicate that NO may be important in the signal transduction pathway of the early phase of glucose-stimulated insulin secretion.

Uroguanylin: gene structure, expression, processing as a peptide hormone, and co-storage with somatostatin in gastrointestinal D-cells

Guanylin/GCAP-I and uroguanylin/GCAP-II are two structurally related peptides which play an important role in the regulation of water/electrolyte balance within the gut. In order to enable the investigation and comparison of both peptide hormones at the genomic level, we decided to clone the corresponding genes. The human gene for guanylin/GCAP-I and its 5'-flanking region have been described recently. Here, we report the three exon/two intron structure of the human uroguanylin/GCAP-II gene and its localization on chromosome 1 p35-34, as determined by radiation hybrid mapping. Together with data obtained for the guanylin/GCAP-I gene we show that these genes are localized in the same chromosomal area with other guanlyl cyclase-activating peptides like ANP etc. Northern hybridization revealed that the expression of the uroguanylin/GCAP-II gene is highest in the intestinal mucosa, especially in the ileum and colon. By means of polymerase chain reaction (PCR), an expression was also observed in the stomach where no guanylin/GCAP-I expression is detectable. Using immunohistochemical methods, uroguanylin/GCAP-II immunoreactive material was distinctly localized in D-type gastric and intestinal endocrine cells. Although the comparable data on the genomic organisation of both peptide hormones verify their high degree of relationship, this finding indicates a special task of uroguanylin/GCAP-II within the stomach, such as regulatory functions in gastric secretion. The redundant expression of the GCAP/GC-C system in the small and large intestine, however, is as yet unclear.

Insulin treatment reduces the increased serum and lung angiotensin converting enzyme activity in streptozotocin-induced diabetic rats

Serum and lung angiotensin-converting enzyme (ACE) activity is increased in the streptozotocin (STZ)-diabetic rat. In the present study, the effect of insulin treatment on this increased ACE activity in the STZ-diabetic rat was investigated. Serum and tissue ACE activity was determined by radiometric assay using [3H]-Hippuryl-glycyl-glycine as substrate. Fifteen days after onset of diabetes (n = 16), 8 rats received insulin daily (6-12 units/kg, s.c.) for 33 days, 8 diabetes rats remained untreated. Control, non-diabetic, rats (n = 8) received saline. The baseline serum ACE activity in the control group was 595 +/- 13 nmol/ml/min and did not change significantly throughout the study. However, serum ACE activity in the untreated diabetic rats increased significantly as of day 14 post-STZ (650 +/- 24 nmol/ml/min, p < 0.001) compared to the corresponding values of the control group and compared to baseline values. Insulin administration to diabetic rats starting on day 15 post-STZ caused a gradual reduction in serum ACE activity to basal values, being (527 +/- 22 nmol/ml/min) at day 47. ACE activity in lungs of untreated diabetic rats was increased by 46%, 47 days post-STZ. Insulin treatment reduced lung ACE activity to values similar to those observed in non-diabetic rats. These changes were associated with reduced kidney weight and urine volume. In summary, insulin administration to hyperglycaemic rats resulted in a reduction in the enhanced serum and lung ACE activity to values seen in non-diabetic rats. Normalizing the activity of the renin-angiotensin system may slow or prevent the glomerular hypertension, a major factor in the development of diabetic nephropathy.

Localization, expression, and characterization of guanylin in the rat adrenal medulla

The peptide guanylin, recently isolated from the intestine, and localized to cells of the gut mucosa, is involved in electrolyte/water transport in the intestinal epithelium by means of a paracrine mode of regulation. Since high amounts of this peptide are present also in the systemic circulation, we investigated the adrenal gland as a potential endocrine source of guanylin. Using a reverse transcriptase-polymerase chain reaction and hybridization with an internal oligonucleotide designed for rat guanylin, 514-bp signals were obtained in intestinal tissue and adrenal gland. Successive analyses of extracts from intestine and adrenal gland by HPLC, western blotting, and radioimmunoassay revealed the presence of the same high-molecular mass (about 12.4 kDa) guanylin that corresponds to the mass of the guanylin prohormone. About 60 fmol/ml of circulating immunoreactive guanylin was determined in plasma. Localization studies with antisera directed against different epitopes of guanylin revealed that, in the adrenal gland, guanylin immunoreactivity is restricted to the medulla, where it is mainly confined to norepinephrine chromogranin A-containing cells. On the ultrastructural level, guanylin immunoreactivity was exclusively located to secretory granules of chromaffin cells. The present data indicate that, in addition to entero-endocrine cells, the adrenal medulla represents a further source of guanylin. Thus, an endocrine mode of function of guanylin may accrue to its hitherto evidenced paracrine action in fluid transport in the intestinal epithelium. Furthermore guanylin may be considered as a neurohormonal peptide.

[The differential diagnosis of Parkinson diseases--123I-IBZM-SPECT vs. the apomorphine test]

The aim of our study was to compare the striatal dopamine D2-receptor density as measured by 123I-IBZM-SPECT with the results of the apomorphine-test. 30 patients were studied; 21 with idiopathic Parkinson's disease (IPD), 9 with Parkinson plus syndromes (PPS). Patients with IPD showed a significantly higher striatal IBZM binding as compared to patients with PPS (p = 0.006). A good correlation between IBZM binding and outcome of the apomorphine-test was found (p = 0.006). Low striatal IBZM binding indicates reduced dopamine D2-receptor density. This compromises successful dopaminergic medical therapy and is indicative of non-IPD disease. 123I-IBZM-SPECT could be diagnostic aid in the work-up of patients with extrapyramidal movement disorders. The response to dopaminergic drug treatment might be precluded by IBZM-SPECT in patients with Parkinsonian syndromes.

Dynamics of the effects of levoprotiline and maprotiline on EEG in patients with major depressive episodes (DSM-III-R)

The presented study compares the effect of the well-tested antidepressant maprotiline and a new antidepressant with an atypical pharmacological profile, levoprotiline, on EEG during repeated assessment after single dose administration. From the original number of 34 patients fulfilling the criteria of a major depressive episode (DSM-III-R) on account of a low-voltage record or pathological findings 11 were eliminated. To 12 of the remaining patients levoprotiline was administered and to 11 maprotiline, after a one-week placebo period, in doses of 150 mg. The EEG was recorded after an accommodation session immediately before, 1.5, 3, 4.5, 6 and 24 hours after a single dose administration. The record was taken on a 16-channel average reference montage at rest with closed eyes. Two-minute intervals were divided into 30 four-second periods at a sampling frequency of 128 Hz. From the signal by means of FFT the spectra were estimated and the mean spectrum for the entire recording was calculated. This was then divided into 10 frequency bands. The new method of frequency analysis of alpha-entropy was also used which is a global measure of the difference between two spectra. Three hours after administration of a single dose levoprotiline had an EEG profile corresponding to the profile of tricyclic antidepressants, i.e. it increased the values of the power spectra density in the region of 5-8.5 Hz and in the entire beta band; the decline of power in the alpha band was, however, absent. As regards maprotiline, 3 hours after administration a profile typical for antidepressants was not found; obviously because of the great variance of values of power spectra density as a result of great interindividual differences in the ingestion phase. Changes of the EEG spectrum expressed as values of alpha-entropy during different periods of apparently assessment are not incidental. After the initial rise of values a decline occurs.

[Results of a clinical trial of levoprotiline]

The authors submit results of a double blind clinical trial of levoprotiline controlled by maprotiline. In the multicentre study (which is processed and interpreted in stages) participated after written informed consent 58 patients with the diagnosis of a major depressive disorder. During the first three weeks the results of levoprotiline and maprotiline (from 26 patients each) were processed. The trial lasted 42 days. The psychopathology of the patients was evaluated by independent blind raters by means of Montgomery and Asberg's scale (MADRS), Hamilton's scale for depression (HRDS) and general clinical impression (CGI). In all patients also the pharmacological and EEG response was assessed. In comparison to maprotiline, levoprotiline was clinically ineffective. Its plasma levels (40 ng/ml) were one third to one half of the values obtained with maprotiline in the same daily dosage (150 mg). Although levoprotiline has an EEG profile typical for classical thymoleptics, its clinical antidepressive action is negligible.

Oral clofilium produces sustained lowering of defibrillation energy requirements in a canine model

The effect of long-term oral administration of antiarrhythmic drugs on defibrillation energy requirements is not well understood. We examined the effect of clofilium, a drug that prolongs cardiac action potential duration without slowing cardiac conduction, on defibrillation energy requirements and ventricular effective refractory periods in a canine model during a 3-week period. Epicardial patch electrodes were implanted in 12 dogs, and baseline testing was conducted under fentanyl anesthesia on day 7. An oral clofilium (100 mg/day) regimen was started on day 8. Six clofilium-treated and six control dogs underwent repeated testing on days 14, 21, and 28 after surgery. Truncated trapezoidal shocks were given repeatedly at various stored energies in random order; delivered current and impedance were measured; and delivered energy was calculated. The energy and current for 50% success in defibrillation (E50 and I50, respectively) were determined. For control animals, E50 increased by a mean 34 +/- 78%, 60 +/- 83%, and 69 +/- 122% compared with baseline (day 7) on days 14, 21, and 28, respectively. In contrast, E50 in clofilium-treated dogs decreased by 39 +/- 62%, 24 +/- 33%, and 32 +/- 15% on days 14, 21, and 28, respectively. Mean current requirements (I50) remained relatively stable compared with baseline in control animals (-7 +/- 39%, +25 +/- 36%, +40 +/- 75% on days 14, 21, and 28, respectively). After clofilium administration I50 decreased by 36 +/- 22%, 32 +/- 17%, and 33 +/- 17% on days 14, 21, and 28, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of hypertension levels control and management (hypertension "AUDIT" project). Study in a population of workers

The hypertension AUDIT project (WHO) was used for the study of large populations of workers in two Romanian industrial centers, Slatina and Sibiu, constituted into two main groups. The objects of the study were: the detection of new cases of arterial hypertension (AH) and of their proportion as compared with older cases, the assessment of the quality of diagnosis control and treatment methodology as well as the estimation of the patient's attitude regarding the conditions of treatment and of the physician's knowledge and attitude regarding AH. Group I (Slatina) included 22,839 workers and the program was applied in 15,740 randomly chosen subjects. Group II (Sibiu) included 14,874 workers of whom 2,838 were randomly chosen for study. From a total of 606 (6.20%) subjects aged 35 to 64 years with AH in both groups, 494 (81.51%) were older cases and 112 (18.48%) were newly detected. The prevalence of AH was found to increase with age and to be higher in women aged 55 to 64 years. The treatment in older cases from both groups was considered effective in 232 cases (46.96%) (of which 26 (11.2%) with overtreatment) and insufficient in 262 (53%). The reasons alleged by the patients for the late detection of AH were the absence of symptoms and a casual interest for their state of health. The risk factors were systematically checked. Smoking was found in 30.36% of the subjects in group I and in 31% of those in group II. The use of diagnostic laboratory procedures was corresponding to the present recommendations. The nonpharmaceutic therapy was frequently recommended, especially reduction of salt consumption. Besides that, pharmaceutic treatment was indicated in most of the patients (63% in group I and 90% in group II). Diuretics (41.26% in group I and 75% in group II), and beta blocking drugs (35.3% in group I and 70% in group II) were the most frequently administered and in a lesser proportion vasodilators with central or peripheral action, calcium blockers, Rauwolfia and angiotensin conversion enzyme inhibitors. The consumer inquiry showed satisfactory compliance of patients, most of them took their tablets regularly, were satisfied with the medical assistance and preferred to consult the same physician. The data of the physician inquiry regarding diagnosis treatment of AH and professional training also proved satisfactory. The use of the AUDIT project has allowed a complex estimation of AH in the groups studied and will prove useful for a more efficient control of AH in the whole population.

Neuroendocrine response to clomipramine and desipramine--the evidence of partial determination by heredity and sex

A single dose of clomipramine, 10 mg i.v., or desipramine, 25 mg i.m., was administered to seven healthy young sibling pairs in a randomized cross-over experiment. The response of serum growth hormone, prolactin and cortisol was measured. The main findings were (1) sex differences in the growth hormone and cortisol response to desipramine and (2) a significant genetic component of the prolactin and cortisol response to desipramine as indicated by significantly (p less than 0.05) lower within-pair than between-pair variance in the sibling pairs but not random pairs of the experimental subjects.

Inhibitory effects of pyridoxal phosphate, ascorbate and aminoguanidine on nonenzymatic glycosylation

Nonenzymatic glycosylation of serum albumin was studied in the presence of naturally occurring metabolites, pyridoxal, pyridoxal phosphate and ascorbate/dehydroascorbate, and a hydrazine compound, aminoguanidine. Pyridoxal, pyridoxal phosphate, ascorbate and dehydroascorbate, at concentrations of 0.1 mM or greater, significantly inhibited the nonenzymatic glycosylation of albumin. Aminoguanidine was the most potent inhibitor of nonenzymatic glycosylation and 54% or 85% inhibition occurred when 5 or 50 mM aminoguanidine, respectively, was present in the incubation mixture containing 20 mM glucose. A major effect of aminoguanidine was to lower the free glucose concentration in the incubation mixture by a direct reaction with glucose as judged by thin layer chromatography. The present studies suggest that vital metabolites such as pyridoxal phosphate and ascorbate may be potentially important in controlling glucose-induced nonenzymatic glycosylation of proteins. Pyridoxal phosphate forms a Schiff base with proteins as does glucose and therefore may be a preferable drug, over aminoguanidine which is a hydrazine, for inhibiting the effects of glucose-induced nonenzymatic glycosylation.

Mitral valvuloplasty and repair for infective endocarditis

The traditional therapy for acute bacterial endocarditis of the mitral valve refractory to medical treatment is valve replacement. Successful valvuloplasty may be feasible in selected cases, in which the infection is limited to a small portion of the mitral valve anulus. The following report describes a case in which valvuloplasty with excision of the affected valve was performed successfully with no recurrence of infection over a 3-year follow-up period.

Gelfoam occlusion of peripheral bronchopleural fistulas

A technique for occlusion of peripheral bronchopleural fistulas using Gelfoam as a temporary endobronchial blocker is described.

Mediastinal hematoma mimicking aortic rupture

The case of a child who fell a relatively short distance and had clinical and x-ray findings consistent with a ruptured aorta is presented. At surgery, a mediastinal hematoma was found. Diagnostic and therapeutic implications are discussed.

Thoracic surgical implications of the yellow nail syndrome

Idiopathic lymphedema associated with yellow discoloration of the nail beds constitutes the yellow nail syndrome. Pleural effusions and chronic sinusitis are also frequently present. This report describes a case of yellow nail syndrome in a 65-year-old woman.

A time-dependent stopping problem with application to live organ transplants

We consider a time-dependent stopping problem and its application to the decision-making process associated with transplanting a live organ. "Offers" (e.g., kidneys for transplant) become available from time to time. The values of the offers constitute a sequence of independent identically distributed positive random variables. When an offer arrives, a decision is made whether to accept it. If it is accepted, the process terminates. Otherwise, the offer is lost and the process continues until the next arrival, or until a moment when the process terminates by itself. Self-termination depends on an underlying lifetime distribution (which in the application corresponds to that of the candidate for a transplant). When the underlying process has an increasing failure rate, and the arrivals form a renewal process, we show that the control-limit type policy that maximizes the expected reward is a nonincreasing function of time. For non-homogeneous Poisson arrivals, we derive a first-order differential equation for the control-limit function. This equation is explicitly solved for the case of discrete-valued offers, homogeneous Poisson arrivals, and Gamma distributed lifetime. We use the solution to analyze a detailed numerical example based on actual kidney transplant data.

Compression of intrapulmonary bronchi by abnormally branching pulmonary arteries associated with absent pulmonary valves

In 3 patients with absent pulmonary valve syndrome and absent ductus arteriosus, the lungs were injected and analyzed postmortem using morphometric techniques. Two patients had tetralogy of Fallot and 1 had D-transposition of the great arteries, the latter being the first autopsy-proved case of absent pulmonary valve with transposition. In addition to the expected dilatation of the central pulmonary arteries and compression of the mainstem bronchi, postmortem pulmonary arteriography revealed a bizarre pattern of hilar branching. Instead of single segmental arteries, tufts of arteries arose which entwined and compressed the intrapulmonary bronchi. In all 3 patients the histologic structure of the pulmonary arteries was abnormal. The elastic lamina of the media of the right and left pulmonary arteries were increased in number outside the lung, but were decreased within the lung. At both sites, the elastic laminae were thickened and fragmented. In the 2 ventilator-dependent patients, there was slight medial hypertrophy and extension of muscle into normally nonmuscular arteries. In 1 of the 2 cases in which the number of bronchial generations was counted, they were decreased, and in the 1 case in which bronchial count was unknown, alveolar multiplication was severely impaired. Therefore, our data may explain why, in some patients with absent pulmonary valve syndrome, relief of compression of the mainstem bronchi alone does not appreciably alleviate or reverse severe respiratory disease.

Potentially parachute mitral valve in common atrioventricular canal: pathological anatomy and surgical importance

An essentially single focus of left ventricular chordal insertion was found in 23 of 164 autopsied cases of common atrioventricular canal (CAVC) with a normally formed spleen (14%). Suture closure of the cleft of the mitral valve in such cases results in the surgical creation of parachute mitral valve, often with fatal iatrogenic mitral stenosis. In such patients, the cleft of the mitral valve is its main orifice and must not be sutured closed. There are four anatomic types of potentially parachute mitral valve in CAVC: (1) with one papillary muscle group and one mitral orifice (type 1A), in 10 cases (43%); (2) with one papillary muscle group and two mitral orifices (type 1B), in one case (4%); (3) with two papillary muscle groups and one mitral orifice (type 2A), in five cases (22%); and (4) with two papillary muscle groups and two mitral orifices (type 2B), in seven cases (30%). Parachute mitral valve exists only when the AVC is divided, either naturally or surgically. The essence of parachute mitral valve is an essentially single focus of chordal insertion. One or both left ventricular papillary muscle groups may be present. The presence of only one focus of left ventricular chordal insertion contraindicates cleft closure.

What is a ventricle? The single-ventricle trap

Whether a chamber is or is not a ventricle is determined by its myocardial morphological characteristics, not by the entering atrioventricular (AV) valves. The anatomic characteristics of the morphologically right ventricle and the morphologically left ventricle have been well described, are widely understood, and do not need to be changed. What a ventricle is should not be redefined in terms of the AV connections because such redefinition is based on the classic definition of single ventricle, which itself is not satisfactory. This old definition is wrong in principle, violates the morphological method of diagnosis and designation of the cardiac principle, violates the morphological method of diagnosis and designation of the cardiac chambers, and has two kinds of exceptions. Consequently the classic definition of single ventricle must not be used as a paradigm (model) for the redefinition of what a ventricle is or is not. The approach and terminology based on the use of the unsatisfactory single-ventricle is or is not. The approach and terminology based on the use of the unsatisfactory single-ventricle paradigm approach and terminology based on the use of the unsatisfactory single-ventricle paradigm should be discontinued, eg, "primitive ventricle," "main chamber," "accessory chamber," "trabecular pouch." Being unnecessary, these nonmorphological components of the terminology of congenital heart disease may be omitted. Morphological anatomy, unadorned, is the key to clarity, simplicity, and accuracy.

Pericardial tamponade and its effect on cardiac performance in absence of the pulmonic valve

A controlled study was undertaken to quantitate and compare the amount of accumulated pericardial fluid causing acute pericardial tamponade in animals with or without an intact pulmonary valve. In 13 mongrel dogs, acute pericardial tamponade was induced by gradual loading of the pericardial cavity with fluid (mean 21.3 cc/m2). In 10 dogs (Group A) the pulmonic valve was completely excised under caval occlusion and the pericardium resealed. In Group B, the control group (n = 3), caval occlusion was performed for the same period of time but the pulmonary valve was left intact. Reloading of the pericardium with fluid in both groups revealed that whereas in the Control Group B a similar volume of fluid was required (mean 213 cc/m2) to cause critical tamponade, in Group A a much smaller volume (mean 132 cc/m2) (40% decrease) now produced tamponade (p less than 0.001). The results of the study may have important practical implications in patients having cardiac operations in which the pulmonary valve is left incompetent, such as after complete repair of tetralogy of Fallot.