[Psychobiological approach to personality disorders]

Current categorical classifications of the personality disorders are based on psychological perspectives. Consequently, biological research using these models has been unsuccessful since the nosological categories do not come out from the psychobiological systems underlying personality psychopathology. By contrast, biological research on dimensional models of personality has been more useful. All dimensional models agree on a neurotic-inhibitory dimension and an exploratory dimension of personality but they differ on other primary traits like dependence, emotionality or impulsiveness. However, gathering together all biological data support the existence of five biological axes of personality: a cognitive axis, a mood axis, an anxious-inhibitory axis, an exploratory axis and a action-control axis.

CONCLUSION

Considering these biological axes is bringing a new perspective on the classification of personality disorder and gives way to new pharmacological therapeutic options.

[Secondary prevention of myocardial infarction in Spain. The PREVERSE study]

INTRODUCTION AND OBJECTIVES

We present the results from the PREVESE Study, conducted in two phases: the first to identify the secondary prevention measurements recommended in Spain in patients who were discharged after a myocardial infarction; the second, 6 months later, to determine their evolution.

METHODS

Data was collected from 1,242 patients in 39 hospitals. An analysis was made of the patients background, risk factors, working status, diagnostic procedures used during hospitalization, laboratory findings and drug therapy prescribed at discharge. At the second control, the risk factors status, diagnostic or assessment tests performed during the 6-month period, working status, mortality and cardiac events were revised.

RESULTS

The previous history and risk factors studied showed a high risk profile among patients after myocardial infarction. Among the drug therapies prescribed at discharge the small percentage (6.7%) of lipid lowering prescriptions should be highlighted. An improvement in the risk factor profile was found at the six month checkup with a substantial reduction in the number of smokers, a very low number of hypertensives and an improvement in physical activity. There was no improvement in total-cholesterol levels.

CONCLUSIONS

The implementation of preventive measures is not similar in all risk factors. An improvement is reached in prevention of smoking habit and hypertension, but not in the treatment of abnormal levels of hyperlipidemia.

[Sertraline in the treatment of mixed anxiety and depression disorder]

INTRODUCTION

Mixed anxiety and depression disorder (MAD) has been recognized in ICD-10 as a diagnostic group including those anxious and depressed patients who do not fit criteria for any major axis 1 disorders. Mad is usually treated with a combination on AD and BZD although recent reports suggest that SSRI might have both anxiolytic and AD intrinsic properties.

METHODS

36 patients diagnosed of MAD (ICD-10 criteria) underwent treatment with a flexible dose of sertraline for 8 weeks. No BDZ werre allowed during the trial. Efficacy was tested with the Clinical Global Improvement Scale and with changes in Hamilton Depression and Anxiety Scales. Personality scales, including the Cloninger's TCI and the Eysenck's EPQ were used to test the predictive value of personality traits in treatment.

RESULTS

Anxiety was reduced in 55% and depression in 60%. At the 8th week, 27 patients were responder (CGI 1-2). 2 patients discontinued the trial and only one due to adverse events.

CONCLUSIONS

Sertraline demonstrated excellent tolerability in these MAD patients, despite the high levels of baseline anxiety in the group. Efficacy was as high as described in patients with major depression. These results warrant further placebo controlled pharmacological trials of SSRI in MAD.

Cytogenetic analysis of 280 patients with multiple myeloma and related disorders: primary breakpoints and clinical correlations

Cytogenetic analysis of unstimulated short-term bone marrow cell cultures was performed on 280 patients with multiple myeloma and related disorders. In 65% of the cases, an additional short term B-cell stimulated culture was also examined. Chromosomally abnormal clones were found in 31% of the patients, 15% in Waldenström macroglobulinemia. 25% in monoclonal gammopathies, 33% in multiple myeloma, and 50% in plasma cell leukemia. Three primary chromosomal breakpoints were recurrently involved: 14q32, 16q22, and 22q11. Structural rearrangements of chromosome 1 were the most frequent (26% of the abnormal cases), but always as a secondary change. Rearrangements of band 14q32 were found in 22% of the abnormal cases. Among the multiple myeloma patients who showed an abnormal karyotype, 33 (46%) were hyperdiploid, most frequently, with 52-56 chromosomes, 29 patients (40%) were pseudodiploid, and the remaining 12 cases (14%) were hypodiploid. A highly significant relation was observed between the presence of an abnormal karyotype and the following clinical parameters: stage III (P = 0.0001), bone marrow plasma cell infiltration greater than 30% (P = 0.0001), presence of bone lesions (P = 0.0009), and beta 2-microglobulin levels greater than 4 mg/L (P = 0.0001).

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]

The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses.

RESULTS

There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

[Body dysmorphic disorder as an obsessive-compulsive spectrum disorder]

Considerable evidence supports consideration of body dysmorphic disorder (BDD) and obsessive-compulsive disorder as related disorders. BDD may share common phenomenological and neurobiological features with OGD and other disorders characterized by repetitive thoughts and behaviors and mediated by serotonin dysfunction. Within this substrate, specific psychological and sociological factors may shape the specific BDD syndrome. Further research incorporating dimensional models of these disorders, may delineate specific similarities and differences.

[Seasonal affective disorder and light therapy]

Seasonal affective disorders (SAD) represents a subgroup of major depression with a regular occurrence of symptoms in autumn and winter and full remission in spring and summer. Light therapy or phototherapy has become the standard treatment of this type of depression. The phototherapy is affective therapy for depressive symptoms of SAD. However, the action mechanism of light therapy is uncertain. Finally, new lines of the investigation of light therapy are aforementioned.

BCR-ABL rearrangement and 'variant' Philadelphia chromosome in de novo acute myelogenous leukaemia FAB subtype M1

We report a case of de novo acute myelogenous leukaemia FAB subtype M1 that presents a cytogenetic complex translocation between chromosomes 7, 9 and 22, producing a 'variant' Philadelphia chromosome. Molecular analysis revealed a BCR-ABL rearrangement involving exons b3 and a2 (b3a2). Haematological parameters and genetic analysis again raise the problem of the true nature of this disease, which is briefly discussed.

[Psychooncology: anxiety]

Some specific aspects of Psychooncology, particularly different types of anxiety, are revised and classified according to its causes (situational, somatic, postreactivation and posttherepeutic) and to the time of onset (postdiagnosis, postreatment and terminal states). Therapeutical guides are proposed.

Low platelet monoamine oxidase activity in pathological gambling

Decreased platelet monoamine oxidase (MAO) activity has been reported in association with sensation-seeking personality type and in some mental disorders associated with a lack of impulse control. Pathological gambling itself has been related with both sensation-seeking and reduced impulse control. Platelet MAO activity was investigated in 15 DSM-III-R pathological gamblers from our outpatient clinic. Gamblers had a significantly lower platelet MAO activity than a group of 25 healthy controls. The range of MAO levels in gamblers was also significantly shorter than in controls. In controls, platelet MAO levels showed the previously described negative correlations with sensation-seeking scores but not in gamblers. The findings are consistent with previous studies showing an association of low platelet MAO activity with impulse control disorders and raise some interesting therapeutic alternatives for pathological gambling.

Ataque de nervios and panic disorder

OBJECTIVE

Ataque de nervios ("attack of nerves") is an illness category used frequently by Hispanic individuals to describe one or more particular symptom complexes. A review of the literature on ataque suggested some overlap with panic disorder. This study investigated the overlap with panic disorder as well as other DSM-III-R axis I disorders.

METHOD

Hispanic subjects seeking treatment at an anxiety disorders clinic (N = 156) were assessed with a specially designed questionnaire for self-report of ataque de nervios and panic symptoms and with structured or semistructured psychiatric interviews for axis I disorders.

RESULTS

Seventy percent of the subjects reported at least one ataque de nervios; 80% of these were female, whereas 57% of the group without these attacks were female. There were no differences in DSM-III-R diagnoses between the groups with and without ataque de nervios. Ataque was frequently associated with one or more anxiety and affective disorders, including panic disorder, generalized anxiety disorder, recurrent major depression, and anxiety not otherwise specified. Of the 45 subjects with both ataque de nervios and primary panic disorder, 80% appeared to have labeled panic disorder as ataque. Ataque de nervios was associated with panic symptoms even in subjects without panic disorder, but the self-reporting of ataque conveyed additional clinical information about the subjects with panic disorder. Ataque de nervios was similar in frequency and symptoms among subjects of Dominican and Puerto Rican origin.

CONCLUSIONS

Ataque de nervios overlaps with panic disorder but is a more inclusive construct. Further study of its interrelation with axis I disorders is needed.

Antigenic relationships between chloroplast and cytosolic fructose-1,6-bisphosphatases

Cytosolic fructose-1,6-biphosphatases (FBPase, EC 3.1.3.11) from pea (Pisum sativum L. cv Lincoln) and spinach (Spinacia oleracea L. cv Winter Giant) did not cross-react by double immunodiffusion and western blotting with either of the antisera raised against the chloroplast enzyme of both species; similarly, pea and spinach chloroplast FBPases did not react with the spinach cytosolic FBPase antiserum. On the other hand, spinach and pea chloroplast FBPases showed strong cross-reactions against the antisera to chloroplast FBPases, in the same way that the pea and spinach cytosolic enzymes displayed good cross-reactions against the antiserum to spinach cytosolic FBPase. Crude extracts from spinach and pea leaves, as well as the corresponding purified chloroplast enzymes, showed by western blotting only one band (44 and 43 kD, respectively) in reaction with either of the antisera against the chloroplast enzymes. A unique fraction of molecular mass 38 kD appeared when either of the crude extracts or the purified spinach cytosolic FBPase were analyzed against the spinach cytosolic FBPase antiserum. These molecular sizes are in accordance with those reported for the subunits of the photosynthetic and gluconeogenic FBPases. Chloroplast and cytosolic FBPases underwent increasing inactivation when increasing concentrations of chloroplast or cytosolic anti-FBPase immunoglobulin G (IgG), respectively, were added to the reaction mixture. However, inactivations were not observed when the photosynthetic enzyme was incubated with the IgG to cytosolic FBPase, or vice versa. Quantitative results obtained by enzyme-linked immunosorbent assays (ELISA) showed 77% common antigenic determinants between the two chloroplast enzymes when tested against the spinach photosynthetic FBPase antiserum, which shifted to 64% when assayed against the pea antiserum. In contrast, common antigenic determinats between the spinach cytosolic FBPase and the two chloroplast enzymes were less than 10% when the ELISA test was carried out with either of the photosynthetic FBPase antisera, and only 5% when the assay was performed with the antiserum to the spinach cytosolic FBPase. These results were supported by sequencing data: the deduced amino acid sequence of a chloroplast FBPase clone isolated from a pea cDNA library indicated a 39,253 molecular weight protein, with a homology of 85% with the spinach chloroplast FBPase but only 48.5% with the cytosolic enzyme from spinach.

Cloning, structure and expression of a pea cDNA clone coding for a photosynthetic fructose-1,6-bisphosphatase with some features different from those of the leaf chloroplast enzyme

A positive clone against pea (Pisum sativum L.) chloroplast fructose-1,6-bisphosphatase (FBPase; EC 3.1.3.11) antibodies was obtained from a copy DNA (cDNA) library in lambda gt11. The insert was 1261 nucleotides long, and had an open reading frame of 1143 base pairs with coding capability for the whole FBPase subunit and a fragment of a putative processing peptide. An additional 115 base pairs corresponding to a 3'-untranslated region coding for an mRNA poly(A)+ tail were also found in the clone. The deduced sequence for the FBPase subunit was a 357-amino-acid protein of molecular mass 39,253 daltons (Da), showing 82-88% absolute homology with four chloroplastic FBPases sequenced earlier. The 3.1-kilobase (kb) KpnI-SacI fragment of the lambda gt11 derivative was subcloned between the KpnI-SacI restriction sites of pTZ18R to yield plasmid pAMC100. Lysates of Escherichia coli (pAMC100) showed FBPase activity; this was purified as a 170-kDa protein which, upon sodium dodecyl sulfate-polyacrylamide gel electrophoresis, displayed a 44-kDa band. As occurs with native FBPases, this indicates a homotetrameric structure for the expressed FBPase. When assayed under excess Mg2+ (10 mM), the expressed enzyme had a higher affinity for the substrate than the native pea leaf FBPase; this parameter appears to be substantiated by a tenfold higher specific activity than that of the native enzyme. However, when activated with dithiothreitol plus saturating concentrations of pea thioredoxin (Td) f, both FBPase had similar activities, with a 4:1 Td f-FBPase stoichiometry. In contrast to the native pea chloroplast FBPase, the E. coli-expressed enzyme did not react with the monoclonal antibody GR-PB5.(ABSTRACT TRUNCATED AT 250 WORDS)

Alpidem in the treatment of panic disorder

Alpidem, an imidazopyridine that acts at the gamma-aminobutyric acid/benzodiazepine receptor complex, has been reported to be an effective anxiolytic with a more favorable side effect profile than benzodiazepines. The effect of alpidem was investigated in an 8-week, open, clinical trial in 13 patients with panic disorder, with or without agoraphobia. Three patients were responders (much improved or very much improved), five patients were nonresponders, and five patients dropped out after less than 6 weeks of treatment. Significant improvement was seen in the sample as a whole for spontaneous panic attacks, phobic avoidance, and anticipatory anxiety. Most improvement occurred during the first 4 weeks of treatment, and responders had milder panic disorder at baseline. Adverse effects were generally mild. After 8 weeks of treatment, taper of medication over 2 weeks occurred without significant worsening of panic disorder symptoms. The efficacy of alpidem in the treatment of panic disorder remains uncertain and requires assessment in a controlled trial.

Treatment outcome of obsessive compulsive disorder with comorbid social phobia

BACKGROUND

Treatment of obsessive compulsive disorder (OCD) with serotonin reuptake blockers has been demonstrated effective in 50% to 60% of patients in open and placebo-controlled studies. However, some reports indicate that comorbid Axis II psychopathology, including avoidant personality disorder, and deficiency of social skills could be predictors of a poor response to treatment in OCD patients.

METHOD

A retrospective review elicited 12 patients who met DSM-III-R diagnostic criteria for both OCD and social phobia and were treated in our clinic last year with adequate trials of serotonin reuptake blockers or MAOIs.

RESULTS

Only 3 (27%) of the 11 patients treated with serotonin reuptake blockers had a substantial improvement of OCD symptoms. Among them, only 1 (11%) of 9 patients with generalized subtype of social phobia versus 2 (100%) of 2 patients with the nongeneralized subtype responded to serotonin reuptake blockers. Four (80%) of 5 patients with comorbid generalized social phobia receiving phenelzine had marked improvement of OCD symptoms. In general, response of social phobia occurred parallel to that of OCD.

CONCLUSION

Comorbid generalized social phobia seems to be associated with a poor response to serotonin reuptake blockers in OCD patients. Deficient social skills, as well as distinct biological mechanisms, may be involved. MAOIs might be an effective alternative medication in refractory cases. Larger and controlled studies are needed to define the implications of the association of OCD and social phobia.

[Masked Philadelphia chromosome: diagnostic implications in a case of chronic myeloid leukemia presenting in blast crisis]

We present a female patient with acute non-lymphoblastic leukemia (ANLL) and with haematologic features suggestive of its evolution from chronic myeloid leukaemia (CML), in which a bone marrow karyotype showing a "masked" Philadelphia (Ph) chromosome due to a variant translocation of complex type t(9;9;22)(q32;q34;q11) was found. We comment the peculiarities of this special Ph chromosome as well as the differential diagnostic problems between ANLL Ph(+) and CML with onset in blastic crisis.

Left hemispheric activation in depersonalization disorder: a case report

Depersonalization disorder is classified in DSM-III-R (APA 1987) as a dissociative disorder characterized by altered perception or experience of the self. To date, there are no known reports of the neurobiological features of this disorder. We report clinical and biological correlates in a patient with depersonalization disorder previously unresponsive to a variety of anticonvulsant, monoamine oxidase inhibitor, and tricyclic antidepressant trials, but for whom fluoxetine partially reduced depersonalization symptoms, but not associated anxiety and depression. Neurophysiological, neuroanatomical and neuropsychological findings revealed left hemispheric frontal-temporal activation and decreased left caudate perfusion. These findings suggest a similarity to the neuropsychiatric data reported in obsessive-compulsive disorder patients.

Plasmatic somatostatin as a marker of positive symptoms of schizophrenia

1. Somatostatin displays a regulatory function on several aminergic neurotransmitters, including dopamine. In addition, decreased CSF levels of the peptide has been found in Schizophrenia and other neuropsychiatric disorders. 2. In the present work, we have investigated levels of plasmatic somatostatin in a sample of 50 schizophrenic patients compared with a normal control group. 3. Somatostatin was increased in the patient group (p less than 0.01) as a whole but statistical analysis revealed that the increase was associated with the presence of positive symptoms (Factorial Analysis) with a significant correlation, specially with delusion and hallucination scores in the Andreasen rating scales.

Abrupt homeostatic responses to transient intracardiac occlusion during balloon valvuloplasty

The present study analyzes the hemodynamics of intracardiac occlusive periods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 +/- 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p less than 0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p less than 0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed.

[Personality and triggering life events in the affective psychoses]

60 bipolar patients and 30 patients with recurrent major depression, both fulfilling DSM-III criteria, were studied in terms of sociodemographic profile, personal and family antecedents, clinical psychopathology, personality type and triggers of the first episodes. We found a greater frequency in the bipolar group of personality disorders of the hypomanic, cyclothymic and sociopathic types; the melancholic-anancastic being more associated with unipolar depression. The bipolar patients in our study had a higher socioeconomical and cultural level compared with the unipolar patients. More than 50% of the depressive episodes of each group had unfavourable life event triggers; 45% of the manic episodes also had previous unfavourable life events; 44% of the patients of this later group, exhibited a previous hypomanic, sociopathic or cyclothymic personality.

[Hysterical psychosis: clinical aspects and disease course]

30 patients admitted to our psychiatric service with the initial diagnosis of psychogenic psychosis, dissociative psychosis or hysterical pseudo-psychosis are studied anamnestically and in their catamnesis (average follow up 5.1 years). The objective of the study was to see if these disorders are independent nosologic entities or are masking other ones, such as affective, schizophrenic or neurotic disorders. In this study we found a greater percentage of women (3/1) with a previous hysterical personality in more than 50%; many of the patients were hospitalised in order to clarify the diagnosis; in 70% we found psychogenic triggers; a greater predominance of an abrupt onset of the disorder (which would favour the concept of reaction); 60% had fluctuating symptoms (not so common in endogenous psychosis). In almost 100% there was a complete remission during the hospitalization period (average 22.7 days), which would bring them closer to the present concept of brief reactive psychosis. With a follow up of an average of five years, the diagnosis is maintained in 93.3% of the cases. The majority of the patients fulfilled the criteria for hysterical psychosis as defined by Hollender and Hirsch. We think that these disorders are well delimited, both clinically and nosologically, not having received up until now an exact placing in modern classification systems (DSM-III, ICD-10, etc.).

Physiopathology of transient ventricular occlusion during balloon valvuloplasty for pulmonic or aortic stenosis

Hemodynamic observations were made at different cardiac levels during transient balloon occlusion at the time of aortic or pulmonary valvuloplasty in 37 patients (mean age 8 +/- 9 years); 22 had pulmonary stenosis and 15 had aortic stenosis (6 valvular and 9 discrete subvalvular types). Eighty-two tentative dilatations were performed in patients with pulmonary stenosis and 61 in patients with aortic stenosis. The hemodynamics of the right and left heart were monitored during inflation-deflation time. From selected tracings mean beat-to-beat pressures curves were constructed during occlusion-recovery time. The cycle length (RR interval) did not change significantly during occlusion, except for patients with pulmonary occlusion and patent foramen ovale, where a significant increase in cycle length (p less than 0.01) was observed during recovery time. The mean maximal increase in ventricular pressure reached 95% of basal values for the right ventricle and 58% for the left ventricle. The hypertension was retrogradely transmitted to all cardiac chambers. Angiographic observations during occlusion suggest that the atrioventricular valves and the foramen ovale, when patent, become escape orifices during occlusion, for adapting and relieving intracavitary pressures. The ventricle seems to adapt to sudden occlusion by generating hypertensive and hypokinetic contractions, with atrioventricular regurgitation.

Formula for calculating vaccine profitability

A mathematical formula is developed for calculating the profitability of real or stimulated vaccination campaigns, in relation to the years elapsed since the vaccination date and within the period of immunity given by the vaccine. According to the formula, profitability depends on the annual attack rates and corresponding costs, vaccine price and efficacy, and number of postvaccination years considered. The factors that do not affect profitability are values of local currency, annual discount rates and the absolute number of vaccines, provided the relative proportion of subjects vaccinated is maintained constant among the distinct risk groups, when comparing different policies. Examples of vaccinations against hepatitis B and measles are presented.

Effects of acute changes in load and inotropic state on the exponential rate of fiber shortening and other indices of myocardial contractility in the anesthetized intact dog

The effects of an acute increase in preload, afterload, and inotropic state on several indices of left ventricular contractility were studied in 20 anesthetized intact dogs. The behaviour of the exponential rate of fiber shortening (ERFS), a newly described index, which is based on the instantaneous fiber length--time relationship through ejection, was compared with other classical ejection and isovolumic indices of left ventricular contractility. Acute volume overload by dextran 40 infusion produced a significant increase in preload as reflected by a 103% (p less than 0.01) increase in left ventricular end-diastolic pressure and a 121% (p less than 0.001) increase in end-diastolic circumferential wall stress. There was also a smaller but significant increase (p less than 0.05) of heart rate (30%) and of peak systolic circumferential wall stress (24%). None of the left ventricular contractility indices showed any significant change. Acute pressure overload, produced mechanically by an aortic balloon, increased the afterload significantly as reflected by a 33% (p less than 0.05) rise of end-systolic circumferential wall stress and a 43% (p less than 0.001) increase in systemic resistance. Stroke volume decreased significantly by 23% (p less than 0.05). All ejection indices, including ERFS, were significantly diminished by 30-37%; all isovolumic indices showed no significant changes. Positive inotropic intervention was induced by dopamine infusion, which caused a significant 28% (p less than 0.05) increase in cardiac output. End-diastolic and end-systolic circumferential wall stress were significantly diminished. All indices of left ventricular contractility increased significantly and ERFS showed the quantitatively greatest change.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural immunity to measles, rubella and mumps among Spanish children in the pre-vaccination era

Prior to the start of mass vaccination campaigns against measles, rubella and mumps, a prevalence study of natural immunity to these diseases was undertaken in a sample of 1700 unvaccinated Spanish children. They were representative of the 3-7 year-old population in terms of age, regional distribution and urban or rural environment. Measles infection prevalence was significantly higher than that for rubella and mumps from 3 (48.3%, 14.2%, 25.5%, respectively) through 7 years of age, (64%, 40.9%, 39%). As a function of age, naturally-acquired immunity increased according to parabolic progressions. In the 3-5 year-old group, rural environment, low socioeconomic status, no school attendance and lack of brothers were associated with statistically lower levels of measles, rubella, or mumps infection. In the 6-7 year-old group, only 12% of the children showed antibodies against the three diseases and 18.7% exhibited triple susceptibility.

Vaccination against hepatitis B in renal dialysis units: short or normal vaccination schedule?

Three I.M. injections of hepatitis B vaccine (Merck Sharp & Dohme) were administered, according to the recommended schedule (0, 1, 6 mos), to seronegative individuals of one renal dialysis unit (33 patients, 58 health care personnel) and, according to a shorter regimen (0, 1, 3 mos), in another unit of similar characteristics (30 patients, 53 health care personnel). Staff members and renal patients received, respectively, 20 y 40 mcg of vaccine per injection. In the early vaccination phase, the two regimens did not lead to a difference in seroconversion rates nor in anti-HBs titers. After a 9-month surveillance, lower seroconversion rates, although not significant, were observed with the accelerated regimen among staff members (84.2%) and renal patients (79.2%) as compared with 93% and 87.5%, respectively, following the normal schedule. At the same time, anti-HBs titers were significantly lower (p less than 0.001) in the staff (316 RIA U) and patients (93 U) vaccinated according to the short regimen than in their respective counterparts (4196 and 1047 U) assigned to the normal schedule. A fourth dose of vaccine given to subjects with low and no anti-HBs titers significantly increased seroconversion and anti-HBs levels, although with little success among the former non-responders.

Hepatitis B virus infection and vaccination in children undergoing hemodialysis

Among 54 patients, between 2 and 18 years of age, submitted to hemodialysis due to severe chronic renal failure, the prevalence of hepatitis B virus markers was 66.7% and that of HBsAg was 13.0%. Eighteen children, with no evidence of hepatitis B virus infection, were vaccinated. Following three vaccine injections, only 2 patients did not respond and a third one developed low anti-HBs titers. The vaccine was well tolerated. No relationship was observed between the intensity of the humoral immune response and age, sex, type of renal disease and time on dialysis. Seroconversion rates (87.5%) and geometric means of anti-HBs titers (greater than 4 000 Ausab Units) of these patients are similar to those observed following vaccination of healthy adults.

A study on the Valsalva manoeuvre in young healthy subjects

The Valsalva manoeuvre was performed by 2 groups of young healthy male subjects: novice divers and professional divers. The electrophysiological features of this manoeuvre are summarized and the results of the test are correlated with subject age, motivation and FEV1/VC coefficient (forced expiratory volume sec/vital capacity). Positive test results (fainting caused by the Valsalva manoeuvre) increased with subject motivation (novice divers), FEV1/VC coefficient and decreasing subject age. The various hypotheses proposed to account for fainting caused by the Valsalva manoeuvre are discussed with respect to these data. The implications of Valsalva positivity in young divers are discussed.

The ascending slope of the apexcardiogram. Its relationship with angiographic determination of left ventricular function

The relationship between the ascending slope of the apexcardiogram (ACG) and direct determination of left ventricular (LV) performance as assessed angiographically by measurement of the ejection fraction (EF), mean velocity of circumferential fiber shortening (mVcF), mean normalized systolic ejection rate (MNSER), and percentage of the systolic shortening of ventricular long axis (%L), were studied in 40 patients with a wide variety of cardiac diseases. The ascending slope correlated closely and significantly (P less than 0.05) with all of them: (1) EF (r = 0.774), (2) mVcF (r = 0.776), (3) MNSER (r = 0.767) and (4) %L (r = 0.668). In a control group of 10 normal subjects, phi was determined and compared with that obtained in patients with depressed LV function, the difference being statistically significant (P less than 0.01). Other noninvasive indices derived from simultaneous phono-mechano-cardiographic readings were also studied. The calibrated ACG did not correlate with any of the hemodynamic indices; however the calibrated carotidogram did correlate with the peak systolic aortic pressure (r = 0.503). The ratio preejection period/left ventricular ejection time correlated significantly, but less than previously reported with the EF (r = 0.574). We conclude that the value of phi leads to additional evidence supporting the use of quantitative ACG as a noninvasive measure of LV performance in patients with cardiac disease.

Hemodynamic and angiocardiographic changes following nitroglycerin in coronary artery disease

33 patients with suspected coronary artery disease were studied hemodynamically and angiocardiographically in the resting state and following administration of 0.4 mg of sublingual nitroglycerin (NTG). After NTG several parameters were changed: LVEDP, mean LV systolic pressure, EDVI, ESVI, SVI and SWI were decreased; EF, mean Vcf, MNSER, heart rate (P less than 0.01; r = 0.801) and chords, hemichords and shortening of long axis were increased. However, the changes after NTG were markedly different in patients with diffuse and localized LV asynergy, suggesting a more important inotropic effect of NTG in patients with localized LV asynergy, while reduction in venous return and EDV would be the main effect of NTG in patients with diffuse LV asynergy.