Primary pulmonary hypertension: clinical, echocardiographic and haemodynamic features in 14 patients

Clinical, echocardiographic and haemodynamic features in 14 patients (8 male and 6 females) with primary pulmonary hypertension, diagnosed by strict clinical and haemodynamic criteria are described. Age of the patients at diagnosis ranged from 11 years to 40 years with a mean of 23 years. The mean interval from onset of symptoms to diagnosis was 2.6 years. Common symptoms included dyspnoea on exertion (86%), fatigue (78%) and palpitation (78%). Raynaud's phenomenon was not encountered but one patient had signs and symptoms of left recurrent laryngeal nerve palsy. Pulmonary function studies showed mild restrictive ventilatory impairment (mean forced vital capacity 80% of predicted) with hypoxaemia and hypocapnea. The M-mode tracing of the pulmonary valve showed flat or negative E-F slope, a small or absent 'a' wave, and midsystolic notching in all the patients. Two-dimensional echocardiographic images showed a thickened right ventricular wall in 12(86%) patients; a normal to small left ventricular end-diastolic internal dimension in all the patients and right ventricular and right atrial enlargement in 78% of patients. Significant tricuspid regurgitation and pulmonary regurgitation was documented by Doppler interogation in 87% and 62% of patients examined respectively. Haemodynamic findings consisted of a marked rise of pulmonary artery pressure and pulmonary vascular resistance, low cardiac index and normal pulmonary artery wedge pressure. At cardiac catheterisation the mean right atrial pressure (mean +/- SD) was 9.8 +/- 4.8 mmHg; mean pulmonary artery pressure, 63.2 +/- 14.3 mmHg; cardiac index, 2.2 +/- 0.9 L/min. m2; and pulmonary vascular resistance index, 22.3 +/- 10.6 mmHg/L/min. m2; in these patients. No, death nor any sustained morbid events occurred during the diagnostic evaluation of the patients.

A four-step, inexpensive protocol for large-scale purification of goat uterine estrogen receptor

A relatively inexpensive yet highly efficient and extremely rapid procedure has been developed for the isolation and purification of estrogen receptor from the goat uterine cytosol. Greater than 1 mg of purified receptor protein could be obtained from 75 g of uterine tissue within a period of < 24 h, following this protocol. The procedure does not require the use of an ultracentrifuge, a cold room, or a column chromatography setup. The entire isolation procedure, which involves adsorption to and selective elution from different chromatography matrices, is carried out at the laboratory bench using beakers kept in an ice bath. Antibodies raised against this receptor cross-react with the goat uterine estrogen receptor activation factor, a DNA binding protein having no capacity to bind estradiol but which dimerizes with the nonactivated estrogen receptor, an estrogen receptor incapable of binding to DNA on its own.

Acute leukaemia in children--French-American-British (FAB) classification and its relation to clinical features

A retrospective study of 45 patients of acute leukaemia in children (15 years age), in relation to FAB classification, is presented. Acute lymphoblastic leukaemias (ALL) were commoner than acute myeloid leukaemias (AML), with an ALL:AML ratio of 4.63:1. Amongst ALL, L1 was the most frequent type (59%), followed by L2 (35%) and L3 (5.4%), respectively. FAB types M2, M3, M4 and M5 were diagnosed in 2 patients each. An analysis of clinical features in relation to FAB classification is also presented.

Primary aortoduodenal fistula. Diagnosis by computed tomography

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Computed tomography in a symptomatic but stable patient enabled preoperative evaluation and even diagnosis of abnormal communications, real or incipient, between the vascular and enteric system. This case demonstrated the effectiveness, ease, and low cost of documenting a primary aortoduodenal fistula. Surgical results were ultimately improved by initiating early intervention and aggressive management. Therapeutic principles included early intervention with aneurysmectomy, duodenorrhaphy, and extra-anatomic bypass. Anatomic graft placement may be acceptable in selected cases.