Effects of extract of Cistus populifolius L. on the central nervous system

We report the effects on the central nervous system (CNS) and on analgesic activity of an aqueous extract of Cistus populifolius L. The extract was assayed for effects on spontaneous locomotor activity, methylphenidate-induced hypermotility, motor coordination, exploratory behaviour, rectal temperature and sodium pentobarbital-induced hypnosis. Analgesic activity was evaluated using the hot plate test. The C. populifolius extract at dosages of 286 and 430 mg/kg caused very significant reductions in spontaneous locomotor activity, hypermotility, motor coordination, exploratory behaviour and rectal temperature, and a slight increase of sleeping time was noted in the sodium pentobarbital-induced sleep test. The extract exhibited central analgesic affects in the hot plate test.

Multicenter evaluation of Neo-Sensitabs, a standardized diffusion method for yeast susceptibility testing

The agar diffusion method Neo-Sensitabs for sensitivity testing, was evaluated with 33 reference strains by fourteen laboratories. Tablets with 5-fluorocytosine, amphotericin B, nystatin, fluconazole, itraconazole, ketoconazole and tioconazole were used on Shadomy modified medium. These tests classify each strain as susceptible, intermediate or resistant to all tested antifungals by measuring the inhibition zone diameters. Intra and interlaboratory reproducibility was studied. Neo-Sensitabs sensitivity for fungi was easy to perform and reliable method with a reproducibility of 97.1% and superior to other commercialized methods, being specially interesting for antifungal susceptibility in vitro testing of triazole derivatives fluconazole and itraconazole.

Multicenter survey of in vitro antifungal resistance in yeasts of medical importance isolated from Spanish patients

Twelve Spanish laboratories collected 325 yeast clinical isolates during a 30 day's period, among them 224 Candida albicans, 30 Candida glabrata, and 27 Candida parapsilosis. In vitro antifungal susceptibility to amphotericin B, ketoconazole, fluconazole and itraconazole was determined by an agar diffusion test (Neo-Sensitabs, Rosco, Denmark). All the isolates tested were susceptible in vitroto amphotericin B and nearly all (97.2%) to itraconazole. In vitrosusceptibility to fluconazole and ketoconazole was high (90.2% and 91.4% of isolates, respectively) but showed variations depending on the species tested. Resistance to fluconazole and ketoconazole was low in C. albicans (4% and 3%, respectively), but 30% of Candida guilliermondii and 36% of C. glabrata isolates were resistant to fluconazole. Ketoconazole resistance was observed in 40% of C. glabrata, and 17% of Candida tropicalis. Resistance to antifungal drugs is very low in Spain and it is related to non-C. albicans isolates.

Electronic channel fringe holography for depth and delay measurements

Electronic spectral holography in the form developed by Shih [Ph.D. dissertation, University Microfilms, Ann Arbor, Mich. (1995)] is adapted to various applications, including optical coherence tomography in scattering media, contouring of surfaces, and optical fiber mode examination.

Frequency of oropharyngeal candidiasis in HIV-infected patients on protease inhibitor therapy

OBJECTIVE

The purpose of this study was to investigate the effect of HIV-1 protease inhibitors on the frequency of oropharyngeal candidiasis in HIV-infected patients.

STUDY DESIGN

A clinical and analytic follow-up was carried out to determine the number of episodes of oropharyngeal candidiasis during HIV-1 protease inhibitor therapy and the relation of this incidence to the CD4 lymphocyte count and circulating neutrophils level. Seventy-five HIV-positive patients were selected, and HIV-1 protease inhibitor therapy was administered to each patient over a minimum of 6 months. These patients did not receive long-term preventive antifungal therapy for oral candidiasis, even as secondary prophylaxis against cryptococcosis. Results were compared with those obtained during the previous 6 months, during which patients had been treated only with reverse transcriptase inhibitors.

RESULTS

At least one episode of oropharyngeal candidiasis was seen in 56% (42/75) of patients during reverse transcriptase inhibitor therapy and in only 9.3% (7/75) of patients after the initiation of protease inhibitor therapy. The number of relapses decreased significantly when the 2 follow-up periods were compared (P<.0001). The CD4 and CD8 lymphocyte counts increased significantly with protease inhibitor therapy (P<.001 and P<.05, respectively). During reverse transcriptase inhibitor treatment, the probability of the presentation of oropharyngeal candidiasis correlated with falling CD4 counts (P<.0001). The HIV-1 protease inhibitor therapy was associated with a significant increase in the neutrophil count (P<.01). The probability of the occurrence of some episode of candidiasis correlated inversely with the circulating neutrophil level (P<.05).

CONCLUSIONS

Protease inhibitor therapy decreases the frequency of HIV-related oropharyngeal candidiasis. The mechanism involved is unknown, but it can be speculated that a reduction of the viral load increases the number of intact T helper cells, which in turn enhances the number of circulating polymorphonuclear neutrophils and regulates their function by means of colony-stimulating factors.

Antiviral activity of Bolivian plant extracts

Ethanolic and aqueous extracts of seven plant species used in the traditional medicine of Bolivia have been tested for their antiviral activity against herpes simplex type I (HSV-1), vesicular stomatitis virus (VSV), and poliovirus type 1. The aqueous extracts of most of the species investigated showed antiviral activity. Two of these plants-namely, Satureja boliviana and Baccharis genistelloides-were active against two different viruses-HSV-1 and VSV.

Retinal image quality in the human eye as a function of the accommodation

The changes in the retinal image quality with accommodation in the human eye were studied by using a near-infrared double-pass apparatus. A slightly better modulation transfer function (MTF) in the unaccommodated eye with respect to the accommodated eye was found when using an artificial pupil with a fixed diameter. The technique allows the estimation of the MTF of the accommodated eye discounting the effect of the accommodative defocus error. Most of the reduction found in the MTF with accommodation could be explained in terms of the accommodative defocusing error. However, the shape of the retinal images clearly changes with accommodation, indicating that other aberrations are also altered with accommodation. In general, the double-pass image for the accommodated eye tends to be more symmetric than that of the unaccommodated eye. This is probably due to either a decrease in the amount of coma-like aberrations with accommodation or to an increase of other symmetric aberrations, such as defocus or spherical aberration, that hide the asymmetries present in the retinal image of the unaccommodated eye.

Estimates of the ocular wave aberration from pairs of double-pass retinal images

We apply a computational technique to retrieve the wave aberration of the eye from the point-spread function obtained from pairs of double-pass retinal images. The method consists of an adapted pyramidal version of a nonlinear least-squares fitting procedure to a wave aberration expressed as an expansion in Zernike polynomials. Although the procedure provides accurate estimates of the wave aberration, it presents several drawbacks that are discussed in detail. In particular, since a great deal of computational time is necessary to retrieve a single wave aberration, this technique is not useful for real-time applications. We present results of wave aberrations in five normal subjects in the fovea for a 4-mm-pupil diameter. In every case there is a clear presence of comalike aberrations, while the third-order spherical aberration is usually smaller than previous estimates. The root-mean-square error in the retrieved wave aberration, when defocus and astigmatism were corrected, ranges from 0.24 to 0.5 wavelength. The particular values of the aberration coefficients present a large intersubject variability.

Parametric Wave-Aberration Retrieval from Point-Spread Function Data by use of a Pyramidal Recursive Algorithm

A new, to my knowledge, procedure for retrieving the wave aberration from the point-spread function is presented. It uses the Levenberg-Marquardt optimization algorithm in a mutiresolution pyramidal scheme. The method, tested with simulated large aberrations without initial estimates, accelerates convergence and avoids stagnation in local minima.

Antiinflammatory and antioxidant activity of plants used in traditional medicine in Ecuador

Ethanolic extracts from 15 plant species, representing eight different families, used in traditional medicine in Ecuador were evaluated for antiinflammatory and antioxidant activities. Conyza floribunda, Eupatorium articulatum, Bonafousia longituba, Bonafousia sananho, Tagetes pusilla and Piper lenticellosum extracts showed a significant antiinflammatory activity in vivo in the carrageenan-induced paw oedema model in mice. The extracts were also tested in vitro for their ability to inhibit lipid peroxidation and to scavenge superoxide and hydroxyl radicals. E. articulatum extract possesses both activities. Baccharis trinervis, E. articulatum and Phytolacca rivinoides extracts were active as antioxidants.

Reconstruction of the point-spread function of the human eye from two double-pass retinal images by phase-retrieval algorithms

In the double-pass technique used to measure the optical performance of the eye, the double-pass image is the cross correlation of the input spread function with the output spread function [J. Opt. Soc. Am. A 12, 195 (1995)]. When entrance and exit pupil sizes are equal, the information on the point-spread function is lost from the double-pass image, although the modulation transfer function of the eye is obtained. A modification of the double-pass technique that uses unequal-sized entrance and exit pupils allows a low-resolution version of the ocular point-spread function to be recorded [J. Opt. Soc. Am. A 12, 2358 (1995)]. We propose the combined use of these two double-pass measurements as input in a phase-retrieval procedure to reconstruct the ocular point-spread function. We use an adapted version of the iterative Fourier-transform algorithm consisting of two steps. In the first step, error-reduction iterations with expanding weighting functions in the Fourier domain yield an estimation of the phase that serves as an initial guess for the second step, which consists of cycles of hybrid input-output iterations. We tested the robustness and limitations of the retrieval algorithm by using simulated data with and without noise. We then applied the procedure to reconstruct the point-spread function from actual measurements of double-pass retinal images in the living eye.

Neutrophil phagocytosis in AIDS patients with azole resistant candidiasis

OBJECTIVE AND SUBJECTS

This study aimed to evaluate phagocytosis of C. albicans by neutrophils in 10 AIDS patients and 50 control subjects. Five of the AIDS patients were colonised with azole-resistant C. albicans isolates and five with azole-sensitive isolates.

RESULTS AND CONCLUSIONS

Percentage phagocytosis was within normal limits for seven of the 10 AIDS patients and was reduced in the remaining three patients. Phagocytosis was unaffected by the carriage of azole resistant C. albicans, and the patients' own strains were phagocytosed as readily as a standard strain of C. albicans. This study suggests that azole resistance is not related to impaired phagocytosis in AIDS patients.

Optical modulation transfer and contrast sensitivity with decentered small pupils in the human eye

Human observers experience a large decrement in visual acuity when a small artificial pupil is displaced from the center to the edge of the dilated natural pupil. This decrement in visual resolution, called the Campbell effect, has been attributed to the retina, the ocular optics, or a combination of the two. Given the uncertainty about the relative magnitudes of these two components over the range of spatial frequencies used in normal vision, we have obtained objective measurements of the retinal image quality and psychophysical measurements of visual performance, with decentered pupils. The contributions of monochromatic aberrations were determined by using double pass measurements of the modulus of the optical transfer function (MTF). For all of the observers, there was a substantial decrement in the MTF with decentering, showing that even when using a 1.5 mm pupil and appropriate spherical/cylindrical refractive corrections, there is a considerable contribution of monochromatic aberrations to the effect. We have compared these optical MTFs with the psychophysical contrast sensitivity functions (CSFs) measured under exactly the same conditions using green gratings generated on the screen of a color monitor. At the low and intermediate spatial frequencies considered (2-16 c/deg), we find the fall in the CSF is much greater than the fall in the monochromatic MTF, with the difference becoming greater as the spatial frequency increases. We show that this discrepancy can be mostly attributed to the effect of transverse chromatic aberration due to the bandwidth of the green stimulus used for the CSF measurements. In conclusion, the combination of the ocular transverse chromatic aberration and monochromatic aberrations accounts for the loss in visual sensitivity found with a decentered small pupil at low and intermediate spatial frequencies.

Double-pass measurements of the retinal-image quality with unequal entrance and exit pupil sizes and the reversibility of the eye's optical system

We have used a modified double-pass apparatus with unequal entrance and exit pupil sizes to measure the optical transfer function in the human eye and have applied the technique to three different problems. First, we confirm that in the eye the double-pass spread function is the cross correlation of the input spread function with the output spread function [J. Opt. Soc. Am. A 12, 195 (1995)]. Consequently, when entrance and exit pupil sizes are equal, phase information is lost from the double-pass images. Second, we show that in double-pass measurements the eye behaves like a reversible optical system. That is, when entrance and exit pupils are equal, the double-pass image results from two passes through an optical system having a transfer function that is the same in both directions. To test for reversibility in the living eye we have used a double-pass apparatus with different exit and entrance pupil sizes (one of them small enough to consider the eye diffraction limited), so that the ingoing and the outgoing transfer functions are different. The measured image quality was unchanged when the pupils were interchanged, i.e., when the first-pass entrance pupil size becomes the second-pass exit pupil size, and vice versa. Third, the technique provides a means for inferring the complete optical transfer function of the eye, including the phase transfer function, and the shape of the point-spread function.

[Quantification of myocardial tomography with thallium in coronary disease. Evaluation of the Cedars-Sinai technique]

OBJECTIVE

The aim of this study is to evaluate the contribution of the Cedars-Sinai quantification tomographic method (CS) in the diagnosis and localization of ischemic areas in coronary artery disease (CAD) and to optimize the threshold values proposed by CS.

PATIENTS AND METHODS

Fifty patients with clinical suspicion of CAD performed a maximal stress test by cycloergometer; thallium myocardial tomographic images were obtained; applying the CS program afterwards. The sensitivity and specificity variations obtained by changing the criteria for extent of myocardial hypoperfusion (range 1% to 100%) were used to calculate the new thresholds (CS-I), using the results of coronariographic studies as a reference. The data determined by qualitative analysis were compared with that obtained by quantitative analysis by means of CS and CS-I using coronary angiography as the standard of reference.

RESULTS

The coronary angiography showed coronary disease in 37 patients. The sensitivity for the diagnosis of CAD was superior using CS (97%) at the expense of low specificity (15%) which nevertheless improved with CS-I (54%). For the location of CAD, the visual analysis was statistically significant (p < 0.05) in the left anterior descending and right coronary arteries, CS being superior in the diagnosis of 3 vessel disease.

CONCLUSIONS

The quantification of tomographic studies with thallium by means of CS needs a readjustment of the thresholds. The tested values (CS-I) improved the CS results, although they require prospective validation. Quantitative study permits the confirmation of visual findings, being a complementary method that can be rapidly and easily interpreted, although it is not recommended as a single technique for the diagnosis of coronary disease.

[The threat syndrome of the anterior descending coronary artery]

Some patients with unstable angina develop a deep T-wave inversion in ECG leads V1 to V4. It has been suggested that this special ECG pattern is associated with a severe stenosis of the left anterior descending (LAD) coronary artery. We have studied 73 of this patients. All of them had an LAD involvement, nearly always as severe atherosclerotic plaque and in 5% of the cases due to non-atherosclerotic alterations (milking or spasm). Angioplasty was performed in 33% and bypass surgery in 61%. In both cases the immediate results were good (0% and 4% respectively in-hospital mortality) as well as the outcome (12% restenosis and 0% late mortality respectively). The ECG signs disappeared in the year after.

[Dynamic cardiomyoplasty. Preliminary experience]

INTRODUCTION AND OBJECTIVES

The purpose of this study is to show our experience in clinical dynamic cardiomyoplasty.

PATIENTS, MATERIALS AND METHODS

Six patients with end-stage heart failure and 2 patients with left ventricular aneurysm underwent dynamic cardiomyoplasty using the latissimus dorsi muscle. The latissimus dorsi was electrically conditioned before the procedure through a lead placed under local anesthesia and connected to an external cardiac pace-maker. Surgical technique--including dissection of the latissimus dorsi and encircling of the ventricles with the muscle flap--was performed in general terms as described at the Broussais Hospital. In the first 3 patients a bipolar lead connected to a single impulse generator was used. In the other 5 patients a train of impulses cardiomyostimulator was used. Changes in systolic function were studied through Doppler-echocardiography and radionuclide studies. Changes in diastolic function were evaluated through E wave velocity and deceleration time.

RESULTS

Mean follow up was 9 +/- 5.7 months. No early deaths were recorded. One patient underwent emergency surgery, one week after the procedure, because of a tear of the patch used to close the wall defect after left ventricular aneurysm resection. In 2 patients a subcutaneous serous collection secondary to muscle dissection was evacuated. One patient died due to a stroke 4 months after the procedure. Another patient died after an unsuccessful coronary transluminal percutaneous angioplasty 11 months after the procedure. An improved functional class was observed in all patients. No changes in systolic function were observed after surgery when the cardiomyoestimulator was turned-off either with echocardiography (26.7 +/- 8.6 vs 24.8 +/- 5.8% [NS]) or radionuclides (24.5 +/- 9.5 vs 20.2 +/- 8.3% [NS]). When the cardiomyostimulator was turned-on a statistically significant increase of the left ventricular ejection fraction was observed either with echocardiography (24.8 +/- 5.8 vs 37 +/- 10.3%; p < 0.05) or radionuclides (20.2 +/- 8.3 vs 33.3 +/- 12.2%; p < 0.05). This significant increase of the ejection fraction has been observed in subsequent studies. Nevertheless the differences when the cardiomyostimulator is turned-on and turned-off have decreased several months after the procedure. A significant increase of the left ventricular outflow velocity (cm/seg) was observed when the generator was turned-on (57.7 +/- 20.4 vs 75.1 +/- 17.8%; p < 0.01). A significant increase of the dP/dt (mmHg/seg) was observed when the generator was turned-on (706.3 +/- 291.5 vs 592.6 +/- 181.6%; [NS]). No significant changes were observed on E wave velocity. A significant decrease of the deceleration time was observed several months after the procedure (p < 0.05).

CONCLUSIONS

We believe that dynamic cardiomyoplasty is a safe and valid surgical procedure for some patients with end stage cardiomyopathies as well as in association with Jatene's technique for the management of left ventricular aneurysms. An improvement in functional class is present and a significant increase of the left ventricular systolic function. Nevertheless it is necessary to find new systolic parameters, independent of volumetric calculations, to evaluate the mechanical support of the muscle as well as to determine the long-term pattern of electrical stimulation.

[Non-invasive diagnosis of rejection in heart transplant: usefulness of Doppler echocardiography]

Cardiac transplantation is a valid therapeutic option for advanced chronic heart failure, with a one year survival of 60-80%. Although the introduction of cyclosporine has markedly improved survival in heart transplant recipients, early detection of cardiac allograft rejection remains the major problem to be solved. At present, the diagnosis of cardiac rejection has been based on the results of endomyocardial biopsy, which remains actually as the gold standard for rejection surveillance. However, ideally the detection of cardiac rejection should be noninvasive to allow frequent follow-up of the patients. Several attempts have been made to find a noninvasive alternative to replace endomyocardial biopsy, doppler-echocardiography being the most promising technique. A review of current noninvasive methods for graft rejection detection will be discussed emphasising the importance of doppler-echocardiography.

[Oro-esophageal candidiasis resistant to fluconazole in patients with AIDS]

BACKGROUND

Fluconazole-resistant Candida albicans has been seldom reported in the literature. in this study, two clinical cases of oro-esophageal candidosis resistant to this antifungal drug are described.

METHOD

Infection was confirmed by isolation of yeasts (culture of mouth swabs, oesophagoscopy and histology of biopsy specimens). In vitro antifungal susceptibility tests were performed with standard methods (NCCLS).

RESULTS

Clinical and microbiological fluconazole-resistant Candida albicans was isolated.

CONCLUSIONS

Causes of development of resistances are commented, and the role of immunodeficiency and the possibility of a Candida strain selection is discussed.

[Changes in diastolic function in heart rejection: role of Doppler echocardiography]

In acute cardiac rejection, left ventricular diastolic function is altered. To study these abnormalities and their utility in cardiac allograft rejection, we studied 56 cardiac transplant recipients. All patients were assessed with endomyocardial biopsy and Doppler echocardiography done in the same day. A total of 163 Doppler studies were recollected. Cardiac transplant recipients were excluded during the early 6 weeks postoperative period. Totally, 100 biopsies were normal, 48 positive for mild rejection (Billingham Gde I-II) and 15 positive for moderate or severe rejection (Billingham Gde III-IV). Compared to negative biopsies, during acute rejection left ventricular wald thickness significantly increased (p < 0.05); isovolumic relaxation period and pressure half-time significantly decreased (p < 0.05, p < 0.001 respectively). Nevertheless, increase in peak early mitral flow velocity was only significantly associated with severe rejection (p < 0.001). Correlating only progressive shortening of isovolumic relaxation period parameter in the diagnosis of graft rejection, we forward a high sensibility (85%) and low specificity (57%). Thus, Doppler echocardiographic evaluation of left ventricular diastolic function provides a non-invasive tool for early detection of acute rejection monitoring after the early postoperative period.

Dynamic cardiomyoplasty in a patient with end-stage cardiomyopathy

Dynamic cardiomyoplasty is a relatively new surgical procedure by which a transformed fatigue-resistant skeletal muscle wrapped around the heart is stimulated to contract in synchrony with it, thereby augmenting the ventricular functions of a failing heart. We performed a cardiomyoplasty with latissimus dorsii (LD) in a patient who was refused the heart transplant programme because of pulmonary hypertension and psychosocial contraindications. The patient was 34 years old, functional class grade IV of the New York Heart Association (NYHA), with a three-month history, due to ischemic cardiomyopathy with multiple vessels affected, 10% ejection fraction, arteriolar pulmonary resistance of 7.5 U Wood. Cardiomyoplasty was performed after training the LD muscle for four weeks. One week later the pacemaker was programmed in a DDD mode: amplitude 3.75 V, pulse duration 0.50 ms, AV delay 175 ms. The patient reached functional class grade I-II (NYHA). Inotrope support was discontinued and great clinical improvement was noted. The ejection fraction rose from 10% to 30%. Echocardiographic left ventricular outflow tract velocity increased from 0.33 m/s to 0.60 m/s. These values were compared with radionuclide angiocardiography and echocardiography evaluations. The great clinical improvement and positive changes in left ventricular parameters suggest that cardiomyoplasty is useful in the treatment of some cases of dilated or ischemic cardiomyopathy as an alternative to heart transplantation. Long term follow-up is necessary to evaluate this procedure.

Dynamic Cardiomyoplasty in a Patient with End-Stage Cardiomyopathy

Dynamic cardiomyoplasty is a relatively new surgical procedure by which a transformed fatigue-resistant skeletal muscle wrapped around the heart is stimulated to contract in synchrony with it, thereby augmenting the ventricular functions of a failing heart. We performed a cardiomyoplasty with latissimus dorsii (LD) in a patient who was refused the heart transplant programme because of pulmonary hypertension and psychosocial contraindications. The patient was 34 years old, functional class grade IV of the New York Heart Association (NYHA), with a three-month history, due to ischemic cardiomyopathy with multiple vessels affected, 10% ejection fraction, arteriolar pulmonary resistance of 7.5 U Wood. Cardiomyoplasty was performed after training the LD muscle for four weeks. One week later the pacemaker was programmed in a DDD mode: amplitude 3.75 V, pulse duration 0.50 ms, AV delay 175 ms. The patient reached functional class grade I-II (NYHA). Inotrope support was discontinued and great clinical improvement was noted. The ejection fraction rose from 10% to 30%. Echocardiographic left ventricular outflow tract velocity increased from 0.33 m/s to 0.60 m/s. These values were compared with radionuclide angiocardiography and echocardiography evaluations. The great clinical improvement and positive changes in left ventricular parameters suggest that cardiomyoplasty is useful in the treatment of some cases of dilated or ischemic cardiomyopathy as an alternative to heart transplantation. Long term follow-up is necessary to evaluate this procedure.

[Pleuro-pericardial effusion following the early intragraft thrombolysis of an occluded aortocoronary graft]

A case of contrast extravasation associated with pleuro-pericardial effusion occurring during recanalization of an early occluded aortocoronary bypass by intragraft fibrinolysis is reported. This is, to the best of our knowledge, the second report of angiographically demonstrated contrast extravasation from an aortocoronary bypass graft during this technique and the first associated with pleural effusion as a clinical manifestation.

[Ischemic cardiopathy in women]

Life expectancy in western women is 8 years larger compared to men. This is due to the higher incidence of ischemic heart disease in men at least before reaching 45 years of age. This may also be due to differences in blood lipoprotein levels, differences in smoking habits, use of hormonal contraceptives, plasma iron levels, parity and other risk factors also found in men. After menopause the difference in the incidence of ischemic heart disease progressively decreases, basically because of a decrease in estrogen secretion. However, the role of estrogen supplement treatment in this group of women in the prevention of ischemic heart disease has not yet been clearly defined. The objectives of this study are to review the risk factors involved in the development of ischemic heart disease in women, the changes brought about by menopause and the possible beneficial effects of supplemental estrogens in the postmenopausal period.

[Update on coronary syndrome X]

Syndrome X is not a well-defined clinical entity. Patients included are those with typical effort angina with angiographically normal coronary arteries and with no evidence of other causes of chest pain. The pathophysiologic mechanisms involved in this syndrome could be a reduced vasodilatory capacity. The prognosis is usually good, but a subgroup of patients with left bundle brunch block in the ECG may develop a dilated cardiomyopathy. To present it lacks a full effective treatment.

[Current use of anti-hemostatics in ischemic cardiopathy]

Antihemostatic drugs are widely used in the treatment and prevention of ischemic heart disease. Fibrinolytic agents are prescribed in the early phase of acute myocardial infarction, to reduce its size and improve survival. Their use in unstable angina is still controversial. Anticoagulants have substantial benefit in myocardial infarction, unstable angina and primary prevention of coronary disease. Finally, antiplatelet agents are used in stable and unstable angina, myocardial infarction and high risk patients.

[Dysautonomic syncope. Diagnosis and treatment]

Inappropriate activation or disbalance of vasomotor reflexes may have a close relationship with the pathogenesis of disautonomic syndromes, a frequent underlying cause of recurrent syncope. A combined approach of meticulous historical data, physical examination and selected laboratory procedures may delineate the most common causes of recurrent syncope. Tests of autonomic function may be particularly helpful in the diagnosis of this entity. They include some non-invasive maneuvers such as stimulation of carotid sinus, Valsalva maneuver or tilt-table test. Therapy for this syndrome includes pharmacologic agents, surgical and radiotherapeutic maneuvers and atrioventricular sequential pacing. In this work we will present an overall formulation of the diagnostic evaluation and a therapy approach of the patient presenting with this complaint.

[Antiphospholipid syndrome and cardiovascular disease]

Recurrent thrombosis, abortion and thrombocytopenia are the most frequent manifestation of antiphospholipid syndrome, which usually presents antibodies against some anionic phospholipids. A few years ago, this syndrome was considered as a manifestation of systemic lupus erythematosus; nowadays it is classified as an isolated systemic lupus erythematosus; nowadays it is classified as an isolated autoimmune disease. Hypotheses have been proposed to explain the origin of antiphospholipid antibodies, including infectious and autoimmune diseases with high titles of anticardiolipin antibodies. Genetic factors have also been involved. Laboratory tests of choice for the detection of anticardiolipin antibodies are RIA and ELISA tests; there are some structural differences among them depending on the underlying disease. Hypercoagulability and recurrent thrombosis are the main features of this entity; ischemic heart disease is in this context of outmost importance. Despite the lack of any clinically demonstrated association between antiphospholipid syndrome and ischemic heart disease, there are many "in vitro" studies that support this possibility.

[Contraceptives and ischemic cardiopathy]

The incidence of myocardial infarction is higher in women that use oral contraceptives. The most important pathophysiologic mechanisms are: a) modification of coronary risk factors: the pill produces an elevation of both serum cholesterol and trygliceride levels, increase of blood pressure and decompensation of diabetes mellitus; b) blood coagulation disorders: oral contraceptives increase platelet aggregation and fibrinogen blood levels, therefore they have a considerable thrombogenic capacity. At this moment there are several update publications concerning this matter; however most of the mechanisms involved in the increase of coronary heart disease in this specific group still remain unclear.

[Oxygen-derived free radicals. Their role in cardiology]

Oxygen-derived free radicals are highly reactive molecules characterized by the presence of an unpaired electron in one of its outer orbitals. They have been found responsible for some pathologic phenomenons which in the field of cardiology, occurs during tissue reperfusion of a previously ischemic area. Ischemia predisposes an outburst in the production of these molecules upon the reintroduction of oxygen during reperfusion. Animal experimental models have been designed to reduce the damages induced by free radicals using various pharmacologic agents. It is probable that these agents may form a part of the conventional treatment of certain cardiac pathologies in the future.

[Aneurysm of interauricular septum associated with mesosytolic click]

An echocardiographic study was performed to a patient with symptoms of cardiac failure and midsystolic click confirmed by phonocardiography. The echocardiograms suggested an incipient dilated myocardiopathy and also atrial septal aneurysm. We report the relationship between midsystolic click and atrial septal aneurysm.

[The risk and treatment of hyperlipoproteinemias]

The role of lipid disorders in the pathogenesis of coronary heart disease is reviewed. It is also presented the pathophysiology of hyperlipidemias and its current therapeutic policies.