Detection of dysfunctioning mitral prosthetic regurgitation: transesophageal echocardiography in comparison with transthoracic echocardiography and angiography

Transesophageal echocardiography has been increasingly used in addition to the transthoracic approach. It not only allows an unobstructed window for viewing the left atrium, but also provides high-quality imaging to improve diagnosis of prosthetic valve dysfunction. To determine the value of transesophageal echocardiography in detection of dysfunctioning mitral prosthetic regurgitation, 11 patients clinically suspected of dysfunctioning mitral prosthesis were studies by transthoracic, transesophageal echocardiography and was documented by a left ventricular angiography. There were 7 biological tissue valves and 4 metallic Bjork-Shiley valves. Compared with a left ventricular angiography, the transthoracic approach to 8 patients made an underestimation of the grade of regurgitation. The angiographic grading confirmed the transesophageal approach in all patients except one who was graded as mild regurgitation by left ventricular angiography, moderate regurgitation by transesophageal echocardiography, but no regurgitation by transthoracic echocardiography. Our results indicated that in patients with suspected mitral prosthetic dysfunction, a transesophageal echocardiography is more sensitive than a transthoracic echocardiography in detecting mitral regurgitation.

Effects of exercise and ticlopidine on platelet function and prostanoids in patients with old myocardial infarction

Twenty-eight subjects, 16 with old myocardial infarction (OMI) and a control group of 12, received ticlopidine 250 mg/day for 4 weeks. All subjects underwent the standard Bruce protocol exercise test before and after therapy. Blood was collected from a peripheral vein to study platelet function at pre-exercise (rest), peak exercise (end point), and 6 min post-exercise (recovery). Platelet count, platelet aggregatory response, plasma thromboxane B2 (TXB2), and 6-keto-PGF 1 alpha were measured by Coulter counter, aggregometry, and radioimmunoassay, respectively. The platelet count, aggregatory response (induced by ADP, adrenalin, and collagen) and the plasma concentration of TXB2 and 6-keto-PGF 1 alpha were not significantly affected by exercise in the OMI and control groups. Overall, there were no significant changes in exercise duration, heart rate, and blood pressure in both groups before or after ticlopidine treatment, with some minor exceptions. There were no significant changes in the peripheral blood profiles, the bleeding and coagulation times, the blood chemistry data, and the platelet counts between the groups before or after treatment. There was a significant decrease in collagen- and ADP-induced platelet aggregation in both groups after ticlopidine therapy. Prior to treatment, a higher plasma TXB2 concentration was noted in the OMI group during and after exercise; the difference was no longer statistically significant after ticlopidine therapy when both groups were compared. There was a significant reduction in the TXB2 levels in the OMI group after ticlopidine treatment despite exercise. Before therapy, plasma 6-keto-PGF 1 alpha was significantly elevated in the OMI group before or after exercise but was not statistically significant after ticlopidine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonparasitic hepatic cysts detected in ultrasonographic examination: analysis of 95 cases

Ultrasonography has gained wide use in the diagnosis of hepatic cystic diseases. Ninety cases with nonparasitic hepatic cysts were detected in 4,615 patients who underwent routine abdominal ultrasonography. In this series, hepatic cysts were mostly discovered in men (62.1%), in the age range of 51-70 years (63.1%) and located in the right lobe of the liver (62.1%). Hepatomegaly, abdominal mass, abdominal pain, and jaundice were the common clinical manifestations in patients with symptomatic hepatic cysts (13.7%), especially in cases with larger or multiple cysts. Only 4 patients received invasive management; 2 with ultrasonographic guide aspiration alone, 1 with external drainage, and 1 with alcohol instillation. Complications in this series of liver cysts were noted in 3 patients (3.16%) including infection, portal hypertension and jaundice.

[A preliminary report of the fetal effects of dengue infection in pregnancy]

This Manuscript was read at the Clinical Aspects on Dengue Fever and Dengue Hemorrhagic Fever held at Kaohsiung Medical College, Kaohsiung City, Taiwan, Republic of China, November 13, 1988. There is not enough evidence to prove that the dengue virus will cause teratogenicity, abortion, or intrauterine growth retardation of a fetus during pregnancy. Nine cases of women infected with dengue fever in early pregnancy received amniocentesis (or chorion villi sampling) in the Department of Obstetrics and Gynecology, KMCH. The chromosome analysis revealed that all were normal, and the level of alpha-fetoprotein in amniotic fluids and maternal sera were within normal range. Antibodies to the dengue virus in the dengue infected mother can cross the placenta and transfer to the fetus, which can cause new born infants to develop dengue hemorrhagic fever or dengue shock syndrome easily when they are primarily infected with dengue virus. Anti-dengue activity was found in the lipid component of human milk and colostrum. This suggests that breast feeding will protect the infant from the dengue virus in the endemic area of dengue infection.

Inhibition of ovulation, steroidogenesis and collagenolytic activity in rabbits by sulpiride-induced hyperprolactinaemia

Ovulation induced by hCG in rabbits was reduced significantly (P less than 0.005) by sulpiride-induced hyperprolactinaemia. The pre- and post-ovulatory increases in peripheral and ovarian venous progesterone (but not oestradiol or testosterone) were suppressed in the treated animals. The condition of hyperprolactinaemia also prevented the usual changes in 2,4-dinitrophenyl-Pro-Gln-Gly-Ile-Ala-Gly-Gln-D-Arg-OH peptidase (DNP-peptidase) and alpha-N-benzoyl-DL-Arg-beta-naphthylamide hydrolase (BANA-hydrolase) activities in follicular tissue that had been stimulated by an ovulatory dose of hCG. These results suggest that inhibition of progesterone production and collagenolytic enzyme activity by sulpiride-induced hyperprolactinaemia may be responsible for the ovulatory dysfunction that occurs when a mammal has a high level of circulating prolactin.

Inhibition of human chorionic gonadotropin-induced ovulation and steroidogenesis by short-term hyperprolactinemia in female rabbits

To clarify the possible direct effects of hyperprolactinemia on the ovulatory process, we experimentally established hyperprolactinemia in female rabbits with 4 daily injections of sulpiride (SLP) at different doses and induced ovulation with human chorionic gonadotropin (hCG). Plasma levels of prolactin (PRL) were increased significantly before hCG injection in each SLP-treated group compared with the corresponding values for the controls. The ovulation rates at 14 h after hCG were significantly reduced in the 16 and 24 mg/kg/day SLP-treated groups. An inverse correlation (r = -0.74, P less than 0.001) was found between the ovulation rate and the increasing in plasma PRL measured just prior to hCG injection. The increase in peripheral as well as ovarian venous progesterone and 20 alpha-hydroxypregn-4-en-3-one(20 alpha-OHP) at 4 and 14 h after hCG injection in inhibited ovulation groups was much less than in the control group. However, the estradiol, androstenedione and testosterone concentrations were comparable with the control values. These results indicate that hypersecretion of PRL induced by SLP has a direct effect on ovary by inhibiting follicular rupture induced by hCG and this inhibitory effect was partly due to the suppression of progesterone secretion during the course of ovulation. This may be one of the causes leading to hypogonadism during hyperprolactinemia.

Thyrotropin-releasing hormone and gonadotropin-releasing hormone test to predict effectiveness of bromocriptine therapy in infertile women

Sixty-four infertile women presenting with luteal phase defect, anovulatory cycle, and secondary amenorrhea were compared with 15 normal cycling women with bolus injections of thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) before bromocriptine (BCPT) therapy. All of the women had normal baseline prolactin (PRL), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) concentrations. Responses of PRL, LH, and FSH levels were measured. PRL responses in BCPT responders were markedly greater than in controls and nonresponders. A better responder rate to BCPT therapy was observed in patients with apparent (88.9%) or borderline (69.2%) exaggerated responses of PRL to TRH than in normal patients (41.7%). Further, in patients with normal PRL responses, the inappropriately enhanced LH responses were seen in BCPT responders but not in nonresponders. These findings suggest that TRH and GnRH tests are worthwhile in predicting the outcome of BCPT therapy in infertile patients.

Spoilage bacteria in canned foods. II. Sulfide spoilage bacteria in canned mushrooms and a versatile medium for the enumeration of Clostridium nigrificans

Clostridium nigrificans was found to be a spoilage organism of canned mushrooms in Taiwan. A modified beef extract tryptone iron medium, both in broth and agar form, was designed for the detection and recovery of the organisms. A procedure of simple plate counting method of C. nigrificans was established.