Mitral valve prolapse in a case of Marfan syndrome with congenital cardiac disease, chronic obstructive pulmonary disease and schizophrenia

Mitral valve prolapse (MVP) is a common pathological finding in several inherited connective-tissue diseases among which the Marfan syndrome. In the literature several cases of Marfan syndrome characterized by schizophrenia, chronic obstructive pulmonary disease and severe mitral regurgitation due to a MVP have been reported. Our case of MVP was observed in a patient with Marfan syndrome with its characteristic musculoskeletal disorders associated with congenital cardiac disease, severe chronic obstructive pulmonary disease and schizophrenia. According to the latest genetic studies, Marfan syndrome seems to result from genetic mutations in an extracellular matrix glycoprotein, fibrillin. Authors believe that MVP represents only one of several pathological alterations which may be seen in the Marfan syndrome, as expression of a more generalized genetic disorder.

Spondylo-epimetaphyseal dysplasia with joint laxity and severe kyphoscoliosis in an Italian girl

A case of spondylo-epimetaphyseal dysplasia with joint laxity (SEMDJL) in an Italian girl is reported. This condition is mainly observed in the Afrikaans population of South Africa with an ancestral founder believed to be localized in West Germany. This case might support a link with the European origin of SEMDJL.

Influence of lipophilicity on the biological activity of cyclic pseudopeptide NK-2 receptor antagonists

A series of cyclic pseudopeptides of the formula cyclo(Leu psi[CH2NH]Xaa-Gln-Trp-Phe-beta Ala), where Xaa represents the residue of an alpha-amino acid, has been synthesized in order to establish the role of the Xaa side chain for tachykinin NK-2 receptor antagonist activity. Syntheses have been carried out in solid phase with either Fmoc or Boc strategy. The antagonist potency on NK-2 receptors in the hamster isolated trachea (HT) and the rabbit isolated pulmonary artery (RPA) bioassays increases with Xaa lipophilicity; cyclo(Leu psi[CH2NH]Cha-Gln-Trp-Phe-beta Ala) and cyclo(Leu psi[CH2NH]Asp(NHBzl)-Gln-Trp-Phe-beta Ala) resulted in being the two most active antagonists (pA2 = 9.06 and 9.26 on HT, respectively). A significant linear correlation was found between pA2 values determined in HT and RPA bioassays and capacity factors measured in reversed phase HPLC. The comparison between the biological activities of cyclic hexapeptides containing or not containing the aminomethylene moiety proved the crucial role of the pseudopeptide bond for determining high antagonist potency at the NK-2 receptor.

Detection of growth hormone-producing cells in human thymus by immunohistochemistry and non-radioactive in situ hybridization

It is well recognized that growth hormone (GH) may act as a growth and differentiation factor for the thymus gland. Recently, it has been reported that Pit-1/GHF-1 transcription factor, which controls the expression of both GH and prolactin, is expressed in stromal (not lymphoid) cells of human thymus. Here, we demonstrated by immunohistochemistry and in situ hybridization the presence of distinct GH-producing epithelial cell subsets in human thymus. The cells positive for GH mRNA and GH-immunoreactive substance are both located in the same thymus compartments, i.e., along the thymus capsule, in the subcapsular cortex, and within the septa. Local concentration of GH higher than systemic ones, in combination with other factors, may be important in regulating the thymic microenvironment necessary for T-lymphocyte differentiation.

Mild sialoadenitis: a common finding in patients with hepatitis C virus infection

BACKGROUND

Sjögren's syndrome (SS) is an autoimmune disease of presumed viral origin; sialoadenitis has been reported to occur in hepatitis C virus (HCV) infection.

METHODS

Lip biopsy specimens were graded in 32 consecutive patients with either HCV-related chronic liver disease or SS.

RESULTS

Seventeen of 22 HCV-positive patients had sialoadenitis, although generally mild (15 of 17, grades I-II). Severe inflammation (grades III-IV) was observed in 8 of 10 patients with SS (chi-square = 12.6; P < 0.0005). Moreover, HCV-positive patients with sialoadenitis differed from patients with SS in female sex prevalence (6 of 17 versus 10 of 10; chi-square = 10.9; P = 0.0001) and presence of serum antinuclear autoantibodies (0 of 17 versus 9 of 10; chi-square = 23.0; P < 0.0001). Five of 13 HCV-positive patients and 7 of 8 patients with SS were HLA-DR3-positive (chi-square = 4.9; P < 0.05).

CONCLUSIONS

Sialoadenitis of HCV-related liver disease is common but differs from SS with regard to predisposing genetic factors, expression of autoimmune markers, and histopathologic severity.

Echographic diagnosis of pretibial myxedema in patients with autoimmune thyroid disease

In the present study we have evaluated the use of pretibial ultrasound for the diagnosis of pretibial myxedema (PTM). We studied 76 patients, 58 with Graves' disease, 13 with Hashimoto's thyroiditis and five with idiopathic hypothyroidism. Thirty-two normal subjects were also studied as controls. Sixty-four patients had associated ophthalmopathy. The ultrasound scanner was equipped with 10- and 13-MHz probes. Punch biopsies were carried out in 11 patients and tissue sections examined on a light microscope. On clinical examination 21 patients (28%) had suspected PTM. By ultrasound, we measured the thickness of dermis and subcutaneous tissue (D1) and that including only deeper dermis (D2) in normal subjects to define the echographic parameters of normal pretibial skin. We then found increased skin thickness in 25 patients (33%), with mean D1 and D2 values significantly higher than those measured in controls (p < 0.00001). The echographic study was positive in 20 patients with ophthalmopathy (31%). Ultrasound showed increased skin thickness in 16 of 21 patients (76%) with clinically suspected PTM. Histopathological findings confirmed the presence of PTM in all the patients who underwent pretibial skin biopsy. We believe that the measurement of pretibial skin thickness by ultrasound may be useful for revealing the presence of PTM.

Cobalt powdersintering industry (stone cutting diamond wheels): a study of environmental-biological monitoring, workplace improvement and health surveillance

This communication deals with an aspect of occupational hygiene in a factory producing granite cutting diamond wheels by sintering, in moulds, of fine cobalt powder. The factory has been studied between 1988 and 1991; the Department of Preventive and Occupational Medicine of the Local Sanitary Unit of Reggio Emilia has followed the evolution of the local exhaust ventilation equipment supplied by the employer in that period. At the same time, the following measurements and observations were carried out: (a) cobalt exposure by personal sampling, (b) airborne cobalt measurements by area sampling, (c) biological monitoring of cobalt in urine, (d) health surveillance.

Expression of acidic glycosphingolipids and arylsulphatase A activity in human pathological endometrium

Endometrium biopsic samples from women with cystic hyperplasia or adenocarcinoma were analysed by biochemical procedures to verify fluctuations in the acidic glycosphingolipid (sulphatide) concentration and arylsulphatase A (ASA) activity. Comparing the values of the considered parameters with those obtained in normal subjects, it was observed that ASA activity significantly increased in both pathologies; in contrast, sulphatide concentration underwent a non-significant decrease in hyperplasia and a statistically significant increase in neoplasia. The thin-layer chromatography (TLC) images revealed not only quantitative, but also qualitative differences in the lipid fractions. In fact, compared with controls, the sulphatides showed one more marked fraction in the neoplastic endometrium, and two fractions with different Rf values in the hyperplastic one. Moreover, two new unknown fractions also appeared in some subjects with cystic hyperplasia. The findings suggest the lipid metabolism undergoes considerable changes under the pathological conditions examined. The fluctuations observed, in particular, in the sulphatide concentration are believed to be related to changes in the biosynthetic and catabolic activities of the key enzymes directly involved in their metabolism, i.e. arylsulphatase A and sulphotransferase, which are regulated by sex hormones.

Osteo-odonto-keratoprosthesis. Description of surgical technique with results in 85 patients

Osteo-odonto-keratoprosthesis is a technique designed for patients with severe corneal opacification who would be at high risk of graft rejection should donor tissue transplantation be performed. Because of the isolation of the prosthetic implant from the tissues that the technique provides, the authors are of the opinion that it is the only viable option in such patients. The visual outcome and complications of the procedure in a series of 85 cases are presented.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

[Early echocardiographic identification of viable myocardium after acute myocardial infarct using inotropic agents: comparison of dobutamine and enoximone]

BACKGROUND

The reversibility of regional dysfunction early after acute myocardial infarction may be obtained with inotropic adrenergic stimulation, in particular during low dose dobutamine infusion, suggesting the presence of viable myocardium. The aim of this study was to determine whether viable myocardium can be identified by two-dimensional echocardiography after an i.v. bolus of enoximone-positive inotropic non-adrenergic drug, phosphodiesterase III inhibitor as well as during dobutamine infusion, in patients with acute myocardial infarction.

METHODS

Twelve male patients, aged 57 +/- 10 years and treated with rtPA (100 mg i.v. in 180 minutes) within the first 6 hours of a first anterior myocardial infarction were studied. All patients underwent a dobutamine infusion (5 and 10 mcg/kg/min, 5 minutes per dose) 4 +/- 1 days after entrance, followed by an enoximone bolus (1 mg/kg over 5 minutes) 1 hour later. Echocardiography was performed before dobutamine and enoximone, during dobutamine, 10 minutes after enoximone and at 6 +/- 2 months follow-up. A Wall Motion Score Index (WMSI) was calculated as recommended by the American Society of Echocardiography. All patients underwent coronarography on days 9-11 post-infarction.

RESULTS

Improvement in regional function of basally asynergic segments occurred in 8 patients during dobutamine infusion, as well as after enoximone i.v. bolus, and in 1 patient only during dobutamine infusion. Both dobutamine and enoximone tests were found to be negative in the other 3 patients. A decrease of WMSI was observed with both dobutamine and enoximone tests (from 1.84 +/- 0.32 to 1.73 +/- 0.31; p = .002 with dobutamine; from 1.84 +/- 0.32 to 1.70 +/- 0.27; p = .0132 with enoximone) with concordant wall motion changes between two tests in 73/84 (87%; K = 0.61) basally asynergic segments. There were no complications occurred during the study. Of 8 patients with positive response for viable myocardium to both tests, 6 had a patent and 2 an occluded infarct-related artery. However, in the latter a collateral circulation toward necrotic area was present. At follow-up improvement in regional function of basally asynergic segments, with a decrease of WMSI (from 1.74 +/- 0.23 to 1.59 +/- 0.24; p < .05), was observed in 4 of 8 patients with viable myocardium detected by either dobutamine or enoximone.

CONCLUSIONS

1) Viable asynergic myocardium may be identified early after acute myocardial infarction by enoximone bolus, as carefully and safely as by dobutamine infusion; 2) transient recovery of post-ischemic myocardial dysfunction may be obtained independently of beta-receptor stimulation.

Optic nerve granuloma as first sign of systemic sarcoidosis

We report a rare casse of optic nerve involvement as the first sign of systemic sarcoidosis. A 43-year-old white woman presented with visual loss in her right eye, and the clinical appearance of optic nerve head swelling. Visual acuity was reduced to 20/200, and the only clinical signs were the presence of an enlarged optic nerve head, with engorged retinal veins and flame-shaped haemorrhages. Computed tomography scans showed an enlarged orbital portion of the right optic nerve, which was confirmed by magnetic resonance imaging. With a diagnosis of optic nerve tumour (possibly glioma) a surgical resection of the tumour was performed. Histopathology showed multiple nodular granulomas with epithelioid cells, consisted with the diagnosis of sarcoidosis. This was confirmed by systemic involvement of the parotids and liver. We review the literature and consider all possible involvement of the optic nerve in sarcoidosis. The rarity of systemic sarcoidosis with a first manifestation as papilloedema is discussed.

Effect of steroid eluting versus conventional electrodes on propafenone induced rise in chronic ventricular pacing threshold

The aim of this study was to evaluate chronic ventricular pacing threshold increase after oral propafenone therapy. Eighty-three patients affected by advanced atrioventricular block and sick sinus syndrome were studied at least 3 months after pacemaker implantation, before and after oral propafenone therapy (450-900 mg/day based on body weight). The patients were subdivided into three groups according to the type of unipolar electrode that was implanted: group I (41 patients) Medtronic CapSure 4003, group II (30 patients) Medtronic Target Tip 4011, and group III (12 patients) Osypka Vy screw-in lead. In all cases a Medtronic unipolar pacemaker was implanted: 30 Minix, 23 Activitrax, 14 Elite, 12 Legend, and 4 Pasys. Propafenone blood level was measured in 75 patients 3-5 hours after propafenone administration. The pacing autothreshold was measured at 0.8 V, 1.6 V, and 2.5 V by reducing pulse width. At the three different outputs before and after propafenone, threshold increments were significantly lower in group I in comparison with group II and group III (propafenone ranging from < 0.001 to < 0.05). No significant difference was found in pacing impedance or in propafenone plasma concentration in the three groups. Strength-duration curves were drawn for each group at baseline and after propafenone administration. Before propafenone, in group I, the knee was markedly shifted to the left and downward as compared to the classic curve, so that the steep part was predominant; in group II and group III this shift was progressively less evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Defibrotide versus heparin in the prevention of coronary reocclusion after thrombolysis in acute myocardial infarction

A multicenter controlled study versus heparin was conducted to explore the activity of defibrotide, a polydesoxyribonucleotide drug, in preventing reocclusion after urokinase thrombolysis in patients with acute myocardial infarction (AMI). The study involved 137 consecutive patients with AMI and a time from the onset of symptoms < or = 6 hours, treated with urokinase (1,000,000 U intravenous bolus followed by 1,000,000 U slow-drip infusion over 12 hours). Immediately after thrombolysis, patients were allocated to treatment with defibrotide (group D: day 0, 3.6 g by intravenous infusion in 12 hours; days +1 to +6, 800 mg tid intravenously; days +7 to +10/+12, 400 mg tid intramuscularly), or heparin (group H: day 0, 1000 IU/hour infused over 12 hours; days +1 to +10/+12, 5000 IU tid subcutaneously). Coronary angiography was done, whenever possible, at +10/+12 days. The following parameters were assessed: (a) noninvasive estimate of myocardial reperfusion, through the analysis of CPK time-activity curves; (b) incidence of infarct-related artery (IRA) patency (TIMI scores 2-3) at coronary angiography. A total of 125 patients had a complete enzymatic curve (63 in group D and 62 in group H) and 106 had coronary angiography as well. IRA patency (the main end point) was observed in 63% of group D versus 43% of group H patients (p = 0.07). No statistically significant differences were found in the proportion of patients with indirect signs of early reperfusion (63% in group D versus 52% in group H patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Dipyridamole echocardiography evaluation of acute inferior myocardial infarction with concomitant anterior ST segment depression

The significance of anterior ST segment depression in inferior acute myocardial infarction (AMI) remains controversial. The aim of this study was to relate precordial ST segment depression to the topography of residual myocardial ischaemia, with myocardial mapping of the asynergic area and coronary anatomy. Twenty-five patients with first inferior AMI (15 patients with anterior ST segment depression: group A and 10 patients without anterior ST segment shift: group B), all underwent: (1) electrocardiographic evaluation on admission to the Coronary Care Unit and at 24 h intervals thereafter; (2) 2D-echocardiographic study within 3 h of CCU admission; (3) dipyridamole echocardiographic test (DET) (doses of dipyridamole up to 0.84 mg.kg-1 i.v. over 10 min) 4 days after AMI; (4) coronary arteriography within 14 days from AMI. To assess regional left ventricular wall motion, a 16 segment model was used and a wall motion score index (WMSI) was derived. The results of DET were correlated to the anatomy of the infarct-related vessel. Compared to group B, group A patients showed a significantly greater maximal ST segment elevation in inferior limb leads (lead III: 3.9 +/- 1.9 mm vs 2.2 +/- 1.1 mm, P < 0.05; aVF: 3.5 +/- 1.3 mm vs 1.7 +/- 0.8 mm, P < 0.001). Group A patients showed greater WMSI (1.35 +/- 0.22 vs 1.17 +/- 0.12, P < 0.05), with more frequent postero-lateral wall involvement (72% vs 20%, P < 0.05). No patient of either group showed asynergy of the anterior, anterolateral or anteroseptal segments. No differences in the distribution of coronary artery disease were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The prognostic value of the ejection fraction at rest and under stress assessed by nuclear angiography in myocardial infarct patients]

BACKGROUND

The aim of this study was to assess the utility of ejection fraction at rest (rEF) and its change during stress (delta EF) as a predictor of cardiac events during the follow-up of patients (pts) with myocardial infarction.

METHODS

74 pts (44 treated with thrombolytic therapy (TR), and 30 not (noTR)), were studied with 99mTcPYP angiography within 2 +/- 1 months, after AMI. By 20 +/- 10 months, 41 pts had no events (Group A) while 33 pts experienced cardiac events (3 deaths, 16 angina, 12 CABG, and 2 PTCA).

RESULTS

rEF was similar in both Groups A and B (A 47 +/- 8 vs B 45 +/- 10 p. ns), 44 +/- 15 vs B-noTR 46 +/- 12 p. ns). delta EF was different between Groups A and B. Group A showed a positive delta EF (3.2 +/- 6), and this result was more evident in thrombolyzed AMI (A-TR 4.4 +/- 4.5 vs A-noTR 1.16 +/- 3.9 p. < 0.01). Group B showed a negative delta EF (-4.4 +/- 5.3), and this result was more evident in non thrombolyzed AMI (B-TR -2 +/- 6.4 vs B-noTR -5.8 +/- 8 p. < 0.01).

CONCLUSIONS

A decrease in EF during exercise radionuclide angiography is useful in identifying pts with high risk of cardiac events after AMI. Thrombolytic therapy improves stress EF in both Groups A and B.

Costello syndrome: further clinical delineation, natural history, genetic definition, and nosology

In 1977 Costello described two unrelated children with poor postnatal growth, mental retardation, curly hair, coarse face of similar appearance, and nasal papillomata, suggesting the existence of a previously undescribed syndrome of uncertain familial nature [Costello, Aust Paediatr J 13: 114-118, 1977]. The existence of this syndrome as a separate entity was substantiated several years later by two additional reports by Der Kaloustian et al. [Am J Med Genet 43:678-685, 1991] and Martin and Jones [Am J Med Genet 41:346-349, 1991]. More recently Borochowitz et al. [Am J Med Genet 43:678-685, 1992] described a new "multiple congenital anomalies/mental retardation syndrome with facio-cutaneous-skeletal involvement." Whether this condition should be considered separately from the Costello syndrome is currently a matter of debate. We present three cases, two of whom are sibs, who support the identity of the two syndromes. Our aim is to better redefine the diagnostic criteria, describe the natural history, and confirm the genetic cause of the Costello syndrome, whose pattern of inheritance is most likely autosomal recessive.

Effects of genetic hypertension and nutritional anaemia on ventricular remodelling and myocardial damage in rats

OBJECTIVE

In order to determine whether alterations in cardiac function and structure occur early in life in spontaneously hypertensive rats (SHR) and whether the addition of a volume load would affect myocardial growth and haemodynamic performance, SHR were exposed to an iron and copper deficient diet for 12 weeks (SHR-A) and compared with untreated SHR and Wistar Kyoto controls (WKY).

RESULTS

Systolic arterial blood pressure increased in SHR, whereas nutritional anaemia prevented the rise of blood pressure in SHR-A. The diet employed provoked a severe hypochromic microcytic anaemia with a marked reduction in blood viscosity and increased volume load on the heart in SHR-A. Genetically determined hypertension alone induced a 16% increase in left ventricular weight and an increase in left ventricular peak systolic pressure (LVPSP) and +dP/dt. The superimposition of anaemia resulted in a 43% expansion in left ventricular weight with a decrease in LVPSP and +dP/dt, and an increase in left ventricular end diastolic pressure. Wall thickening and a preservation of chamber volume occurred in SHR, while SHR-A had a degree of ventricular dilatation which exceeded the extent of wall thickening. However, genetic hypertension was accompanied by myocardial tissue injury which was fully prevented by the addition of nutritional anaemia. Moreover, the capillary volume was decreased in SHR and increased in SHR-A.

CONCLUSIONS

Genetically determined hypertension in combination with anaemia results in eccentric ventricular hypertrophy and cardiac dysfunction in spite of an increase in capillary luminal volume and limited structural damage.

Spirapril prevents left ventricular hypertrophy, decreases myocardial damage and promotes angiogenesis in spontaneously hypertensive rats

To test whether angiotensin-converting enzyme (ACE) inhibition may prevent myocardial damage and may affect coronary microvasculature in spontaneously hypertensive rats (SHR), young 5-week-old SHR were treated for 3 months with spirapril and changes in blood pressure (BP) were monitored. Untreated SHR were used as controls. The rats were killed; left ventricular (LV) shape, weight, and wall thickness were examined and the ventricular myocardium was analyzed morphometrically to determine the effect of the drug on the relative amount, number per unit area of myocardium, and average dimension of foci of myocardial scarring. Moreover, volume fraction, surface, numerical density, and diffusion distance for oxygen of the coronary capillaries were analyzed. BP remained 20-30% lower in treated SHR with respect to controls, and LV weight and thickness decreased 20 and 21%, respectively. The number and dimension of the foci of fibrosis were reduced, resulting in an overall 68% decrement in the amount of myocardial damage. Finally, a 28% increment in numerical density of capillary profiles associated with a 13% reduction in their cross-sectional area decreased the diffusion distance for oxygen from the capillary wall to the myocytes by 14% in treated SHR. Spirapril decreases BP and LV weight and thickness in the SHR model of hypertension and substantially improves coronary capillary microvasculature, decreasing hypertensive myocardial damage. These results may be attributed to inhibition of the systemic effects of angiotensin II (AII) as well as to a local protective action of the drug against possible intramyocardial AII production.

Real time ultrasonography of the gastric antrum

This study aimed to evaluate whether serial ultrasound measurements of antral volumes are reproducible and, if so, whether they are representative of the entire gastric contents and reliably measure gastric emptying. The antral volume was measured in man after oral and intragastric administration of known amounts of 5% glucose solutions, and on two separate occasions in the same subjects, after the ingestion of a standardised solid-liquid meal (1050 kcal). Antral volume measurements were performed in both supine and upright positions; inter- and intraobserver measurement errors were also assessed. After ingestion or intragastric administration of equal amounts of liquid, antral volumes determined by ultrasound showed a wide intersubject variability. In each individual subject, however, a linear trend was found between the antral volume and amount of ingested or administered liquid. Intrasubject variability of antral volume measurements was at its minimum in fasting conditions and 300 minutes after ingestion of the solid-liquid meal. Intra- and interobserver variations and whether the patient was erect or supine did not affect measurements of antral volumes. These results support the use of real time ultrasound in determining the gastric emptying time. Results at fasting and 300 minutes after a solid-liquid meal are stable end points of measurement.

Computed tomography detection of gastrointestinal neoplasms

Gastrointestinal (GI) tract neoplasms can be detected, evaluated and staged by computed tomography (CT), especially from high-resolution examinations, but routine CT scanning may occasionally discover GI neoplasms in patients with non-specific symptoms. We therefore evaluated the sensitivity and main signs of CT examinations resulting from routine sessions. In 46 out of 1560 patients who underwent abdominal CT, it was possible to obtain a diagnosis of primitive gastric or colo-rectal tumour by means of barium X-ray and/or endoscopy. The sensitivity rate of CT obtained from the present study was 86% in gastric tumours and 87% in colonic tumours. In gastric lymphoma, infiltrating carcinoma of stomach and rectal carcinoma, the sensitivity rate was 100%. The CT diagnosis of GI neoplasms was based on diffuse or local thickening of the gut on a solid dishomogenous mass showing contrast enhancement. The prevalence of various patterns depends on site of origin and on macroscopic features of the neoplasia. In conclusion the results suggest that abdominal CT, even if performed with a method not specifically devoted to GI tract, has high sensitivity rates and then a high probability of detecting GI neoplasms when unsuspected at time of the examination. In our series 11% of GI neoplasms were initially diagnosed by routine CT examination.

Myocyte cellular hypertrophy and hyperplasia contribute to ventricular wall remodeling in anemia-induced cardiac hypertrophy in rats

To determine the effects of chronic anemia on the functional and structural characteristics of the heart, 1-month-old male rats were fed a diet deficient in iron and copper, which led to a hemoglobin concentration of 4.63 g/dl, for 8 weeks. At sacrifice, under fentanyl citrate and droperidol anesthesia, systolic, diastolic, and mean arterial blood pressures were decreased, whereas differential pressure was increased. Left ventricular systolic pressure and the ventricular rate of pressure rise (mmHg/s) were reduced by 9% and 14%, respectively. Moreover, developed peak systolic ventricular pressure and maximal dP/dt diminished 14% and 12%. After perfusion fixation of the coronary vasculature and the myocardium, at a left ventricular intracavitary pressure equal to the in vivo measured end diastolic pressure, a 10% thickening of the left ventricular wall was measured in association with a 13% increase in the equatorial cavitary diameter and a 44% augmentation in ventricular mass. The 52% hypertrophy of the right ventricle was characterized by an 11% thicker wall and a 37% larger ventricular area. The 33% expansion in the aggregate myocyte volume of the left ventricle was found to be due to a 14% myocyte cellular hypertrophy and a 17% myocyte cellular hyperplasia. These cellular parameters were calculated from the estimation of the number of myocyte nuclei per unit volume of myocardium in situ and the evaluation of the distribution of nuclei per cell in enzymatically dissociated myocytes. Myocyte cellular hyperplasia provoked a 9% increase in the absolute number of cells across the left ventricular wall. In contrast, myocyte cellular hypertrophy (42%) was responsible for the increase in myocyte volume of the right ventricle. The proliferative response of left ventricular myocytes was not capable of restoring diastolic cell stress, which was enhanced by the changes in ventricular anatomy with anemia. In conclusion, chronic anemia induced an unbalanced load on the left ventricle, which evoked a hyperplastic reaction of preexisting myocytes, in an attempt to normalize diastolic wall and myocyte stress.

Strampelli's osteo-odonto-keratoprosthesis. Clinical and histological long-term features of three prostheses

The histological features are reported of osteo-odonto-acrylic laminae removed from three patients who for differing underlying causes received Strampelli's osteo-odonto-keratoprostheses (OOK) 20, 16, and 12 years previously. It appears that preservation of the alveolar-dental ligament plays a definitive role in the maintenance of the prosthesis. If this tissue undergoes necrosis as a consequence of an inflammatory disease the implanted material is eventually lost. However when no such event occurs the OOK is well preserved and well tolerated even 20 years after implantation.

Comparative analysis of lysosomal hydrolases and natural glycoprotein substrates in the rat major salivary glands

1. The activities of some lysosomal hydrolases and the concentrations of their natural substrates were studied in the submandibular and sublingual glands of male and female rats using biochemical procedures. 2. In sublingual gland enzyme activities and substrate concentrations show the highest values. 3. The enzyme activities appear, in general, lower and the natural substrate concentrations higher in the females with respect to males. 4. In both glands beta-galactosidase shows the highest activity and beta-glucosidase the lowest. 5. These findings suggest that metabolic turnover of glycoproteins is slower in females than in males, probably because the oestrogens control the activity of lysosomal hydrolases.

Growth-inhibitory effect of quercetin and presence of type-II estrogen-binding sites in human colon-cancer cell lines and primary colorectal tumors

We studied the effect of quercetin (Q) on the proliferation of HT-29, WiDr, COLO 201, and LS-174T human colon cancer cell lines. Q, between 10 nM and 10 microM, exerted a dose-dependent, reversible inhibition of cell proliferation. Cell-cycle analysis revealed that the growth-inhibitory effect of Q was due to a blocking action in the G0/G1 phase. Using a whole-cell assay with 17 beta-[3H]-estradiol as tracer, we demonstrated that all these cell lines contain type-II estrogen-binding sites (type-II EBS). By using Q and other chemically related flavonols (3,7-4'-trimethoxyquercetin, 3,7,3',4'-tetramethoxyquercetin, kaempferol, morin, and rutin), we observed that the affinities of these compounds for type-II EBS are correlated with their growth-inhibitory potential. Furthermore, the Q sensitivity of the colon cancer cell lines was correlated with the number of type-II EBS/cell. Then Q could regulate colon cancer cell growth through a binding interaction with type-II EBS. This mechanism could also be active in vivo as we have observed that cytosolic type-II EBS are present in primary colorectal cancers and that Q is effective in inhibiting the in vitro bromodeoxyuridine incorporated by neoplastic cells in these cancers.

Demonstration of the formation of hydroxyl radicals in acute myocardial infarction in man using salicylate as probe

Dihydroxybenzoic acid (DHBA) derivatives of acetylsalicylic acid (ASA) are formed in vivo by the action of the hydroxyl radical (OH.). In order to evaluate the possible formation of OH(.) in acute myocardial infarction (AMI) in man, 9 consecutive patients with a first episode of AMI (8 males, 1 female, mean age 50.3 years), treated with rt-PA, and 8 healthy volunteers (7 males, 1 female, mean age 29.8 years) were studied. All subjects received 100 mg ASA p.o. daily; venous blood samples were taken 30 min after the first dose (time 0) and then at 3-, 6-, 12-, 24- and 48 h and 5 days. Serum was analyzed by HPLC and electrochemical detection for 2,3- and 2,5-DHBA contents. 2,3-DHBA was present in all subjects with AMI and undetectable in healthy volunteers at all time points studied. Serum levels of 2,5-DHBA did not show statistically significant differences between AMI patients and healthy volunteers. These data support the hypothesis that hydroxyl radicals are formed during AMI in man.

[Pharmacological effects on left diastolic ventricular function in acute myocardial infarct: comparison of gallopamil and atenolol]

The aim of the study was to assess the effects of gallopamil and atenolol administration on left ventricular (LV) relaxation and filling in patients (pts) with acute myocardial infarction (AMI), by pulsed Doppler echocardiography (PDE). Two days after first AMI, 14 pts aged 56 +/- 10 years in Killip class I and treated with thrombolysis were randomized to gallopamil (50 mcg/Kg over 5 min) or atenolol (5 mg over 5 min) IV 10 ml bolus, with a 24 hour time interval, in a cross-over double blind sequence. Four PDE were performed in each patient: at baseline, before gallopamil and atenolol IV bolus, and a 15 min after each bolus. The following Doppler parameters were calculated: early (E) and late (A) peak filling velocities and their ratios (E/A), early (Ei), late (Ai) and total (TVi) diastolic filling time velocity integrals; the ratio between Ei and Ai (Ei/Ai), the peak filling rate normalized to mitral stroke volume (calculated as E/TVi [nPRP]), the percentage of atrial contribution to total diastolic filling (%AC), and the isovolumic relaxation time (nTRIV) normalized to an 800msec RR cycle length. Compared to baseline PDE evaluation, gallopamil administration significantly shortened nTRIV (89 +/- 13 vs 116 +/- 13 msec), improved early LV filling parameters (E: 74.5 +/- 14.0 vs 58.1 +/- 14.6 cm/sec; E/A 1.2 +/- 0.4 vs 0.9 +/- 0.3; Ei: 11.2 +/- 1.8 vs 8.9 +/- 2.0 cm; Ei/Ai: 1.8 +/- 0.6 vs 1.3 +/- 0.6; nPRP: 3.9 +/- 1.0 vs 3.5 +/- 1.0 SV/sec), and reduced %AC (35.6 +/- 8.8 vs 44.6 +/- 10.6). A and Ai were not significantly changed.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiproliferative activity of quercetin on normal bone marrow and leukaemic progenitors

We used an in vitro clonogenic assay in semi-solid medium to test the sensitivity of normal bone marrow and acute myeloid and lymphoid leukaemia progenitors to the flavonol quercetin. We have studied 14 acute myeloid (AML) and four acute lymphoid (ALL) leukaemias. All ALL and the vast majority of AML (12/14) had a high sensitivity to quercetin with more than 50% growth inhibition at 2 x 10(-6) M quercetin. One M3-AML was partially quercetin-sensitive displaying 60% surviving AML-colony forming units (CFU-AML) at a quercetin concentration of 10(-5) M. One M1-AML was resistant to the growth inhibitory effect of quercetin at a concentration of 2 x 10(-5) M. The clonogenic efficiency of both AML and ALL positively correlated with leukaemic colony-forming unit (CFU-L) sensitivity to quercetin suggesting that this parameter can be useful in predicting quercetin responsiveness of leukaemic cells. We have also studied the effect of various quercetin concentrations on colony formation by normal bone marrow cells. At a quercetin concentration of 10(-5) M, we observed (in five different experiments) a mean recovery of 53% and 65% of erythroid blast-forming units (BFU-E) and granulocyte-macrophage colony-forming units (CFU-GM), respectively. Thus, normal bone marrow appeared partially resistant to quercetin, being inhibited less than 50% by quercetin concentration higher than 2 x 10(-5). When normal bone marrow were deprived in CD34+ haematopoietic progenitors the resultant population became highly sensitive to quercetin, with a mean recovery of BFU-E and CFU-GM of 5% and 12% of controls respectively in the presence of 2 x 10(-5) M quercetin. Furthermore, CD34 progenitors, positively selected, appeared fully resistant to quercetin concentrations as high as 2 x 10(-5) M. Thus, CD34+ progenitors are a quercetin-resistant component in normal bone marrow. In conclusion, our results further provide a biological basis for the therapeutic use of quercetin, considering that this compound could inhibit leukaemic cell growth without suppressing normal haematopoiesis.

[The incidence and clinical implications of left ventricular thrombosis in 769 patients with acute myocardial infarct treated with antithrombotics and fibrinolytics]

Seven hundred sixty-nine patients (pts) admitted to the Coronary Care Unit (CCU) between January 1987 and January 1990 suffering from first acute myocardial infarction (AMI) were studied. The presence of left ventricular thrombosis (LVT) was evaluated by two-dimensional echocardiography (2D-echo). The relation of LVT to site, size and intra-CCU clinical outcome of AMI, in terms of systemic embolic events, Killip class and mortality, was also assessed. AMI was transmural in 707 pts (92%), anterior in 446 pts (58%) and inferior in 261 pts (34%), non-Q in 62 pts (8%). Two hundred sixty-one pts (34%) were treated with IV thrombolytic therapy followed by IV heparin 1000 IU/h over 12 hrs and then calcium heparin (CH) 12500 IU s.c. bid; 508 pts (66%) were given only antithrombotic therapy (CH 12500 IU s.c. bid). 2D-Echo was performed within 48 hours and on day 5-7 from the onset of AMI. In 41 pts (5.3%) LVT was observed: 39 had anterior AMI (8.7% of all anterior AMI pts), one had inferior AMI (0.4% of all inferior AMI pts), and one had non-Q AMI (1.6% of all non-Q AMI pts) [p less than 0.001 for anterior AMI vs inferior and non-Q AMI]. Pts with LVT had a greater infarct size (number of akinetic plus dyskinetic segments/total number of segments x 100) compared to pts without LVT (32.3 +/- 12.6% vs 16.4 +/- 5.7%, p less than 0.001). In pts treated with thrombolytic therapy, LVT incidence was not significantly different from that of pts treated with antithrombotic therapy (4.2% vs 5.9%) alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of long-term administration of two beta-blocking agents on myocardial structure in spontaneously hypertensive rats

Two vasodilating beta-blockers, dilevalol and pindolol, were studied for their effects on the development of hypertension and left ventricular hypertrophy in spontaneously hypertensive rats. Dilevalol has agonist activity at beta 2-, whereas pindolol interacts with both beta 1- and beta 2-receptor subtypes. Groups of 7-week old spontaneously hypertensive rats were given dilevalol (30 mg/kg) or pindolol (3 mg/kg) in the drinking water for 3 months. A control group of spontaneously hypertensive rats and age-matched normotensive Wistar Kyoto rats were also used. Systolic blood pressure and heart rate were recorded weekly. Cardiac structural changes were determined by morphometric analysis. Control spontaneously hypertensive rats developed hypertension and left ventricular hypertrophy as compared with normotensive rats. Dilevalol and pindolol prevented the rise in blood pressure, but only dilevalol lowered heart rate. However, neither of the compounds prevented the development of left ventricular hypertrophy, but they differently influenced myocardial structure as measured by the volume fraction of fibrotic tissue in the left ventricle. Dilevalol markedly prevented the amount of fibrosis to a level comparable to that found in normotensive rats, whereas pindolol had a weaker effect. The data suggest that individual pharmacologic characteristics, such as partial agonist activity of each beta-blocker examined, may account for differential effects on the myocardial structure.

Immunodeficiency and plasma zinc levels in children with Down's syndrome: a long-term follow-up of oral zinc supplementation

To evaluate the possible effect of zinc treatment on immune disorders in children with Down's syndrome (DS), 38 noninstitutionalized DS children were investigated. Twenty-four patients (63.2%) had plasmatic zinc levels lower than 0.70 microgram/dl ("hypozinkemic," LZn) and 14 patients (36.8%) had levels higher than 0.75 microgram/dl ("normozinkemic," NZn). No correlation was found between the zinc deficiency and recurrence and/or intensity of infections. The absolute numbers of peripheral lymphocytes, the percentages of B lymphocytes, total T cells, and serum IgG, IgA, and IgM levels did not differ between the DS children and the controls. Eight (21%) patients had CD4+ T cell counts below the lowest value for the controls. Seventeen (44%) DS patients had increased levels of CD8+ T cells. The mean percentage of Leu 7+ cells in DS subjects (22.8 +/- 12.9%) was significantly higher than that in controls (15.8 +/- 4.8%) (P less than 0.01). Notably, Ig levels and numbers of lymphocytes in each subset did not show any significant difference in NZn and LZn trisomic subjects. On the contrary the peripheral blood mononuclear cells (PBMCs) from LZn DS children showed a significantly lower proliferative response to phytohemagglutinin (PHA) (S.I. = 23.4 +/- 22.4) than that of PBMCs from NZn DS children (S.I. = 46.1 +/- 21.5, P less than 0.01). A significant increase in DNA synthesis was obtained after oral administration of zinc sulfate (20 mg/kg/day, for 2 months). The lymphocyte response to PHA appeared to be normal in all patients up to 6 months after the end of the zinc treatment and it became low in half of the patients 22 months after therapy.

Detection of mRNA and hnRNA using a digoxigenin labelled cDNA probe by in situ hybridization on frozen tissue sections

A full-length cDNA clone encoding the constant region of T cell receptor beta chain was labelled by random priming DNA with digoxigenin-dUTP. The probe was used to estimate the relative amount of the receptor beta chain mRNA by in situ hybridization on frozen sections from human thymus and lymph nodes. The hybridization was visualized in blue using an anti-digoxigenin antibody conjugated with alkaline phosphatase and a subsequent enzyme-catalysed colour reaction. The distributions of the signal in tissue sections were as expected. Moreover, labelled cells showed hybrids both in the cytoplasm and in the nucleus, and strongly and weakly stained cells were clearly distinguishable. The results indicate that this method of in situ hybridization should be useful in the detection of specific mRNA in frozen sections.

Effects of acute administration of gallopamil on left ventricular relaxation and filling dynamics in acute myocardial infarction assessed by Doppler echocardiography

The purpose of this study was to assess the acute effect of an intravenous bolus of the calcium antagonist gallopamil on left ventricular diastolic function using Doppler echocardiography. Fifteen patients with acute myocardial infarction in the first Killip class and sinus rhythm were randomized to an intravenous bolus of gallopamil (50 micrograms/kg over 5 minutes) or placebo in a crossover sequence. Doppler echocardiography was performed at baseline and 15 minutes after each bolus. No patients had received calcium antagonists or beta blockers before the study; all patients received nitroglycerin, which was withdrawn at least 2 hours before the baseline Doppler echocardiogram. The following Doppler parameters were calculated: the early (E) and late (A) peak filling velocities, the velocities ratio (E/A), the diastolic filling time-velocity integral (TVI), the peak filling rate normalized to the mitral stroke volume (nMPFR), the isovolumic relaxation time (IVRT), and the systolic flow velocity integral (SFVI). Expressing the parameters measured after a gallopamil bolus as the percent change of those measured after placebo, E, E/A, and nMPFR increased by 25.5 +/- 11.5%, 30.6 +/- 15.5%, and 19.0 +/- 12.2%, respectively (p less than 0.001); IVRT decreased by 13.5 +/- 7.0% (p less than 0.001); and TVI increased mildly by 6.9 +/- 9.9% (p = 0.01). SFVI and A did not change significantly. Negligible differences were observed between placebo and baseline values. Heart rate, mean blood pressure, and left ventricular and atrial diameters did not change significantly. It was concluded that gallopamil infusion improves early left ventricular filling and relaxation in patients with acute myocardial infarction. Considering the unchanged loading conditions, this indicates an improvement in left ventricular diastolic performance.

Type II oestrogen binding sites in human colorectal carcinoma

Seven cases of colorectal adenocarcinomas were investigated for the presence of oestrogen receptors and progesterone receptors. The tumours specifically bound oestradiol. This binding almost exclusively resulted from the presence of high numbers of type II oestrogen binding sites. Oestrogen receptors were absent or present at very low concentrations. Immunohistochemical investigation of nuclear oestrogen receptors gave negative results. This indicates that antioestrogen receptor antibodies recognise oestrogen receptors but not type II oestrogen binding sites. The presence of specific type II oestrogen binding sites and progesterone binding offers further evidence for a potential role for these steroids and their receptors in colorectal carcinoma.

Cells immunoreactive for neuropeptide in human thymomas

The presence of opioid peptides, bombesin, and substance P was investigated by immunohistochemistry in tissue sections from six human thymomas. The number of immunoreactive cells seemed to vary from one case to another. Ultrastructural investigation, showing the presence of desmosomes in labelled cells, allowed these cells to be classified as epithelial lineage cells. The occurrence of cells containing neuropeptide in thymomas suggest that peptide molecules could have modulated the behaviour of this tumour, given the reported influence of these molecules on immune functions and their growth promoting activity on several cell types, including mesenchymal and epithelial cells.

Neuropeptide-immunoreactive cells in human thymus

The outer cortex of the human thymus contains a one- to two-cell-thick layer that is immunoreactive with antisera against beta-endorphin, (Leu)- and (Met)-enkephalin, bombesin, and substance P. The epithelial nature of these immunostained cells is revealed by immunoelectron microscopic studies showing the presence of desmosomal junctions. The presence of peptide-containing cells in the outer cortex, where the most immature and recently immigrated thymocytes are found, emphasizes the role of neuropeptides in regulating the microenvironment for T cell development.

Ventricular cross stimulation in a dual chamber pacing system: phenomenon analysis

Seven cases of ventricular cross stimulation from a group of 23 patients implanted with DDD devices are presented. In two patients the phenomenon was observed at the moment of DDD programming at nominal values, and in five other patients it was reproduced by increasing the atrial output voltage up to ten volts. In all 23 patients cross stimulation disappeared permanently within 24 hours after implantation. From the onset of cross stimulation to its end, atrial and ventricular threshold voltages were unchanged, while the atrial and ventricular impedances significantly decreased. These results suggest that an important role in the phenomenon occurs by impedance variation at the interface between the pulse generator and body tissue.

Type II estrogen binding sites (EBS) in intracranial tumors

Four meningiomas and six neuroepithelial tumors were assayed for the presence of estrogen receptors (ER), type II estrogen binding sites (EBS) and progesterone receptors (PgR). ER were detected in 7 out of 10 cases with levels ranging between 2.5 and 20.7 fmoles/mg of cytosolic protein. On the contrary, PgR were found in all samples (10 cases) and their levels ranged between 8.8 and 130.6 fmoles/mg of cytosolic protein. All tumor samples expressed appreciable amounts of type II EBS ranging between 452 and 2320 fmoles/mg of protein. Although the precise functional role of type II EBS is still unknown, their presence may reflect an hormonal sensitivity of these tumors.

Sialic acid and neuraminidase activity in the frog oviduct: comparative biochemical investigation in the different tracts during the reproductive cycle

1. A biochemical study was carried out on the protein-bound and lipid-bound sialic acid, and neuraminidase activity in the different tracts of the oviduct of the frog Rana esculenta during the reproductive cycle. 2. Plasma sexual steroids were also investigated by RIA. 3. Fluctuations in neuraminidase activity are related to that of glycoprotein sialic acid and plasma estradiol. Glycolipid sialic acid does not have a close relationship either with neuraminidase or plasma estradiol. 4. Very high plasma concentration of progesterone before ovulation and, on the contrary, its drop after ovulation were observed. 5. The results are discussed and hypotheses advanced to explain fluctuations of the studied parameters during the reproductive cycle.

Interleukin-2 receptor expression in human mast cells and basophils

Surgical human thymus, upper respiratory tract, lung and small and large bowel specimens were analyzed for the presence of interleukin 2 receptor (IL2-R)-positive cells. Histochemical (toluidine) and immunologic (anti-IL2-R monoclonal antibody) staining procedures revealed a distinct anti-IL2-R positivity in most of metachromatically staining cells. These positive cells were observed not only in tissues showing strong inflammatory reaction and mast cell hyperplasia, as in Crohn's disease, but also in those not histologically affected by pathologic conditions. This finding suggested that human mast cells, like T blast cells, express the p55 chain of IL2-R on their surface. To see whether IL2-R was being actively synthesized, a cell preparation rich in peripheral blood basophils (PBB), which are cells closely related to mast cells, was obtained. Ultrastructural analysis of PBB after indirect immunogold procedure revealed that the vast majority expressed the IL2-R. Moreover, the presence of intracellular reaction products in the cytoplasm of most membrane-positive PBB was indicative of active antigen synthesis. Furthermore, Northern blot analysis evidenced specific IL2-R mRNA in PBB, while its expression was augmented several times when PBB were cultured in the presence of stimulated T cell supernatant.

Oral administration of loxiglumide (CCK antagonist) inhibits postprandial gallbladder contraction without affecting gastric emptying

The effect of a single oral dose of loxiglumide, a cholecystokinin antagonist, on postprandial gallbladder contraction and on gastric emptying was evaluated in humans. Following a 12-hr fasting period, two tablets of loxiglumide (400 mg each) or placebo was administered on different days, in random order and in a double-blind fashion to 10 healthy volunteers 15 min before the ingestion of a 1050-kcal standard meal. Gallbladder and antral volumes were measured by real-time ultrasonography in basal conditions and at fixed time intervals after the meal. Oral loxiglumide administration was followed by a total inhibition of the gallbladder contraction for 60 min after the end of the meal ingestion. Thereafter, up to the end of the study period, gallbladder volume was larger than that of the placebo study (at 300 min after the meal 2.7 +/- 1.6 ml after placebo and 8.2 +/- 3.5 ml after loxiglumide; P less than 0.008). No difference between placebo and loxiglumide was found in the antral volumes at any time interval (postprandial 63.5 +/- 16.5 ml after placebo and 59.4 +/- 24 ml after loxiglumide; at 300 min after the meal 20.8 +/- 13.3 ml after placebo and 18.9 +/- 9.5 ml after loxiglumide). In conclusion, a single oral dose of loxiglumide at the dose of 800 mg can inhibit postprandial gallbladder contraction without affecting gastric emptying. It would therefore appear that in man endogenous CCK, released after a solid-liquid, caloric, nutrient-balanced meal, plays a major role in the contraction of the gallbladder but does not affect gastric emptying.

Long-term pressure-induced cardiac hypertrophy: capillary and mast cell proliferation

To determine whether a prolonged duration of mechanical load on the ventricular myocardium leads to capillary proliferation, constriction of the pulmonary artery was produced in rats at 3 mo of age, and the hearts were examined 200 days later. Functionally, elevations of right ventricular systolic pressure, from 30 +/- 12 to 67 +/- 11 mmHg, and right ventricular end-diastolic pressure, from 2.4 +/- 1.4 to 8.6 +/- 2.4 mmHg, were found. Anatomically, a 69% enlargement in right ventricular mass was observed, and this hypertrophic growth was characterized by a 78% thickening of the wall with no change in ventricular wall area, the latter calculated from the quotient of ventricular volume and wall thickness. Morphometric data showed a 44% increase in the capillary-to-myocyte ratio, a 66% augmentation of the total length of capillaries in the whole ventricle, and a 77% greater number of capillaries across the ventricular wall. Furthermore, these indexes of neogenesis of capillary units were associated with a more than three fold increase in the numerical density of mast cell profiles in the myocardium. In conclusion, capillary proliferation occurs in the adult rat heart, and this process appears to be coupled with mast cell hyperplasia.

Capillary growth in anemia-induced ventricular wall remodeling in the rat heart

To determine whether anemia-induced cardiac hypertrophy affects ventricular size and shape and the component structures of the capillary network of the left and right ventricles, young male rats were fed an iron- and copper-deficient diet for 7 weeks. By that time, blood hemoglobin content fell to 5 +/- 1 g/dl, and packed cell volume fell to 18 +/- 3%. To further characterize the implications of anemia, red blood cell number, hemoglobin corpuscular content, systemic arterial pressure, heart rate, and blood viscosity were measured. Moreover, the changes in ventricular weights were analyzed in terms of the alterations in ventricular wall area and ventricular wall thickness to establish the impact of the elevation in load associated with a high cardiac output state on ventricular remodeling. The quantitative properties of the capillary circulation were also examined biventricularly by low power electron microscopic morphometry to evaluate the adaptive growth potential of the coronary microcirculation in this form of cardiac hypertrophy. Anemia was found to interfere with the production of red blood cells and their mean corpuscular hemoglobin content and resulted in a 40% reduction in blood viscosity and a 12% and 27% decrease in systolic and diastolic blood pressure, respectively. The changes in heart rate were not statistically significant. In comparison with control animals, heart weight increased by 50%, but the enlargement in right ventricular mass (65%) was greater than that of the left ventricle (47%). Ventricular hypertrophy occurred with increases in wall area and wall thickness although the former increased consistently more than the latter in either ventricle. Tissue growth was accompanied by a 60% lengthening of the capillary network, which in combination with an increase in capillary diameter resulted in a 65% and 34% expansion in capillary luminal volume and 56% and 20% larger luminal surface density in the left and right sides of the heart, respectively. In conclusion, hypochromic microcytic anemia leads to eccentric ventricular hypertrophy with a significant amount of capillary proliferation that may tend to protect the myocardium from the increased potential for ischemic injury.

Morphometric analysis of coronary capillaries during physiologic myocardial growth and induced cardiac hypertrophy: a review

The quantitative structural properties of the ventricular myocardium with respect to its capillary concentration and distribution have been measured morphometrically during postnatal physiologic growth and later in life in the rat, and compared with those accompanying an increased load in the adult heart to determine whether induced cardiac hypertrophy is a pathologic condition or a form of accelerated myocardial growth. The following morphometric parameters of the capillary microvasculature were examined: 1. Capillary luminal volume density; 2. Capillary luminal surface density; and 3. The average diffusion distance for oxygen. The expansion of the ventricular myocardium during maturation shows a remarkable degree of well balanced compensatory response, because the capillary microvasculature and myocytes grow in proportion to the increase in cardiac mass. In older rats parenchymal cells increase more than the capillary network resulting in a reduction of the oxygenation potential of the tissue and local ischemic damage. Cardiac hypertrophy produced by pressure overload, volume overload and by a combination of both may also show alterations affecting capillary luminal volume and surface densities and the path length for oxygen molecular transport, which indicate an inadequate growth adaption of the component structures responsible for tissue oxygenation. In conclusion, myocardial enlargement that develops with age or as a result of an increased work load on the heart may lead to a conditioned state of the myocardium that can be expected to increase its vulnerability to ischemia as in pathologic cardiac hypertrophy.

[Sedation in ambulatory minor oral surgery: sublingual triazolam]

In a random trial on 40 patients undergoing extraction of the third lower molar 0.125 mg of triazolam were administered sublingually to 20 patients and placebo (lactulose solution 66.7%) to 20 patients. The sedative and amnesic effect rapidly appeared after triazolam while the anxiolytic effect was less pronounced. The recovery of psychomotor functions measured by standard psychomotor tests occurred rapidly and all patients were discharged after about 120 min from the end of the surgery. The judgment of the surgeon was positive as far as the anxiolytic and relaxing effects of triazolam was concerned. The patients treated with triazolam moreover appreciated the sedation induced by the drug. No cardiocirculatory complication was observed and the patients showed a considerable stability from the circulatory stand point. The results show that triazolam may represent a safe alternative to the use of other anxiolytic and sedative drugs in the minor surgery of the oral cavity.