Testis morphometry in varicocele

This study was conducted to evaluate morphometrically the microscopic components of the testis in cases of varicocele, the leading cause of male infertility, with the aim to identify consistent differences from controls. In our specimens of patients with varicocele, the vascular and interstitial fractions, as well as the Leydig cell count, were significantly increased. Our data support the notion that the interstitium is the testicular compartment most consistently affected and that the damage to the tubules is erratic and probably late.

Mitotic activity of schwannomas

A significant (p less than 0.01) difference in the mitotic index between 31 benign and 4 malignant schwannomas is reported. An increased mitotic activity has been related to malignancy in previous works, although no statistical studies have been carried out on its diagnostic value. Our results suggest that the mitotic index should be considered an effective, convenient feature of distinction in doubtful instances, especially as no other trait of malignancy can be similarly measured.

Diagnostic value of electrocardiogram and vectorcardiogram in postinfarction ventricular asynergy

The ability of ECG-VCG to predict the severity of postinfarction LV asynergy was evaluated in 152 patients with previous myocardial infarction who underwent left cineventriculography in the right anterior oblique view. Various ECG and VCG signs were examined in order to predict the existence of severe asynergy in general (dyskinesia or akinesia or severe hypokinesia) and of dyskinesia in particular. In patients with inferior myocardial infarction (Group A) persistent ST segment elevation was the only specific ECG sign (100%) of severe asynergy; it had a poor sensitivity (6.2%). Four frontal VCG signs (presence of terminal bite, y- greater than 0.18 mV, maximum early superior vector along x axis = MESV greater than or equal to 1.3 mV, duration of initial superior forces = DISF greater than 50 msec) increased the sensitivity of the ECG-VCG method to 75.8% while maintaining a 100% specificity. Regarding the diagnosis of dyskinesia, only the ECG sign of persistent ST segment elevation and the VCG sign of y- greater than or equal to 0.3 mV had a 100% specificity. The sensitivity of the ECG-VCG method was 33.3% (16.6% ECG and 16.6% VCG). In patients with anterior myocardial infarction (Group B), concerning the diagnosis of severe asynergy, the ECG signs of sigma ST greater than 3 mm in anterior leads; pathologic Q wave in four or more anterior leads (including D1 and aVL); and the presence of LAH or LAH + RBBB, had a 100% specificity and a good sensitivity (60.5%). The VCG sign of a narrow horizontal QRS loop increased the sensitivity of the ECG-VCG method to 71% while maintaining a 100% specificity. As for the diagnosis of dyskinesia, the ECG signs with a 100% specificity were sigma ST greater than or equal to 5 mm in anterior leads, a pathologic Q wave in more than five anterior leads (including I and a VL) and RBBB + LAH; these variables had a sensitivity of 48.3%. The VCG sign of a narrow horizontal QRS loop increased the sensitivity of the ECG-VCG method to 79.3% while maintaining a 100% specificity. In patients with inferior plus anterior myocardial infarction (Group A + B) the signs mentioned above for each group were evaluated, confirming a 100% specificity. Regarding the diagnosis of severe asynergy, the ECG signs had a sensitivity of 61.3%, while VCG increased the sensitivity of the ECG-VCG method to 90.3%.(ABSTRACT TRUNCATED AT 400 WORDS)

[Determination of cardiac output by thoracic electric impedance: comparison with thermodilution]

When an alternating current of high frequency is applied to the thorax, the first derivative of the impedance (dZ/dt) is affected by the cardiac cycle, resulting in a characteristic wave form. The maximum negative of this wave occurring during systole together with the length of ejection time (VET), the blood resistivity, the basal impedance (ZO) and the distance between the inner detecting electrodes (L) makes it possible to calculate stroke volume (SV) and related parameters, as cardiac output (CO) and cardiac index (Cl) by a formula developed by Kubicek. Thoracic electrical impedance has been proposed as a non invasive technique to evaluate cardiac emodinamics. In the present study we have evaluated thoracic electrical impedance by comparing it with thermodilution, simultaneously performed in 21 catheterized patients. Reproducibility was assessed by comparing Cl measured several times in the same patient during ten minutes of rest in the supine position: coefficient of variation, expressed as CV = SD/m X 100 was 8,5 +/- 4,2% and 9,4 +/- 3,2% (p = NS) for thermodilution and thoracic electrical impedance respectively. Cl values obtained by both methods correlated well, with little scatter either baseline (r = 0,784, n = 40, p less than 0,001), either after an handgrip manoeuvre (r = 0,629, n = 15, p less than 0,05). This degree of correlation is similar to that observed comparing invasive techniques (Fick, thermodilution, dye dilution) either among them, or with noninvasive methods (echocardiography, gated equilibrium blood pool scintigraphy and ultrasonic Doppler).(ABSTRACT TRUNCATED AT 250 WORDS)

Nomogram for calculation of stenotic cardiac valve areas from cardiac output and mean transvalvular gradient

In 15 patients (group 1) with isolated mitral stenosis and in 14 patients (group 2) with isolated aortic stenosis the stenotic valve areas were calculated according to: A) Gorlin's formula; B) Hakki's simplified formula, using mean mitral gradient by planimetry or peak-to-peak aortic gradient; C) the three-point simplified formula, using mean gradient calculated by the three-point method for both mitral and aortic valve. The three-point method is definitely easier to use than planimetry. The values (mean +/- SD) of mitral valve areas in group 1 patients were, respectively: 1.56 +/- 0.63 cm2; 1.56 +/- 0.55; 1.51 +/- 0.53. The values of aortic valve areas in group 2 patients were: 0.91 +/- 0.63; 0.77 +/- 0.41; 0.88 +/- 0.52. An excellent correlation was shown between the valve area calculated by Gorlin's formula and both Hakki's simplified formula and the three-point simplified formula. For aortic valve area the correlation is even better if the mean gradient by the three-point method is used instead of the peak-to-peak gradient. On the basis of the simplified formula, a nomogram was constructed which allows an immediate calculation of valve areas from cardiac output and transvalvular gradient.

[Duration of electric systole in the acute phase of myocardial infarct. Methodology, natural history, semiological value, therapeutic consequences]

Extension of the duration of electric systol in the acute phase of coronary thrombosis can be analysed in satisfying conditions whatever the physiological frequencies by the measurement (formula; see text) represents the average QT measurement of three non-consecutive complexes in five derivations (DI, DIII, aVF, VI and V6). This extension is of prognostic value when the QTc is greater than 44 c/s. Out of 1 255 acute phase thrombosis patients, 18 Out of 20 cases of ventricular fibrillation revealed a QTc greater than 44 c/s in the 24 hours preceding sudden death. Therapeutic intervention with anti-andrenergic drugs such as bretylium tosylate or beta-blocking agents appears to reduce the QTc of these patients and thus prevent sudden death.

Criss-cross heart with discordant atrioventricular connections

A case of criss-cross heart is presented in which there was situs solitus with atrioventricular (AV) discordance and single outlet, the aorta arising from the right ventricle. Associated lesions were pulmonary atresia and ventricular septal defect. The apparently normal AV relation in the presence of a discordant AV connection can be explained by the hypothesis that an embryonic l-bulboventricular loop developed and was followed by marked counter-clockwise rotation of the ventricles.