Lipoprotein(a) in Children of Asian Indian Descendants and Their Caucasian Neighbors: The Slovak Lipid Community Study

To elucidate a higher rate of premature cardiovascular disease (CVD) in Asian Indian descendants (Roma) in Slovakia, we investigated frequency distribution, correlates and relationship of lipoprotein(a) [Lp(a)] to family CVD risk factors in Roma children and their Caucasian neighbors. The study sample consisted of 607 healthy children aged 7-18 years (55% Roma, 48% male) as part of the biracial (Roma-Caucasian) Slovak Lipid Community Study. Overall, frequency distribution data of Lp(a) were highly skewed to low concentrations, with markedly higher Lp(a) levels in Roma than in Caucasian children (median and range, mg/dL: 14.5; 0-159.2 vs 6.2; 0-112.3, P < 0.001), regardless of age and gender. Lp(a) was positively correlated with apo B (0.159, P = 0.004) in Roma, and LDL cholesterol (0.170, P = 0.005) in Caucasian children. In addition, daily income of the family was negatively related with Lp(a) in Roma (-0.134, P = 0.036) while positively in Caucasians (0.136, P = 0.047). For both race groups, no significant association was found between Lp(a) and age, body mass index, mean arterial pressure, smoking, and physical activity. Also, no significant relationships were examined between serum Lp(a) levels >30 mg/dL in children and family CVD risk factors, except for diabetes mellitus in parents of Caucasian origin (OR 4.46; 95%CI: 1.23-16.20). In a multivariate analysis, daily income, LDL cholesterol or apo B explained ~7% of the variance of Lp(a). This study suggests a significantly higher serum Lp(a) levels in Roma than in Caucasian children and a small effect, in general, of relevant CVD risk factors on the variation of Lp(a) levels in childhood.

Cytosolic free Ca2+ concentration in canine aortic endothelial cells lining the polyester arterial prosthesis

A rise in baseline cytosolic free Ca2+ in canine vascular endothelial-like cells (VEC) lining the luminal surface of the polyester arterial prosthesis is described. In one, three and six month implantation experiments we employed six adult mongrel dogs, polyester arterial prostheses Arteknit Ra K, fluorescent Ca2+ indicator Fura-2 and digital imaging microscopy to study cytosolic free Ca2+ in cultured VEC. The electron microscopy scanning of the luminal surface in different regions of the graft were also performed. A rise in cytosolic free Ca2+ in the VEC lining the luminal surface of the prosthesis is probably the result of the immunologic reaction and mechanical stress which stimulate the proliferation activity of the endothelial cells. It seems that the baseline cytosolic free Ca2+ reflects the course of the endothelization process on the polyester arterial prosthesis.

[Management of ventricular tachycardia after acute myocardial infarct]

BACKGROUND

Risk stratification of malignant ventricular tachyarrhythmias and sudden cardiac death after myocardial infarction is essentially important for high risk patients identification, who require specific therapeutic procedures. Non-invasive risk markers--LVEF, late potentials LP, Q-T dispersion, decreased heart rate variability (HRV) and baroreflex sensitivity (BRS)--and ventricular tachycardia inducibility have low positive predictive value. The appropriate combination and consecutiveness which will provide most precise identification of patients threatened by sudden arrhythmic death, applicable to all patients after myocardial infarction, is being analysed.

METHODS

In a group of 87 patients after myocardial infarction suffering from ventricular tachycardia retrospective assessment of sudden cardiac death risk markers incidence was performed.

RESULTS

1. The most frequent risk marker was LVEF 0.40 (48.3%), abnormal LP (84.9%), DQT 80 ms and decreased HRV (73.1%) and their combinations. 2. Patients with inducible ventricular tachycardia (62.1%) had lower LVEF in comparison with non-inducible ventricular tachycardia patients (0.42 +/- 0.11 vs 0.51 +/- 0.01, p = 0.002), higher QT dispersion (85.0 +/- 30.5 ms versus 63.6 +/- 30.7 ms, p = 0.003). 3. In patients with recurrent malignant ventricular tachyarrhythmias and sudden cardiac death occurring during the follow-up is sustained inducible ventricular tachycardia with antiarrhythmic therapy and induction of ventricular tachycardia during native state significantly more frequent. LVEF is significantly reduced, FQRS on SAECG is significantly prolonged, DQT is significantly higher.

CONCLUSION

On the basis of the results and data from literature the authors recommend LVEF assessment in all patients after myocardial infarction and further stratification in patients with left ventricular dysfunction.

[Risk factors and prevention of sudden cardiac death in patients with ventricular tachycardia after myocardial infarct]

The optimal therapeutic procedure for prevention of sudden cardiac death (SCD) after myocardial infarction involves identification of the patients with a high risk of malignant ventricular arrhythmias using non-invasive risk markers, invasive electrophysiological evaluation of high risk patients, selection of treatment (ICD, RFTA, antiarrhythmics) and evaluation of the effectiveness of treatment. The objective of this work is retrospective evaluation of the incidence of risk markers of sudden cardiac death and the importance of programmed ventricular stimulation for the prognosis of patients with malignant ventricular arrhythmias after myocardial infarction.

RESULTS

1. Retrospective analysis of 87 patients with ventricular tachycardia (VT) after myocardial infarction confirmed a high incidence of non-invasive risk markers. 2. For the long-term course a combination of the left ventricular ejection fraction (LVEF) < 0.40 + reduced heart rate variability (HRV) and abnormal ventricular potentials are most important (or dispersion of QT > 80 ms). The absence of ventricular extrasystoles on the Holter monitor does not predict the course without malignant arrhythmical episodes. 3. There is a statistically significant relation to the inducibility of BP during programmed ventricular stimulation with LVEF, persisting BP, RMS voltage of the terminal 40 ms (RMS40) and QT dispersion. 4. The inducibility of BP and persistence of inducibility on antiarrhytmic drugs in patients with LVEF < 40 is associated with a 14.8% incidence of SCD within four months after the first arrhythmic episode. The authors recommend to examine LVEF as the basis of risk stratification of SCD along with values of coronary reserve after myocardial infarction. In patients with LVEF (they recommend to examine Holter s monitor (assessment of HRV and analysis of ventricular arrhythmias) and mean ECG. Abnormal late ventricular potentials, reduced HRV or BP indicate programmed ventricular stimulation.

[Dispersion of the Q-T interval after myocardial infarct]

Non-homogenity of ventricular myocardial repolarization is a substrate for the reentry mechanism of ventricular arrhythmias. It is manifestant by dispersion of Q-T and Q-Tc intervals on the standard ECG curve. The authors studied the possibility of using the dispersity of Q-T and Q-Tc intervals in clinical practice. They evaluated the dispersion of these intervals within the set of 21 patients after myocardial infarction with sustained ventricular tachycardia, and compared it with the dispersion within the control set of 17 patients after myocardial infarction without an arrhythmic episode. By means of comparison, they have discovered that: 1) the dispersion of Q-T and Q-Tc intervals is significantly higher in patients with ventricular tachycardia: Q-T (mean +/- SE) 82.8 +/- 7.8 msec vs 42.2 +/- 4.8 msec, Q-Tc 93.0 +/- 10.2 msec vs 47.1 +/- 4.8 msec, p > 0.001, 2) the dispersion of Q-Tc when higher than 60 msec is an optimum discrimination value for the prognosis of sudden arrhythmic death after myocardial infarction (sensitivity 81%, specificity 76%) and 3) the dispersion of Q-T and Q-Tc intervals has no relation to the function of the left ventricle. Therefore the authors consider the dispersion of Q-T and Q-Tc intervals as being a useful marker of malignant ventricular arrhythmia which could be included into the algorithm of assessment of the risk of sudden arrhythmic death after myocardial infarction.

Importance of lipid peroxidation, protective enzymes and trace elements in chronic leg ischaemia

The aim of this study was to assess the lipid peroxidation in chronic leg ischaemia by determining thiobarbituric acid reactants. Furthermore, Cu, Zn-superoxide dismutase and glutathione peroxidase activities as well as the trace element profile (Zn, Cu, Se, Mg) were determined. Fasting blood samples from the common femoral artery and vein were taken from both legs of 15 patients (57 +/- 7 years) with peripheral arteriosclerosis and 9 individuals (54 +/- 9 years) of the control group without chronic leg ischaemia. Patients with peripheral arteriosclerosis showed significantly decreased venous thiobarbituric acid reactant levels (2.01 +/- 0.37 vs. 2.39 +/- 0.59 mumol/l in controls, p < 0.05). Both arterial and venous samples from patients showed lower Cu, Zn-superoxide dismutase activities and higher glutathione peroxidase activities than controls. Venous activities of glutathione peroxidase were significantly higher than arterial activities in both groups (patients 0.52 +/- 0.18 vs 0.43 +/- 0.15 mukat/g Hb, p < 0.001, control group 0.51 +/- 0.12 vs 0.39 +/- 0.19 mukat/g Hb, p < 0.01). The trace element profile of the patients showed a highly significant decrease in magnesium levels (p < 0.001) and increased venous copper levels (p < 0.05). No significant changes were found in zinc and selenium levels. The results of this study show that during chronic leg ischaemia the production of free oxygen radicals at rest is well controlled, but the activity of antioxidant enzymes seems to be impaired.

Primary retroperitoneal mucinous cystadenocarcinoma

A case of primary retroperitoneal cystadenocarcinoma is presented as the fourth reported case in the world literature to date. The cyst was removed intact and demonstrated an infiltrating malignant process with nuclear pleomorphism and mitotic activity. No ovarian tissue was identified and a cancer antigen 125 (CA 125) test was normal. The patient underwent a staging procedure subsequently that included peritoneal washings, hysterectomy, bilateral salpingoophorectomy, and iliac node dissection. No metastases were found and the patient is without recurrence 22 months postoperative. The literature is reviewed to better define the origin and prognosis of these tumors.

Foreign body reactions secondary to cellulose lint fibers

Twenty-four cases of foreign body reactions secondary to cellulose lint fibers have been identified in three Portland area hospitals over a 5 year period. Ten of these cases involved extraperitoneal granuloma and 14 cases intraperitoneal granuloma. Six of the intraperitoneal reactions resulted in acute granulomatous peritonitis, and one of these patients died from this complication. Twenty-two additional operations were performed on these patients because of complications directly associated with this reaction. As estimated 400 days of additional hospitalization were required secondary to complications of foreign body reaction. Several precautionary measures have been identified that have decreased the incidence of this complication in our hospitals. Polypropylene drapes and gowns may provide a solution to this problem in the future.

Surgical implications of infectious mononucleosis

A series of 50 consecutive patients admitted to the hospital with a primary diagnosis of infectious mononucleosis is reviewed, with particular emphasis on the abdominal complaints and physical findings. Forty-eight percent of the patients had abdominal pain. Abdominal symptoms were the chief complaint in 24 percent of the patients. Two cases of splenic rupture are presented. One case of spontaneous rupture of the spleen is emphasized, as there are only 18 well-documented cases of true spontaneous rupture of the spleen in infectious mononucleosis. Four young persons with infectious mononucleosis in Portland, Oregon, recently bled to death at home from a ruptured spleen. Guidelines are presented to aid the surgeon in evaluating the patient with infectious mononucleosis. The risk of splenic rupture persists after the patient recovers. Recommendations are made regarding the resumption of physical activity in these young, active patients.