Hyperbaric oxygen and thrombolysis in myocardial infarction: the ''HOT MI'' randomized multicenter study

Reactions mediated by the brain are part of the response to intraperitoneal administration of endotoxin, a model of gram-negative bacterial infection. To test the hypothesis that a compromised blood-brain barrier (BBB) may contribute to these reactions, the integrity of the BBB was measured following lipopolysaccharide administration. Rats received intraperitoneal injections of 50 microg/kg or 2 mg/kg of endotoxin. Brain uptake of a macromolecular vascular marker, 3H-labelled rat serum albumin, and of a poorly permeable low molecular weight substance, [14C]sucrose, was then measured with the intravenous bolus injection method. Compared to controls, neither dose of endotoxin affected the BBB permeability for these tracers. This was true when brain uptake was measured 5 min or 2 h after lipopolysaccharide injection. It is concluded that intraperitoneal endotoxin even at a high dose does not acutely disrupt the BBB.     

Electron-beam computed tomography: preliminary experiences in the Netherlands]

The difference between computer tomography (CT) and electron beam tomography (EBT) is that for CT the x-ray tube rotates in a ring round the patient, and for EBT the x-ray beam rotates itself. As a result, with EBT the speed of making images is not limited by the mechanical rotation of the tube, and 16 images can be made per second. An EBT scan of a whole thorax takes 9 seconds. Specific application areas are fast moving organs and patients who cannot remain in one position for long, e.g. children and intensive care patients. Research is being conducted into the possibilities of this non-invasive technique for the demonstration of coronary artery lesions, pulmonary embolism, pulmonary metastases and dynamic examination of the major respiratory tract. Costs of an EBT scan currently amount to Dfl. 450.--but they will probably decrease as this imaging system is developed further. The exposure to radiation is about the same as that caused by a (spiral) CT.     

Endopeptidase inhibitors decrease myocardial ischemia/reperfusion injury in an in vivo rabbit model

Periods of ischemia followed by reperfusion of the ischemic tissue are associated with myocardial damage and ventricular arrhythmia. Angiotensin converting enzyme inhibitors limit the occurrence of these arrhythmias. The protective effects of angiotensin converting enzyme inhibitors may be due to inhibition of bradykinin (BK) degradation, rather than inhibition of angiotensin II formation. Other enzymes which catabolize BK include the endopeptidases EP24.11 and EP24.15. The purpose of this study was to determine if inhibitors of EP24.11 and EP24.15 decrease ischemia/reperfusion injury and if this protection is mediated by BK receptors. Rabbits were anesthetized and prepared for recording of cardiovascular parameters. The chest was opened and a left ventricular artery occluded for 30 min, followed by a 2-hr reperfusion period. Infarct size was determined using triphenyl tetrazolium chloride staining immediately after reperfusion. The enzyme inhibitors, ramiprilat, N-[1-(R,S)-carboxy-3-phenylpropyl]-Phe-pAB, and N[1-(R,S)-carboxy-3-phenylpropyl]-Ala-Ala-Phe-pAb, singly and in combinations were administered 3 min before reperfusion. Compared to saline (32.1 +/- 2.1), ramiprilat (18.3 +/- 2.8) and the EP inhibitors (14.4 +/- 1.4 for the combination) significantly decreased infarct size, with the greatest decrease occurring when all three inhibitors were combined (10.6 +/- 1.5). The protective effect of the EP inhibitors was blocked by the BK2 receptor antagonist, HOE 140 (30.1 +/- 2.6). Enzyme assays demonstrated EP24.11 and EP24.15 in the rabbit heart. We conclude that the EP inhibitors decreased ischemia/reperfusion injury by protecting BK from metabolism and that a combination of inhibitors provides superior protection to that given by a single agent.     

Thoracic tumors in children with neurofibromatosis-1

Lymphocytes were isolated from volunteers before and after receiving a single supplement of vitamin C, vitamin E or beta-carotene. The lymphocytes were treated with H2O2, and DNA strand breaks were measured by single cell gel electrophoresis (the comet assay). Significant protection against oxidative DNA damage was evident 2-4 h after vitamin C intake, and 18-24 h after consumption of the other antioxidants. Lymphocytes from smokers were more sensitive to DNA damage than those from non-smokers, and they showed at least as great a protective effect with antioxidants.     

Erectile response to transurethral alprostadil, prazosin and alprostadil-prazosin combinations

PURPOSE: Transurethral alprostadil has been shown to be efficacious in many men with erectile dysfunction. We compared transurethral alprostadil and prazosin alone, and in combination to treat this disorder. MATERIALS AND METHODS: In this double-blind, placebo controlled study the erectile responses to transurethral alprostadil, prazosin and alprostadil-prazosin combinations were assessed in 234 men 26.8 to 81.5 years old with complete organic erectile dysfunction. Patients self-administered a random sequence of 7 doses in the clinic in 4 weeks. The erectile response was assessed using categorical and visual analog scales. RESULTS: Full penile enlargement or rigidity was achieved by 165 of the 234 men (70.5%) after at least 1 active dose of medication. The most effective alprostadil dose (500 microg.) resulted in full penile enlargement or rigidity in 51.8% of administrations, whereas the most effective prazosin dose (2,000 microg.) and placebo resulted in a similar response in 12.7 and 2.7%, respectively (p <0.001). The 500/2,000 microg. alprostadil/prazosin combination, which resulted in full enlargement or rigidity in 58.9% of doses, was only slightly better than the most effective dose of alprostadil alone (500 microg.). However, combinations of 125/500 and 250/500 microg. alprostadil/prazosin were more effective (p <0.01) than 125 and 250 microg. alprostadil given alone, respectively. The most common side effect of therapy was penile pain, which rarely led to study discontinuation. Hypotension most commonly developed at the higher alprostadil-prazosin combination. CONCLUSIONS: Transurethral alprostadil and alprostadil-prazosin combinations produced erections in men with complete organic erectile dysfunction. This combination therapy may be an option in patients who do not respond to transurethral alprostadil alone.     

Autonomic effects on noise recorded during signal-averaged electrocardiography

The purpose of this study was to assess the effects of autonomic stimulation and blockade on noise levels and to compare the noise measurements in the ST and TP segments of the signal-averaged ECG. Five-minute electrocardiographic data were recorded in 14 normal volunteers (8 males and 6 females; mean age 28.5 +/- 5.0 years) on two separate days (day 1-baseline, epinephrine infusion, isoproterenol infusion, beta-blockade, and combined adrenergic and parasympathetic blockade; day 2-baseline, phenylephrine infusion, parasympathetic blockade, and during phenylephrine infusion following atropine). Signal averaging was done off-line on 100 beats and noise was measured in both the ST and TP segments as the standard deviation of voltage in the segment of interest. For all conditions tested, the mean noise level measured in the ST segment (0.46 +/- 0.16 microV) was significantly less than that measured in the TP segment (0.52 +/- 0.24 microV; P = 0.0003), but there was good correlation between the noise measured in the ST and the TP segment (R2 = 0.62, P < 0.0001). Noise increased with isoproterenol infusion and decreased following adrenergic blockade. In addition, day 2 baseline noise was less than baseline noise on day 1. Finally, neither parasympathetic stimulation or blockade nor alpha-adrenergic stimulation significantly affected signal-averaged electrocardiography (SAECG) noise levels. Thus, the data support the notion that enhanced sympathetic tone increases noise levels and beta-adrenergic blockade may decrease noise levels, likely due to effects from muscle sympathetic nerve activity. These findings are important since the target population for the SAECG are patients with myocardial infarction and congestive heart failure, conditions associated with increased sympathetic tone, which may in turn impact on the reproducibility or technical aspects of the SAECG. In addition, because noise in the ST and TP segments are highly correlated and the noise measured in the ST segment is less than that in the TP segment, uniform adoption of noise measurement in the ST segment seems most appropriate.     

Microleakage of multi-step and simplified-step bonding systems

PURPOSE: To measure and compare the microleakage of Class V resin composite restorations using the following three pairs of multi- and simplified-step dentin bonding systems (DBS): OptiBond vs. OptiBond FL, All-Bond 2 vs. One-Step, and Tenure vs. Tenure Quik. MATERIALS AND METHODS: V-shaped cavities were prepared in the mesial and distal surfaces of 30 extracted human mandibular molars with margins in both enamel and cementum, and randomly assigned into three equal groups of 10 each. All DBSs were applied strictly following manufacturers' specifications before three incremental layers of resin composite (Pertac-Hybrid) were applied in all cavities. Specimens were stored for 7 days in 37 degrees C water, thermocycled for 300 cycles between 5 degrees C and 55 degrees C, immersed in 0.5% basic fuchsin solution for 24 hours, and embedded in resin before being sectioned longitudinally in multiple sections. Dye solution penetration at the tooth/composite interface was scored from 0 to 4 under a microscope at x100 at both enamel (E) and cementum (C) margins. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests with alpha = 0.05. RESULTS: OptiBond FL and One-Step showed less microleakage at the cementum margins compared to their multi-step versions. At the enamel margins Tenure Quik showed less microleakage compared to Tenure, and none of the other DBSs tested showed significant dye penetration at that interface. All DBSs showed significantly less microleakage at the enamel margins compared to the cementum margins except for OptiBond FL and One-Step that did not show any significant dye penetration at the cementum margins as well.