Clinical aspects of biclonal myelomas

In this study, a cohort of 109 patients with multiple myeloma were followed prospectively. Eight patients (7%) were found to have biclonal M component, an occurrence rate considerably higher than that reported in literature. Biclonal myelomas were compared with the other monoclonal variants of myeloma by a number of biologic, clinical, immunological, biochemical, roentgenological, therapeutical and prognostic parameters. Among the biclonal myeloma patients there was strong male predominance, higher frequency of patients in advanced stage of the disease, combined production of predominantly kappa light chains, hypoalbuminemia and thrombocytopenia. Their response to therapy did not differ from that of the patients with monoclonal myeloma variants. The median survival of patients with biclonal myelomas was 25 months, ranking third by shortened survival after patients with light chain and D-type myelomas.     

Ischemia-associated intraventricular conduction disturbances during exercise testing as a predictor of proximal left anterior descending coronary artery disease

To determine the incidence and significance of transient intraventricular conduction abnormalities occurring in association with myocardial ischemia during exercise testing, the recordings of 2,200 consecutive exercise tests were reviewed. Ten patients (0.45%) were identified as having both ischemia and intraventricular conduction abnormalities that developed transiently during the exercise test. In all 10 patients both typical angina and electrocardiographic evidence of ischemia developed during exercise. Among the 10 patients, left anterior hemiblock developed in 4, left posterior hemiblock in 2, right bundle branch block (RBBB) in 2, RBBB with left axis deviation in 1, and left anterior hemiblock progressing to complete left bundle branch block (LBBB) in 1. All 10 patients had cardiac catheterization showing significant obstruction of the left anterior descending (LAD) coronary artery at or before the origin of the first septal branch. Eight patients were treated surgically and 2 medically, all with relief of ischemic symptoms. Nine of the 10 had repeat exercise stress testing without angina or electrocardiographic evidence of ischemia and without recurrence of the transient intraventricular conduction disturbance. It is concluded that the development of transient intraventricular conduction abnormalities associated with myocardial ischemia during exercise testing is an uncommon occurrence (0.45%). When such conduction disturbances do develop, the existence of significant disease in the proximal portion of the LAD coronary artery is strongly suggested. With control of myocardial ischemia, the transient conduction disturbances during exercise are ameliorated.     

Inhibition of head and neck squamous cell carcinoma growth and invasion by the calcium influx inhibitor carboxyamido-triazole

Local invasion and lymph node metastasis are correlated with a decreased overall survival in head and neck cancer patients and warrant new strategies to intervene in the metastatic cascade. One approach is to focus on the intracellular signaling pathways underlying the metastatic process. A common regulatory point in several signal transduction pathways is intracellular calcium homeostasis. We assessed the effect of a novel calcium influx inhibitor, carboxyamido-triazole (CAI), on the growth and invasive phenotype of cell lines derived from head and neck squamous cell carcinoma (HNSCC). CAI inhibited the growth of FaDu and EVSCC17M cells in a dose-dependent (IC50, 13-15 microM) and reversible manner. CAI also caused a generalized attenuation of receptor-mediated calcium elevation to several calcium mobilization agonists, including epidermal growth factor and bradykinin. The effects of CAI on the invasive phenotype of HNSCC cell lines were assessed by a chemo-invasion assay. HNSCC cell lines exhibited a range of invasive potential as measured by the capacity of tumor cells to penetrate a reconstituted basement membrane of Matrigel. HNSCCs were classified as highly invasive (EVSCC14M and EVSCC17M) or weakly invasive (EVSCC18, EVSCC19M, UMSCC10A, and FaDu). Treatment of HNSCC cell lines with 10 microM CAI for 24 h reduced invasion 2-14-fold in a dose-dependent manner. HNSCCs also exhibited different motilities as measured by a chemotaxis assay. EVSCC14M and EVSCC17M were highly motile, whereas EVSCC18, EVSCC19M, UMSCC10A, and FaDu were less motile. CAI reduced the migration of all cell lines. Conditioned medium from HNSCC cell lines was analyzed by zymography for production of Mr 72,000 type IV collagenase [matrix metalloproteinase (MMP)-2)] and Mr 92,000 type IV collagenase (MMP-9). All HNSCC cell lines secreted MMP-2 and/or MMP-9 into conditioned medium. Treatment of cells with 10 microM CAI for 24 h resulted in a reduction of both MMP-2 and MMP-9 production. The results demonstrate that CAI blocks cellular proliferation, migration, chemoinvasion, and MMP production by HNSCC in vitro and identify calcium-dependent signaling as a new target for inhibition of the malignant phenotype of HNSCC.     

Avoiding litigation in an implant practice

The increase of low-density lipoproteids contents, high-density lipoproteids level lowering, reduction of the lymphocytes blast transformation reaction indexes, IgG level lowering, the rosette formation reduction were noted in patients with an acute pancreatitis. While the programmed relaparotomy application of the lipid-aliphatic metabolism restoration was noted, and the immunological reactivity as well with the dynamics higher than after single operative intervention conduction.     

The regulatory mechanisms of the blood respiratory function in iron-deficiency anemias

Experience of vascular thrombosis prophylaxis and treatment after reconstructive operation conduction on abdominal aorta and peripheral arteries in 244 patients, including 112 of them immediately after the operation, 32-up to one year time, 100-in long-term follow-up period was summarized. Main aetiological cause for thrombosis occurrence immediately after the operation were technical and tactical failures committed during its conduction, in the early postoperative period-the neointima hyperplasia in the anastomosis area, in late terms-the blood outflow disorder from the reconstructed segment due to the atherosclerosis progression. Original methods of reoperation conduction for the transplant thrombosis and the outflow arteries reconstruction were proposed. Mortality lowering from 8.8 to 5.3% and the extremity revascularization occurrence, in 75% of patients immediately after the operation and in 84%-in long-term period was promoted owing to tactics of postoperative thrombosis treatment elaborated.     

Methods of intestinal drainage for an acute mechanical ileus

There were examined 362 patients with acute small intestine ileus (SII). It was established, that retrograde intubation according to Zhitnyuk is necessary to apply while treating low SII, especially in patients of elderly and senile age with concomitant cardiovascular and respiratory systems diseases. In patients with an adhesive SII the application of nasogastrointestinal intubation in combination with respiratory therapy is indicated. The jejunostomy with one-stage intestinal intubation via enterotomic hole application is mandatory for high SII, especially if an early enteral feeding is necessary. One-stage intestinal intubation via enterotomic hole as the independent method may be applied for intestinal preparation before the one-stage radical operation conduction.     

The early diagnosis of the severity of blast trauma to the brain and auditory system]

This paper presents the information on the early period of an explosive head trauma and trauma to the auditory system. Different types of hearing impairment, the staging of the pathological process were determined along with various immunological and biochemical changes occurring in this group of patients. The results of the study call for necessity of the early ENT observation of all patients in whom an explosive trauma is suspected.     

The role of smoothing techniques in the interpretation of results from genomic scans using sib-pair data

BACKGROUND: Budesonide, a corticosteroid with high topical anti-inflammatory activity and low systemic activity, has been shown to prolong time to relapse in Crohn's disease. In the present study, the efficacy of budesonide in an oral pH-modified-release formulation was evaluated for maintenance treatment in patients with steroid-dependent ulcerative colitis. METHODS: Fourteen patients with steroid-dependent ulcerative colitis in the reduction phase of conventional glucocorticosteroids (c-GCS) following a severe attack, were treated with budesonide 3 mg t.d.s. for 6 months. The primary investigation parameters were changes in the clinical activity index (CAI) and in the daily dose of c-GCS. RESULTS: In 11 cases the CAI improved significantly and treatment with c-GCS could be terminated. Three patients experienced relapse and needed further c-GCS treatment. The average daily dose of c-GCS and the average value of the CAI before treatment with budesonide were significantly higher in the relapse group than in the remission group. CONCLUSIONS: In patients with c-GCS-dependent ulcerative colitis, a dose of 9 mg budesonide daily in an oral pH-modified-release formulation was well tolerated, significantly decreased the CAI, and rendered c-GCS unnecessary in the majority of cases.     

The biological properties of Haemophilus influenza isolated from healthy children and from patients with acute and chronic respiratory diseases

The comparative study of the biological properties of H. influenzae strains isolated from healthy children and from patients with acute and chronic respiratory diseases has been made, taking into account the biochemical features (biotypes) and adhesive activity of these strains. Differences in various biotypes of H. influenzae strains isolated from patients with bronchopulmonary diseases and from healthy carriers have been established. H. influenzae strains isolated from various sources differ by their adhesive properties: strains isolated from patients with acute bronchopulmonary diseases have the highest adhesive activity, while strains isolated from healthy controls have the lowest adhesive activity. The data thus obtained indicate the possible dependence of the degree and duration of the colonization of the respiratory tract by H. influenzae on the biological properties of these microorganisms. The monitoring of the sensitivity of H. influenzae strains to antibiotics has demonstrated that these strains retain high sensitivity to ampicillin, chloramphenicol, gentamicin and exhibit a tendency towards an increase in resistance to penicillin and erythromycin.     

Extracorporeal blood correction in the therapy of drug-resistant mental disorders

544 patients resistant to pharmacotherapy were treated by different methods of extracorporal hemocorrection (EH). Positive changes in mental state were achieved in more than half of the patients by means of EH without any psychopharmacologic drugs. These changes were caused by antipsychotic and antidepressive effects of EH as well as by its ability to normalize biochemical, immunological and rheological blood indices     

Nortropane-3beta-acetic acid, tropaquinuclidine and dehydrotropaquinuclidine (author''s transl)]

The greater decrease of conduction velocity in sensory than in motor fibres of the peroneal, median and ulnar nerves (particularly in the digital segments) found in patients with chronic carbon disulphide poisoning, permitted the diagnosis of polyneuropathy to be made in the subclinical stage, even while the conduction in motor fibres was still within normal limits. A process of axonal degeneration is presumed to underlie occurrence of neuropathy consequent to carbon disulphide poisoning.     

Heterologous fibrinogen for tissue adhesion. immunological and histological investigations (author's transl)

The immunological reactions of heterologous fibrin were investigated in a sensitive experimental system. In 10 rabbits autologous full-thickness skin grafts were glued with bovine fibrinogen cryoprecipitate. 5 of these animals had been immunized against this adhesive before transplantation. In a control group the graft was fixed with homologous fibrinogen cryoprecipitate. Examination of the sera of the animals for antibodies against fibrinogen was performed before immunization, 1 day prior to and 14 days after skin grafting. 14 days after skin adhesion all grafted areas were examined by histological methods. In the group without preoperative immunization antibodies were found against fibrinogen. The skin graft healed in this series in the same manner as in the sham group. In the series with preoperative immunization the glued skin graft was discharged early and the healing procedure of the defect was retarded.     

Clinical picture of cardioborreliosis: from AV block to perimyocarditis

The third degree A-V heart block with severe Adams-Stokes attacks in nine patients with Lyme borreliosis was described. All patients had similar clinical picture: previously healthy with syncope as abrupt onset of the disease. Data on skin changes--erythema migrans--were obtained subsequently although the patients did not recall being bitten by a tick. Diagnosis was based on clinical manifestation, and on positive serologic tests to Borrelia. After the administered therapy (on admission atropine 0.5 mg i.v., and/or isoproterenol 0.02 mcg/kg/min, temporary pace-maker in two patients; and after proved diagnosis penicillin 20 mil. unit per day 10 days, and tetracyclin 2.0 gr per day 20 days A-V block returned to sinus rhythm with normal A-V conduction, and all biochemical parameters returned to normal limits. Perimyocarditis is not rare during Lyme borreliosis, but in this case infection syndrome is dominant.     

Sex difference in the mortality trends of acute myocardial infarction in Taiwan, 1974 to 1993

The nutritional status of 75 maintenance hemodialysis (MHD) patients was evaluated according to the dietary intake analysis, anthropometric measurements, biochemical and immunological parameters in this study. Furthermore, some possible factors which would affect nutritional status of hemodialysis patients were discussed. The results showed that hemodialysis patients demonstrated a high incidence of malnutrition. The low intake of protein and calorie, metabolic acidosis and inadequate dialysis would worsen the malnutrition while erythropoietin treatment improve the nutritional status of hemodialysis patients. Based on these results, suggestions were proposed for the improvement of nutritional status of MHD.     

Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans

BACKGROUND: During atrial fibrillation (AF), the atrium is activated by multiple wavelets that continuously change in size and direction. The aim of this study was to correlate the temporal variation in AF electrogram configuration with the varying spatial patterns of activation. METHODS AND RESULTS: In a group of 25 Wolff-Parkinson-White patients undergoing cardiac surgery, the free wall of the right atrium was mapped (244 points) during electrically induced AF. The unipolar electrograms recorded during 4 seconds of AF were classified into four categories: (1) single deflections, (2) short-double potentials, (3) long-double potentials, and (4) fragmented potentials. The proportion of these four types of electrograms during AF was as follows: singles, 77 +/- 12%; short-doubles, 7 +/- 3%; long-doubles, 10 +/- 7%; and fragmented, 6 +/- 4%. Electrogram morphology was an indicator for rapid uniform conduction (single potentials; positive predictive value [PPV] of 0.96), collision (short-double potentials; PPV of 0.33), conduction block (long-double potentials; PPV of 0.84), and pivoting points or slow conduction (fragmented potentials; PPV of 0.87). In type I, II, and III AF, the proportion of long-double potentials was 4 +/- 2%, 12 +/- 3%, and 18 +/- 7% (P < .05); the proportion of fragmented complexes was 2 +/- 2%, 6 +/- 3%, and 10 +/- 4% (P < .05), respectively. During electrically induced and self-terminating episodes of AF, no preferential anatomic sites for double or fragmented potentials were found in the right atrium. CONCLUSIONS: The morphology of single unipolar electrograms during AF reflects the occurrence of various specific patterns of conduction. This might be used to differentiate between different types of AF and to identify regions with structural conduction disturbances involved in perpetuation of chronic AF.     

Diagnostic and therapeutic punctures of pancreatic cavities under control of ultrasonic investigations

Transcutaneous puncture of pancreatic cavities under ultrasonographic control was conducted in 68 patients. The cavity contents investigation using cytological, bacteriological and biochemical methods was conducted. The method permits to diagnose the cavity, its connection with ductal system of pancreas, to select the adequate antibacterial therapy, to conduct the cavity decompression before the operation. It may be applied for symptomatic treatment conduction. There were no complications observed as a consequence of the procedure.     

On the experimental distinction between ssbs and dsbs in circular DNA

Positive serum anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA) have been reported in 10-66% of patients with chronic hepatitis C virus (HCV) infection from Western countries. However, the mechanism involved in this immunological disorder is still unknown. This study was carried out to evaluate the prevalence and clinical significance of positive serum auto-antibodies in Chinese patients with chronic hepatitis C and to assess the role of serum HCV-RNA titre and HCV genotype in the presence of serum auto-antibodies. Serum ANA, SMA and anti-mitochondrial antibody (AMA) were measured in 122 patients with chronic hepatitis C. Clinical, biochemical and virological data (serum HCV-RNA titre and HCV genotype) were compared between patients with and without serum auto-antibodies. Fifty-eight (48%) patients were associated with positive serum auto-antibodies: 42 (34%) positive for ANA, six (5%) positive for SMA, nine (7%) positive for both ANA and SMA and one (1%) positive for AMA. Clinical parameters (age, sex, blood transfusion history), liver biochemical tests, the presence of cryoglobulinaemia or cirrhosis, and the response to interferon treatment were not significantly different between patients with and without positive serum auto-antibodies. Serum HCV-RNA levels and HCV genotypes were also not significantly different between the two groups. Logistic regression analysis showed that none of the previously mentioned parameters were significant predictors to associate with serum auto-antibodies in chronic hepatitis C. We concluded that 48% of Chinese patients with chronic hepatitis C were associated with positive serum auto-antibodies. Hepatitis C virus genotypes and serum HCV-RNA levels were not correlated to the presence of serum auto-antibodies. The clinical significance and actual pathogenesis of this phenomenon remain to be clarified.     

Central motor conduction in motor neuron disease

Central motor conduction time (CMCT) to abductor digiti minimi (ADM) and tibialis anterior (TA) was measured in 21 patients of motor neuron disease (MND). In the upper limb, the motor pathways were inexcitable in 13 and central motor conduction time (CMCT-ADM) was prolonged in 7 sides. In the lower limbs the motor pathways were inexcitable in 10 and CMCT-TA was prolonged in 14 sides. The CMCT abnormalities did not follow a constant pattern but were randomly distributed and were asymmetric in the upper limbs in 7 and lower limbs in 3 patients. Asymmetric and randomly focal abnormalities in central motor conduction in our patients are consistent with asymmetric and focal neuronopathy in MND.     

Antegrade or retrograde blood cardioplegic method: comparison of postsurgical right ventricular function and conduction disturbances

This study was undertaken to compare postsurgical right ventricular function and the occurrence of conduction disturbances after employing cold blood antegrade or retrograde cardioplegia during open heart surgery. Thirty-four patients were divided into AC (antegrade) and RC (retrograde) groups for the difference of route for delivery of cardioplegic solutions. Preoperative evaluation of cardiac and respiratory function revealed to be equal characteristics between the groups. Postoperatively, A-aDO2 and respiratory index (RI) as functional parameters of oxygenation capacity, LVSWI, RVSWI, dosage of dopamine and conduction disturbances were monitored at 0, 3, 6, 12 hours after termination of cardiopulmonary bypass and at extubation period. Although the recovery of respiratory function and left ventricular function were similar in both groups, temporal suppression of right ventricular function was indicated in RC group during early period after surgery, and then recovered to the same values of AC group within 3 hours. In RC group, several type of conduction disturbances were detected in 28 per cent of patients. But none of the persistent conduction disturbances were remained in all patients. We suggest retrograde coronary sinus perfusion may emerge as a valuable alternative to antegrade methods for delivery of cardioplegia.     

PD 98059 prevents establishment of the spindle assembly checkpoint and inhibits the G2-M transition in meiotic but not mitotic cell cycles in Xenopus

Human mast cells and basophils play a key role in the pathogenesis of several immunological and inflammatory disorders, not only by producing inflammatory and fibrogenic mediators, but also by directly (CD40 ligand) and indirectly secreting various cytokines and chemokines. Studies carried out to evaluate the effects of drugs that modulate the release of mediators and cytokines from these cells have contributed to clarifying the biochemical mechanism by which immunological and non-immunological stimuli activate these cells. Significant differences have been documented between human mast cells and basophils as regard the pharmacological agents that modulate the release of mediators, between mast cells isolated from different anatomical sites, and between compounds of the same class of drugs. Efforts to gain insight into the biochemical events occurring during immunological activation of mast cells and basophils could lead to the identification of new biochemical targets for therapeutic interventions in several immunological disorders.