Chlamydia pneumoniae in coronary and iliac arteries of Japanese patients with atherosclerotic cardiovascular diseases

OBJECTIVE: This pilot study was undertaken to assess the need and acceptability of a theoretically based audit model to assist GPs improve their asthma care. METHOD: Seventeen GPs from two GP divisions conducted a chart audit and patient survey of asthma patients presenting during the 8 week audit period. Audit results were discussed at a workshop providing a forum for GP peer groups to review their asthma care against current guidelines. This workshop allowed the GPs to develop strategies to improve their asthma care in the context of the resources of their individual practice, GP division, local community and health services. RESULTS: Of the 243 asthma patients audited 177 (72.8%) had a review of their asthma recorded in the past 12 months, 138 (56.8%) were prescribed regular preventive therapy and 118 (48.2%) had been given an asthma action plan. Despite the time commitment required to participate in the activity, 16 respondents who answered the audit evaluation questionnaire reported that the audit was a useful process and 15 (93.8%) stated that it had motivated them to change their practice. CONCLUSION: The results confirmed the need for improved asthma care in general practice and demonstrated the feasibility of the GP-peer led, regionally coordinated, audit-workshop model.     

Significance of the state of the celiac and mesenteric arteries in the treatment of occlusive lesions of the abdominal aorta and iliac vessels

The status of the celiac and mesenteric arteries in 124 patients with occlusive injuries to the abdominal aorta and iliac arteries has been studied by means of the antero-posterior and lateral translumbar abdominal aortography. Clinical picture and symptoms of pathological conditions with the regard to the localization of occlusion are described. Some practical recommendations are given.     

The modern principles of the diagnosis and treatment of diseases of the aorta and major arteries of the lower extremities

The primary goal of any skin care program should be prevention of breakdown. Unfortunately, that goal is not always achievable. As our bodies age or when they become immunosuppressed, incontinent, malnourished, underhydrated, immobile or simply fragile, our skin is less able to preserve its integrity or heal on its own.     

Errors in diagnosis and treatment of pancreatic cysts

The authors observed 136 patients with pancreatic cysts. Complicated forms of the disease were found in 26 patients. It was established that despite apparent signs of disturbed functioning of the pancreas for a long time there was not a single case of correct diagnosis in local hospitals. The greatest amount of errors were made in surgical interventions in patients with pancreatic cysts.     

Ligation of internal iliac arteries in pelvic haemorrhage

Considerable evidence implicates the neurotransmitter gamma-aminobutyric acid (GABA) in the biochemical pathophysiology of mood disorders. In this study, we investigated the possibility that the gene for the gamma-aminobutyric acid type A (GABAA) receptor alpha-1 subunit (GABRA1) might be associated with depressive symptomatology in a sample of mood disorder subjects. Sixty-seven inpatients affected by unipolar (n = 37) and bipolar (n = 30) disorder (DSMIV) were assessed at admission by the Hamilton depression rating scale (HAMD) and were typed using polymerase chain reaction (PCR) techniques. GABRA1 variants were not associated with depressive symptomatology, and consideration of possible stratification effects such as sex, psychiatric diagnosis and illness severity did not reveal any association either. GABAA alpha-1 subunit gene is not, therefore, associated with depressive symptomatology in mood disorder subjects.     

Spontaneous rupture of the non-aneurysmal atherosclerotic abdominal aorta

Spontaneous rupture of the non-aneurysmal atherosclerotic aorta is rare. The experience with the patient, the subject of this report, is the sixth reported case. The formation of the false aneurysm in the retroperitoneal area explained why our patient did not have a life-threatening hemorrhage. The obvious treatment is prompt surgical intervention.     

Ligation of the internal iliac arteries in cases of placenta accreta

Three cases of excessive hemorrhage in the third stage due to Placenta accreta are described. The authors preferred to treat these cases by ligation with catgut of the internal iliac arteries instead of hysterectomy, because the patients were young and likely to want more children. The results were very satisfactory: The hemorrhage was controlled in each case. By mean of arteriography, hysterography, and endometrial biopsy they were able to show that the I.I. arteries became patent after 3-4 months, and all the uterine functions were completely restored. Two pregnancies with normal delivery, occurred out of these 3 cases.     

Management of the atherosclerotic ascending aorta with endoaortic occlusion

Application of an external cross-clamp to an atherosclerotic ascending aorta increases the risk of an embolic event and traumatic injury of the aorta. Currently, there are limited management options in these patients when the clinical situation requires cardiac arrest during an operation. We present our approach to these patients using the Heartport Endoaortic Clamp (Heartport, Redwood City, CA).     

Collagen-synthesizing cells in initial and advanced atherosclerotic lesions of human aorta

Accumulation of extracellular matrix, fibrosis, is regarded to be one of the major manifestations of atherosclerosis. Collagen type I is the predominant matrix component in human atherosclerotic plaques. In this work we have demonstrated procollagen type I expressing cells (PCI-cells) and studied their localization in grossly normal human aorta and atherosclerotic lesions: initial lesions, fatty streaks, fibrolipid lesions (fibrolipid plaque, fibroatheroma), fibrotic lesions (fibrous plaque). PCI-cells were revealed immunocytochemically using SPI.D8 monoclonal antibody against human procollagen type I. We failed to detect PCI-cells in the areas of grossly normal aorta and media underlying atherosclerotic lesions. Positively stained cells were shown in the areas of initial lesions, fatty streaks, fibrolipid and fibrous plaques. The largest amount of PCI-cells was revealed in fatty streaks. These cells were predominantly localized in the preluminal proteoglycan-rich intimal sublayer. Intimal cells in grossly normal regions formed a common cellular network contacting each other with their processes. The cellular network is found to be partly disintegrated in atherosclerotic lesions, which leads to the appearance of isolated cells. The share of isolated PCI-cells localized outside the intimal cellular network was higher in advanced lesions than in the areas of early atherosclerotic lesions. In initial lesions most of PCI-cells were identified as smooth muscle cells using antibodies to smooth muscle alpha-actin. In fatty streaks PCI-expressing smooth muscle cells were fewer in number. Much fewer cells double-stained with anti-alpha-actin and anti-PCI antibodies were found in fibrolipid and fibrous plaques. The proportion of these double stained cells was higher among total number of PCI-cells involved in the cellular network versus PCI-cells outside the network. The results of the study demonstrated that the most active de novo synthesis of interstitial collagen takes place in the regions of atherosclerotic lesions characterized by lipid deposition, which may lead to the further progression of atherosclerotic lesions.     

Rupture of the perivisceral aorta: atherosclerotic versus mycotic aneurysm

This study examines the contribution of GABAergic inhibition to the discharge pattern and recovery properties of 110 bat inferior collicular neurons by means of bicuculline application to their recording sites. When stimulated with single pulses, 74 (67%) neurons discharged one or two impulses (phasic responders), 19 (17%) discharged three to ten impulses (phasic bursters) and 17 (16%) discharged impulses throughout the entire stimulus duration (tonic responders). Bicuculline application changed phasic responders into phasic bursters or tonic responders, increased the number of impulses by 10-2000% and shortened the response latency of most neurons. When stimulated with pairs of sound pulses, the recovery cycles of these neurons can be described as: (1) long inhibition (n = 49, 45%); (2) short inhibition (n = 41, 37%); and (3) fast recovery (n = 20, 18%) based upon the 50% recovery time that was either longer than 20 ms, between 10 and 20 ms or shorter than 10 ms. Bicuculline application shortened the 50% recovery time of most neurons by 11-2350% allowing them to respond to pairs of sound pulses at very short interpulse intervals. These data demonstrate that GABAergic inhibition contributes significantly to auditory temporal processing.