An echocardiographic study of the interventricular septum in constrictive pericarditis

Ten patients with constrictive pericarditis were studied echocardiographically with specific reference to inter-ventricular septal dynamics. Abnormal movement of the interventricular septum was present in 8 patients and consisted of flattening in systole and unusual posterior motion in diastole. The aetiology of this type of movement is at present unknown but may be related to restriction of normal cardiac rotational dynamics. The interventricular septum also showed diminished degree of thickening (mean 21-2%). The amplitude of excursion was generally at the upper limit of or greater than normal. Left ventricular posterior wall amplitude of excursion was normal. Flattening of left ventricular posterior wall diastolic movement was seen in 4 patients. Right ventricular end-diastolic dimension was slightly increased (1-2 to 1-7 cm/m2) in 5 of 8 patients with abnormal septal motion, but no haemodynamic evidence of diastolic volume overload was found. Posterior pericardial thickening was noted echocardiographically when posterior calcification was present. We conclude that the most common though non-specific feature of the echocardiogram in patients with constrictive pericarditis is abnormal septal motion. Flattening of left ventricular posterior wall diastolic movement, posterior pericardial thickening, and epicardial-pericardial separation may also occur.     

Effect of hemodialysis on QT dispersion in chronic uremia]

PURPOSE: The invasive nature of vaginal sonography, recently introduced as an improved diagnostic method for imaging the contents of the pregnant uterus, has provoked discussion about patient preference for female sonographers. This study examined whether patients had a gender preference for the sonographer who would conduct such an examination. METHODS: Over 3 months, a written survey was given to pregnant women to complete anonymously while waiting for their scheduled sonographic examination. The survey covered gender preference for the sonographer and education, ethnicity, and previous experience with the procedure. Surveys were turned in by 1,002 pregnant women. RESULTS: Of the women whose survey responses were analyzed, 62% preferred a female sonographer. The principal reason given for this preference was comfort with the same gender. The majority of respondents were 25-40 years old, married, white, and multiparous. The level of education varied widely. CONCLUSIONS: These findings point to a need to seek consumer input when new technology is introduced, to provide women with choices where possible, and to ensure that they have access to information about those choices.     

Elderly patients in chronic hemodialysis: risk factors for left ventricular hypertrophy

In the past few years in Western countries, there has been an increasing proportion of elderly patients beginning renal replacement therapy. Left ventricular hypertrophy (LVH) is associated with an increased mortality rate due to cardiovascular disease, the main cause of death in patients on chronic hemodialysis. In this study, we evaluated 67 chronic hemodialysis patients older than 65 years (33 women and 34 men; mean age, 72.6 years; mean time on chronic hemodialysis, 51.3 months). Several biological and laboratory data were analyzed. The left ventricular mass was calculated using the Penn convention criteria. LVH was observed in 49 patients (73%). These 49 patients were divided into two groups (group 1, concentric hypertrophy, n = 22; and group 2, eccentric hypertrophy, n = 27) and compared with a control group (patients without LVH, n = 18). Group 1 (P = 0.06) and group 2 (P = 0.055) showed higher systolic blood pressures and group 2 showed a lower hematocrit (P = 0.024). The echocardiographic parameters were expectedly different: group 1 had higher posterior left ventricular wall thickness (P = 0.0001), interventricular septum thickness (P = 0.0001), and left ventricular wall relative thickness (P = 0.002), and group 2 had higher left ventricular end-diastolic diameter (P = 0.0001), interventricular septum thickness (P = 0.01), and posterior left ventricular wall thickness (P = 0.023). Using the left ventricular mass index as the dependent variable and the evaluated biological and laboratory data as the independent variables, we found in a stepwise multiple regression model that only systolic blood pressure (t = 3.430; P = 0.0011), age (t = 2.059; P = 0.044), interdialytic weight gain (t = 2.236; P = 0.029), and hematocrit (t = -1.961; P = 0.054) independently influenced the left ventricular mass index (R2 = 0.313; P = 0.0001). Further studies are needed to determine whether reduction of the left ventricular mass index, through control of blood pressure and correction of anemia, will decrease the cardiovascular events in this particular population.     

Change of platelet function after the beginning of repeated hemodialysis treatment in patients with uremia

The disturbances of platelet function in end-stage renal failure varies in dialysed and non-dialysed patients. We examined some platelet function in 11 uremic patients treated conservatively (TC) and, again in the same patients, 3-month after the beginning of repeated hemodialysis treatment (HD). The blood samples were taken before hemodialysis. In TC patients normal platelet count, prolonged bleeding time, normal platelet aggregation, unchanged PF4 activity and decreased PF3 availability were shown, compared with control group. In HD patients also normal platelet count and prolonged bleeding time were noted, but increased platelet aggregation, increased PF4 activity and PF3 availability were observed, compared with control group and with TC patients. We conclude that in TC patients rather decreased platelet function was observed; after the beginning of hemodialysis treatment some platelet function became significantly enhanced, which suggests platelet activation. Moreover, in HD patients the disturbances of platelet function before dialysis were shown, then it is possible that platelet activation persists in interdialytic period.     

Radiographic examination of the pelvis in patients under periodic hemodialysis for terminal uremia

The efficacy and tolerability of pyritinol (PY) and auranofin (AU) were compared in a multicentre double-blind study. Patients with RA received 600 mg/day PY or 6 mg/day AU for 1 year. Response was rated by a defined improvement in at least four of the following: Ritchie index, joint swelling index, rating scales for pain and general well-being, functional index, morning stiffness, ESR. Of the 139 fully evaluable PY patients 61 (44%) dropped out due to adverse events or response failure compared with 44 (31%) of the 142 AU patients. In patients treated for 1 year efficacy parameters improved more in the PY than in the AU group, with significant differences for the general well-being (P = 0.022), ESR (P = 0.029) and haemoglobin (P = 0.0042). The response rate for PY (61/78 patients, 78%) was significantly superior to AU (58/98 patients, 59% P = 0.009). An intention-to-treat analysis corroborated this result (P = 0.030). Adverse events (AE) occurred in 64% of PY patients and in 58% of AU patients: main AE were mucocutaneous symptoms (PY 36%, AU 23%) and gastrointestinal complaints (PY 30% AU 37%). Single cases of proteinuria, hepatic and haematological abnormalities were noted in both groups.     

Colonization with vancomycin-resistant enterococci in chronic hemodialysis patients

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.     

Heart function in patients with chronic glomerulonephritis and mildly to moderately impaired renal function. An echocardiographic study

We recently described a novel nonviral/viral vector for gene transfer, the plasmovirus (Noguiez-Hellin P, Robert-le Meur M, Laune S, et al. C R Acad Sci Paris, Sciences de la Vie. 1996;319:45-50; Noguiez-Hellin P, Robert-le Meur M, Salzmann J-L, et al. Proc Natl Acad Sci USA. 1996;93:4175-4180). Plasmoviruses are plasmids capable of expressing all the viral genes required for generating infectious particles and packaging a defective genome containing a transgene. Transfected as plasmids, plasmoviruses transform the transduced cells into packaging cells that release infectious replication-defective retrovirus vectors (RV) containing a transgene, which are capable of infecting nearby cells. We previously showed that such a vector can efficiently "propagate" the transgene after transfection. Here we examine in greater detail the different steps of plasmovirus replication in vitro in human (143 B TK-) and murine (NIH 3T3 TK-) cells. Molecular-biological analysis revealed plasmovirus-coded protein expression starting from 24 hours post-transfection, followed by the detection of infectious RV 48 hours post-transfection. The gag proteins were correctly processed in the released particles. Electron microscopic analysis revealed typical type C particles. Nonintegrated plasmovirus DNA was not toxic for the cells and could be detected for at least 14 days post-transfection. While the transfected gag gene and the transgene could also be detected throughout this period, we observed that env-coded proteins decreased after 72 hours post-transfection. Nevertheless, the production of RV resulted in the propagation of the transgene in the culture, with stable integration of plasmovirus proviral DNA into the host genome of infected cells. We show that this propagation results in a major improvement in therapeutic efficacy using an HSV1-TK transgene and ganciclovir treatment, when compared to that of plasmovirus constructs that cannot propagate. Altogether, these results demonstrate the functionality of this gene transfer method and suggest that improvements in the vector design enhance its efficacy.     

Post-ejection thickening as a marker of viable myocardium. An echocardiographic study in patients with chronic coronary artery disease

Useful medical diagnostic information has been reported from low-frequency rotational testing of the horizontal vestibulo-ocular reflex (VOR) of patients with vestibular disorders. Servocontrolled rotating systems have been used as the only practical method to generate stimuli over lower VOR frequency response ranges, the decade from 0.01 to 0.1 Hz. Active head movements have been used for testing the human VOR at higher frequencies, exceeding 0.5 Hz. We examined whether active head movements could be used also to test the VORs of subjects over lower frequency ranges, extending to 0.02 Hz. We used a swept-frequency, active head movement protocol to generate a broad-band stimulus. Eye position was recorded with electro-oculography. Head velocity was recorded with a rotational sensor attached to a head band. Six individual test epochs from human subjects were concatenated to form complex, periodic waveforms of head and eye velocity, 75 seconds in duration. Broad-band cross-spectral signal processing methods were used to compute horizontal VOR system characteristics from these waveforms extending from 0.02 to 2 Hz. The low-frequency VOR data appeared to originate from amplitude modulation of high-frequency active movements, acting as carrier signals. Control experiments and processing of simulated data from a known system excluded the possibility of signal processing artifacts. Results from six healthy subjects showed low-frequency gains and phase values in ranges similar to those from published rotational chair studies of normal subjects. We conclude that it is feasible to test the human VOR over extended low-frequency ranges using active head movements because of amplitude modulation of the head and eye signals.     

A clinical study of persistent hypotension in patients on chronic hemodialysis

In order to clarify the pathogenesis of hypotension seen in the patients on chronic hemodialysis, we studied the vascular reactivity to exogenous vasoactive substances and the change of plasma ANP level during hemodialysis treatment. The vascular responsiveness to intravenously infused norepinephrine was decreased in hemodialysis patients, particularly in hypotensive group, compared with healthy controls (< 0.05). The blood pressure response to angiotensin II was also diminished significantly in hypotensive patients, compared with normotensive patients (p < 0.05). The plasma ANP concentration before and after each hemodialysis treatment was not different statistically between hypotensive and normotensive patients. Furthermore, the change of plasma ANP concentration was not correlated with the blood pressure change during each hemodialysis procedure. These findings suggest that the decrease of vascular responsiveness may be a factor for causing persistent hypotension in patients on chronic hemodialysis, and that the plasma ANP level is not responsible for the pathogenesis of hypotension.     

"Anatomical M-mode": a new echocardiographic technique potentially useful in the quantitative study of the left ventricle

According to the data collected at the Rome-based National Reference Centre for Enterobacteria, 266,547 Salmonella strains isolated from human sources (226,513) and from non human sources (40,034) were characterised in Italy during the period 1973-1995. The serotype of all isolates, and the antibiotype and phage type of selected isolates were determined. Human-source isolations grew from 4372 in 1973 to 12,310 in 1995: non-human source isolations, from 339 in 1973 to 3459 in 1995. Salm. Typhimurium ranked first in the list of the most common serotypes isolated from both sources in the period 1973-1988 except in the years 1975 and 1976 when it was overtaken by Salm. Wien. Since 1983 Salm. Enteritidis has been among the top ten isolates from animals, and ranked first in the list of isolates from humans in 1988 and from non human sources in 1991. During the last years the number of multidrug-resistant strains, mostly belonging to phage types 104 and 193 of Salm. Typhimurium has been rising. Salmonella strains have also been isolated from numerous extraintestinal infections, almost exclusively caused by Salm. Enteritidis and Typhimurium.     

Medium-sized peptides in the blood of patients with uremia

We have carried out high performance liquid chromatographic analysis of serum and ultrafiltrate of blood obtained from uremic patients and normal subjects to elucidate the presence of medium-sized peptides unique to uremia. Many fluorescamine-positive substances, excluding amino acids and guanidine compounds, were increased in uremic serum compared with normal serum. At the 0.5-1.0 pmol/ml serum level, several peaks were unique to uremia. The retention time, fluorescamine reactivity, molecular weight distribution and the result of enzymatic digestion revealed that these peaks are peptidic substances.     

Prognostic value of hypercapnia in patients with chronic respiratory failure during long-term oxygen therapy

Hypercapnia observed in patients with chronic respiratory failure may not be an ominous sign for prognosis when they are receiving long-term oxygen therapy (LTOT). In this study, we selected 4,552 patients with chronic obstructive pulmonary disease (COPD) and 3,028 with sequelae of pulmonary tuberculosis (TBsq) receiving LTOT from 1985 to 1993 throughout Japan and prospectively analyzed their prognoses. The hypercapnic patients (PaCO2 >= 45 mm Hg) had a better prognosis than the normocapnic patients (35 <= PaCO2 < 45 mm Hg) for TBsq, but no difference was found between the two groups with COPD. Furthermore, Cox's proportional hazards model revealed that in TBsq hypercapnia was an independent factor for favorable prognosis, and that the relative risk for mortality was 0.76 in patients with 45 <= PaCO2 < 55 mm Hg, 0.64 for those with 55 <= PaCO2 < 65 mm Hg, and 0. 49 for patients with PaCO2 >= 65 mm Hg against normocapnic patients. This favorable effect of hypercapnia in TBsq was particularly apparent in the patients without severe airway obstruction. Even a rise of 5 mm Hg or more in PaCO2 over the initial 6- to 18-mo follow-up period was not associated with poor prognosis in TBsq, although it was in COPD. From these findings, we conclude that hypercapnia should not be generally considered an ominous sign for prognosis in those patients who receive LTOT.     

Liver histology in chronic hemodialysis patients infected with hepatitis C virus

To investigate the influence of genetic and/or environmental factors in the development and shaping of the human peripheral T cell repertoire the authors studied the T-cell receptor (TCR) V beta usage in 10 adult monozygous (Mz) and nine dizygous (Dz) twin pairs living in a Plasmodium falciparum endemic area in West Africa. The TCR repertoire was determined using a small panel of anti-V beta specific monoclonal antibodies (MoAbs) using conventional immunofluorescence assays. The results revealed that the V beta repertoire was similar to that recently described for a Caucasian population using a similar panel of antibodies. The frequencies of particular V beta genes tested were influenced neither by anti-malarial antibody titres nor by parasite densities, indicating that the P. falciparum parasite is not a dominating factor in determining the peripheral T cell repertoire. All donors were human leucocyte antigen (HLA) class I and II typed; no association was found between the expression of any V beta genes and MHC haplotype. The V beta usage was more concordant within the Mz than within the Dz pairs. For a group comprising four HLA class II identical individuals, the average within-pair difference was significantly greater than for the whole Mz group, but similar to that seen for the total Dz group. Thus, the data suggest that genetic, rather than environmental, factors have a profound effect on the shaping of the human circulating T cell repertoire and that the major genetic factors are encoded by non-HLA class II genes.     

Symmetric and asymmetric left ventricular hypertrophy in patients with end-stage renal failure on long-term hemodialysis

BACKGROUND: Patients with end-stage renal disease on regular hemodialysis have an increased prevalence of left ventricular (LV) hypertrophy that is associated with morbidity and mortality. Asymmetric septal hypertrophy and impairment of LV outflow can occur in these patients and may contribute to adverse outcomes. More insight into the prevalence, extent, geometry, and promoting factors of LV hypertrophy is important. METHODS: An unselected group of 62 patients (31 women), aged 55 +/- 14 years, on maintenance hemodialysis was investigated by Doppler echocardiography. Eight patients with valvular heart disease were excluded from further analysis. We assessed prevalence of LV hypertrophy and asymmetric septal hypertrophy, as well as parameters of LV geometry and LV filling and outflow dynamics. RESULTS: Prevalence of LV hypertrophy was 65%. Patients were analyzed according to LV mass and geometry. Mean LV mass index was normal (105 +/- 17 g/m2) in Group 1 without LV hypertrophy (n = 19); it was markedly elevated in Group 2 (symmetric hypertrophy, n = 22) and Group 3 (asymmetric hypertrophy with systolic anterior movement of mitral valve, n = 7), and highest (191 +/- 54 g/m2) in Group 4 (asymmetric hypertrophy without systolic anterior movement of mitral valve, n = 6, p < 0.001). Age, body mass index, and duration of hypertension were associated with LV hypertrophy and asymmetric septal hypertrophy (p = 0.01). Group 3 with systolic anterior motion of mitral valve had the smallest end-diastolic LV diameters (p = 0.02); increased heart rates, and increased ejection velocities in the LV outflow tract (p = 0.03, and p = 0.005, respectively, vs. Groups 1, 2, and 4) which pointed to an impairment of LV outflow. CONCLUSIONS: Symmetric LV hypertrophy and asymmetric septal hypertrophy are frequent in patients on maintenance hemodialysis. Predictors for LV hypertrophy were age and body mass index, and, particularly for asymmetric septal hypertrophy, age and hypertension duration. Volume withdrawal during hemodialysis may lead to symptomatic hypotension due to dynamic obstruction in some patients with severe asymmetric septal hypertrophy.