Comparison of the Asymptomatic Cardiac Ischemia Pilot and modified Asymptomatic Cardiac Ischemia Pilot versus Bruce and Cornell exercise protocols

The Asymptomatic Cardiac Ischemia Pilot (ACIP) and modified ACIP treadmill exercise protocols were developed to test patients with coronary artery disease and to linearly increase work load between stages. The physiologic changes that occurred with ACIP and modified ACIP were compared to those with the Bruce and Cornell protocols in 28 normal subjects and 16 men with coronary artery disease. The exercise protocols were randomly assigned over 2 days, and gas exchange data were obtained continuously with each test. In normal subjects, the peak heart rate, systolic blood pressure, peak oxygen consumption rate (VO2) and minute ventilation were similar for the 4 protocols tested, with exercise time shortest for the Bruce protocol in comparison with the ACIP, modified ACIP and Cornell protocols (10.2 +/- 3.1 vs 13.4 +/- 4.9, 13.9 +/- 4.5, and 15.0 +/- 4.2 minutes, respectively; p < 0.001). The difference between predicted and observed VO2 was smallest for the ACIP protocol (37.0 +/- 11.0 vs 35.8 +/- 13.5 ml/kg/min) and greatest for the Bruce protocol (41.1 +/- 11.8 vs 36.7 +/- 15.0 ml/kg/min) in normal subjects, as well as in patients with coronary artery disease (ACIP protocol 26.9 +/- 7.1 vs 22.5 +/- 6.7, and Bruce protocol 29.1 +/- 7 vs 22.6 +/- 5.7 ml/kg/min, respectively). The ratio of VO2 to work rate, expressed as a slope, was similar in normal subjects for the 4 protocols tested. However, in patients with coronary artery disease, the slope was 0.84 and 0.83 for the ACIP and modified ACIP protocols, respectively, versus 0.61 and 0.71 for the Bruce and Cornell protocols, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fetal alcohol syndrome

The most notable features of fetal alcohol syndrome involve the face and eyes, and include microcephaly, short palpebral fissures, an underdeveloped philtrum and a thin upper lip. Evidence of intrauterine or postnatal growth retardation, mental retardation or other neurologic abnormalities, and at least two of the typical facial features are necessary to make the diagnosis. Newborns with the syndrome may be irritable, with hypotonia, severe tremors and withdrawal symptoms. Mild mental retardation, the most common and serious deficit, and a variety of other anomalies may accompany fetal alcohol syndrome. Sensory deficits include optic nerve hypoplasia, poor visual acuity, hearing loss, and receptive and expressive language delays. Atrial and ventricular septal defects, as well as renal hypoplasia, bladder diverticula and other genitourinary tract abnormalities, may occur. Complete abstinence during pregnancy is recommended, since alcohol consumption in each trimester has been associated with abnormalities, and the lowest innocuous dose of alcohol is not known.     

Dentists put pedal to the metal on information superhighway

To study immunological phenotype of tumor cells in the blood and tumor tissue of 68 patients with non-Hodgkin's lymphomas, the authors have used flow cytometry of lymphocytes and enzyme immunoassay in cryostat sections of lymph nodes with application of monoclonal antibodies to differentiating antigens of human lymphocytes. Histological types of lymphoma are shown to differ immunophenotypically. Differential antigens of prognostic and diagnostic value have been determined.     

Apnea and airway obstruction during feeding and sleep

Recent awareness of the magnitude of sudden unexplained deaths in apparently healthy infants has lead to an increased interest in those circumstances that are associated with or can elicit prolonged and serious apneic episodes. In the present studies, attention was directed toward the study of physiologic activity during sleep and feeding. Apneic episodes of varying durations occur during sleep which, in some instances, can be of sufficient length to warrant resuscitative intervention. A number of infants also reveal transient upper airway obstruction following brief periods of sleep apnea. This functional airway obstruction produces sudden and severe bradycardia. Similarly, infant feeding can induce dangerously prolonged periods of apnea and, in some infants, transient airway obstruction. Few detailed studies have been performed to identify the anatomical level or characteristics of the obstruction. Available evidence suggests that this can take the form either of muscle hypotonicity or hypertonicity. Two infants observed by means of direct laryngoscopy revealed transient failure of vocal cord abduction. These results have provided for the development of two theoretical models that can result in the sudden infant death syndrome; furthermore, continuous recordings of respiratory and cardiac activity during feeding and sleep can be extremely valuable in elucidating the mechanisms responsible for the sudden development of apneic and cyanotic episodes in infants.     

Deliberate hypotension in head and neck surgery

The deliberate reduction of blood pressure in an attempt to reduce intraoperative blood loss has generated significant controversy in the 30 years since its clinical introduction. Numerous series have been reported, but few have met generally accepted, current criteria for controlled studies. In this article, the effect of blood pressure reduction on organ perfusion will be presented together with a review of techniques of achieving hypotension. A summary of results is included and, based on this data, recommendations are offered regarding the application and limits of deliberate hypotension.     

Phylogenetic relationships of the Nassulida within the phylum Ciliophora inferred from the complete small subunit rRNA gene sequences of Furgasonia blochmanni, Obertrumia georgiana, and Pseudomicrothorax dubius

The objective of the study was to ascertain the occurrence and inter-relationships of locomotor symptoms, joint hypermobility and skin involvement in patients with the Marfan syndrome. A single clinical evaluation, using a standardized protocol, of randomly selected out-patients was made. Joint hypermobility was measured by two scales in wide clinical use (Beighton and Contompasis), skin hyperextensibility was assessed on the dorsum of the hand, and skin thickness and light transmissibility was measured at the same site with a modified Harpenden caliper. The setting was an out-patient medical genetics clinic at an urban teaching hospital in Baltimore, Maryland, USA. The subjects comprised 27 children and 48 adults who met strict diagnostic criteria for the Marfan syndrome. In patients less than 18 yr old, 70% had experienced at least one locomotor syndrome, and 40% had had multiple symptoms, of which arthralgia, myalgia and ligamentous injury were the most frequent. Symptoms were absent in children younger than 5 yr. Thereafter, the number of symptoms increased with age. Considerable joint hyperextensibility (> 3/9 of Beighton's criteria) was present in 85%. While one-third had received orthopaedic attention, there had been little if any rheumatological input. In adult patients, locomotor symptoms had occurred in 96%, with 88% having experienced more than one complaint. Spinal pain, arthralgia, ligament injury and fracture were the most common. Most (81%) of the adults had some (> 1/9), and 56% had considerable (> 2/9) evidence of joint hypermobility. Only 20% had received specialist attention for their locomotor symptoms. Skin changes are documented in the Marfan syndrome for the first time in this study.(ABSTRACT TRUNCATED AT 250 WORDS)