The effect of long-term Enduracin monotherapy on the clinical and biochemical status of patients with ischemic heart disease

13 patients aged 39 to 60 years with coronary atherosclerosis confirmed at selective coronary angiography combined with primary hyperlipidemia (phenotypes 2a and 2b) received enduracin in a dose 1500 mg/day. As a result of the treatment total cholesterol (TC) and LDL cholesterol lowered by 10.3 and 13.1%, respectively, whereas HDL cholesterol rose by 15.2%. Half of the patients demonstrated activation of hepatic transaminases, but discontinuation of the drug was not necessary. In 3 out of 4 patients after 2 years of enduracin treatment stabilization of atherosclerosis was observed. Thus, long-term enduracin is able to inhibit progression of atherosclerosis in coronary heart disease patients.     

Airway pressure changes during one-lung ventilation

This investigation analyzed the changes in inspiratory airway pressures during transition from two-lung to one-lung ventilation in patients tracheally intubated with a double-lumen endotracheal tube (DLT) using a classical method of intubation without fiberoptic bronchoscopy. All patients were anesthetized in a standardized fashion. Ventilation was accomplished with the Siemens 900 constant-flow mechanical ventilator (Solna, Sweden). Peak (Ppeak) and plateau (Pplateau) inspiratory airway pressures were recorded with an on-line respiratory monitor before and after clamping the tracheal limb of the DLT. The position of the DLTs was evaluated by fiberoptic bronchoscopy with the patient in supine position. Of the 51 intubations, the DLT was malpositioned in 15 cases (29.5%). Ppeak and Pplateau increased significantly when switched from two-lung ventilation to one-lung ventilation in both correctly and incorrectly positioned DLTs. When the DLT was in a correct position, Ppeak increased by a mean of 55.1% and Pplateau increased by a mean of 41.9%. When the DLT was malpositioned, this increase was significantly larger (74.9% and 68.8%, respectively). Three tests commonly used as markers of malpositioned DLTs were evaluated based on the data of this study, and it was established that, although the pressure differences related to position are statistically significant, as a single value, they cannot be used for clinical decision making.     

Eosinophilia-myalgia syndrome: mortality data from the US national surveillance system

OBJECTIVE: To describe some of the most severe features of eosinophilia-myalgia syndrome (EMS) and identify potential prognostic indicators. METHODS: Systematic review of data from initial case reports and from followup supplemental death report forms forwarded to the national surveillance system administered by the US Centers for Disease Control (CDC). RESULTS: As of August 10, 1991 36 deaths related to EMS had been reported to CDC. Among all patients fitting the surveillance case definition for EMS, we found that patients who died were older, had higher absolute leukocyte and eosinophil counts, and reported a greater frequency of cough or dyspnea, neuropathy, hepatomegaly, leukocytosis, and elevated erythrocyte sedimentation rate. All patients who died had illnesses affecting multiple organ systems. Of the 36 patients who died, 33 (92%) had neuromuscular sequelae, 29 (81%) had pulmonary complications, and 23 (64%) had cardiac manifestations. The most commonly observed disease process leading to death was progressive polyneuropathy and myopathy (24 of the 36 reported deaths) which produced complications of pneumonia and sepsis or respiratory failure due to weakness; cardiomyopathy was the underlying cause of death for 4 patients, primary pulmonary disease for 3, sudden death attributed to arrhythmia for 2, stroke for 2, and septic complications of therapy for one. CONCLUSION: Although neuromuscular complications were the most prominent sequelae among patients reported to have died, this is clearly a multisystemic disease. Older age and involvement of more than one organ system suggest a particularly poor prognosis, and the neuromuscular, pulmonary and cardiovascular sequelae appear to be the most worrisome.     

Catheter ablation in patients with refractory cardiac arrhythmias with radiofrequency techniques

The author suggests a working classification of dermopertorators from analysis of his own designs and devices described in the literature for forming netlike skin grafts in the treatment of patients with large tissue defects. It is shown that the well-known dermoperforators require essential modernization. The most promising model is a device with plane knives whose simple technology allows their production to be organized in Soviet industry.     

Acute ethanol intoxication increases the risk of infection following penetrating abdominal trauma

Acute alcohol (ETOH) intoxication as a risk factor for infection in trauma victims to our knowledge has not been previously reported. To determine if ETOH intoxication increases infection risk we examined data from 365 patients with penetrating abdominal trauma who were enrolled in a multi-center antibiotic study. Ninety-four patients sustained an injury to a hollow viscus. To separate acute from chronic ETOH effects, infections were divided into two categories: (1) trauma related; infections caused by bacterial contamination at the time of injury, while blood alcohol level (BAL) was elevated. (2) nosocomial; infections caused by bacteria acquired during hospital stay, after BAL had normalized. A BAL > or = 200 mg/dL was associated with a 2.6-fold increase in trauma-related infections. There was no association between BAL and subsequent nosocomial infection. Since infection rates for intoxicated patients were not higher after BAL had normalized, acute rather than chronic effects of ETOH appear to be responsible.     

Repetitive conundrums of centromere structure and function

BACKGROUND: Adult participants in randomized controlled trials often have better outcomes than patients who are eligible but not enrolled. OBJECTIVE: To examine whether newborn infants who were allocated to placebo in an investigational drug trial had better outcomes than infants who were eligible but not randomized (eligible NR). Study design: During a randomized controlled trial of antithrombin therapy in premature infants with respiratory distress syndrome, data were collected prospectively on all 76 infants in the eligible NR group. Study outcomes were compared with those of all 61 infants who were randomized to placebo. The same exogenous surfactant was used in all patients. RESULTS: In the placebo group the mean (SD) birth weight was 1201 (314) g, mean (SD) gestational age was 28.8 (2.3) weeks, and 51% were male. In infants in the eligible NR group, mean (SD) birth weight was 1141 (262) g, mean (SD) gestational age was 28.3 (2. 3) weeks, and 58% were male; 57% of infants in both groups had been exposed to steroids before birth. The median duration of mechanical ventilation was reduced from 6.2 days in the eligible NR group to 4. 8 days in the placebo group (P =.008). There was also a trend toward less frequent and less severe intraventricular hemorrhage in trial participants. CONCLUSIONS: These data are consistent with the hypothesis that sick newborn infants may benefit from participation in a randomized controlled trial.     

Ligand migration in sperm whale myoglobin

Geminate oxygen rebinding to myoglobin was followed from a few nanoseconds to a few microseconds after photolysis for more than 25 different oxymyoglobin point mutants in the presence and absence of 12 atm of xenon. In all cases, two relaxations were observed: an initial fast phase (half-time 20 ns) and a slower, smaller phase (half-time 0.5-2 micros). Generally, xenon accelerates the fast reaction but slows the slower reaction and diminishes its amplitude. The rates and proportions of the two components and the effects of xenon on them vary widely for different mutants. The locations of specific xenon binding sites [Tilton, R. F., Kuntz, I. D. Jr., and Petsko, G. A. (1984) Biochemistry 23, 2849-2857], the effects of point mutations on the geminate reactions, and molecular dynamics simulations were used to suggest locations in the protein interior occupied by ligands on the nanosecond to microsecond time scale. Photodissociated ligands may occupy xenon site 4 in the distal pocket and xenon site 1 below the plane of the heme. Rebinding from these positions corresponds to the slower geminate phase for O2 rebinding. The rapid geminate component is determined by competition between rebinding from a position closer to the iron atom and escape to solvent or more distant locations in the protein.     

Aortocaval fistula: diagnosis with MR angiography

A case of intramuscular hemangioma (large vessel type) occurring in an eighteen year old woman is described. Medical history reported a pulled muscle in the same region 5 years earlier. By needle biopsy was performed the diagnosis of hematoma evolved to sclerosis. Since pain persisted the neoplasia was removed. Intramuscular hemangioma is a benign neoplasia. Recurrences are always due to incomplete excision. Angiosarcomas and liposarcomas are the two tumors to be differentiated from hemangiomas of skeletal muscle. The relative paucity of cases combined with widespread histological pictures make the diagnosis very difficult.