Measurement of cerebral blood flow during cardiopulmonary bypass with near-infrared spectroscopy

OBJECTIVES: We sought to assess the incidence and clinical relevance of examination data to recurrent ischemia within an international randomized trial. BACKGROUND: Ischemic symptoms commonly recur after thrombolysis for acute myocardial infarction. METHODS: Patients (n = 40,848) were prospectively evaluated for recurrent angina and transient electrocardiographic (ECG) or hemodynamic changes. Five groups were developed: Group 1, patients with no signs or symptoms of recurrent ischemia; Group 2, patients with angina only; Group 3, patients with angina and ST segment changes; Group 4, patients with angina and hemodynamic abnormalities; and Group 5, patients with angina, ST segment changes and hemodynamic abnormalities. Baseline clinical and outcome variables were compared among the five groups. RESULTS: Group 1 comprised 32,717 patients, and Groups 2 to 5 comprised 20% of patients (4,488 in Group 2; 3,021 in Group 3; 337 in Group 4; and 285 in Group 5). Patients with recurrent ischemia were more often female, had more cardiovascular risk factors and less often received intravenous heparin. Significantly more extensive and more severe coronary disease, antianginal treatment, angioplasty and coronary bypass surgery were observed as a function of ischemic severity. The 30-day reinfarction rate was 1.6% in Group 1, 6.5% in Group 2, 21.7% in Group 3, 13.1% in Group 4 and 36.5% in Group 5 (p < 0.0001); in contrast, the 30-day mortality rate was significantly lower (p < 0.0001) in Groups 1, 2 and 3 (6.6%, 5.4% and 7.7%, respectively) than in Groups 4 and 5 (21.8% and 29.1%). CONCLUSIONS: Postinfarction angina greatly increases the risk of reinfarction, especially when accompanied by transient ECG changes. However, mortality is markedly increased only in the presence of concomitant hemodynamic abnormalities.     

In vivo depletion of T-cells and cytokines during primary exposure of sheep to parasites

This study examined the role of CD8+ and WC1+ T-cells and of interferon (IFN)-gamma in the development of protective immunity against infection with the enteric nematode parasite Trichostrongylus colubriformis in sheep. Monoclonal antibodies (mAb) were administered during induction of the immune response to deplete or neutralise these components. Protection against the primary and challenge infections was assessed by faecal egg count and total worm count. Prolonged administration of mAb recognising IFN-gamma and CD8 resulted in significantly increased protection during the 6 week primary infection and following challenge. CD8+ cells were depleted from blood but not from intestinal mucosa. After injection of mAb (CC15) recognising the surface antigen WC1, WC1+ and Tcr gamma delta + cells were depleted from blood but not markedly from enteric mucosa, and protection against challenge, although variable, was increased by up to 88%. It appears that CD8+ and WC1+/gamma delta+ cells and IFN-gamma all retard the potential development of naturally acquired immunity against the parasite.     

Autonomic control of asystolic vasovagal syncope

A 30 year old woman with a lifelong history of severe, recurrent, vasovagal syncope became asystolic for 30 seconds after 37 minutes of 60 degrees head-up tilt. During early tilt, sympathetic activity, heart rate, left ventricular contractility, and cardiac output increased. Mean blood pressure was initially maintained. Presyncope was associated with maximal contractility and bradycardia despite sustained sympathetic activity. Subsequently, asystole occurred associated with complete withdrawal of muscle nerve sympathetic activity. In asystolic vasovagal reactions, presyncope may be triggered by increased left ventricular contractility and is associated with increased levels of parasympathetic and sympathetic activity. Asystole and peripheral vasodilatation may be caused by sudden and complete withdrawal of the increased sympathetic activity.     

Risk factors for Trypanosoma cruzi infection among children in central Brazil: a case-control study in vector control settings

This population-based case-control study was conducted in northern Goias State, central Brazil, in rural settings under vector control surveillance. One hundred forty-nine children seropositive for Trypanosoma cruzi antibodies, selected in a cross-sectional survey carried out in village schools, were compared with 298 seronegative classmate controls matched for age, sex, and place of residence. Information on potential environmental, familiar, and social economic risk factors for T. cruzi infection was collected during household visits, and interviews with parents and entomologic inspections of domestic and peridomestic environments were conducted. The presence of triatomines in dwellings or evidence of triatomine colonization was found to be statistically associated with seropositivity in children. The presence of exuviae and a report of triatomines indoors or outdoors by householders in the past were strong predictors of an infected child. Children from seropositive mothers had a 3.9-fold increase in the risk of having anti-T. cruzi antibodies after adjusting for the confounding variables, including triatomine capture, mother's age, and family size in multivariate analysis. Parent's report of vector presence showed a 97.7% sensitivity in identifying a dwelling with at least one seropositive child. The possibility of transplacental T. cruzi transmission and its implication for Chagas' disease control were considered.     

Antimicrobial activity of some medicinal plants extracts on Escherichia coli, Salmonella paratyphi and Shigella dysenteriae

AIM: To study the toxic effects of norfloxacin (Nor) on EEG and ultrastructure of the brain. METHODS: EEG was recorded in the sensorimotor area of rat cortex after Nor 150 and 300 micrograms.kg-1 were injected into the right ventricle of the brain. RESULTS: Spike waves occurred, first at the ipsilateral side and then bilaterally. The seizure spike appeared at 168 +/- 129, 51 +/- 35 s, and 276 +/- 138, 118 +/- 65 s in the right and left cerebral cortices in 150 and 300 micrograms.kg-1 groups, respectively. The wave forms were variable, the wave amplitude and frequency increased gradually, accompanied with limb twitching. Neuron degeneration was seen in both cerebral hemispheres, hippocampus, and cerebellum 120 min after the i.c.v. of Nor 300 micrograms.kg-1: myeloid degeneration of Golgi complex, rough endoplasmic reticulum, and neuropils; swelling of cytoplasm; dissolution of nuclears and chromatin; necrosis of gliocytes and the appearance of changes in both the light and dark neurons, especially the dark ones. CONCLUSION: Rat brain was widely damaged after the kindling by Nor.     

Sarcoidosis: 25-year clinical follow-up

Based on the follow-up of 1,600 patients with sarcoidosis from 1971 to 1996, the authors analyzed the value of various methods for identifying the disease, the frequency and nature of misdiagnoses. They showed the efficiency of basic treatments in patients with sarcoidosis: corticosteroidal hormones, nonhormonal antiinflammatory drugs, plasmapheresis, and physiotherapy. Recurrencies and progression were seen in 23.85% of patients. The likely causes of recurrent sarcoidosis are considered. It is concluded that recurrencies are one of the important problems of modern sarcoidosis.