Adipose tissue glyceride synthesis in patients with hyperapobetalipoproteinemia

Adipose tissue was obtained at thoracotomy in five control patients with valvular heart disease, all of whom were free of coronary artery disease and all of whom were normolipidemic with normal low density lipoprotein apolipoprotein B levels, and eight patients with coronary artery disease, all of whom had hyperapobetalipoproteinemia. In both groups, the rates at which linoleic acid and palmitic acid were incorporated into diglyceride and triglyceride were determined in vitro. The data indicate that fatty acid incorporation into adipose tissue glycerides was twice as rapid in controls as in patients with hyperapobetalipoproteinemia. By contrast there was no difference between the groups in the rate of net lipolysis of adipocyte glyceride. The data at hand do not establish the mechanism responsible for the difference in synthesis between normal subjects and patients with hyperapobetalipoproteinemia, but this may explain the delayed chylomicron triglyceride clearance previously observed in the disorder.     

Compensation of the effects of shifts of anatomic positions of the heart on electrical tracings

The heart can take different anatomical orientations in the chest of various subjects and even in the same subject. The corresponding changes in perspective can deeply affect the electrical tracings recorded by fixed standardized leads. One same electrogenesis takes many appearances, complicating the analysis. Anatomically intrinsic tracings can be obtained with O. H. Schmitt's Resolver from a usual X, Y, Z lead system. Its moving trihaedral X', Y', Z', has to be brought onto the heart's axis and septum. Being directly related to the heart, these tracings become independent of the heart's anatomical position in the chest. They show the electrical to anatomical topographic relations. However, they have not been in favour because Clinicians could not relate them to their usual rules of interpretation. This Note describes how to obtain normalized tracings that can benefit from the usual criteria of interpretation, as if shifted hearts were seen in an intermediate position. A constant opposite intermediate shift is applied to the three, X', Y', Z', intrinsic components to restore an arbitrary normalized position. The new X', Y', Z', components follow the moving trihaedral brought on the individual anatomical position measured by X rays and echocardiography. A heart being naturally in an intermediate position gives tracings as if no Resolver was in action. Compensated (or normalized) ECG's or isopotential maps can be similarly computed.     

Microtia reconstruction: does the cartilage framework grow?

The use of free rib cartilage ear frameworks in unilateral microtia reconstruction has prompted much discussion about their potential for growth. The senior author has reconstructed ear frameworks in 132 microtia patients, most of whom were under 3 years of age when surgery was initiated. Of this group, 29 were assessed for ear growth through comparison of the lead-plate model of the original normal ear to the normal ear growth and the reconstructed ear framework after a period of at least 2 years. Similarly, 14 reconstructed ears were compared to 14 normal ears at least 2 years after reconstruction. The perimeters of tracings made from the original lead plates and of tracings of normal and reconstructed ears were determined by image analysis techniques. The results demonstrated no significant difference in growth between normal ears and reconstructed ear frameworks after an interval of at least 2.5 years. Therefore, the reconstructed ear is growing at a rate similar to that of the normal ear.     

Mechanography: a non-invasive technique for the evaluation of cardiac function in children

Experience in the pediatric age group with mechanography, an indirect method of cardiovascular investigation, is described with emphasis on the recording technique and on the analysis of the tracings. A few examples are presented with comments on the morphological aspects and the time characteristics of the pulse curves, showing how much information about cardiac disease and especially myocardial function in children may be obtained.     

Alteration of human pancreatic secretions by pancreatic and ampullary carcinoma. A computer-aided analysis of isoelectric focusing patterns.

Human pancreatic secretions obtained from patients with pancreatic carcinoma and carcinoma of the ampulla of Vater differ significantly from those obtained from patients without pancreatic disease. Differences were also apparent between secretions from the two types of carcinoma cited above. This was shown by computer analysis of the isoelectric focusing protein patterns from 30 specimens. Average densitometric tracings ± the standard deviation were prepared by the computer for the acidic portion (pH 3–5.7) of the pH 3–10 isoelectric focusing patterns for each group of ten specimens. In this pH region 19 bands were located by the computer. The major bands had isoelectric points of 4.7, 5.0, 5.2, and 5.7.     

Changes in the Cardiovascular Function in Healthy Subjects and Patients with Ischemic Heart Disease during Sleep

The purpose of this study was to investigate the autonomic regulation of the cardiovascular system during sleep in health and disease. The examination included 396 subjects: 29 healthy subjects and 367 patients with ischemic heart disease, of whom 149 had left-ventricular failure and 214 hypertension. Sleep quality and the presence of obstructive sleep apnea syndrome were evaluated by polysomnography; the character of autonomic regulation of cardiac rhythm and hemodynamics was determined by computerized testing during night sleep and an active orthostatic test immediately before and after sleep. The results permitted the authors to conclude that autonomic regulation may be restored to various degrees in health and disease, depending on the pathology level. The sleep quality influenced the restoration of hemodynamics more than that of the cardiac rhythm, mainly when obstructive sleep apnea syndrome was present.     

Hydatid Disease in Toronto

Two case reports of Echinococcus granulosus disease are presented in detail, together with a survey of 35 cases of the disease encountered in Toronto hospitals since 1932; 32 of these have occurred since 1949. Only six of the 35 patients were born in and lived in Canada, and all of these came from Northern Ontario. The liver was involved in 20 of the 35 patients, and the lung in 16. In seven the lesions were multiple at the time of the first operation or several years later. The Casoni skin test was positive in 14 of 21 patients tested and the complement fixation test was positive in 13 of 16 subjects tested. Eosinophilia of 6% or more occurred in nine of the 26 patients on whom a differential white blood cell count was performed, and allergic manifestations were recorded in eight of the 35 subjects in the series.     

Communication of Pulmonary Function Test Results: A Survey of Patient’s Preferences

IntroductionPhysician-patient communication in patients suffering from common chronic respiratory disease should encompass discussion about pulmonary function test (PFT) results, diagnosis, disease education, smoking cessation and optimising inhaler technique. Previous studies have identified that patients with chronic respiratory disease/s often express dissatisfaction about physician communication. Currently there is a paucity of data regarding patient awareness of their PFT results (among those who have undergone PFTs previously) or patient preferences about PFT result communication.MethodsWe undertook a three-month prospective study on outpatients referred to two Pulmonary Function Laboratories. If subjects had undergone PFTs previously, the awareness of their previous test results was evaluated. All subjects were asked about their preferences for PFT result communication. Subjects were determined to have chronic respiratory disease based on their past medical history.Results300 subjects (50% male) with a median age (±SD) of 65 (±14) years participated in the study. 99% of the study participants stated that they were at least moderately interested in knowing their PFT results. 72% (217/300) of the subjects had undergone at least one PFT in the past, 48% of whom stated they had not been made aware of their results. Fewer subjects with chronic respiratory disease preferred that only a doctor discuss their PFT results with them (28% vs. 41%, p = 0.021).ConclusionOur study demonstrates that while almost all subjects want to be informed of their PFT results, this does not occur in a large number of patients. Many subjects are agreeable for their PFT results to be communicated to them by clinicians other than doctors. Further research is required to develop an efficient method of conveying PFT results that will improve patient satisfaction and health outcomes.     

Reciprocal translocation and the Philadelphia chromosome

Summary We examined metaphases from three patients with chronic myeloid leukaemia and a typical Philadelphia chromosome with one chromosome 9 as the recipient to determine whether the 9q+ 22q- translocation is reciprocal. Good quality G-banded photographs of the chromosomes concerned were subjected to light absorption density analysis. This provided enlarged tracings corresponding to the relevant chromosome regions and so facilitated accurate measurement. This technique has unambiguously shown that the typical Philadelphia chromosome results from a reciprocal translocation and that probably no material is gained or lost in the exchange. Furthermore, in a total of six patients for whom sequential G and C banding was performed, the chromosome 9 with the largest block of centromeric heterochromatin received the translocated material. We offer tentative explanations for this curious observation.     

Genetic relationship among isolates of Helicobacter pylori: evidence for the existence of a Helicobacter pylori species-complex

We investigated the population genetics of 23 isolates of H. pylori by allozyme electrophoresis using 16 enzyme loci. Isolates were obtained from adult patients of whom 48% were of Greek extraction. Eight patients (35%) had an active duodenal ulcer. Allelic variation per loci ranged from 2 to 11 alleles. Four major genetic clusters were apparent, having >75% fixed genetic differences. There was no distinct clustering (clonal structure) on the basis of the geographical origin of the persons from whom isolates were obtained, indicating that this bacterium has not recently jumped a species barrier into humans. Isolates associated with ulcer disease were not monophyletic, with isolates from ulcer patients being found in phylogenetically diverse branches of the dendogram derived from the data. Based on the genetic diversity of H. pylori isolates, we propose that isolates should be classified as belonging not to a single species but to a `Helicobacter pylori species-complex'.     

Factors controlling the effect of praziquantel on liver fibrosis in Schistosoma mansoni-infected patients

An association study of a cohort of 177 Sudanese patients infected with Schistosoma mansoni [82 (46%) males and 95 (54%) females] was conducted to evaluate the factors controlling the regression of liver fibrosis 39 months after treatment with praziquantel using ultrasound evaluation. Periportal fibrosis (PPF) was regressed in 63 (35.6%) patients, while the disease progressed to higher grades in 24 (13.6%) patients. The grade of PPF did not change in 90 (50.8%) patients. The mean values of portal vein diameter, splenic vein diameter and index liver size in subjects in whom PPF regressed after treatment were significantly lower than in subjects in whom the disease was progressed ( P <0.0001, P =0.031 and P =0.003, respectively). The progression of hepatic fibrosis in males (15, 8.5%) was greater than that in females (9, 5.1%). Patients with regression or progression phenotypes tend to cluster in certain families. Our study indicated that regression, progression and stabilization of PPF after praziquantel therapy is controlled by gender, age, grade of fibrosis and possibly inherited factors.     

Clinical Experience with the Elema Vario Pacemaker

Early problems after implantation of an endocardial electrode for permanent pacing occur in many patients. Difficulties can be anticipated in many of these patients and their management made much easier by a knowledge of the daily endocardial threshold obtained in patients with an implanted Elema Verio pacing unit by a simple non-invasive technique using a magnet and electrocardiogram. Twenty patients are described in whom permanent pacing with an Elema Vario unit was undertaken. The practical advantages of this unit can be readily seen in the patient who developes exit block or in the patient with obstructive airways disease, in whom frequent coughing or right ventricular hypertrophy may make stable electrode placement difficult. The chief advantage of the Elema Vario pacemaker is the extreme simplicity with which knowledge of the endocardial threshold can be obtained.     

Blood 5-hydroxytryptamine, 5-hydroxyindoleacetic acid and melatonin levels in patients with either Huntington's disease or chronic brain injury

Following a study of oxidative tryptophan metabolism to kynurenines, we have now analysed the blood of patients with either Huntington's disease or traumatic brain injury for levels of 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) and melatonin. There were no differences in the baseline levels of these compounds between patients and healthy controls. Tryptophan depletion did not reduce 5-HT levels in either the controls or in the patients with Huntington's disease, but it increased 5-HT levels in patients with brain injury and lowered 5-HIAA in the control and Huntington's disease groups. An oral tryptophan load did not modify 5-HT levels in the patients but increased 5-HT in control subjects. The tryptophan load restored 5-HIAA to baseline levels in controls and patients with brain injury, but not in those with Huntington's disease, in whom 5-HIAA remained significantly depressed. Melatonin levels increased on tryptophan loading in all subjects, with levels in patients with brain injury increasing significantly more than in controls. Baseline levels of neopterin and lipid peroxidation products were higher in patients than in controls. It is concluded that both groups of patients exhibit abnormalities in tryptophan metabolism, which may be related to increased inflammatory status and oxidative stress. Interactions between the kynurenine, 5-HT and melatonin pathways should be considered when interpreting changes of tryptophan metabolism.     

How well can we predict coronary heart disease? Findings in the United Kingdom Heart Disease Prevention Project.

The probability of myocardial infarction developing over five years in a group of middle aged men was predicted with knowledge of their ages, blood pressures, cholesterol concentrations, and smoking habits as recorded in an initial screening examination. Although the top 15% of the risk distribution predicted 115 (32%) of the subsequent cases of myocardial infarction, there was a considerable overlap in predicted risk between those subjects who did and those who did not go on to develop a myocardial infarction. Of the subjects in the top 15% of risk, only 72 (7%) of those initially free of coronary heart disease and 43 (22%) of those initially with coronary heart disease actually developed a myocardial infarction over the subsequent five years. Thus, although a group of subjects at high risk can be identified, among whom will be a high proportion of potential victims of heart attack, many subjects will be wrongly classified. These findings may explain part of the difficulty in persuading patients of the potential benefits of reducing risks and highlight the need for research to improve the prediction of the development of coronary heart disease.     

THE ELECTROENCEPHALOGRAM IN EPILEPSY

In light of the considerable divergence of opinion among various investigators regarding the incidence of electroencephalographic abnormality in patients with convulsive disorders, the author made a study of his own records of 430 patients with a diagnosis of epilepsy. In 122 the seizures were symptomatic, in the remainder idiopathic, and the overall incidence of electroencephalographic abnormality was little different in the two groups. In the whole series 64.9 per cent showed abnormal tracings, while in those under 16 years of age the incidence was 71.8 per cent. The highest incidence was in patients in whom seizures had begun when they were between 10 and 15 years of age and in those with a duration of seizures from 5 to 10 years. Of patients with clinical petit mal, 76 per cent had abnormal records, but only 34.6 showed petit mal complexes. Lateralized or focal abnormality was three times as frequent in the symptomatic as in the idiopathic group.     

An Assessment of the “Radioactive Renogram” Using O-Iodohippurate Sodium (Hippuran) Labelled with Radioactive Iodine

A “radioactive renogram” using o-iodohippurate sodium (Hippuran)-I¹³¹ was performed in 57 patients who had either hypertension or various renal diseases. In longstanding essential hypertension, the initial uptake and secretory phases are often reduced below normal. In five hypertensive patients who were shown to have unilateral renal disease, the renogram showed significantly abnormal tracings on the affected side. In three patients suffering from ureteral obstruction, the excretory phase was significantly prolonged.On the basis of comparative albumin and iodohippurate renograms, the initial uptake can no longer be considered as a vascular phase, as previously believed.The iodohippurate-I¹³¹ renogram is a useful adjunct in the investigation of hypertension and renal disease, providing information about each kidney not so readily obtained by other means. Nevertheless, the test does not supplant any other investigative procedure and should not be depended upon as a screening procedure.     

Platelet aggregation and thromboxane A2 release in primary biliary cirrhosis and effect of D-penicillamine treatment

Platelet function was assessed in 28 patients with primary biliary cirrhosis (PBC), of whom 10 were receiving D-penicillamine. Patients not on D-penicillamine treatment had platelet aggregation similar to that in the healthy control group; the group treated with D-penicillamine showed significantly enhanced platelet aggregation in response to threshold doses of adrenaline and collagen but not ADP. Median thromboxane B2 production was also higher in D-penicillamine treated patients than in controls or untreated patients; this difference did not reach statistical significance. The addition of D-penicillamine in vitro to platelet rich plasma from normal subjects was shown to enhance adrenaline- and collagen-induced platelet aggregation. Abnormalities of platelet function in PBC patients did not correlate with serum cholesterol concentration or with liver function tests but were related to the stage of disease. The present study emphasises the need to consider the aetiology, disease stage and type of treatment when assessing platelet function and prostanoid release in liver disease.     

Dynamic detection of rhythmic oscillations in heart-rate tracings: a state-space approach based on fourth-order cumulants

 This paper presents a new procedure specifically aimed at providing a dynamical detection of the oscillations occurring in long-term heart-rate (HR) tracings. The procedure is based on a time-variant state-space modelling of the fourth-order cumulants of the HR signal. The state-space estimator was selected because of its demonstrated capability to distinguish between deterministic and stochastic components of the signal, while the fourth-order cumulants of the signal were used as input of the model to further reduce adverse effects of coloured, white and 1/f Gaussian noise possibly present in the input data. The procedure was tested by the analysis of simulated signals and its performance was compared with the results obtained by state-space modelling applied directly on the test signals (instead of on the fourth-order cumulants of the signals) and by the more traditional auto-regressive modelling. The comparison has shown a clear superiority of the proposed procedure over the other techniques in discriminating deterministic oscillations from coloured noise. Finally, the applicability of the procedure to biological data was verified by analysing five experimental HR tracings recorded in normal subjects during laboratory and daily life conditions. Received: 17 May 1996 / Accepted in revised form: 29 November 1996     

Influence of load changes on tricuspid inflow

In healthy subjects, the right ventricular filling pattern estimated from tricuspid valve inflow is highly load-dependent. This can be clearly demonstrated by changes of Doppler inflow tracings recorded during tidal breathing at rest. The aim of our study was to test the magnitude of tricuspid inflow changes during more pronounced load changes induced by specific maneuvers. In 31 apparently healthy subjects (16 men and 15 women, mean age 36+/-16 years) we recorded pulsed Doppler tracings of tricuspid inflow during forced inspiration, elevation of lower extremities (increased preload) and handgrip exercise (increased afterload). The obtained values were compared with end-expiratory phase of tidal breathing at rest. We found a significantly larger increase in the early and late filling velocities (for E and A p<0.001) under the conditions of increasing preload (elevation of legs) and less pronounced, but still significant changes with isometric exercise (for E p<0.001 and for A p<0.01). We conclude that the right ventricular filling pattern in healthy humans is highly load-sensitive and for this reason the effect of any intervention (e.g. pharmacological) must be studied under strict and well-defined resting conditions.     

Effects of spinal cord stimulation on spasticity and spasms secondary to myelopathy

16 subjects with severe spasms secondary to traumatic and nontraumatic myelopathy underwent epidural spinal cord stimulation. 4 patients had a complete motor and sensory spinal cord lesion. 6 of the subjects with an incomplete spinal cord lesion were ambulatory. All patients had previously undergone extensive trials with medications and physical therapy. All 14 subjects in whom a satisfactory placement of the electrode could be obtained had a reduction in the severity of the spasms. In 6 patients, the spasms were almost abolished. Extremity, trunkal and abdominal spasms were affected. Clonus in the upper extremities was consistently reduced. Marked improvement in bladder and bowel function was observed in each of 2 subjects. In over 1-year follow-up, 5 subjects show persistence of the results, with less stimulation required to maintain the therapeutic effects. No neurological deterioration occurred following the procedure or after long-term spinal stimulation. 1 patient showed after several months of continuous stimulation increased voluntary motor control present only when spinal cord stimulation was activated. Complications included 1 system infection, 1 electrode migration, 1 wire breakage and skin breakdown at a connector site, development of high impedance in 1 electrode and 1 skin breakdown over the lead.