Spontaneous Regression of Budd-Chiari Syndrome (Hepatic Venous Occlusion) in a Young Female

ABSTRACT. Hultcrantz R, Angelin B, Einarsson K, Friman L (Departments of Internal Medicine and Roentgenology, Serafimer Hospital, and Department of Internal Medicine, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden). Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female. Acta Med Scand 1987; 221:503–7. A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparo-centesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.     

Should Radiofrequency Therapy Be Performed in Every Symptomatic Patient with Supraventricular Tachycardia? (Pro Drug Position)

The indication for treatment of paroxysmal supraventricular tachycardia depends on the frequency and severity of the tachycardia attacks. If the tachycardia attacks are mildly symptomatic and occur only once or twice a year, there is no indication for either continuous drug therapy or radiofrequency oblation. The only therapeutic measure required is termination of each acute event. If symptoms occur frequently, long-term antiarrhythmic drug therapy is then indicated and will be effective for chronic prophylaxis in most individuals with a low risk of proarrhythmic events. Only in patients with severe or life-threatening symptoms or cases refractory to drug therapy would radiofrequency ablation possibly be justified.     

Drug Addiction in the Federal Republic of Germany: problems and responses

Drug addiction started to become a serious problem in the Federal Republic of Germany (FRG) around 1970. The number of heavy users of illicit drugs, predominantly young people and mainly opiate dependants, increased continually up to the years 1979–80 to an estimated 50,000 people. Since then it has stayed at that plateau. Today there is a strong trend towards polydrug abuse including legal drugs and alcohol. The abuse of cocaine shows an increase, especially among first users of ‘hard’ illicit drugs. At present the most threatening problem is the development of the disease Aids: at least a third of those intravenous drug abusers who underwent the test are HIV positive. The treatment system for drug abusers is predominantly psychosocially orientated and does not include substitute (methadone) programmes. Today there are 580 out-patient and 154 residential drug treatment centres in the FRG. Outcome evaluation studies of the current treatment approach show that about 25 to 35% of the drug addicts are abstaining. The new Narcotics Law of 1982 with its outstanding principle of ‘therapy instead of punishment’ still causes considerable problems in practice. The experience that treatment programmes alone cannot solve the drug problem has led to a large extension of drug abuse prevention during the last years. However, without changes in the organization of research and more participation and research orientation of practitioners we cannot expect marked progress.     

Left Ventricular Diastolic Dysfunction in Atrial Fibrillation: Predictors and Relation with Symptom Severity

Left Ventricular Diastolic Dysfunction in Atrial Fibrillation Background: Left ventricular diastolic dysfunction (LVDD) is common in the general population, but its prevalence in atrial fibrillation (AF), predictors for LVDD in AF and the association between LVDD and AF‐related symptom severity has not been well studied. Methods: In 124 consecutive patients (mean age 61 ± 11years, 60% male) with paroxysmal (n = 70) or persistent AF (n = 54) referred for AF catheter ablation, LVDD was evaluated according to current guidelines using transthoracic echocardiography. AF‐related symptom severity was quantified using the European Heart Rhythm Association score. Results: LVDD was present in 46 patients (37%). In uni‐ and multivariable regression analysis, age (OR 1.068 per year, 95% CI 1.023–1.115, P = 0.003) and persistent AF (OR 2.427 vs. paroxysmal AF, 95% CI 1.112–5.3, P = 0.026) were associated with LVDD. LVDD was found in 11% with mild AF symptoms (n = 27) as opposed to 44% in patients with moderate–severe AF symptoms (n = 97, P = 0.002). Thus, the OR for moderate–severe AF symptoms was 6.368 (1.797–22.568, P = 0.004) in the presence of LVDD. Conclusions: LVDD (1) occurs frequently in AF, (2) is associated with advancing age and AF progression and (3) is correlated with symptom severity in AF. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1073‐1077, October 2012)     

Follow-up of the Antibody Response to Measles Vaccine in a Rural Area of Guinea-Bissau

ABSTRACT. One hundred and fourty-four children who either were already immune or had been successfully immunized against measles were reexamined after 16 months. All still had circulating Elisa antibodies at a clearly detectable level. Titres were higher in the group of children stated to have had measles prior to the immunization. None of the children had measles after immunization. Boostering by the wild virus may have occurred, whereas no evidence of a booster effect from the vaccine was found. About one third of the children were underweight. Plasmodium falciparum parasitaemia rate, and also its seasonality, varied with the location of the child's homestead. Even children exposed to mesoendemic P. falciparum malaria and moderate malnutrition can be successfully immunized with a conventional live attenuated measles vaccine from 8 months of age, which probably results in a lasting protection.     

Capillary permeability in healthy males with different insulin response to glucose

The capillary permeability in human skeletal muscle, expressed as capillary diffusion capacity (CDC) for 51Cr-EDTA, was determined during exercise with a local clearance method in two groups of healthy male subjects: a younger group with a mean age of 30 years and an older one with a mean age of 58 years. The main finding was that, in both age groups, CDC was significantly negatively correlated to the early phase of insulin response to an intravenous glucose load. No correlation was found between CDC and peripheral insulin sensitivity. CDC was significantly higher in the older age group (P less than 0.01) independent of insulin response, blood flow and body weight. These data indicate that subjects with low insulin response to glucose have a higher capillary permeability than high responders, and that muscle capillary permeability increases with age.     

Lack of Effect of Exogenous or Endogenous Gastric Inhibitory Polypeptide on the Elimination Rate of Intralipid® in Man

Abstract Six healthy subjects were studied by means of an intravenous fat tolerance test on three occasions, in the fasting state, in the postprandial state, and during an intravenous infusion of gastric inhibitory polypeptide (GIP). No effects on the elimination rate of Intralipid® were seen either by endogenous or exogenous GIP.