Significance of a mitral regurgitation systolic murmur complicating a first acute myocardial infarction in the coronary care unit -- assessment by colour Doppler flow imaging

To determine the prevalence and significance of a systolic mitralmurmur heard after a first acute myocardial infarction (MI),we studied 186 consecutive patients in the coronary care unit(CCU) during a one-year period. Fifteen patients had a murmuras a result of mitral regurgitation (MR) (prevalence 8%) documentedby colour Doppler flow imaging. It was heard before the thirdday of hospitalization in 10 (67%) patients, and on the thirdday itself in the remainder. The severity of MR was graded semi-quantitatively:moderate in 12 (80%) patients, and mild, moderate to severeand severe in three respectivety. The direction of the MR jet,determined by colour flow imaging, improved the informationobtained by two-dimensional echocardiography (2D echo) thatcould only diagnose mitral leaflet abnormality in seven (47%)patients. in 10 of 15 (67%) patients, the 2D echo ejection fractionwas 40% and in eight (53%) the wall motion score obtained byanalysing 11 left ventricular (LV) segments was 8. Two (13%)patients died in tile CCU, four (27%) had LV failure, one anginaand eight (53%) remained asymptomaric in the hospital. Of 171patients without a systolic murmur, 22 (13%) had LV failure,13 (8%) angina and 25 (15%) died during the in-hospital stay(P-NS for these complications between patients with and withoutMR murmur). During a follow-up of 12–24 months, one MRpatient died, and seven (47%) remained asymptomatic. We conclude that the prevalence of MR systolic murmurs in acuteMI patients is low. The LV function and the prognosis of a majorityof these patients is rather good.     

Effects of platelet-activating factor on nitrergic transmission in rabbit corpus cavernosum

AIM: The information currently available suggests that nonadrenergic noncholinergic (NANC) transmitters, particularly nitric oxide, are involved in the relaxation of penile erectile tissues. Platelet-activating factor (PAF) is a chemical mediator and is involved in many physiological and pathophysiological events. It is well known that several of the vascular actions of PAF are mediated by the generation of nitric oxide. We designed this study to test the hypothesis that PAF has an effect on NANC responses in rabbit corpus cavernosum strips. METHODS: Rabbit corpus cavernosum strips were precontracted with phenylephrine (10(-5) mol/L). Isometric tension changes produced by carbachol (10(-9)-10(-5) mol/L), sodium nitroprusside (10(-8)-10(-5) mol/L) and electrical field stimulation (for 10 s at sequential frequencies of 2, 4, 8, 16, and 32 Hz as square-wave pulses of 50 mV) were recorded with a pressure transducer. These relaxations were compared to those obtained in the presence of PAF. RESULTS: PAF had no effect on endothelium-dependent, endothelium-independent or electrical field stimulation-induced NANC relaxation responses in isolated rabbit corpus cavernosum strips. There was no statistically significant difference between the pD(2) and E(max) values for carbachol or sodium nitroprusside in the presence of PAF. CONCLUSIONS: Our results suggest that PAF does not modify the endothelium-dependent, endothelium-independent or electrical field stimulation-induced NANC relaxation responses in isolated rabbit corpus cavernosum strips.     

Prostatic ductal adenocarcinoma showing Bcl-2 expression

Prostatic ductal adenocarcinoma represents a rare histological variant of prostatic carcinoma with features of a papillary lesion at cystoscopy. There are conflicts regarding the existence, origin, staging, grading, treatment and clinical behavior of this tumor. The aim of the present study is to examine the expression of Bcl-2 and p53 in prostatic ductal adenocarcinoma and to evaluate its origin by analyzing prostate specific antigen, prostate specific acid phosphatase, cytokeratins, epithelial membrane antigen and carcinoembryonic antigen expressions. The results confirmed the expression of prostate specific antigen and prostate specific acid phosphatase in prostatic ductal adenocarcinoma. The demonstrated expression of Bcl-2 was predominant in the better-differentiated tumor. Bcl-2 expression appears not to be associated with neuroendocrine differentiation as assessed by chromogranin A reactivity. Thus, the first case of a prostatic ductal adenocarcinoma showing Bcl-2 expression is presented. The tumor was negative for p53.     

Human Brucellosis in Kuwait: A Prospective Study of 400 Cases

SUMMARY The clinical pattern of 400 cases of brucellosis in Kuwait ispresented. The disease was acute in 77 per cent, sub-acute in12. 5 per cent and chronic in 10. 5 per cent of cases. Raw milkwas the major source of infection. The major features on presentation,irrespective of the course of the disease, were fever, sweating,headache, rigors, arthralgia, myalgia, and low back pain. Hepato-splenomegalywas present in 41 per cent of cases and in 32 per cent neitherliver nor spleen were palpable. The haematologic findings werenot specific and hepatic dysfunction (shown by liver enzymeabnormalities) was common. Skeletal (26 per cent) and genital(8. 5 per cent) changes and neurobrucellosis (7 per cent) werethe major complications. The ELISA was the most sensitive andreliable diagnostic test especially in relation to chronic brucellosisand neurobrucellosis. ELISA allowed the determination of brucella-specificimmunoglobulins (Ig)G, IgM and IgA in the CSF, and providedprofiles of Ig, in sera, which were different in patients withchronic (elevated IgG and IgA) from those with acute (elevatedIgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline,doxycycline or rifampicin gave a cure rate of over 91 per centin acute and subacute brucellosis. Co-trimoxazole was associatedwith a relapse rate of 50 per cent. Two drug combinations ofstreptomycin and tetracycline, streptomycin and rifampicin orstreptomycin and doxycycline were effective, but one of fivepatients with chronic brucellosis relapsed. A combination ofstreptomycin, tetracycline and rifampicin with or without steroidswas used successfully in neurobrucellosis, septicaemic shockand subacute bacterial endocarditis.     

A case of mucocutaneous leishmaniasis in Saudi Arabia caused by Leishmania major and its response to treatment

A case is presented of mucocutaneous leishmaniasis in a male Saudi infant caused by Leishmania major. The extensive lesions of the nose and right cheek healed rapidly and completely following parenteral therapy with sodium stibogluconate (Pentostam®). This appears to be the first case of mucocutaneous leishmaniasis described in the Kingdom of Saudi Arabia. A brief comparison is drawn with the condition as described in other areas.     

Detection and prevention of chronic kidney disease in Indonesia: Initial community screening

Aim:   This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m²) and its risk factors amongst subjects from urban and semi-urban areas.
Methods:   History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according Cockcroft–Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and Chinese MDRD equations.
Results:   Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%. Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and 19.8%, respectively.
Conclusion:   The present study showed a high prevalence of CKD in representative urban and semi-urban areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.     

The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia

Background: There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia. Methods: Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26‐gauge, atraumatic needle either in the standard lateral decubitus, knee‐chest position (group I, n = 90) or lateral decubitus, knee‐chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP. Results: The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged <12 months of age but not significant in children older than 12 months of age. Conclusions: Because of higher success rate, lateral decubitus, knee‐chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.