Transplantation for myocarditis: a controversy revisited.

Myocarditis is a major cause of end-stage heart failure and is responsible for up to 10% of cases of idiopathic dilated cardiomyopathy (IDC). Worldwide, approximately 45% of all heart transplants are performed for IDC and up to 8% for myocarditis. Early reports suggested that survival after transplantation for myocarditis was poor and patients had an increased risk of rejection. More recently, larger case series suggest that overall survival after transplantation for myocarditis is similar to survival after transplantation for other causes. However, certain disorders, including cardiac sarcoidosis and giant cell myocarditis (GCM), require heightened surveillance for post-transplantation disease recurrence. We present the case of a 42-year-old man with recurrence of GCM 8 years after transplantation and review the literature on the role of cardiac transplantation for patients with myocarditis.     

Anaesthesia for neurosurgery in the sitting position.

The sitting position offers many advantages in terms of surgical access for posterior fossa and posterior cervical spine surgery. However, these advantages must be balanced against the risks which include venous and paradoxical arterial air embolism, cerebral and myocardial ischaemia secondary to hypotension, and complications of the positioning itself. These are largely in the domain of the neuroanaesthetist. In this paper, therefore, we will review the advantages, disadvantages and management of complications of the sitting position, from the neuroanaesthetist's perspective.     

The versatile rhomboid (Limberg) flap

The rhomboid (Limberg) flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The present paper demonstrates the versatility of the rhomboid flap.     

Disposition of tacrolimus in isolated perfused rat liver: influence of troleandomycin, cyclosporine, and gg918.

The disposition of tacrolimus and the influence of cyclosporine, troleandomycin, and GF120918 (GG918, or N-[4-[2-(1,2,3,4-tetrahydro-6,7-dimethoxy-2-isoquinolinyl)-ethyl]-phenyl]-9,10-dihydro-5-methoxy-9-oxo-4-acridine carboxamine) on its hepatic disposition were examined in the isolated perfused rat liver. Livers from groups of rats were perfused in a recirculatory manner following a bolus dose of tacrolimus (100 microg), a substrate for P-glycoprotein (P-gp) and CYP3A, or with felodipine (200 microg), a substrate only for CYP3A. Perfusions of each substrate were also examined in groups of rats in the presence of the inhibitors: troleandomycin (20 microM, CYP3A inhibitor), GG918 (1 microM, P-gp inhibitor), or cyclosporine (10 microM, CYP3A and P-gp inhibitor). In all experiments, perfusate and bile were collected for 60 min. Tacrolimus, felodipine, and their primary metabolites were determined in perfusate and bile by liquid chromatography/tandem mass spectrometry. The area under the curve (AUC) from 0 to 30 min was determined. For the dual CYP3A and P-gp substrate, tacrolimus, AUC +/- S.D. was decreased from control (2,260 +/- 430 ng. min/ml) by GG918 (1,730 +/- 270 ng. min/ml, P < 0.05) and was increased by troleandomycin (5,200 +/- 2,470 ng. min/ml, P < 0.05) and cyclosporine (4,390 +/- 2,080 ng. min/ml, P < 0.05). For the exclusive CYP3A substrate, felodipine, AUC was unchanged from control by GG918 but increased by troleandomycin and cyclosporine. It is concluded that GG918 increased the hepatic exposure of tacrolimus by inhibiting the canalicular P-gp transport, whereas GG918 has no effect on hepatic disposition of felodipine. These results support our hypothesis that the hepatic metabolic clearance of a dual substrate will be increased by inhibiting the efflux transporter.     

Detection of chromosomal alterations affecting the 1cen-1q12 region in irradiated granulocytes and lymphocytes by multicolour FISH with tandem DNA probes

A multicolour tandem labelling fluorescence in situ hybridization(FISH) procedure was used to compare the frequencies of radiation-inducedchromosome breakage and hyperdiploidy of chromosome 1 occurringin non-cultured granulocytes and Go lymphocytes with those observedin cultured metaphase and interphase lymphocytes. Whole blood,obtained from healthy male donors, was exposed in vitro to 0,100, 200, 300 and 400 cGy of ionizing radiation from a ¹³⁷Cssource. Aliquots containing granulocytes and Go lymphocytesfrom each dose were treated immediately with hypotonic KCl onice and harvested. Cells were hybridized with     

Alcohol inhibition of NMDA-stimulated catecholamine efflux in aging brain.

The influence of aging on the ability of ethanol to inhibit N-methyl-D-aspartate-stimulated catecholamine overflow in rat brain was examined. Alcohol effects on N-methyl-D-aspartate stimulated [3H]norepinephrine or [3H]dopamine overflow from the cortex, hippocampus, and striatum of aged (24-28 months) middle aged (12-14 months), and young (3-5 months) rats were examined. N-methyl-D-aspartate (500 microM) stimulated catecholamine overflow in all brain regions, with aged rats showing declines in overflow of 33% in the hippocampus and 41% in the striatum. Alcohol (30-200 mM) produced a concentration-dependent inhibition of overflow at all ages and brain regions tested. The IC50 for alcohol inhibition of NMDA-stimulated catecholamine release was not significantly different in aged brain or across brain regions. These results indicate that alcohol's ability to inhibit NMDA-stimulated catecholamine release is not significantly altered with aging.     

Physicochemical aspects of drug release. XV. Investigation of diffusional transport in dissolution of suspended, sparingly soluble drugs

The dissolution rates of sparingly soluble, fine particulate, suspended drugs have been studied using a Coulter Counter Model TAII. For two sieve fractions of oxazepam the dissolution rates were monitored in media with varying viscosities brought about by the addition of glycerol, while for griseofulvin the change in the medium's viscosity was induced by changing the temperature. By calculating the dissolution rate, and compensating for differences in particle surface area and media solubility, it was shown that the dissolution rate was diffusion controlled. After additional normalization for the diffusion coefficient, it was suggested that the so-called apparent diffusional distance decreased substantially with particle size. The effect of particle size was more limited above approx. 15 μm.     

Perceptions of admission committee members: some aspects on individual admission to dental education at Karolinska Institutet

The aim of the study was to generate an overall impression of the admission committee's (AC) perspective on individualised admission procedures, derived from some perceived experience of the individual committee members using semi-structured interviews. Qualitative research was used and data were collected by use of interviews. The results show that the committee members are highly committed to the task and try to identify desirable, non-cognitive attributes in the applicants, such as motivation, empathy, drive, and tenacity: 'emotional intelligence'. The committee members were of the opinion that it was possible to identify these attributes in an applicant. The AC further believes that the admissions procedure influences academic achievements because students regard themselves as specially selected and therefore aspire to higher achievements.