The interrelationship of arteriosclerotic heart disease and chronic congestive failure

It was the purpose of this study to determine what factors are responsible for the development of chronic congestive failure in chronic coronary disease and myocardial fibrosis.The clinical and post-mortem records of 100 unselected cases were studied. The overwhelming majority were in, or gave a history of, congestive failure. Varying degrees of vascular and myocardial damage were common to the entire series, but the vast majority of those in congestive failure had definite and in most instances advanced cardiac hypertrophy. There were but three exceptions to this rule. The group not in failure had nonhypertrophied or, in a few cases, slightly hypertrophied hearts.The characteristic feature of the chronic congestive phase of chronic coronary artery disease is the presence of cardiac hypertrophy.The genesis of cardiac hypertrophy in relation to muscle damage is discussed. The view is accepted that increased initial fiber tension rather than increased work is the stimulus for generalized cardiac hypertrophy. Contraction with increased initial tension compensates for inadequate contractility. Myocardial disease by diminishing contractile power calls forth increased initial fiber tension and may, according to the above theory, be the cause of generalized cardiac hypertrophy. Application of this concept to the question of cardiac hypertrophy in coronary artery disease is not sufficiently supported, however, by clinical experience. Since the data in the literature are contradictory on this point, it is necessary to study further the causal relationship of chronic coronary artery disease to generalized cardiac hypertrophy by following patients whose blood pressure figures and heart size are known before and after the onset of the disease. Our present belief is that in the majority of cases generalized and advanced cardiac hypertrophy is caused by hypertension, present or antecedent, and not by vascular and myocardial damage.Diminished blood supply and severe muscle damage produce loss of contractility and may cause failure without leading to fiber hypertrophy. The striking predominance of hypertrophied hearts of the group in failure, however, indicates that it is work under long standing increased fiber tension irrespective of the cause, and the eventual loss of contractile power of the hypertrophied fiber, that leads to chronic congestive failure.Congestive failure in chornic arteriosclerotic heart disease is—like that of other types of heart disease—overwhelmingly the failure of the hypertrophied heart. (Table II.)     

Migration and health in the European Union

The paper gives a brief overview of a wide spectrum of health issues and problems, ranging from communicable disease to mental health and family formation, which affect migrants and host countries.     

Spontaneous activity in premature infants affects bone strength.

OBJECTIVE: Determination of bone strength of lower extremities in very low birth weight (VLBW) premature infants with central nervous system pathology resulting in reduced unilateral spontaneous leg movements. STUDY DESIGN: Quantitative ultrasound (QUS) measurements of speed of sound (SOS) of the tibiae of both legs in three VLBW premature infants with brain insult and unilateral reduced spontaneous activity. Results were compared to QUS measurements of both legs in healthy premature infants. Measurements were performed by the same investigator who was blinded to the clinical course of the participants. RESULTS: Reduced spontaneous activity of one leg due to brain pathology resulted in decreased tibial SOS in the affected side. There was no difference in bone SOS between the legs of the healthy controls. CONCLUSION: Spontaneous movements (mainly antigravity flexion and extension) are important for bone structure and mineralization in VLBW premature infants. QUS may become an important diagnostic modality for the evaluation, treatment, and follow-up of bone strength and osteopenia in this unique population.     

The effects of Ipomoea carnea on goats and sheep

The clinical signs and lesions of Nubian goats and Desert sheep orally dosed with fresh and dry leaves and stems of Ipomoea carnea at 2.5, 5 and 10 g/kg/day were studied. The signs of Ipomoea poisoning were inappetence, depression, weakness of the hind limbs, dyspnea, staggering, and pallor of the visible mucous membranes. The main lesions were focal necrosis and fatty vacuolation of centrilobular hepatocytes, accumulation of fibroblasts in hepatic portal tracts, degeneration or necrosis of the cells of the renal proximal convoluted tubules, hemorrhage in renal cortices, in renal medullas and in cardiac muscle fibers, focal pulmonary edema, and emphysema and straw-colored fluid in serous cavities. Increased serum aspartate amino transferase and ammonia concentrations, and decreased concentrations of total protein, calcium and magnesium in the serum of Ipomoea-poisoned animals were detected. Hematological changes indicated the development of normocytic normochromic anaemia.     

Dissociation between in vitro and in vivo epileptogenicity in a rat model of cortical dysplasia.

OBJECTIVE: Malformations of cortical development are frequent causes of human refractory epilepsy. The freeze-lesion model in rats shows histopathological features similar to those found in human polymicrogyria. Previous studies reported in vitro hyperexcitability in this model, but in vivo epileptogenicity has not been confirmed. METHODS: Neocortical freeze lesions were induced in Sprague-Dawley rat pups (n = 10) on postnatal day 0 or 1 (P0/P1). Sham-operated animals served as controls (n = 10). On P60, animals were implanted with epidural electrodes for long-term video-EEG monitoring (4 weeks). The threshold for pentylenetetrazol-induced seizures was determined. Animals were sacrificed and brain sections processed for histological staining and in vitro electrophysiological recordings. Epileptiform field potential repetition rate, amplitude and integral were compared between slices containing a cortical freeze lesion, and slices from sham-operated rats. RESULTS: No interictal spikes and no electrographic or clinical seizures occurred in either group. The median threshold for pentylenetetrazol-induced seizures was 60 mg/kg for lesioned, and 45 mg/kg for control animals (difference not significant). No spontaneous epileptiform field potentials were recorded from either freeze-lesion or control slices bathed in normal, artificial cerebrospinal fluid (ACSF). Upon omission of Mg(2+) from the bath, epileptiform field potentials were elicited that showed a significantly higher burst integral in the freeze lesion slices compared to control slices. CONCLUSION: Neocortical freeze lesions induced in newborn rat pups show histological characteristics reminiscent of human cortical dysplasia. Brain slices containing neocortical freeze lesions display hyperexcitability in vitro, but the same lesion does not appear to show spontaneous epileptogenicity in vivo.     

Lymphocyte subsets in normal human bone marrow harvested for routine clinical transplantation

Bone marrow and peripheral blood of 25 healthy bone marrow donors from our allogeneic bone marrow transplantation program were assessed for cell subsets bearing T11(CD2), T4(CD4), T8(CD8), B1(CD20) J5(CALLA, CD10), Mo1(CD11b), MY7(CD13). Mo2(CD14), MY9(CD33) and NKH-1 antigens. Bone marrow cell samples were taken for analysis at the start or at the end of the harvesting procedure of aspiration from the iliac crest. All samples were analysed on a flow cytometer at the lymphocyte window as obtained on the two-parameter (L90oLSxFALS) scatter diagram. There were no differences in the lymphocyte subset composition of bone marrow samples taken at the start or at the end of the harvesting procedure. In contrast to the majority of literature data, a high CD4/CD8 ratio was detected in bone marrow samples: it did not differ from that in the peripheral blood. The proportions of CD2 and CD4 T cell markers in the bone marrow correlated with those in the peripheral blood, thus further documenting a substantial bone marrow contamination with peripheral blood cells. A relatively large aspirate volume (4-5 ml) obtained from individual aspiration sites was identified as the only factor possibly accounting for the high-level contamination of bone marrow samples with peripheral blood. This conclusion was corroborated by low T cell proportions and low CD4/CD8 ratios found in the bone marrow washed from bone fragments and in bone marrow samples aspirated at first bone puncture in a volume of 1.0 ml. Taken together, these findings imply that less vigorous suction may decrease the number of T lymphocytes in bone marrow harvested for transplantation purposes.     

Ocular saccades in Duane''s syndrome.

Since Hering's law might be affected when paradoxical innervation exists, 10 patients with Duane's syndrome were studied. Eye movements were measured by binocular recording of electro-oculogram. Our study shows clearly that the sound eye's motility is also affected. When adduction of the affected eye is present, Hering's law holds, whereas when adduction is limited this law cannot be demonstrated.     

Laser in situ keratomileusis in myopic patients with congenital nystagmus

PURPOSE: To evaluate the results of laser in situ keratomileusis (LASIK) and IntraLASIK in the treatment of myopic patients with nystagmus. METHODS: Eight patients with congenital nystagmus (16 eyes), aged 23 to 49 years, had LASIK surgery. Corneal flaps were created using the Bausch & Lomb Hansatome microkeratome or the IntraLase femtosecond laser. The ablations were performed with the Bausch & Lomb excimer laser with an active tracking system. In some patients, the eyes were fixated with forceps or a fixation ring during laser ablation. RESULTS: The refractive errors were corrected in all cases. There was no decentration or loss of best corrected visual acuity greater than 1 line. In 56% of the eyes, the postoperative uncorrected visual acuity was better than the best spectacle-corrected visual acuity (BSCVA). The BSCVA improved in 62.5% of the eyes. The overall visual performance improved in all patients. One patient who did not drive before surgery became eligible for a driver's license after surgery. CONCLUSIONS: Selected patients with myopia and congenital nystagmus may benefit from laser refractive surgery. Laser refractive surgery may be safely and accurately performed using the Hansatome microkeratome or the IntraLase femtosecond laser and an active tracking system with or without mechanical fixation. The BSCVA may improve in certain patients postoperatively.     

A technique for medial canthal fixation using resorbable poly-L-lactic acid-polyglycolic acid fixation kit

Achieving secure bony fixation of medial canthus is a challenge. We used a resorbable poly-L-lactic acid-polyglycolic acid screw (LactoSorb office fixation kit) in 5 cases: 2 with traumatic medial canthal dystopia, 1 with scleroderma and orbital fat atrophy causing malapposition of the medial canthus to globe, and 2 with invasive medial canthal tumors necessitating subtotal medial orbital exenteration. The resorbable screw with preplaced suture was drilled into the medial orbital wall, using a handheld self-drilling tap. The preplaced suture was used to anchor the medial canthus. We achieved satisfactory canthal position in all 5 cases. There were no complications in 4 cases during a mean +/- SD follow-up of 11.3 +/- 6 months; however, the scleroderma case developed wound dehiscence 6 weeks after surgery. The LactoSorb kit is a safe and effective technique to achieve bony medial canthal fixation in carefully selected cases.