Functional significance of collateral coronary circulation in univascular obstructions (1)

The presence, degree and functional significance of the coronary collateral circulation was investigated in a group of 68 patients with angiographycally important (greater than 60%) univascular coronary obstruction. The following clinical parameters were reviewed. Smoking, hypertension, diabetes mellitus, functional class (NYHA), and degree of angina pectoris. In the ECG the presence of abnormal Q waves and the response to the stress test were analysed. To evaluate the functional significance of the collateral circulation the following angiographic and hemodynamic parameters were measured: ejection fraction (FE 100), mid sistolic ejection fraction (FE 50), percent of regional shortening of the left ventricular wall and finally the end diastolic pressure. According to the obstructed vessel (R, DA, Cx) the degree of obstruction (parcial or complete) and the degree of collateral circulation (O, I, II, III) several groups were formed. Statistical analysis of all the above mentioned clinical, electrocardiographic and angiographic findings were compared amongst the various groups. Coronary collateral circulation was demonstrated in 45 patients (68%) being present in 82% of those with complete coronary obstruction. In most of the patients (87%) an abundant collateral network was present (grade II or III). No statistical differences were demonstrated between the groups with abundant or poor collateral circulation in all the clinical, electrocardiographic or angiographic parameters. Finally we conclude that important collateral circulation usually develops in the presence of severe coronary obstruction; however its functional value is limited.     

Deprivation of dietary nucleotides decreases protein synthesis in the liver and small intestine in rats

BACKGROUND & AIMS: Dietary nucleotides are reported to influence the growth and functioning of the liver and small intestine. The aim of this study was to examine the mechanism by which nucleotides exert their effects in these tissues by assessing protein synthesis activity and related parameters in the presence or absence of dietary nucleotides. METHODS: Rats were fed a purified diet with or without nucleotides for 10 days. Fractional protein synthesis rate, RNA and DNA concentrations, polysome size distribution, and number of ribosomes were assessed. RESULTS: Fractional protein synthesis rates of the liver and small intestine were lower in the nucleotide-deprived group than in the control group. In the liver, RNA concentration was also lower in the nucleotide-deprived group, but values in the small intestine were similar in the two groups. In the liver, deprivation of nucleotides resulted in a reduction in the number of ribosomes and in polysome breakdown. Protein and DNA concentrations did not vary in the liver; however, the concentration of DNA was lower in the small intestine of the nucleotide-deprived group than in the control group. CONCLUSIONS: Dietary nucleotides can modulate protein synthesis in the liver and small intestine as a result of tissue-specific nucleic acid changes. (Gastroenterology 1996 Jun;110(6):1760-9)     

Recurrence and spontaneous remission of nephrotic syndrome in secondary renal amyloidosis

Secondary systemic amyloidosis (AA) occurs in association with chronic inflammatory disorders and chronic infections. Regression can occur after therapeutically induced remission of the underlying disease; spontaneous remissions has been reported infrequently. We report a 61 year-old woman, with antecedent pulmonary tuberculosis, who developed a nephrotic syndrome at the time of a respiratory infection. Renal biopsy showed secondary amyloidosis. Remission in the nephrotic syndrome appeared spontaneous, but it recurred in the course of pneumonia, and had a second spontaneous remission a maintained at present.     

Value of the electrocardiogram to predict the pattern of left ventricular contraction in ischemic cardiopathy]

A correlative electrocardiographic and ventriculographic study was performed in a series of 100 patients with clinical and electrocardiographic diagnosis of ischemic heart disease. The analysis was focused on the possibility of predicting ventricular contraction pattern (VCP) disturbances, through electrocardiographic signs of coronary insufficiency. Two main groups were separated on the basis of the presence of necrosis. There were 66 cases with necrosis, and 34 without it. The type of VCP was calssified in accordance with the criterion of Herman et al. in: asyneresis, akinesis and dyskininesis. The degree of coronary narrowing was arbitrarily evalued as less than 50%, between 50 and 75%, and over 75% of the lumen.     

Polyunsaturated Fatty Acid Deficiency in Liver Cirrhosis: Its Relation to Associated Protein-Energy Malnutrition (Preliminary Report)

Plasma fatty acids (FA) from C14:0 to C22:6 omega 3 were measured in five healthy subjects and in 27 patients with liver cirrhosis. According to the assessment of triceps skinfold, mid-arm muscle circumference, and serum albumin concentration, patients were prospectively included in three groups: group A (n = 7) with acceptable nutritional status (including good nutrition and mild malnutrition), group B (n = 10) with moderate malnutrition, and group C (n = 10) with severe malnutrition. Plasma levels of total FA, saturated FA, linoleic acid, and omega 6 greater than 18C and omega 3 greater than 18 polyunsaturated fatty acids (PUFA) were lower in cirrhotics than in controls. Linoleic:arachidonic ratio was increased and delta 5-desaturation precursors:products ratio did not change, suggesting a reduction in delta 6-desaturase and/or C18-C20 elongase activities. In addition, a stepwise fall in plasma levels of all but saturated FA was found as the nutritional status worsened, suggesting that, in cirrhosis, impairment in PUFA biosynthesis is related to the severity of associated malnutrition. Since PUFA have important biological functions as components of cell membranes and precursors of eicosanoids, the results reported here may open new perspectives in the understanding of the cirrhosis-malnutrition relationship.     

Brush cells in the human fetal trachea

We performed a morphologic examination of human fetal lung tissue, using scanning and transmission electron microscopy, in order to establish the presence of brush cells in extrapulmonary and intrapulmonary airways, and developing acinar epithelium. Brush cells, characterized by a border of regular straight microvilli containing a filamentous core, were observed within the tracheal epithelium of a 19-20 week gestational age fetus. These cells constituted 0.5% of the total epithelial cell population. Brush cells were not seen within the bronchial, bronchiolar or developing acinar epithelium. Our study shows that brush cells occur infrequently but normally in the developing tracheal epithelium of the second trimester fetus.     

Pneumonia and acute renal failure as complications of varicella in adults

Varicella is a disease in childhood. When it affects adults, serious complications can develop, the most frequent and most dangerous being pneumonia. Acute renal failure is an exceptional complication which infrequently is reported in relevant current literature. The association of pneumonia with acute renal failure in a patient with varicella is unusual. We report a varicella case in an adult patient who suffered from pneumonia with respiratory distress syndrome and acute renal failure, both of them had a favourable clinical course.     

Clinical, Endoscopic, Immunologic, and Therapeutic Aspects of Oropharyngeal and Esophageal Candidiasis in HIV-Infected Patients: A Survey of 114 Cases

The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.