Effects of epoprostenol on right ventricular hypertrophy and dilatation in pulmonary hypertension

OBJECTIVES: To gain more knowledge of changes in main pulmonary artery flow and right ventricular mass and volumes in patients with pulmonary hypertension during epoprostenol therapy. METHODS: Eleven patients (9 women) were evaluated before the start of therapy and every 4 months thereafter. Right and left ventricular volumes and masses were measured by cine MRI. Flow was measured with MRI velocity quantification. At the same times, 6-min walking tests were performed. Right-heart catheterizations were performed at baseline and after 1 year. RESULTS: Right ventricular mass in the patient group was significantly higher from that in a control group of healthy volunteers (95 +/- 26 g vs 42 +/- 10 g, p < 0.05 [mean +/- SD]), whereas the stroke volume was lower (34 +/- 11 mL vs 81 +/- 11 mL, p < 0.05). The greatest improvement in right ventricular stroke volume (to 41 +/- 11 mL, p < 0.05) took place in the first 4 months. During the 1-year follow-up, right ventricular end-diastolic volume and mass did not change, and mean pulmonary artery pressure remained nearly stable at 55 mm Hg at baseline and 53 mm Hg after 1 year. Pulmonary vascular resistance decreased by 12.5% (p = 0.06). CONCLUSIONS: From these data we conclude that epoprostenol lowers pulmonary vascular resistance, leading to an increase in pulmonary artery flow. This increase in pulmonary artery flow corresponds well with the increase in 6-min walking distance and can be noninvasively monitored by MRI (flow quantification). Right ventricular dilatation and hypertrophy are not reversed by epoprostenol therapy, but do not progress either.     

Uterine artery embolization for symptomatic fibroids.

OBJECTIVES: The aim of this study was to introduce uterine artery embolization (UAE) as an effective and safe treatment option in patients with symptomatic fibroids. METHODS: Sixty-one patients underwent UAE with a 3- and 12-month follow-up. RESULTS: The procedure was well tolerated in all patients with the following symptoms improving: heavy bleeding [90% (95% CI 80.21%; 95.4%)]; dysmenorrhea [median -4 (95% CI -5; -4)]; feeling of a mass [74% (95% CI 57.9%; 85.8%)]; abdomino-pelvic discomfort [88% (95% CI 75.5%; 94.9%)]; and deep dyspareunia [90% (95% CI 71.1%; 97.3%)]. Uterine volume decreased by a median difference of 188 cm(3) (95% CI 146.5; 236), which related to a median % reduction of 37.7% (95% CI 32.4%; 45%) at 12-month follow-up. Most (91%) patients were satisfied with the procedure and only minor complications occurred. CONCLUSIONS: Uterine artery embolization can be performed effectively and safely at centers with the necessary expertise and can be used with success in Africa.     

Pyelonephritis: renal urokinase activity in rats on essential fatty acid diets

This study was undertaken to assess whether additions of different oils to the diets of male rats would affect the renal urokinase (UK) activity of healthy and pyelonephritic kidneys. Four groups of fatty acid diets were studied: fat-free, coconut oil, fish oil and evening primrose oil (EPO). Pyelonephritis was obtained by unilateral extrarenal urinary obstruction and subcutaneous injection ofEscherichia coli. The UK activity of the non-obstructed kindeys did not differ statistically between rats infected and not infected with bacteria (P>0.056), except within the coconut oil group. A statistically decreased UK activity was obtained with bacteria injected animals on a coconut oil diet (P<0.0001). This phenomenon, namely a decrease in UK activity, was also seen with pyelonephritic kidneys of rats on fat-free, coconut and fish oil diets (P<0.0065). However, the UK activity of the obstructed kidneys with and without infection in the EPO group remained similar (P=0.8477). These results suggest that the UK activity in infection-induced renal stones may be restored by EPO containing diets and may be of high relevance in the prevention and treatment of infection-induced renal stones. This revelation now needs to be more fully investigated.     

Anesthesia for patients with intestinal obstruction]

The pre- and intra-operative care of patients with acute intestinal obstruction is reviewed. The most important pre-operative problems are hypovolaemia, sepsis, electrolyte and acid-base imbalances. The evaulation and treatment of these disorders are discussed. The importance of preventing regurgitation and inhalation of stomach contents is emphasised and the methods which are used are described. The safest techniques of induction and maintenance of anaesthesia as well as muscle relaxation and intra-operative fluid therapy are indicated.     

Combination chemotherapy with cisplatin and bleomycin in advanced cervical cancer

Seventeen patients with advanced and recurrent squamous cell cervical cancer were treated with a combination of cisplatin and bleomycin. One complete and nine partial responses were observed (53%). The median duration of response was 8 months and the median survival was 12.7 months (5 months for nonresponders). Response was documented, particularly in patients with nodal disease and lung metastases. No life-threatening toxic effects were reported. This combination appears to be as effective as other combinations, has low toxicity, is well-tolerated, and merits further study.