Multiple complex coronary plaques in a patient with acute myocardial infarction

 This report describes the case of a patient who developed acute myocardial infarction with ST segment elevation in anterior and inferior leads, simultaneously. After treatment with systemic thrombolysis, and after an initial short-lasting symptomatic improvement, chest pain and ST segment elevation recurred. Coronary angiography revealed severe complex stenotic lesions at both the right coronary artery and the left anterior descending (LAD) coronary artery. Percutaneous coronary angioplasty and stent implantation were successfully performed at both lesions. This case supports the concept that, at least in some patients, acute coronary artery disease reflects a diffuse pathophysiologic process that may lead to multifocal plaque instability associated with clinical instability at multiple sites. Received: November 12, 2001 / Accepted: February 16, 2002     

Behavioral symptoms in preschool children at the time of school entrance from the perspective of parents--data regarding prevalence and risk factors in an epidemiological study

Behavioral and emotional problems based on parents information from the Child Behavior Checklist (CBCL) were investigated in a large epidemiological sample of 4363 six year old pre-school children from the area of Heidelberg and Rhein-Neckar county. An overview about symptom frequencies of boys and girls is given, taking age specific evaluations into account. Considering symptoms and syndromes, externalizing and attention problems show high prevalence, especially for boys. Family problems are the most important predictors of child global symptomatology, explaining about 10% of variance of the CBCL total score. Other factors like gender, chronical illness, adverse living conditions, family constellation or amount of TV consumption prove as additional independent predictors. An overall model explains about 20% of variance of child symptomatology. Results are discussed from the view of normal child development, developmental psychopathology, changing norms and altered socio-cultural conditions.     

Changes in test norms of spelling achievement and nonverbal intelligence

The norms of the spelling test R-T Form C "Moselfahrt" (Althoff et al. 1974) from the year 1968 and of the nonverbal intelligence test CFT 20 (form A/part 1) from the year 1977 (Weiss 1987) are evaluated for their actual validity. In 1995, both original tests were being administered to an epidemiological sample (N = 592) of adolescents and young adults in the age of 16 to 30 years having passed at least their obligatory amount of school years. These results are being compared to those of the original norm samples. Using the norms for the CFT 20 from 1977 adolescents and young adults achieve in the year 1995 a mean IQ of 110.8 points, equaling a yearly IQ-gain of 0.6 IQ-points. This exceeds the expected gain of 0.33 IQ-points annually according to the literature and indicates a distinct change of norms. There were no significant gender differences found. The distribution of mistakes in the spelling test R-T "Moselfahrt" compared to the original norm sample from 1968 changes considerably as well and requires revised test norms. With an increase from 9-11 mistakes (depending on the age norm) to 19.8 mistakes the mean amount of mistakes is almost being doubled. Extremely high numbers of mistakes occurred more frequent and could not be differentiated according to the old norms. Using the original norms from 1968 in the year of 1995 12.4% of the sample achieve with a T-score of 20 the lower limit of the measured value scale and the overall mean has decreased by 1.2 standard deviations to T-score = 38.48% of the sample reach a result that equates percentage 10 or less which is interpreted as insufficient school mark. Women's mean spelling achievement is significantly better than men's. Causes and implications of this scissors-like development of deteriorated spelling achievement and increased nonverbal intelligence are being discussed. Tables containing the new standardization scores are included in the appendix.     

A note on poly-L-lysine-mediated gene transfer in HeLa cells

Poly-L-lysines of chain lengths varying from 70 to 300 residues are shown to bring about luciferase pRSVL DNA uptake and expression in HeLa cells. Transfection was approximately 50% that of the cationic liposome DOTAB. Expression was higher in the presence of chloroquine. Of interest was the fact that luciferase activity depended on the polysine/DNA charge ratio (+/ -). Maximum activity occurred at a charge ratio (+/ -) of 3, while at a charge ratio of 1 (conjugate electrically neutral) activity was much lower. At the higher charge ratios (+/ -) of 4 and 5, luciferase activity decreased. The results obtained are discussed.     

Genetic Polymorphisms in Cytokine and Adhesion Molecule Genes in Coronary Artery Disease

Both inflammation and genetics play an important role in the pathogenesis of atherosclerosis and coronary artery disease. Epidemiological studies have investigated the association between coronary artery disease (CAD) and gene polymorphisms of the inflammatory molecules tumor necrosis factors (TNF) alpha and beta, transforming growth factors (TGF) beta-1 and beta-2, interleukin (IL)-1 and its receptor antagonist (IL-1ra), CD14 (the receptor for lipopolysaccharide), P- and E-selectins, and platelet endothelial cell adhesion molecule (PECAM)-1. Current evidence suggests that the TNF polymorphisms explored so far are not linked to CAD. The majority of studies conducted showed no significant association between TGFbeta-1 and coronary atherosclerosis, but the data currently available are somewhat controversial. Some polymorphisms may increase the risk of myocardial infarction (MI) within specific ethnic groups or in certain populations. The association between the IL-1 system and atherosclerosis is complex and may vary as a result of a number of factors, such as stage of disease, clinical phenotype, and possibly population characteristics. The E-selectin gene (SELE) Arg128, 98T, and Phe554 alleles may increase the risk of atherosclerosis, but not necessarily the risk of MI. This association seems to be more pronounced in younger patients. The PECAM1 Leu125Val and Ser563Asn polymorphisms may increase the risk of atherosclerosis but not necessarily of MI. This association may be especially important in patients with a low risk for developing atherosclerosis. Current data indicate that screening for CD14-260C/T genotypes is unlikely to be a useful tool for risk assessment and it remains unclear whether CD14 polymorphisms significantly increase the risk of MI. The associations between candidate gene polymorphisms and CAD are complex as a consequence of pleiotropy, variations with age, selection due to the high lethality of the disease, and interactions with other genes and environmental factors. Nonetheless, although the current data is preliminary and partly conflicting, it does provide some evidence that alterations in the genetics of the inflammatory system may modify the risk of CAD.     

Comparison of subcutaneous and intravenous rehydration in geriatric patients: a randomized trial

OBJECTIVES: To compare the acceptance, feasibility, and adverse effects of subcutaneous (SC) and intravenous (IV) rehydration in dehydrated geriatric patients and clinical changes exhibited by the patients. DESIGN: A prospective, randomized, open clinical trial. SETTING: Hospital geriatric wards during a period of 20 months. PARTICIPANTS: Ninety-six patients with a mean age +/- standard deviation of 85.3 +/- 6.7 with signs of mild to moderate dehydration needing parenteral fluids. INTERVENTION: Geriatric patients were randomly allocated to receive SC or IV infusions of half-normal saline-glucose solutions as long as clinically necessary. MEASUREMENTS: A standardized patient record form was used to document the observed adverse effects. Using a Likert-like scale based on the German school marks system with scores ranging from 1 = very good to 6 = very bad, patients were asked to score their discomfort; nurses and doctors scored the feasibility of the intervention. Changes in laboratory and clinical findings (including patients' orientation and activities of daily living using the Barthel Index) and adverse effects were recorded. RESULTS: Forty-eight patients were randomized into each group. Median duration of fluid administration was 6 days (SC and IV, P =.33). Median volume was 750 mL/day (SC) and 1,000 mL/day (IV, P =.002). In 13 patients, the therapy had to be changed from SC to IV (SC/IV subgroup): 11 times because of the exigency of an IV drug application and twice because of poor resorption. In 17 patients, there was a change from IV to SC (IV/SC subgroup), mainly because of impossibility of further peripheral IV punctures (8 times) and permanent removal of the IV cannula (5 times). The patients of the IV/SC subgroup scored their discomfort significantly worse (median 5.5 vs all other groups median 2, P =.017). This corresponded with the scoring of feasibility by the nurses (IV/SC: median 4.25 vs all other groups median 2, P =.009) and by the doctors (IV/SC: median 4 vs all other groups: median 2, P =.001). Both methods of rehydration caused only few systemic adverse reactions; acute cardiac failure occurred twice in the SC group versus four times in the IV group (P =.68) and hyponatremia once in the SC group versus twice in the IV group (P = 1.0). Some patients experienced local side effects (SC, n = 29 vs IV, n = 24; P =.41), mainly to a mild extent (SC, n = 25 vs IV, n = 24; P = 1.0). Major local side effects (large edema, phlebitis, cellulitis, erythema and strong pain) occurred in nine SC and eight IV (P = 1.0) patients. The clinical and laboratory changes during therapy were similar in both trial arms. CONCLUSIONS: Rehydration by hypodermoclysis is equally well accepted by geriatric patients as the IV therapy and offers a similarly easy feasibility. Additionally, in confused patients and in those in whom IV punctures are difficult to achieve, it represents the far superior method. Both techniques are comparably safe and effective.