Smoking and relation to other risk factors in postmenopausal women with coronary artery disease,with particular reference to whole blood viscosity and beta-cell function

OBJECTIVES: To investigate possible associations between smoking habits and other coronary risk factors in postmenopausal women with known coronary heart disease (CHD). SETTING: The study was conducted at a university clinic. SUBJECTS: A total of 118 postmenopausal women with CHD verified with angiography, consecutively recruited. INTERVENTIONS: Conventional treatment for CHD. The women were randomized to hormone replacement therapy (HRT) with transdermal 17-beta oestradiol and medroxyprogesterone acetate, or to a control group. RESULTS: Smokers were younger (P = 0.005), had lower body mass index (P = 0.04) and lipoprotein Lp(a) levels (P = 0.02) compared with nonsmokers. Smokers had reduced beta-cell function (homeostasis model assessment, P = 0.006), whereas whole blood viscosity (WBV) was higher at all shear rates. WBV was not affected by HRT over a 12-month period. Oestrone levels were higher in smokers. CONCLUSIONS: Smoking adversely affects insulin secretion (beta-cell function) and WBV in postmenopausal women with established CHD, which could be of importance as a mechanism for the increased risk of CHD in smokers. The importance of smoking as a risk factor, overrides the effect of Lp(a), which is lower in smokers compared with nonsmokers.     

Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US

At the authors' medical center, most patients with postappendectomy fluid collections are treated conservatively. Thirty-two (15%) of 216 children underwent postoperative sonography following appendectomies. In ten patients (31%), a total of 16 fluid collections were found on the initial postoperative sonogram. In the seven patients (70%) whose fluid collections were confined to the pelvis, the condition was treated conservatively and it resolved in 2-9 weeks. In three patients, fluid collections required surgical drainage and proved to be abscesses. In two of the three patients, abscesses were multiple and widely distributed in the abdomen, and the patients were clinically ill. The authors conclude that clinically symptomatic fluid collections develop postoperatively in approximately 5% of children who have undergone appendectomy for acute appendicitis and that the size and course of the fluid collection can be objectively monitored using sonography. Such fluid collections confined to the pelvis ultimately resolve with conservative, nonoperative therapy, although resolution may take up to 2 months.     

Cellulitis due to Escherichia coli in three immunocompromised subjects

A case of severe photosensitivity in a girl with the Smith–Lemli–Opitz syndrome is reported. Children with this recessively inherited metabolic disorder of cholesterol metabolism present with a variety of congenital abnormalities of the nervous system and internal organs in association with varying degrees of mental retardation. Photosensitivity is a feature which has previously only briefly been mentioned in the literature in association with this syndrome. However, more recently, it has become apparent that photosensitivity is not uncommon among children with the Smith–Lemli–Opitz syndrome, although the nature of the photosensitivity in these patients has remained undefined. Our patient has suffered from sunlight intolerance since early infancy, with redness and pruritus of sun-exposed skin developing within minutes of sun exposure. Monochromator ultraviolet (UV) radiation and visible light testing revealed an immediate and persistent reaction to low-dose UVA at 350 nm, and an abnormal erythemal response to visible light at 400 nm.     

Comparison in the Same Patient of Aberrant Conduction and Bundle Branch Reentry After Dofetilide, a New Selective Class III Antiarrhythmic Agent

Dofetilide may induce aberrant intraventricular conduction due to its Class III effect. This report describes an atrial fibrillation patient in whom intraventricular conduction was studied before and after dofetilide using multiple endocardial recordings. Dofetilide provoked aberrant conduction during atrial fibrillation, and aberrancy could be mimicked with programmed atrial stimulation after restoration of sinus rhythm. However, during right ventricular slimulation, isolated bundle branch reentrant beats were recorded after induction of critical retrograde conduction delays. This occurred in the setting of relatively large differences in refractoriness between the right bundle branch and the right ventricular myocardium. This favored distal retrograde bundle branch block during ventricular extrastimulation, in turn enhancing bundle branch reentry. This potendal proarrhythmic mechanism deserves close attention in the further deveiopmeni of dofetilide and also of other new "pure" Class III agents.     

A new approach to the evaluation of Plaque Index scores

The aim of the present study was to evaluate and compare methods of expressing the plaque situation recorded by the Plaque Index System (Silness and Löe 1964). Basic information based on 48 plaque recordings in each of 154 children indicated 16 ± 13% score 0, 63± 13% score 1, and 19± 14% score 2. The criteria of the Plaque Index System are at the ordinal or ranking level of measurement, whereas means and standard deviation should be performed at the interval and ratio scales of measurements, i.e. on the frequencies of the scores. Re-examinations of the children as well as a toothbrushing experiment indicated that the frequency of score 2 adequately expressed the plaque situation. The conventional toothbrushing seemed to have no effect on the total number of score 1.     

Transmural heterogeneity of postjunctional alpha 2 adrenergic coronary vasoconstriction in hypoperfused cat left ventricle.

OBJECTIVE: The aim was to analyse the influence of coronary postjunctional alpha 1 and alpha 2 adrenergic vasoconstriction in hypoperfused myocardium with special emphasis on transmural distribution of blood flow. METHODS: The left coronary artery was hypoperfused by means of a clamped shunt line. Sequential selective postjunctional alpha 1 (doxazosin) and alpha 2 (SK&F 104078) adrenergic antagonism was established following beta adrenergic antagonism with propranolol. Regional myocardial blood flow was measured with radiolabelled microspheres during equal coronary perfusion pressures. Experimental subjects were nine pentobarbitone anaesthetised open chest cats. RESULTS: Left coronary hypoperfusion decreased endocardial blood flow, whereas epicardial flow was unaltered. In this situation alpha 1 adrenergic antagonism did not affect myocardial blood flow. Subsequent alpha 2 antagonism impaired endocardial blood flow, whereas epicardial blood flow was augmented. Mean coronary vascular resistance declined following combined alpha 1 and alpha 2 adrenergic antagonism. CONCLUSIONS: Coronary alpha adrenergic vasoconstriction is localised mainly epicardially in hypoperfused myocardium and counteracts endocardial hypoperfusion distal to a fixed coronary stenosis. Furthermore, this vasoconstriction is of the postjunctional alpha 2 adrenergic subtype.     

Acceptance, caries reduction and reported adverse effects of fluoride prophylaxis in Norway

Water fluoridation has not been introduced in Norway, although 99% of the population receive water with suboptimal fluoride levels. Alternative methods of fluoride prophylaxis have gained wide acceptance in this country. While less than 1% of the children received fluoride tablet in 1971, sales data in 1976 indicated a daily supply of fluoride tablets to 50% of the 0-5-year-olds and to 20% of the 6-11-year-olds. Most schoolchildren have joined mass prophylactic programs with regular with regular applications of fluoride solutions. Furthermore, fluoride-containing dentifrices have become available and are increasingly used. The increased use of fluoride has been paralleled by a marked reduction in caries and restorative need. During the past 5 years, a reduction of about 45% in the number of fillings inserted in 6-17-year-old children has been noted. In some areas, a 70% reduction has been recorded. The ratio between expenses for prophylaxis and savings in cost of treatment is favorable. The Norwegian Adverse Drug Reaction Committe received 34 case reports of adverse effects ascribed to fluoride prophylaxis, from 1970 to 1977. None of the 25 follow-up studies performed, suggested fluoride to have been responsible for the reported symptoms. In Norway, the benefits of fluoride prophylaxis are becoming increasingly evident.