St. Jude Medical valve replacement: clinical experience with 1,039 patients

St. Jude Medical valve replacement was performed in 1,039 patients; 320 had aortic (AVR), 543 mitral (MVR), and 176 had double valve replacement (DVR). There were 44(4.2%) early deaths. Follow-up extended in 995 patients from 10 to 130 months, with a cumulative period of 2,730 patients-years. The overall survival rates of AVR, MVR, and DVR patients at 10 years were 60.5%, 89.6%, 90.3% respectively. The linearized incidences of valve thrombosis, thromboembolism, anticoagulation-related hemorrhage, prosthetic valve endocarditis, and significant hemolysis were as follows: 0.11%/pt-yr, 1.33%/pt-yr, 0.04%/pt-yr, 0.18%/pt-yr, and 0.11%/pt-yr, respectively. There were no structural failure after 10 years follow-up. Reoperation (explant and re-replacement or suture repair) was required in 10 patients. Seven of them had periprosthetic leakage, 2 had valve thrombosis, and one underwent reoperation because of a technical error. Actuarially over 98% of patients were free of valve-related mortality at 10 years. St. Jude Medical valve is an excellent alternative for use in the surgical treatment of valvular heart disease.     

Attempt at predicting paraphrenic outcome in young, first admitted schizophrenic patients

A sample of 110 consecutive first admission young schizophrenic patients treated between 1964 and 1967 was rediagnosed in 1981. Among 92 survivors, 27 could be labelled as paraphrenics. From information available at inception 97 variables were coded covering such areas as personality, previous disturbances, age and type of onset, and symptoms around admission. Sixty-three out of 97 variables were hypothesized to differentiate, at admission, future paraphrenics from the rest of the sample. Paraphrenics were found to have had less contact disturbance, better self-esteem, less neurotic symptoms in adolescence and childhood, and less complaints of unhappiness when growing up. They had more regressive and paranoid symptoms at admission, were older at onset of the disease, which was more acute, more often connected with precipitating events, and confusion. Certain non-regressive symptoms such as brooding, anhedonia and concentration difficulties were less common. A discriminant analysis yielded a proportion of correct predictions = 0.64 (p less than 0.05). The results are in accordance with the theory of more favourable energetic and organizational capacity in paranoid schizophrenics as compared with non-paranoids.     

Radiation dosimetry of iodine-123 HEAT, an alpha-1 receptor imaging agent

Biologic distribution data in the rat were obtained for the alpha-1 adrenoceptor imaging agent (+/-) 2-[beta-(iodo-4-hydroxyphenyl)ethylaminomethyl]tetralone (HEAT) labeled with [125I]. The major excretory routes were through the liver (67%) and the kidney (33%). Internal radiation absorbed dose estimates to nine source organs, total body, the GI tract, gonads, and red bone marrow were calculated for the human using the physical decay data for [123I]. The critical organ was found to be the lower large intestine, receiving 1.1 rad per mCi of [123I]HEAT administered. The total-body dose was found to be 58 mrad per mCi.     

Cholecystokinin-peptides--new knowledge and possibilities for clinical use

This issue comprises selected topics of CCK peptides. CCK peptides are linear peptides and were found within and outside the CNS. There is growing evidence that CCK peptides play a physiological role in food intake, contraction of gallbladder and regulation of motility of the gastrointestinal system. New aspects of the CCK research are concentrated on interaction with other transmitter systems especially with the dopamine and opioid system. The therapeutic action to improve clinical symptoms in human is unclear up to new. World-wide, the interest is focused to determine the potential of CCK peptides as an antipsychotic agent by controlled clinical studies.     

Active abdominal tuberculosis in Canada in 1970-81.

We reviewed all 341 cases of abdominal tuberculosis reported in Canada between 1970 and 1981. Over the study period abdominal tuberculosis accounted for a stable proportion (0.8%) of all reported cases of tuberculosis in Canada. Its incidence declined steadily. It was more common in women, in native Indians and in people born in Asia. Detailed records of the 55 cases reported to Statistics Canada from British Columbia and of an additional 31 cases not reported to Statistics Canada (usually because they involved concomitant disease elsewhere, notably the lungs) were studied. Five of the 55 cases reported to Statistics Canada had been reported incorrectly. Of the 81 cases in British Columbia 51% involved peritonitis, 21% ileocecal disease, 20% anorectal disease, 10% mesenteric lymphadenitis, 1% disease of the sigmoid colon and 1% disease of the liver. The rate of bacteriologic confirmation was low (51%).     

Chemical radioprotectors

Basic mechanisms of radioprotection and clinical applicability of radioprotectors for low-and high-LET radiotherapy were reviewed and discussed here. Chemical radioprotectors are able to inhibit indirect radiation damage, to repair direct and indirect damage once they occur, and to facilitate the recovery of damaged cells on depleted cell populations. The vast majority of radioprotective agents that have been developed and tested are the aminothiols. WR-2721 or ethiofos represents a significant improvement in effectiveness, potency and reduction of toxicity over the early radioprotectors. WR-151327 provided substantial protection against neutron irradiation. Dose modification factors after single doses of cyclotron neutrons were 1.5 for both early and late skin damage and 1.5-2.4 for late muscle damage.     

A brain site for the antigonadal action of melatonin in the white-footed mouse (Peromyscus leucopus): involvement of the immunoreactive GnRH neuronal system

Quantitative assessment of immunocytochemical staining for gonadotropin-releasing hormone (GnRH) was undertaken to determine the effects of an intracranial implant of melatonin on the GnRH neuronal system in the male white-footed mouse (Peromyscus leucopus). Melatonin-containing pellets stereotaxically placed in the anterior hypothalamic area (AH) caused a 60% reduction in testes weight relative to control mice with melatonin-free pellets in the AH (p less than 0.01). Subcutaneous melatonin-containing implants had little effect on reproductive state (p less than 0.8). Melatonin pellets in the AH increased significantly both the optical density (OD) for immunostaining of cell bodies in the medial preoptic area and AH (p less than 0.04), and the percentage of area covered by GnRH fibers and beads in the median eminence (p less than 0.01). The melatonin-induced increase in OD of the GnRH cell bodies was independent of the distance of the cells from the melatonin implant, and there was little apparent effect of melatonin on the size and morphology of the GnRH cell bodies, or the trajectories of their fiber pathways. These results support the hypothesis that the antigonadal action of melatonin in the brain involves suppression of the release, rather than the synthesis of GnRH. Also, this effect may not be mediated via a direct action of melatonin on GnRH neurons. The finding that the brain site and time course for melatonin's antigonadal action in male. P. leucopus is similar to that found previously in the female is evidence that melatonin may induce gonadal regression, in part, by helping to suppress the tonic secretion of gonadotropins.