Left ventricular function during systole and diastole in mitral incompetence

Left ventricular function during systole and diastole was studied in 17 young patients with mitral incompetence and sinus rhythm; 13 had established chronic mitral incompetence, 3 had prolapsing posterior leaflet syndrome and 1 had ruptured chordae tendineae. In chronic mitral incompetence and prolapsing posterior leaflet syndrome, clinical disability was related to a low forward stroke index, a large regurgitant volume and tall left atrial V wave. The defect was mechanical, and the ventricle had adapted by compensatory dilatation so that overall systolic function was normal, as measured by peak rate of rise of left ventricular pressure ($\text{dP}\text{dt}$) and ejection fraction. The dilated ventricle operated at a normal or slightly increased end-diastolic pressure, a consequence of normal resting tension (O point) and a more elastic myocardium with a low rate of change of instantaneous stiffness (m) and a flattened diastolic pressure-volume curve.In acute mitral incompetence, systolic function was normal but the sudden volume overload caused the unprepared ventricle with an almost normal modulus of elasticity and slope (m) to ascend its pressure-volume curve in diastole. End-diastolic pressure was increased.     

Pulmonary hemorrhage in systemic lupus erythematosus.

The clinicopathological features of four patients with systemic lupus erythematosus and pulmonary hemorrhage are described. Our study confirms that pulmonary hemorrhage may be a dominant clinical expression of lung involvement in this disease. Its clinical manifestations are usually quite characteristic. However, hemoptysis may be absent. Radiographically, bilateral alveolar infiltrates resembling pulmonary edema or infection may be seen. Pulmonary hemorrhage was a major contributing factor to the death of three of our patients. The possible pathogenetic mechanisms responsible for pulmonary hemorrhage in our patients and other patients previously recorded in the literature are reviewed. Evidence supporting an immune complex pathogenesis is presented. Our immunopathological and ultrastructural studies demonstrate deposition of immune aggregates in the lungs in the alveolar septa, large blood vessels, and bronchioles in a manner similar to that which has been observed in the experimental serum sickness model of immune complex mediated pulmonary injury. The histological abnormalities, although nonspecific, are consistent with this interpretation, and collectively show diffuse alveolar lining cell and endothelial cell injury. However, an immune complex pathogenesis may not completely explain the occurrence of pulmonary hemorrhage in SLE. Other factors, including bleeding disorders, pulmonary infection, oxygen toxicity, and the "shock lung" syndrome, may also have contributed to lung hemorrhage in some of these patients.     

Coronary arteriography 1984–1987: A report of the registry of the society for cardiac angiography and interventions. II. An analysis of 218 deaths related to coronary arteriography

In a 42-month period, 218 deaths occurred in 222, 553 patients undergoing coronary arteriography (0.098%). Age > 60 years, NYHA Class IV function, presence of left main coronary disease, and ejection fraction < 30% all significantly increased the risk of the procedure. Sex and approach (brachial or femoral) used for the catheterization did not affect mortality. Since the SCAI report in 1982, the death rate has dropped significantly in high-risk patients. Low-risk patients (NYHA Class I or normal coronary arteries) who died generally were elderly or had associated valvular heart disease.     

Auditory Sensory/Perceptual Alteration: Suggested Revision of Defining Characteristics

This correlational study of acutely ill geriatric patients examined (1) if psychosocial dysfunctioning is associated with hearing impairment, as popularly believed; (2) the utility of using psychosocial changes as cues for making the nursing diagnosis sensory/perceptual alterations: auditory; and (3) an alternative model of defining characteristics for predicting auditory perception using variables that have been reported in the literature as being associated with hearing loss but, to date, are not part of the approved diagnostic category. A random sample (n = 226) was drawn from daily admission lists of English-speaking patients 65 years of age or older, admitted to nonintensive care units of a medical center hospital. The major defining characteristics for sensory/perceptual alterations were operationalized as seven variables: depression, cognitive function, social contact with children, social contact with other relatives, social contact with friends, subject-reported hearing ability, and subject-reported overall health status. Auditory sensory perception was operationalized as number of tones heard on audiometric examination. Findings indicate that assessing psychosocial functions does not provide nurses with helpful cues for making the auditory alteration diagnosis. Rather results suggest that nurses can make a more accurate diagnosis merely by knowing the patient's age, self-rating of hearing, and checking ear canals for impacted cerumen.     

Emr, an Escherichia coli locus for multidrug resistance.

An Escherichia coli chromosomal DNA fragment cloned on a multicopy plasmid conferred resistance to carbonylcyanide m-chlorophenylhydrazone, nalidixic acid, and a number of other toxic compounds. The sequence of the cloned emr locus located at minute 57.5 of the chromosome revealed two open reading frames, emrA and emrB. emrB encodes a highly hydrophobic 56.2-kDa peptide, with 14 potential alpha-helices to span the inner membrane. The peptide is homologous to QacA, a multidrug-resistant pump from Staphylococcus aureus, and belongs to a gene family that includes tetracycline-resistant pumps of Gram-positive bacteria and the galactose/H+ symporter of E. coli. emrA encodes a putative 42.7-kDa peptide containing a single hydrophobic domain and a large C-terminal hydrophilic domain. An active pho-fusion to the C domain suggested that EmrA is a membrane protein. Disruption of emrB significantly increased sensitivity of cells to uncouplers. The cellular content of uncoupler increased in the order: overexpressed emrB cells greater than wild type greater than emrB-.     

A severe defect in CRAC Ca2+ channel activation and altered K+ channel gating in T cells from immunodeficient patients

Engagement of the TCR triggers sustained Ca(2+) entry through Ca(2+) release-activated Ca(2+) (CRAC) channels, which helps drive gene expression underlying the T cell response to pathogens. The identity and activation mechanism of CRAC channels at a molecular level are unknown. We have analyzed ion channel expression and function in T cells from SCID patients which display 1-2% of the normal level of Ca(2+) influx and severely impaired T cell activation. The lack of Ca(2+) influx is not due to deficient regulation of Ca(2+) stores or expression of several genes implicated in controlling Ca(2+) entry in lymphocytes (kcna3/Kv1.3, kcnn4/IKCa1, trpc1, trpc3, trpv6, stim1). Instead, electrophysiologic measurements show that the influx defect is due to a nearly complete absence of functional CRAC channels. The lack of CRAC channel activity is correlated with diminished voltage sensitivity and slowed activation kinetics of the voltage-dependent Kv1.3 channel. These results demonstrate that CRAC channels provide the major, if not sole, pathway for Ca(2+) entry activated by the TCR in human T cells. They also offer evidence for a functional link between CRAC and Kv1.3 channels, and establish a model system for molecular genetic studies of the CRAC channel.     

Cardiovascular Complications of Extreme Obesity in Women

Severe obesity (body mass index ≥35 kg/m²) is occurring at younger ages in US women and is relatively common among women of certain racial/ethnic backgrounds. It is associated with a high incidence of cardiovascular risk factors and cardiovascular outcomes and may represent an increasingly important facet of cardiovascular risk for US women. Bariatric surgery has the strongest literature base for producing substantial and sustained weight loss among the severely obese but carries the risk for potentially severe complications. An emerging literature shows that lifestyle intervention may lead to clinically meaningful weight loss in the severely obese, but that maintenance of such loss may be problematic.     

MASSIVE LOWER GASTROINTESTINAL HAEMORRHAGE SECONDARY TO METASTATIC SQUAMOUS CELL CARCINOMA OF THE LUNG

SUMMARY Clinically significant symptoms due to gastrointestinal metastases from primary lung cancers is rare. A case of life-threatening lower gastrointestinal haemorrhage secondary to metastatic squamous cell carcinoma of the lung is reported. Previous reports of such metastases are reviewed, with reference to management and prognosis. After resection of colonic metastases from squamous cell lung cancer, survival is similar to that for primary disease. It is suggested that patients with known or suspected squamous cell lung cancer presenting with lower gastrointestinal symptoms be managed as aggressively as those with no previous history of disease.