Gender differences in post-infarction hypertrophy in end-stage failing hearts

OBJECTIVES: We explored whether there are gender differences in cardiac remodeling and whether etiology influences organ and cellular remodeling in advanced heart failure (HF). BACKGROUND: Several studies have shown a survival benefit for women compared to men with symptomatic HF. This observation may be related to gender differences in cardiac remodeling. METHODS: We studied hearts from 100 patients (72 men and 28 women) receiving cardiac transplantation at our institution. Cardiac morphology was assessed with echocardiography and direct measurement of cardiac mass. Cardiac myocyte volume, length, width, cross-sectional area, and contraction were measured using previously validated techniques. RESULTS: Among 50 patients with idiopathic cardiomyopathy (CM), we observed no gender-based differences in cardiac or cellular remodeling. In contrast, among 50 patients with ischemic cardiomyopathy (ICM), the heart weight index was significantly greater in men, and there was a strong trend toward an increased left ventricular (LV) mass index as well. These gender differences in cardiac and LV mass were paralleled by marked gender differences in myocyte volume, such that average myocyte volume was 36% greater in men than in women, in association with a 14% increase in resting cell length. CONCLUSIONS: Our studies demonstrate a multilevel gender difference in post-infarction remodeling, with women exhibiting reduced hypertrophy. Our studies further demonstrate that gender differences in cardiac remodeling in ICM are largely related to fundamental differences in cellular remodeling rather than simply differences in infarct size or expansion. Distinctions observed between ischemic and idiopathic CM suggest that gender may influence local myocardial responses to injury.     

Fludarabine: a new agent with major activity against chronic lymphocytic leukemia

Fludarabine was used to treat 68 patients with previously treated chronic lymphocytic leukemia (CLL). Nine (13%) patients achieved a complete remission and 30 (44%) a partial remission. The response rates for Rai stages 0 to 2, 3, and 4 were 64%, 58%, and 50% respectively. Seventeen (43%) of the 40 Rai stage 1 to 3 patients and four (19%) of the Rai stage 4 patients returned to Rai stage 0. Survival was strongly correlated with the final Rai stage achieved. The survival of the 11 partial responders with residual disease consisting only of residual bone-marrow nodules was similar to the complete responders (36+ months) and superior to the other partial response patients (16 months). The response to fludarabine was rapid, with 36 (92%) of the 39 responders having achieved at least a partial response following the first three courses. Complete responses occurred in the blood, liver, spleen, and lymph nodes in 48% to 69% of the patients. Eradication of all disease in the bone marrow occurred in only 13% of the cases. Neutropenia and thrombocytopenia occurred in 56% and 25% of evaluable courses. Major infections occurred in 9% of evaluable courses and fevers of unknown origin or minor infections in 12% of courses respectively. Myelosuppression and infection were more common in patients with initial Rai stages 3 and 4 and in nonresponding patients. Other toxicity was mild. No CNS toxicity was noted.     

Increased endothelin in experimental heart failure

Recent studies demonstrate that endothelin, a potent endogenous vasoconstrictor peptide, circulates in plasma of normal animals and humans. However, the role of this peptide in pathophysiological states remains unclear. The present study was designed to test the hypothesis that circulating endothelin concentrations are increased in experimental congestive heart failure (CHF), a pathophysiological state characterized by activation of vasoconstrictor mechanisms. In anesthetized dogs with CHF produced by 8 days of rapid ventricular pacing (n = 28), circulating plasma endothelin was increased compared with values for normal controls (n = 28; 20.4 +/- 1.4 versus 9.7 +/- 0.9 pg/ml, respectively; p less than 0.0001). A plasma endothelin level of more than 14.0 was a sensitive and specific indicator of significant CHF. Moreover, within the group with experimental CHF, right atrial pressure and pulmonary capillary wedge pressure correlated independently with circulating endothelin levels. Based on recent studies demonstrating the physiological actions of twofold increases in circulating endothelin, as observed in the present study, a possible role for endothelin in the pathophysiology of CHF is advanced.     

Duodenal necrosis secondary to a closed-loop bowel obstruction with novel reconstruction

Duodenal necrosis is rare in children and presents a significant surgical challenge. We describe a 12-year-old girl who presented with duodenal necrosis secondary to a closed-loop bowel obstruction. We describe the diagnostic images, operative findings, and a novel reconstruction technique. This case highlights an alternative strategy for reestablishing gastrointestinal and biliopancreatic continuity while avoiding more complex procedures.     

眼部用药对老年人的全身影响

老年人使用眼药的情况是很普遍的,这些药物可能具有严重的全身影响,特别是在老年病人。这在医源性疾病的鉴别诊断中应予以考虑。文献报道的这个问题并非仅限于老龄人群,尽管大多数病人属于老年。眼药滴入球结膜囊中,除少量流出或吞下外,大部分均经由结膜毛细血管、鼻粘膜及咽部直接进入血液循环,其吸收量之大可足以产生副作用。由于老年人常常使用多种药物,因而与其他药物产生药物相互作用的可能性亦是存在的。现根据眼部用药的不良反应所涉及的主要     

Membranous fat necrosis

We report the case of a 66-year-old man with nodular lesions on the chest that were clinically diagnosed as epidermal cysts. Histologically the lesions consisted of fat necrosis with cystic spaces lined by striking membranous structures, mimicking a parasitic cuticle and exhibiting all the staining reactions of ceroid. Retrospective review of 33 consecutive cases of fat necrosis revealed similar membranous changes in 21% of the cases. The etiology and pathogenesis of this variant of fat necrosis are uncertain.     

An algorithm for selection of instrumentation levels in scoliosis

Appropriate levels for instrumentation and fusion in scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity. We set out to examine the hypothesis that the amount of correction achieved in all planes during surgical instrumentation of a curve should be less than, or comparable to, the degree of correction attainable at any non-instrumented adjacent curve. An algorithm was designed to facilitate preoperative planning and intraoperative performance of spinal fusion procedures in the management of scoliosis. To test the validity of the hypothesis and the proposed algorithm, measurements were taken from the preoperative radiographs of 200 patients. The dimensions of the curves were obtained from an initial set of four X-ray films: (1) standing anteroposterior film of the whole spine, (2) standing lateral film of the whole spine, (3) two properly performed side-bending films including each curve of the spine. With this data, a plan was designed using the algorithm. The results of this plan were compared with the actual results of the surgery, which were revealed only at this stage. All patients in whom actual instrumentation levels fell within those predicted by the proposed algorithm had no imbalance at follow-up. All patients whose actual instrumentation levels were short of those recommended by the algorithm showed obvious imbalance on final postoperative standing radiograph. Received: 10 May 1997 Accepted: 16 September 1997     

Delta 9-tetrahydrocannabinol alters cerebral metabolism in a biphasic, dose-dependent manner in rat brain.

delta 9-tetrahydrocannabinol (THC)-induced alterations in limbic and neocortical function are associated with deficiencies in short-term memory and recall. The 2-deoxy-D-glucose (2DG) autoradiographic method was used to examine the effect of acute THC administration (0, 0.2, 0.5, 2.0, 10.0 mg/kg) on regional brain metabolism in limbic and cortical brain regions of male rats. THC altered 2DG uptake in a biphasic, dose-dependent manner in most limbic and cortical structures, however most diencephalic and brainstem structures examined were unaffected. The 0.2 mg/kg THC dose significantly increased 2DG uptake relative to vehicle treatment in all cortical and selected limbic regions, whereas the 2.0 and 10.0 mg/kg THC doses decreased 2DG uptake in most of these regions. Certain limbic regions, particularly the hippocampus, are more sensitive to THC suggesting a selective regional action of the drug at lower doses. The incidence of enhanced metabolic activity in limbic and cortical regions is consistent with the occurrence of high density cannabinoid receptors in these regions.