Reference values for pulsed Doppler signals from the blood flow on both sides of the aortic valve

Pulsed Doppler signals were recorded in 215 healthy subjects,120 males and 95 females, between 1 and 65 years of age. Themeasurements were performed in the left ventricular outflowtract (LVOT) and in the ascending aorta (AAO). Amplitude spectrafrom the Doppler signals were stored in digital form togetherwith adjustment data for the instrument, the simultaneouslyregistered ECG and respiration signal. The maximum velocity(V_max, the maximum acceleration (A_max) and the width of thevelocity distribution around V_max (width) were derived fromthese spectra and used for the characterization of the signals.These parameters were computed without observer interactionusing a computer program. Effects of age, sex, body surfacearea, heart rate and respiration were studied. Reference rangeswere calculated. The following conclusions can be drawn: V_maxand A_max in the AAO decrease clearly with increasing age fromapproximately 100 to 60 cm s^-1 and from 2000 to 1000 cm s^-2(medians), respectively. The variation of the width in the AAOis greater for people over 45 years. V_max, A_maxand width inthe LVOT increase slightly with advancing age from approximately60 to 80 cm s^-1, 800 to 1000 cm s^-2 and 12 to 15 cm s^-1 (medians),respectively. These parameters of flow were either unrelatedor only weakly related to other physiological variables in thisstudy group.     

Percutaneous Transvenous Mitral Valvuloplasty, Percutaneous Transluminal Coronary Angioplasty, and Coronary Thrombolysis Applied Successfully to One Patient

The present report describes a patient with severe mitral stenosis and coronary artery disease who was successfully treated by combined percutaneous mitral valvuloplasty and coronary angioplasty. A few days following these procedures, the patient, probably as a result of thrombus embolization in the LAD artery, developed signs of an evolving anterior myocardial infarction and was successfully treated with intravenous thrombolytic therapy. This case demonstrates the feasibility of the combined appliance of interventional techniques in selected patients as an alternative to cardiac surgery.     

Tilt Training: A New Treatment for Recurrent Neurocardiogenic Syncope and Severe Orthostatic Intolerance

Medical treatment of neurocardiogenic syncope is insufficient in many cases. We have observed a therapeutic effect of repeated head-up till testing. Therefore, we have started a program of tilt training for heavily symptomatic patients. After hospital admission, they were tilted daily (60° inclination) until syncope, or until a duration of 45–90 minutes (90 sessions in 13 patients). The mean tilt tolerance, at the first diagnostic head-up tilt table test, was 22.3 minutes (st. dev. 10.9). Before hospital discharge, 12/13 patients could sustain the full duration of tilt table testing without any symptom. In one patient syncope persisted. The patients were instructed to continue a program of daily tilt training at home, by standing against a wall for 30 minutes, one or two times per day. This resulted in a complete disappearance of syncope in all 13 patients.
Orthostatic intolerance and the excessive autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training, without the administration of drugs.     

Ridogrel does not increase the speed and rate of coronary recanalization in patients with myocardial infarction treated with alteplase and heparin

Ridogrel, a compound with the dual property of inhibiting thesynthesis of thromboxane and blocking the receptors of thromboxanelprostaglandinlendoperoxides,has been shown to accelerate the speed of recanalization andto delay or prevent reocclusion during systemic thrombolysiswith tissue plasminogen activator in experimental animals. Ninetypatients who had not taken any antiplatelet drugs within thelast 10 days were randomized to either intravenous ASA 250 mgimmediately before the thrombolytic treatment and 100 mg oncea day orally thereafter or ridogrel 300 mg i. v. before thrombolytictreatment and 300 mg b.i.d. orally thereafter. All patientswere given intravenous heparin concomitantly with alteplase.The patency of the infarct-related artery was determined bycoronary angiography before the administration of the thrombolyticagent and by repeated coronary angiography every 15 min untilthe end of the administration of alteplase. A final angiogramwas obtained 48 to 72 h later. At 90 min, the recanalizationand patency rates were the same in the two treatment groupswith no intergroup difference in the speed of recanalization.     

Prediction of mortality following hospital discharge after thrombolysis for acute myocardial infarction: is there a need for coronary angiography?

The role of coronary angiography before hospital discharge aftermyocardial infarction was assessed in 1043 hospital survivorsof the alteplase/placebo and the alteplase/PTCA trial of theEuropean Cooperative Study Group. Forty-two of 1043 patients(4.0%) died after 1 to 489 days after predischarge coronaryangiography. In survivors, follow-up ranged from 34 to 1106days. In a stepwise multivariate regression model (Cox), useof diuretics and/or digitalis, a history of previous infarctionand age exceeding 60 years were retained in the model with clinicaldata only. In addition, inability to perform exercise testingand less than 30 mmHg exercise-induced systolic blood pressureincrease were selected by multivariate analysis. Large enzymaticinfarct size, radionuclide left ventricular ejection fractionbelow 40%, and multivessel disease were also determinants ofmortality after hospital discharge. The risk function, including coronary angiography, performedno better in late mortality prediction than functions basedon clinical data and non-invasive testing. Patients withouta history of previous infarction, not treated with diureticsand/or digitalis and with a systolic blood pressure increaseof 30 mmHg or more during exercise had an excellent survival(98.6%) in the first year after hospital discharge, irrespectiveof whether symptoms of recurrent ischaemia occurred. This lowrisk group formed 47% of the total patient population and doesnot benefit from coronary angiography.     

INNERVATION OF THE STRIATED MUSCLE OF THE MEMBRANOUS URETHRA OF THE MALE DOG

Purpose

To identify the functional innervation of the striated muscle layer of the post-prostatic urethra of male dogs.

Materials and Methods

Detailed anatomic dissection of the pelvic and pudendal nerves was carried out. The pressure and contractile responses to stimulation of these nerves were recorded in vivo and in vitro.

Results

Small branches of the pelvic nerve entered the membranous urethra but passed through the striated muscle to the inner smooth muscle layer. Stimulation of the nerve with 1 msec pulses at 10 Hz produced a slow contraction of the urethra which was unaffected by d-tubocurarine. Pudendal nerve branches entered the striated layer from the caudal end. Stimulation produced a rapid, visible contraction that was abolished by d-tubocurarine. Field stimulation of isolated strips of striated muscle resulted only in rapid, d-tubocurarine sensitive contractions.

Conclusions

The striated muscle of the membranous urethra is innervated exclusively by the pudendal nerve.     

Heart Rate Variability After Cardiac Transplantation in Humans

The reappearance of cardiac innervation after cardiac transplantation remains a matter of debate. We evaluated the ability of heart rate variability (HRV) analysis to detect the extent and time course of functional cardiac allograft reinnervation. Time- and frequency-domain analysis of heart rate was performed on Holter recordings of 120 heart transplant and four heart-lung transplant recipients. A high frequency (HF) component was clearly distinguished on visual inspection of power spectral density in 42 patients. In eight patients an HF component of normal magnitude was detected. The other 34 patients in this group, including all four heart-lung transplants, presented with a very small HF component. The other 82 patients showed a flat spectrum. The group with an HF component of normal amplitude was significantly different, compared to the other groups, for all HRV parameters. Serial plotting of HRV parameters of the patients with an HF component of normal amplitude against time posttransplant, revealed, from 12 months onwards, a progressive increase of parameters denoting HF variability. In five heart transplant patients with acute allograft rejection, the use of HRV analysis for rejection monitoring was unsuccessful. These results suggest that, inasmuch as the HF component of HRV is caused by parasympathetic cardiac innervation, the HF component of normal amplitude, observed in only a minority of cardiac transplant recipients (6%), is a marker for parasympathetic reinnervation. The evolution over time of this HF component is compatible with a biological phenomenon as gradual parasympathetic reinnervation of the sinus node.     

Serum lipids, biliary lipid composition, and bile acid metabolism in vegetarians as compared to normal controls

Since dietary factors have been implicated in various diseases, such as coronary heart disease, gallstone formation and colonic cancer, possibly by affecting cholesterol and bile acid metabolism, we studied serum lipid levels, biliary lipid composition, cholic acid and deoxycholic acid kinetics in a group of young healthy male vegetarians and in age, sex and weight matched control subjects. Daily intake of nutrients was higher with respect to polyunsaturated fatty acids, carbohydrates and dietary fibre in the vegetarian group. Although mean serum lipid levels in the vegetarian were 8-28% lower than in the control subjects, differences were not statistically significant. Biliary lipid and biliary bile acid composition were similar in both groups. Bile acid kinetics, measured after simultaneous injection of [3H]cholic acid and [14C]deoxycholic acid, showed a slightly lower output of cholic acid and a slightly higher input of deoxycholic acid in the vegetarians, this causing a significantly (P less than 0.025) higher 7 alpha-dehydroxylation fraction (input deoxycholic acid divided by synthesis of cholic acid) in the vegetarians. Our results in young males suggest that bile acid conservation is associated with a vegetarian diet, but do not support the supposition that a vegetarian diet reduces deoxycholate formation.     

Dyspepsia and Helicobacter pylori in Japanese employees with and without ulcer history

In a Dutch working population, the apparent association between dyspeptic symptoms and Helicobacter pylori infection was found to be entirely due to subjects with an ulcer history. In general populations with a much higher prevalence of H. pylori infection and peptic ulcer disease, such as in Japan, the relationship between dyspepsia and H. pylori has yet to be clarified. A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3 month period was obtained from apparently healthy Japanese employees who underwent a periodic medical examination. In addition, serum samples were analysed for anti-H. pylori IgG antibodies. A total of 196 men and 35 women, aged 23–71 years, participated in the study. Seven women (20%) and 49 men (25%) had a diagnosis of peptic ulcer disease. Among 41 subjects with verified duodenal (26) and/or gastric (17) ulcer, 95% were H. pylori positive while 32% had had frequent dyspeptic symptoms in the 3 months prior to the study (29% of the 35 men and 50% of the 6 women). Among the 147 men and 28 women without an ulcer history, the 3 month period prevalence of frequent dyspepsia was 14 and 32%, respectively. The rate of H. pylori positivity was 80% in non-ulcer dyspeptics and 68% in all other non-ulcer subjects (95% confidence intervals: 61–92 and 61–76%, respectively). Significant differences in symptoms between H. pylori positive and negative subjects could not be detected, neither in the whole population nor in the non-ulcer group. In conclusion, in this Japanese working population, no association was found between dyspeptic symptoms and H. pylori infection, irrespective of the inclusion of subjects with a peptic ulcer history.