Cardiac involvement in ankylosing spondylitis

Ankylosing spondylitis is a rheumatic disease that affects the axial skeleton and has predilection for young men. Of its extraarticular manifestations, the cardiac involvement, reported up to 48%, has been pointed out in recent years. It seems to exist a racial variation in the features of the spondylitis and since most of the studies have been performed in northern countries therefore it appears inadequate to extrapolate the conclusions of such studies to our society. We studied 23 patients with definitive diagnosis of ankylosing spondylitis. All of them had a complete physical examination, electrocardiography and X-ray of the chest; eight patients underwent a Holter study of 24 hours and seven patients were examined by echocardiography. The mean age of the group was 36 years; there were 21 men and two women. The mean duration of the rheumatic disease was 11.5 years. In only 4 (17.4%) of the patients we found cardiac involvement that would not be related to another etiology. By the clinic examination we found two patients with isolated aortic insufficiency; one case had a right bundle branch block. The Holter study did not show modifications, except in the one with isolated aortic insufficiency and right bundle branch block, in whom this block became of variable degree. The echocardiographic study showed the mentioned aortic valvular lesions and did reveal the same lesion in another patient in which the other studies were normal. It is emphasized that it is adequate to search for signs of ankylosing spondylitis in every patient with isolated aortic insufficiency or/and conduction disturbances of unknown etiology and also to performe cardiac careful in each patient with ankylosing spondylitis examination.     

Hippocratic fingers and hypertrophic osteoarthropathy. Their interrelation and probable physiopathogenic mechanisms

Based in our own clinical studies, we state our point of view, regarding two controversial issues in the literature: 1) the relationship between digital clubbing and hypertrophic osteoartropathy (HOA), and 2) its pathogenic mechanisms. We agree with the theory which proposes that clubbing is the initial, and most conspicuous sing of a full syndrome, (HOA). These entities develop when the lung fails to inactivate a vasodilator and bone-remodeling substance normally present in the systemic venous circulation. This failure of the lung could be due to exclusion, as is the case in the right-to-left shunts, or because of functional deterioration that develops in conditions such as in lung cancer or cystic fibrosis.     

Cardiac autonomic neuropathy in the diabetic patient

The importance of cardiac autonomic neuropathy (CAN) derives from its remarkable frequency and its clinical impact. The clinical features are postural hypotension and resting tachycardia, these abnormalities may be overlooked in a high number of patients asymptomatic. Although rarely life threatening, CAN causes considerable morbidity, which can be ameliorated by its identification and appropriate treatment. Circulatory reflexes were studied in 48 diabetic patients and 14 normal control subjects. Twenty-six of the diabetic patients had normal response. The remaining 22 had evidence of neuropathy and abnormal cardiac response during these tests. Only one patient had postural syncope but he had severe orthostatic hypotension. The others remained asymptomatic. All the control subjects had normal reflexes. Beat-to-beat variation with deep breathing (sinus arrhythmia), carotid body massage and mental stress, were important for the detection of CAN (86, 90 and 90% sensitivity respectively). The Valsalva maneuver and sinus arrhythmia showed 82 and 92% of specificity for the diagnosis of CAN. Our findings suggest that CAN in diabetic patients can be detected by these relatively simple test. We propose a rational approach to the diagnosis. Our method is applicable as a clinical routine examination for cardiac neuropathy.     

Hemopoietic cell line distribution and immunoprecipitation of cell surface proteins recognized by two newly prepared monoclonal antibodies elicited by a human non-T, non-B leukemia cell line

Two newly prepared monoclonal antibodies elicited by a human non-T, non-B acute lymphoblastic leukemia cell line REH recognized distinct antigenic specificities characterized by the pattern of their immunofluorescence reactivities with a panel of hemopoietic cell lines and by immunoprecipitation of 125I-lactoperoxidase radioiodinated cell surface proteins, as well as periodate/tritiated borohydride radiolabeled cell surface sialoglycoproteins. Monoclonal antibody anti-p30 (BraFB6; IgG2b) recognized an antigen similar in its distribution to MHC class II antigens and immunoprecipitated a p30 cell surface protein, radiolabeled by lactoperoxidase catalyzed radioiodination. Monoclonal antibody anti-gp95 (BraEA10; IgG3) reacted in immunofluorescence intensively with non-T, non-B, T-leukemia and myeloid leukemia cell lines, less intensively with lymphoblastoid and lymphoma cell lines of B-phenotype and no reactivity was observed with examined non-hemopoietic human tumor cell lines. This antibody immunoprecipitated a lactoperoxidase radioiodinated and periodate/NaB3H4 tritium-radiolabeled cell surface sialoglycoprotein of approximately 95k (gp95) with variability in its apparent molecular weight, related to the origin of cells utilized for radiolabeling and immunoprecipitation.     

Results of total repair of tetralogy of Fallot after previous subclaviopulmonary or aortopulmonary anastomosis

Total repair of tetralogy of Fallot was performed in 69 patients after the primary construction of a Blalock (28 patients) or a Waterston (41 patients) anastomosis. A total of 7 patients (10.1%) died. One to 5 yrs after correction, 62 patients (89.9%) survive: 52 (75.4%) are in a very good condition, 7 (10.1%) are in a good condition and the condition of 3 (4.4%) is unsatisfactory. 8 (11.6%) patients have serious late complications. The result of correction is not much influenced by the previous Blalock anastomosis (mortality rate 6.9%). After the Waterston anastomosis, however, there are frequent serious complications (pulmonary hypertension in 25.0% of patients), which adversely affect the result and increase mortality (12.5%) of the subsequent correction. The authors prefer two-stage repair of tetralogy of Fallot in the first two years of life. By administration of beta-blockers and prostaglandins they endeavour to postpone the construction of a Blalock anastomosis or an anastomosis performed by means of a polytetrafluoroethylene vascular prosthesis up to the age when the pulmonary artery branches are at least 4 mm in diameter. They plan the subsequent correction to be performed between the 2nd and the 5th year of age.     

Ankylosing spondylitis and rheumatoid arthritis in a patient with Paget's disease. Differential effects of indomethacin, D-penicillamine, or gold sodium thiomalate in the respective arthritides

A patient developed both ankylosing spondylitis and rheumatoid arthritis, each of which responded to D-penicillamine or gold sodium thiomalate and indomethacin, respectively. The patient was both HLA-B27 and -DR4 positive. In addition, he was found to have Paget's disease of bone, which has required no treatment.     

Substrate-level energy dependence of acid secretion in the isolated human gastric mucosa

The substrate-level energy dependence of acid secretion was investigated in the human gastric mucosa in vitro using biopsy specimens obtained during fiberoptic gastroscopy in symptomatic patients. The oxygen consumption and the accumulation of aminopyrine were used as indexes of secretory activity. Basal and histamine-stimulated oxygen uptake by fundic biopsy specimens were not affected by medications (pethidine and diazepam) administered during gastroscopy. Under substrate-depleted conditions, the oxygen consumption and the aminopyrine accumulation of fundic mucosa were not significantly increased by histamine. Stimulation of functional activities by gastric secretagogues was observed only in the presence of exogenous substrates. The ability of various substrates to support acid formation in the presence of gastric secretagogues was evaluated. Carbohydrates were found to be effective substrates in supporting the functional responses of the tissue, with glucose being the most effective. Propionate, butyrate, beta-hydroxybutyrate, and octanoate were ineffective as substrates. Glucose by itself, but not butyrate, significantly increased oxygen uptake and aminopyrine accumulation. The results suggest that the human gastric mucosa, in vitro, has an absolute requirement for metabolic substrates to support secretory responses and that carbohydrates seem to be the preferential substrates.     

I-labelling of an internally Se-labelled monoclonal antibody—Biodistribution in tumour-bearing nude mice

A monoclonal antibody, C215, was first internally labelled with ⁷⁵Se-methionine and then labelled with ¹²⁵I. The biodistribution of the dual-labelled [¹²⁵I][⁷⁵Se]C215 was studied in tumour-bearing nude mice killed 3 days after injection. The biodistribution of the dual-labelled [¹²⁵I][⁷⁵Se]C215 was compared with the biodistribution of single-labelled [¹³¹I]C215 and [⁷⁵Se]C215. Iodine-labelled antibodies seem to be damaged during iodination, affecting the disappearance rate and tumour uptake. There were no signs of dehalogenation of circulating antibodies or antibodies taken up in the tumour.     

Aplasia cutis congenita of the scalp with large underlying skull defect: a case report

Localised agenesis of the scalp is the most frequent patern in aplasia cutis congenita (ACC), a congenital absence of the skin and occasionally of deeper layers. Several clinical groups are characterised by the location and pattern of skin defects, associated malformations and the mode of inheritance. Death occurs in 20% of cases, secondary to the associated anomalies, to infections or to haemorrhage from ulceration of the sagittal sinus when there is also a defect of the underlying skull. In this latter case, we close the defect by two rotational scalp flaps (Orticochea technique) at birth. A three-dimensional CT study is useful for showing the extent of the skull defect and the deformity of the craniofacial complex and the changes in the bone after treatment.     

Comparative study of 3 techniques for total intravenous anesthesia: midazolam-ketamine, propofol-ketamine, and propofol-fentanyl]

OBJECTIVE: To compare the characteristics of induction, maintenance and awakening for three techniques of combined total intravenous anesthesia (TIVA): propofol-ketamine, midazolam-ketamine and propofol-fentanyl. PATIENTS AND METHODS: Sixty patients were randomly assigned to three TIVA groups. Group 1 (n = 20) received midazolam, ketamine and vecuronium. Group 2 (n = 20) received propofol, ketamine and vecuronium. Group 3 (n = 20) received propofol, fentanyl and vecuronium. The variables compared were hemodynamic changes during induction and maintenance and upon awakening; time until awakening; and the incidence of postanesthetic complications. We also assessed whether propofol was better than midazolam at preventing the psychomimetic effects of ketamine. RESULTS: The demographic characteristics of the three groups were similar. Hemodynamic variables were most stable in group 2. Perfusion of midazolam-ketamine was accompanied by a significantly higher number of hypertensive peaks. Time to awakening was significantly shorter in Group I (11.8 +/- 5 min) than in group 2 (20.2 +/- 12.5 min); in group 2 time to awakening was 16.6 +/- 5.6 min. Eight patients in group 1, 5 in group 2 and 1 in group 3 reported having bad dreams, the difference between groups 1 and 3 reaching statistical significance. No patient experienced hallucinations and all reported satisfaction with the anesthetic technique used. CONCLUSIONS: TIVA with ketamine and propofol is comparable to the most commonly used combination of propofol and fentanyl and may be an appropriate choice when hemodynamic stability is of great importance; withdrawal 15 min before ending surgery prevents prolonged awakening. Perfusion of midazolam-ketamine is not recommendable for scheduled surgery because it induces too many hypertensive peaks. Although neither midazolam nor propofol completely prevents the psychomimetic effects of ketamine, such effects are not so severe that patients reject the anesthetic technique used.