Long-term follow up of surgically-treated congenital heart disease: interauricular communication, aortic coarctation, tetralogy of Fallot

Based on data from the literature and their own experience, the authors study the long-term clinical course of patients with interatrial communications (IAC), coarctation of the aorta (CAo) and tetralogy of Fallot (TF) who have been operated. According to data from the literature and 50 cases which were reviewed an average of 11 years after the operation, operated cases of IAC are at risk of developing arrhythmias or conduction disturbances, especially if the operation was performed after the age of 20, in cases with cardiomegaly, with a mean pulmonary artery pressure of more than 20 mmHg and a pulmonary flow/systemic flow ratio due to the shunt greater than 1.5. Surgery for CAo carries a risk of long-term residual hypertension (HT). According to the majority of authors and a study of 55 cases. HT is present in 3 to 6% of cases operated between the ages of 1 and 10 years. This percentage is much higher for the older age groups. The increase in blood pressure on effort and the demonstration of a gradient between the upper limb and the lower limb are the methods of detecting post-operative hypertension and residual stenosis. Cardiac failure and coronary occlusion can occur in the cases which were operated late. Following complete correction of TF, severe ventricular arrhythmias can arise in the long term. From a study of 59 patients at least 3 years after the operation, the authors outline the elements which favour the development of these arrhythmias. The cases at highest risk are those which were operated after the age of 2 years with significant residual lesions, cardiomegaly and ventricular extrasystoles on the resting trace.(ABSTRACT TRUNCATED AT 250 WORDS)     

The concurrence of microalbuminuria and retinopathy with cardiovascular risk factors; reliable predictors of asymptomatic coronary artery disease in type 2 diabetes

People with diabetes mellitus type 2 (DM2) have a greater risk for premature morbidity and mortality due to cardiovascular disease than the general population: cardiovascular disease accounts for 75% of deaths in this population group. We examined whether or not the association of clinical cardiovascular risk factors (RF) with both microalbuminuria (MA) and diabetic retinopathy (DR) constitutes reliable evidence for the existence of asymptomatic coronary artery disease (CAD), as assessed by positive myocardial thallium scintiscan using the SPECT method (Tl-scan) in patients with DM2. The study included 76 individuals with DM2 (54 men and 22 women, aged 46-70 years), with a negative history for infarction and negative clinical or ECG findings of CAD. In all patients, 3 overnight (11 pm - 7 am) urine collections were made for evaluation of MA. Fundoscopy after dilatation and a Tl-scan (reference method) were also carried out. In addition, blood pressure and waist/hip ratio were measured and smoking habits were recorded. In the 35 patients with a positive Tl-scan (46%) a higher (p<0.001) incidence of MA, DR, hypertension, smoking and higher waist/hip ratio were detected. Of the 16 patients with concurrent presence of MA and DR, 15 had a positive Tl-scan (94%), whereas the Tl-scan was negative in 30/36 (83%) patients with absence of both MA and DR. One or no cardiovascular RF in the absence of MA and DR increased the prediction of a negative Tl-scan to 100% (NPV: 1.00). Based only on history, fundoscopy and MA testing, and without resorting to expensive and laborious testing procedures, it is possible to safely distinguish patients with type 2 diabetes, who require no further investigations for asymptomatic CAD.     

Do characteristic spermatozoal morphological abnormalities exist in patients who have undergone unilateral orchiectomy and preventive radiotherapy?

DESIGN: We examined 16 men who had been subjected to unilateral orchiectomy owing to seminoma and to preventive radiotherapy, in order to investigate the morphologic abnormalities of the spermatozoa (headless and small-round-headedness) that may contribute to infertility. RESULTS: The same morphologic abnormalities of the head and neck found in the semen samples of fertile men were also found in the semen samples of the patients, albeit in higher percentages; the morphologic abnormalities of the tail in the semen samples of the patients were similar to those of the fertile men, both qualitatively and quantitatively. CONCLUSION: No specifically characteristic morphologic abnormalities of the spermatozoa were detected in men who were subjected to unilateral orchiectomy and to preventive radiotherapy in comparison with fertile men. The percentage rate of morphologic tail abnormalities is not affected by preventive radiotherapy.     

Serum leptin levels in normal-weight and overweight women with polycystic ovary syndrome

The aim of this study was to evaluate serum leptin levels in women with polycystic ovary syndrome (PCOS) and in controls with normal or abnormal body mass index (BMI), since the literature data are contradictory. The study population comprised 34 women with PCOS and 30 regularly cycling women, with normal or abnormal BMI. PCOS was defined by clinical, ultrasonographic, and hormonal findings. The women were divided into four groups according to the diagnosis of PCOS and their BMI values. In all women serum levels of FSH, LH, prolactin, testosterone, androstenedione, DHEA-S, 17alpha-OH progesterone, SHBG, insulin, glucose and leptin were determined. It was found that: (a) there was a significant interaction between BMI and PCOS in increasing serum leptin levels; (b) the dominant factor for serum leptin levels in women of all Groups was BMI, followed by insulin; (c) once we corrected for BMI, it was found that there was a significant correlation between serum leptin levels and insulin values, as well as between serum leptin levels and testosterone concentrations; and (d) the QUICKI IR formula presented the most significant correlation with serum leptin levels than the other measures of insulin sensitivity. Our results showed that serum leptin levels in a subgroup of overweight women with PCOS and insulin resistance were higher than those expected for their BMI, and therefore leptin might interfere in the pathogenesis of this syndrome.     

Could the theory of chaos contribute to the interpretation of pathogenesis of polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a syndrome involving defects in primary cellular control mechanisms that result in the expression of chronic anovulation and hyperandrogenism. In this syndrome the relation between the various parameters is of particular interest. These relations constitute the cornerstone of the pathogenesis of PCOS. The fact that the pathogenesis of the PCOS has not yet been clarified, despite the plethora of relative information, may be the result of a general way of thinking in the interpretation of several scientific data, and especially those that refer to biochemical phenomena. The use of the various models of the theory of chaos, that permits a concrete approach for the interpretation of data, may constitute an optional procedure for the future understanding of the association of different parameters and their disturbances in the pathogenesis of PCOS.     

Adenomyosis

Adenomyosis is characterized as ectopic endometrial tissues within the myometrium in the uterus. The etiology and pathogenetic mechanism(s) responsible for adenomyosis are poorly understood. Definite diagnosis is made on hysterectomy specimens, although attempts are made at securing preoperative diagnosis by magnetic resonance imaging and myometrial biopsies. Definite treatment of symptomatic women is hysterectomy.     

The influence of long-term administration of conjugated estrogens and antiandrogens to serum leptin levels in women with polycystic ovary syndrome.

It is well known that a strong exponential relationship exists between leptin levels and body mass index (BMI). The different serum leptin levels, however, that are observed for each BMI value, suggest that other factors, as well, interfere with leptin secretion. This study was designed in order to estimate serum leptin levels in patients with polycystic ovary syndrome (PCOS), before and after long-term treatment with conjugated estrogens and antiandrogens. Sixteen women with PCOS were included in the study. They were divided into two groups: the first group comprised 11 non-obese women (BMI 21.6 +/- 0.5 kg/m2), aged 23.5 +/- 1.1 years; the second consisted of five obese women (BMI 28.9 +/- 1.5 kg/m2), aged 22.8 +/- 1.9 years. Blood samples for leptin measurement were drawn before and 2, 4, 6, 9 and 12 months after administration of conjugated estrogens and antiandrogens. Our results showed that obese women exhibited higher serum leptin levels in all blood samples. Moreover, the administration of conjugated estrogens and antiandrogens caused an increase in serum leptin levels in the 2nd, 4th, 6th and 9th month in both groups of women. Finally, leptin concentrations during the 12th month of the treatment returned to basic levels in both groups of women with PCOS. Our results support the view that BMI is the main variable that influences serum leptin levels, and that the effect of conjugated estrogens and antiandrogens on serum leptin concentrations is poor.     

Hospitalizations of pregnant HIV-infected women in the United States in the era of highly active antiretroviral therapy (HAART)

Highly active antiretroviral therapy (HAART) has improved the outlook of HIV-infected patients, but it has several side effects, particularly when it is used during pregnancy. Prior to the advent of HAART, HIV-infected women were at increased risk for adverse pregnancy outcomes. This report describes hospital use among pregnant HIV-infected women in the United States in the HAART era and compares hospitalizations for select morbidities in pregnant HIV-infected vs. uninfected women. In 2003, the majority of HIV-infected pregnant women were hospitalized in urban hospitals in the South and had Medicare or Medicaid as the expected payer. HIV-infected pregnant women had longer hospitalizations and incurred higher hospitalization charges than uninfected women. In addition, HIV-infected pregnant women were more likely to be hospitalized for major puerperal sepsis, sexually transmitted infections, urinary tract infections, bacterial infections, liver disorders, and preterm labor/delivery than uninfected women, even after adjusting for sociodemographic factors and comorbid conditions. No significant differences were observed in the rates of preeclampsia and antepartum hemorrhage in the two groups. HIV-infected pregnant women in the United States in the era of HAART remain at higher risk for several morbidities and adverse obstetrical outcomes than uninfected women.     

Inhibition of pathologic retinal neovascularization by alpha-defensins

Proliferative retinopathies, such as those complicating prematurity and diabetes, are major causes of blindness. A prominent feature of these retinopathies is excessive neovascularization, which is orchestrated by the hypoxia-induced vascular endothelial growth factor (VEGF) stimulating endothelial cells and the integrin-mediated adhesive interactions of endothelial cells with extracellular matrix components such as fibronectin (FN). Recently, we demonstrated that alpha-defensins interfere with alpha5beta1-FN interactions and dependent endothelial cell functions. Here, alpha-defensins were studied in hypoxia-induced proliferative retinopathy. In vitro, alpha-defensins specifically inhibited alpha5beta1-integrin-dependent migration of bovine retinal endothelial cells (BRECs) to FN, attenuated the VEGF-stimulated increase in endothelial permeability, and blocked BREC proliferation and capillary sprout formation in 3-dimensional fibrin-matrices. An up-regulation of beta1-integrin and FN was observed in the retinal vessels in the mouse model of hypoxia-induced retinal angiogenesis. Systemic and local administration of alpha-defensins reduced retinal neovascularization by 45% and 60%, respectively, and this effect was comparable to the inhibitory effect of alpha5beta1-blocking antibody. alpha-Defensins were detected in human diabetic retinas associated with normal retinal vessels but were absent from proliferative lesions. Together, these data show that alpha-defensins inhibit pathologic retinal neovascularization in vivo and may provide a clinically efficient strategy against proliferative retinopathies.