Effect of parathyroidectomy on T cell functions in patients with primary hyperparathyroidism

The notion that parathyroid hormone (PTH) can serve as an immunomodulator was examined. T cell function tests were performed in 3 patients with primary hyperparathyroidism before and 1 month after parathyroidectomy (PTX). Three normal volunteers, age and sex matched, were used as controls. One patient with lipoma of the neck was also examined before and after surgical removal of the lesion. In the primary hyperparathyroidism patients the total T cells were lower, the suppressors were higher and the helper to suppressor ratio was significantly lower than in control subjects. The lectin-stimulated lymphocyte transformation was significantly inhibited. All these abnormalities were restored to normal after PTX. Depressed lymphocyte activity was found also in the patient with lipoma. However, no change occurred after surgery. These results support the assumption that excess blood levels of PTH may have an immunosuppressive effect.     

Directional Atherectomy of Complex Coronary Disease: Lesion Specific Outcomes and Treatment Strategies

Complex coronary disease may be defined as a disease in which one or more morphological features are present that are known to be associated with an increased risk of complications during angioplasty. Directional coronary atherectomy may be useful in treating such complex lesions. We review our experiences with complex coronary lesions treated with directional coronary atherectomy. Outcome data are presented within the context of the reported literature, and strategies for approaching complex disease with directional atherectomy are suggested. (J Interven Cardiol 1996;9:135–144)     

Radionuclide ventriculography for evaluation and prevention of doxorubicin cardiotoxicity

Chemotherapy with doxorubicin often leads to congestive heart failure, particularly after cumulative doses of 550 mg/m2 have been reached. Certain risk factors, however, may predispose the patient to development of cardiomyopathy at lower doses. Radionuclide ventriculography with determinations of resting and exercise ejection fractions has emerged as the most reliable noninvasive screening procedure to detect subclinical cardiotoxicity. Before embarking on a course of doxorubicin therapy, patients should be stratified into low-risk and high-risk groups. Those in the high-risk group should undergo frequent monitoring by means of radionuclide ventriculography. For patients in the low-risk group, such monitoring could be postponed until they are ready to cross into the high-risk group by virtue of cumulative doxorubicin dose. Doxorubicin should be discontinued if the ejection fraction drops to less than or equal to 45% at rest or fails to increase with exercise.     

Oxidatively modified low density lipoprotein is a chemoattractant for human T lymphocytes.

Oxidatively modified low density lipoprotein (Ox-LDL) is a known chemoattractant for monocytes. Here we demonstrate, using a modified Boyden chamber assay, that human peripheral blood T lymphocytes, but not B lymphocytes, also respond chemotactically to Ox-LDL, showing a threefold increase over control and an optimum response at 10 micrograms/ml. Copper and endothelial cell-oxidized LDL and beta-VLDL were used and gave similar results. The activity was not chemokinetic and native LDL possessed no chemoattractant activity. The chemoattractant activity was found to reside in the lipid fraction of Ox-LDL. Lysophosphatidylcholine is a major phospholipid component of Ox-LDL and is known to be chemotactic for monocytes. We show that lysophosphatidylcholine is also chemotactic for T lymphocytes with a maximal fourfold increase at 10 microM. Nonmetabolizable analogues of lysophosphatidylcholine had no such chemotactic effect. Thus, Ox-LDL, by virtue of its lysophosphatidylcholine content, may contribute to the recruitment of both T lymphocytes and monocytes into developing atherosclerotic lesions.     

The utility of the SCL-90-R for the diagnosis of war-zone related posttraumatic stress disorder

A scale for assessing war-zone-related posttraumatic stress disorder (WZ-PTSD scale) was derived from the Symptom Checklist-90-R by identifying items that best discriminated Vietnam theater veterans with and without PTSD (N= 202). The 25-item WZ-PTSD scale had excellent internal consistency, and signal detection analyses revealed that its diagnostic utility was comparable to or exceeded that of several established PTSD scales and measures of global distress. In a cross-validation sample (N=99), the diagnostic utility of the WZ-PTSD scale was stable, whereas other PTSD scales performed more poorly. The WZ-PTSD scale appears to be a valuable new measure of PTSD that can be particularly useful in archival data sets or in any situation where other PTSD measures are not available.     

The Mirror Pelvic Examination: Assessment in a Clinic Setting

The traditional pelvic examination is often viewed by patients with mixed feelings, and there are reasons to believe that enhanced patient knowledge might foster more positive attitudes toward this important aspect of women s health care. One proposed technique in accomplishing this goal is the mirror pelvic examination (MPE). However, there is a paucity of reported clinical experience dealing with this modification of the traditional pelvic examination. Accordingly, a questionnaire was designed to assess attitudes and impressions toward the MPE among a sample of 21 women who were offered the procedure at a metropolitan clinic. This survey revealed the MPE to be well received by patients, both as a method of anxiety reduction and as one of patient education.