Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis

Background

Significant tricuspid regurgitation (TR) is occasionally associated with severe mitral stenosis and has an adverse impact on morbidity and mortality in patients undergoing mitral valve surgery. However, the effect of successful mitral balloon valvotomy (MBV) on significant TR is not fully elucidated. The aim of this study was to investigate TR after MBV in patients with severe mitral stenosis.

Methods

We analyzed the data of 53 patients with significant TR (grade ≥2, on a 1 to 3 scale) from the mitral balloon valvotomy database at our hospital. Patients were evaluated by Doppler echocardiography before valvotomy and at follow-up 1 to 13 years after MBV. Patients were divided into group A (27 patients), in whom TR regressed by ≥1 scale, and group B (26 patients), in whom TR did not regress.

Results

The Doppler-determined pulmonary artery systolic pressure was initially higher and decreased at follow-up more in group A (from 70.7 ± 23.8 to 36.5 ± 8.3 mm Hg; P < .0001) than in group B (from 48.7 ± 17.8 to 41.6 ± 13.1 mm Hg; P = NS). Compared with patients in group B, patients in group A were younger (25 ±10 vs 35 ± 11 years; P < .005), had higher prevalence of functional TR (85% vs 8%; P < .0001), and had lower incidence of atrial fibrillation (7% vs 38%; P < .005). Significant decrease in right ventricular end-diastolic dimension after MBV was noted in group A but not in group B. The mitral valve area at late follow-up was larger in group A than in group B (1.8 ± 0.3 vs 1.6 ± 0.3 cm²; P < .05).

Conclusions

Regression of significant TR after successful MBV in patients with severe mitral stenosis was observed in patients who had severe pulmonary hypertension. This improvement in TR occurred even in the presence of organic tricuspid valve disease.     

Paraoxonase1 55 and 192 gene polymorphisms in an Egyptian population with diabetic complications

Type 2 diabetes is a polygenic disease characterized by interaction of environmental and genetic factors. The paraoxonase 1 gene (PON1) 55 and 192 polymorphisms have been reported to be associated with type 2 diabetes and its complications. Our aim is to study the PON1 55, 192 gene polymorphisms and enzyme activity in type 2 diabetic Egyptian population with complications. 100 type 2 diabetic patients with complications (34 with cardiac and 66 with microvascular complications (neuropathy, retinopathy and/or nephropathy)). This was in addition to 100 healthy control subjects of matched age and sex were taken. PON1 55 L?M and 192 Q?R gene polymorphisms and PON1 enzyme activity serum levels were detected. The LL genotype of PON1 55 polymorphism and QR and QQ genotypes of PON1 192 polymorphism were more frequent among the patients with diabetic complications. The PON1 enzyme activity levels were lower among the diabetic patients than in control subjects. PON1 55 and 192 polymorphisms and enzyme activity seems to be related to diabetic complications in this population.     

Adaptation of adult bone marrow transplant recipient long-term survivors

Although there is a small literature on psychosocial and psychiatric aspects of bone marrow transplants (BMT) in adult recipients during the BMT hospitalization phase, adaptation of long-term adult BMT recipient survivors has received little study. This study surveyed the adaptation of BMT recipient survivors over age 17 who were an average of 42 months posttransplant. Study variables included the recipients' current self-reported health status, mood state, social role function, self esteem, life satisfaction, and relationships with their BMT donors and other family members. A companion study of those who donated BMT to the recipients eligible for this study was also performed. The study participants were preponderantly young adults who currently were in an intimate relationship and vocationally active. About 1/4 of the subjects reported ongoing medical problems. Also, 15-25% reported significant emotional distress, low self-esteem, and less-than-optimal life satisfaction. The subjects' current quality of relationship with their donors was highly correlated with many measures of their psychosocial status. The findings indicate that about 75% of BMT recipient long-term survivors are doing well from a psychosocial as well as a medical standpoint, that the recipient-donor relationship may be sensitive to any changes in the recipient's status, and that 15-20% of BMT recipient survivors report a degree of psychological distress that might benefit from specific psychological/psychiatric intervention.     

Severe supravalvular aortic stenosis: successful surgical correction by extended aortoplasty

Surgical treatment of severe discrete supravalvular aortic stenosis by placement of a patch graft across the narrowed area of aorta at one point has been associated with a substantial incidence of residual stenosis. Successful relief of a severe stenosis was achieved by a modification of a previously reported technique in which the stenotic area is expanded at two points. Use of this technique should be considered in cases of severe discrete supravalvular aortic stenosis.     

Data omitted from psychiatric consultation notes

To assess how often psychiatric consultants omit written data from their consultation notes, the authors reviewed 78 initial consultation notes written by second-year psychiatric residents. Data considered essential for an adequate psychiatric evaluation were typically omitted. Categories that were observed to have the highest frequencies of missing data included family history of psychiatric illness (60.3%), history of substance abuse (44.9%), marital status (37.2%), previous psychotropic drug use (35.9%), previous psychiatric treatment (26.9%), and patient history of psychiatric illness (24.4%). The frequencies of omissions were significantly (p less than .001, except for the last item, p less than .01) higher than those from the consultation notes written by a second cohort of psychiatric residents who used a worksheet that listed data categories. The authors' findings argue for the use of worksheets delineating data categories to ensure that clinicians write adequate consultation notes.     

Inhibition of human non-pancreatic phospholipases A2 by retinoids and flavonoids. Mechanism of action

The interaction of retinoids and flavonoids with phospholipases A2 (PLA2) was studied to assess the mechanism of inhibition. Retinoids, such as retinal, retinol, retinoic acid and retinol acetate, and flavonoids, such as quercetin, rutin, morin and sciadopitysin, inhibit Ca2+-dependent PLA2 activity of human synovial fluid (HSF) in vitro in a dose-dependent fashion; ID20S ranged from 2-8 microM. Retinal inhibited neutral active Ca2+-dependent PLA2S from human platelets, human plasma, human polymorphonuclear leukocytes and Naja mossambica mossambica venom in a dose-dependent manner while quercetin inhibits extracellular PLA2 activities of human plasma, HSF and N. m. mossambica venom in a dose-dependent manner but not PLA2 activity derived from human platelets and polymorphomonuclear leukocytes. Inhibition of PLA2 activity by both flavonoid and retinoids were independent of Ca2+ or Na+. Increasing substrate concentration (9-144 nmols) relieved the inhibition of HSF-PLA2 activity by quercetin indicating probable interaction with the substrate. The inhibition by retinal is independent of substrate concentration suggesting that inhibition by retinal is probably due to direct interaction with the enzyme. both retinal and quercetin quenched the relative fluorescent intensity of N. m. mossambica PLA2 and in a dose-dependent manner in the same concentration range at which they inhibit in vitro PLA2 activity. Retinal and quercetin shift the thermotropic phase transition of distearoylphosphatidylethanolamine (DSPE) liposomes. Both compounds broadened the transition peak, shifted the Tm to lower temperature, and decreased enthalpy significantly. These findings indicate that inhibition of non-pancreatic human PLA2S by retinoids and flavonoids can be mediated by interaction with enzyme and/or substrate.     

Generational continuity in the use of substances: the impact of parental substance use on adolescent substance use

Two hundred sixty-two adolescents, ages 13 through 17, and one of the parents of each, interviewed separately, are compared with regard to their use of substances. Youthful subjects in each comparison group are similar in age, sex, ethnicity and socioeconomic status. Results show a variety of relationships between parental use of coffee, cigarettes, beer and wine, hard liquor and marijuana/hashish and adolescent use of such substances. Generally, parental use of these substances is moderately to strongly related to use by their children. The strongest relationships are found for coffee, mother's use of cigarettes, and father's use of hard liquor. All of these relationships are not linear. For example, fathers who are moderate drinkers of hard liquor are more likely to have adolescent children who are substance users. Two theories of intergenerational substance use are discussed.     

Evaluation of psychosocial problems of the homebound cancer patient: I. Methodology and problem frequencies

Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.