Left ventricular growth in a patient with critical coarctation of the aorta and hypoplastic left ventricle

An infant is presented who at birth met criteria consistent with hypoplastic left heart syndrome. He was followed clinically and by 11 weeks of age demonstrated substantial growth of the left ventricle. He underwent successful repair of coarctation of the aorta and continues to do well with moderate aortic stenosis. The difficulties of predicting left ventricular growth and function are discussed, and management options are reviewed.     

多发性硬化症的治疗时机窗：单克隆抗体治疗的依据

1991—2002年间采用可长期消耗T淋巴细胞的人单克隆抗体(Cam path-1H)治疗58例多发性硬化症(M S)患者,患者的临床症状和炎性替代标记物得到抑制。在M S的复发-缓解(R R)和继发进展(SP)期,Cam path-1H可降低患者的年复发率(分别由2.2降至0.19和由0.7降至0.001,P<0.001)。7年前使     

Percutaneous transluminal coronary angioplasty. A growing surgical problem

The incidence of prior percutaneous transluminal coronary angioplasty in surgical cases is nearly doubling yearly. In 1985, 11.4% of our bypass patients had one or more prior angioplasties. One hundred thirty-five patients with prior angioplasty are compared to 2,205 patients without angioplasty undergoing surgical revascularization. The mortality is 3.2 times higher in the angioplasty patients than in the control patients and the perioperative infarction rate is 2.5 times higher. Forty-four patients were taken directly to the operating room from the catheterization laboratory, 50 were operated on within 10 days, and 41 underwent operation more than 10 days after angioplasty. All of these late failures were of the lesion previously dilated. The infarction rate was less in patients taken immediately to the operating room on an emergency basis than in those whose operation was delayed up to 10 days (30% versus 70%). All patients who died had angioplasty of the anterior descending coronary artery. Angioplasty of this artery increases operative mortality should surgical treatment become necessary acutely. Patients should be informed before angioplasty of the increased surgical risks after a failed angioplasty procedure.     

Social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample.

This study investigated the social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample. Based on the 'Theory of Planned Behaviour', but with additional variables of benefits, barriers and self-efficacy, it was found that both intended and actual activity could be predicted but only when strenuous activity was considered. In addition, the predictors were different for men and women. Specifically, the best predictors of intention to exercise were attitude, perceived control, benefits and self-efficacy for women, but only attitude for men. Predicting self-reported strenuous activity for women were intention and self-efficacy, and for men intention and attitude. Theoretical and practical implications for attitude research and exercise promotion are discussed.     

Correction of severe secondary hyperparathyroidism in two dialysis patients: surgical removal versus percutaneous ethanol injection.

Two chronic hemodialysis patients had recurrent, severe secondary hyperparathyroidism. The first had no sonographically visible parathyroid gland in the neck. Computed tomography (CT) scan indicated the existence of a parathyroid mass in the upper mediastinum, which was removed surgically. The second patient had two intracervical, hyperplastic parathyroid glands visible on ultrasound examination. He volunteered for nonsurgical removal via sonographically guided percutaneous injection of ethanol. In both patients, serum total calcium concentration decreased dramatically to values near 1.5 mmol/L 24 hours after treatment. In patient 1, serum immunoreactive parathyroid hormone (iPTH) (1-84) decreased from 1,582 pg/mL before surgery to 34 pg/mL after 24 hours (normal range, 10 to 65 pg/mL). In contrast, serum iPTH (1-84) decreased only progressively in patient 2, from 1,680 pg/mL before ethanol injection to 865 pg/mL after 24 hours and to 378 pg/mL after 72 hours to reach 30 pg/mL after 14 days. Thus, patient 2 had a striking decrease of plasma calcium immediately after parathyroid gland destruction, even though circulating iPTH was still very high. The reason for such a discrepancy remains unexplained at present, and further study will be necessary to solve this issue.     

Dipyridamole-thallium myocardial scanning in the pre-operative assessment of patients undergoing abdominal aortic aneurysmectomy

Dipyridamole thallium scanning (DTS) is an imaging technique with good sensitivity for coronary artery disease (CAD). The purpose of this study was to compare the haemodynamic courses and the correlation between pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) in patients with normal DTS (Group 1: n = 12) with those whose scans demonstrated CAD (Group2: n = 11). Haemodynamic profiles were obtained prior to anaesthesia and at several times during surgery. The haemodynamic courses in both groups were similar with significant decreases in cardiac index, stroke index, and left ventricular stroke work index during aortic cross-clamping compared with values prior to anaesthesia. There were no significant changes in PCWP and CVP throughout the study. The correlations between PCWP and CVP were significant in both groups as were the correlations between the changes in PCWP and the changes in CVP observed at the time of cross-clamping. These correlations all had large standard errors of the estimate, however, making it impossible to predict the PCWP from the CVP with precision. It is concluded that, in a limited study population, an abnormal DTS did not identify patients in whom the PCWP and CVP correlated poorly during abdominal aortic aneurysmectomy.     

Premalignant conditions and markers of elevated risk in the breast and their management

Most epithelial hyperplasias of the human breast indicate an increased likelihood of carcinoma development, and the majority are best understood as markers or indicators of higher risk. Prospective studies of women with hyperplasia biopsied in the premammographic era indicate that about 70 per cent of women had mild or no hyperplastic epithelial alterations and experienced no increase in the risk of subsequent carcinoma. About 25 per cent of women had well-developed hyperplastic changes associated with a risk 1.5 to 2.0 times that of the general population controlled for age and length of follow-up. Somewhat fewer than 5 per cent of women had specific patterns of atypical hyperplasia that approached the patterns of carcinoma in situ. The women with atypical hyperplasia had a risk of cancer four to five times that of the general population, or about half the risk associated with microscopic carcinoma in situ. Only ductal carcinoma in situ should be considered without question to be an intrinsically precancerous lesion because of its regular association with recurrence at the site of its initial diagnosis. No follow-up studies of comparable type involving women with mammographically detected lesions are as yet available. However, it is clear that the incidence of atypical hyperplasia is higher in mammographically directed biopsies. The principal therapeutic implication of these premalignant lesions is a need for intensified breast cancer surveillance and screening for these patients.