Sex chromosomal anomalies: a possible association with leg ulcers

Study of three male patients with sex chromosome anomalies and a review of a further thirteen collected from the literature suggest an association between the occurrence of leg ulcers and some sex chromosome anomalies in men. The early onset of the leg symptoms is emphasized.     

Impact of infarct artery patency on the relationship between electrocardiographic and ventriculographic evidence of acute myocardial ischaemia

Routine invasive evaluations are being abandoned, and thus simplenon-invasive methods for estimating the extent of jeoparizedmyocardium during evolving myocardial infarction are neededfor risk stratification to guide the appropriate therapeuticintervention. With this in mind the aim of the paper was toevaluate the association between ischaemic changes in the standardelectrocardiogram and the function of acutely infarcted myocardiumin relation to infarct artery patency status. Forty consecutive patients with a first acute myocardial infarction,admitted within 6 h of symptom onset and without bundle branchor fascicular block were included. Summated ST segment elevationin 11 electrocardiographic leads (aVR excluded) was measuredto the nearest 005 m V and compared to regional wall motion,estimated by the centreline method (SDIchord) and global leftventricular ejection fraction (% LVEF) after thrombolytic therapy.Acute angiographic and ST segment measurements were performedat a median 254 min (range 70–485) after the onset ofsymptoms. Patients were grouped according to infarct artery patency statusafter intravenous thrombolysis. Of the 40 patients, 27 had apatent (Thrombolysis In Acute Myocardial Infarction trial (TIMI)grade 2-3 flow) and 13 had persistently occluded (TIMI 0–1flow) infarct arteries. Anterior myocardial infarction was presentin 13 and seven patients in the two groups. In the TIMI 2-3group, the summated ST elevation did not correlate with % LVEFor SDIchord (r_s=0.08; and r_s= – 0.17, respectively). Inthe TIMI0–1 group the summated ST elevation correlatedinversely with both % LVEF and SDIchord (r_s= –0.70; andr_s= –0.56, respectively). These results show that acute summated ST segment elevationcorrelates with both global and regional left ventricular functionin patients with persistently occluded infarct arteries, thusproviding a non-invasive method for estimating the amount ofjeopardized myocardium.     

Vasospastic Ischaemia Induced by the Hyperventilation Test in Patients with a Negative Response to Ergometrine

ABSTRACT. We present the case histories of two patients with angina pectoris who developed coronary artery spasm in response to provocation with prolonged hyperventilation (verified by ST segment elevation in both and coronary angiography in one) despite a negative ECG response to intravenous injection of 0.4 mg ergometrine. This new observation, which is in conflict with recent publications stating that ergot provocation is more sensitive than hyperventilation, suggests that in some patients diagnostic provocation with hyperventilation may be an alternative to the widely used ergot provocation.     

Conformational differences of ovine and human corticotrophin releasing hormone A CD,IR, NMR and dynamic light scattering study

The differences in the conformational properties of ovine (o) and human (h) CRH in aqueous solution, structure-inducing TFE and in the presence of detergent micelles and lipid vesicles have been investigated by circular dichroism, Fourier transform infrared spectroscopy, NMR and dynamic light scattering. o-CRH was found to exist as a monomer with little regular structure in dilute aqueous solution. Association at concentrations higher than 10^?3 mol/L results predominantly in dimers. The induction of a substantial amount of intermolecular β-structure seems to be the result of interactions of the C-terminal hexapeptide and the N-terminal region 6-12 of o-CRH chains in antiparallel orientation. In contrast, h-CRH exhibits a high tendency of association which is highly sensitive to the pH. The formation of tetramers at millimolar peptide concentration is related to a helical content of ca. 50%. The potentially helical, highly hydrophobic region 6-20 enlarged by more hydrophobic residues in position 23 and 25 is proposed to stabilize the h-CRH associates. In the presence of structure inducing TFE (<40%v) both CRH peptides exist as monomers. o-CRH reveals about 72% helicity, in h-CRH the formation of about 85% helix is observed. The differences in helicity of the two CRH molecules are located in the C-terminal heptapeptide, as concluded on the basis of NMR studies. Both peptides bind to detergent micelles at pH 4 as well as 7.4 associated with an increase in the α-helical content. Interaction of the two peptides with DMPC vesicles was found exclusively at pH 4. Above the phase transition temperature of DMPC the α-helical content in h-CRH increases slightly; however, o-CRH reveals a substantial amount of β-type structure. The intramolecular type of β-structure is associated with a deeper insertion of the o-CRH region 6-12 into the hydrophobic region of the lipid bilayer, whereas the corresponding region of h-CRH is kept in the bilayer surface. The higher helicity of h-CRH might explain to some extent its higher affinity to the CRH receptor, CRH antibodies and the CRH binding protein. © Munksgaard 1996.     

Superiority of the T and N integer score (TANIS) staging system for squamous cell carcinoma of the oral cavity

An alternative to the TNM classification system has been proposed for patients with head and neck cancer. The T and N integer score (TANIS) system adds the integer values of T and N classifications. The TNM and TANIS staging systems were retrospectively evaluated for 186 patients with squamous cell carcinoma of the oral cavity (tongue and floor of mouth). The TANIS system was found to better separate the patients into prognostic groups and allowed a more accurate prediction of disease-free survival. (OTOLARYNGOL HEAD NECK SURG 1995;112:691-4.)     

Reliability of Atrial Screw-in Leads

The aim of this study was to investigate long-term performance of a carbon coated atrial screw-in lead. During implantation of 247 leads of this type we measured an average stimulation threshold of 0.74 V(range: 0.2–1.6 V) at 1 ms pulse width. Mean lead impedance came to 446 ohms (range: 263–1000 ohms) resulting in an arithmetical energy consumption of 1.51 μJ(range: 0.1–7.21 μJ). Average P wave amplitude was 3.9 mV (range: 1.3–11 mV). After a mean follow-up of 16.4 months (range; 3–60 months) we found excellent threshold results in 76% of the patients permitting a safety programming al half of nominal value. An additional 14% nominal settings could be retained. With regard to chronic lead impedance of 488 ohms (range: 315–1327 ohms) we calculated an average chronic energy consumption of 10.83 μJ (range: 1.62–22.78 μJ) during safety programming. This made up 34.6% of the corresponding energy consumption during nominal programming. Eighty percent of the patients showed chronic P waves above 2 mV; nearly half of them (n - 94 = 38%) showed a proper sensing function even when programmed to minimal sensitivity settings or above 4 mV. In 19 leads (8%) we observed unsatisfying threshold results requiring high output programmings. All threshold increases occurred within the first year, 84% (n = 16/19) within the first 3 postoperative months. An additional five leads (2%) were found to have a loss of capture, and one (0.5%) a loss of sensing. These complications required reoperation as well as one dislocation (0.5%) resulting in a low complication rate of 3% as compared to the total complication rate of all implanted atrial leads which was substantially higher (n = 48/652 = 7.5%). With regard to our results we consider the carbon coated atrial screw-in lead to have proven long-term reliability.