Sensitization to thimerosal (Merthiolate) is still present today

The results on thimerosal (Merthiolate) hypersensitivity of a retrospective study, together with the relevant data on thimerosal hypersensitivity referred to in the literature up to 1993, are presented. Positive patch test reactions to thimerosal (0.1% pet.) were observed in 32 (1.3%) of 2461 adult patients with suspected contact allergy examined in the period 1987–1992. 20 (0.8%) patients had a solitary positive patch test to thimerosal. The observed incidence is low. Clinical symptoms related to thimerosal hypersensitivity were observed in only 3 patients. The collected results are discussed with emphasis on the clinical implications of sensitization to thimerosal. It appears that a positive patch test to thimerosal is frequently clinically irrelevant.     

Test battery for metal allergy in dentistry

Some alloys used in restorative dentistry may evoke an allergic contact stomatitis in certain persons. In order to protect patients from materials with undesired reactions, and considering corrosion characteristics of different alloys used, it is useful to devise an adequate patch test battery to include the most relevant metals. Dental alloys are composed of a combination of various metals. 12 different ions of frequent occurrence (Au3+, Pd2+, Zn2+, Mo6+, Sn2+, Ga3+, In3+, Co2+, Cr3+(6+), Ni2+, Fe2+(3+) and Si4+) were epicutaneously tested as the aqueous solution of the respective salt. The concentrations are given in g/100 ml and also in m.mole/l. The 12 different metal ion solutions were patch tested on patients in 3 groups: one group with a positive history of contact stomatitis (30 patients, group 1), one group with a positive history of contact dermatitis (16 patients, group 2), and a control group (17 persons, group 3). In contrast to the control group, a remarkable high percentage (11%) of positive skin reactions to Pd was found in groups 1 and 2. No allergic or irritant skin reactions were detected to Ga, Sn and Zn. No irritant reaction was observed at pH values as low as 1.5. In the case of SiCl4 (pH = 0.5), 41% positive irritant reactions were evoked. In the group with a positive history of contact dermatitis (group 1), a positive reaction was found more often (69%) than in the group with a positive history of contact stomatitis (30%) (group 2). The difference between these groups was mainly caused by reactions to Ni and Pd.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sensing Through the Esophagus for Temporary Atrial Synchronous Ventricular VDD Pacing

The purpose of this study was to evaluate the effectiveness and safety of temporary VDD pacing using an esophageal electrode for sensing of the atrial electrogram. We studied 15 patients, 8 men and 7 women, aged 77 ± 2 years (mean ± SE, range 61–90), with severe atriovenfricular (AV) conduction disturbances. A 24-hour beat-to-beat ECG analysis was used to evaluate the effectiveness of the pacing system and special tests were performed to test the stability of pacing and sensing. The system performed satisfactorily in 12 of the 15 patients. The 24-hour Holter ECG monitoring revealed the following percentages of beats: 96.32 ± 0.5 VDD, 2.92 ± 0.6 VVI, and 0.14 ± 0.05 paced beats resulting from pseudosensing. All the latter were single, with no bigeminy or salvos. The results of the stability tests were as follows: the percentage of VDD beats was significantly lower than the 24-hour mean when the patient lay on his right side (92.8 ± 0.5, P < 0.001), during the swallowing of liquids (91.26 ± 0.4, P < 0.001) and soft foods (84.2 ± 1.4, P < 0.001), and during coughing (94.2 ± 0.6, P < 0.001). The percentage of VVI type beats increased in these four cases (6.7 ± 0,5, 7.2 ± 0.3, 13.2 ± 1.2 and 4.8 ± 0.4, respectively, P < 0.001 in each case). The percentage of ectopic beats due to pseudosensing did not change significantly during any of the tests. These results indicate that the method described is a safe and effective technique for temporary VDD pacing.     

脊髓全横断大鼠神经生长因子和脑源性神经营养因子表达及三七皂苷的干预效应

目的:神经生长因子和脑源性神经营养因子同属神经营养素家族,在神经系统发育及维持正常神经元功能中有重要作用。实验拟证实脊髓全横断损伤三七皂苷对大鼠神经生长因子及脑源性神经营养因子蛋白水平的表达变化产生了影响。方法:实验于2005-06/09在昆明医学院神经科学研究所完成。①实验材料:清洁级健康雌性SD大鼠72只,质量(200±20)g;三七皂苷由云南植物药业提供。②分组及实验过程:大鼠被随机分为4组:假手术组、单纯脊髓全横断损伤组、脊髓全横断损伤 生理盐水(0.5mL/次)组、脊髓全横断损伤 三七皂苷(100mg/kg/次)组,每组18只。于T10水平横断大鼠脊髓,假手术组仅剪开硬脊膜而不损伤脊髓。后2组于术后30min,4,24,48,72h腹腔注射给药各1次。③实验评估:各组于术后3,7及21d分别取6只大鼠L1～2段脊髓制作冰冻切片,采用免疫组织化学ABC法染色。观察并计数脊髓腹角神经生长因子、脑源性神经营养因子蛋白的表达变化;常规苏木精伊红染色观察脊髓的组织病理变化。结果:72只大鼠全部进入结果分析:①脊髓全横断损伤后脊髓出现明显的神经变性坏死、炎性浸润等病理变化,三七皂苷可减轻这些变化。②神经生长因子蛋白主要分布于灰质神经元胞浆及胶质细胞胞核中。在正常脊髓有少量表达,脊髓损伤后7d表达明显升高,直到伤后21d仍高于假手术组(P<0.05);三七皂苷可明显促进其表达,伤后3,7d均明显高于其他各组(P<0.05),在21d时下降但仍高于假手术组(P<0.05)。③脑源性神经营养因子蛋白主要分布于腹角的运动神经元胞浆中,胶质细胞未见着色。在正常脊髓有少量表达,脊髓损伤后7d表达明显升高(P<0.05),伤后21d已下降,同假手术组相比差异无显著性(P>0.05);三七皂苷可明显促进其表达,伤后3,7,21d均明显高于所有对照组(P<0.05)。结论:三七皂苷可减轻脊髓横断性损伤后继发损害,增加神经生长因子、脑源性神经营养因子表达量及提前神经生长因子、脑源性神经营养因子表达时间,提示其可以促进脊髓损伤早期修复。     

应用彩色多普勒血管回声跟踪技术监测老年高血压患者经苯磺酸氨氯地平干预后动脉弹性功能变化

目的:动脉弹性与高血压颈动脉粥样硬化的发病以及最终的心脑血管事件密切相关。试验采用血管弹性量化分析技术-血管回声跟踪技术观察苯磺酸氨氯地平对老年高血压患者动脉弹性功能的影响。方法:选取2006-06/12井冈山学院附属医院就诊的52例符合WHO/ISH原发性高血压诊断标准的老年患者为高血压组,入选患者未服用过降压药物或已停用降压药1周以上。高血压组服用苯磺酸氨氯地平,5～10mg/d,服药观察时间24周,治疗前后测定收缩压、舒张压、脉压差及心率,并应用ALOKA超声波诊断装置和血管回声跟踪技术获取动脉弹性功能指标,包括僵硬度指数、颈动脉脉搏波传导速度、反射波增强指数、压力-应变弹性指数、动脉顺应性、颈动脉内膜中层厚度。以51例血压水平正常的老年人为对照组。所有受试者对试验及检测项目知情同意。结果:103例受试者全部进入结果分析。①治疗前高血压组的收缩压、颈动脉内膜中层厚度、僵硬度指数、颈动脉脉搏波传导速度、压力-应变弹性指数各项指标均值都比对照组高,动脉顺应性低于对照组,差异都有显著性意义(P<0.05)。高血压组反射波增强指数与对照组相比差异没有显著性意义(P>0.05)。②高血压组使用苯磺酸氨氯地平24周后,收缩压、颈动脉内膜中层厚度、僵硬度指数、颈动脉脉搏波传导速度、压力-应变弹性指数比用药前降低,差异有显著性意义(P<0.05)。动脉顺应性动脉顺应性升高,差异有显著性意义(P<0.05)。反射波增强指数虽有升高,但差异无显著性意义(P>0.05)。结论:①应用彩色多普勒血管回声跟踪技术可无创、直观监测患者动脉弹性功能。②苯磺酸氨氯地平有改善老年高血压患者动脉弹性的作用。     

CGMP Levels Following ANF Challenge are Markers of Subsequent Successful Reversion of Lone Atrial Fibrillation to Sinus Rhythm

The aim of the present study was to assess whether cGMP release to ANP stimulation can be a biochemical marker of subsequent successful electrical cardioversion of lone atrial fibrillation to sinus rhythm. For this purpose, we studied 13 patients with chronic, lone atrial fibrillation of less than one year's duration who presented to our laboratory for electrical therapy of their arrhythmia. Prior to electrical cardioversion, peripheral venous cGMP levels were assessed at baseline and following an tntravenous challenge of 50 Ug human ANP. Venous blood samples for cGMP assessment were taken a) at baseline, b) 5 and 10 mins after the end of ANP infusion. ANOVA of repeated measures was used for statistical analysis. Eight of the study patients were successfully cardioverted to sinus rhythm, while the remaining 5 were not. Although no difference was noted between the two groups regarding the mean time of arrhythmia duration as well as left atrial and ventricular dimensions, ANP stimulation provoked significantly greater cGMP release in patients whose arrhythmia reverted to sinus rhythm, when compared with that of patients whose arrhythmia persisted (p<0.001). Therefore, cGMP levels following ANP challenge might discriminate between patients with chronic AF who are going to be successfully cardioverted and those who are not. These findings imply that the underlying atrial disease might be different in extent/nature between patients with lone AF responsive to cardioversion and those with resistant arrhythmia.     

Infection of human T-cell leukemia virus type I and development of human T-cell leukemia lymphoma in patients with hematologic neoplasms: a possible linkage to blood transfusion

Among 354 adult patients with either hematological malignancy or aplastic anemia, eight were positive for anti-HTLV-I antibodies; six of eight had received multiple transfusions. There was an approximately 3.5-fold increase (P less than .001) of HTLV-I seropositivity in the patients with hematologic disease (8 of 354, 2.23%) compared to the healthy adults older than 20 years (34 of 5252, .65%). Two hematological patients, one with Hodgkin's disease and one with acute promyelocytic leukemia, were found to be positive for HTLV-I, and developed and died of adult T-cell leukemia/lymphoma (ATL) subsequently. Both were long-term survivors of the primary disease and had received multiple transfusions. The latent period from blood transfusion to onset of ATL was 6 months and 11 years, respectively. Immunocompromised patients, who were seropositive for HTLV-I, may be at increased risk for ATL compared to healthy carriers of HTLV-I, and the latent period may be shorter.     

The atherogenic plasma remnant-like particle cholesterol concentration is increased in the fasting and postprandial state in active acromegalic patients

BACKGROUND: Premature atherosclerosis is a clinical feature in untreated acromegaly. Increased postprandial lipoprotein remnant levels are associated with premature atherosclerosis. In most studies, remnants have been measured indirectly using retinyl esters (RE) as a chylomicron core label. Remnants can also be directly quantified by immunoseparation using monoclonal antibodies to apolipoprotein (apo) AI and apo B100 to remove nonremnant lipoproteins. Cholesterol is quantified in the remaining apo E-rich remnant fraction (RLP-C). OBJECTIVE: The aim of the present study was to investigate the role of postprandial lipaemia in patients with acromegaly to further define abnormalities leading to increased susceptibility for atherosclerosis. PATIENTS: In a case-control study, the plasma postprandial lipoprotein remnant fraction (RLP-C and RE) were analysed in six patients with active acromegaly [two females, four males; aged 53 +/- 9 years; body mass index (BMI), 29 +/- 4 kg/m2] and in six normolipidaemic control subjects (matched for age, gender, BMI and apo E genotype). They underwent an oral vitamin A fat loading test. RESULTS: Baseline plasma triglycerides (TG) were not significantly different in patients (1.75 +/- 0.71 mM) and controls (1.15 +/- 0.46 mM). Lipoprotein lipase activity was significantly lower in patients than in controls (108 +/- 21 vs. 141 +/- 19 U/l, respectively; P < 0.05). Baseline plasma apo E levels were higher in patients (60.8 +/- 7.9 mg/l) than in controls (48.3 +/- 5.9 mg/l; P < 0.05). No differences were found in the area under the postprandial TG curve (AUC-TG), the incremental AUC-TG (DeltaAUC-TG) and AUC-RE in the Sf < 1000 remnant fraction. However, fasting plasma RLP-C concentrations, isolated by immunoseparation, were increased in patients with active acromegaly (0.41 +/- 0.13 mM) compared to control subjects (0.20 +/- 0.07 mM; P < 0.05). Incremental postprandial RLP-C response (corrected for fasting values) was also significantly elevated in patients (2.14 +/- 1.19 mM/h/l) compared to controls (0.86 +/- 0.34 mM/h/l; P < 0.05). In both groups, the maximal RLP-C concentration was reached between 2 and 4 h. CONCLUSIONS: In conclusion, the atherogenic postprandial remnants, represented by RLP-C, were significantly elevated at baseline and in the postprandial period, whereas the larger-sized remnants, represented by retinyl esters (Sf < 1000), were not different from controls. The disturbances in the postprandial RLP-C response increased the susceptibility for premature atherosclerosis as observed in patients with acromegaly.