Postural effect on gas exchange in patients with unilateral pleural effusions

The effect of body position (right and left lateral decubitus positions) on arterial oxygen tension (PaO2) and the relationship between this postural effect on gas exchange and pulmonary function were evaluated in 21 patients who had unilateral pleural effusions without roentgenographic and bronchoscopic evidence of bronchopulmonary disorders. Our results indicated that a positional influence on gas exchange existed in these patients. We failed to find a consistent relationship between the size of effusion estimated by chest roentgenogram and alterations in PaO2 during different positions. Postural change did affect gas exchange in the patients with unilateral pleural effusions and this postural effect on gas exchange was highly correlated with their FEV1 and FVC. This may be of clinical significance in managing such patients.     

Megas and cancer. Cancer of the large intestine in chagasic patients with megacolon

This is a review of 4.690 necropsies and 24.209 surgical pathology specimens describing the association between megacolon chagasic and malignant tumors of the large bowel. The prevalence of malignant tumors of the large bowel was not higher in megacolon.     

Variability of coronary blood flow measurements with microspheres in the rat: role of injection site and sphere number

Although fully explored in larger animals, the role of injection site and sample microsphere content on variability of coronary blood flow (CBF) measurement using the microsphere technique remains controversial in rats despite the fact that this species is extensively used in cardiovascular research. We therefore investigated these variables in two studies. In a first study, we established that the precision of the method, assessed by the variability of four simultaneous CBF determinations, was a function of the sample microsphere number. Coefficient of variation (CV) averaged 4-10% when the tissue and reference samples received greater than 1000 and greater than 100 spheres, respectively, and did not improve appreciably with larger numbers of microspheres. In a second study, flow CV was measured following left atrial (LA) or left ventricular (LV) microsphere injections performed nearly simultaneously in the same conscious animal or in two similar groups of animals. CBF variability was lower by 22-62% after LA than after LV injections. Estimates obtained from separate analysis of the main variability components indicated that, with one exception, the variability associated with LV injections was at least 1.4 to 2.8 times higher than that due to LA injections. These findings establish the minimum number of microspheres needed to obtain precise blood flow determinations in the rat model and confirm previous reports, in anaesthetised rats, that LA microsphere injections generally yield more precise coronary blood flow determinations than LV injections.     

Enoximone and the therapeutic strategy in patients awaiting emergency cardiac graft

Enoximone is a positive inotropic agent belonging to the group of phosphodiesterase F-III inhibitors. The drug was tested in 34 patients uncontrolled by sympathomimetic drugs and referred to our department for urgent heart transplantation or circulatory assistance. After insertion of a Swan-Ganzgatheter and a radial artery catheter for haemodynamic monitoring, enoximone was administered as a 15-minute intravenous bolus injection of 1 to 2.5 mg/kf every 8 hours, in addition to sympathomimetic agents. Clinical and haemodynamic improvement was observed after thirty minutes in 30 patients. The cardiac index rose from 1.82 to 2.67 l/min/m2 and the pulmonary wedge pressure fell from 30.8 to 18.9 mmHg. Systemic arterial resistance decreased from 2170 to 1520 dyn. s. cm-5, and pulmonary resistance from 5.5 to 4.6 Wood units (p less than 0.01 for all values). Four patients had no haemodynamic improvement and were put on circulatory assistance, using a Jarvik 7 total artificial heart in 3 of them and heterotopic circulatory assistance in one. After clinical investigation for contra-indication to heart transplantation, and as their improved haemodynamic status permitted, 12 of the 30 patients were considered suitable (group B) for heart transplantation. Transplantation was performed within a week of admission in 11 patients without any need for mechanical assistance. One of the group B patients who required implantation of a Jarvik 7 artificial heart died after 12 hours of assistance. Eighteen patients were considered unsuitable for transplantation (group A) and treated medically.(ABSTRACT TRUNCATED AT 250 WORDS)     

Portal thrombosis: Percutaneous transhepatic treatment with urokinase — A case report

We present a case report of a patient suffering from portal and superior mesenteric vein thrombosis secondary to splenectomy. No surgical procedure could be performed due to the extension of thrombus.Local fibrinolysis treatment with urokinase through a percutaneous transhepatic approach was decided upon, and this procedure had a successful patient outcome.     

Life-span development: a review of theory and practice for families with chronically ill members

While the family's primacy in the patient's adaptation to chronic illness increasingly is being recognized by health professionals and social scientists, the reverse side of the coin, that is, the impact of chronicity on the family, has received little attention. A life-span development perspective is used to enrich the more traditional frameworks employed to study family development and also as a unifying framework from which to view the impact of illness on individual family members and the family as a unit. A review of selected literature reveals a profile of families most at risk for serious disruption in situations involving chronic illness. Propositions suggesting interventions directed at patients and families experiencing chronicity are derived.     

Antibodies to the ADP/ATP carrier, an autoantigen in myocarditis and dilated cardiomyopathy, penetrate into myocardial cells and disturb energy metabolism in vivo

We identified the ADP/ATP carrier, located within the inner mitochondrial membrane, to be an organ- and conformation-specific autoantigen in myocarditis and dilated cardiomyopathy. We also showed that autoantibodies to the ADP/ATP carrier inhibit the nucleotide transport in vitro. Specific binding of the autoantibodies to the carrier was demonstrated by radioimmunoassay and the immunoblot technique; the inhibition of the nucleotide transport was determined by the inhibitor stop method. To establish if these autoantibodies might also affect cardiac energy metabolism in vivo, we measured whether they are capable of penetrating into myocytes and whether subcellular ATP/ADP ratios and phosphorylation potentials of ATP change in hearts of guinea pigs that have been immunized with the isolated ADP/ATP carrier. An intracellular deposition of autoantibodies was observed by direct immunofluorescence and by immunoperoxidase staining on cryosections of the myocardial tissue of animals immunized with the ADP/ATP carrier. Furthermore, binding of autoantibodies to mitochondrial membrane structures was shown by immunoelectron-microscopic methods. The cytosolic and intramitochondrial distribution of adenine nucleotides in stimulated, isolated perfused hearts of guinea pigs immunized with the ADP/ATP carrier was measured by nonaqueous fractionation. Compared with controls performing equal external heart work, the cytosolic ATP decreased in the immunized animals, whereas the mitochondrial ATP increased strongly; ADP concentrations showed an opposite change. Thus, a resultant cytosolic decrease and a marked mitochondrial increase of the ATP/ADP ratio was established. As a consequence, the cytosolic-mitochondrial phosphorylation potential of ATP was diminished. These findings demonstrate that antibodies against intracellular antigens are able to penetrate into living cells, and that autoimmunity to the ADP/ATP carrier may contribute to the pathophysiology of myocarditis and dilated cardiomyopathy by causing an autoantibody-mediated imbalance between intracellular energy delivery and demand.     

Subacute cutaneous lupus erythematosus during PUVA therapy for psoriasis: case report and review of the literature

Lesions typical of subacute cutaneous lupus erythematosus developed in an elderly woman after 6 months of PUVA (8-methoxypsoralen and longwave ultraviolet light) therapy for psoriasis. Pancytopenia, antibodies to double-stranded DNA, and hypocomplementemia developed concurrently with the appearance of the cutaneous lesions. With discontinuation of photochemotherapy, the cutaneous lesions disappeared and the pancytopenia improved.