Repair of Sinus of Valsalva Aneurysm Associated with Aortoventricular Discontinuity

The case of a patient with unruptured sinus of Valsalva aneurysm with absence of the intervalvular lamina fibrosa is presented. The association of Valsalva aneurysm and aortic subvalvular defects has been explained as a deficiency of elastic tissue at the aortic root or maldevelopment of the fibrous trigone. Valvular aortic insufficiency with histological evidence of myxoid changes required prosthetic replacement. Myxomatous changes in the fibrous trigone and aortic annulus can explain this unusual, complex anomaly. Accurate preoperative diagnosis may require special views and simultaneous left and right injections at cineangiography. Techniques of repair that have been successful are reviewed, and the essential features of adequate correction are outlined.     

Surgical treatment of the postgastrectomy dumping syndrome

Fifteen patients were treated surgically for dumping syndrome at the University of Florida between 1972 and 1977. Five of them had a reversed jejunal segment interposed between the stomach and the Roux limb and 10 had simple 45 cm Roux-en-Y gastrojejunostomy. The reversed segment has been, in our experience, a uniform disappointment. Straight Roux-en-Y duodenal diversion, with the exception of temporary delay in gastric emptying in a few cases, has proved successful in treating the postgastrectomy dumping syndrome.     

Pharmacologic prophylaxis of allergic rhinitis: Relative efficacy of hydroxyzine and chlorpheniramine

The efficacy of hydroxyzine and chlorpheniramine in preventing exacerbations of ragweed allergic rhinitis was compared in a double-blind, randomized manner. Ninety-five subjects with positive skin tests, a history of two previous symptomatic seasons, and discontinuation of immunotherapy for at least 1 yr received either hydroxyzine 150 mg/day, chlorpheniramine 24 mg/day, or placebo during the 1978 ragweed season. Subjects in the placebo group experienced annoying or disabling sneezing 50% of days during the period of highest pollen counts whereas those in the chlorpheniramine and hydroxyzine groups experienced this symptom with equal severity only 22% and 12% of days, respectively. Suppression of rhinorrhea and itchy nose was similar although less dramatic. Both antihistamines were more effective than placebo in altering conjunctivitis, but neither decreased the frequency or severity of nasal stuffiness. Skin tests to ragweed decreased in diameter during the season by 38%, 13%, and 3% among patients receiving hydroxyzine, chlorpheniramine, and placebo, respectively. Frequent drowsiness occurred initially in subjects taking both antihistamines but did not persist. Thus, prophylactic antihistamine therapy effectively prevents most symptoms of seasonal allergic rhinitis without persistent drowsiness. These data further suggest a therapeutic advantage for hydroxyzine over chlorpheniramine in the doses used.     

Subchronic organophosphorus ester-induced delayed neurotoxicity in mallards

Eighteen-week-old mallard hens received 0, 10, 30, 90, or 270 ppm technical grade EPN (phenylphosphonothioic acid O-ethyl-O-4-nitrophenyl ester) in the diet for 90 days. Ataxia was first observed in the 270-ppm group after 16 days, in the 90-ppm group after 20 days, in the 30-ppm group after 38 days; 10 ppm failed to produce ataxia. By the end of 90 days all 6 birds in the 270-ppm group exhibited ataxia or paralysis whereas 5 of 6 birds in the 90-ppm group and 2 of 6 birds in the 30-ppm group were visibly affected. Treatment with 30 ppm or more resulted in a significant reduction in body weight. Brain neurotoxic esterase activity was inhibited by averages of 16, 69, 73, and 74% in the 10-, 30-, 90-, and 270-ppm groups, respectively. Brain acetylcholinesterase, plasma cholinesterase, and plasma alkaline phosphatase were significantly inhibited as well. Distinct histopathological effects were seen in the 30-, 90-, and 270-ppm groups which included demyelination and degeneration of axons of the spinal cord. Additional ducks were exposed in a similar manner to 60-, 270-, or 540-ppm leptophos (phosphonothioic acid O-4-bromo-2,5-dichlorophenyl-O-methylphenyl ester) which resulted in similar behavioral, biochemical, and histopathological alterations. These findings indicate that adult mallards are probably somewhat less sensitive than chickens to subchronic dietary exposure to organophosphorus insecticides that induce delayed neurotoxicity.     

Effects of aging on hepatic and pulmonary glutathione S-transferase activities in male and female Fischer 344 rats

The effects of aging on cytosolic glutathione S-transferase activities were evaluated with liver and lung cytosol from male and female Fischer 344 rats 3, 12, and 24 months of age. Age-related changes were tissue-, sex-, and substrate-specific. With liver and lung cytosol from both males and females, rates of metabolism of 1,2-epoxy-3-(p-nitrophenoxy)propane and p-nitrobenzyl chloride were lower in the old group than in the young group; however, patterns of decrease differed with tissue and sex. With 1,2-dichloro-4-nitrobenzene, metabolism was affected by aging only in liver and lung cytosol from males. Finally, with 1-chloro-2,4-dinitrobenzene, metabolic rates were altered during aging only with liver cytosol from females. However, the apparent Km was higher with liver cytosol from old males; those values from lung cytosol of males and liver or lung cytosol from females were unchanged. These data indicate that changes in the cytosolic glutathione S-transferase isozymes occurred during aging.     

Drinking and creativity: Objective and subjective effects

A literature characterized by considerable speculation but a paucity of empirical studies prompted this experiment on the relation between drinking and creativity. After being queried about how they believed alcohol would affect their creative performance, 40 male undergraduate social drinkers were assigned to one of four treatments in a balanced placebo design. Those actually receiving alcohol consumed a mixture containing .6 g of ethanol per kg of body weight. All subjects then completed the entire Figural portion and the Unusual Uses subtest of the Verbal portion of the Torrance Tests of Creative Thinking. Posttesting explored subjects' own evaluations of their creative products and the kinds of attributions they made about factors contributing to the outcomes. Results showed minimal effects of beverage manipulations on measured creativity even when a priori belief and concurrent mood scores were covaried. However, those individuals who thought they had received alcohol gave significantly more positive evaluations of their creative performances than did subjects who believed they were in the non-alcohol treatments. Subjects did not attribute changes in creativity to drinking. Theoretical and practical implications of these findings were discussed.     

Effects of bepridil on exercise tolerance in chronic stable angina: a double-blind, randomized, placebo-controlled, crossover trial

Bepridil, a calcium antagonist with a half-life of approximately 42 hours, was compared with placebo in a double-blind, randomized, crossover trial. Thirteen men (average age 62 years) with exercise-related angina pectoris and a positive exercise test (modified Bruce protocol) were studied. In the group as a whole, bepridil (400 mg once a day) caused an increased total exercise time (2.6 +/- 1.8 minutes, mean +/- standard deviation), time to onset of angina (3.3 +/- 1.6 minutes), time to 1 mm of ST-segment depression (2.2 +/- 2.3 minutes), time to 2 mm of ST-segment depression (2.4 +/- 1.4 minutes) and total work load achieved (1.8 +/- 1.4 kpm) compared with the preceding placebo phase (all p less than 0.05). Frequency of angina and nitroglycerin consumption were low and did not change significantly during bepridil therapy. Comparison of the 3 placebo periods (run-in, double-blind and washout) did not reveal a change in any measurement except time to onset of angina, suggesting no training effect or change in patient status. Adverse effects were common in patients taking both placebo and bepridil, but only 2 patients had adverse effects (dizziness) with bepridil that necessitated discontinuation of therapy. Similarity of the double product (systolic blood pressure X heart rate) at the end of exercise suggests a decrease in myocardial oxygen demand as the primary mode of action. This study suggests that bepridil is a promising agent for the treatment of exercise-induced myocardial ischemia.