Assessment of left ventricular relaxation in patients with valvular regurgitation

Impaired left ventricular (LV) relaxation has been demonstrated in patients with coronary heart disease and in patients with hypertrophic or congestive cardiomyopathy but not yet in those with aortic or mitral regurgitation. Indeed, in patients with valvular regurgitation the lack of isovolumic relaxation and variations in the filling rate invalidate most relaxation indexes. The aim of this study was to assess ventricular relaxation in patients with valvular insufficiency. The hemodynamic and angiographic data were analyzed during the phase of decreasing left ventricular elastance (that is, when pressure is decreasing while volume is increasing) in 57 patients (27 with valvular regurgitation, 17 normal subjects, and 13 patients with coronary heart disease). Starting from a fixed level of wall stress (40 kdyne/cm²), we determined the incremental LV elastance (ratio $\text{solΔAP}\text{ΔV}$) and the changes in velocity of lengthening produced by a constant increase in LV volume (+ 20 ml/m²). In aortic and mitral regurgitation, both the incremental elastance (?0.52 versus —0.95 mm Hg/ml per m² in normal subjects: p <0.001) and the changes in velocity of lengthening (+ 0.76 versus +1.17 circ/s; p <0.05) were abnormal. These indexes were also impaired in patients with coronary heart disease. Further, significant correlations were found in the whole group between incremental elastance and ejection fraction (r = 0.63), mean velocity of fiber shortening (r = 0.62), and end-systolic volume (r = 0.53), suggesting a relation between impaired incremental elastance and alterations in inotropic state or afterload, or both. This hypothesis was confirmed by the fact that patients who had a peak systolic wall stress of less than 400 kdyne/cm² and a normal index of inotropic state also had normal incremental elastance: in contrast, all but 1 patient with the same afterload but abnormal contractility had abnormal incremental elastance. It is concluded that abnormalities in early diastolic filling are common in patients with valvular regurgitation and are likely to be related to impaired LV relaxation.     

Anomalies of the long arm of chromosome 11 in human myelo- and lymphoproliferative disorders. I. Acute nonlymphocytic leukemia

In a series of 365 consecutive ANLL cases of which 45.1% had abnormal karyotypes, 13 cases were detected with a structural abnormality of the long arm of chromosome 11. Besides one isochromosome 11q, there were six deletions and six translocations. Of these 12 patients, seven had acute monocytic leukemia (FAB-type M5), two had an M4, two had an M2, and one case of secondary leukemia had an M3-like disorder. Similar results with regard to the type of leukemia were obtained upon analysis of 41 cases of ANLL with an 11q anomaly described in the literature. This study confirms that a high proportion of acute monocytic leukemias and a lesser proportion of acute myelomonocytic leukemias are characterized by an 11q anomaly, mostly involving bands q22 and/or q23. Acute monocytic leukemia with an 11q structural anomaly appears to have a poor prognosis.     

Hysterectomy in six European countries

Gynaecologists have been criticized in recent years because of their attitude towards hysterectomy; it is often stated that they are too ready to consider hysterectomy to be indicated and that hysterectomies are carried out too frequently.In order to obtain insight into the incidence of hysterectomy, 2066 women between 40 and 70 yr of age, composing a sample covering 6 European countries, were asked whether they had undergone this operation. Of the total sample, 11.4% had been hysterectomized, the highest percentage being found in Italy (15.5%) and the lowest in France (8.5%).The most important factor that influenced the relative frequency of hysterectomy was age: the percentage of women who had undergone hysterectomy increased with age up to 55–59 yr, but fell thereafter. Another significant factor was civil status; there were fewer divorcees or widows at the moment of operation than married or never-married women.The relationship between the incidence of hysterectomy and age is a parabolic one. To explain this curve the authors postulate that two trends must have played a rôle: firstly; a greater need for hysterectomy with increasing age and, secondly a decrease in the reluctance of the gynaecological profession to perform a hysterectomy and/or of women to undergo this operation.Statistical analysis confirms the existence of this second trend over the period 1960–1975. The chances of a young woman losing her uterus before her 70th year went up linearly to 19.8% in 1975. By extrapolation a figure of 21% is obtained for 1980. Satisfaction with the result of the operation was lowest in Italy and Germany; satisfaction was also lowest in rural areas.     

3q−, 3q+ anomaly in malignant proliferations in humans

Anomalies of both No. 3 chromosomes, of the t(3q?; 3q+) type can be observed in human malignancy as reported previously. It is our experience that this anomaly is found predominantly in myeloproliferative disorders, as a rather rare event, though occurring more frequently than similar exchanges between other homologous chromosomes. Previous claims about a relationship between this anomaly and thrombocytosis could not be confirmed, but the features found in a few patients indicate that further research should be undertaken to clarify this point.     

Plasma and urinary cortisol levels after dexamethasone in affective disorders

The validity of the dexamethasone suppression test was evaluated for the differential diagnosis of primary and secondary depressions.Forty hospitalized psychiatric patients (14 primary depressed, 15 secondary depressed and 11 non-depressed controls) were studied. The Research Diagnostic Criteria of Spitzer et al. (1978) were used to classify these patients.Eight out of the 14 primary depressed patients had an abnormally high plasma cortisol at 4 p.m. after dexamethasone. Only 2 out of the 15 secondary depressed patients and none of the 11 controls had an abnormal response to dexamethasone.Based on these results, the dexamethasone suppression test has a sensitivity of 57%, a specificity of 87% and a predictive value of 80%.The determination of urinary free cortisol excretion does not improve the performance of the test.     

Hepatitis B virus (HBV) genotyping in Belgian patients with chronic HBV infection

Several studies have demonstrated that pathogenic and therapeutic differences exist among hepatitis B virus (HBV) genotypes. Therefore, this study established the prevalence of different HBV genotypes in 128 Belgian patients with chronic HBV infection. The prevalences of genotypes A and D, and mixed genotypes A and D, were 53%, 37% and 8%, respectively, for a group of blood donors, and 54%, 31% and 9%, respectively, for a group of patients from the gastroenterology units. The results indicated that genotypes A and D are the predominant genotypes in Belgian patients with chronic HBV infection.     

Q Fever Serological Survey and Associated Risk Factors in Veterinarians,Southern Belgium, 2013

A sero‐epidemiological survey was organized among veterinarians working in Southern Belgium to estimate the seroprevalence of Q fever and the risk factors associated with exposure. A total of 108 veterinarians took part to this cross‐sectional study, with a majority practicing with livestock animals. The overall seroprevalence was 45.4%, but it increased to 58.3% among veterinarians having contact with livestock. Three main serological profiles were detected (relatively recent, past and potentially chronic infections). The contact with manure during the prior month was the risk factor associated with seropositivity after multivariate logistic regression analysis. Classification and regression tree analysis identified the age as the most predictive variable to exclude potentially chronic infection in apparently healthy seropositive veterinarians. In conclusion, livestock veterinarians practicing in Southern Belgium are highly exposed to Q fever, a neglected zoonosis for which serological and medical examinations should be envisaged in at risk groups.