The cold pressor test: Vascular and myocardial response patterns and their stability

The purposes of the present study were to compare the cardiovascular response patterns evoked by three versions of the cold pressor test (either forehead stimulation or hand or foot immersion) and to determine the reproducibility of the responses over a 2-week interval. Blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance, and systolic time intervals were obtained during rest and during the cold pressor test in 42 young men. Across conditions, the pressor response was supported by peripheral resistance increases with concomitant stroke volume decreases. Although the response panerns were generally similar across sites, exceptions were apparent for heart rate. Forehead stimulation was characterized by no significant change in heart rate, whereas limb (hand or foot) immersion was associated with significant heart rate acceleration. The responses elicited by the three cold pressor test conditions were reliable and showed little evidence of attenuation over the test-retest interval.     

Malignant Ventricular Tachycardia During Propafenone Treatment in a Child with Junctional Automatic Tachycardia: Effectiveness of Intravenous Molar Sodium Lactate

Propafenone may aggravate the preexisting arrhythmia or induce another one. Usually, such proarrhythmic effects occur in patients with spontaneous ventricular arrhythmias and/or coronary heart disease with poor left ventricular function. We report the case of a 5-year-old girl with Junctional automatic tachycardia and no structural heart disease, in whom malignant ventricular tachycardia occurring during propafenone treatment could be terminated by molar sodium lactate (MSL) infusion. The serum propafenone level obtained before MSL infusion was within the therapeutic range. Two hypothesis could explain the beneficial effects of MSL in our patient: (1) alkalinization facilitates the cell membrane hyperpolarization and thus can decrease the voltage-dependent effect of Class Ic drugs, (2) alkalinization could displace propafenone from its tissue receptor sites by an increase in the nonionized fraction.     

Potential Efficacy of a Delta 5-Aminolevulinic Acid Bioadhesive Gel Formulation for the Photodynamic Treatment of Lesions of the Gastrointestinal Tract in Mice

A delta 5-aminolevulinic acid (ALA) bioadhesive gel has been developed and evaluated in an in-vivo mouse model for photodynamic treatment of gastric cancer or Barrett's oesophagus. Four gels were tested: noveon AA-1, keltrol T, lutrol and blanose. An initial in-vitro study of gel adhesion showed that noveon and keltrol had longer polyethylene transit times than lutrol and blanose. In-vivo assays indicated that protoporphyrin IX was synthesized by gastric mucosa when ALA-noveon and ALA-lutrol were used (preferable results for noveon). Keltrol was eliminated from the study after these investigations. Only ALA-noveon gel was retained for studies of the relationship between ALA dose and fluorescence. Fluorescence measurements in-vivo showed that ALA concentration and application time had an influence on protoporphyrin IX synthesis. Maximum intensity (2091 counts s^?) was found with 2 mg mL^? ALA, and fluorescence intensities differed with application time, reaching 1805 counts s^? after 240 min. ALA-noveon, showing good adhesion and enabling efficient diffusion of ALA at a pH < 6, was considered the best formulation for maintaining ALA stability.     

Influence of liver cirrhosis on sertraline pharmacokinetics

Sertraline is a serotonin reuptake inhibitor. The enhancement of serotoninergic transmission is associated with antidepressant activity. In order to determine the pharmacokinetics of sertraline in patients with chronic stable hepatic insufficiency, 10 patients were matched (age, weight, sex) with 10 healthy subjects in an open study. Each participant received a single capsule containing the equivalent of 100  mg sertraline base. Blood samples were taken during 264  h after administration for measurement of plasma concentrations of sertraline. The results confirm that the oral clearance of sertraline is reduced with a 1.7-fold increase in C _max and a significant prolongation in elimination half-life in hepatically impaired patients     

Gianotti-Crosti syndrome: a study of 26 cases

We have studied 26 patients presenting with a symmetrical papular or papulovesicular acrolocated eruption of more than 10 days duration. Mean age at onset was 2 years (range 10 months to 5.75 years). Lymphadenopathy was noted in eight cases, and hepatomegaly in one case. In 12 cases, histopathology and direct immunofluorescence were non-contributory. Cytolytic hepatitis occurred in one case and was associated with HBs antigenemia. A history of recent immunization was given in two cases. There was serological evidence of recent Epstein-Barr virus infection in seven out of 13 cases tested. Coxsackie B viruses were isolated from three patients, and cytomegalovirus was probably associated with the syndrome in one case. We conclude that the Gianotti-Crosti syndrome is not rare in France, and that non-hepatitis B virus (HBV)-associated cases are more frequent than the classical HBV-associated papular acrodermatitis of childhood.     

Post-radiotherapeutic left main coronary ostial stenosis: clinical and histological study

Pericardial abnormalities remain the most common manifestationof radiation-induced cardiac disease, but coronary artery lesionsare not rare. In this report we describe a left coronary ostialstenosis which appeared five years after mediastinal irradiationfor breast carcinoma in a 50-year-old woman. The patient underwentcoronary angiography. A pressure drop was observed as the leftcatheter tip engaged the left coronary ostium; so, only nonselectivecoronary opacifications were performed showing an isolated,marked narrowing of the left coronary ostia. During surgery,a circumferential aortotomy allowed the examination of the leftcoronary ostium which appeared severely stenosed. The coronarytree was otherwise normal. A termino-terminal saphenous veingraft was anastomosed on the left stem and its proximal partwas implanted on the ascending aorta. The coronary ostium andthe proximal part of the left main stem were excised and themacroscopic examination of the proximal part of the left coronaryartery confirmed the diagnosis of severe ostial stenosis. Microscopicexamination of the coronary ostium showed a severe intimal thickeningwithout any evident lesion of the media. This intimal thickeningconsisted of fibrous tissue without extracellular lipid deposit.Microscopic examination of the aorta near the coronary ostiumalso demonstrated an intimal thickening without any lesion ofthe media. Coronary ostial stenosis appears to be a rare lesion;its incidence has varied between 0·13 and 2·7%in angiographic studies and there is co-existing disease inmultiple coronary vessels in the majority of cases. This coronarylesion in a middle-aged woman after a mediastinal irradiation,its histologic aspect (pure intimal fibrous thickening), andthe secondary appearance of complete atrio-ventricular block,fits the pattern previously ascribed to radiotherapy. Only twoother cases of coronary ostial lesion almost certainly secondaryto mediastinal irradiation have been reported.     

应用埋藏式心脏自动复律除颤器预防心脏猝死

目的：观察埋藏式心脏自动复律除颤器(AICD)在心脏猝死二级预防中的作用及57例AICD应用的临床体会。方法：选择有心脏猝死病史的57例病人给予AICD治疗，其中4倒合并严重心衰者给予三腔AICD。术后每3个月进行1次AICD遥测检查及进行一般的临床检查。观察室性心律失常的发生情况、AICD工作情况，并适时调整AICD工作参数及治疗用药。结果：全部病例随访3—24个月，最长l例随访5a。共发生室速、室颤154次。非持续性室速170次。AICD启动抗心动过速起搏功能87次，成功67次，成功实施低能电复律6次，采取高能电除颤101次，成功复律87次，另12次为感知窦性心动过速造成误放电。AICD漏感知室速2次而未实施放电治疗。4例安装三腔AICD患者术后3个月时ET值改善。心衰症状减轻。全组病例随访其间无死亡发生。结论：AICD用于心脏猝死的二级预防安全有效，三腔AICD是治疗合并严重心力衰竭的恶性室性心律失常有效的新方法。及时适当的调整AICD的心律失常识别标准和工作参数是AICD正常工作的保证。     

Stimulus dimensions of the cold pressor test and the associated patterns of cardiovascular response

Hemodynamics of the cold pressor response in relation to its pain and nonpain stimulus components were investigated in normotensive college men using the foot and forehead cold pressor tasks. Mechanisms of pain- and non-pain-related increases in blood pressure were analyzed as residual effects of concurrent changes in total peripheral resistance and cardiac output. The identified partial relationships suggested that the response pattern associated with pain included positive change both in cardiac output and in total peripheral resistance, whereas the nonpain-related response was limited to an increase in total peripheral resistance. Analyses of individual differences in car-diovascular responses to pain further indicated that pain-related increments in blood pressure were mediated by a steeper rise in total peripheral resistance, an increase in heart rate, and an apparent increase in preload. At baseline, high reactors to pain manifested relatively elevated total perpheral resistance, diminished cardiac output, and an indication of a reduced inotropic state, suggesting that altered basal homeostasis may discriminate normotensive individuals displaying heightened cardiovascular reactivity to aversive cold stimulation.