Comparison of effects on systolic and diastolic left ventricular function of nebivolol versus atenolol in patients with uncomplicated essential hypertension

This was a double-blind, randomized, prospective study comparing the effects of nebivolol and atenolol on systolic diastolic left ventricular function in patients with essential hypertension. A significant difference was seen in stroke volume between these 2 drugs. The blood pressure lowering effect of atenolol was strongly related to cardiac output and heart rate reduction. The blood pressure lowering effect of nebivolol was related to a reduction in peripheral resistance and an increase in stroke volume with preservation of cardiac output. This preservation of cardiac output, together with a reduced peripheral resistance, may be potentially important in treating heart failure.     

Impact of flow level on coronary flow velocity pattern. A doppler flow study in patients with first acute myocardial infarction

Analysis of coronary flow velocity pattern has been used to assess microvascular function post acute myocardial infarction (AMI). This study sought to analyze whether the flow level has an impact on parameters of coronary flow velocity pattern. Parameters of coronary flow velocity pattern were determined at baseline and during increased flow due to maximal hyperemia induced by adenosine in 25 patients after PTCA for first AMI using Doppler flow wires. Patients were divided into those with depressed (global wall motion index (GWMI) > or = 1.5; n = 14) and those with preserved (GWMI < 1.5; n = 11) left ventricular (LV) function at 4 weeks. Coronary flow velocity pattern at rest was different between patients with depressed and patients with preserved LV function at follow-up. A difference in flow pattern between the groups remained at increased flow level. However, increase of flow altered parameters of flow pattern. Diastolic deceleration rate (DSR) increased for patients with preserved LV function (53.7+/-25.6 at baseline vs. 67.0+/-29.8 cm/s2 with adenosine) and depressed LV function (95.3+/-58.6 vs. 110.7+/-61.4 cm/s2, respectively, p = 0.0012). Induction of hyperemia resulted also in increased systolic and diastolic peak flow velocity and diastolic deceleration time (DDT). Higher flow had no impact on early systolic retrograde flow, systolic flow duration and diastolic-systolic velocity ratio (DSVR). The coronary flow velocity pattern allows prediction of LV function at 4 weeks after AMI. However, it should be considered that some parameters of the flow velocity pattern are affected by the coronary flow level.     

Borderline Personality Disorder and Psychosis: A Review

Early views of borderline personality disorder (BPD) were based on the idea that patients with this pathology were “on the border” of psychosis. However, more recent studies have not supported this view, although they have found evidence of a malevolent interpersonal evaluation and a significant proportion of BPD patients showing psychotic symptoms. For example, in one study, 24% of BPD patients reported severe psychotic symptoms and about 75% had dissociative experiences and paranoid ideation. Thus, we start with an overview regarding the prevalence of psychotic symptoms in BPD patients. Furthermore, we report findings of studies investigating the role of comorbidity (eg, post-traumatic stress disorder) in the severity and frequency of psychotic symptoms in BPD patients. We then present results of genetic and neurobiological studies comparing BPD patients with patients with schizophrenia or nonschizophrenic psychotic disorders. In conclusion, this review reveals that psychotic symptoms in BPD patients may not predict the development of a psychotic disorder but are often permanent and severe and need careful consideration by clinicians. Therefore, adequate diagnosis and treatment of psychotic symptoms in BPD patients is emphasized.     

Intermittent harmonic imaging and videodensitometry significantly enhance ability of intravenous air-filled ultrasonographic contrast agent to produce ventricular and myocardial opacification.

We used visual and videodensitometric evaluation to investigate the influence of intermittent harmonic imaging (IHI) compared with intermittent fundamental imaging on cavity and myocardial signal intensity after administration of the air-filled transpulmonary contrast agent BY963. Twelve patients were studied with intermittent fundamental imaging and IHI after administration of 5 mL and 10 mL of contrast agent. Contrast effect was graded in the parasternal short-axis view. Visually, IHI improved opacification of both the right and left ventricular cavities, especially the left. Densitometrically, right ventricular opacification did not differ significantly between imaging modalities, whereas left ventricular cavity opacification was significantly higher when using IHI. Myocardial opacification was observed in a small minority of segments when assessed by visual estimation, whereas videodensitometry revealed opacification in 42 of 48 anterior, 39 of 48 posterior, and 42 of 48 septal segments. Differences were not significant between doses. We conclude that with IHI and densitometry, air-filled contrast agents like BY963 show significantly improved performance in producing cavity and myocardial contrast effects.     

Long-term restoration of the human T-cell compartment after thymectomy during infancy: a role for thymic regeneration?

Thymectomy during early childhood is generally thought to have serious consequences for the establishment of the T-cell compartment. In the present study, we investigated the composition of the T-cell pool in the first 3 decades after thymectomy during infancy due to cardiac surgery. In the first 5 years after thymectomy, naive and total CD4(+) and CD8(+) T-cell numbers in the blood and T-cell receptor excision circle (TREC) levels in CD4(+) T cells were significantly lower than in healthy age-matched controls. In the first years after thymectomy, plasma IL-7 levels were significantly elevated and peripheral T-cell proliferation levels were increased by ～ 2-fold. From 5 years after thymectomy onward, naive CD4(+) and CD8(+) T-cell counts and TRECs were within the normal range. Because TREC levels are expected to decline continuously in the absence of thymic output, we investigated whether normalization of the naive T-cell pool could be due to regeneration of thymic tissue. In the majority of individuals who had been thymectomized during infancy, thymic tissue could indeed be identified on magnetic resonance imaging scans. Whereas thymectomy has severe effects on the establishment of the naive T-cell compartment during early childhood, our data suggest that functional regrowth of thymic tissue can limit its effects in subsequent years.