Septal rupture repaired in the acute stage of myocardial infarction. Clinical, hemodynamic and angio-coronarography findings in the evaluation of surgical risk

Between 1977 and 1987, 27 consecutive patients (16 men, 11 women, mean age 66 years, range 54 to 75 years) with ventricular septal rupture complicating acute myocardial infarction underwent surgical repair. The purpose of this retrospective study was to analyse the post-operative mortality factors from clinical, haemodynamic and operative data in all patients and also from coronary angiographic data in 23/27 patients whose haemodynamic status allowed this type of exploration. Seventeen patients (63 p. 100) died during the first post-operative month, 10 survived and were discharged. Factors that influenced the prognosis were: (1) inferiorly-located necrosis associated with a 75 p. 100 mortality rate (9 out of 12 patients), as opposed to 53 p. 100 (8 out of 15 patients) with anterior necrosis; (2) right ventricular dysfunction, observed in 83 p. 100 of patients with inferior necrosis and 53 p. 100 with anterior necrosis, which was responsible for 7 out of 9 deaths in the inferior necrosis subgroup and contributed to 3 out of 8 deaths in the anterior necrosis subgroup; this established a cause-effect relationship between right ventricular function and the overmortality of patients with inferior necrosis; (3) independently of the haemodynamic status, two- and three-vessel lesions (56 p. 100 of all lesions) which had an 84 p. 100 mortality rate as opposed to 40 p. 100 with one-vessel lesions; (4) the presence of a state of shock which was associated with a 78 p. 100 mortality rate as opposed to 55 p. 100 in patients without shock. We conclude that when permitted by the patient's haemodynamic status coronary angiography should be part of the pre-operative evaluation to assess the operative risk and guide the surgical procedure.     

Involvement of the different rat hippocampal glutamatergic receptors in development of seizures induced by soman: an autoradiographic study.

Glutamate (GLU)-receptor subtypes, (quisqualate (QA)-, kainate (KA)-, N- methyl-D-aspartate (NMDA)-receptors) and the phencyclidine sites localized in the ion-channel associated to the NMDA-receptors, were studied by autoradiography in the hippocampus of rats subjected to a convulsive dose of the acetylcholinesterase inhibitor soman (0-, 1,2,2-trimethylpropyl methylphosphonofluoridate). In intoxicated rats, a significant increase in L-[3H]-GLU binding occurred within the first 40 min of seizures in the hippocampal CA3 and CA1 areas. Whereas binding to KA- and NMDA-receptors remained unchanged, L-[3H]-GLU binding to CA3 QA-receptors increased by 31 and 50% respectively after 10 and 40 min of seizures. In CA1, the change in QA-receptors was delayed (+30% after 40 min) and accompanied by an increase in the phencyclidine site binding capacity, reflecting the probable concomitant opening of NMDA ion-channels. These findings confirmed the previously suspected involvement of GLU in the earliest stages of soman-induced seizures, and suggested that, in hippocampus, the primary activation of QA-receptors in the CA3 region could lead to the secondary recruitment of combined non-NMDA (QA) and NMDA mechanisms in CA1.     

Differential maturation of brainstem auditory evoked potentials in preterm infants according to birthweight.

Brainstem auditory evoked potentials (BAEPs) were recorded from 39 preterm infants, divided into 3 groups: small-for-gestational-age, with a birthweight less than or equal to 1500 g (SGA); appropriate-for-gestational-age, with a birthweight less than or equal to 1500 g (AGA1); and appropriate-for-gestational-age, with a birthweight higher than 1500 g (AGA2). A significant shortening of the I-V interval due to an increase in wave I latency was found in the SGA group. The lower-weight AGA group (AGA1) was never significantly different from the SGA group. Although there was no correlation between conceptional age and weight at the time of the examination for the studied population, negative correlations were found between wave I latency and weight at the time of the examination. These findings confirm previous research and suggest the existence of a link between weight and basal cochlear maturation.     

Laparoscopic treatment of giant paraoesophageal hernias

Summary The authors report their experience of laparoscopic repair of large paraoesophageal hernias (POH). From February 1994 to January 1997, nine patients with a large POH containing at least 50% of the stomach have been treated laparoscopically. The surgical procedure included reduction of the herniated stomach, closure of the hiatal orifice, and construction of a circular fundoplication. There was no conversion into open surgery. One case of postoperative atelectasis was seen (morbidity: 12.5%). Postoperative X-Ray demonstrated the restoration of a normal anatomical arrangements as well as an effective anti-reflux fundoplication. Laparoscopy makes it possible to safely and efficiently repair large POHs with an acceptable morbidity. However, this type of operation requires a good training in laparoscopic surgery.     

Does previous infection protect against atopic eczema and recurrent wheeze ininfancy?

BACKGROUND: Frequent infection in infancy and early childhood has been hypothesized to explain the low prevalence of asthma and other atopic disease among children in developing countries (the so-called 'hygiene hypothesis'), but the low prevalence in Eastern Europe remains unexplained. OBJECTIVE: To test the hygiene hypothesis in the Republic of Belarus by examining the relationship between gastrointestinal (GI) and respiratory infection and two potentially atopic outcomes in the first 12 months of life: atopic eczema and recurrent wheeze. METHODS; We carried out two case-control studies nested within a large (n=17 046) randomized trial in Belarus, with cases defined as (1) first occurrence of atopic eczema (n=819) and (2) second episode of wheezing (n=112). Incidence density sampling was used to select four matched controls born within 1 month at the same hospital as the case. Exposure was defined as one or more episodes of GI or respiratory infection (examined separately) with onset >7 days before onset of the case's atopic outcome. Analyses controlled for family atopic history, duration of exclusive breastfeeding, sex, birth weight, maternal education, and (for recurrent wheeze) maternal smoking. RESULTS: For atopic eczema, prior GI infection occurred in 7.4% of cases vs. 6.0% of controls [adjusted OR=1.27 (0.94-1.72)] and prior respiratory infection in 35.2% vs. 32.6% [adjusted OR=1.14 (95% CI=0.94-1.37)]. For recurrent wheeze, prior GI infection occurred in 9.8% of cases vs. 7.4% of controls [adjusted OR=1.30 (0.60-2.82)]. CONCLUSION: Our results do not support the hypothesis that infection protects against atopic eczema or recurrent wheezing in the first 12 months of life.     

Evoked otoacoustic emissions: relative importance of age, sex and sensorineural hearing-loss using a mathematical model of the audiogram.

The influence of age, sex and of hearing loss on the EOAEs were studied in 140 subjects. The EOAEs were never found when hearing loss on the best hearing frequency was above 40 dB HL and when the threshold of intelligibility was above 45 dB HL. The presence of EOAEs therefore does not only give specific information on the midfrequencies, but also shows a hearing loss below or equal to 40 dB HL on at least one frequency. In addition, there is a relation between the audiometric curve and the spectrum analysis of EOAEs. These seem to be promising results for clinical applications.     

Evoked otoacoustic emissions and sensorineural hearing loss

Following Kemp's original studies, several others have confirmed the existence of otoacoustic emissions. Their clinical relevance remains, however, to be clarified. The various published studies have concerned small series. This study sought to specify otoacoustic emission characteristics in relation to sensorineural hearing loss (148 ears of 76 subjects). The results show that the presence of otoacoustic emissions drops as a function of hearing loss and that there is a highly statistically significant correlation between otoacoustic emission threshold and hearing loss at the 1000-Hz frequency. Otoacoustic emissions are never found when hearing loss at 1000 Hz exceeds 40 dB hearing level and when the mean audiometric hearing loss (at 500, 1000, 2000, and 4000 Hz) exceeds 45 dB hearing level. The main practical conclusion is that otoacoustic emission presence indicates middle frequency functional integrity of the outer hair cells of Corti's organ. Absence of otoacoustic emissions is harder to interpret.