Preservation of All Chordae Tendineae and Papillary Muscle During Mitral Valve Replacement with a Tilting Disc Valve

Mitral valve replacement was performed in 21 patients using a surgical technique that preserves the entire papillary muscle and chordal apparatus. With this technique, the anterior mitral leaflet is split from the center of the free edge toward the annulus. Bilateral incisions are made from the proximal end of this split to the two mitral commissures, detaching the anterior leaflet from the annulus. These two halves of the leaflet, with all chordae intact (corresponding to the anterolateral and posteromedial papillary muscles), are judiciously trimmed to remove areas of leaflet untethered by chordae tendineae and (when necessary) fibrous thickening; then swung posteriorly and sutured to the posterior mitral annulus using mattress sutures with pledgets. This surgical technique is expected to favor the preservation of left ventricular function and avoid occurrence of irreversible left ventricular dilation/dysfunction, and has been used successfully for calcific and degenerative etiologies, using both tilting disc valves and porcine bioprostheses. It is especially useful in the implantation of tilting disc and bileaflet mechanical prostheses because anterior subvalvular chordae tissue may interfere with the disc excursion and relocated to the posterior leaflet annulus.     

THE EFFECT OF ALPHA ADRENERGIC MANIPULATION ON THE 24 HOUR PATTERN OF CORTISOL SECRETION IN MAN

We have studied the role of central alpha-1 adrenoceptor mechanisms which stimulate cortisol secretion throughout the 24 h period in man. Six normal subjects were given 24 h i.v. infusions of the alpha-1 adrenoceptor agonist methoxamine, the alpha-1 antagonist thymoxamine, and saline under double-blind conditions. The only cardiovascular effects of these adrenergic manipulations was a slight bradycardia accompanying the methoxamine infusion. The methoxamine infusion was accompanied by higher concentrations of cortisol than the saline infusion during waking hours and the food related secretory surges were exaggerated, while the converse held with thymoxamine. In contrast, the nocturnal surge of cortisol secretion was unaffected by these adrenergic manipulations. These findings suggest that an alpha-1 adrenoceptor mechanism contributes to the maintenance of cortisol secretion during waking hours, but not at night.     

Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation

The effect of dose rate to the lungs and development of interstitial pneumonitis (IP) was evaluated in 114 bone marrow transplant patients receiving fractionated total body irradiation (TBI) (1200 rads TD in 6 fractions twice daily over 3 days) as part of their pre-conditioning regimen. The tumour dose (TD) was calculated as the mean lung dose as previously described (1). A 6MV linear accelerator at a mid-line dose rate of 7.5 rads/minute was used between March 1981 and June 1985 and a Co-60 source at 5 rads/minute thereafter. This resulted in a range of dose rates to the lung of between 6.9 and 8.9 rads/minute and 2.9 and 6.5 rads/minute respectively. In the majority of patients the aetiology of IP was investigated by lung biopsy with histology and culture. There was no statistically significant difference in the incidence of IP over the two sets of dose rates. Our study suggests tat the incidence of IP using fractionated TBI is not influenced by dose rates below 8.9 rads per minute.     

Sickness Absence from Work and Influenza Immunization

The worth of influenza immunization for employees in U.K. industryhas been debated for more than a decade. In this study no evidencecould be found of a protective effect for sickness absence patterns.Other evidence is also cited that suggests routine influcnzalimmunization programmes for healthy adults of working age areno longer justilied. *Requests for reprints should be addressed to: Dr Robin Philipp, Department of Epidemiology and Community Medicine, University of Bristol, Bristol BS8 2PR.     

Efficacy of recombinant granulocyte colony-stimulating factor (rhG-CSF) in experimental colitis

Inflammatory bowel disease is associated with mucosal neutrophil recruitment and activatation, mediated in part by arachidonic acid metabolites. G-CSF attenuates the immune response to sepsis and ameliorates glycogen storage disease Ib-related colitis. These actions may be effected through the shedding of neutrophil adhesion molecules, or inhibition of proinflammatory mediator synthesis. Immune complex colitis was used to evaluate the effect of rhG-CSF on colonic mucosal inflammation, neutrophil recruitment and the generation of eicosanoids. Immune complex colitis was induced in White New Zealand rabbits. Animals were pretreated with rhG-CSF either 24 h before induction, or at induction, with dosages of 50 and 200 μg/kg. rhG-CSF caused a time- and dose-dependent neutrophilia in all animals. Pretreatment with rhG-CSF resulted in increased tissue myeloperoxidase levels, despite a histologically similar mucosal polymorphonuclear cell infiltrate between treated and control colitis groups. Leukotriene B₄ (LTB₄) and thromboxane B₂ (TXB₂) dialysis fluid levels were lower in treated animals, in particular in the groups receiving two doses (LTB₄: both P < 0.01; TXB₂: both P < 0.01. Prostaglandin E₂ (PGE₂) levels in dialysis fluid of the rhG-CSF-treated animals showed no difference from controls. In this model of experimental colitis, high-dose therapy with G-CSF resulted in a marked decrease of proinflammatory mediators, but mucosal generation of the protective PGE₂ was preserved. These results suggest that prolonged high-dose therapy with G-CSF may have anti-inflammatory effects in colitis.     

Sensory Responses to Fat are Not Affected by Varying Dietary Energy Intake From Fat and Saturated Fat Over Ranges Common in the American Diet

Objective To examine the effects of manipulating dietary fat in foods on sensitivity and hedonic response to fat in selected foods.Design Twenty subjects were randomly assigned to a sequence of three 8-week experimental diets (average American diet, step 1 diet, low-saturated-fat diet) that varied in energy from fat (37%, 30%, and 26%, respectively) and saturated fat (17%, 10%, and 6%, respectively). Subjects participated in sensory tests designed to assess their sensitivity to and liking for fat in several foods, before the study (baseline), after consumption of each diet, and after the study (washout).Subjects/setting Subjects were participants in the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study.Results No significant differences were found among diets for difference thresholds (ie, just noticeable differences) for fat in milk and pudding, ad libitum mixing of low- and high-fat samples of milk and soup, and hedonic scaling of fat concentrations in milk and muffins and of cheese, mayonnaise, hot dog, and pastry samples.Applications/conclusions Within the dietary fat ranges and for the fat stimuli tested in this study, dietary fat as percentage of energy from fat and saturated fat was not a significant determinant of sensitivity to and/or liking for fat. Sensory factors should not be a barrier to the implementation of low-fat diets such as the step 1 and low-saturated-fat diets. J Am Diet Assoc. 1999;99:690–696.     

Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review

Aim The aim of this paper was to systematically review the efficacy and safety of botulinum toxin (BoNT) injections to the salivary glands to treat drooling in children with cerebral palsy and neurodevelopmental disability. Method A systematic search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and the Physiotherapy Evidence Database (PEDro) was conducted (up to 1 October 2011). Data sources included published randomized controlled trials (RCTs) and prospective studies. Results Sixteen studies met inclusion criteria. Three outcome measures support the effectiveness of BoNT for drooling. One RCT found an almost 30% reduction in the impact of drooling on patients’ lives, as measured by the Drooling Impact Scale (mean difference ?27.45; 95% confidence interval [CI] ?35.28 to ?19.62). There were sufficient data to pool results on one outcome measure, the Drooling Frequency and Severity Scale, which supports this result (mean difference ?2.71; 95% CI ?4.82 to ?0.60; p<0.001). There was a significant reduction in the observed number of bibs required per day. The incidence of adverse events ranged from 2 to 41%, but was inconsistently reported. One trial was terminated early because of adverse events. Interpretation BoNT is an effective, temporary treatment for sialorrhoea in children with cerebral palsy. Benefits need to be weighed against the potential for serious adverse events. More studies are needed to address the safety of BoNT and to compare BoNT with other treatment options for drooling.     

The Effect of Etiocholanolone on Granulocyte Kinetics

The effect of etiocholanolone on granulocyte kinetics in 12 hematologicallynormal patients has been investigated using the technic of ³H-DFP labelingof autologous blood in vitro.

Baseline determinations of the total blood granulocyte pool (TBGP), thecirculating pool (CGP), and the marginated pool (MGP) were performed.The values for the total blood granulocyte pools were similar to those previously reported. Following the administration of etiocholanolone, there was a98 per cent increase in the TBGP, which was considered to be due to mobilization of granulocytes from the bone marrow reserve. There was no change inthe ratio of CGP to MGP.

These studies suggest that etiocholanolone may be a useful agent for theestimation of bone marrow reserve.

Submitted on November 21, 1966 Accepted on April 13, 1967     

OSTEOLYTIC PROPERTIES OF THE SYNOVIAL-LIKE TISSUE FROM ASEPTICALLY FAILED JOINT PROSTHESES

Relationships were found between the bone-resorbing abilityof conditioned media (CMs) from cultures of peri-prosthetictissues and their levels of bone-remodelling agents. Bone-resorbingactivity was measured by ⁴⁵Ca release from pre-labelled mousecalvaria and 23 of 40 CMs exhibited bone-resorbing activity.Cytokine and prostanoid levels in the CMs were measured by immunoassay,and the levels of interleukin (IL)-1ß, IL-6, tumournecrosis factor (TNF) and prostaglandin E₂ (PGE₂) correlatedwith each other, except for the latter two. Significantly higherlevels of IL-6 were present in those CMs with bone-resorbingactivity than in those without, and a similar pattern was observedfor PGE₂ and IL-1ß. However, some CMs with high levelsof IL-1ß, IL-6, TNF and PGE₂ failed to induce resorption,whereas a few CMs with low levels of these agents induced resorption.Moreover, neither dialysis of CMs nor addition of neutralizingantisera to IL-1 and IL-1ß to CMs, either alone orin combination, reduced the bone-resorbing activity of the CMs.It is considered that these agents may act synergistically tomediate osteolysis around failed joint implants, but that otherunidentified bone-resorbing agent(s) must be involved. KEY WORDS: Implant failure, Pseudosynovial membrane, IL-1ß, IL-6, TNF, TGFß1, Prostaglandins, Bone resorption, Leucocytes