Congenital pernicious anemia: report of seven patients, with studies of the extended family

Unstimulated whole saliva was collected from 203 uninfected individuals at various ages from birth until adulthood. Levels of specific antibodies against Escherichia coli O antigens of secretory IgA, secretory IgM and IgG, as well as total amounts of SIgA, were determined using ELISA. Levels of SIgA antibodies found in adults were approached by the age of 12 months, but high levels could be attained earlier, presumably in response to antigenic exposure at the mucosal level. During the first few months of life, secretory IgM antibodies appeared in the saliva, possibly compensating for the relative lack of IgA.     

Comparison of myocardial preservation techniques for aortocoronary bypass surgery.

The myocardial properties of three different techniques for cardiac arrest during aortocoronary bypass surgery were analyzed. Ventricular fibrillation and moderate total body hypothermia (30–33°C) (Group I) was found to be an insecure method of preservation. It produced a high incidence of focal irreversible ultrastructural changes (7 of 10 patients), high post-bypass CK-MB levels (mean 85.54 U/liter) indicative of myocardial damage, and impaired clinical and physiologic recovery courses. Six out of ten patients needed inotropic support, three had prolonged stay in ICU, and three patients showed Type III (unacceptable) recovery trajectories, one of whom died of myocardial decompensation four weeks after surgery. This method, which was the most common one used in our institution, was completely abandoned as a result of these studies. Potassium induced cardioplegia combined with methylprednisolone sodium succinate, hypertonic glucose and intermittent moderate topical cooling (25–27°C) of the heart (Group III) offered a generally acceptable form of myocardial protection, as only one patient showed irreversible ultrastructural changes. The mean post-bypass CK-MB level was only moderately elevated (mean 22.32 U/liter), but seven of ten patients needed inotropic support. There were no Type III recovery trajectories and two patients showed an optimal Type I recovery. Only one patient had a prolonged stay in ICU, and another patient exhibited electrocardiographic evidence of a perioperative myocardial injury pattern. Selective intracavitary profound hypothermic arrest (15–18°C) (SIPHA) offered the best myocardial protection as evidenced by remarkably well preserved ultrastructure and significantly (P< 0.005) lower post-bypass CK-MB levels (mean 7.85 U/L). All SIPHA patients had acceptable physiologic recovery trajectories of the Type I or Type II with minimal need for inotropic support (one patient), and none had a Type III recovery.These data also suggest that the major determinant of a successful myocardial preservation is the level of myocardial layer temperature, being best at the lowest temperature (15–18°C), worst at the highest temperature (30–33°C) and intermediate at 25–27°C. Additional injury may also be induced by ventricular fibrillation which by itself increases myocardial metabolic demands.     

Blood pressure variability and the type a behavior pattern in adolescence

The present investigation assessed the relationship between Type A behavior and blood pressure variability in a sample of 211 adolescents. Consistent with the adult literature, analyses revealed an association between Type A behavior and both systolic blood pressure variability and peak systolic pressure. The measures of diastolic blood pressure, however, were unrelated to Pattern A. The association with systolic variability remained when controlling for initial blood pressure level, sex, weight, and age. Subsidiary analyses of the components of Pattern A showed that high systolic variability teenagers are characterized by Type A speech characteristics (quick response latencies) and high levels of hostility. These findings support the validity of the Type A construct in adolescence.     

Tracheal Blood Supply

Perioperative and late follow-up hemodynamic cardiovascular studies to assess the effects of direct myocardial revascularization on cardiac function objectively have been completed on 51 patients. Analysis of the data delineated three distinct groups based on the pattern of their early postoperative recovery. Group I patients (12) had a hyperdynamic cardiovascular response to operation and returned to a normal physiological range of cardiac function within 24 hours. Group II patients (24) initially had moderate to severe myocardial decompensation postoperatively but responded to inotropic support and moved into the normal physiological range within 24 to 48 hours. Group III patients (15) had severe, prolonged myocardial decompensation with little response to inotropic support. There were no early deaths in Group I, 1 early iatrogenic death in Group II, and 2 deaths from sepsis, 1 in Group I and 1 in Group II. All 7 cardiogenic deaths occurred in Group III patients. Late follow-up studies 4 to 23 months postoperatively have been completed on 29 patients. These showed cardiovascular stability in the mean values in Groups I and II. Significant improvement in mean cardiac function was seen in surviving Group III patients.