1- and 7-year risk of cardiac events in relation to Holter monitoring in patients admitted with chest pain in whom AMI is not confirmed

The prognostic value of ventricular premature beats (VPBs) was evaluated in 198 patients with chest pain (non-AMI patients) in whom the diagnosis of acute myocardial infarction was ruled out after admission to hospital. VPBs were registered at the time of discharge during a 24-hour Holter monitoring. The amount of cardiac events (CEs) were analyzed after 1 and 7 years follow-up. After 1 year, CEs were seen in 9% of the non-acute myocardial infarction (AMI) patients. After 7 years, 51 CEs (20 nonfatal AMIs and 31 cardiac deaths) had occurred (25%). After 1 year, only pairs of VPBs were associated with an increased risk of CEs. CEs were seen in 25% of the patients with pairs of VPBs and in 6% of the patients without pairs (p<0.01). The occurrence of CEs after 7 years was related to the presence of pairs of VPBs and multiform VPBs. Fifty-five percent of the patients with pairs of VPBs had CEs during the long-term follow-up, compared with 22.5% without pairs (p<0.0005). CE was seen in 48.9% of the patients with multiform VPBs, compared with 19.0% without multiform VPBs (p< 0.0001). Thus, Holter monitoring seems to be of better value for predicting long-term prognosis than for predicting short-term prognosis in non-AMI patients. The presence of multiform VPBs or pairs of VPBs is strongly associated with an increased risk of CE after 7 years. Non-AMI patients with pairs of VPBs or multiform VPBs should be considered as high-risk patients.Presented at The 35th World Congress, International College of Angiology, Copenhagen, Denmark, July 1993     

Plasma antidiuretic hormone in acute respiratory failure

The role of antidiuretic hormone (ADH) in the pathogenesis of renal impaired water excretion in acute respiratory failure has not been clearly delineated. Plasma sodium concentration and plasma ADH levels (radioimmunoassay) were therefore serially measured in 13 patients with acute respiratory failure (10 with acute exacerbations of chronic lung disease and three with acute lung disease) and eight “control” patients admitted to the intensive care unit with suspected myocardial infarction. None of the patients had systemic hemodynamic, hepatic or renal dysfunction. ADH levels were significantly elevated in patients with acute respiratory failure (15.1 ± 5.2 pg/ml versus 5.7 ± 1.9 pg/ml, p < 0.05) when compared with levels in control patients. The elevated ADH levels occurred despite significantly lower plasma sodium concentration (133 ± 1 meq/liter versus 138 ± 2 meq/liter, p < 0.05) compared with control values. Moreover, markedly increased ADH values (range 1.1 to 13.0 pg/ml) were often encountered in patients with acute respiratory failure despite significant hyposmolality (263 to 275 mOsm/kg H₂O). This was not observed in any control patients. These results suggest that patients with acute respiratory failure are susceptible to water retention and hyposmolality due to nonosmotic release of antidiuretic hormone.     

Two-dimensional echocardiographic detection of pericardiocentesis-induced intrapericardial thrombus

Heart puncture-induced hemopericardium is a serious complication of the pericardiocentesis. Two-dimensional echocardiographic examination performed in two patients just before and after the development of hemopericardium revealed a unique image in which pericardial bleeding manifested itself by an echodensity thrombus appearance adjacent to the cardiac chambers. With appropriate differentiation to some other intrapericardial echodensity masses, such distinctive images can be highly specific for active bleeding into the pericardial sac.     

Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma?

The progress of 139 patients operated upon for cure of colorectal carcinoma, was followed postoperatively with a standardized protocol. A CEA test was performed for comparison with other parameters. Median observation time was four years. When an upper limit for CEA of 7.5 μg/l was allowed, sensitivity was found to be 78 per cent, specificity 91 per cent, and predictive value of an elevated CEA concentration, 83 per cent. In general, CEA measurement traced, recurrence six months before clinical diagnosis. In only a few cases was recurrence first heralded by an abnormality in other blood chemistry test results. CEA may thus be used in postoperative screening for recurrence even though most recurrences, when detected, are not curable. Read at the meeting of the American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 5–9, 1983 Presented in part at The World Congresses of Gastroenterology (OMGE) and Coloproctology, Stockholm, Sweden, June 14–19, 1982.     

Addisonian Crisis and Relative Adrenal Failure

Reviews in Endocrine and Metabolic Disorders -     

CCR5 or CXCR4 is required for efficient infection of peripheral blood mononuclear cells by promiscuous human immunodeficiency virus type 2 primary isolates

Primary human immunodeficiency virus type 2 (HIV-2) isolates are characterized by their ability to use a broad range of coreceptors, including CCR5, CXCR4, and several alternative coreceptors. However, the in vivo relevance of this in vitro promiscuity in coreceptor usage remains unclear. We set out to evaluate the relative importance of CCR5 and CXCR4 for infection of activated peripheral blood mononuclear cells (PBMC). PBMC from donors homozygous for wild-type CCR5 (CCR5(+/+) or CCR5Delta32 (CCR5(-/-)) were tested for their susceptibility to infection with 10 primary HIV-2 isolates with known coreceptor usage by parallel 50% tissue culture infectious dose (TCID50) titrations. Although all isolates, except one, were able to establish productive infection in CCR5(-/-) PBMC, the infection of these cells was inefficient for all isolates that were unable to use CXCR4. For CXCR4-using isolates there were only minor differences in TCID50 between CCR5(+/+) and CCR5(-/-) PBMC. When we compared the replication kinetics in PBMC from donors of the two genotypes we observed an average delay in replication onset of 9 days in the CCR5(-/-) PBMC. This study shows that HIV-2 can use alternative coreceptors for infection of PBMC, but that this infection is much less efficient than infection mediated by CCR5 or CXCR4. Thus, CCR5 and CXCR4 appear to be the major coreceptors for HIV-2 infection of PBMC.     

Intravascular ultrasonic comparative analysis of degree of intimal hyperplasia produced by four different stents in the coronary arteries

Intravascular ultrasound studies were performed at angiographic follow-up on 121 native coronary lesions treated with 1 bare metal stent (n = 50), high-dose dexamethasone-eluting stents (n = 18), non-polymer-based paclitaxel-eluting stents (n = 18), or sirolimus-eluting stents (n = 35). Paclitaxel- and sirolimus-eluting stents reduced mean intimal hyperplasia thickness compared with bare metal stents by 49% and 90% (p = 0.048 and p <0.001), respectively, whereas mean intimal hyperplasia thickness treated with dexamethasone-eluting stents was similar to those lesions treated with bare metal stents.     

Sjögren's syndrome with myalgia is associated with subnormal secretion of cytokines by peripheral blood mononuclear cells

OBJECTIVE: To measure in vitro cytokine release from peripheral blood mononuclear cells (PBMC) and serum cytokines in patients with primary Sj?gren's syndrome (SS) with and without myalgia, compared to patients with rheumatoid arthritis (RA) and healthy controls. METHODS: Sixteen women with SS (8 with myalgia, 8 without pain), 15 women with RA, and 14 healthy women were studied. PBMC were isolated and cultured. Secretion of interleukin 1 beta (IL-1 beta), IL-6, IL-10, and tumor necrosis factor-alpha (TNF-alpha) was measured in cell supernatants with or without stimulation with phytohemagglutinin, tetanus toxoid, or purified protein derivative (PPD). Enzyme-linked immunospot was used to enumerate interferon-gamma (IFN-gamma) and IL-4-secreting cells. Serum concentrations of IL-8 and IL-18 were analyzed by ELISA. RESULTS: PPD-stimulated PBMC from SS patients responded with less production of IL-10, TNF-alpha, and IFN-gamma compared to controls. Patients with SS and pain were hyporesponsive also with respect to IL-1 beta and IL-6. The generally subnormal cytokine release was statistically significant in myalgic patients with SS compared to healthy controls. Serum IL-18 was increased in both SS groups as well as in patients with RA, and the highest levels were found in myalgic patients with SS. Serum IL-8 was increased in RA but not in SS. CONCLUSION: Patients with SS, especially those with myalgia, had diminished PBMC cytokine release and increased serum IL-18. This finding suggests that impaired cytokine regulation may have pathogenetic importance for myalgia in SS.     

Postoperative blood loss in coronary surgery. No real impact of fibrinolysis detected by thromboelastography and D-dimers. A prospective, randomized study

Although in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited. Sixty-five patients scheduled for coronary surgery were randomized into 3 groups: group A--conventional coronary artery bypass grafting, group B--off-pump surgery, and group C--coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected. Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardio-pulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found.