[Efficacy and safety of pancrealipase delayed-release capsules (Creon) in patients with pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery].

In the article design, objectives, methods of conducting double-blind, randomized study which results prove efficacy and safety of new formulation of Creon are presented.

Noninvasive assessment of local myocardium repolarization changes using high resolution surface ECG mapping.

A method using body surface potential maps for assessment of myocardium lesions with changed repolarization is presented and suitable mapping system is introduced. Differences between normal and altered QRST integral maps together with torso volume conductor model were used to determine the equivalent dipole representing the lesion. Performance of the method was studied on simulated data. Changed repolarization was modeled by shortening of myocyte action potentials in regions typical for stenosis of the main coronary arteries. The equivalent dipole estimated the positions of small lesions with a mean error of 9+/-4 mm (17+/-14 mm for larger transmural lesions). The subepicardial or subendocardial character of the lesions was reflected in the dipole orientation. Tests of the method on patients after myocardial infarction that underwent coronary intervention on a single coronary vessel showed that in 7 of 8 successfully treated patients the dipole position matched well with the treated vessel. A small dipole moment in another patient indicated unsuccessful treatment. The method was implemented in a new 128-channel mapping system. Its active electrodes, battery powered measuring unit and optical computer interface help to minimize noise in ECG and guarantee patient's safety. The results suggest that the method and mapping system offer useful tools for noninvasive identification of local repolarization changes in the myocardium.

[Dyshormonal strain bone disease in young people]. / Disgormonal'no-peregruzochnaia bolezn' kosti u molodykh liudei.

There were studied 453 young servicemen with dyshormonal strain bone disease in whom the hormonal status, state of carbohydrate and protein metabolism were investigated. It was established that in 92.9% of patients the growth hormone--somatotropic hormone (STH) was significantly decreased, production of thyroid hormones necessary for physiologic osteogenesis (T3 and T4) was impaired and albuminous fraction dissociation was revealed. The authors consider that in dyshormonal strain bone disease in young people the insufficiency of hormonal regulation of growth processes and bone regeneration is the primary factor while the physical strain is the additional secondary factor.

Plasma levels of soluble cellular adhesion molecules in patients with arterial hypertension. Correlations with plasma endothelin-1.

Background: Several reports have shown that circulating, soluble cellular adhesion molecules and endothelin-1 (ET-1) are implicated in the pathophysiological events of atherosclerosis and may reflect the endothelial dysfunction characterizing this disorder. Methods: To evaluate the expression of these factors in arterial hypertension (AH), we measured plasma levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble P-selectin (sP-selectin), and ET-1 in 60 untreated patients with mild to moderate AH (hypercholesterolemic: n=31, normocholesterolemic: n=29) and 30 sex- and age-matched normocholesterolemic normotensive controls. Results: Hypertensive patients exhibited significantly higher levels of sICAM-1 (234+/-21 vs. 187+/-12 ng/ml, P<0.005), sVCAM-1 (681+/-42 vs. 589+/-23 ng/ml, P<0.005), sP-selectin (89+/-17 vs. 55+/-11 ng/ml, P<0.01) and ET-1 (6.2+/-0.7 vs. 2.4+/-0.3 pg/ml, P<0.01) than did normotensive controls. The normocholesterolemic hypertensives had lower levels of sICAM-1, sVCAM-1 (P<0.01), sP-selectin and ET-1 (P<0.05) than hypercholesterolemic hypertensives, but higher levels than normotensive controls (P<0.05). In hypertensives, plasma ET-1 was significantly correlated with mean arterial pressure (r=0.51, P<0.03) and sICAM-1 levels (r=0.64, P<0.01). In hypercholesterolemic hypertensives, LDL cholesterol was also significantly correlated with plasma levels of sICAM-1 (r=0.53, P<0.04) and sP-selectin (r=0.41, P<0.05). Conclusions: Plasma levels of soluble cellular adhesion molecules are elevated in hypertensive patients in comparison to normotensive controls and may be related to plasma ET-1 activity. The coexistence of hypercholesterolemia may enhance the plasma soluble adhesion molecule activity induced by AH.

Arthroscopic stabilization plus thermal capsulorrhaphy for anterior instability with and without Bankart lesions: the role of rehabilitation and immobilization.

The use of thermal energy is an exciting new technology in the treatment of anterior instability with and without Bankart reconstruction. The current approach for treating anterior instability in the absence of a Bankart lesion as discussed here is to perform thermal capsular shrinkage with a monopolar RF heat probe to address laxity in the anterior capsule and the inferior glenohumeral ligaments. If a Bankart lesion is present, repair of the lesion with arthroscopic suture anchors followed by thermal capsulorrhaphy is our treatment of choice. We currently reserve open anterior reconstruction for patients with pathology inappropriate for arthroscopic techniques and in cases where arthroscopic suturing is found to be inadequate intraoperatively. Furthermore, patients who require revision and athletes who engage in contact sports are evaluated on an individual basis to ascertain if arthroscopic techniques are appropriate (CD-2.1). Nonetheless, basic science research has revealed the importance of a formal period of immobilization followed by guarded mobilization. By using the aforementioned algorithm and postoperative protocol, low recurrence rates have been achieved while at the same time maintaining motion in the functional range. Of course, further follow-up, more patient studies, and peer review publications are required to determine if thermal capsulorrhaphy can replace open procedures as the gold standard for addressing capsular laxity associated with anterior instability.

Clinical and neurohormonal correlates of circulating granulocyte-macrophage colony-stimulating factor in severe heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

In this report, we showed for the first time that granulocyte-macrophage colony-stimulating factor plasma levels are elevated in patients with severe heart failure, and these levels are correlated well with neurohormonal activation and hemodynamic deterioration characterizing this syndrome.

Serum profiles of granulocyte-macrophage colony-stimulating factor and C-C chemokines in hypertensive patients with or without significant hyperlipidemia.

The present study investigates the differences in serum activity of granulocyte-macrophage colony-stimulating factor, macrophage chemoattractant protein-1, and macrophage inflammatory protein-1alpha between hypertensive patients with and without significant hyperlipidemia before receiving any medical treatment. The serum activity of the studied inflammatory factors is more elevated in hypertensive patients with significant hyperlipidemia and may be associated with atherosclerotic inflammatory process induced by the coexistence of 2 major cardiovascular risk factors.

Tumor necrosis factor-alpha serum activity during treatment of acute decompensation of cachectic and non-cachectic patients with advanced congestive heart failure.

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine that produces left ventricular dysfunction and a negative inotropic effect in cardiac tissue when overexpressed in human subjects. Previous studies have shown that levels of circulating TNF-alpha are elevated in patients with advanced congestive heart failure (CHF) and especially in those with cardiac cachexia. To clarify the potential role of TNF-alpha in the unstable state of decompensated advanced CHF, we investigated the TNF-alpha serum activity in 25 cachectic and 22 non-cachectic CHF patients (New York Heart Association, NYHA functional classes III or IV), who were treated with intravenous diuretics and positive inotropic agents for acute decompensation of the disease, during a 5-day hospitalization period, as well as in 15 age-matched healthy control subjects. Cachectic CHF patients needed higher dosages of inotropic agents than non-cachectic patients and the determination of TNF-alpha serum concentrations in this patient group showed high levels of TNF-alpha at hospital admission (18.3 +/- 3.2 pg/ml) and a transient increase in circulating TNF-alpha during the treatment period with the highest levels on the 2nd day of hospitalization (32.5 +/- 7.1 pg/ml). The TNF-alpha serum levels were low in non-cachectic CHF patients and healthy controls on the 1st day (4.0 +/- 0.9 and 3.7 +/- 0.6 pg/ml, respectively) and did not change substantially during the course of the study. The present results show that TNF-alpha serum activity is transiently increased during the treatment of decompensated cachectic CHF patients only and may be related to the clinical instability and the consequent therapeutic interventions in this category of CHF patients.

Subscapularis transfer for reconstruction of massive tears of the rotator cuff.

Twenty patients who had a massive tear greater than five centimeters (of the rotator cuff that was not amenable to direct tendon-to-bone or tendon-to-tendon repair had reconstruction consisting of transfer of the subscapularis tendon in conjunction with subacromial decompression. At a mean of thirty months (range, twenty-three to seventy months) after the operation, seventeen of the patients were satisfied with the result. Nineteen patients reported a decrease in pain compared with preoperatively. However, nine patients had weakness and discomfort with prolonged or repetitive overhead activities, and two patients had most active elevation of the shoulder despite substantial relief of pain. Subscapularis transfer is a useful adjunct in the operative treatment of massive tears of the rotator cuff; it facilitates the closure of larger defects that are not amenable to simpler, more traditional reconstructive techniques. However, because there is a risk of the procedure adversely affecting active elevation of the shoulder, it should be used with caution in patients who have full functional elevation preoperatively.

Normal coronary flow reserve in patients with mitral valve prolapse, a positive exercise test and normal coronary arteries.

We studied 12 patients (eight females and four males), ages 30-46 years, with echocardiographically documented mitral valve prolapse and clinical suspicion of coronary artery disease, based on a history of chest pain (five patients), angina-like pain (three patients), a positive exercise stress electrocardiogram (12 patients) and a focally positive thallium-201 stress perfusion scan (three patients), who were referred for cardiac catheterization and found to have normal coronary arteries. Ten patients without evidence of heart disease served as controls. In all mitral valve prolapse patients, coronary flow velocity reserve was determined successively in the left anterior descending, left circumflex and right coronary arteries as the ratio of the maximum (after intracoronary papaverine) to the resting mean coronary flow velocity. Coronary flow reserve values were fairly similar in the mitral valve prolapse and control patients; all 12 mitral valve prolapse patients had normal coronary flow reserve ( > or = 3.5) in all three coronary arteries with no significant differences among the arteries tested. Mean values +/- 1 standard deviation of the coronary flow reserve (mitral valve prolapse vs control patients) were 4.7 +/- 0.5 vs 4.6 +/- 0.6 for the left anterior descending, 4.6 +/- 0.4 vs 4.6 +/- 0.3 for the left circumflex and 4.5 +/- 0.4 vs 4.4 +/- 0.5 for the right coronary artery (all P = non-significant). The subsets of mitral valve prolapse patients with different clinical "ischaemic' manifestations were similar in terms of the calculated coronary flow reserve in all three major epicardial coronary arteries. In conclusion, this study demonstrated that an inadequate regional coronary flow reserve does not account for the clinical manifestations of myocardial ischaemia and positive exercise tests in patients with mitral valve prolapse and normal coronary arteries.

Serotonin content in human blood platelets is not stable.

A large variation of platelet serotonin content over short time intervals has been shown. This oscillation of platelet serotonin does not result from the accumulation of random technical variations, but can be considered as an objectively existing phenomenon which might be due to alternation of serotonin release and uptake processes in platelet-rich plasma. Sex and age do not influence the variation of platelet serotonin.

Relationship of biopsy and final specimens in evaluation of tumor thickness in floor of mouth carcinoma.

A number of studies have suggested that tumor thickness may be a valuable prognostic indicator in the evaluation of head and neck cancers. This study examined the relationship between tumor thickness measured in preliminary biopsy specimens with the final specimens obtained in 31 patients with floor of mouth epidermoid carcinoma. There was a significant statistical correlation between biopsy and final specimens. The Pearson's product-moment correlation coefficient was 0.58, which corresponded to a significance level of P < .0005. The results of this study showed that those patients who had biopsies with a thickness less than or equal to 1 mm were likely to have final specimens with a thickness less than 2 mm. All patients with a thickness greater than 2 mm had a final specimen with a thickness greater than 3.5 mm. Modification of current biopsy techniques may result in values more predictive of final thickness measurements.

Functional plyometric exercises for the throwing athlete.

In this article we provide athletic health care professionals with a variety of functional strengthening exercises to use in improving the muscular strength of the throwing athlete's shoulder. Upper extremity functional plyometric exercise in sport-specific patterns can be an important component of a throwing athlete's rehabilitation. We discuss several plyometric exercises, using the Inertial Exercise System, the Plyo-ball, and the Theraband. Proper use of these exercises can facilitate a safe and progressive rehabilitation program for the injured, throwing athlete. After the athlete has successfully completed the functional plyometric exercises, a throwing progression can be initiated.

[The serotonin content in human platelets is unstable: data and possible mechanisms]. / Soderzhanie serotonina v trombotsitakh cheloveka nestabil'no: fakty i vozmozhnye mekhanizmy.

The study of serotonin content in platelets showed the instability of this trait and its interrelation with plasma serotonin. The oscillations of platelet serotonin are stabilized by the removing of plasma proteins, calcium and by incubation with lithium. The model of synchronization of serotonin transport via the membrane of platelets bound into a spongy net by fibrinogen molecules is discussed.

Relatedness of schizotypal personality to schizophrenic disorders: multifactorial threshold model.

Genetic analysis of schizophrenia and schizotypal personality disorder (SPD) was conducted on two pedigree samples. The results are interpreted in terms of a multifactorial threshold (MFT) model. A high rate of schizophrenia was found in relatives of both samples, but any excess of SPD was found only in relatives of the SPD sample. Based on these data, the hypotheses assuming a single liability with two thresholds (Reich's model) and different liability (Smith's model) for both disorders were rejected. The coefficient of genetic correlation is 0.61. Our data suggest that schizophrenia and SPD are separate nosological entities and that some of the factors which constitute liability to SPD influence the development of schizophrenia, but not vice versa.

Coronary intimal proliferation after balloon injury and stenting in swine: an animal model of restenosis.

OBJECTIVES: This study was designed to compare the proliferative response in coronary arteries after tantalum stent placement or balloon injury in a normolipemic swine model of restenosis. BACKGROUND: Restenosis remains a significant complication of percutaneous transluminal coronary angioplasty. Efforts to study restenosis have been hampered by the lack of a suitable animal model. METHODS: In an attempt to create lesions resembling those of human restenosis, normolipemic swine underwent injury of either the left anterior descending or the left circumflex coronary artery with either balloon inflation or deployment of a tantalum stent. At 4 weeks, they were killed and the injured vessels processed for histopathologic analysis. Intimal area, lumen area and maximal intimal thickness were measured. The degree of stenosis was expressed as residual lumen area (lumen area/intimal area ratio). RESULTS: Vessels injured by either method demonstrated significant intimal smooth muscle proliferation leading to reduction in lumen area. In the 18 stented vessels residual lumen area measured 0.64 +/- 0.18 and maximal intimal thickness measured 0.6 +/- 0.3 mm; in the 15 balloon-injured vessels these values were 0.75 +/- 0.18 and 0.4 +/- 0.3 mm, respectively (p less than 0.05). In addition, most stented vessels had reactive inflammatory infiltrates surrounding the stent wires composed of lymphocytes, histiocytes and many eosinophils. CONCLUSIONS: These data indicate that coronary artery injury in swine with either balloon inflation or stenting leads to intimal smooth muscle cell proliferation similar to that seen in human restenosis. The degree of intimal proliferation appears to be greater after stenting than after balloon injury. Intracoronary stenting in swine is associated with a marked inflammatory reaction around the stent wires. These models may be helpful in planning systemic and local antirestenosis strategies.

The study of agglutination of trypsin-treated sheep red cells by Corynebacterium diphtheriae strains.

620 Corynebacterium diphtheriae strains from 472 sick and healthy persons were studied for their adhesive activity (AA) in direct agglutination of trypsin-treated sheep erythrocytes. Toxigenic strains had more active AA than non-toxigenic ones which was not dependent on the presence of toxin in the culture. Neither biotype nor serotype of the strains correlated with their AA. Several lysotypes among toxigenic and non-toxigenic strains were more active than others. Toxigenic strains from patients had higher AA than those from carriers. Both toxigenic and non-toxigenic strains isolated from the prolonged carriers possessed the highest AA. It was concluded that AA measured in this way was an important colonization factor for all diphtheria strains and a pathogenicity factor for toxigenic strains.

[The adhesive activity of diphtheritic strains in relation to the characteristics of the infectious process they induce]. / Adgezivnaia aktivnost' difteriinykh shtammov v zavisimosti ot osobennostei vyzyvaemogo imi infektsionnogo protsessa.

The degree of adhesiveness of 602 C. diphtheriae strains isolated from patients with different forms of diphtheria was studied on trypsinized sheep red blood cells (SRBC) used as an experimental model. The titer of bacterial suspension, i.e. its highest dilution ensuring the agglutination of 50% of SRBC, was assumed to be the index of adhesive activity. The toxigenic strains were more homogeneous with respect to the degree of their activity and proved to be moderately and highly adhesive, while among the nontoxigenic strains faintly and moderately adhesive ones prevailed. The degree of adhesiveness was not linked with the cultural biological strains variants, but depended on the form of C. diphtheriae infection. The toxigenic strains isolated from diphtheria patients were essentially more active than those isolated from carriers. Both toxigenic and nontoxigenic strains isolated in cases of prolonged carrier state (more than 4 weeks) did not differ in the degree of their adhesiveness and were essentially more active than the strains isolated from short-term carriers. The strains circulating in 10 closed groups with a high proportion of pronounced cases of carrier state (70.6% to 86.7%) were essentially more active than those circulating in 10 similar groups, but having a low proportion of pronounced cases of carrier state (6.7% to 23.8%). The conclusion was made that the degree of adhesiveness proved to be an important factor of C. diphtheriae pathogenicity, responsible for the formation of carrier state. Along with pathogenicity, this factor should be taken into consideration in the evaluation of the epidemiological importance of different sources of infection.

Restenosis following coronary angioplasty.

Restenosis is the most important problem limiting the success of coronary angioplasty. Clinically, restenosis is seen in approximately one-third of patients undergoing percutaneous transluminal coronary angioplasty. Several clinical and angiographic risk factors have been identified which may contribute to the development of restenosis. Histopathologic studies indicate that restenosis is characterized by intimal proliferation of smooth muscle cells in a loose connective tissue matrix. These intimal lesions are associated predominantly with the nonatheromatous portion of the vessel wall. Thinning of the media of the plaque-free wall and marked fragmentation of the internal elastic lamina are also seen. Traumatic injury of the vessel wall during angioplasty probably triggers a series of cellular and subcellular events which may ultimately lead to myointimal proliferation and restenosis. Although the exact mechanism by which this occurs is unknown, several factors may enhance smooth muscle cell growth and therefore may play a role in the development of restenosis. These include platelet deposition, mechanical stretching of the media, inflammation of the vessel wall, the activity of growth factors, and alterations in vessel geometry. These possible mechanisms of restenosis suggest several potential ways to limit the proliferative response to vascular injury. Anticoagulants and platelet antagonists, direct inhibitors of smooth muscle proliferation, anti-inflammatory agents, growth factor inhibitors, and new devices which improve final vessel geometry are currently being tested as methods to curb restenosis. Unfortunately, no treatment has yet been shown to reduce significantly the rate of restenosis following angioplasty. The problem of restenosis will most likely be solved by better understanding of the basic molecular and biologic phenomena involved in vascular injury and repair.