Inter- and intra-individual variation in applied force when listening at a surface, and resulting variation in earprints.

We aimed to explore the level of inter- and intra-individual variation in applied force when listening at a surface, and assess the resulting variation in earprints. We further intended to identify possible sources of this variation. Forty subjects each listened twenty-four times at a surface while applied force was recorded. In between efforts the level and frequency of the target sound, and the level of ambient noise were varied. Each listening effort was characterized by two values: the mean of a series of force recordings ('functional force') and the highest force reading of the effort ('peak value'). A mixed model analysis of variance revealed that repetition during multiple efforts of listening and the level of the target sound significantly affected both values for applied force. The frequency of the target sound affected the peak value, but we assume this was due to confounding effects. The level of ambient noise did not affect applied force. To explore the correlation between values for applied force of various efforts by single ear, the intra-class correlation coefficient was calculated. For functional force it was 0.80; for the peak value it was 0.79. To study intra-individual variation in earprints, five prints from each ear were lifted and studied. Variation in prints is discussed.

Interatrial septal aneurysm and genetic prothrombotic disorders: possible interaction in the pathogenesis of pediatric stroke.

Stroke in children is a rare condition and has a multifactorial etiology. The association between ischemic stroke in young adults and some minor cardiac abnormalities such as atrial septal aneurysm with or without interatrial shunting has recently been reported: however, the pathogenetic mechanism still remains unclear. Genetic and acquired prothrombotic disorders are also risk factors for cerebral ischemic events in children. We report a case of ischemic stroke in a 10-year-old female child who was heterozygous for the prothrombin G20210A variant and who presented with an atrial septal aneurysm associated with an interatrial shunt. We hypothesize that these risk factors play a synergic role but their relative importance and whether alone they can determine cerebral embolism remain to be determined.

Comparative evaluation of two commercial amplification assays for direct detection of Mycobacterium tuberculosis complex in respiratory specimens.

Two commercial assays detecting the presence of Mycobacterium tuberculosis complex in clinical specimens by rRNA target amplification (Gen-Probe Amplified M. tuberculosis Direct Test [AMTD]) and PCR (Amplicor) were evaluated. The tests were applied to 327 digested, decontaminated respiratory specimens collected from 236 patients. Results were compared with those of acid-fast staining and culture. The combination of culture and clinical diagnosis was considered the "gold standard." A total of 60 specimens were collected from 27 patients with a diagnosis of pulmonary tuberculosis. Thirteen of these specimens were from patients receiving standard antituberculosis therapy and therefore were not included in the comparison. Of the remaining 47 specimens, 33 were smear positive, 40 were culture positive, 45 were AMTD positive, and 39 were Amplicor positive. After resolution of discrepant results, the overall sensitivities, specificities, and positive and negative predictive values were 77, 100, 100, and 95 for staining; 87, 100, 100, and 97.4 for culture; 95.9, 98.9, 94, and 99.2 for AMTD; and 85.4, 99.6, 97.9, and 97.1 for Amplicor, respectively. Agreement between AMTD and Amplicor assay results was 96.8%. It is concluded that although both nucleic acid amplification methods are rapid and specific for the detection of M. tuberculosis complex in respiratory specimens, AMTD appeared to be more sensitive than Amplicor.

[Percutaneous mitral valvuloplasty: the immediate and long-term results]. / Valvuloplastica mitralica percutanea: risultati immediati e a lungo termine.

BACKGROUND: Between December 1988 and December 1992, 235 patients (pts) underwent percutaneous balloon mitral valvuloplasty (PBMV). METHODS AND RESULTS: There were 55 men (23%) aged 49 +/- 13 years and 180 women (77%) aged 51 +/- 13 years. Previous surgical commissurotomy (PSC) had been performed in 22 pts. Procedure was successful (area > 1.5 cm2 or area increase > or = 50% without mitral regurgitation > 2+) in 91.9% of pts, with increase in mitral valve area from 1.05 +/- 0.2 to 2.26 +/- 0.6 cm2, decrease of transvalvular mean pressure gradient from 14.4 +/- 5.5 to 6.05 +/- 4.91 mm Hg and increase of cardiac index from 2.79 +/- 0.75 to 3.17 +/- 0.9 l/m'/m2 (p < 0.001). Insufficient increase in valve area occurred in 3.8% of pts. Major complications included 5 pts with 3+ mitral regulation (MR) requiring mitral valve replacement (MVR), 2 TIA's (0.85%) and 1 pericardiocentesis (0.42%). At follow-up (mean 18.9 months) clinical improvement was achieved in 93.8% of pts (NYHA class from 2.4 to 1.3); mitral valve area was 1.9 +/- 0.4 cm2 and mean mitral valve gradient 5.3 +/- 2.3 mm Hg. Restenosis (area < 1.5 cm2 or > or = 50% loss of initial gain) occurred in 24 pts (10.16%). Six pts required MVR; 1 pt underwent a second successful PBMV. Multivariate study (logistic regression) identified as independent factors of severe MR NYHA class and PSC; echo score, age and basal mean mitral valve gradient were independent factors for restenosis. CONCLUSIONS: In conclusion, PBMV is a safe technique and stable clinical improvement can be obtained in the majority of pts.

[The complete regression of multiple cardiac rhabdomyomas in childhood]. / Regressione completa di rabdomiomi cardiaci multipli in età pediatrica.

Rhabdomyoma, even if rare, is the most common primary cardiac tumor in infancy and childhood. We present the case of a newborn in whom several intramural and intracavitary cardiac masses were found at birth by two-dimensional echocardiography, and showed complete regression at the follow-up examinations. Except for supraventricular arrhythmias, there were no symptoms or signs of cardiac involvement at birth: the baby was acyanotic and is no apparent distress; no murmur was detected and chest roentgenogram revealed normal heart size; association with Tuberous Sclerosis was excluded. Despite major anatomical cardiac anomaly, neither in-flow nor out-flow tract obstruction was found by Doppler investigation and therefore a noninterventional approach was preferred. At the two-year follow-up control the baby was asymptomatic and the echocardiogram revealed complete regression of cardiac tumors. Our report confirms the possible favourable outcome of Rhabdomyoma and the utility of echocardiography in these patients' follow-up.

[Morphofunctional correlations in dilated cardiomyopathies]. / Correlazioni morfofunzionali nelle cardiomiopatie dilatative.

The aim of this study was to state whether in patients with dilated cardiomyopathy indices of left ventricular function (i.e. left ventricular end-diastolic and end-systolic volumes, ejection fraction, end-systolic pressure to end-systolic volume ratio, mass to volume ratio, elastic stiffness constant) are related to histologic findings, namely percentage of myocytes, of fibrosis and of interstitium. We have studied 26 patients (18 males and 8 females) aged 13-65 years, who underwent right and left heart catheterization, quantitative angiography, coronary angiogram, and in whom a diagnosis of dilated cardiomyopathy was established. All of them had a biopsy specimen taken from the right aspect of interventricular septum, following the technique of King's College. Histology was automatically evaluated with a computerized system for the percent content of myocytes, of fibrous tissue and interstitium. Correlation with hemodynamic parameters was calculated with the least square method. A significant correlation was found between percentage of fibrosis, left and right ventricular ejection fraction and preload index, and between percent myocytes and right ventricular ejection fraction and duration of disease. Thus, left ventricular function indices do not correlate with percent myocytes, as previously shown: this could be due to the fact that alterations in contractile machinery are due primarily to alterations in cell biochemistry. Moreover, the inverse relationship between myocyte content and duration of the disease may reflect those mechanisms, which tend to perpetuate failure in a dilated heart by increasing subendocardial fibrosis. However, the correlation found between myocyte content and right ventricular ejection fraction may be due to the fact that biopsy specimens were taken from the right ventricle.

[Persistent T-wave inversion in unstable angina: the correlation with the global and regional function of the left ventricle]. / Inversione persistente dell'onda T nell'angina instabile: correlazione con la funzione globale e regionale del ventricolo sinistro.

The correlation between persistent negative T wave on basal electrocardiogram and coronary anatomy or global and regional left ventricular function was investigated in 34 patients with unstable angina defined as new onset (< 2 months), crescendo or rest angina. The patients with history of previous myocardial infarction, pathological Q waves on electrocardiogram or documented elevation of CPK were excluded. Eighteen patients (group A) showed T wave inversion (> 1 mV) in at least two leads on the basal electrocardiogram, persisting for at least 48 hours before coronary arteriography. In 16 patients (group B) the basal electrocardiogram was normal. Left ventricular volumes and ejection fraction were calculated and the regional systolic wall motion was analyzed using the area method in the 30 degrees right anterior oblique view. Hypokinesis was defined as more than 2 standard deviation below the mean value calculated in 24 normal subjects. No difference was present for age (A: 61 +/- 9 vs B: 57 +/- 9 yrs) and sex distribution. Critical stenoses of at least one coronary artery was documented in all but one patient (in group B). The number of critical stenosis per patient was equal (1.8) in the two groups. Left main coronary artery showed narrowing > 50% in three patients of group A and in two patients of group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of L-carnitine on physical performance in chronic respiratory insufficiency.

Bicycle ergometer exercise tests were used to study two groups of 10 subjects suffering from type A chronic respiratory insufficiency before and after a 4-week course of L-carnitine or placebo. Analysis of the ventilatory and metabolic response to physical exercise (60 watts) revealed an improved utilization of the bio-energetic substrates obtained with L-carnitine as compared to patients treated with placebo. The substantial change observed in ventilatory and metabolic response to exercise after L-carnitine is characterized by an appreciable production of lactate and by the stability of pCO2, pH and HCO3 values, which would appear to support the hypothesis of a reduced anaerobic metabolism requirement for energy purposes.

Miocamycin doesn't affect theophylline serum levels in COPD patients.

The effects resulting from the administration of therapeutic doses (1,200 mg/day for 8 days) of miocamycin, a novel macrolid derived from midecamycin, on theophylline elimination kinetic were investigated on 25 patients affected with chronic obstructive pathology on the respiratory tract. The curves of theophylline clearance, recorded before and after the treatment with miocamycin have shown to be perfectly overlapping (trend analysis). The assumption that the capacity of slackening the theophylline pharmacokinetic would be tightly bound to the particular structure of some macrolids appears to be fully confirmed by the results of the present investigation. When miocamycin is administered in combination with theophylline, the monitoring precautions of plasma levels of the latter are practically of no use.

Rifampicin-isoniazid and delayed elimination of theophylline: a case report.

This paper reports a case of tuberculosis relapse and chronic obstructive lung disease treated with rifampicin and isoniazid. The subsequent introduction of slow-release theophylline therapy revealed a delay in the theophylline elimination kinetics resulting in a toxic plasma level. Interference with hepatic microsomal enzymes is considered to occur.