Potent radioprotective effects of combined regimens of famotidine and vitamin C against radiation-induced micronuclei in mouse bone marrow erythrocytes.

To investigate the radioprotective effect of the combination of famotidine and vitamin C against radiation-induced micronucleus formation in mouse bone marrow erythrocytes, various doses of famotidine or vitamin C or combinations thereof were administered intraperitoneally to adult male NMRI mice 2 h before 2 and 4 Gy γ-irradiation. The frequency of micronucleated polychromatic erythrocytes (MnPCEs) was scored in 5,000 polychromatic erythrocytes (PCEs), and the cell proliferation ratio [PCE/(PCE + NCE); NCE = normochromatic erythrocytes] was also calculated for each treatment group. Data were statistically evaluated using one-way ANOVA test. The results show that pretreatment with various doses of famotidine and vitamin C before γ-irradiation significantly reduced the frequency of MnPCEs with a protection factor (PF) of 2 and 1.7, respectively. Pretreatment with vitamin C also significantly increased the cell proliferation ratio, while famotidine had no effect. Combination of famotidine and vitamin C was more effective in reducing MnPCEs than each compound alone, leading to a PF of 4.3 after irradiation. Cell proliferation ratio was also significantly improved by the combination compared with the irradiated control groups. Both famotidine and vitamin C are potent scavengers of free radicals and reactive oxygen species, especially OH(·). The combination of the two compounds probably further enhances this activity, thus leading to high bone marrow protection.

Assessment of Frequency of Twin Pregnancy and Neonatal Outcome in Deliveries of Mo'tazedi Hospital, Kermanshah in 2004-2007.

INTRODUCTION: Twin pregnancy is a high-risk pregnancy with different prevalences in different regions of the world which is on the rise due to growing use of assisted reproductive technology. The objective of this study is to determine the frequency of twin pregnancy and the neonatal outcome of these pregnancies. MATERIALS AND METHODS: This is a descriptive-analytic study conducted in 2004-2007 in Mo'tazedi Hospital, Kermanshah on 142 twin deliveries as well as the singleton deliveries before and after twin pregnancy as the control group. The required information, including maternal age, gestational age, newborn's gender, presentation of twins, birth weight, Apgar score, fetal anomalies, and neonatal mortality were extracted from medical files and analyzed statistically. FINDINGS: After assessment of 29,438 deliveries performed from 2004 to 2007, the frequency of twin pregnancy was found out to be 1 in 208 cases (48 %). The mean age of mothers was higher in twin pregnancies. The mean gestational age of twin pregnancy was 34.3 weeks. Apgar score and neonatal weight were significantly lower in twin pregnancy compared to singleton pregnancy (p < 0.001). Furthermore, visible anomalies and mortality were significantly higher in neonates born to twin pregnancies compared to singleton pregnancies (p < 0.0001 and p = 0.009, respectively). The ratio of male to female neonates was 1. CONCLUSION: This study indicated that twin pregnancy is a high-risk condition and entails greater neonatal complications compared to singleton pregnancy. Therefore, it is recommendable to have greater perinatal care and perform deliveries in well-equipped centers under supervision of an obstetrician.

Maternal complications associated with severe preeclampsia.

OBJECTIVE: Hypertension disorders are associated with higher rates of maternal, fetal, and infant mortality, and severe morbidity, especially in cases of severe preeclampsia, eclampsia, and HELLP syndrome. The aim of the study was to determine maternal outcomes in pregnant women with severe preeclampsia. DATA SOURCE: The data source consisted of 349 cases with severe preeclampsia. DESIGN: A cross-sectional study was undertaken on 349 cases of severe preeclampsia in pregnancy. SETTING/PERIOD: The patients selected for this study were from those who presented at Kermanshah University of Medical Sciences, Department of Obstetrics and Gynecology during 2007-2009. MATERIALS AND METHODS: Statistical analysis was performed using SPSS 16 software and conducting Chi square and independent sample t tests. Demographic data involving age, parity, gestational age, clinical, and laboratory findings were recorded from the medical files. In addition, delivery route, indications of cesarean delivery, and maternal complications were determined. RESULTS: Of the 349 severely preeclampsia cases, among the 22 cases (6.3 %) who had suffered from eclamptic seizers, 17 cases (77.3 %) were in the age group of 18-35 years (P = 0.351) and 13 cases (59.1 %) in the gestational age group of 28-37 weeks (P = 0.112). One case (0.3 %) was demonstrated to have HELLP syndrome. Placental abruption was obstetric complication in 7.7 % (27 cases). Delivery route was vaginal in 120 cases (34.4 %), while 229 cases (65.6 %) underwent cesarean delivery. The most frequent maternal complication (37 cases) reported was coagulopathy (10.6 %). CONCLUSIONS: We concluded that severe preeclampsia and eclampsia are associated with higher rates of maternal severe morbidity and that these two factors still remain the major contributors to maternal morbidity in Iran.

A flow cytometric opsonophagocytic assay for measurement of functional antibodies elicited after immunization with outer membrane vesicle of Neisseria meningitidis serogroup B.

Opsonophagocytosis mediated by antibody and complement is the major defense mechanism for clearing Neisseria meningitidis from the host. Therefore, a newly developed phagocytosis assay based on flow cytometry (flow assay) was using sera obtained from rabbit postvaccination with outer membrane vesicle of N. meningitidis serogroup B, was done in order to evaluation of the potential efficacy of (experimental) meningococcal vaccines. The Outer Membrane Vesicles (OMVs) and control were injected intramuscularly into groups of five rabbit with boosters on 14, 28 and 42 days after the primary immunization. The serum on 0, 14, 28, 42 and 56 days were collected and stored at -20 degrees C for next analysis. Phagocytic function of and intracellular oxidative burst generation by rabbit polymorphonuclear (PMN), against N. meningitidis serogroup B, was measured with flow cytometer, using dihydrorhodamine-123 as probes, respectively. We use a Coulter Epics XL-profile (USA) with an argon laser operating at 488 nm. The results of quantitative flow cytometric analysis of rabbit PMN function in hyperimmun sera with OMVs revealed a highly significant increase in opsonophagocytic responses against serogroup B meningococci after 56 day in comparison with the control group (p < 0.05). Present results indicated that OMVs could be as a candidate for vaccine toward serogroup B meningococci and a new standard flow cytometric method to measure the opsonophagocytosis activity by rabbit PMNs was shown by this study.

ANP but not BNP reflects early left diastolic dysfunction in type 1 diabetics with myocardial dysinnervation.

OBJECTIVE: We investigated whether plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) reflect impaired diastolic relaxation or its improvement after ACE inhibition. METHODS: 7 long-term Type 1 diabetic patients with normal systolic but impaired diastolic function and with sympathetic myocardial dysinnervation and 10 controls were included. Exercise tolerance and maximal O 2 uptake were evaluated by bicycle exercise prior to the study. ANP, BNP and norepinephrine/epinephrine (NE/E) were determined at baseline and at 80 % .VO2 max workload and after recovery, before and following 12 weeks of treatment with fosinopril (10 mg/d). RESULTS: Isovolumetric relaxation time (IVRT) and A/E wave ratio were increased by 26.7 +/- 11.5 % and 54.4 +/- 26.1 % in diabetic patients as compared to controls, respectively (p < 0.02). After 12 weeks of fosinopril treatment, no differences in IVRT or A/E wave ratio were detectable between groups. ANP was enhanced in Type 1 diabetes as compared to controls (baseline: 9.2 +/- 3.0 vs. 4.5 +/- 1.1; exercise: 22.4 +/- 7.7 vs. 7.9 +/- 1.2; recovery: 20.3. +/- 4.6 vs. 9.5 +/- 2.0 fmol/ml, p < 0.02). Fosinopril treatment abolished any differences between groups. BNP plasma levels did not differ between groups and no exercise dependent changes were observed. NE- and E-increase was greater at 80 % .VO2 max work load in Type 1 diabetes than in controls (p < 0.05). Again, fosinopril abolished differences between groups. CONCLUSION: In Type 1 diabetes, impaired diastolic function is associated with elevated ANP and catecholamine plasma levels that are normalized after ACE inhibition. Thus, ANP but not BNP appears to be a sensitive biochemical marker for early diastolic dysfunction in Type 1 diabetes.

Treatment of left ventricular hypertrophy in hypertensive patients with a combination of verapamil and captopril--a multicenter study.

UNLABELLED: The regression of left ventricular hypertrophy in hypertensive patients was evaluated in a multicenter study with a combination therapy of verapamil 120 mg and captopril 25 mg given once or twice daily. The degree of left ventricular hypertrophy was assessed using echocardiography, while hypertension was evaluated by means of twice daily blood pressure self-measurements and ambulatory blood pressure monitoring. RESULTS: An overall of 61 patients was evaluated. Left ventricular mass had decreased by 13.5% during the 6-month treatment period. This reduction neither correlated with the baseline left ventricular mass nor with the extent of blood pressure decrease. CONCLUSION: The combination therapy-verapamil 120 mg plus captopril 25 mg--is well tolerated by hypertensive patients with left ventricular hypertrophy and produced a decrease of left ventricular mass that is independent of the extent of blood pressure decrease.

Value of three-dimensional echocardiography as an adjunct to conventional transesophageal echocardiography.

Three-dimensional imaging of cardiac structures could enhance the functional understanding and the interpretation of pathologies. Limited processing capabilities, relocation problems and inadequate two-dimensional image quality have previously limited its applicability. Recently, an integrated echocardiographic computerized tomography unit (echo-CT) which uses a transesophageal approach has been developed. This system is capable of sampling and processing multiple echocardiographic images and, thus, provides three-dimensional views. To evaluate the feasibility and potential of this technique, we studied 69 patients with various cardiac disorders. All but 3 patients (96%) tolerated the procedure well allowing at least one scan to be performed. No complications were encountered. The indication for echo-CT included coronary artery disease (n = 4), mitral valve disease (n = 18), suspected arterial embolism (n = 19), masses (n = 8), congenital malformation (n = 10), postcardiac surgery (n = 8), aortic aneurysm (n = 1) and suspected left-to-right shunt (n = 1). Conventional transesophageal echocardiography revealed a pathology in 45 patients. Of these pathologies, 37 (82%) could be reconstructed and displayed in three-dimensional views. Three-dimensional imaging provided an improved spatial understanding of the pathology in 21 cases (39%). Echo-CT was especially valuable in diseases of the mitral value (i.e. mitral valve prolapse, flail leaflets, mitral stenosis) where it had the potential to delineate the location, type and morphology of defects. In conclusion, three-dimensional transesophageal imaging enhances image interpretation and understanding. This could be of value in complex morphologies and cardiac disorders in which surgical repair is attempted.

Three-dimensional echocardiography using a transoesophageal imaging probe. Potentials and technical considerations.

Appreciation of three-dimensional relationships could be useful in cardiac diagnosis, decision making and planning of surgery. However, current ultrasound techniques provide only two-dimensional views. A recently developed echocardiographic computerized tomography unit allows reconstruction of three-dimensional images from a series of transoesophageal slices. To evaluate the potentials and limitations of this technique we performed echo computer tomographic examinations in 104 patients with a total number of 227 scans. All but two patients tolerated the procedure well and no serious complications were encountered. Indications for echo computer tomography included coronary artery disease, valvular heart disease, atrial masses, myocardial infarction, mitral and aortic valve replacement, aortic aneurysm and congenital defects. Most of the anatomical structures could be visualized with the best results obtained for the left atrium, the left ventricular outflow tract and the aortic and mitral valve apparatus. However, a variety of technical factors must be considered to achieve optimal results and to avoid misinterpretation. In 86% of patients the underlying pathology could be visualised by echo-computed tomography, particularly congenital defects such as those of the atrial or ventricular septa, but mitral valve pathologies provided the best results. In these cases three-dimensional imaging led to a better perception and understanding of structural relationships. In conclusion, despite current limitations in data acquisition, processing and computing power, echo computer tomography has the potential to provide relevant information in selected clinical settings.

Free fat autotransplantation for the cosmetic treatment of first web space atrophy.

The results of free fat autotransplantation for the correction of first web space atrophy were reviewed for 25 patients who sustained war injuries resulting in ulnar nerve palsies. In anticipation of partial graft resorption, a 30% overcorrection of the first web space deformity was performed compared with the normal hand. Average follow-up was 5 years. All patients were satisfied with their cosmetic results. Whereas 21 patients (84%) demonstrated less bulk when compared to their normal side, 4 (16%) retained slight overcorrection of the web space. After 1 year of follow-up, there was no further evidence of graft resorption. There were no long-term complications. We conclude that free fat autotransplantation for the cosmetic correction of atrophy of the first web space is a safe and effective procedure. Although graft resorption was encountered, overcorrection provided patients with dramatic cosmetic improvement.

Hemodynamic and hemorheologic determinants of left atrial spontaneous echo contrast and thrombus formation in patients with idiopathic dilated cardiomyopathy.

The purpose of the present study was to evaluate the specific role of hemorheologic and hemodynamic parameters for spontaneous echo contrast and thrombus formation in vivo. We therefore investigated the association between the presence of left atrial spontaneous echo contrast and thrombus formation by transesophageal echocardiography and multiple clinical, hemodynamic, and hemorheologic parameters in 70 patients with idiopathic dilated cardiomyopathy. Transesophageal echocardiography showed left atrial spontaneous echo contrast and left atrial thrombi in 33% and 19% of patients, respectively. Patients with left atrial spontaneous echo contrast had a lower cardiac index (2.1 +/- 0.9 versus 2.6 +/- 0.9 L/min/m2; p < 0.02), a lower left atrial (21 +/- 8 versus 38 +/- 10 cm/sec; p < 0.001) and left atrial appendage flow velocity (17 +/- 14 versus 39 +/- 13 cm/sec; p < 0.001), a larger left atrial diameter (53 +/- 6 versus 46 +/- 10 mm; p < 0.002), and more often presented with atrial fibrillation (62% versus 32%; p < 0.02). Plasma fibrinogen concentration (4.0 +/- 1.1 versus 3.5 +/- 0.7 gm/L; p < 0.02) and plasma viscosity (1.83 +/- 0.10 versus 1.76 +/- 0.15 mPa.sec; p < 0.05) were higher in patients with spontaneous echo contrast. Multivariate analysis revealed an association between the presence of spontaneous echo contrast and left atrial flow velocity p < 0.0001) and plasma viscosity (p < 0.01). In patients with left atrial (appendage) thrombus or a history of embolism, left atrial appendage flow velocity was lower (15.0 +/- 8.2 versus 29.6 +/- 14.5 cm/sec; p < 0.005) and spontaneous echo contrast was more frequently observed (52% versus 23%; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Significance of left-sided heart disease for the detection of patent foramen ovale by transesophageal contrast echocardiography.

Detection of patent foramen ovale by contrast echocardiography is based on transient inversion (right atrial pressure higher than left atrial pressure) of the interatrial pressure gradient. Therefore, the presence of left-sided heart disease with potential elevation of left atrial pressure might obscure the diagnosis of patent foramen ovale. Accordingly, 150 patients (88 men, 62 women; mean age 51.7 +/- 15.2 years) were evaluated for a patent foramen ovale by transesophageal contrast echocardiography. Additionally, atrial septal motion during normal respiration and during the Valsalva maneuver was analyzed. Patency of the foramen ovale was observed in 20 (27%) of 74 patients without left-sided heart disease and with previous arterial embolism, in none (0%) of 25 patients with left-sided heart disease and embolism, in 7 (39%) of 18 patients without left-sided heart disease and without embolism and in 3 (9%) of 33 patients with left-sided heart disease and without embolism. The detection rate of patent foramen ovale was lower in patients with than without left-sided heart disease (5% vs. 29%, p = 0.0007) but was similar in patients with and without embolism (20% vs. 19.5%, p = NS). Abnormal atrial septal motion was more frequently observed in patients with left-sided heart disease (p = 0.0003) and was inversely correlated to detection of patent foramen ovale (p = 0.0003). Multivariate analysis revealed an independent association between the absence of left-sided heart disease and the detection of patent foramen ovale (p = 0.0003). These data suggest that in patients with left-sided heart disease, patency of the foramen ovale may be missed even by transesophageal contrast echocardiography.

[The value of echocardiography in diagnosis of bacterial endocarditis]. / Stellenwert der Echokardiographie in der Diagnostik der bakteriellen Endokarditis.

In recent years echocardiography has become the most important method for the diagnosis of bacterial endocarditis. Though identification of valve vegetations by M-mode echocardiography was rather limited, two dimensional echocardiography--especially with transoesophageal application--has a sensitivity of more than 90% and a specificity of 98%. In addition, echocardiography is able to supply valuable contributions for the evaluation of the patient's prognosis and in the identification of complications of infective endocarditis, such as: the extent of valve destruction, rupture of chordeae and other parts of the valves, as well as the presence of intramyocardial and paravalvular abscesses. In addition, the application of Doppler-echocardiography allows the semiquantitative evaluation of the degree of any valve insufficiency.

Distribution of ischemic cerebrovascular events in cardiac embolism.

Distribution and number of ischemic cerebrovascular events were studied in 57 patients who suffered from heart disorders with proven or highly probable source of cardiac embolism and compared to 39 patients with ulcerations of the craniocervical vessels. Patients with coexisting lesions were excluded from the present study. Out of the 57 patients with cardiac disorders, a single episode of cerebral embolism occurred in 33 patients. Of the 24 patients with recurrent ischemic episodes, different vascular territories were involved in only six cases. There was no evidence of a distinct distribution of vascular territories involved in cerebral embolism. The left middle cerebral artery was affected in 42.9%, the right middle cerebral artery in 23.8%, the vertebrobasilar territory in 19%, and the ophthalmic arteries in 14.2%. Statistical analysis revealed no significant differences in lesion localization between the group with a cardiac source of embolism and the group with ulcerations of the craniocervical vessels. There was a high frequency of patients with recurrent cardiogenic emboli in the ophthalmic (6 of 9 patients) as well as in the vertebrobasilar (6 of 12 patients) circulation who experienced a delayed initiation of cardiac assessment. The possibility of cardiac embolism should be considered in any patient with cerebral ischemia, independently of the vascular territory affected.

[The effect of concomitant aortic valve insufficiency on the values of Doppler sonographic gradient determination in patients with aortic stenosis]. / Einfluss der begleitenden Aorteninsuffizienz auf das Ergebnis der dopplersonographischen Gradientenbestimmung bei Patienten mit Aortenstenose.

We examined the influence of concomitant significant aortic incompetence (AI) on Doppler-gradient measurements in valvular aortic stenosis (AS) by comparing catheter and Doppler gradients of 51 patients with isolated AS and of 24 patients with additional AI. In patients with additional AI there was a significantly greater overestimation of the peak-to-peak gradient by the maximal instantaneous Doppler gradient (AS + AI: overestimation 31.0 +/- 17.6 mm Hg, AS: overestimation 10.5 +/- 20.2 mm Hg; p less than 0.01) and also by the maximal instantaneous catheter gradient (AS + AI: overestimation 32.8 +/- 11.8 mm Hg, AS: overestimation 20.4 +/- 14.0 mm Hg; p less than 0.01). Comparison of the respective catheter-derived and Doppler-sonographically measured instantaneous and mean gradients showed no differences between the two patient subgroups. Higher instantaneous gradients in patients with additional AI are mainly explained by the lower end-diastolic aortic pressure. However, Doppler-sonographic overestimation of the severity of stenosis in patients with combined AS + AI, due to the sole measurement of the instantaneous gradient in clinical practice, should be of limited importance because in these patients significant AI already sufficiently indicates aortic valve replacement.

Day to day reproducibility of Doppler sonographic measurements in patients with valvular aortic stenosis.

High reproducibility of Doppler gradient measurements is necessary for both the reliable noninvasive assessment of the severity of aortic stenosis and for repeated follow-up examinations in individual patients. We therefore studied day to day reproducibility of Doppler sonographically measured peak pressure drops in 46 patients with valvular aortic stenosis. Clinically stable patients were examined twice within 29 +/- 18.2 days by the same examiner. Peak pressure drop (PPD) and peak flow velocity differed between the two examinations by 8.6 +/- 7.0 (range 0-29) mmHg and by 0.25 +/- 0.18 (range 0-0.7) m/s, respectively. Reproducibility was comparable in patients with excellent, good, and moderate quality examinations, but was lower in the 6 patients with poor quality examination. Variability of PPD, but not of peak flow velocity was higher (p less than 0.05) in patients with severe (PPD greater than 60 mmHg) stenosis. Reproducibility was comparable in patients with or without concomitant aortic incompetence and in patients with normal or reduced left ventricular function. Similar reproducibility was obtained in patients with heart rate changes below or above 10 beats/min between the two examinations. It is concluded that good reproducibility of Doppler measurements in patients with aortic stenosis allows reliable noninvasive assessment of the severity of the stenosis. In follow-up studies of patients with mild to moderate aortic stenosis increases in peak flow velocity in excess of 15% (mean day to day variability +2 SD) are highly indicative of the true progress of the stenosis.

[Doppler echocardiographic determination of aortic valve gradients]. / Doppler-Echokardiographische Bestimmung des Aortenklappengradienten.

Doppler-echocardiography is the most important non invasive method for the assessment of the severity of aortic stenosis. After measuring the maximal transstenotic flow velocity (= Vmax) the maximal pressure drop between left ventricle and aorta (= maximal instantaneous gradient) can bei calculated according to a simple formula. The accurate determination of Vmax may be difficult and time consuming, however, and when interpreting the Doppler-data it is important to realize that there is always a systematic numerical difference between the instantaneous gradient and those gradients which one usually measures at catheterization (peak to peak and mean gradient respectively). In mixed aortic valve disease the aortic insufficiency will distort the relationship between the various gradients still further. Despite these problems Doppler-echocardiography is extraordinarily useful in quantitating aortic stenosis and obviates the need for catheterization in most patients.