Analysis and Tendencies of Metals and POPs in a Sediment Core from the Alvarado Lagoon System (ALS), Veracruz, Mexico.

This study focused on dating of a sediment core from the Alvarado Lagoon System, Veracruz, Mexico, calculating the sedimentation rate by using 210Pb to determine the tendency towards pollution by polycyclic aromatic hydrocarbons, organochlorides, the metals Cd, Cr, Cu, Hg, Ni, Pb, and V, and organic matter content. The activity of total Pb and supported Pb in the samples was 83.1 and 29.5 Bq kg-1, respectively, whereas the average estimated sedimentation rate was 0.48 ± 0.09 cm per year-1. The organic matter values exhibited linear behavior throughout the historical profile, with values under 2.5%. Metal concentrations followed the order V > Cr > Ni > Cu > Pb > Hg > Cd. Variations found in Cr, Ni, Pb, and V concentrations are basically due to three meteorological phenomena that hit the region: hurricanes Gladys, Hilda, and Janet in September of 1955. V, Ni, and Hg input comes from anthropogenic and lithogenic sources. The presence of individual polycyclic aromatic hydrocarbons showed no ascending accumulation pattern over time, nor did it show any significant statistical correlation to OM. As for the organochlorine pesticides, 63.61% of the total sum of these compounds were from the ciclodienics family. Concentration of p,p'-DDT was observed only in the earliest profile, from 1929.

First Report of Pepper vein yellows virus Infecting Sweet Pepper in Spain.

In November 2012, unusual symptoms were observed in plants of sweet pepper (Capsicum annuum L.) grown in commercial greenhouses of Almería Province, southeastern Spain. Symptoms included interveinal yellowing, upward leaf curling, and internode shortening, and were more evident in the upper part of the plant. Abnormal ripening of fruits was observed in symptomatic plants, with fruits remaining orange in the red varieties and yellow in the orange varieties, thus reducing their marketability. During December 2012 and January 2013, severe outbreaks of this disease syndrome occurred, with many greenhouses exhibiting almost 100% incidence. The symptoms observed were similar to those reported for isolates of Pepper vein yellows virus (PeVYV, genus Polerovirus, family Luteoviridae) (previously also named Pepper yellow leaf curl virus [PYLCV] and Pepper yellows virus [PYV]) (2,4). Twenty five symptomatic leaf and/or fruit samples (some of them supplied by Zeraim Ibérica, S.A.), each from a different greenhouse, were analyzed and all reacted positively in double-antibody sandwich-ELISA with an antiserum against the polerovirus Cucurbit aphid-borne yellows virus (CABYV) (Sediag, Longvic, France), known to cross-react with PeVYV (2). Total RNA was extracted by TRIsure reagent (Bioline, London, United Kingdom) from symptomatic leaves and analyzed by reverse transcription (RT)-PCR with primers Pol-G-F (5'-GAYTGCTCYGGYTTYGACTGGAG-3') and Pol-G-R (5'-GATYTTATAYTCATGGTAGGCCTTGAG-3') designed for universal detection of poleroviruses by amplifying the RNA-dependent RNA polymerase (RdRp) and coat protein (CP) partial genes (3). DNA fragments of the expected size (1.1 kbp) were amplified supporting a polerovirus infection in all the analyzed samples. The PCR product obtained from one sample (Almería-1) was extracted from agarose gel with a QIAquick gel extraction kit (Qiagen, Hilden, Germany), cloned in pGEM-T Easy vector (Promega, Madison, WI), and one clone was sequenced (Macrogen Inc., Seoul, South Korea). The PCR products amplified from three other samples (2-13, 7-13, and 8-13) were directly sequenced. The nucleotide identity between the amplified fragments (GenBank Accession Nos. KC769487, KC839992 to 94), calculated after alignment with ClustalW, was 99.7 to 100%. The highest nucleotide identity of the Spanish sequences was with a PeVYV isolate from Turkey (FN600344, named as PYV) (98.5 to 98.7%). The spread of PeVYV in Spain is additional evidence of the emergence of this virus as a global threat for pepper crops after its first detection in Japan in 1995 and recent reports from the Mediterranean Basin (1,2). References: (1) N. Buzkan et al. Arch. Virol. 158:881, 2013. (2) A. Dombrovsky et al. Phytoparasitica 38:477, 2010. (3) D. Knierim et al. Plant Pathol. 59:991, 2010. (4) R. Murakami et al. Arch. Virol. 156:921, 2011.

Determination of policyclic aromatic compounds, (PAH, nitro-PAH and oxy-PAH) in soot collected from a diesel engine operating with different fuels.

A qualitative and quantitative analysis of polycyclic aromatic compounds (PACs; polycyclic aromatic hydrocarbons (PAHs), oxygenated and nitrated polycyclic aromatic hydrocarbons (OPAHs and NPAHs)) present in the soluble organic fraction (SOF) of different soot samples has been carried out to determine the effect of soot-generation conditions on their composition and health effects. The soot samples were generated using a diesel engine bench powered by diesel (DS) and biodiesel (BS) fuels under different combustion conditions. To optimize the procedure, a surrogate soot (Printex-U) and a certified reference material (SRM1650b) were also tested. Different extraction methods were used to extract the PAHs, OPAHs and NPAHs, and the Soxhlet technique using pyridine:acetic acid 1 % was found to be the most suitable procedure to extract the highest concentration (ng mg-1) and more types of PAHs and OPAHs from the soot. The results show that the PACs identified, and their concentrations, depend on the formation and collection conditions. The predominant compounds in all soot samples studied were fluorene (Flo), phenanthrene (Phe), fluoranthene (Fla), pyrene (Pyr), 9-fluorenone (9Flo) and 9,10-anthraquinone (9,10Anq). As such, the presence of these PACs in the atmosphere of urban and rural areas can mainly be attributed to the emissions from diesel vehicles. The percentage of OPAHs with respect to total PACs was highest in the soot generated from a biofuel. These oxidized compounds favor regeneration of the diesel particulate filter (DPF). The results also indicate that the carcinogenicity of the soot depends on the combustion conditions and type of fuel.

Post-transplant patients with COVID-19 associated acute respiratory distress syndrome, a role for Tociluzumab: A case series.

COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.

[Eosinophilic cholecystitis: a case report.]. / Colecistitis eosinofílica. Presentación de un caso.

Eosinophilic cholecystitis is a rare disease with clinical presentation similar to acute cholecystitis. The diagnosis is based on typical symptoms of acute cholecystitis with presence of more than 90% eosinophilic infiltration within the gallbladder wall. The case of a 27-year-old woman with periodic epigastric pain during ten years is presented. Routine and Boyden s technique biliary ultrasounds were normal. Hepatobiliary scintigraphy showed delayed gallbladder empty and patient underwent endoscopic sphinterotomy. Laparoscopic cholecystectomy was performed with uneventful postoperative course. Histopathologic examination of the gallblader demonstrated infiltration with eosinophils, consistent with acute eosinophilic cholecystitis.

[Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]. / Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria.

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.

Peripheral leukocyte response to oncological radiotherapy: expression of heat shock proteins.

PURPOSE: To study Heat Shock Proteins (HSP) expression in patients subjected to radiotherapy and their potential use as biomarkers for radiation tolerance. An evaluation is also made of whether irradiated volume is critical to the outcome of normal tissue injury using polymorphonuclear neutrophils as biosensors, and whether HSP antibodies (Ab) may be involved in post-radiotherapy disease. MATERIAL AND METHODS: Twelve patients receiving the same total dose of radiotherapy, but in three different volumes, and four healthy volunteers used as controls were analysed. hsp27 and 70i mRNA were determined by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Southern-blot, HSP by flow cytometry, and HSP-Ab by Enzyme-linked Immnoadsorbent Assay (ELISA). The clinical protocol included radiation related toxicity based on clinical and analytical scales. RESULTS: Radiotherapy caused hsp downregulation, maximum in patients with the largest irradiated volumes, and a decrease in intracellular HSP content. Patients with greatest intraleukocyte HSP levels before treatment suffered more severe radiation morbidity. Patients with endocrine neoplasms presented the highest HSP-Ab titers. CONCLUSIONS: Radiotherapy downregulates hsp27 and 70i, which would enhance radiosensitivity. HSP content prior to treatment is suggested as a prognostic biomarker for radiation tolerance, with circulating leukocytes as biosensors. HSP-Ab may be biomarkers of tumor disease, but do not seem to be involved in the morbidity of acute post-radiotherapy disease, which is closely related to the volumes irradiated.

Detection of coronary artery stenosis with power Doppler imaging.

BACKGROUND: Power Doppler is a new imaging method for detecting microbubbles during myocardial contrast echocardiography (MCE) based on the registration of variance resulting from ultrasound-induced nonlinear bubble behavior. We tested the hypothesis that power Doppler imaging can be used to quantify coronary stenoses. METHODS AND RESULTS: Three left anterior descending (LAD) coronary stenoses of varying severity were created in each of 9 open-chest dogs. MCE was performed by continuous intravenous infusion of a nitrogen-filled bilayer shell microbubble, PB127, during triggered power Doppler imaging at incremental pulsing intervals. MCE and radiolabeled microsphere measurements were made at baseline and during each stenosis, with and without adenosine stress. Videointensities in the LAD and left circumflex (LCx) beds were plotted against pulsing interval and fit to a previously described exponential function modeling microbubble destruction and replenishment, which was used to derive parameters of bubble velocity (beta) and peak plateau videointensity (A). Contrast defects matching the location of radiolabeled microsphere hypoperfusion were clearly seen, without need for image processing. The product of beta and A was linearly related to LAD/LCx flow (r=0.90, P<0.0001) and inversely related to stenosis gradient (r=-0.70, P<0.0001). Endocardial/epicardial flow ratios were visualized and quantifiable. CONCLUSIONS: As with B-mode harmonics, a model of microbubble destruction/replenishment can be applied to power Doppler data as a means to detect a broad range of stenoses. Image clarity and the lack of attenuation or requirement for background subtraction are additional advantages of this imaging approach. Power Doppler MCE imaging holds promise for the detection of coronary artery disease.

Coronary collateral development during chronic ischemia: serial assessment using harmonic myocardial contrast echocardiography.

OBJECTIVES: We sought to characterize collateral development in an experimental model of chronic myocardial ischemia by using myocardial contrast echocardiography (MCE). BACKGROUND: Coronary collaterals maintain myocyte viability during myocardial ischemia. The natural history and determinants of collateral development are difficult to study serially in vivo. METHODS: The left anterior descending coronary artery (LAD) in nine dogs was encircled (day 0) with a hydraulic occluder and ameroid constrictor to enable reversible and gradual total LAD occlusion, respectively. Myocardial contrast echocardiography was performed using intravenous injection of perfluorocarbon gas-containing microbubbles during two-dimensional harmonic echocardiographic imaging. Myocardial contrast echocardiography images and radiolabeled microsphere flow measurements were obtained during transient LAD occlusion on day 0. Over the ensuing six weeks, MCE imaging was performed during LAD occlusion at 10-day intervals. RESULTS: Myocardial contrast echocardiography risk area size (expressed as a percent of the left ventricular short axis slice) decreased over the course of six weeks (32%+/-3% on day 0, 21% +/-3% at day 10, 5+/-3% at day 20, 1%+/-1% at day 30 and 1%+/-1% at day 42, p< or =0.001 vs. day 0). Radiolabeled microsphere-derived LAD flow, normalized to left circumflex flow, correspondingly increased between day 0 and day 42 (0.14+/-0.02 to 0.90+/-0.07, p<0.02). CONCLUSIONS: Collateral development occurs relatively early and rapidly in this chronic canine model. Myocardial contrast echocardiography using harmonic imaging and intravenous injection of microbubbles can uniquely track the spatial and temporal course of collateral growth, and may be a powerful tool for noninvasively mapping the efficacy of therapeutic angiogenic strategies in vivo.

Albumin microbubble adherence to human coronary endothelium: implications for assessment of endothelial function using myocardial contrast echocardiography.

OBJECTIVES: We hypothesized that sonicated 5% human albumin microbubbles (Albunex) adhere to disrupted vascular endothelium and that this interaction is a marker of endothelial integrity. This study sought to identify sites and determinants of Albunex-endothelial cell (EC) attachment. BACKGROUND: Under normal conditions, Albunex microbubbles used in myocardial contrast echocardiography (MCE) pass unimpeded through the coronary microcirculation. During pathophysiologic states associated with endothelial dysfunction, however, microbubbles linger in the myocardium despite normal flow. The sites and conditions regulating microbubble adhesion are unknown. METHODS: Coverslips with cultured human coronary artery ECs were mounted in a parallel plate perfusion system and perfused with a suspension of fluorescein-labeled Albunex in culture medium, followed by a bubble-free wash at a wall shear rate of 100 s-1. To create inflammatory ECs, phorbol myristate acetate was added 4.5 h before perfusion, and flow cytometry was used to confirm an inflammatory response. Perfusions were performed under normal and inflammatory conditions using surfaces of confluent and subconfluent ECs and isolated extracellular matrix. Bubble adherence was quantified in 20 random fields per cover-slip using epifluorescent video microscopy. RESULTS: No microbubbles adhered to normal confluent ECs, although small numbers adhered to inflamed ECs (0.03 +/- 0.01 bubbles/cell, p < 0.01 vs. normal cells). Fever microbubbles attached to normal versus inflamed matrix of both partially exposed (1,800 +/- 520 vs. 4,100 +/- 1,000 bubbles/mm2, p = 0.05) and completely denuded (2,700 +/- 1,300 vs. 7,200 +/- 1,100 bubbles/ mm2, p < 0.03) endothelium. CONCLUSIONS: Albunex microbubbles preferentially adhere to inflammatory endothelial extracellular matrix. These data suggest that MCE can be used to noninvasively study endothelial integrity and may have implications for the assessment of preclinical atherosclerotic heart disease.

Myocardial contrast echocardiography and the transmural distribution of flow: a critical appraisal during myocardial ischemia not associated with infarction.

OBJECTIVES: This study was undertaken to determine whether myocardial contrast echocardiography can be used to estimate the transmural distribution of flow. BACKGROUND: Myocardial contrast echocardiography has been shown to reliably measure average transmural blood flow during myocardial ischemia. However, there is controversy regarding its ability to determine the transmural distribution of flow. METHODS: The transmural distribution of flow was measured in 21 open chest anesthetized dogs with use of radiolabeled microspheres and sonicated albumin microbubbles (mean size 4.5 microns). In the 11 Group I dogs, myocardial contrast echocardiography was performed at baseline and during left anterior descending artery stenosis. In five of these dogs, it was also performed during left circumflex artery stenosis. In these dogs large (mean 12 microns) hand-agitated bubbles were also used. In the five Group II dogs, myocardial contrast echocardiography was performed before and 45 s after intracoronary injection of 6 mg of papaverine in the presence of a critical left circumflex artery stenosis. The five Group III dogs were studied during cardiopulmonary bypass at baseline and during left anterior descending artery stenosis. Off-line image analysis of the echocardiographic images was performed and time-intensity curves obtained from these images were correlated with radiolabeled microsphere-derived flows. RESULTS: The ratios of the parameters derived from the endocardium and epicardium during myocardial contrast echocardiography were found to correlate poorly (ranging from R2 = 0 to R2 = 0.35) with radiolabeled microsphere-derived endocardial/epicardial flow ratios over a wide range of flow ratios (0.01 to 2.58). These results were not influenced either by the location of the regions of interest (left anterior descending vs. left circumflex artery bed) or by the size of the bubbles (4.5 vs. 12 microns). CONCLUSIONS: Myocardial contrast echocardiography cannot be used to assess the transmural distribution of flow during myocardial ischemia not associated with infarction.

Resolution of severe pulmonary hypertension after heterotopic cardiac transplantation.

In patients with severe congestive heart failure, a marked elevation in pulmonary vascular resistance limits the success of orthotopic cardiac transplantation, thus providing the rationale for heterotopic transplantation. To determine the changes in pulmonary hemodynamics after heterotopic cardiac transplantation, postoperative right heart pressures were serially measured in five patients who underwent this operation for end-stage congestive heart failure accompanied by severe secondary pulmonary hypertension and elevation in calculated pulmonary vascular resistance. Hemodynamics were compared with those of a matched group of 10 orthotopic cardiac transplant recipients. Preoperatively, pulmonary artery mean and wedge pressures, pulmonary vascular resistance and transpulmonary pressure gradient (pulmonary artery mean minus wedge pressure) were significantly higher in the heterotopic group. Postoperatively, significant improvement in pulmonary hemodynamics occurred in both groups and, by 12 months, the pulmonary artery mean pressure, wedge pressure, pulmonary vascular resistance and transpulmonary pressure gradient were similar in the two groups. These findings suggest that pulmonary hypertension secondary to congestive heart failure, even when severe and associated with a high pulmonary vascular resistance, is to a great extent reversible.

CD4+ CD25+ lymphocyte and dendritic cell mobilization with intermediate doses of recombinant human granulocyte colony-stimulating factor in healthy donors.

We prospectively conducted a quantitative and phenotypic analysis of T, B, natural killer (NK), NKT, type 1 and 2 dendritic cells (DC), and regulatory T cells, before and after mobilization with intermediate doses of granulocyte colony-stimulating factor (G-CSF) (16 microg/kg per day). Between November, 2003, and December, 2004, we collected stem cells from 25 HLA identical sibling donors for allogeneic hematopoietic stem cell transplantation. Before mobilization and 3 h after the fourth and fifth doses of G-CSF, blood samples were taken for blood counts and flow cytometry. The median number of regulatory T cells before and after G-CSF was statistically different (69 +/- 41 x 10(6)/L versus 161 +/- 159 x 10(6)/L, p < 0.01). We observed a 1.7-fold increase in NK and NKT cells (p < 0.009 and p < 0.02, respectively). DC were mobilized with a 11.5-fold increase in type 2 (p < 0.004) and a 8.5-fold increase in type 1 DC (p < 0.003). The patients received a mean of: 2.2 x 10(7)/kg +/- 1.4 x 10(7)/kg of NK cells, 0.95 x 10(7)/kg +/- 0.81 x 107/kg of NKT cells, 0.43 x 107/kg +/- 0.53 x 10(7)/kg of type 1 DC, 0.3 v 10(7)/kg +/- 0.45 x 10(7)/kg of type 2 DC and 1.4 x 10(7)/kg +/- 1.2 x 10(7)/kg of regulatory T cells. Using intermediate doses of G-CSF, we have demonstrated the mobilization of different lymphocyte subsets, in particular regulatory T cells and DC, which can be expanded later and used in the treatment of cancer and autoimmune diseases.

Allogeneic peripheral blood stem cell transplantation using reduced intensity versus myeloablative conditioning regimens for the treatment of leukemia.

Reduced intensity conditioning (RIC) have allowed the application of transplantation to older patients and to patients with underlying medical problems. Between October, 1999, and June, 2003, 61 patients with acute leukemia or chronic myeloid leukemia received allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) from HLA-identical siblings. Thirty-four were conditioned with myeloablative protocols and twenty-seven with RIC regimens. The patients in the myeloablative group were younger (29 vs. 37 years; p < 0.0003), most of them were transplanted in complete remission (74% vs. 59%; p < 0.03), had a shorter interval between diagnosis and HSCT (12 vs. 21 months; p < 0.02) and a greater proportion belonged to standard-risk prognosis (68% vs. 48%; p < 0.1). The median times to neutrophil, platelet and red blood cell engraftment for the myeloablative and RIC groups were 14 versus 11 days (p < 0.009), 17 versus 9 days (p < 0.0001), and 19 versus 12 days (p < 0.007), respectively. Transfusion requirements were lower in the RIC group. Severe mucositis was present in 32% and 7%, respectively (p < 0.01). The proportion of patients having acute graft versus-disease (GVHD), chronic GVHD, and infections was the same, as well as early and late mortality, disease-free survival, and overall survival. Analyzing all the patients together, three factors significantly influenced overall survival: standard risk patients, complete remission at transplant, and the absence of severe acute GVHD. In conclusion, our data suggest that even in high-risk patients, RIC transplantation seems to be as useful as ablative HSCT.

ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates.

The goal of this study was to determine whether dipyridamole-induced ST-segment depression reflects more severe or extensive myocardial hypoperfusion than the absence of this electrocardiographic finding. The clinical, hemodynamic and scintigraphic correlates of ST-segment depression during intravenous dipyridamole infusion were studied in 204 consecutive patients undergoing dipyridamole stress thallium-201 (Tl-201) imaging for evaluation of coronary artery disease. Of 182 patients with a diagnostic baseline electrocardiogram, 28 (15%) developed ST depression after dipyridamole. Patients with ST depression, compared with those without, were older (64 +/- 1 vs 60 +/- 1 years; p less than 0.03) and had a higher frequency of chest pain (57 vs 23%; p less than 0.001) and a higher heart rate-blood pressure product (12.7 +/- 0.6 vs 11.2 +/- 0.2 x 10(3); p less than 0.008) after dipyridamole. Patients with ST depression were more likely to have Tl-201 redistribution (64 vs 38%; p less than 0.02) and a greater number of redistribution defects (2.3 +/- 0.04 vs 0.9 +/- 0.1, p less than 0.001) than were those without ST depression. By multivariate logistic regression analysis, the most powerful correlate of ST depression was the number of segments having Tl-201 redistribution (p less than 0.001). Other independent correlates were presence of chest pain, heart rate at Tl-201 injection, and age. Thus, the determinants of dipyridamole-induced ST-segment depression include the scintigraphic extent of reversible hypoperfusion, as well as indexes of myocardial oxygen demand.

Value and limitations of current methods of evaluating patients presenting to the emergency room with cardiac-related symptoms for determining long-term prognosis.

The goal of this study was to determine the value and limitations of the current approach for evaluating patients in the emergency room (ER) with cardiac-related symptoms in terms of predicting long-term outcome. Accordingly, 274 consecutive prospectively identified patients presenting to the ER with such symptoms were evaluated, and follow-up was obtained at 20 +/- 9 months in 265 of them (97%). Adverse cardiovascular events were defined as: nonfatal myocardial infarction, death, cerebrovascular accident with neurologic deficit, life-threatening arrhythmia and cardiac surgery. Eighty-three patients (31%) had a cardiovascular event during follow-up; 42 occurred within 48 hours of ER presentation, whereas 41 occurred in the ensuing months. Findings on physical examination and electrocardiogram provided additional prognostic information, compared with that of history alone, when added sequentially into a Cox model. However, by discriminant function analysis, only 63% of actual events were correctly predicted by the model. Events occurring after 48 hours of ER presentation were correctly predicted only 50% of the time compared with those occurring within 48 hours of ER presentation, which were correctly predicted 75% of the time (p = 0.04). It is concluded that patients presenting to the ER with cardiac-related symptoms are at high risk for adverse cardiovascular events. The likelihood of an event occurring after 48 hours of presentation is as high as one occurring within 48 hours. Current methods of evaluating such patients have limited prognostic value, particularly for those at long-term risk for events.

Prevalence and correlates of increased lung/heart ratio of thallium-201 during dipyridamole stress imaging for suspected coronary artery disease.

There is little information concerning the prevalence and clinical correlates of increased pulmonary thallium-201 uptake during dipyridamole thallium-201 stress imaging. Accordingly, the clinical characteristics and quantitative thallium-201 findings were correlated with quantitative lung/heart thallium-201 ratio in 87 patients undergoing dipyridamole thallium-201 stress testing. Nineteen patients (22%) had an elevated ratio (greater than 0.51). These patients were more likely to have had an infarction, to be taking beta blockers, and have a lower rate-pressure product after dipyridamole administration than those with a normal ratio (p less than 0.03). An elevated ratio was associated with a greater likelihood of initial, redistribution and persistent defects, as well as left ventricular cavity dilatation on thallium-201 imaging (p less than 0.05). In addition, the number of myocardial segments demonstrating initial, redistribution and persistent defects was also greater in patients with increased ratios (p less than 0.03). Multivariate analysis demonstrated that the presence of redistribution and left ventricular cavity dilatation were the most significant correlates of lung/heart thallium-201 ratio. It is concluded that the prevalence of increased lung/heart thallium-201 ratio with dipyridamole thallium-201 stress imaging is similar to that seen with exercise stress imaging. As with exercise thallium-201 imaging, increased pulmonary thallium-201 uptake may be a marker of functionally more significant coronary artery disease.

On-line intraoperative quantitation of regional myocardial perfusion during coronary artery bypass graft operations with myocardial contrast two-dimensional echocardiography.

We hypothesized that the success of coronary artery bypass graft operations could be assessed by means of on-line quantitative myocardial contrast echocardiography. Accordingly, myocardial contrast echocardiography was performed at baseline and after each placement of venous graft in 21 patients undergoing coronary artery bypass graft operations. Time-intensity plots were generated on-line with the use of a dedicated computer system, and areas under the curve were assessed for each injection. Successful on-line quantitation of myocardial contrast echocardiography data was performed in 17 patients; this allowed comparison before and after coronary artery bypass graft operations for 21 grafts, with agreement between expert visual analysis and quantitative data in 91% of these cases. Three distinct perfusion patterns were noted on myocardial contrast echocardiography: (1) reduced contrast effect before coronary artery bypass graft operations with improvement after coronary artery bypass graft operations (n = 11); (2) adequate contrast effect before coronary artery bypass graft operations with no change after coronary artery bypass graft operations (n = 9) (for patients in group 2, the mean percentage of coronary stenosis was less than the mean for patients in group 1-67% +/- 25% vs. 88% +/- 20%, p = 0.05); and (3) no contrast effect either before or after coronary artery bypass graft operations in one patient with previous infarction. One third of the time (34 of 95 injections), on-line quantitation was unsuccessful. Failure was related three times more often to problems associated with myocardial contrast echocardiography, such as attenuation and inadequate quality of bubbles, than to computer failure. Despite its limitations, on-line quantitative myocardial contrast echocardiography is feasible in patients undergoing coronary artery bypass graft operations and provides important objective information regarding the success of revascularization.

Intravesical rhGM-CSF for the treatment of late onset hemorrhagic cystitis after bone marrow transplant.

In the present study, we assessed the clinical effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in the treatment of refractory, grade III-IV hemorrhagic cystitis (HC) in six patients who underwent bone marrow transplantation (BMT). These were four males and two females, aged 24-40 years (median age 30.5 years). All received allogeneic BMT from HLA-identical siblings after preparation with busulfan-cyclophosphamide. HC was evident 24. 5 days (range 15-33 days) after BMT. Median duration of HC before treatment was 5 days (range 4-9 days). Treatment consisted of intravesical instillation of rhGM-CSF (400 microg) for 3 consecutive days. A complete response was observed in three patients, the other three showed a partial response. Median time to achieve response was 36 h (range 0.2-72 h). Hematuria was controlled after the first (two patients), second (two patients) or third (two patients) dose of intravesical rhGM-CSF. Patients were discharged from the hospital 10. 5 days (range 3-41 days) after treatment. All patients have been followed for up to 10 months and none have required further treatment. No systemic or bladder side-effects have been observed. Although our results indicate that intravesical instillation of rhGM-CSF is effective in the treatment of HC, a phase II clinical trial, including a larger series of patients, is needed.