Left subclavian flap aortoplasty for coarctation of the aorta: effects on forearm vascular function and growth.

This study evaluated vascular function and growth of the forearm in nine children (mean age 9.2 years) who had undergone left subclavian flap aortoplasty for the infantile type of coarctation of the aorta many years (mean 9.0) earlier. Variables used to investigate bilateral forearm vascular function included forearm blood flow and resistance measured by strain gauge plethysmography under rest conditions, in response to 30 s of static handgrip exercise at 40% maximal voluntary contraction and in response to 10 min of forearm arterial occlusion (that is, the reactive hyperemic blood flow response). Forearm growth was ascertained by measuring right and left forearm volumes, lengths, circumferences and skinfold thickness. Mean arterial pressure at rest in the right and left arms differed by 9% (right 78.2 +/- 2.1, left 71.0 +/- 2.7 mm Hg; p less than 0.05). Forearm blood flow, however, was not significantly different between the surgically altered left arm and the normal right arm under any of the study conditions. Likewise, forearm vascular resistance was not statistically different under any conditions, although the left arm tended to have a lower resistance at rest (right 23.5 +/- 3.2, left 18.7 +/- 2.0 mm Hg.min.100 ml/ml; p = 0.057). Left forearm anthropometric measurements showed a 9% reduction in volume and a 3% reduction in circumference and length. In addition, skinfold thickness tended to be larger on the left arm, suggesting that this limb had a smaller muscle mass. In conclusion, early repair with a subclavian flap does not impair vascular function in the altered limb and is associated with only minor reductions in forearm growth variables. Hence, left subclavian flap aortoplasty appears to be a safe and effective procedure for repair of coarctation of the aorta.

Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study.

OBJECTIVES: The purpose of this study was to determine long-term outcome in adults with congenitally corrected transposition of the great arteries (CCTGA), with particular emphasis on systemic ventricular dysfunction and congestive heart failure (CHF). BACKGROUND: Patients with CCTGA have the anatomical right ventricle as their systemic pumping chamber, with ventricular dysfunction and CHF being relatively common in older adults. METHODS: Retrospective analysis of records of 182 patients from 19 institutions were reviewed to determine current status and possible risk factors for systemic ventricular dysfunction and CHF. Factors considered included age, gender, associated cardiac defects, operative history, heart block, arrhythmias and tricuspid (i.e., systemic atrioventricular) regurgitation (TR). RESULTS: Both CHF and systemic ventricular dysfunction were common in groups with or without associated cardiac lesions. By age 45, 67% of patients with associated lesions had CHF, and 25% of patients without associated lesions had this complication. The rates of systemic ventricular dysfunction and CHF were higher with increasing age, the presence of significant associated cardiac lesions, history of arrhythmia, pacemaker implantation, prior surgery of any type, and particularly with tricuspid valvuloplasty or replacement. Aortic regurgitation (a previously unreported problem) was also relatively common in this patient population. CONCLUSIONS: Patients with CCTGA are increasingly subject to CHF with advancing age; this complication is extremely common by the fourth and fifth decades. Tricuspid (systemic atrioventricular) valvular regurgitation is strongly associated with RV (anatomical right ventricle connected to aorta in CCTGA patients; systemic ventricle in CCTGA) dysfunction and CHF; whether it is causative or a secondary complication remains speculative.

Preserved cardiac beta-adrenergic sensitivity in early renovascular hypertension.

To determine the mechanism of blunted sympathetic reflex responses in early renovascular hypertension, we measured inotropic and chronotropic responses of the heart to beta-adrenergic stimulation in vivo and myocardial beta-adrenergic receptor number and adenylate cyclase activity in 10 dogs during an early stage of one-kidney renal hypertension. Mean aortic pressure was higher in the hypertensive dogs (152 +/- 4 mm Hg) than in eight sham-operated dogs (122 +/- 1 mm Hg; p less than 0.001), but heart rate, cardiac output, and left atrial pressure did not differ between the two groups. Blood pressure reduction with a direct-acting vasodilator, pinacidil, resulted in marked increases in heart rate (+97 +/- 12 beats/min) and rate of change of left ventricular pressure (dP/dt; +1447 +/- 367 mm Hg/sec) in normotensive dogs but only blunted heart rate (+54 +/- 12 beats/min) and minimal left ventricular dP/dt (+376 +/- 264 mm Hg/sec) responses in hypertensive dogs. In contrast, intravenously administered isoproterenol produced similar increases in heart rate and left ventricular dP/dt in the two groups. These two groups also did not differ in either left ventricular beta-adrenergic receptor number and affinity or basal, isoproterenol-stimulated, and fluoride-stimulated adenylate cyclase activity. Thus, despite blunted reflex responses to blood pressure reduction, hypertensive dogs showed neither reduction in chronotropic and inotropic responses to direct beta-adrenergic stimulation nor beta-adrenergic desensitization of the myocardium, as assessed by beta-adrenergic receptor number and adenylate cyclase activity. Blunted reflex responses in this model of early hypertension must be due to factors operating at some locus other than the beta-adrenergic receptor-adenylate cyclase complex.

Esophageal dysfunction and chest pain in patients with mitral valve prolapse: a prospective study utilizing provocative testing during esophageal manometry.

PURPOSE: The cause of chest discomfort in patients with mitral valve prolapse (MVP) remains unknown. Our aim was to determine prospectively the incidence of esophageal disorders and abnormal responses to edrophonium chloride and esophageal acid infusions in patients with MVP and troublesome non-ischemic chest pain. PATIENTS AND METHODS: After coronary artery disease was excluded, 20 patients with MVP and chest pain underwent esophageal manometry and provocative testing with edrophonium chloride and acid infusion. Seven patients with MVP but without chest pain served as control subjects; they also underwent esophageal manometry with provocative testing. RESULTS: Esophageal manometry revealed esophageal disorders in 16 patients: diffuse esophageal spasm in 14 patients, nutcracker esophagus in one, and hypotensive lower esophageal sphincter in one. Esophageal motility was normal in four patients. Injection of edrophonium and acid infusion tests evoked typical chest discomfort in three of 18 and five of 19 patients, respectively. In six of seven control subjects with MVP but with no chest discomfort, esophageal motility was normal and provocative testing did not produce chest discomfort (p less than 0.05 versus results in patients). CONCLUSION: Esophageal disorders were common and may account for chest discomfort in certain patients with MVP and persistent chest pain syndromes.

Influence of aging on pulmonary hemodynamics in a population free of coronary artery disease.

Previous studies showing an increase in pulmonary artery (PA) pressures and vascular resistance with aging have not systematically excluded subjects with coronary artery disease or left ventricular systolic dysfunction. To better determine the influence of aging on PA hemodynamics in the absence of disease, we identified 47 normal subjects angiographically free of coronary artery disease (18 men, 29 women) with normal left ventricular systolic function (ejection fraction greater than or equal to 50% and left ventricular end-diastolic pressure less than 14 mm Hg) from 5,508 consecutive patients undergoing cardiac catheterization and coronary angiography between September 10, 1982 and March 9, 1987. All subjects met a set of clinical and laboratory criteria identifying them as normal. In group I (age greater than or equal to 60 years) mean PA pressure was 16 +/- 3 mm Hg, pulmonary vascular resistance was 124 +/- 32 dynes s cm-5 and the pulmonary/systemic vascular resistance ratio was 0.099 +/- 0.046. In contrast, in group II (age less than 60 years), these values were lower at 12 +/- 2 mm Hg, 70 +/- 25 dynes s cm-5 and 0.057 +/- 0.019, respectively (all p values less than 0.01 to 0.001). All these parameters increased linearly with age (r = 0.69, p less than 0.001 for pulmonary vascular resistance). The differences were not attributable to body surface area or gender. There was no difference in cardiac output, PA wedge pressure, aortic pressure or systemic vascular resistance between the 2 groups. Thus, PA pressure and vascular resistance increase with aging, a change not attributable to coronary disease or left ventricular systolic dysfunction.

Applications of a versatile technique for trace analysis: atmospheric pressure negative chemical ionization.

The ability to use ambient air as a carrier and reagent gas in an atmospheric pressure chemical ionization source allows instantaneous air analysis to be combined with hypersensitivity toward a wide variety of compounds. The TAGA (Trace Atmospheric Gas Analyser) is an instrument which is designed to use both positive and negative atmospheric pressure chemical ionization (APCI) for trace gas analysis; this paper describes several applications of negative APCI which demonstrates that the technique is not limited to environmental monitoring. Examples are described which suggest that the TAGA can be used for the detection of illicit drugs and explosives, and for the analysis of breath or skin emissions, as well as for air pollution measurements. The applications are not restricted by the use of ambient air as a reagent gas; addition to the air carrier of various gases allows specific reagent ions such as Cl- or Br- to be generated. Furthermore, in certain situations pure gas carriers can be used to provide even more flexibility in the ion chemistry, with a short term absorber-desorber system used to transfer the sample from the ambient air into the ion source region. The potential uses for APCI are expanding continuously as the understanding of the complex ion-molecule chemistry grows. This paper underlines the complementary relation between the development of new negative chemical ionization (NCI) techniques and practical applications using the TAGA system.

Echocardiographic evaluation of size, function, and mass of normal and hypertrophied rat ventricles.

The noninvasive evaluation of cardiac structure and function in small animals would provide a means for investigators to repeatedly evaluate treatment effects at various stages of experimental protocols. In this study, commercially available echocardiographic and Doppler equipment was utilized to evaluate hypertrophied (HYP) and normal (SH) rat hearts. Surgically induced renovascular hypertension was used to produce a 35% increase in left ventricular (LV) weight in HYP relative to SH hearts. A commercially available echocardiographic system with integral Doppler capabilities and a 7.5-mHz single-crystal mechanical transducer was used to obtain parasternal long- and short-axis images of HYP and SH hearts in anesthetized animals. HYP hearts were found to have normal systolic function, as evidenced by preserved LV systolic and diastolic dimensions and volumes as well as fractional shortening and ejection fraction. HYP hearts demonstrated a 62% increase in their echocardiographically measured LV posterior wall thicknesses and a 44% increase in calculated ventricular mass. Both parameters were reliable in predicting the presence and degree of left ventricular hypertrophy. Doppler flow velocities through the aortic root and pulmonic valve did not differ between groups, again suggesting preserved LV systolic performance. These results indicate that two-dimensional echocardiography provides a useful means to noninvasively evaluate cardiac structure and function in rats.

Aortic dissection in a weight lifter with nodular fasciitis of the aorta.

We report a case of spontaneous aortic dissection in a young weight lifter without aortic medial disease but with a myofibroblastic proliferation of the aortic adventitia consistent with nodular fasciitis. Successful treatment included ascending aorta replacement with Dacron graft and aortic valve resuspension. We believe that the underlying aortic pathology most likely contributed to the development of the aortic dissection.

The spectrum of left ventricular-right atrial communications in the adult: essentials of echocardiographic assessment.

Left ventricular-right atrial communication may be a congenital defect or can result from trauma, endocarditis, or valve replacement. Traditionally the preoperative diagnosis of this entity was made during cardiac catheterization, but recent advances in echocardiography, particularly color Doppler imaging, have greatly facilitated the noninvasive diagnosis of left ventricular-right atrial communication. We present four cases of left ventricular-right atrial communication, each identified by two-dimensional and color Doppler imaging. One case is a congenital defect, two were identified years after cardiac surgery, and one presents as an unusual complication of myocardial infarction. Optimal views for identifying this defect are discussed along with clues to quantifying its hemodynamic significance.

Seasonal and annual abundance of Amblyomma americanum (Acari: Ixodidae) in central Georgia.

Seasonal and annual changes in the abundance of Amblyomma americanum (L.) larvae, nymphs, and adults were monitored over a 5-yr period in the Piedmont physiographic region of Georgia. Tick abundance was monitored with cloth drags (all life stages) and CO2-baited cloth panels (nymphs and adults) monthly during March through September from 1987 through 1991. Larvae appeared in substantial numbers in July and were most numerous in August and September. Small numbers of unfed larvae apparently overwintered each year based on their presence during March, April, or May. Nymphs were most numerous from April through June and declined to much lower numbers by August and September. Adults were most numerous from March through May and virtually disappeared by August. These seasonal patterns were similar to those reported for A. americanum at other southeastern locations. Each life stage exhibited similar trends of annual abundance with an increase in 1988 followed by a relatively steady decline to levels equivalent to or below initial 1987 values by 1991. Major environmental variables that potentially could have influenced annual abundance were identified from Haile & Mount's (1987) computerized model of A. americanum population dynamics. Habitat type, host density, and day length were constants and rationally could be excluded as causes of annual variations in abundance; weather and host-finding rate were presumed to have been primarily responsible for these annual differences.

Influence of annual and biennial prescribed burning during March on the abundance of Amblyomma americanum (Acari: Ixodidae) in central Georgia.

A 5-yr study to evaluate the influence of annual and biennial prescribed burning in March on the abundance of Amblyomma americanum (L.) was conducted on Oconee Wildlife Management Area in the Piedmont physiographic region of Georgia. Tick abundance on plots embedded in larger burned and unburned areas were monitored with cloth drags and CO2-baited cloth panels monthly during March through September from 1987 through 1991. Annual and biennial prescribed burning from 1988 to 1991 significantly reduced the abundance of larvae, nymphs, and adults but did not alter their seasonal trends of abundance. Annual burning more consistently suppressed all life stages than biennial burning. The magnitude of tick suppression tended to increase with successive burns, especially with the annual burning regime. The order of vulnerability to direct incineration appeared to be overwintered larvae > adults > nymphs; however, only overwintered larvae were highly vulnerable. Consistent reductions in larvae during June-September following burning were associated with reduced litter depths and presumably lowered habitat suitability. During years of fire omission, the abundance of larvae on biennially burned plots increased to levels equal to or exceeding those on unburned plots. Based on cloth drag sampling, mean percentage control during 1988-1991 for larvae, nymphs, and adults, respectively, was 80, 75, and 70% on annually burned plots and 48, 73, and 65% on biennially burned plots. Frequent late-winter prescribed burning, which is commonly used to achieve wildlife habitat management objectives, could be an effective and economical component of an integrated A. americanum control program in habitats ecologically suited to regimes of frequent fire.

Site-specific geographic association between Amblyomma americanum (Acari: Ixodidae) infestations and Ehrlichia chaffeensis-reactive (Rickettsiales: Ehrlichieae) antibodies in white-tailed deer.

Serum samples from white-tailed deer, Odocoileus virginianus Zimmermann, collected from 1982 through 1992 from the southeastern United States were tested for antibodies reactive to Ehrlichia chaffeensis Anderson, Dawson, Jones, & Wilson, the causative agent of human ehrlichiosis. Results were compared between areas based on known infestations of the lone star tick, Amblyomma americanum L., a suspected vector of E. chaffeensis. One hundred and twenty-five of 300 (41.7%) deer tested positive (> or = 1:128) for E. chaffeensis-reactive antibodies by fluorescent antibody analysis. Thirty of 30 (100%) collection areas known to be lone star tick infested contained deer that tested positive for E. chaffeensis-reactive antibodies, corresponding to 121/150 (80.7%) of deer examined. A few deer, 4/150 (2.7%) of those examined, from 2 of 30 (6.7%) areas where lone star ticks were not detected were positive for E. chaffeensis-reactive antibodies. This site-specific geographic association between A. americanum and the presence of E. chaffeensis-reactive antibodies in deer provides strong evidence that A. americanum is a natural vector of E. chaffeensis or a closely related species among white-tailed deer.

Novel Ehrlichia organism (Rickettsiales: Ehrlichieae) in white-tailed deer associated with lone star tick (Acari: Ixodidae) parasitism.

Polymerase chain reaction (PCR) evidence of a novel Ehrlichia organism was found recently in wild white-tailed deer, Odocoileus virginianus Zimmermann, and lone star ticks, Amblyomma americanum L., from the southeastern United States. To evaluate whether lone star tick parasitism was associated with the presence of this novel Ehrlichia organism in deer, 2 retrospective studies were conducted using specific nested PCR to test archived deer serum samples. The 1st study of 150 serum samples collected from a single deer population over a 15-yr period examined the temporal association between the presence of the Ehrlichia organism in deer and parasitism by lone star ticks. The deer Ehrlichia was not detected in serum samples collected before 1986, when lone star ticks were absent or rare, but was detected in samples collected in 1986 and every year thereafter, when lone star ticks became increasingly abundant. In the 2nd study, serum samples from 120 deer from 24 sites in 14 southeastern states were tested to evaluate if a site-specific, spatial association existed between the presence of the deer Ehrlichia and lone star ticks. All 60 serum samples from the 12 deer populations without evidence of lone star tick infestation were negative for the deer Ehrlichia, whereas 83% of the 12 populations infested by lone star ticks had PCR evidence of infection. These data suggest that lone star ticks may be a vector of the deer Ehrlichia; however, they do not preclude the involvement of other arthropods in maintaining infection with this organism in deer populations.

Evaluation of C3H/HeJ mice for xenodiagnosis of infection with Ehrlichia chaffeensis.

Because mice are experimentally susceptible to infection with Ehrlichia species, C3H/HeJ mice were evaluated as a potential xenodiagnostic model for detection of infection with and isolation of E. chaffeensis. Intraperitoneal inoculation of mice with E. chaffeensis-infected DH82 cell cultures produced seroconversion, with peak serum antibody titers of 1:256, at high dosages (>1.9 x 10(4) infected cells) but not at low dosages (1.9 or 1.9 x 10(2) infected cells). Ehrlichia chaffeensis was not reisolated from blood samples collected from inoculated mice on postinoculation day 21. Nested polymerase chain reaction (PCR), using primers specific for E. chaffeensis, was positive for only 2/70 (2.9%) tissue samples. A field evaluation in which C3H/HeJ mice were inoculated with blood and lymph node suspensions from 5 seropositive white-tailed deer, including 3 deer that were PCR positive for E. chaffeensis, failed to produce seroconversion in mice. The lack of seroconversion at low dosages, the failure to reisolate at any dosage, and the inability to confirm infection in PCR-positive field samples suggests C3H/HeJ mice are not a sensitive model for xenodiagnosis or detection of E. chaffeensis.

Failure of Heterakis bonasae to transmit Histomonas meleagridis.

Studies were conducted to determine whether Heterakis bonasae eggs from bobwhite quail infected with Histomonas meleagridis would transmit histomoniasis to turkeys. Fifteen helminth-free bobwhites were inoculated per os with embryonated H. bonasae eggs. Each bobwhite was then infected with H. meleagridis via rectal inoculation. Bobwhites that developed cecal lesions rarely retained mature H. bonasae. H. bonasae eggs recovered from bobwhites exposed to or known to have concurrent H. meleagridis infections were inoculated per os to eleven helminth-free turkeys. None of the turkeys developed H. meleagridis infections.

Deletrocephalus dimidiatus infestation in an adult rhea (Pterocnemia pennata).

Infection with the nematode Deletrocephalus dimidiatus was found in the distal small and proximal large intestines of a 30-month-old female rhea that had died after a prolonged illness. Numerous strongyle-like eggs were found on fecal flotation. Possible treatments include fenbendazole (60 ppm in water) and ivermectin (200 mg/kg). Preventive measures such as artificial incubation, segregation of chicks from adults, and placing chicks in uncontaminated environments may help slow or stop the transmission of the parasite.

Health status of northern bobwhite quail (Colinus virginianus) in eastern Kansas.

The health status of wild northern bobwhite quail (Colinus virginianus) from Lyon County, Kansas, was evaluated by conducting comprehensive health assessments on 25 birds. Gross lesions indicative of avian pox, ulcerative enteritis, and quail bronchitis were not present. Serologic tests for antibodies to Salmonella pullorum, Salmonella gallinarum, Pasteurella multocida, Mycoplasma gallisepticum, Mycoplasma synoviae, and avian adenoviruses were all negative. Intestinal coccidia (Eimeria spp.) were found in 36% of the birds. Only three species of helminth parasites were found: Dispharynx nasuta in two birds, Cyrnea colini in one bird, and larval Physaloptera sp. in four birds. Arthropod parasites (ticks, lice, mites, and/or chiggers) were present on 96% of the birds examined. Compared with wild bobwhite populations in the southeastern United States, the diversity, prevalence, and intensities of microbial and parasitic agents were low.

Dirofilariaformia pulmoni sp. n. (Nematoda: Onchocercidae) from the eastern gray squirrel (Sciurus carolinensis Gmelin).

Dirofilariaeformia pulmoni sp. n. from the eastern gray squirrel (Sciurus carolinensis Gmelin) is differentiated from other species of the genus by its smaller body size, shorter spicules, arrangement of caudal papillae, and morphology of microfilariae. Adult filarids were found in the pulmonary artery and its branches, and the microfilariae occurred in the blood. A large antemortem thrombus that occluded approximately two-thirds of the lumen of the artery was associated with infection in one squirrel.

Apteragia pursglovei sp. n. (Trichostrongyloidea: trichostrongylidae) from the white-tailed deer, Odocoileus virginianus.

Two species of Apteragia were found in white-tailed deer (Odocoileus virginianus) from 152 counties in 13 southeastern states. Specimens previously reported as Skrjabinagia odocoilei were reidentified as belonging to 2 similar species of the genus Apteragia, A. odocoilei, and A. pursglovei sp. n. Apteragia pursglovei sp. n. is differentiated primarily by the length, conformation, and degree of sclerotization of the spicules. Of the 824 deer, A. odocoilei occurred in 76.5%, A. pursglovei in 13.8%, both species in 5.0%, and neither in 4.7%. Reassessment of distribution data revealed that only A. odocoilei was present in deer from 99 counties, only A. pursglovei in deer from 25 counties, and both species in deer from 28 counties. Both A. odocoilei and A. pursglovei were found in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Virginia. Apteragia odocoilei also occurred in Maryland, Tennessee, West Virginia, Texas, Oklahoma, New Jersey, and the Virgin Islands.

Prevalence of antibodies to Neospora caninum in white-tailed deer, Odocoileus virginianus, from the southeastern United States.

Serum samples from 305 white-tailed deer (Odocoileus virginianus) from 14 states in the southeastern United States were examined for antibodies to Neospora caninum using a direct agglutination test. Positive agglutination titers were found in 145 (48%) of the white-tailed deer examined: 21 (7%) had titers of 1:25, 92 (30%) had titers of 1:50, and 32 (10%) had titers of > or = 1:500. These findings that antibodies to N. caninum are common in white-tailed deer support the concept that a sylvatic cycle might exist for this economically important parasite of domestic cattle.