Complement factor 5 blockade reduces porcine myocardial infarction size and improves immediate cardiac function.

Inhibition of complement factor 5 (C5) reduced myocardial infarction in animal studies, while no benefit was found in clinical studies. Due to lack of cross-reactivity of clinically used C5 antibodies, different inhibitors were used in animal and clinical studies. Coversin (Ornithodoros moubata complement inhibitor, OmCI) blocks C5 cleavage and binds leukotriene B4 in humans and pigs. We hypothesized that inhibition of C5 before reperfusion will decrease infarct size and improve ventricular function in a porcine model of myocardial infarction. In pigs (Sus scrofa), the left anterior descending coronary artery was occluded (40 min) and reperfused (240 min). Coversin or placebo was infused 20 min after occlusion and throughout reperfusion in 16 blindly randomized pigs. Coversin significantly reduced myocardial infarction in the area at risk by 39% (p = 0.03, triphenyl tetrazolium chloride staining) and by 19% (p = 0.02) using magnetic resonance imaging. The methods correlated significantly (R = 0.92, p < 0.01). Tissue Doppler echocardiography showed increased systolic displacement (31%, p < 0.01) and increased systolic velocity (29%, p = 0.01) in coversin treated pigs. Interleukin-1ß in myocardial microdialysis fluid was significantly reduced (31%, p < 0.05) and tissue E-selectin expression was significantly reduced (p = 0.01) in the non-infarcted area at risk by coversin treatment. Coversin ablated plasma C5 activation throughout the reperfusion period and decreased myocardial C5b-9 deposition, while neither plasma nor myocardial LTB4 were significantly reduced. Coversin substantially reduced the size of infarction, improved ventricular function, and attenuated interleukin-1ß and E-selectin in this porcine model by inhibiting C5. We conclude that inhibition of C5 in myocardial infarction should be reconsidered.

[Dysphagia treatment in a clinical-geriatric setting PEG and functional therapy of dysphagia]. / Behandlung der Dysphagie in einem klinisch-geriatrischen Setting: funktionelle Dysphagietherapie und PEG-Einsatz.

OBJECTIVES: Patients with dysphagia whose food intake is inadequate and who may compromise their airways need to receive nasogastric (NG) or gastrostomic (PEG) feeding. There are controversial discussions about the best time for intervention and the best method. Each approach has its advantages and disadvantages. Further research is required to assess the optimum method of treating patients with dysphagia. A retrospective study was undertaken to investigate the influence of functional dysphagia therapy with or without PEG feeding. METHODS: A total of 164 patients with dysphagia were investigated in a center for geriatric medicine (EGZB) within one year. Patients were divided into two groups: those with PEG (group 1, n=59) and those without (group 2, n=105). Both groups received functional training (training of oral motor skills and sensation, compensatory swallowing techniques) by speech-language therapists.Geriatric basic assessment was used. Speech-language therapists also evaluated language, speech and swallowing disorders pre- and post-training. Diet modification for oral intake altering viscosity and texture of foods and liquids was used. Additional data on the time between being admitted to hospital and receiving a PEG tube, the hospitalization period, the number of complications and mortality were collected. RESULTS: Both groups benefited from functional dysphagia therapy. The patients of group 2 showed a significant improvement in functional oral intake post-treatment. In most of the cases, diet modification improved from pasty consistency to firm meals. Swallowing abilities were much better than those of the more severely disabled patients of group 1. Group 1 still needed PEG feeding post-treatment but could also take in some food orally. However even the patients of group 1 showed a significant increase in functional oral intake.Group 2 also showed significantly stronger improvements in communication abilities and speech intelligibility after training compared to the severely disabled patients of group 1.In terms of the clinical outcome of group 1 it was demonstrated that the sooner a PEG was placed, the more significantly functional oral intake improved. The results of a multiple regression analysis showed a small but nevertheless significant association between an early supply of PEG and improvement of functional oral intake which had been achieved by functional dysphagia therapy.Significantly more complications and significantly higher mortality occurred in group 1 (PEG feeding) compared to group 2 (exclusively oral feeding). CONCLUSION: The treatment of dysphagia in the elderly requires a multi-professional setting, differentiated assessment and functional training of oral motor skills and sensation and swallowing techniques. Compared to patients with severe dysphagia, however, patients with mild to moderate dysphagia benefit most from functional training. The results reveal the importance of precise and early diagnosis of swallowing disorders in order to introduce PEG supply early in cases of persistent dysphagia.

Acquired immunodeficiency syndrome (AIDS). Clinical, immunological, pathological, and microbiological studies of the first case diagnosed in Norway.

The first case of acquired immunodeficiency syndrome (AIDS) in Norway, diagnosed in January 1983, is presented, with results of clinical, immunological, and microbiological studies and the results of autopsy. Immunological studies showed several immunological abnormalities, including a profound deficiency of the T-cell system of the type usually associated with AIDS. During the 11 months of symptomatic disease the patient had a series of opportunistic infections, including recurrent candida esophagitis, probable Pneumocystis carinii pneumonia, and severe and recurrent perioral Herpes simplex virus infection. During the last months he had increasing signs and symptoms of disseminated cytomegalovirus infection, which was probably the major cause of death, as revealed by autopsy. Autopsy also showed the presence of disseminated infection with a slowly growing, so far unclassified Mycobacterium species, and signs of a focal aspergillus pneumonia.

Epidural analgesia and perinatal retinal haemorrhages.

The incidence and magnitude of retinal haemorrhages in a group of neonates delivered spontaneously (n = 50), whose mothers received epidural analgesia during labour, has been compared to those of a spontaneously delivered control group (n = 50) who received conventional analgesia. The second stage of labour was significantly longer in the epidural group (P less than 0.001), which contained a higher number of primiparas than did their controls. Still, a lower incidence of retinal haemorrhages was noted in the epidural group (P less than 0.01). The study indicates that epidural analgesia offers a certain degree of protection against perinatal retinal haemorrhages in the spontaneously delivered neonate.

Ocular polyarteritis nodosa. Report of a case.

A patient with bilateral amaurosis as a complication to polyarteritis nodosa is presented. He developed affection of the central retinal arteries and the arteries supplying the optic discs followed by retinal and optic atrophy. After one month no vessels could be observed neither in the retinae nor at the optic discs. The importance of early diagnosis and aggressive immunosuppressive treatment is stressed.

Survival of glaucoma patients.

PURPOSE: To investigate the survival of patients with capsular or simple glaucoma compared with that of the common population, with particular attention to the impact of sex and use of acetazolamide (Diamox). METHODS: The 30 year survival of 1147 patients with capsular or simple glaucoma who were finally hospitalized at the Eye Department, Rikshospitalet, Oslo, from 1961 to 1970, are analysed, using log rank tests. The time varying impacts of sex and acetazolamide on survival are also studied using a regression model. RESULTS: There was a significant increased mortality for patients with acetazolamide, and for men also those not using it. The observed mortality for men was initially lower than the average Norwegian population, but later the mortality increased more rapidly in the glaucoma group. This may be explained by a selection of the healthiest patients to Rikshospitalet, and actually indicates that the excess mortality is even higher than calculated here. CONCLUSION: The analysis of data indicated increased mortality for glaucoma patients when the disease had lasted for some time. This was especially pronounced for men using acetazolamide. A similar study from a period when acetazolamide was not in common use and an analysis of causes of death is also asked for.

Retinal hemorrhages in the preterm neonate. A prospective randomized study comparing the occurrence of hemorrhages after spontaneous versus forceps delivery.

The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29-35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28-35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.

Retinal haemorrhages in the newborn.

The present study shows the frequency and severity of retinal haemorrhages in 200 newborn, of which 100 were delivered spontaneously, 51 delivered by vacuum extractor and 49 by forceps. The incidence of retinal haemorrhages was highest in the vacuum group (50%), lowest in the forceps group (16%), while the spontaneously delivered children showed an incidence of 41%. The incidence of severe retinal haemorrhages was about five times higher in the vacuum group than in both forceps and control groups. The authors propose a quantitative grading of the haemorrhages. The purpose has been to obtain a better way of relating the haemorrhages to mode of delivery and probably also to relate retinal haemorrhages to possible brain damage.

Effect of instrumental delivery on the frequency and severity of retinal hemorrhages in the newborn.

The frequency and severity of retinal hemorrhages were studied in 200 newborns within the first 72 hours of life. One hundred of the neonates were delivered instrumentally by either forceps (49 cases) or vacuum extraction (51 cases). Another hundred neonates were delivered spontaneously and served as controls. Both the highest and the lowest frequency of retinal hemorrhages were found among the babies delivered by instrumentation. The actual values were 50 per cent in the vacuum groups and only 16 per cent in the forceps group (p less than 0.01). The spontaneously delivered babies, who served as controls, showed retinal hemorrhages in 41 per cent of the cases. The frequency of severe retinal hemorrhages was five times higher in the vacuum group compared to both the forceps group and the control group (p less than 0.01, p less than 0.001).

Severe hearing loss and retinopathy in children: on the possible association with rubella virus infection.

Among 145 children with severe hearing loss 35 had a characteristic retinopathy. Only few of these had additional malformations. Most of these children (28) were born during the months September through February. Rubella antibodies were present more frequently than in matched controls. No such difference was found for cytomegalovirus and herpesvirus hominis.

Cerebral computed tomography in newborn children with large retinal hemorrhages.

Cerebral computed tomography was performed in 10 neonates with large retinal hemorrhages compared with a control group of 10 full-term neonates without such hemorrhage. No signs of intra-cranial hemorrhage were found. The cerebral ventricles were poorly visualized in both groups. Periventricular low attenuation areas was a frequent finding in both groups.

Perinatal retinal haemorrhages and development. Follow-up in seven year olds.

Depending on methods of delivery, 7-50% of all children are born with retinal haemorrhages (RH). To assess the prognostic value of extensive RH for the future development of the child, the ophthalmological, neurological and psychological status of 52 children, 26 born with RH and 26 controls, were examined at the age of seven years. There were significant differences between the two groups using only psychological measures. Children with RH performed poorer than the control group, but the results did not point to any particular cerebral areas being affected. However, children with both RH and low socio-economic status were significantly less emotionally stable than the controls. Socio-economic factors also seem to be more highly correlated with later performance than do RH.

Diabetes mellitus and pregnancy--management and results at Rikshospitalet, Oslo, 1970-1977.

During the years 1970-1977, 234 pregnant diabetics were treated in Oslo. A regimen of close metabolic and obstetric control was used. The total perinatal mortality was 4.3%, and 3.1% in 160 patients followed from before week 28. In 74% of patients mean blood glucose (determined 4 times daily) during the last 5-6 weeks of pregnancy was below 6 mmol/1 and in only one patient above 8 mmol/1. There was a low incidence of ketoacidosis (5 patients), pyelonephritis (3 patients), and severe preeclampsia (1 patient), although mild to moderate preeclampsia occurred in 28 patients. Preeclampsia was not associated with foetal loss. Macrosomia was rare. Respiratory distress occurred in 33 infants, in most cases light to moderate. Two foetal deaths were associated with respiratory distress. Progression of retinopathy was frequent, and appearance of or progression of proliferative changes occurred in 15 patients with retinopathy before pregnancy. Loss of visual acuity was rare, and reading vision was not lost by any patients. Induced vaginal delivery has been used in half the deliveries during the last years, whereas Caesarean section was preferred during the first years. Mean duration of pregnancy at delivery has been 260 days, 256 days during the first four years, and 262 days during the last four.

Combined renal and pancreatic transplantation: effects on advanced diabetic neuropathy and retinopathy.

In this study of 24 uremic diabetic patients treated with combined kidney and pancreas transplantation, the one year patient, kidney and pancreas graft survival was 96, 78 and 55%, respectively. In recipients followed for three months or more, a regression of neuropathy was registered in all patients, whereas improvement in visual acuity was seen only in two patients with simplex type retinopathy. The advanced proliferative retinopathy observed in most recipients at the time of transplantation, was not significantly altered after pancreas and kidney transplantation.

A new syndrome: thrombocytopathia, muscle fatigue, asplenia, miosis, migraine, dyslexia and ichthyosis.

A new multifacetted syndrome inherited as an autosomal, dominant trait is described encompassing not only two hitherto undescribed hereditary defects--thrombocytopathia and asplenia--but also muscle contractile defect, migraine-like headache, miosis, dyslexia and ichthyosis. None of these defects has so far been assigned to a specific chromosome or linkage group. Further studies on the various aspects of the syndrome are in progress.

Exfoliative glaucoma and primary open-angle glaucoma: associations with death causes and comorbidity.

PURPOSE: To investigate whether type of glaucoma or use of acetazolamide are associated with main cause of death and comorbidity. MATERIAL AND METHODS: The survival data, including date and cause of death, for 1147 patients with capsular or simple glaucoma who were ultimately hospitalized at the Eye Department, National Hospital, Oslo, between 1961 and 1970, were analysed. Binary logistic regression was carried out to investigate the patterns of death causes and comorbidity in subgroup analyses. RESULTS: Patients with exfoliative glaucoma (XFG) and those with primary open-angle glaucoma (POAG) showed no significant differences in rates of death caused by acute cerebrovascular diseases, cardiac diseases and cancer. Interestingly, we found that chronic cerebral diseases such as senile dementia, cerebral atrophy and chronic cerebral ischaemia (n = 81) were more common in patients with XFG than in those with POAG (p = 0.01) and in the group of acetazolamide users (p = 0.03). Patients with XFG had a higher probability of developing an acute cerebrovascular disease than patients with POAG (n = 228, p = 0.03). CONCLUSION: In this retrospective study, we found that comorbidity with acute cerebrovascular disease and chronic cerebral diseases (senile dementia, cerebral atrophy and chronic cerebral ischaemia) were more common in patients with XFG than in patients with POAG. Prospective data are needed in order to conclude upon the associations found in this study.

Comparison of survival of exfoliative glaucoma patients and primary open-angle glaucoma patients: impact of acetazolamide use.

PURPOSE: To compare the survival rates of patients with exfoliative glaucoma (XFG) and those with primary open-angle glaucoma (POAG), and to establish whether the use of acetazolamide has any influence on survival. METHODS: The survival data, including date and cause of death, for 1147 patients with XFG or POAG who were ultimately hospitalized at the Eye Department, National Hospital, Oslo, between 1961 and 1970, were analysed retrospectively. The Cox proportional hazard model was used in the survival analyses. RESULTS: No statistically significant differences in survival were found between patients with XFG and those with POAG (p = 0.85). As expected, female gender and younger age at diagnosis were associated with longer survival periods. Surprisingly, we found that patients with more recent birth dates had relatively lower survival rates than patients with earlier birth dates; when this was included in the analyses, the use of acetazolamide was found to be associated with reduced survival (n = 492, p = 0.02).

[Symptomatic cytomegalovirus infection in patients with acquired immunodeficiency syndrome]. / Symptomatisk cytomegalovirusinfeksjon hos pasienter med ervervet immunsviktsyndrom.

During a seven-year period, symptomatic cytomegalovirus (CMV)-infection was diagnosed in 21.5% (n = 10) of all AIDS patients at the National Hospital of Norway (retinitis n = 8, colitis n = 3, pneumonitis n = 2, gastritis n = 1). Symptomatic cytomegalovirus-infection was associated with a poor long-term prognosis (median survival 174 days, range 10-415). Median CD4+ lymphocyte counts at onset of symptomatic cytomegalovirus-infection was 24 x 10(6)/l (range 6-68). Regular ophthalmological examination of HIV-infected patients with severe immunodeficiency, and endoscopy with multiple mucosal biopsies in patients with suspected cytomegalovirus-infection of the gastrointestinal tract, were of major importance in diagnosing symptomatic cytomegalovirus-infection. Six patients received an induction course of ganciclovir, and foscarnet was administered in two patients due to leukopenia. Problems of toxicity to the available anti-CMV agents make the development of additional therapeutic approaches desirable.