Seasonal plasticity in photoprotection modulates UV-induced hsp gene expression in copepods from a clear lake.

Zooplankton from clear alpine lakes is exposed to stressful levels of solar UV radiation (UVR). As these pelagic organisms experience high UVR and large changes in solar radiation conditions between ice-free and ice-cover periods, they have evolved various strategies to minimize UVR exposure and damage. Here, we studied the relation between photoprotection levels (mycosporine-like amino acids, carotenoids), antioxidant capacities, and gene expression of heat shock proteins (hsps) as indicator of stress in the copepod Cyclops abyssorum tatricus during the course of a year. Expression of hsp60, hsp70, and hsp90 was measured in the field (baseline expression [BE]) and after UVR exposure in the laboratory. The BE differed among genes and seasons (hsp60: high during summer, hsp70 and hsp90: high during the ice-cover period). The gene expression of hsp70 was upregulated after exposure to UVR (up to 5.2-fold change), while hsp60 and hsp90 were only constitutively expressed. A strong seasonal pattern was found in the photoprotective compounds and antioxidant capacities, with highest levels during the ice-free period. The extent of upregulation of hsp70 gene expression increased with decreasing photoprotection levels and peaked 24 h post UVR exposure (9.6-fold change) at the time of lowest photoprotection (February). Our data suggest that hsp70 gene expression is modulated by seasonal plasticity in photoprotection. This ability of adequate stress response is essential for survival in highly variable ecosystems such as alpine lakes.

[Long-term follow-up 10 years after transpupillary thermotherapy (TTT) for small, posterior located malignant melanomas of the choroid]. / Langzeitverlauf 10 Jahre nach transpupillarer Thermotherapie (TTT) kleiner, posteriorer maligner Aderhautmelanome.

BACKGROUND: The aim of this study was to evaluate the long-term results of transpupillary thermotherapy (TTT) for small malignant choroidal melanomas. PATIENTS AND METHODS: In the time period 1/1998 to 10/1999 in a prospective non-randomised analysis 26 eyes with small malignant melanomas (located posterior to the equator with base ≤ 12 and thickness ≤ 4.5 mm) were primary treated with the TTT standard protocol (follow-up over a time span of at least 10 years). RESULTS: Thirteen women and thirteen men (mean age: 64 years) underwent TTT. The mean preoperative tumour thickness was 2.45 mm (0.8 - 4.5 mm). Ten years postoperatively tumour regression without recurrence after 1.4 treatment sessions (mean) was achieved in 16 / 26 eyes, primary regression followed by tumour regrowth in 6 / 26 eyes, and primary failure of tumour regression in 4 / 26 eyes. Two patients died on liver metastasis. Ocular complications (with preference in posterior tumours after multiple TTT sessions) were observed in 14 eyes: macular pucker in 8, macular oedema in 6, choroidal neovascularisation in 4 and posterior synechia with iris atrophy in one eye. CONCLUSIONS: Choroidal melanomas treated with TTT as a stand-alone procedure need a close monitoring since these tumours developed a significant rate of local recurrences and ocular side-effects in the long run.

Pars plana vitrectomy for visually disturbing vitreous floaters in pseudophacic eyes.

BACKGROUND: The aim of this study was to evaluate the role of vitrectomy in patients with visually disturbing vitreous opacities. PATIENTS AND METHODS: A retrospective analysis of the patient characteristics and the outcome of all pseudophacic eyes, which consecutively received in the decade 1996 to 2005 20 G pars plana vitrectomy for visually disturbing floaters, was carried out at the Mainz University Eye Clinic. RESULTS: Forty-one eyes of 32 patients (63 % university graduates, median age: 64 years) were included in the study. The mean axial length of the globe was 25.3 mm (range: 22.8 to 28.9 mm). Additional pathologies having influence on the vitreous condition were history of laser or cryo retinopexy (12 ×), buckle surgery (5 ×), complicated cataract surgery (16 ×) and Nd:YAG laser capsulotomy (4 ×). Vitreous floaters were considered to be the result of posterior vitreous detachment alone in 61 %, of asteroid hyalosis accompanied by posterior vitreous detachment in 17 %, and vitreous syneresis in 15 % of the eyes. Intraoperatively retinopexy with endolaser or cryo was performed in 6 % of cases. A secondary retinal detachment occurred in one eye (2 %). Thirty-one of 32 patients reported to be very satisfied with the postoperative result. Objectively, their visual acuity was better than or equal to preoperative acuity in 95 % of the eyes. CONCLUSION: Pars plana vitrectomy provides a highly effective treatment for visually disturbing vitreous floaters. In an era in which the expectations and demands of individuals on the quality of vision and life have increased significantly, with careful case selection the benefits of the surgical intervention may outweigh the surgical risks.

[Effect of various compositions of riboflavin eye drops on the intraoperative corneal thickness during UVA-cross-linking in keratoconus eyes]. / Entwicklung der Hornhautdicke während der UV-Vernetzungstherapie unter Anwendung verschiedener Kompositionen von Riboflavin-Augentropfen.

BACKGROUND: During the UVA-cross-linking treatment in keratoconus patients, the UVA rays are partially absorbed in the stroma of the riboflavin-loaded cornea. This effect protects the corneal endothelium from UVA irradiation damage. The intensity of UVA light reaching the endothelium is inversely correlated with corneal thickness. The common composition of riboflavin eye drops may lead to a marked reduction in corneal thickness increasing the risk of endothelial damage. PATIENTS AND METHODS: In a retrospective analysis of 23 UVA-cross-linking procedures on 23 patients we collected data about the pre-, intra- and postoperative corneal thickness (measured with ultrasound). Among these patients and depending on the preoperative state, 8 eyes received Medio Cross (TM) eye drops (group 1), 8 eyes received Medio Cross (TM) eye drops combined with riboflavin 0.1 %/methylhydroxypropylcellulose 1,5 %/NaCl 1.1 % (group 2) and 7 eyes received riboflavin 0.2 %/methylhydroxypropylcellulose 0.5 %/NaCl 0.7 % eye drops (group 3) before and during UVA irradiation. Data are presented as means ± standard deviation. A comparison of the data was performed using (one-way) ANOVA. RESULTS: The mean corneal thickness at the end of the UVA cross-linking procedure was 67 ± 9 % (means ± standard deviation) of preoperative thickness in group 1, 118 ± 14 % in group 2 and 140 ± 23 % in group 3. The values in groups 2 and 3 were significantly different from those in the reference group 1. CONCLUSIONS: Our results show a strong variability of the postoperative corneal thickness using different standard compositions of riboflavin eye drops. Further studies are needed to find a composition of riboflavin eye drops ensuring a moderate increase in intraoperative corneal thickness to protect the corneal endothelium.

Clinical outcomes after increasing bladder outlet resistance without augmentation cystoplasty in neurogenic bladder.

INTRODUCTION: Patients with neurogenic bladder (NGB) and urinary incontinence (UI) due to low bladder outlet resistance may require bladder neck procedures (BNPs) to achieve continence. These patients may also have reduced bladder capacity and or elevated detrusor storage pressures that require augmentation cystoplasty (AC). AC is not without complications that include risks for bladder rupture, urolithiasis, urinary tract infections and metabolic issues. Avoidance of AC would be helpful in patients with neurogenic urinary incontinence that have safe bladder parameters in the setting of low bladder outlet resistance. OBJECTIVE: To determine if pre-operative urodynamics could select children with NGBs and UI for isolated BNPs without AC. Additionally we sought to determine the safety of BNPs without AC and future need of AC with long-term follow-up. STUDY DESIGN: This is an IRB-approved retrospective analysis of all patients undergoing BNPs for management of neurogenic UI over a 17-year period. We separated these BNP patients into two groups: No AC + BNP (Group 1) vs. AC + BNP (Group 2). Our primary analyses focused on postoperative outcomes for patients in Group 1. Outcomes assessed included additional surgical procedures, urodynamic changes, development of CKD, new hydronephrosis (HDN) and vesicoureteral reflux (VUR). Secondary analysis included the timeline for the development of any bladder deterioration that necessitated AC in Group 1. RESULTS: 93 patients underwent BNP at a mean age of 10.8 years. Thirty did not have AC at the time of surgery (Group 1). These children had larger (p < 0.001) and more compliant (p < 0.001) bladders than Group 2 having simultaneous augmentation. At 6 years mean follow-up in Group 1 patients, three developed new reflux and three had new hydronephrosis. Nine (30%) had additional continence procedures. Twelve required (40%) AC at a mean of 23 months after the initial BNP. No patients had AC after 5 years. Detrusor end filling pressure increased 14.8 cm H2O (p = 0.028) and expected bladder capacity decreased 26.1% (p = 0.005) after isolated BNP. DISCUSSION: We found that from our cohort of patients who had normal bladder compliance and normal/near normal expected capacity preoperatively 40% required subsequent AC. We were unable to find pre-operative clinical parameters which predicted failure or conversion to AC. We found that 43.3% of our BNP without AC patients had no subsequent invasive procedures with mean 6-year follow-up. We found that none of our patients developed any degree of CKD. Finally, we found that the majority of patients that converted to AC after their BNP did so within the first 2 years after their initial BNP and no patients required augmentation 5 years post their initial BNP. This data validates that these patients require very strict follow up, particularly in the first 5 years after surgery. CONCLUSIONS: BNP without AC is safe in only a few selected patients with NGB. Despite preoperative selection, there are significant changes in bladder dynamics and 40% required subsequent augmentation. Bladder deterioration occurs early and generally in the first 2 years. Since there are no apparent reliable pre-operative variables predicting the need for subsequent AC, parents should be counseled regarding vigilant post-operative follow-up.

Thinking about the past to shape the present: neural activation during the recall of relationship episodes.

Reflecting on oneself and others in relationships is an ability that is central to our social existence. Specifically, considering formative autobiographical experiences in relationships may contribute to more flexibility in perceiving, as well as in shaping present relationships. Reflecting on such experiences mobilizes different social cognitive and affective processes. We aim to explore the neural basis of these processes. With a newly developed functional magnetic imaging (fMRI) task, we investigated brain activation in 35 healthy individuals during recall of relationship episodes involving themselves or others. We found that recalling formative episodes involving themselves modulated brain activity in the right parahippocampus, left precuneus, bilateral fusiform gyrus, bilateral insula, and left presupplementary motor area. These areas are involved in memory processes, self-generated thought, and affective experience. The recall of relationship episodes involving others led to similar activation patterns. Our results underscore the close link between self-reflection, understanding others, and memory processes and emphasize the role of affective dimensions for self-relevant experiences. They contribute to a growing body of research on neural mechanisms involved in complex social cognitive processes decisive for our capacity to navigate our social environment.

Comparison of monophasic with single and dual capacitor biphasic waveforms for nonthoracotomy canine internal defibrillation.

Monophasic and single capacitor and dual capacitor biphasic truncated exponential shocks were tested in pentobarbital-anesthetized dogs with use of a nonthoracotomy internal defibrillation pathway consisting of a right ventricular catheter electrode and a subcutaneous chest wall patch electrode. Seven dogs weighing 20.2 +/- 0.5 kg were utilized. Monophasic pulses of 10 ms duration were compared with three biphasic pulses. All biphasic waveforms had an initial positive phase (P1) followed by a terminal negative phase (P2) and the total duration of P1 plus P2 was 10 ms. The dual capacitor biphasic waveform (P1 9 ms, P2 1 ms) had equal initial voltages of P1 and P2. Two simulated single capacitor biphasic waveforms were also tested, the first designed to minimize the magnitude of P2 (P1 9 ms, P2 1 ms with initial voltage of P2 equal to 0.3 of the initial voltage of P1) and the second to maximize P2 (P1 5 ms, P2 5 ms with initial voltage of P2 = 0.5 P1). Alternating current was used to induce ventricular fibrillation and four trials of eight initial voltages from 100 to 800 V were performed for each of the four waveforms. Stepwise logistic regression was utilized to construct curves relating probability of successful defibrillation and energy. In the logistic model, the dual capacitor biphasic and single capacitor biphasic waveforms that maximized P2 were associated with significantly (p less than 0.001) lower energy requirements for defibrillation than those of the monophasic waveform. The single capacitor biphasic waveform that minimized P2 was not significantly better than the monophasic waveform.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative efficacy of monophasic and biphasic truncated exponential shocks for nonthoracotomy internal defibrillation in dogs.

Pentobarbital-anesthetized dogs were studied to determine the relative efficacy of monophasic and biphasic truncated exponential shocks employing a nonthoracotomy internal defibrillation pathway that consisted of a right ventricular catheter electrode (cathode) and a subcutaneous chest wall patch electrode (anode). In part 1 of the experiments, six dogs (19.6 +/- 1.1 kg) were utilized. Monophasic pulses of 5, 7.5, 10 and 12.5 ms duration were compared with biphasic pulses of the same total duration. The biphasic pulses had an initial positive phase (P1) followed by a terminal negative phase (P2) with the initial voltage equal for each phase. For each biphasic total pulse width, five relative P1 versus P2 durations were tested (50 and 50%, 75 and 25%, 90 and 10%, 25 and 75%, 10 and 90%). Ventricular fibrillation was induced by alternating current and pulse configurations were tested randomly to determine the minimal voltage and energy for defibrillation (threshold). Biphasic shocks with P1 longer than P2 were associated with significantly lower (p less than 0.01) energy thresholds than were monophasic shocks. Additionally, there was no significant relation between pulse width and voltage or energy thresholds. In part 2 of the experiments, six dogs (20.2 +/- 1.6 kg) were studied. Monophasic shocks were compared with biphasic shocks with P1 versus P2 durations of 75 and 25% and 90 and 10% for total pulse widths of 7.5, 10 and 12.5 ms. Threshold determinations were performed as in part 1. Subsequently, five initial voltages clustered about threshold were randomly tested four times and dose-response curves constructed for each pulse configuration with the use of stepwise logistic regression. Biphasic shocks resulted in significantly lower energy (p less than 0.0001) and voltage (p less than 0.001) requirements than did monophasic shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

Restenosis after directional coronary atherectomy.

OBJECTIVES: This study evaluates the incidence of restenosis after successful directional coronary atherectomy and identifies risk factors for restenosis. BACKGROUND: Directional coronary atherectomy has been shown to be a safe and effective treatment of obstructive coronary artery disease; however, information regarding restenosis is limited. METHODS: Between October 1986 and December 1989, 289 patients with 332 lesions were successfully treated with directional coronary atherectomy and followed up prospectively. Clinical follow-up information was available for 98% and angiographic follow-up information was obtained for 82% at approximately 6 months, or earlier if symptoms recurred. Angiograms were quantitatively analyzed. Restenosis was defined as greater than 50% stenosis at the site of intervention. RESULTS: Seventy-four percent of patients were either asymptomatic or clinically improved after the procedure. Thirty-two percent were subsequently treated by coronary artery bypass surgery (14%), percutaneous transluminal coronary angioplasty (4%) or repeat atherectomy (13%). Angiographic evidence of restenosis was observed in 42%. The restenosis rate in native coronary arteries was 31% for primary lesions and 28% and 49%, respectively, for lesions treated with one or two previous angioplasty procedures. The restenosis rate for saphenous vein grafts was 53% for primary lesions and 58% and 82%, respectively, for lesions treated with one or two previous angioplasty procedures. The median interval to angiographically documented restenosis was 133 days. A higher restenosis rate was associated with a saphenous vein graft, hypertension, a longer lesion (greater than or equal to 10 mm), a smaller vessel diameter (less than 3 mm), a noncalcified lesion and use of a smaller (6F) device. CONCLUSIONS: Restenosis remains a limitation of directional coronary atherectomy. A subset of patients with larger vessels, shorter lesions or lesions treated with a larger (7F) device may have a more favorable outcome.

Effect of lesion characteristics on outcome of directional coronary atherectomy.

Directional coronary atherectomy, a new transluminal procedure for treatment of obstructive lesions in coronary arteries by excision and removal of tissue, was performed on 447 lesions in 382 procedures. Successful outcome, defined as a reduction of stenosis by greater than or equal to 20% with a less than 50% residual stenosis, was achieved in 89.5% of lesions and mean stenosis was reduced from 75.9 +/- 13.3% to 14.5 +/- 22.1% (p less than 0.001). Complications included vessel occlusion during the procedure, 2.4%; vessel occlusion after the procedure, 1.3%; new lesion, 0.5%; nonobstructive guiding catheter-induced dissection, 0.3%; perforation, 0.8%; distal embolization, 2.1%; Q wave myocardial infarction, 0.8% and non-Q wave myocardial infarction, 4.2%. Twelve patients (3.1%) required coronary artery bypass surgery for these complications. The atherectomy success rate was greater than 80% and the combined atherectomy and angioplasty success rate was greater than 90% for complex morphologic features such as eccentric lesions, lengthy lesions, lesions with abnormal contour, angulated lesions, ostial lesions and lesions with branch involvement. In the presence of calcific deposition, atherectomy success rate was 52% for primary lesions and 83% for restenosed lesions. Among angiographically complex lesions, calcium was the predictor for failed atherectomy (p less than 0.0001). In summary, directional coronary atherectomy is safe and effective for treatment of obstructive lesions in coronary arteries in selected cases. In particular, it achieves a high success rate in lesions with complex morphologic characteristics, such as eccentricity, abnormal contour and ostial involvement.

Accuracy of prospective two-dimensional/Doppler echocardiography in the assessment of reparative surgery.

Between January 1987 and January 1989, all 129 patients (aged 11 days to 25 years, median 39 months) undergoing both an echocardiographic examination and cardiac catheterization after reparative surgery were prospectively included in a study to assess the accuracy of combined two-dimensional and Doppler color flow imaging. The patient diagnoses were transposition of the great arteries (n = 20), tetralogy of Fallot (n = 38), coarctation of the aorta (n = 24), complete atrioventricular (AV) canal (n = 15), atrial septal defect (n = 8), ventricular septal defects (n = 3), pulmonary stenosis (n = 4), aortic stenosis (n = 8) and subaortic stenosis (n = 9). In arterial tract stenosis, there was high correlation between Doppler estimates and catheterization-derived measurements of residual right ventricular outflow tract obstruction in patients after the arterial switch operation for transposition of the great arteries (r = 0.95) as well as in patients after corrective repair of tetralogy of Fallot (r = 0.84). In semilunar/AV valve regurgitation, graded as none, mild, moderate or severe, echocardiographic estimates correlated exactly with angiographic grading in 84% and differed by one angiographic grade in the other 16%. In residual left to right shunting, no hemodynamically significant shunt was missed by echocardiography. For residual shunts at the ventricular level (n = 32), addition of Doppler color flow imaging improved the sensitivity (from 63% to 94%) and the negative predictive value (from 88% to 98%). In elevated right ventricular pressure, Doppler-derived right ventricular-right atrial pressure estimates in 24 patients correlated well with catheterization measurements (r = 0.93). Combined two-dimensional and Doppler color flow echocardiography was highly accurate in the prospective evaluation of these four types of postoperative residual.

Long-term hypokalemia in acute myeloid leukemia.

A 48-year-old man suffering from acute myeloid leukemia presented a hypokalemia that persisted almost constantly during 18 months despite total hematological remission. The renal investigation demonstrated a hypokalemic nephropathy with an impairment of urinary concentrating function. Light and electron microscopy showed renal lesions related to potassium depletion. We did not observe specific lesions explaining the renal potassium wasting. Metabolic studies showed persistent hyperkaluresis, which appeared to be the main kaliopenic factor. We also found hypomagnesemia and changes of the renin-aldosterone system. We observed a hyperreninism, probably due to hypokalemia and a slight hyperaldosteronism, which could have been one of the kaluretic agents.

Humoral autoimmune response against S-antigen and IRBP in ocular onchocerciasis.

Autoimmune mechanisms are thought to play a role in the pathogenesis of the chorioretinal changes in ocular onchocerciasis. In this study, the involvement of autoimmunity against retinal antigens in developing chorioretinitis was investigated. Serum levels of autoantibodies, directed against human S-antigen and interphotoreceptor retinoid-binding protein (IRBP), were determined in patients with onchocerciasis (n = 46) and endemic controls (n = 38) from Sierra Leone with the use of an enzyme immunoassay. In both groups high levels of anti-human S-antigen and IRBP antibodies were detected. No relationship could be demonstrated between the antiretinal antibody level and the occurrence of chorioretinitis in onchocerciasis. The levels of both anti-human S-antigen and IRBP antibodies were significantly higher in patients with onchocerciasis compared with endemic controls (P less than 0.001). Cross-reactivity of antiretinal antibodies with parasitic antigens could not be demonstrated as a possible explanation for the higher levels in patients with onchocerciasis. No correlation was found between the levels of antibodies of different classes against the crude Onchocerca volvulus, the egg antigen, or the microfilariae and the antiretinal antibody levels. Furthermore, in a panel of 13 different monoclonal antibodies directed against O. volvulus, only one showed a slight anti-human IRBP reactivity and none reacted with S-antigen. The immune response against the two retinal antigens investigated was not specific for onchocerciasis because high antibody levels were also found in patients with Bancroftian filariasis from Papua, New Guinea, and Surinam.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence, relation to spontaneous closure, and association of muscular ventricular septal defects with other cardiac defects.

Previous studies on muscular ventricular septal defect (VSD) have not taken into account the specific defect location in the septum. We retrospectively reviewed all patients with a muscular VSD, with and without associated malformations, diagnosed over 32 months to determine the prevalence and rate of spontaneous closure of single defects in relation to location in the muscular septum. Defects were classified into 4 groups: midmuscular, apical, anterior, and posterior. Two hundred seven patients were identified, of whom 125 had a single defect. The relative prevalence of single muscular VSD was: midmuscular 55 (44%), apical 31 (25%), anterior 33 (26%), and posterior 6 (5%). Thirty patients had signs of spontaneous closure and only 1 underwent surgery. There was no difference in rate of closure with respect to anatomic locations. Patients with multiple muscular VSD were either referred for surgery in the first year of life or had a course similar to patients with a single VSD. Muscular VSD associated with other cardiac malformations was more often encountered in patients with conoventricular VSD and coarctation of the aorta. The distribution of anatomic groups of muscular VSD in association with malformations was similar to the single VSD.

Role of early postoperative surface echocardiography in the pediatric cardiac intensive care unit.

OBJECTIVE: To compare surface echocardiographic data with catheterization and surgical observation as a way of deciding on the need to reoperate to correct hemodynamically important sequelae following pediatric cardiac surgery; to determine the false-negative diagnosis rate of surface echocardiography. DESIGN: Case series. SETTING: Tertiary-care center, pediatric cardiac intensive care unit. PATIENTS: All 39 patients who underwent reoperation because of hemodynamically significant anatomic sequelae following primary or elective secondary surgery in 1 calendar year. INTERVENTIONS: None. MEASUREMENTS: Two-dimensional and color Doppler ultrasound assessment of anatomy and physiology following cardiac surgery. RESULTS: In 85 percent, surface echocardiography provided sufficient information for surgeons to reoperate on the same admission. Detection of important residual shunts or arterial stenoses and identification of anatomic causes of pulmonary undercirculation (or overcirculation) in palliated single ventricle are feasible. CONCLUSION: Early postoperative surface echocardiography is a viable way to decide on the hemodynamic adequacy of cardiac surgery.

Effect of volume unloading surgery on coronary flow dynamics in patients with aortic atresia.

OBJECTIVES: The objectives of this study were to define physiologic effects on and a clinical correlate to coronary blood flow during volume unloading surgery in patients with aortic atresia. METHODS: Twenty-two patients with aortic atresia (group I, 13 patients with stage I reconstruction undergoing hemi-Fontan operation; group II, 9 patients with hemi-Fontan undergoing Fontan operation) underwent perioperative transesophageal echocardiography. Doppler spectral patterns, peak velocity, velocity time integral, and blood flow in the native ascending aorta were measured. Preoperative hemodynamics and postoperative clinical data were analyzed. Significance was defined as p < 0.05. RESULTS: Higher values of coronary blood flow (982.9 +/- 321.7 vs 548.6 +/- 333.8 ml/min per square meter), velocity time integral (20.7 +/- 5.6 vs 12.6 +/- 4.0 cm), and peak velocity (96.1 +/- 21.4 vs 51.0 +/- 18.2 cm/sec) were found before operation in group I than after operation and in group II at both times. Flow changed from predominately systolic in preoperative group I to both systolic and diastolic after operation and in group II. Before operation in groups I and II, a number of hemodynamic parameters such as superior vena cava oxygen saturation correlated with coronary blood flow dynamics. After operation in group II, urine output (r = 0.86) and central venous pressure (r = -0.85) correlated with coronary blood flow dynamics. CONCLUSION: Coronary blood flow parameters were higher in group I as a result of the increased energy needs required to pump to two circulations. No changes were found in group II. A number of coronary blood flow parameters correlated with preoperative hemodynamics and postoperative clinical data. These parameters appear to be useful in assessing the performance status of the myocardium after the Fontan operation, consistent with the notion that myocardial perfusion relates directly to ventricular function.

Concurrent parasitic infections in onchocerciasis and the occurrence of adverse reactions after ivermectin treatment.

Ivermectin is a safe, effective, and relatively well-tolerated drug for the treatment of human onchocerciasis. However, due to side effects of the drug, large-scale ivermectin distribution without medical supervision is not recommended. The mechanisms involved in the pathogenesis of ivermectin-induced adverse reactions are not yet known. Since onchocerciasis patients are likely to have concurrent parasitic infections, we investigated whether side effects that occur after ivermectin treatment could be related to the presence of parasite eggs and cysts in stool samples prior to treatment. One hundred twenty-nine onchocerciasis patients were treated with a single dose of ivermectin (150 micrograms/kg) and side effects were graded according to the classification of Greene and others. Stool samples were collected before and three days after treatment. A high percentage (80.5%) of the patients reported adverse effects (57% mild, 14.1% moderate, and 9.4% severe reactions). Most (95.1%) of the patients had one or more concurrent parasitic infections. No relationship could be found between the occurrence and extent of side effects and the severity of concurrent intestinal parasitic infections. However, side effects were significantly correlated with pretreatment microfilarial counts. Ivermectin treatment did not induce significant short-term changes in Trichuris trichiura or Schistosoma mansoni egg counts. However, a significant reduction in Ascaris lumbricoides egg counts and Entamoeba coli cyst loads was observed; a cure rate of 46% for cysts was reached. In contrast, hookworm egg production increased after ivermectin treatment. Further studies are required to verify ivermectin-induced changes in cyst and hookworm loads as well as the significance of these findings.

Mycetoma in the Republic of Niger: clinical features and epidemiology.

Mycetoma is a common disease in the Republic of Niger. In two hospitals 133 cases were observed. The major site of lesions was the foot. Actinomycetomata were seen more often than eumycetomata. Streptomyces somaliensis is prevalent in the north desert zone while Actinomadura pelletieri is common in the southern part of the country. Madurella mycetomatis, the usual etiologic agent of eumycetoma, is seen in both regions. The species incidence and distribution in Niger differs from those of the west and east African endemic areas.

Reactivity of various leishmanial antigens in a direct agglutination test and their value in differentiating post-kala azar dermal leishmaniasis from leprosy and other skin conditions.

A direct agglutination test (DAT) for the detection of post-kala azar dermal leishmaniasis (PKDL) was evaluated in conditions that simulate the disease clinically or immunologically. A reference strain of Leishmania donovani (LEM 1399), and antigen preparations from Leishmania isolates from Bangladeshi patients with post-kala azar dermal leishmaniasis or visceral leishmaniasis were used. A titre of at least 51,200 was obtained in tests of patients with PKDL with all three antigens, whereas a maximum titre of 1600 was recorded in patients with cutaneous leishmaniasis, mucocutaneous leishmaniasis or leprosy. Antigens from dermal isolates of L. tropica (LV 140) and L. braziliensis (LV 65) yielded titres of 1600-6400 in patients with PKDL. The lowest titre recorded in 70 patients tested with the homologous PKDL antigen was 409,600. In patients with leprosy, cutaneous leishmaniasis, syphilis, onchocerciasis, tuberculosis, blastomycosis or vitiligo, titres ranged from 100 to 1600. Tha DAT is better than current parasitological and histopathological methods for the diagnosis of PKDL in areas in which leprosy is co-endemic.

Changes in right ventricular geometry and heart rate early after hemi-Fontan procedure.

To document and quantitate changes in right ventricular (RV) geometry and heart rate, we prospectively examined 35 consecutive patients with hypoplastic left heart syndrome under steady-state conditions (chloral hydrate sedation) before and after a bidirectional cavopulmonary anastomosis (hemi-Fontan) procedure. Right ventricular end-diastolic volume (RVEDV) was calculated as the product of RV cavity areas in two orthogonal planes divided by RV maximal length in either plane. After the hemi-Fontan procedure, RVEDV decreased by 33% from 33 +/- 13 to 22 +/- 11 mL (mean +/- standard deviation). Indexed RVEDV decreased from 86 +/- 37 to 57 +/- 28 mL/m2. The RV wall thickness at the diaphragm in subcostal frontal view (RVWD) increased by only 11% from 8 +/- 0.2 to 9 +/- 0.2 mm (p = not significant), but RVWD/RVEDV increased by 111% from 0.36 +/- 0.22 to 0.76 +/- 0.69 mm/mL (p = 0.002). The RV anterior wall thickness in subcostal sagittal view (RVWA) increased by only 13% from 7 +/- 0.2 to 8 +/- 0.2 mm (p = not significant), but RVWA/RVEDV increased by 103% from 0.31 +/- 0.20 to 0.63 +/- 0.54 mm/mL (p = 0.002). In 11 of 35 patients (31%), resting heart rate did not change (118 +/- 14 versus 108 +/- 9 beats/min; p = not significant); however, in 24 of 35 patients (69%), heart rate increased significantly (108 +/- 9 versus 127 +/- 10 beats/min; p = 0.05). In conclusion, RV wall thickness is high before the hemi-Fontan procedure and increases slightly in the first postoperative week.(ABSTRACT TRUNCATED AT 250 WORDS)