[Requests for online consultations on the operative reconstruction of the hymen--data from the university hospital Zurich and the children's hospital Zurich]. / Anfragen an Online-Arzte über die Möglichkeit einer operativen Rekonstruktion des Hymens: Datenerhebung am Universitäts- und am Kinderspital Zürich.

The "reconstruction of the hymen"consists in a surgical suture of the seam of a hymen that has been fissured due to vaginal intercourse or other causes. This intervention aims at triggering bleeding on the occasion of the next intercourse, a phenomenon often required as proof of virginity within certain traditions. Valid data regarding this ethically and medically controversial and predominantly tabooissue is scarce. In an effort to further explore this practice, we have collected information about hymenorrhaphy from the databases of two anonymous, medical, online counselling services provided by the University Hospital Zürich, and explicitly for teenagers by the Children's Hospital Zürich. We found a sample of 22 questions from women seeking advice, and the results vividly illustrate the psycho-social dilemma these women face, prompting us to suggest that further ethical discussion, collection of empirical data and broad public education on issues related to sexuality are necessary.

[How to follow-up on the recommendations of the ESH/ESC guidelines for different kinds of blood pressure measurement methods]. / Umsetzung der ESH/ESC-Hypertonie-Richtlinien mithilfe verschiedener Blutdruckmessmethoden.

Better understanding of epidemiology and pathophysiology of arterial hypertension has resulted in new definitions of blood pressure levels and treatment targets. The main reason for worldwide modest outcomes in the treatment of hypertension is suboptimal drug treatment including incomplete dose titration and an inadequate antihypertensive drug combinations. New techniques such as teletransmission of home blood pressure measurement together with ambulant 24-hour-blood-pressure-monitoring could serve as a solution to provide the physician the opportunity for an adequate antihypertensive therapy, in order to improve drug compliance and to shorten the time until reaching optimal blood pressure.

Vitamin E prevents extensive lipid peroxidation in patients with hypertension.

Oxidative modification of low-density lipoprotein (LDL) increases atherogenic potential to induce the accumulation of lipids and cells in the vascular wall. Previous studies reveal that hypertensive patients have a higher susceptibility to LDL oxidation. As animal models indicate that vitamin E protects LDL from oxidation, here we study the influence of vitamin E on the resistance of LDL to oxidation (lag time) in 47 subjects (31 normotensive, 16 hypertensive) before and after oral administration of vitamin E (400 IE) daily for two months. LDL was isolated and oxidised by incubation with copper ions. The time course of oxidation was measured by continuous photometric monitoring of diene formation at 234 nm. At the beginning of this study, normotensive subjects showed a lag time of 108 +/- 26 minutes and hypertensive patients a lag time of 85 +/- 24 minutes (P<0.05). Vitamin E caused a significant increase in the lag time in both groups: normotensive subjects 128 +/- 33, hypertensives patients 114 +/- 27 minutes (P<0.01). At completion of the study, lag times in both groups were similar (P=not significant). The data presented here suggests that vitamin E protects against the increased risk of vascular disease in patients with hypertension by reducing the susceptibility to oxidative modification of LDL. Vitamin E may therefore act as an inhibitor of atherogenesis.

ICD implantation with and without combined myocardial revascularisation--incidence of ICD therapy and late survival.

BACKGROUND: Our aim was to evaluate the occurrence of implanted cardioverter-defibrillator (ICD) shock and antitachycardia pacing (ATP), the effect of ICD therapies on mortality and the impact of revascularisation strategies on arrhythmic events. PATIENTS AND METHODS: We investigated 130 CAD patients undergoing ICD implantation between 1984 and 1999. RESULTS: Freedom of shock was 66 +/- 7 %, 48 +/- 9 % and 48 +/- 9 % after 1, 3 and 5 years in patients with revascularisation and 62 +/- 8 %, 43 +/- 8 % and 23 +/- 11 % in patients without revascularisation, respectively; p = n. s. Freedom from ATP was similar in both groups - in patients with revascularisation, 64 +/- 6 %, 58 +/- 7 % and 58 +/- 7 % and without revascularisation 56 +/- 8 %, 51 +/- 9 % and 38 +/- 10 %, respectively; p = n. s. There were no significant differences in cumulative survival between patients with and without revascularisation; p = n. s. CONCLUSIONS: CAD patients with VT/VF and with implanted ICD have, despite successful revascularisation, the same rate of device therapy and mortality as patients without an indication of revascularisation. This implies that patients with chronic ischemic heart disease and ventricular tachyarrhythmias continue to be at risk of sudden death after CABG/PTCA; evaluation for ICD implantation is warranted.

LDL-oxidation and -subgroups in normo- and hypertensive patients with and without a family history of hypertension.

OBJECTIVES: Oxidative modification of low-density-lipoprotein (LDL) increases its atherogenic potential to induce the accumulation of lipids and cells in the vascular wall. Patients have different lipoprotein profiles according to their LDL-subgroup pattern. The subgroup of LDL, which is most susceptible to oxidation, is most likely the dense LDL3 subfraction. In order to study an assumed association between hypertension, LDL subgroup distribution and the susceptibility of LDL to oxidation, 14 normotensive patients without family histories of hypertension (NT), 13 normotensive patients with family histories of hypertension (NT-FH), 10 hypertensive patients without family histories of (HT) and 11 hypertensive patients with family histories of hypertension (HT-FH) were evaluated. PATIENTS AND METHODS: LDL was oxidatively modified by incubation with copper ions (1.6 microM/L). The course of LDL-oxidation was measured in vitro by continuous photometric monitoring and the quantitative distribution of 3 LDL-subgroups by capillary isotachophoresis (ITP). RESULTS: The lag-phases of NT-FH and hypertensive patients were shorter than those of the control group (NT: 116 +/- 36 minutes; NT-FH 92 +/- 32 minutes, p < 0.05; HT: 95 +/- 41 minutes; HT-FH: 76 +/- 33 minutes, p < 0.05). Compared to NT a significant difference in the relative preponderance of LDL3 subgroup was observed for HT-FH (23.5 +/- 4.6% versus NT: 19.3 +/- 6.6%), additionally, statistical analysis showed a similar trend amongst the other patient groups (NT-FH: 20.4 +/- 7.4%, HT: 21.4 +/- 4.6%). CONCLUSIONS: The increased occurrence of the LDL3 subgroup might contribute to a higher susceptibility to LDL oxidation and therefore create an increased risk of vascular disease in the genotypic and phenotypic hypertensive patient population.

[Double aortic arch: clinical aspects, diagnosis and therapy in children and adults]. / Doppelter Aortenbogen. Klinik, Diagnose und Therapie bei Kindern und Erwachsenen.

Double aortic arch is a rare vascular anomaly which usually causes tracheal and esophageal compression in the first few months of life. During the last 30 years, 7 children, 2 to 24 months old, and one 29-year-old woman with double aortic arches have been treatedatour institution. Symptoms, diagnosis and treatment of these patients were evaluated. Dyspnoe, stridor, recurrent pulmonary infections, feeding problems and failure to thrive were the leading symptoms. Despite typical symptoms from early childhood, the diagnosis was missed in our adult patient. Typical compression of the esophageus and the trachea was visualized by esophagography by 7 and bronchoscopy/-graphy by 6 patients. Angiography was performed in all children, whereas magnetic resonance angiography and computed tomography were done in the adult patient. Resection of the smaller aortic arch, left in 3 and right in 5, through a right or a left posterolateral thoracotomy was uncomplicated and fully resolved the symptoms in all patients. Typical symptoms in early childhood should lead to prompt diagnosis and surgical treatment of double aortic arch. Surgical resection of the smaller aortic arch should also be performed in oligosymptomatic patients to prevent complications later. Preoperative angiography can be replaced by the less invasive magnetic resonance imaging and computed tomography.

Double aortic arch: diagnosis missed for 29 years.

Double aortic arch is a rare vascular anomaly which causes tracheal and esophageal compression usually in the first months of life. Typical symptoms in the early childhood should lead to prompt diagnosis and surgical treatment of this malformation. In adults this anomaly is extremely rare. A case of a severely 29-year-old symptomatic woman is presented. Despite characteristic symptoms, the diagnosis was missed during childhood. The importance of different diagnostic procedures and operative therapy is discussed. Preoperative angiography can be replaced by the less invasive magnetic imaging and computed tomography. Surgical operation should also be performed in oligosymptomatic patients to prevent late complications.