Cholesterol screening among children and their parents.

BACKGROUND: The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project is designed to test the hypothesis that universal cholesterol screening of prepubertal schoolchildren is effective in identifying children and their parents at risk of developing premature coronary heart disease (CHD) in a high-risk rural population. METHODS: Seven hundred nine fifth-grade schoolchildren from seven rural Appalachian counties participated in a school-based cholesterol screening program. Family history of premature CHD, anthropometric and blood pressure measurement, tobacco smoke exposure, dietary history, and physical activity levels were collected. RESULTS: One-fourth (174) of the children were "presumptively" dyslipidemic upon measurement of nonfasting finger-stick blood cholesterol (FSC). Subsequent fasting lipid profile obtained for 63 of these children and 79 of their parents confirmed the presence of dyslipidemia in 37 children (59%) and 52 parents (66%). Among confirmed dyslipidemic children, family history was not a good predictor of dyslipidemia (sensitivity 21.6%). FSC levels were significantly correlated with fasting total cholesterol of children and their parents. CONCLUSIONS: Universal nonfasting FSC screening of prepubertal schoolchildren is effective in identifying dyslipidemic children and their parents, whereas family history has low sensitivity in predicting children with elevated blood cholesterol concentrations.

Coronary Artery Risk Detection in Appalachian Communities (CARDIAC): preliminary findings.

West Virginia's mortality and morbidity from cardiovascular disease (CVD) is among the highest in the developed world. Appalachia, and West Virginia in particular, could reduce the high prevalence of premature coronary heart disease (CHD) by addressing modifiable independent risk factors such as poor nutrition, sedentary lifestyle, and tobacco use. School-based health promotion programs have been shown to be an effective means of influencing student and parental health behavior. The pilot phase of the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project substantiated an alarmingly high incidence of CVD risk factors among 347 fifth grade children from three rural counties, and was also an effective means of identifying parents at risk of developing CHD. Utilization of the innovative Rural Health Education Partnerships (WVRHEP), coupled with a health conscious public school system, offers a unique opportunity to establish the first statewide cardiovascular disease community intervention project in the nation.

Estrogen-induced relaxation in bovine coronary arteries in vitro: evidence for a new mechanism.

Numerous studies have shown estrogen to be vasoactive in various circulations. Our objective was to determine the effect of estrogen on isolated bovine coronary arteries and the possible mechanism. Bovine coronary arteries, precontracted with thromboxane mimetic U46619 were given doses (0.01-30 microM) of 17B-estradiol in the presence and absence of endothelium and these inhibitors: 10 microM indomethacin (cyclooxygenase inhibitor), 10 microM methylene blue (inhibits soluble guanylate cyclase), 100 microM nitro-L-arginine (inhibits nitric oxide synthesis), 100 microM isobutylmethylxanthine (phosphodiesterase inhibitor) and 30 microM mifepristone (Ru38486 steroid receptor antagonist). Our results indicated that, estrogen, in the highest concentration used (30 microM), elicited an acute dose-dependent relaxation of bovine coronary arteries from 4%-68% (n = 15). No major difference in relaxation was observed between coronary arteries with or without endothelium, indicating that the mechanism was endothelium-independent. Indomethacin, nitro-L-arginine and methylene blue did not alter this relaxation, suggesting that relaxant prostaglandins, l-arginine products and cGMP are not involved (n = 11-16), isobutylmethylxanthine enhanced relaxation from 20%-40% (n = 15 p < 0.01), suggests a role for cAMP. Furthermore, mifepristone reduced the relaxation by more than 50% (n = 15 p < 0.05) consistent with the role for estrogen receptors. Based on our study, estrogen causes a dose-dependent relaxation of bovine coronary arteries that does not appear to utilize endothelium, prostaglandins, cGMP or arginine products, but may involve cAMP and estrogen receptors. This study may help justify treating myocardial ischemia with estrogen.

Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists.

In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p = 0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p = 0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs. 72/94), with a better specificity, 55% vs. 76% (p = 0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p = 0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent.

Childhood acute rheumatic fever: a comparison of recent resurgence areas to cases in West Virginia.

A resurgence of acute rheumatic fever (ARF) was noted over the last 10 years in several areas of the United States. West Virginia was no exception with two reports appearing in the literature confirming an increased incidence in the 1980s among children and adults. The Pediatric Cardiology Division of West Virginia University Children's Hospital had 30 cases of ARF referred between 1980 and 1995, and surprisingly 27 of these cases had been diagnosed since 1986. This article describes our chart review of these 30 cases which studied epidemiological aspects, diagnostic criteria and regional differences by chi-square analysis. Other issues we present include "silent" mitral regurgitation and the unreliability of a history of a recent pharyngitis with or without appropriate antibiotic therapy while considering ARF in the differential diagnosis.

Partial characterization of an erythropoiesis inhibitory factor.

An inhibitory factor of erythropoiesis, obtained from normal human urine, is indicated to be a complex of a fragment of alpha 1-acid glycoprotein and prostaglandin F2 alpha. Immunoelectrophoresis reveals two protein components in the EIF complex which separate during acrylamide gel electrophoresis. A gamma-globulin (MW 185,000) is a carrier of the complex. A fragment of alpha 1-acid glycoprotein (MW 9300) retains the inhibitory factor, PGF2 alpha. Noncovalent forces bind the PGF2 alpha to the protein, and PGF2 alpha can be extracted with benzene.

An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava.

The surgical management of 15 patients with partial anomalous pulmonary venous connection (PAPVC) to the high superior vena cava (SVC) is described. This new technique redirects the anomalous pulmonary venous flow into the left atrium through the cardiac end of the SVC, transected and oversewn above the anomalous pulmonary vein or veins, by coaptation of the atrial septal defect (or of the surgically created septal defect in patients with an intact atrial septum) to the intracardiac orifice of the SVC. Normal SVC-right atrial flow is reconstituted by atriocavoplasty to the cephalad portion of the transected SVC. A 31-year-old woman with severe pulmonary hypertension died early in the series; this was the only death. Surviving patients enjoy full activity. Except for one symptomatic SVC obstruction due to technical error (since relieved), this technique has achieved total correction of these congenital defects with marked reduction in the undesirable postoperative sequelae often associated with other methods of repair.

Lysosomal glycogen storage disease without acid maltase deficiency.

We studied two brothers with lysosomal glycogen storage disease without acid maltase deficiency in skeletal muscle. Although no specific biochemical defect was identified, a characteristic clinical picture emerged from evaluation of these siblings and two other previously reported patients. The syndrome is manifested by proximal muscle weakness, hypertrophic cardiomyopathy, probable intellectual impairment, and possible liver involvement.

Indomethacin for closure of patent ductus arteriosus in prematures.

A controlled, double blind trial of indomethacin versus placebo was conducted in prematures of birth weight less than 1750 g, with a murmur of patent ductus arteriosus (PDA). The dose of indomethacin was 0.2 mg/kg for 2 doses, orally, 24 hours apart. Forty-seven patients entered the trial. Twenty-four received indomethacin and 12 of these met the criteria for response; 23 received the placebo and two met the criteria for response (p less than 0.01). Subsequent surgical ligation for symptomatic PDA was required in 13 of 23 in the placebo group and 4 of 24 in the indomethacin group (p less than 0.01). When administered early, indomethacin is moderately effective in closing PDA in premature infants.

Patent ductus arteriosus in premature infants: a review of current management.

Problems related to the ductus arteriosus confront the pediatrician more than any other isolated cardiac defect. Due to increased awareness of the problems of prematurity, the reported frequency of patent ductus arteriosus increased threefold between 1970 and 1975. Aggressive therapy directed toward closure of the ductus is indicated within the first week of life in the very immature infant. Pharmacologic closure of the PDA with indomethacin is effective about half the time.

Inhibition of Friend virus (FVP)-induced murine erythropoiesis with prostaglandin (PGF2 alpha): potentiation and inhibition of erythropoietin and prevention of both with PGD2.

An erythropoietin-independent virus-induced murine erythroleukemia (FVP) is used to compare the effects of an erythropoiesis inhibitory factor (EIF) isolated from human urine with the effects of prostaglandin F2 alpha. The consequent inhibition of FVP-induced erythropoiesis suggests that EIF and PGF2 alpha have similar effects on the FVP-induced erythropoiesis in mice, and the effect of PGF2 alpha is indirect. The similarity of the actions of EIF and PGF2 alpha may indicate a potential role for prostaglandins in the physiological control of some types of erythrocytosis.