Transient Myocardial Thickening in Cats Associated with Heart Failure.

BACKGROUND: Cats with hypertrophic cardiomyopathy (HCM) and congestive heart failure (CHF) can have resolution of both left ventricular hypertrophy and CHF. OBJECTIVES: To describe the clinical characteristics of cats with transient myocardial thickening (TMT) and CHF compared with a control population of cats without resolution of HCM. ANIMALS: A total of 21 cats with TMT, 21 cats with HCM. METHODS: Retrospective study. Clinical records at 4 veterinary centers were searched for TMT cases and a control group of cats with HCM and CHF. TMT was defined as initial maximal left ventricular wall thickness (LVWT) ≥6 mm with left-sided CHF, with subsequent resolution of CHF, reduction in left atrium/aorta (LA/Ao), and LVWT<5.5 mm. HCM was defined as persistent LVWT ≥6 mm. RESULTS: Cats with TMT were younger (2 [0.4-11.4] years) than cats with HCM (8 [1.6-14] years) (P < 0.0001), and antecedent events were more common (15/21 versus 6/21, respectively) (P = 0.01). In cats with TMT, LVWT normalized from 6.8 [6.0-9.7] mm to 4.8 [2.8-5.3] mm and LA/Ao decreased from 1.8 [1.6-2.3] to 1.45 [1.2-1.7] after a mean interval of 3.3 (95% CI: 1.8-4.7) months. CHF recurred in 1 of 21 TMT and 15 of 21 cats with HCM. Cardiac treatment was discontinued in 20 of 21 cats with TMT and 0 of 21 HCM cats. All cats with TMT survived, whereas 8 of 19 cats with HCM died during the study period. CONCLUSIONS AND CLINICAL IMPORTANCE: TMT occurs in younger cats, and antecedent events are common. The prognosis is better in cats with CHF associated with TMT than HCM.

Cardiac pathology findings in 252 cats presented for necropsy; a comparison of cats with unexpected death versus other deaths.

OBJECTIVES: To report necropsy and myocardial histopathology in cats with unexpected death and expected death/euthanasia, comparing findings in 4 groups of cats: unexpected death with noncardiac disease (UD-NC); unexpected death with cardiac disease (UD-C); expected death/euthanasia due to noncardiac disease with incidental cardiac disease (OD + HD); and expected death/euthanasia due to congestive heart failure (CHF). ANIMALS: Two hundred fifty-two cats undergoing necropsy at a single centre. METHODS: Signalment, history, body weight, heart weight and myocardial thickness were obtained from medical records. Cardiac histopathology slides were reviewed blindly by a single observer. Data were analysed using a Chi squared, Fisher's exact, Kruskal-Wallis tests or ANOVA as appropriate. RESULTS: Death at a veterinary clinic and suspected poisoning were the most common reasons for necropsy in 158 cats with an unexpected death. No cause other than cardiac disease was found in 87/158 (55.1%), with hypertrophic cardiomyopathy identified in 68/87 (78%) of UD-C cats. Expected deaths or euthanasia occurred in 27 cats with CHF and 67 cats with concurrent heart disease (OD + HD). Myofiber disarray, interstitial fibrosis, subendocardial fibrosis and intramural arteriolosclerosis were more prevalent in UD-C cats than in UD-NC cats, and subendocardial fibrosis and arteriolosclerosis were more prevalent in UD-C cats than in CHF and OD + HD cats. CONCLUSIONS: Cardiac disease, and hypertrophic cardiomyopathy in particular, was commonly present in cats that died unexpectedly in this study population. Subendocardial fibrosis and intramural arteriolosclerosis were more common in cats with unexpected death with cardiac disease than in other cats.

Alcohol consumption is associated with alterations in macrophage responses to interferon-gamma and infection by Salmonella typhimurium.

Abuse of ethanol (EtOH) by human beings and administration of EtOH to experimental animals has been shown to be associated with a suppression of the immune system. Consumption of EtOH has also been associated with an increased incidence and severity of infections of human beings and experimental animals, which has been attributed to the immunosuppression associated with EtOH consumption. It has been shown that EtOH also affects the function of macrophages (MØ), which are important effector cells in the innate and adaptive immune responses to infectious agents. The present studies were designed to investigate the effects of EtOH on MØ function with an animal model of EtOH consumption. The experiments reported in this paper were done with inflammatory MØ and were designed to determine the effects of EtOH on the ability of inflammatory MØ to respond to interferon-gamma (IFN-gamma) to control the intracellular growth of Salmonella typhimurium, as well as the production of proinflammatory cytokines and nitric oxide. The ability of MØ from EtOH-fed mice to respond to bacterial endotoxin (lipopolysaccharide (LPS)) and IFN-gamma was also evaluated. MØ isolated from EtOH-fed mice did not respond as well to IFN-gamma as MØ isolated from control mice as measured by control of S. typhimurium, as well as tumor necrosis factor (TNF) and nitric oxide production. Interleukin (IL)-6 production was not affected. Activation of MØ from EtOH-fed mice with LPS and IFN-gamma produced levels of nitric oxide and TNF only slightly less than the levels seen in MØ from control mice, but a significant decrease in IL-6 was seen when MØ from EtOH-fed mice were stimulated with this combination. Flow cytometric analyses showed that IFN-gamma receptor expression was not affected by EtOH. Together the data presented in this paper show that consumption of EtOH is associated with changes in inflammatory MØ responses to IFN-gamma.

A demographic database for monitoring community life support skills.

Training in community life support has been shown to lessen the mortality from sudden myocardial events 1. Such community training is badly quantified and its efficacy difficult to prove. In a diversity of communities in the West of Scotland emergency life support (ELS) training schemes have been set up in localities ranging from isolated islands to urban centres with considerable social disadvantage. An Access database 2 was created that has captured demographic data about those trained. This simple technique, with data-capture from a wide range of lay trainers, is demonstrating at its crudest exactly how many have been trained. It can show population rates of training and compare these with the international target of 20% of the population. It highlights the age bands of those trained and whether the socially disadvantaged are having equitable training. UK Post-code (Zip-code) has in parallel with other Scottish work 3 been used as a proxy for social circumstances. The greatest value of the database is that it is ready to be married up with national data from the Scottish Ambulance Service and allied studies 4 to show over time how effective the training is in altering mortality. The effort in creating and maintaining such an epidemiological database requires faith. It is the "posterity planting" of modern public health medicine.

The national health demonstration projects.

The White Paper Towards a Healthier Scotland pledged 15 million Pounds to support four national health demonstration projects to lead the way in achieving sustained improvement in child health, young people's sexual health, coronary heart disease and cancer. The Starting Well project aims to demonstrate that child health in Glasgow can be improved by a programme of activities which both supports families and provides them with access to enhanced community-based resources. The Healthy Respect project aims to help young people in Lothian develop a positive attitude to their own sexuality and that of others, and a healthy respect for their partners, in order to reduce unplanned teenage pregnancies and sexually transmitted infections. The Have a Heart Paisley project is targeting coronary heart disease among the population of Scotland's largest town. The Cancer Challenge project is piloting a screening programme in the North East of Scotland for the detection of colorectal cancer. Though each project has specific objectives, appropriate to its own topic, all share underlying principles. The projects will act as test beds for action and a learning resource for the rest of Scotland.

Lewis rat EAN is suppressed by the 21-aminosteroid tirilazad mesylate (U-74006F).

Lewis rat experimental allergic neuritis (EAN) was treated with the 21-aminosteroid, tirilazad mesylate (U-74006F). High doses of tirilazad mesylate, begun just before the onset of clinical signs, reduced the clinical and pathological severity of the disease. In rats immunized with a high dose of myelin, axonal degeneration was a major pathological feature. Tirilazad mesylate reduced the amount of axonal degeneration but had little effect on the other pathological features of EAN, such as inflammation and demyelination. Tirilazad mesylate may block axonal degeneration by inhibiting lipid peroxidation of axonal membranes. Inhibition of axonal degeneration is an important goal in the treatment of human neuropathies.

Antigalactocerebroside antibody increases demyelination in adoptive transfer experimental allergic neuritis.

There is suggestive but inconclusive evidence for a contribution of T cells and antimyelin antibodies to the pathogenesis of the Guillain-Barré polyneuropathy. We have studied the potential synergism of cellular and humoral immunity in the adoptive transfer model of EAN. EAN was induced in Lewis rats by injecting varying doses of P2 peptide (SP26)-sensitized T lymphocytes. Disease severity was dose-dependent. The addition of intravenous GC-AB to a subclinical dose of SP26-sensitized T cells resulted in overt clinical disease and markedly enhanced demyelination. Intravenous injection of antibody alone had no effect. We conclude that activated neuritogenic T cells, while entering into peripheral nerves, alter the blood-nerve barrier, which gives circulating demyelinating antibodies access to the endoneurium. The observations support the concept of a synergistic role of T-cell autoimmunity and humoral responses in the inflammatory demyelination of Lewis rat EAN.

Adoptive transfer of experimental allergic neuritis in the immune suppressed host.

Experimental allergic neuritis (EAN) was induced in normal and irradiated Lewis rats by passively transferring T cells sensitized to SP-26, a peptide fragment of P2 myelin protein. The recipients became sick 4-8 days post transfer and the degree of disability correlated directly with the dose of T cells. Smaller doses caused demyelination of nerve roots and sciatic nerves and larger doses produced more severe demyelination and significant axonal degeneration. Irradiated recipients developed similar clinical EAN and showed macrophage-mediated demyelination despite severe suppression of the host inflammatory response.

P2-peptide induced experimental allergic neuritis: a model to study axonal degeneration.

In experimental allergic neuritis (EAN) severity of clinical disease and pathology correlate with the dose of antigen (Hahn et al., Lab Invest 59:115-125, 1988). To avoid axonal membrane contamination of the antigen, EAN was induced with a synthetic peptide, corresponding to residues 53-78 of bovine P2 myelin protein. Severity of EAN correlated with the dose of peptide in the inoculate. The relationship between demyelination, inflammation and axonal degeneration was studied. Low doses resulted in pure demyelination. Axonal degeneration occurred only with high doses of antigen and in association with very active mononuclear inflammation. The role of macrophages in producing axonal damage is discussed.

Spontaneous regression of squamous cell lung carcinoma with adrenal metastasis.

A 61-year-old man was found to have squamous cell carcinoma of the left hilum with metastasis to the left adrenal gland documented by needle aspiration. About two years later, the primary tumor is not detectable, and the adrenal gland is of normal size on follow-up computerized tomography. To our knowledge, this is the first documented case of spontaneous regression of squamous cell carcinoma of the lung with adrenal metastasis.

Pre-treatment with beta blockers and the frequency of hypokalaemia in patients with acute chest pain.

Plasma potassium concentration was measured at admission in 1234 patients who presented with acute chest pain. One hundred and ninety five patients were on beta blockers before admission. The potassium concentrations of patients admitted early (within four hours of onset of symptoms) were compared with those admitted later (4-18 hours after onset of symptoms). There was a transient fall in plasma potassium concentrations in patients not pre-treated with beta blockers. This was not seen in patients who had been on beta blockers before admission. Non-selective beta blockers were more effective than cardioselective agents in maintaining concentrations of plasma potassium. These findings suggest a mechanism for the beneficial effects of beta blockers on morbidity and mortality in acute myocardial infarction.

Measurement of free palmitic acid in human bile.

Free palmitic acid has been measured in gallbladder bile from patients undergoing surgery for cholelithiasis. The mean concentrations were 0.079 and 0.038 mmol/1 for patients with functioning and non-functioning gallbladders respectively the 2 concentrations differed significantly. None of the patients had palmitic acid or calcium palmitate in their gallstone.

Ionised calcium in pathological human bile.

An automated ion-selective electrode system has been used to measure ionised calcium in bile from patients undergoing cholecystectomy for gallstones. Ionised calcium ranged from 0.63 to 1.73 mmol/l for a range of total calcium concentrations of 1.35 to 10.93 mmol/l. The correlation coefficient for ionised calcium regressed on total calcium was highly significant (r = 0.97). The slope of the line was 0.126 and the intercept 0.443.

Change in bile secretion in patients with calcium carbonate in their gallstones.

Common duct bile in patients with gallstones contains virtually no amylase activity. Therefore the raised levels of total CO2 concentrations found in common duct bile from patients with some calcium carbonate on the surface of their gallstones do not result from a reflux of pancreatic juice. A change in bile secretion is the likely explanation.

The estimation of pyrophosphate in urine with uridine-5'-diphosphoglucose pyrophosphorylase.

The concentration of pyrophosphate in urine has been determined using the enzyme uridine-5'-diphosphoglucose pyrophosphorylase. The technique is relatively quick and easy to perform. Reproducibility of results was good, and results from recovery experiments were excellent. The mean concentration of pyrophosphate found in early morning urine samples from 14 normal adults was identical with that reported by other workers using an ion-exchange method to measure pyrophosphate. The pyrophosphate concentration was related approximately to the phosphate concentration.

Calcium carbonate in human gallstones and total CO2 in bile.

Measurement of total CO2 concentrations in bile from patients undergoing cholecystectomy because of gallstones has shown that the presence of calcium carbonate in the stones can be associated with a raised total CO2 concentration in the common duct bile. In bile from functioning and poorly-functioning gallbladders, total CO2 was nearly always related to pH irrespective of stone composition.

Calcium in bile and calcium salts in gallstones.

In gallbladder and common duct bile from patients undergoing cholecystectomy, usually because of gallstones, calcium was found to exist in at least 2 forms. Ultrafiltration showed some calcium was bound to substances with a molecular weight greater than 10 000, and the chief binding agent is likely to be the mixed micelle. Bound calcium was significantly less in common duct bile than in bile from functioning gallbladders, but the amount of ultrafiltrable calcium was the same. Furthermore, ultrafiltrable calcium in gallbladder bile from patients with cholesterol or some calcium carbonate in their gallstones was almost constant for a range of total calcium concentrations of 2.40--9.70 mmol/l. Comparison of ultrafiltrable and total calcium values for the different types of stone-formers showed that the deposition of calcium carbonate in gallstones was not related to any calcium measurement made. However, the presence of calcium phosphate and/or calcium bilirubinate in gallstones could be related to a significant increase in ultrafiltrable calcium in gallbladder bile.

The crystalline salts of calcium bilirubinate in human gallstones.

1. The acid, neutral and "intermediate" salts of calcium bilirubinate have been synthesized. 2. All are crystalline, and the intermediate salt which has 1 1/2 molecules of bilirubin per calcium atom probably has a crystal structure containing molecules of both acid and neutral salts. 3. The acid or intermediate salts have been found in 14 out of 70 gallstones analysed recently by X-ray diffraction.

Inorganic phosphorus in human bile.

The inorganic phosphorus concentration has been measured in fresh bile from patients undergoing cholecystectomy, usually because of cholelithiasis. The amount in common duct bile for patients with cholesterol on the stone surface was significantly higher than that for patients with some calcium carbonate in this area. For all patients with functioning gallbladders, inorganic phosphorus in gallbladder bile was always higher than that in the corresponding common duct bile. In bile from functioning gallbladders, inorganic phosphorus was linearly related to pH for cholesterol stone-formers, but values for calcium carbonate stone-formers were below the regression line and not related to pH. The results show that bile from calcium carbonate stone-formers is more dilute with respect to inorganic phosphorus.

Diurnal variations in the pH of pathological gallbladder bile.

The pH of gallbladder and common duct bile from patients undergoing surgery for cholecystectomy has been measured. The bile was collected and kept anaerobically at 37 degrees C, and the pH measured at 37 degrees C, generally within 30-60 minutes of the bile being taken from the patient. Only data from patients having functioning or poorly-functioning gallbladders were included in the calculations. The pH of common duct bile was always greater than that of the corresponding gallbladder bile, and the data available suggest that it does not vary diurnally. The mean pH of gallbladder bile from patients undergoing their operation at different times during the day shows a diurnal variation, the bile becoming more acidic with time. Furthermore, there is also a diurnal variation in the activity of the acidifying process. Data for the patients suggest this is retarded by sleep, inactivity, or lying down.