A method for the evaluation of interventions aimed at manipulation of infarct size is described. This method has 2 advantages over other methods: 1. Two small-to-medium sized coronary branches of the same heart are occluded and reperfused in sequence. Thereby a "control-infarct" can be compared with a "test-infarct", both within the same heart. 2. The amount of infarcted tissue in both areas is quantitated by using the p-NBT method. A condition of the method is that the areas of perfusion of both arteries are equal. Infarct size is always expressed as a percentage of the perfusion area of the occluded artery. Validation experiments with simultaneous occlusion and reperfusion of both arteries resulted in infarcts of equal size. Validation experiments with regard to the p-NBT method showed that reperfusion accelerates the washout of dehydrogenases from infarcted tissue which allows early and precise diagnosis of infarcts after relatively short occlusion- and reperfusion periods.

Animals↗

PubMedDate not supplied

Myocardial protection by collateral vessels during experimental coronary ligation: a prospective study in a canine two-infarction model.

Previous work of this laboratory has shown that collateral flow can be increased over six weeks by a subcritical external constriction of the circumflex artery causing a 50 +/- 10% reduction of postocclusive reactive hyperemia. To investigate collateral function in acute myocardial infarction, the model was used to ligate two distant coronary branches on the ventricle simultaneously in order to compare in 8 dogs infarct size and perfusion area of the ligated vessels in control and collateralized sections. The acute collateral flow measured 7.2 +/- 2.5 ml/100 g/min-1 and increased to 17.3 +/- 6.7 (p less than 0.001) over 6 weeks. Separate analysis revealed a predominant increase of collateral flow in the epicardial layers 23.1 +/- 7.5 (p less than 0.01) versus 6.9 +/- 2.8 (p less than 0.01) in the subendocardium. Infarct size in the control area was 52.0 +/- 14.7% of the perfusion area, in the collateralized zone 19.0 +/- 14.2% (p less than 0.001). Infarct size expressed as per cent of perfusion area and collateral flow in the area at risk expressed as per cent of flow of normal sections correlated: (r = 0.76; p less than 0.05). Therefore, infarct size after a 6 hour coronary occlusion can be considered a function of the collateral flow over normal perfusion ratio. Localized induction of collaterals in this model caused a significant reduction of infarct size in relation to the perfusion area at risk.

Animals↗

PubMedDate not supplied

Effect of myocardial oxygen consumption on infarct size in experimental coronary artery occlusion.

The influence of myocardial oxygen consumption (MVO2) at the moment of coronary occlusion on the size of the ensuing necrosis was investigated in 12 anaesthetised dogs. A two-infarction model was used with a sequential occlusion of two distant coronary branches in the same heart, however under different levels of MVO2. One group of occlusions was produced at a high MVO2 of 21.6 +/- 3.0 ml O2 . min-1 . 100 g-1. This group was compared with a second in which necrosis proceeded at a low MVO2 estimated to be 5.9 +/- 1.5 ml O2 . min-1 . 100 g-1 averaged over a 90-min occlusion period. Infarct size expressed as percentage of perfusion area was 43 +/- 28% in group 1 and 11 +/- 11% in group 2 (p less than 0.005). The mass of the perfusion area was equal in both groups (17 +/- 4 g, 19 +/- 6 g). The amount of myocardial necrosis, which after a 90-min occlusion depends on the acute collateral blood flow, was in every case greater under high MVO2. Thus a low MVO2 at the moment of occlusion can postpone myocardial necrosis.

Animals↗

PubMedDate not supplied

MR imaging of pediatric cardiac tumors previously diagnosed by echocardiography.

Ten children, ranging in age from 3 weeks to 11 years, with a history of primary cardiac tumors were studied by two-dimensional echocardiography and by ECG triggered magnetic resonance (MR) imaging (six of them had rhabdomyomas). Eighteen of 31 tumors with intracavitary extension diagnosed by echocardiography were detected by MR. In addition, three intracavitary tumors were found by MR but not by echocardiography. Only 2 of 15 intramural tumors detected by echocardiography were identified by MR. Magnetic resonance imaging is inferior to echocardiography in the detection of intramural rhabdomyomas, but superior in delineation of the intra- and extracardiac extension of nonrhabdomyomal tumors.

Child↗

PubMedDate not supplied

Prophylaxis and treatment of fungal infections with fluconazole in bone marrow transplant patients.

In an open study 31 patients undergoing bone marrow transplantation for various haematological diseases received fluconazole as prophylaxis or treatment of fungal infections. In 26 of these patients an antecedent oral prophylaxis with polyene antimycotics had failed to prevent infections with Candida species. Five of the 31 patients received fluconazole as primary prophylaxis because of non-compliance for polyene antimycotics. Fluconazole was administered orally at a daily dose of 100 mg and 200 mg, respectively (n = 29), or intravenously at a dose of 100 mg and 400 mg (n = 2). Cure or efficient prophylaxis was achieved in 22/31 patients (71%) after a median of 52 (9 to 493+) treatment days. In three patients (10%) Candida was eradicated but the infection reappeared 14-28 days after cessation of the drug; in 6 patients (20%) the infection was persistent or progressive. Four patients developed lethal Aspergillus infection while on fluconazole medication. A moderate and reversible elevation of liver function tests under therapy was observed in 9 patients and was possibly attributable to fluconazole in three of them (10%). One patient developed tremor which resolved after cessation of fluconazole. No other adverse drug reactions could be noted. We conclude that fluconazole is a relatively safe and effective drug for the prevention and treatment of superficial and, possibly, deep Candida infections in severely immunocompromised patients. However, it is presumably without preventive value in Aspergillus infections.

Adult↗

PubMedDate not supplied

Non-value of Aspergillus antigen detection in bronchoalveolar lavage fluids of patients undergoing bone marrow transplantation.

A commercially available antigen assay (Pastorex Aspergillus) was used to detect Aspergillus antigen in serial bronchoalveolar lavage (BAL) fluids and sera of patients undergoing bone marrow transplantation (six patients with autopsyproven aspergillosis and 10 control patients without evidence of fungal infection). Aspergillus antigen was not detected in 17 BAL fluids of the six patients with proven aspergillosis. In two of the six patients the assay gave positive results in serum specimens. Three of the 10 control patients showed reactive BAL fluids. It is concluded that the latex agglutination assay of BAL fluids has no value in the diagnosis of invasive (pulmonary) aspergillosis in patients undergoing bone marrow transplantation.

Adult↗

PubMedDate not supplied

[Value of microbiologic studies for diagnosis of post-enteritis reactive arthritis].

Reactive arthritis may develop within a period of some days until upto 3 weeks after infections with Yersinia enterocolitica, Yersinia pseudotuberculosis, Campylobacter jejuni/coli, Shigella and Salmonella. Intestinal infections with Klebsiella pneumoniae, Clostridium perfringens, Clostridium difficile, Cryptosporidium, Strongyloides stercoralis, Taenia saginata and Schistosoma mansoni are, in some cases, considered to be responsible for reactive arthritis. Detection of pathogenic bacteria in feces is generally most successful in the early stage of the infection. A large spectrum of special tests is required in order to detect all the causative agents and to ensure reliable results. It is therefore necessary that the laboratory is provided with information about the diagnostic object and the tentative diagnosis. The detection of serum antibodies to Y. enterocolitica, Y. pseudotuberculosis, C. jejuni/coli, and Schistosoma may suggest connections between infection and reactive arthritis.

Arthritis, Infectious↗