Algorithmic sequential decision-making in the frequency domain for life threatening ventricular arrhythmias and imitative artefacts: a diagnostic system

A preliminary study to approach the problem of reliably detecting life threatening ventricular arrhythmias in real time is described. An algorithm (DIAGNOSIS) has been developed in order to classify ECG signal records on the basis of the computation of four simple parameters calculated from a representation in the frequency domain. This algorithm uses a set of rules constituting an operative classification scheme based on the comparison of the parameters with a set of pre-established thresholds. This allows us to differentiate four general categories: ventricular fibrillation-flutter, ventricular rhythms, imitative artefacts and predominant sinus rhythm.

Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults

Shigellae have been shown to be highly susceptible to new quinolone agents, with average MICs for 90% of isolates of less than 0.1 microgram/ml. Because these agents also reach high concentrations in the stool after a single dose, the effectiveness of a single 800-mg dose of norfloxacin and of 5-day treatment with trimethoprim-sulfamethoxazole (TMP-SMX) were compared in a randomized trial. Patients with clinical dysentery received one of these treatment regimens, and clinical data and follow-up culture results were analyzed for patients whose stool culture on presentation grew shigellae. When 55 patients with shigellosis (26 treated with TMP-SMX, 29 treated with norfloxacin) whose bacterial isolates were susceptible to the antibiotic given were compared by treatment group, no significant differences were seen in days of illness (mean, 2.5 +/- 0.65 days with TMP-SMX and 2.0 +/- 0.47 days with norfloxacin; P = 0.200) or number of unformed stools after starting treatment (mean, 9.7 +/- 2.37 stools with TMP-SMX and 7.6 +/- 3.19 stools with norfloxacin; P = 0.312). Resistance in vitro to TMP-SMX was seen in 15% of Shigella isolates, whereas none was resistant to norfloxacin. Bacteriologic failure was found in 1 patient among 24 receiving TMP-SMX and in none of 25 patients receiving norfloxacin. One single dose of norfloxacin was as effective as 5 days of treatment with TMP-SMX in these adults with shigellosis.

Neuronal activity in the subcortically denervated hippocampus: a chronic model for epilepsy

Spontaneous and evoked field potentials and cellular discharges were studied in the subcortically denervated hippocampus of the freely moving rat. The fimbria fornix, the ventral hippocampal commissure, and the supracallosal afferent fibers were removed by aspiration, and recordings were made 3-5 months after the lesion. Two types of spontaneous interictal spikes were observed. Type 1 interictal spike had identical depth distribution to physiological sharp waves but they were shorter in duration (less than 40 ms), larger in amplitude (greater than 2.5 mV) and population spikes were riding on the main deflection. Type 2 interictal spikes were negative in the stratum oriens and positive in the pyramidal layer and stratum radiatum of both CA1 and CA3. The amplitude of both types of interictal spikes could exceed 6 mV. We suggest that interictal spikes were initiated randomly in different subpopulations of the CA2-3 region and the location of the initiating population burst determined the polarity and amplitude of the extracellular interictal spike. Repetitive stimulation of the perforant path (5 Hz, 6 s) evoked markedly uniform afterdischarges in both intact and fimbria fornix-deprived rats. The threshold of afterdischarges was significantly lower, the seizure spread to the contralateral hippocampus was slower, and secondary afterdischarges lasted significantly longer in the lesioned rats. We suggest that under physiological conditions the electrical stability of the hippocampus is ensured by the feed-forward inhibitory action of subcortical afferents. Removal of tonic inhibitory influences and/or sprouting of local axon collaterals allows extreme synchronization and reverberation of information in the entorhinal-hippocampal-entorhinal cortex circuitry. The presence of interictal spikes and increased susceptibility to seizures for several months after the lesion offers the fimbria-fornix-deprived hippocampus a useful chronic preparation to study the mechanisms of limbic epilepsy.

Electric activity in the neocortex of freely moving young and aged rats

Electroencephalographic activity of the neocortex was evaluated in young (5-7 months) and aged (26-28 months) rats. All animals in the aged group showed behavioral impairment in a spatial task (water maze). A neocortical electroencephalogram was derived simultaneously from 16 different neocortical locations and was subjected to spectral analysis. The frequency of occurrence and duration of high-voltage spindles was determined in two sessions, each involving a total of 30 min alert immobility. Changes in spectral characteristics and high-voltage spindles in response to scopolamine administration were also evaluated. The power of high-frequency activity (8-20 Hz) was significantly reduced in the aged subjects. This was greatest in the temporo-occipital regions, while no significant changes were seen in the mediofrontal region. Scopolamine resulted in a large power increase in all frequency bands, but the increase in the higher-frequency range (8-20 Hz) was significantly less in the aged group. The incidence of high-voltage spindles was 6 times higher and their total duration was 9 times longer in aged rats, with virtually no overlap with the young group. In young rats, scopolamine increased the incidence and total duration of high-voltage spindles, while it decreased both parameters in the aged subjects. Cholinergic neurons in the nucleus basalis appeared shrunken in the aged animals. These findings demonstrate that reliable electroencephalographic changes are present in the neocortex of the aged rat, and that some of the physiological alterations may be due to the pathological changes in the cholinergic nucleus basalis.

Hunter's syndrome: a study in airway obstruction

Hunter's disease is a genetically transmitted defect known to produce mucopolysaccharide infiltration of multiple organ systems. Upper airway obstruction is caused by an enlarged tongue, deformed pharynx, and short, thick neck. Its eventual lethal outcome by the second decade of life is known to result from an infiltrative cardiomyopathy leading to irreversible heart failure. Instead, our recent experience in the care of five patients with this disorder suggests the lethal event is related to progressive obstruction sequentially involving the upper, mid, and lower airway characterized by gradual deformation and collapse of the trachea. Autopsy and histopathologic whole organ sections demonstrate anteroposterior flattening of the trachea and bronchi with submucosal thickening producing structural alterations known only to this disease.

Epstein-Barr viral serology in nasopharyngeal carcinoma patients in the USSR and Cuba, and its value for differential diagnosis of the disease

Serological responses to Epstein-Barr virus (EBV)-associated antigens were studied in nasopharyngeal carcinoma (NPC) patients in 2 countries non-endemic for the disease: the USSR (77 cases) and Cuba (55 cases). Two age- and sex-matched control groups were available, one consisting of patients with other head-and-neck tumours (OHNT) (171 from the USSR and 56 from Cuba), and the other of normal individuals (blood donors) (83 from the USSR and 80 from Cuba). Unlike the control groups, NPC patients from both countries had high levels of IgG and IgA antibodies, similar to those seen in patients from endemic areas. The only difference between NPC patients in the USSR and those in Cuba was lower (2-2.5 fold) anti-VCA IgG and IgA antibody titres. Using one-factor and multi-factor statistical methods the diagnostic value of different titres of EBV-specific IgG and IgA antibodies and their combinations for NPC patients (in the USSR) was evaluated. It was found that with simple mathematical analysis of EBV-specific antibody titres a differential diagnosis of NPC could be made to a significance level of 90%. The data obtained demonstrated the importance and reliability of EBV serology in the diagnosis of NPC in areas of low incidence of the disease.

[Cirrhosis caused by thorotrast: apropos of a case]

We present the clinical case of a female patient with cirrhosis of the liver. The radiografic and histopathological studies demonstrated that de etiology of this cirrhosis was in relation with the use of thorotrast given during angiografic studies which the patient underwent 35 years ago.

The effects of three different regimens of oral contraceptives and three different intrauterine devices on the levels of hemoglobin, serum iron and iron binding capacity in anemic women

The effects on hemoglobin, iron and iron binding capacity (IBC) in 150 moderately anemic women of 1) a 21-day low-dose combined pill, 2) the same low-dose combined pill for 21 days, followed by 7 days of an iron-containing pill, 3) the same low-dose combined pill administered for 63 consecutive days, followed by 7 days of no pill intake, 4) Lippes IUD, 5) TCu 220C and 6) Progestasert were studied. The three pill regimens were associated with an increase in hemoglobin and serum iron after 12 months. However, the iron pill and 63-day schedule groups produced an increase in hemoglobin and iron at the 6th month ans a diminution of IBC at 12 months. The Lippes and TCu 220C groups did not show any change in hemoglobin, iron or iron binding capacity after 12 months. The Progestasert group showed an increase in hemoglobin and iron levels at 6 and 12 months, and a diminution of IBC at 12 months. The pill and Progestasert have advantages as contraceptives in anemic women.

Bioavailability of iron- and copper-supplemented milk for Mexican school children

Fortification of dairy products with trace metals requires use of assimilable compounds that do not catalyze off-flavors due to lipid peroxidation but show good biological availability. The Fe(III) and Cu(II) chelates of the promising chelator, lactobionic acid, have been compared to Fe(II) and Cu(II) salts for their ability to improve hematological status in a mildly anemic population. Fe- and Cu-fortified cow milk was administered to children (aged 6 to 15) in the Durango, Mexico, "school lunch" program. Children drank milk providing 20 mg Fe and 3 mg Cu as ferric/cupric lactobionate ("chelate") or ferrous/cupric chloride ("salt") for 5 of 7 days/wk for 3 months. Supplementation with "salt" and "chelate" raised Hb significantly by 1 and 0.3 g/dl, respectively, above the control (unsupplemented) group. No significant change was observed in incremental serum ferritin, serum Fe, or transferrin saturation, or in final serum Cu. Ferric lactobionate shows poorer bioavailability than ferrous ion in the presence of Cu, but milk can be an excellent vehicle for Fe or Cu supplementation.

[Hepatic calcifications in isolated necrotizing, granulomatous hepatitis due to Brucella. A case report and review of the literature (author's transl)]

A case of isolated necrotizing, granulomatous hepatitis of Brucella origin is discussed, together with 6 similar cases reported in the published literature. The clinical picture is dominated by the history of the patient (occupation, geographical location), fever, right hypochondrial pain, and altered general condition. Radiological examination shows characteristic calcifications. Diagnosis is confirmed by serology, Brucella suis usually being involved. Pathological appearances are typical : large foci of hepatic necrosis surrounded by marked inflammatory zones with histiocytic cells arranged in palisades. The only possible treatment is surgical.

Ultrasonic diagnosis of primary carcinoma of the gallbladder: a review of 16 cases

Sonographic findings in 16 patients (10 women, six men) with surgically documented gallbladder carcinoma are reported. Two principal forms are described: localized infiltrating, or fungating, tumors (eight patients) and diffuse tumors infiltrating the entire gallbladder wall (eight patients). In all cases, the tumors were adenocarcinomas. Eleven patients also had cholelithiasis. Contiguous extension and metastasis did not correlate with tumor size. The difficulties encountered an the differential diagnosis are discussed in relation to the different sonographic appearances.

Transperitoneal live donor nephrectomy

We review 171 anterior transperitoneal live donor nephrectomies. The transperitoneal approach provides optimum exposure for atraumatic dissection of the kidney and renal vessels. The total and major postoperative complication rates were 30.4 and 3.5 per cent, respectively. These results compare favorably to reported series of extraperitoneal live donor nephrectomies. Transperitoneal live donor nephrectomy is a safe and effective operation with low risk to the donor.

[Ultrasonography and surgical complications after kidney transplants]

The authors conducted a retrospective analysis of 28 case-reports of patients with kidney transplants who had been investigated by ultrasonography. The most representative cases in the 8 patients in whom this examination revealed the presence of surgical complications are described. They included three cases of urinoma, in one case with associated obstruction, two patients with lymphoceles, one of whom had obstruction, and one case each of perirenal hematoma, perirenal abscess, and an arteriovenous fistula following needle biopsy.

[Ultrasonography characteristics of primary cancers of the gallbladder. A report on 16 cases (author's transl)]

Primary cancer of gallbladder was detected by ultrasonography in 16 patients (10 women, 6 men), and confirmed at operation. Two main types of lesion were found: 8 localized forms (infiltrating or vegetating), and 8 diffuse forms with infiltration of the gallbladder wall. The lesion was an adenocarcinoma in each case, and there was associated lithiasis in 11 patients. Extension by contiguity or metastases is independent of the size of the cancer. Problems related to etiological and differential diagnosis of these lesions are discussed in relation to the different ultrasonography appearances observed.

[Diagnostic value of ultrasonography in primary gallbladder cancer (author's transl)]

The authors analyze the clinical, radiological, and ultrasonography findings in a personal series of 3 cases, and 6 other cases reported in the published literature. As a result of their studies, they propose several groupings of symptoms and signs which enabled a precise diagnosis to be made in 5 cases.

[Giant diverticulum of the sigmoid: A report on one case and review of the literature (author's transl)]

The authors report a case of giant diverticulum of the sigmoid and review the approximately forty cases published in the literature. Clinical manifestations can be either an acute abdominal syndrome of symptoms of a chronic disease. Radiological appearances are usually characteristic: the giant diverticulum is located in the sigmoid, though in one case it arose from the transverse colon. An opaque image was noted in 15 of the patients following barium meal examination, and the lesion was associated with diverticulosis of the colon in every case. Apart from 4 cases, histological appearances were also typical: the colon wall is composed of fibrous tissue which has replaced the normal layers, and the neck of the giant diverticulum is always in the antimesenteric position.

Alkaline reflux gastritis associated with abnormalities of the gastrojejunostomy

Alkaline reflux gastritis is presently accepted as being part of the postgastrectomy syndrome complex. Our experience with this entity has revealed a frequent association of alkaline reflux gastritis with functional or organic abnormalities of the gastric remnant and/or newly formed gastrojejunostomy. The role alkaline reflux gastritis plays as a separate entity in the symptomatic patient remains to be clinically determined.

Alkaline reflux gastritis. A study in forty postoperative duodenal ulcer patients

A study to determine the incidence of alkaline reflux gastritis in forty postoperative duodenal ulcer patients has been presented. Since the majority of patients had evidence of gastritis, the precise role that gastritis plays in the production of symptoms is discussed but needs further clarification. It is suggested that the presence of gastritis may only represent an incidental or associated finding in many patients presenting with symptoms presumably characteristics of alkaline reflux gastritis.

Percutaneous cholangiography with the Chiba University needle: a new, safe, and accurate method in the diagnosis of cholestatic syndromes

A modified technique of percutaneous transhepatic cholangiography utilizing the Chiba University needle is described. This new technique employs injection of dye through a thin flexible 22 gauge needle with a short bevel while it is slowly withdrawn under a fluoroscopic monitoring. The results of several investigators are reviewed and indicate that failure to visualize the biliary radicals with the Chiba University needle virtually rules out extrahepatic obstruction. It is anticipated that this technique will replace the traditional sheathed needle cholangiography as a diagnostic modality in the evaluation of the jaundiced patient.

Clinical experiences with colonoscopy. A review of 100 cases

Our experience with 100 colonoscopic examinations are described. The clinical value of the procedure is outlined and the minimal degree of attendant morbidity, when performed by a competent endoscopist, are emphasized. The indications and contraindications for this relatively recently devised diagnostic and therapeutic modality should be commonly known. The procedure should be done whenever indicated.

Electrocardiographic monitoring during coloscopy

Electrocardiographic abnormalities were observed in 15 of 23 patients (65%), five with known heart disease, who were monitored for one hour prior to, during and for one hour after coloscopy. In one patient, ischemic S-T depression, 2 mm. below the resting level, persisted during the one hour following coloscopy. In all other patients, the electrocariographic abnormalities disappeared before the end of the monitoring period.