What underlies sex differences in heart failure onset within the first year after a first myocardial infarction?

Background

Women are more likely to develop heart failure (HF) after myocardial infarction. However, diagnosis and reperfusion are often delayed.

Objectives

To compare the prevalence of HF after primary percutaneous coronary intervention (PPCI)-treated ST segment myocardial infarction (STEMI) between sexes and to study its associations with comorbidities, infarct size, and left ventricular (LV) systolic and diastolic dysfunctions (DD).

Methods

The patients with PPCI-treated anterior STEMI, from the CIRCUS study cohort, were followed up for 1 year and HF events were recorded. Evaluation of ejection fraction (LVEF) and DD were performed at baseline and at 1 year. The elevated LV filling pressure (LVFP) included Grades 2 and 3 DD.

Results

Of the 791 patients from the CIRCUS study, 135 were women. At 1 year, the proportion of patients who developed HF was 21% among men and 34% among women (p = 0.001). In the subset of 407 patients with available diastolic parameters, the rate of HF was also higher in women. HF during the initial hospitalization was comparable between the sexes. However, women had a higher incidence of rehospitalization for HF within the first year after STEMI (14.1% vs. 4.1%, p = 0.005). Women were older with a higher prevalence of hypertension. The infarct size and LVEF were similar between the sexes. Elevated LVFP was observed more frequently in women than in men during the initial hospitalization and at 1 year (26% vs. 12%, p = 0.04, and 22% vs. 12%, p = 0.006, respectively). Interestingly, only initial elevated LVFP (HR 5.9, 95% CI: 2.4-14.5, p < 0.001), age, and hypertension were independently associated with rehospitalization for HF.

Conclusions

After PPCI-treated anterior STEMI, despite comparable infarct size and LVEF, women presented a higher proportion of rehospitalization for HF than men. That was likely due to a greater DD associated with older age and hypertension.

[Introduction of the Couder manoeuvre and perineal injuries]

OBJECTIVE

To analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020.

MATERIALS AND METHOD

A single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020.

RESULTS

In total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7.

CONCLUSION

The practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries.

Passive samplers for chemical substance monitoring and associated toxicity assessment in water

The European legislation, and in particular the Water Framework Directive requires the development of cost efficient monitoring tools that can provide the required information for the assessment of water contamination. Passive sampling methods represent one of the novel tools that have a potential to be used in various regulatory monitoring programmes aimed at assessing the levels of chemical pollutants. These methods are particularly interesting for sampling polar organic pollutants in water because they provide representative information of the water quality over extended time periods (days to weeks) in environments with fluctuating contaminant concentrations. This is achieved by integrative sampling of pollutants over the whole sampler deployment period. These tools can be coupled to toxicity testing using bioassays that give information on toxic and ecotoxic hazards associated to substances that are present, these substances being identified or not. In this study the polar organic chemical integrative sampler (POCIS) was used in surface water to evaluate the water contamination by polar organic compounds and their potential toxicity.

The secretory patterns of growth hormone in pregnant and hysterectomized ewes

This work was undertaken to determine the secretory patterns of GH during pregnancy, and to evaluate the effect, if any, of hysterectomy during early pregnancy on subsequent secretion of GH in ewes. The concentrations of GH were determined in the plasma of jugular blood samples collected at 15-min intervals during a 6-h period on days 20, 40, 60, 80, 100 and 120 post-mating, and three times per week between days 29 and 120 post-mating from 5 pregnant ewes and from 5 ewes from which the gravid uterus was removed on day 30 post-mating. A pulse analysis program (Pulsar) was used to analyse the secretory patterns of GH in individual profiles of the serial sampling period. In the two groups of ewes, peripheral concentrations of GH fluctuated in an episodic manner during the frequent blood sampling of any stage of the post-mating period examined. The overall GH concentrations, the basal GH concentrations, the frequency and the amplitude of GH pulses remained fairly stable between days 20 and 120 post-mating in the two groups of ewes. The parameters of GH secretion were not different between the two groups of ewes. The secretory patterns of GH, as determined in plasma of blood collected three times per week between days 29 and 120 post-mating were also not different between the two groups of ewes. In conclusion, results of this study show that (i) the pulsatile secretion of GH does not change as pregnancy advances, and (ii) hysterectomy performed during early pregnancy does not subsequently affect the secretory patterns of GH. These findings suggest that the gravid uterus and/or the feto-placental unit secretory products are unlikely to be involved in the control of GH secretion during pregnancy in the ewe.

Bilateral radical neck dissection with unilateral internal jugular vein reconstruction

OBJECTIVE

To describe and evaluate the functional and oncologic results of one internal jugular vein replacement after bilateral radical neck dissection (RND).

STUDY DESIGN

A retrospective historical cohort study.

METHODS

Since 1972 all patients (n = 9) undergoing bilateral RND with resection of both internal jugular veins had a reconstruction of one internal jugular vein. In six cases the RNDs were staged, and in three cases the RNDs were performed simultaneously. In every case a vascular reconstruction was performed with an autologous vein graft. All patients received radiation therapy, in five patients before and in four patients after the vein grafting. Functional results were evaluated in terms of postoperative head and neck and neurologic complications. In some patients a Doppler scan was performed to assess vein patency. Oncologic results are reported as relapse-free survival and mortality intervals.

RESULTS

In all patients the postoperative course was uneventful, without neurologic complications. Facial edema was noted in four patients, mild in three and moderate in one. Two patients are alive, with follow-ups of 8 and 18 years. Seven patients are dead, two without evidence of recurrence, four with cervical recurrence after a mean survival of 10 months, and one after distant metastasis after a survival of 7 years. In patients with long-term survival a Doppler scan confirmed the patency of the vein graft.

CONCLUSION

The lack of operative complications and the absence of postoperative neurologic complications make a unilateral internal jugular vein replacement after bilateral RND attractive, although the oncologic results remain poor.

Carotid artery reconstruction following resection during radical neck dissection

From 1972 to 1991, 7 patients with advanced cancer of the head and neck and nodal metastasis with capsular rupture underwent radical neck dissection and sacrifice of the carotid artery. Vascular reconstruction was performed with either an autologous venous (8 cases) or arterial (1 case) graft. In all patients, the postoperative course was uneventful without neurologic complications. One patient is alive 4 years after the procedure. Six patients expired after a mean survival of 20 months. The indications for vascular reconstruction are discussed.

Is collagenous colitis a new etiology of sicca syndrome?

We conducted a prospective cross-sectional study of seven patients with collagenous colitis to determine the clinical, immunologic and histologic features of sicca syndrome associated with this condition. Four patients reported dryness of the mouth and/or eyes. No laboratory evidence of autoimmune disease was found, except in one patient with ankylosing spondylitis. Collagenous infiltration of the salivary glands was quantified in each patient as the percentage of the total gland surface examined. Histologic studies of salivary glands demonstrated significantly more collagen in the group of patients with collagenous colitis than in the group of age-matched controls (30.52% versus 11.8%, p < 0.05). No inflammatory infiltrates were seen. Our data suggest that a common mechanism may underlie the various lesions found in patients with collagenous colitis. However, the mechanism that initiates the fibrotic process in the colon and salivary glands remains unknown.

Four new cases of collagenous colitis with joint symptoms

Collagenous colitis is characterized by chronic watery diarrhea and a greater than 10 micron-thick collagen deposit in the subepithelial layer of the colonic mucosa. Rheumatic and autoimmune diseases have been reported to occur in patients with collagenous colitis. In 1993, we managed four patients with collagenous colitis and joint diseases. One had rheumatoid arthritis, one had a spondylarthropathy and two had seronegative polyarthritis without joint destruction. Three patients had dryness of the eyes and/or mouth and two had Raynaud's phenomenon. These four cases and data from a literature review provide a basis for discussing possible links between collagenous colitis and a number of joint diseases. Although some anecdotal case-reports may reflect a chance association with inflammatory joint diseases, available evidence suggests that collagenous colitis may be a cause of enteropathic arthropathy. Recent data point to an abnormality in the differentiation of fibroblasts in the colonic mucosa, although the mechanism that initiates this abnormality remains unknown.

[Beta-blockers and plasma lipids]

Beta-blockers are frequently used in the treatment of hypertension. However their long term use has been associated with an increase of serum triglycerides and a decrease of HLD-cholesterol concentrations which could diminish the benefit drawn from their hypotensive effect. The effect on lipid metabolism is less unfavourable when beta-blockers exert an intrinsic sympathomimetic activity or are said to be cardioselective. Mechanisms involved are complex and poorly understood.

Follow up study of labial salivary gland lesions in primary Sjögren's syndrome

Labial salivary gland biopsy samples were taken from 27 patients with primary Sjögren's syndrome (SS), 10 with rheumatoid arthritis (RA) and secondary SS, and four normal control subjects on two occasions at intervals of more than one year. In the former group of patients, eight of the nine initially negative analyses were positive on the second sample, whereas two of the seven patients with RA and secondary SS were negative for the first sample and then positive for the second. In primary SS, the mean (SD) variation of the focus score was 1.7 (2.6) and that of salivary duct infiltration 0.2 (0.7). The former correlated well with the latter.

[Post-traumatic osteoid osteoma. Apropos of 2 cases and review of the literature]

Two cases of osteoid osteoma which became clinically apparent after a prolonged silent period are reported. One was located in the tibia in a 30-year-old female and the other in the femur in a 26-year-old male. Both developed after a surgical procedure, at the site of the operation; one was located on the track of an internal fixation screw. Diagnosis was delayed despite the suggestive timing of the pain; isotopic scanning, CT scan and angiography provided suggestive data and diagnosis was confirmed by histologic studies. A review of the literature found 13 other cases meeting the following criteria: initial trauma, silent period, suggestive pain, discovery of an osteoid osteoma at the site of the trauma, and recovery following surgical treatment. The role of the trauma is discussed.