Redescription of Heligmosomoides neopolygyrus, Asakawa and Ohbayashi, 1986 (Nematoda: Heligmosomidae) from a Chinese rodent, Apodemus peninsulae (Rodentia: Muridae); with comments on Heligmosomoides polygyrus polygyrus (Dujardin, 1845) and related species in China and Japan

Heligmosomoides neopolygyrus, Asakawa and Ohbayashi, 1986 (Nematoda, Heligmosomoidea) is redescribed from Apodemus peninsulae from Rangtang, Sichuan, China. A morphological review of the Heligmosomoides spp. belonging to the "polygyrus line" proposed by Asakawa (1988) is made using new characters. This enabled us to distinguish two subspecies in Mus musculus (Heligmosomoides polygyrus bakeri from Japan and H. p. polygyrus from China) and two valid species in Apodemus spp. (H. neopolygyrus from Japan (in A. peninsulae) and from China (in A. agrarius) and H. asakawae from China (in A. uralensis)). Three parasite species of A. agrarius and A. peninsulae, previously identified by Asakawa et al. (1993) as H. neopolygyrus, are considered to be Heligmosomoides incertae sedis. This is the first report of H. neopolygyrus in A. peninsulae from China.

Description of a new species of Heligmosomoides (Nematoda: Heligmosomidae) parasitic in Microtus limnophius (Rodentia: Cricetidae) from Rangtang, Sichuan, China

Heligmosomoides craigi n. sp. (Nematoda: Heligmosomoidea) is described from Microtus limnophilus Büchner, 1889 (Rodentia: Cricetidae) from Rangtang, Sichuan, China. It is related to H. protobullosus Asakawa, 1987 and H. longispiculum Tokobaev & Erkulov, 1966 both parasites of Microtus spp. from Japan and USSR, respectively by the following features: a ratio of spicule length/body length of more than 45% and rays 9 shorter than rays 10. The new species is differentiated by rays 8 being closed to rays 6 and 19-22 cuticular ridges versus 14 in H. protobullosus (synlophe not described in H. longispiculum). H. longicirratus (Schulz, 1954) also a parasite of Microtus sp. from the USSR is the most closely related species based on the number of cuticular ridges (20) and the ratio of spicule length/body length (48% versus 50%). There are no illustrations of this species and the female has not been described; for that reason, it is not possible to compare it accurately with our specimens.

Frenkelia parasites in a small mammal community. Dynamics of infection and effect on the host

A community of small mammals, Clethrionomys glareolus, Arvicola terrestris, Microtus arvalis, M. agrestis, M. subterraneus, Apodemus spp. and Sorex spp., was studied as hosts of Frenkelia glareoli and F. microti in Fronche-Comté (France). They were monitored in spring, summer and autumn on an area of about 1,350 ha comprising open field, hedgerow network and forest. Among 1,714 small mammals examined between July 1992 and October 1993, 47% (178/376) of C. glareolus, 9.9% (14/139) of A. terrestris and 1.3% (4/311) of Apodemus spp. were infected by F. glareoli. The prevalence of infection with F. microti was 9.2% (66/716) in M. arvalis and 8.2% (6/73) in M. agrestis. M. subterraneus and Sorex spp. were not infected. The maintenance of each parasite in a rural landscape is assured both by a forest and a grassland host. Multiple logistic regression showed that prevalence was highly age-dependent, with an apparent seasonal pattern. Prevalence varied between 30% in summer and 60% in early spring for F. glareoli in C. glareolus and between 3% in autumn to 30% in early spring for F. microti in M. arvalis. The year, habitat, host sex, relative density had no impact on prevalence. In M. arvalis only, sexually active voles were preferentially uninfected, indicating a possible impact of this parasitism on fertility.

Interactions between landscape changes and host communities can regulate Echinococcus multilocularis transmission

An area close to the Qinghai-Tibet plateau region and subject to intensive deforestation contains a large focus of human alveolar echinococcosis while sporadic human cases occur in the Doubs region of eastern France. The current review analyses and compares epidemiological and ecological results obtained in both regions. Analysis of rodent species assemblages within quantified rural landscapes in central China and eastern France shows a significant association between host species for the pathogenic helminth Echinococcus multilocularis, with prevalences of human alveolar echinococcosis and with land area under shrubland or grassland. This suggests that at the regional scale landscape can affect human disease distribution through interaction with small mammal communities and their population dynamics. Lidicker's ROMPA hypothesis helps to explain this association and provides a novel explanation of how landscape changes may result in increased risk of a rodent-borne zoonotic disease.

[Aortic stenosis with left ventricular dysfunction]

Patients affected by aortic stenosis with severe systolic left ventricular dysfunction have a poor spontaneous prognosis. The results of valvular replacement are globally good, at the price of an acceptable operative mortality. The existence of surgical failure has however prompted much work aimed at better definition of prognostic factors and for proposing new methods of specifying surgical indications. In this article based on a review of the literature, we discuss the physiopathology of left ventricular dysfunction, predictive factors for operative risk and survival, and the elements to be taken into account in order to adjust therapeutic decisions in these severe cases.

Epidemiology of alveolar echinococcosis in Xinjiang Uygur autonomous region, China: a preliminary analysis

The Xinjiang Uygur autonomous region (XUAR) in north-western China is known to be endemic for Echinococcosis multilocularis, the causative agent of human alveolar echinococcosis (HAE). Despite regular reports of HAE cases in their region, very little is known about the local epidemiology of the disease or the transmission of E. multilocularis. The epidemiology of HAE in Xinjiang has now been investigated by the analysis of data collected from the medical records of 157 clinical cases who had attended the four main hospitals in the region. These data indicate that the disease is relatively common in the Altai, western Junggar, and Tianshan mountain ranges, whereas the Tarim and Junggar basins are likely to be of low endemicity. The prevalence of the disease in the Kunlun mountains is not clear. Semi-nomadic groups, especially those of Kazakh or Mongol origin, have a higher risk of infection than other ethnic groups. Prevalence of the disease in humans appears to be correlated with aspects of the local climate, such as annual precipitation and temperature. Red foxes, Microtinae, Ochotona spp. and Marmota spp. may be important hosts of E. multilocularis in the XUAR, sustaining the transmission cycles of the parasite.

Karyological and dental identification of Microtus limnophilus in a large focus of alveolar echinococcosis (Gansu, China)

A study of voles (Arvicolidae, Rodentia) from Gansu (China) designed to identify a potential host of Echinococcus multilocularis, responsible for human alveolar echinococcosis, leads to a general analysis of Microtus limnophilus population karyotypes, M1 of M. oeconomus populations from all of Eurasia and of M. limnophilus of Mongolia. The Microtus of Gansu belonging to the nominal subspecies M. limnophilus limnophilus (2n = 38; NF = 58) differs markedly in size and shape of M1 from the M. limnophilus of Mongolia, which must therefore be considered as a new subspecies M. limnophilus of malygini nov. ssp. (2n = 38; NF = 60) and the M. oeconomus of Mongolia should be ranked as M. oeconomus kharanurensis nov. ssp. (2n = 30; NF = 60).

Paradoxical embolism following acute pulmonary embolism: diagnosis and outcome

We report on ten cases of paradoxical embolism that occurred following pulmonary embolism and emphasize the echocardiographic contribution. Two patients had a thrombus trapped in a foramen ovale. An embolectomy was performed on one of those patients and the outcome was post-operative death. The other patient died suddenly prior to planned surgery. The remaining eight had inter atrial communication or foramen ovale that were highly patent upon contrast echography. Two of them who presented cardiogenic shock died rapidly despite resuscitation measures. The remaining six patients were treated medically with anticoagulants and have experienced no recurrence of embolism after a mean follow up 34+/-31 months.

[Chronic constrictive pericarditis apropos of 3 cases disclosed by refractory cardiac failure]

Chronic constrictive pericarditis is a difficult diagnosis and may present atypically. The authors report three clinical cases and review the diagnostic strategy of constrictive pericarditis. In these three patients, the diagnosis was finally made after one or more years of symptomatic disease and after several diagnostic work ups and ineffective treatments. In cardiac failure, pericardial calcification is often not observed on chest X-ray and Doppler echocardiography is usually the diagnostic investigation. Adiastole presents with dilatation of the vena cava and atria, contrasting with normal ventricles without major valvular disease. Doppler echocardiography enables distinction of constrictive pericarditis from restrictive cardiomyopathy: normal myocardium, thickened pericardium, specific septal motion, inspiratory increase in right ventricular dimensions, premature opening of the pulmonary valve, important variations in ventricular filling with respiration, expiratory diastolic reflux in the hepatic veins. Catheterisation confirms adiastole and may suggest a pericardial aetiology in characteristic cases, associated with only mild increases in pulmonary artery pressure. If need be, the pericardial thickening > 4 mm may be observed with magnetic nuclear resonance imaging and, when a doubt remains with respect to the diagnosis of cardiomyopathy, the absence of fibrosis on endomyocardial biopsy provides the diagnosis and indication for curative surgery: pericardectomy.

Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging

BACKGROUND

The ability of transesophageal color Doppler echocardiography to provide high-resolution images of both cardiac structure and blood flow in real time is advantageous for many clinical purposes. This study was performed to determine the utility of the regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging in the assessment of severity of mitral regurgitation.

METHODS AND RESULTS

Sixty-three consecutive patients with mitral regurgitation underwent transesophageal color Doppler examination, and the diameter of regurgitant jet at its origin was measured. Both right and left cardiac catheterizations were performed within 24 hours of Doppler studies, and angiographic grading of mitral regurgitation and regurgitant stroke volume were evaluated. There was a close relation between the jet diameter at its origin measured by transesophageal Doppler color flow imaging and the angiographic grade of mitral regurgitation (r = 0.86, p less than 0.001). A jet diameter of 5.5 mm or more identified severe mitral regurgitation (grade III or IV) with a sensitivity of 92%, specificity of 92%, and positive and negative predictive values of 88% and 95%, respectively. In 31 patients with isolated mitral regurgitation, the jet diameter correlated well with the regurgitant stroke volume determined by a combined hemodynamic-angiographic method (r = 0.85, p less than 0.001). A jet diameter of 5.5 mm or more identified a regurgitant stroke volume of 60 ml or more with a sensitivity of 88%, specificity of 93%, and positive and negative predictive values of 94% and 87%, respectively.

CONCLUSIONS

The regurgitant jet width at its origin measured by transesophageal Doppler color flow imaging provides a simple and useful method of measuring the severity of mitral regurgitation, and it may allow differentiation between mild and severe mitral regurgitation.