Idiopathic dilated cardiomyopathy: lack of association with hepatitis C virus infection.

OBJECTIVE: To determine whether there is an association between hepatitis C virus (HCV) infection and dilated cardiomyopathy in a well defined area of north western Greece; such an association has been reported elsewhere. DESIGN: Evaluation of consecutive patients with chronic HCV infection for the presence of clinical or subclinical manifestations of dilated cardiomyopathy by history, physical examination, and non-invasive laboratory procedures (ECG, chest x ray, and echocardiography) before the initiation of interferon alpha treatment; investigation for HCV infection markers in patients with dilated cardiomyopathy by enzyme and immunoblot assays (antibodies to HCV) and the reverse transcriptase polymerase chain reaction (HCV RNA). SETTING: A tertiary referral centre for patients with chronic hepatitis and dilated cardiomyopathy. PATIENTS: 102 patients with well defined chronic HCV infection and 55 patients with well established dilated cardiomyopathy were evaluated. MAIN OUTCOME MEASURES: The need for HCV testing in patients with dilated cardiomyopathy, or follow up for heart disease in patients with chronic HCV infection. RESULTS: None of the patients with chronic HCV infection had clinical or subclinical evidence of dilated cardiomyopathy from history and laboratory findings. None of the patients with dilated cardiomyopathy was positive for antibodies to HCV or viraemic on HCV RNA testing. CONCLUSIONS: The study neither confirms the findings of other investigators, nor indicates a pathogenic link between HCV and dilated cardiomyopathy. For this reason, at least in Greece, testing for HCV in patients with dilated cardiomyopathy or follow up for heart disease in HCV patients appears unnecessary. Genetic or other factors could be the reason for this discrepancy if previously reported associations between HCV and dilated cardiomyopathy or hypertrophic cardiomyopathy were not coincidental.

Isolated corrected transposition of great arteries and double left anterior descending artery originating from the left and right coronary artery. A rate combination of coronary artery anomaly and congenital heart disease.

A case of double left anterior descending coronary artery in a patient with isolated corrected transposition of great arteries is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly seems to be very rare.

Training HIV specialists for community mental health.

There is a critical need for trained HIV mental health specialists who possess the knowledge and attitudes necessary to meet the challenges of the HIV epidemic. A model for an intensive and experimental continuing education tutorial is briefly described, and evaluative data are presented. Upon completion of the three-day workshop, participants show an increase in HIV-related knowledge and a positive shift in attitudes regarding working with people affected by HIV disease.

[Effects of an incremental application technique on the polymerization of two light-activated composite filling materials]. / Auswirkung der Schichttechnik auf die Polymerisation von zwei lichthärtenden Komposit-Füllungsmaterialien.

The influence of the use of an incremental technique on the polymerization depth of two light-activated composite resins (hybrid composite resin, microfilled composite resin) was investigated in vitro. Of each of the two materials specimens were produced using variable increments and different polymerization times. Polymerization depth was determined by means of a microhardness tester (Vickers hardness). At the bottom of the cavity hardness values were significantly higher in samples produced in small increments (2 mm) than in samples with thicker layers (3 mm). A polymerization time of 20 s resulted in a significantly poorer polymerization at the bottom of the cavity than longer polymerization times. Hardness values decreased within each layer from the surface to the bottom. Irrespective of the material and the duration of illumination SEM pictures showed the presence of a line in the interface of the layers. The use of incremental technique in class II restorations resulted in differently polymerized zones that are exposed to the varying conditions of the oral cavity.

Cocaine use by senior medical students.

The authors studied 589 senior medical students' attitudes about and use of cocaine. Reported use was 36% in the students' lifetimes, 17% in the past year, and 6% in the past month. Overall, these rates were lower than those of an age-matched cohort.

Substance use by fourth-year students at 13 U.S. medical schools.

Fourth-year medical students at 13 medical schools in different regions of the United States received an anonymous questionnaire designed to examine their current and prior use of 11 substances and their attitudes toward substance use among physicians. Of 1,427 questionnaires distributed, 41 percent were returned. The questionnaire and distribution method were derived from an ongoing survey on drug use in order to permit comparison of the medical students with a national sample of age- and sex-matched cohorts. The rates of substance use during the 30 days preceding receipt of the questionnaire were: alcohol, 87.8 percent; marijuana, 17.3 percent; cigarettes, 9.0 percent; cocaine, 5.6 percent; heroin, 0.0 percent; other opiates, 0.9 percent; LSD, 0.2 percent; other psychedelics, 0.5 percent; barbiturates, 0.5 percent; tranquilizers, 2.2 percent; and amphetamines, 1.2 percent. Compared with their age and sex cohorts nationally, the medical students reported less use of marijuana, cocaine, cigarettes, LSD, barbiturates, and amphetamines. However, their use of other opiates was approximately the same and their use of tranquilizers and alcohol was slightly higher than that of the other cohorts. Data on their sources of knowledge about drug abuse indicate the need for greater attention to this issue in the medical curriculum.

Substance use and the resident physician: a national study.

A national study of substance use and abuse among resident physicians indicates that except for tranquilizers and barbiturates most illicit use of drugs began prior to medical school and residency. Relatively few residents were aware of substance abuse policies or educational programs in their institutions.

Substance use and abuse among senior medical students in 23 medical schools.

The current study represents the first large-scale study of substance use and abuse among 2,046 senior medical students at 23 nationally distributed medical schools. With the exception of alcohol and tranquilizers, medical students use less of all such substances than do age-related cohorts from the general population.

Computer simulation of Freud's counterwill theory: extension to elementary social behavior.

A model is presented describing decision processes of a living system at the level of the individual, together with its interpersonal relationship context (organism, subsystems, and suprasystem). The beginning point was the 1977 system dynamics model of Wegman, which was itself characterized by quantitative cross-level hypotheses concerning both physiological and psychological levels of functioning within the individual personality system. The extension process was accomplished by synthesizing concepts from many different theories in personality and social psychology into equations linking two multiple-loop feedback systems to form a suprasystem. Each individual model was found to have several distinct operational modes, and the dyadic model had a number of interesting combinations of these modes which correlated with clinical descriptions of steady-state behavior and subjective experience in human marital dyads. For example, under certain conditions an individual operating in an unstable mode could achieve personal system stability within a dyadic relationship. In some cases, two unstable individuals could form a stable system. The process of extending the original model supports the utility of a synthetic approach to the construction of quantitative theories concerning small social systems. This process also suggests new approaches to planning future empirical research on small social systems using methods more appropriate to the study of complex, dynamic systems.

Comparison of insulin hypoglycemia and short metyrapone tests in patients with pituitary disease.

In a retrospective study on 59 patients (2 hypothalamic, 44 pituitary, 13 no confirmed disease) 69 pairs of insulin hypoglycemia tests (IHT) and short metyrapone tests (SMT) were evaluated. Cortisol and 11-desoxy-cortisol rsp. were compared as the endpoints. In 6 cases, the IHT was a technical failure because of insufficient hypoglycemia. In 25% of 63 pairs of tests, both tests were normal, (Group I), in 30% both abnormal (Gr. II). In 21%, IHT was normal, SMT abnormal (Gr. III) and in 24% IHT was abnormal and SMT normal (Gr. IV). The 2 patients with hypothalamic disease were in Group IV with completely normal SMT and severely pathological IHT. Other discrepancies could not be attributed to special pituitary disorders. In 9 patients of Group III and in 8 patients of Group IV (n = 17), the IHT alone was repeated 6-48 months after the original pair of tests which had been performed in most cases early after pituitary surgery. In 12 cases, the repeat IHT followed the trend of the SMT of the original test pair. In 5 cases, the IHT was unchanged. 14 of 19 patients of Group II, but only 5 of 28 patients of Group III and IV required permanent substitution with hydrocortisone.

Risk factors for diabetic retinopathy in youth.

Retinal microvascular abnormalities were evaluated in 74 insulin-dependent diabetic youths by fluorescein angiography on two or more occasions spanning at least 4 years. Half of this group showed progression of the retinal vascular abnormalities from a stage of no significant abnormalities to at least background retinopathy with more than ten microaneurysms. Proliferative retinopathy requiring laser photocoagulation occurred in 14% (10/74). Insulin administration (once or twice a day) and glycemic control as reflected by hemoglobin A1C were identical in those with progression and in those with no progression of retinopathy. More females than males in this age group developed progressive retinopathy (P less than .036). Human lymphocyte antigen (HLA) types DR3 and DR4 in combination occurred more frequently (P less than .001) in those with progression of retinopathy than in those without progression. Teenaged , female, insulin-dependent diabetics with both HLA DR3, and DR4, were at increased risk for developing proliferative retinopathy.