Pulmonary embolism in a patient with "isolated syncope", a diagnostic challenge.

Syncope is a recognized presenting symptom in patients with pulmonary embolism (PE), and is more common in older patients and following a large embolus. Isolated syncope, in the absence of dyspnea or tachycardia, is uncommon in this setting, and may be misdiagnosed as cardiac in origin, leading to a delay in appropriate treatment. We present a case which illustrates the importance of consideration of pulmonary embolism in the differential diagnosis of patients presenting with syncope, and the value of echocardiography in its diagnosis.

[Noncardiological surgical procedure for patients implanted with a ventricular assist device. Anesthesiological management concepts]. / Nichtkardiochirurgische operative Eingriffe bei Patienten nach Implantation eines "ventricular assist device". Managementkonzepte in der Anästhesie.

BACKGROUND: The implantation of a ventricular assist device (VAD) is more frequently used as destination therapy of end-stage heart failure compared to the use of the device as bridge-to-transplantation, this results in an increasing number of noncardiac surgical procedures for patients implanted with a VAD. OBJECTIVE: For these procedures, the anesthesia provider faces various device-related complications, such as an increased risk for bleeding complications, thromboembolism, hypotension, infections, mechanical device limitations, and right heart failure. Anesthesia care is challenging in this high-risk patient population and has significant implications on patient outcome. CONCLUSION: More research is needed to determine specific guidelines for the anesthesiological management of VAD patients undergoing noncardiac surgical procedures. In this manuscript, device-related perioperative complications and concepts of anesthesia care for noncardiac procedures in patients implanted with a VAD are briefly reviewed.

Is there sufficient 'sink' in current bioaccessibility determinations of organic pollutants in soils?

Bioaccessibility tests can be used to improve contaminated land risk assessments. For organic pollutants a 'sink' is required within these tests to better mimic their desorption under the physiological conditions prevailing in the intestinal tract, where a steep diffusion gradient for the removal of organic pollutants from the soil matrix would exist. This is currently ignored in most PBET systems. By combining the CEPBET bioaccessibility test with an infinite sink, the removal of PAH from spiked solutions was monitored. Less than 10% of spiked PAH remained in the stomach media after 1 h, 10% by 4 h in the small intestine compartment and c.15% after 16 h in the colon. The addition of the infinite sink increased bioaccessibility estimates for field soils by a factor of 1.2-2.8, confirming its importance for robust PBET tests. TOC or BC were not the only factors controlling desorption of the PAH from the soils.

Segmental dynamics of interfacial poly(methyl acrylate)-d(3) in composites by deuterium NMR spectroscopy.

The interface in composite materials containing an ultrathin layer of poly(methyl acrylate)-d(3) (PMA-d(3)) on silica was studied using deuterium NMR. PMA-d(3) was deposited from solution at saturation coverage from toluene onto silica. The samples were dried and composite samples made by hot pressing the PMA-d(3)/silica samples with hydrogenated polystyrene (PS) and high (HMW) and low (LMW) molecular weight hydrogenated poly(methyl acrylate) (PMA) as the overlayer. The interfacial layers of PMA-d(3) were studied at the air-polymer-silica and polymer-polymer-silica interfaces using deuterium solid-state quadrupole-echo NMR and the results compared to those for the bulk polymer. It was found that for samples at the air-polymer-silica interface, some of the polymer segments in the surface sample had segmental mobility higher than that of the corresponding bulk PMA-d(3) sample at the same temperature. When overcoated with unlabeled polymer, the interfacial polymer at the polymer-polymer-silica interface showed reduced mobility due to the presence of the overlayer. The adsorbed PMA-d(3), in the composite samples, decreased in mobility in the order of LMW-PMA > HMW-PMA > PS. The PS sample caused the greatest reduction in the PMA-d(3) interfacial mobility. The order was consistent with the segmental mobilities of the polymers used for the overlayers. The lower the mobility of the polymer used for the overlayer, the more restricted were the polymer segments in the adsorbed PMA-d(3) layer.

A differential role of CREB phosphorylation in cAMP-inducible gene expression in the rat pineal.

In the rat pineal gland cAMP mediates nocturnal induction of the enzyme arylalkylamine N-acetyltransferase (AA-NAT) as well as of transcription factors such as inducible cAMP early repressor (ICER), Fos-related antigen-2 (Fra-2) and JunB. Cyclic AMP stimulates the phosphorylation of the DNA binding protein cAMP response element binding protein (CREB). While cAMP-induced CREB phosphorylation appears to be a prerequisite for AA-NAT and ICER gene expression, it is not known whether CREB phosphorylation accounts for the full cAMP response of the two genes. Furthermore, the significance of CREB phosphorylation in cAMP-activated Fra-2 and JunB transcription is unknown. In the present in vitro study we used the serine/threonine protein phosphatase inhibitor okadaic acid (OA) to phosphorylate CREB without altering intrapineal cAMP concentration. It was observed that OA (10(-7) M) was less effective than dibutyryl cAMP (dbcAMP; 10(-3) M) in inducing AA-NAT mRNA and ICER mRNA, respectively. On the basis of this finding, it is concluded that CREB phosphorylation alone is apparently not sufficient for the full cAMP response of the two genes. By contrast, OA and dbcAMP equally stimulated the accumulation of the mRNAs of Fra-2 and JunB. Therefore cAMP may induce Fra-2 and JunB transcripts via CREB phosphorylation. Our observations suggest that CREB phosphorylation plays a critical role in diversification of cAMP-dependent gene induction in the rat pineal.

Serum leptin in obese patients with Laron syndrome before and during IGF-I treatment.

Fifteen patients with primary GH resistance (Laron syndrome, LS) were studied before and during 6 months of daily replacement treatment with IGF-I. The main findings were that patients with LS and normal or high serum GH binding protein (GHBP) were less obese than those with a negative GHBP, and that serum leptin levels varied with body mass as in other types of obesity.

Physical examination as a screening test for pelvic fractures in blunt trauma patients.

This article describes our study of 82 awake, alert blunt trauma victims over the age of 18 with Glasgow Coma Scores of 14 or 15. The purpose was to assess whether the examining physicians were able to determine without benefit of X-ray whether the patients had pelvic fractures. Physicians were asked to complete a questionnaire regarding pain on examination of the pelvis, and were then asked if they believed a fracture was clinically present. Seventy-one patients were tested for alcohol; 15 were positive, and 11 had levels greater than 100 mg%. Fifty-five were tested for mind-altering drugs; 20 were positive. Nine had pelvic fractures; seven required no treatment. Eighteen had pain on examination in at least one plane. Seven of these had fractures; six were suspected clinically. Sixty-four patients had no pain; two had fractures that were not suspected clinically and required no specific treatment. We conclude that selective use of pelvic x-rays in awake, alert blunt trauma patients does not result in any clinically significant missed fractures.

Association of retinal capillary perfusion with visual status during chronic glaucoma therapy.

PURPOSE: The purpose of the study is to determine whether retinal microcirculation is associated with the degree of visual function in glaucomatous eyes receiving chronic bilateral medical therapy with topical beta-blockers. METHODS: A nonrandomized, 3-year prospective clinical study was undertaken on 37 patients with glaucoma and normal visual acuity receiving symmetric topical medication in both eyes. Humphrey 30-2, Henson CFA 2000, and Vistech 3 and 6 cycles/degree contrast sensitivity were obtained bilaterally at multiple visits, along with Oculix 1000 blue-field estimates of perimacular leukocyte velocity. The mean asymmetry of measurements obtained throughout the treatment period for each pair of eyes was determined, and correlations were obtained to assess visual function asymmetry circulatory asymmetry. RESULTS: Significant associations were observed between blue-field entoptic capillary leukocyte velocity measurements and those for all three visual function testing methods, the eye with the superior vision typically having the higher mean leukocyte velocity (P < 0.001 for both Humphrey mean deviation and Henson perimetry, P < 0.002 for Humphrey corrected pattern standard deviation, and P < 0.02 for contrast sensitivity at both 3 and 6 cycles/degree). CONCLUSIONS: Central retinal microcirculation is associated with various measures of central and peripheral visual function in glaucomatous eyes receiving beta-adrenergic blocker therapy.

Superficial migratory thrombophlebitis and the lupus anticoagulant.

The lupus anticoagulant is an antiphospholipid antibody found in association with systemic lupus erythematosus and in a variety of other diseases, as well as in healthy individuals. In the laboratory, the antibody interferes with the conversion of prothrombin to thrombin and prolongs the partial thromboplastin time. In vivo, it exerts a procoagulant effect resulting in thrombosis, mainly of the larger veins and arteries. The case of a young woman who developed superficial migratory thrombophlebitis in association with a high titer lupus anticoagulant is presented. Her diagnosis was initially missed because the partial thromboplastin time was not elevated. This appears to have resulted from the use of a specific thromboplastin relatively insensitive to the presence of the antibody. Retesting with a more sensitive reagent showed a markedly prolonged partial thromboplastin time.

Relation of mouth flow to body surface flow during forced oscillation at the chest.

We have investigated the body surface flow/mouth flow transfer function (magnitude ratio and phase difference) in seven healthy male subjects driven at the chest from 4 to 30 Hz. The measurements were performed with a specially designed plethysmograph and analyzer. The subjects were driven with a mechanical oscillator placed on the sternum. After differences in gas temperature and humidity were taken into account, the data were in agreement up to 15 Hz with a simple second-order model including an airway compartment, with a resistance and an inertance, and a shunt compliance representing alveolar gas. At larger frequencies, closer inspection revealed that a third-order model was optimal. We interpret these results as indicating a compartmentalization of gas compliance within the thorax, communicating via a resistive element. Airway inertance did not seem to be distributed.

Copper ions and hydrogen peroxide form hypochlorite from NaCl thereby mimicking myeloperoxidase.

Sea urchins have elaborated multiple defenses to assure monospermic fertilization. In this work, we have concentrated on a study of the mechanism(s) by which hydrogen peroxide (H2O2) prevents polyspermy in Arbacia punctulata. We found that it is not H2O2 but probably hypochlorous acid/hypochlorite (HOCl/OCl-) derived from H2O2 that is toxic to the supernumerary sperm. The spermicidal activity of H2O2 is potentiated by at least one order of magnitude by cupric ions (Cu2+). This increased toxicity is not due to the formation of hydroxyl radicals (.OH) because .OH scavengers did not counteract the activity of Cu2+. Moreover, substitution of Cu2+ by ferrous ions (Fe2+), which are known to cause formation of .OH from H2O2, had no effect on fertilization even at 10(2)-10(3) times higher concentrations. In contrast, 3-amino-1,2,4-triazole (AT), and HOCl/OCl- scavenger, totally reversed the toxic effects of Cu2+. Furthermore, we found that HOCl/OCl- is generated in solutions of H2O2 and Cu2+ in the presence of 0.5 M NaCl and that its accumulation is abolished by AT. Thus it is possible that the antifertility properties of copper are due to its ability to mediate formation of HOCl/OCl-. HOCl/OCl- generated by Cu2+ from H2O2 and Cl-, a low concentration of exogenously added HOCl/OCl-, or increased concentrations of H2O2 has similar inhibitory effects on the fertilization process in sea urchins. Therefore, we suggest that polyspermy is prevented by the action of a myeloperoxidase that affects the formation of HOCl/OCl- from the Cl- present in sea water through reaction with H2O2 generated by the newly fertilized egg.

Transport properties of polymer solutions. A comparative approach.

A variety of transport properties have been measured for solutions of the water soluble polymer poly(ethylene oxide)(PEO) with molecular weights ranging from 200 to 14,000, and volume fractions ranging from 0-80%. The transport properties are thermal conductivity, electrical conductivity at audio frequencies (in solutions containing dilute electrolyte), and water self-diffusion. These data, together with dielectric relaxation data previously reported, are amenable to analysis by the same mixture theory. The ionic conductivity and water self-diffusion coefficient, but not the thermal conductivity, are substantially smaller than predicted by the Maxwell and Hanai mixture relations, calculated using the known transport properties of pure liquid water. A 25% (by volume) solution of PEO exhibits an average dielectric relaxation frequency of the suspending water of one half that of pure water, with clear evidence of a distribution of relaxation times present. The limits of the cumulative distribution of dielectric relaxation times that are consistent with the data are obtained using a linear programming technique. The application of simple mixture theory, under appropriate limiting conditions, yields hydration values for the more dilute polymer solutions that are somewhat larger than values obtained from thermodynamic measurements.

["Deep scleroderma" or diffuse fibromatous scleroderma. A case-report of uncertain nosologic classification (author's transl)]. / "Sclérodermie profonde" ou fibromatose diffuse. A propos d'un cas de nosologie incertaine.

An unusual form of scleroderma, seen in one patient, is described. Clinical and histological examinations demonstrated no dermal changes. Both the subcutaneous tissue and the fascias were involved. This case can be distinguished from Shulman fasciitis, on both histological and biological grounds, as well as from scleroderma, since Raynaud phenomena, sclerodactylia, and visceral involvement were lacking.

[Dystocia at the onset of labour. An evaluation of the different treatments available (author's transl)]. / Dystocie de démarrage du travail. Evaluation des différentes thérapeutiques.

The authors have carried out a random study on 75 cases in order to evaluate objectively the therapeutic methods usually employed in cases of dystocia in starting labour. These studies have shown the superiority of Syntocinon using an infusion together with epidural analgesia. This attitude goes against the methods of treatment usually used in France. The authors explain the reasons for their choice in the light of factors that they have observed using other therapeutic methods.