Effects of previous infestation with Bemisia tabaci MEAM1 on the resistance to Chrysodeixis includens in Bt and non-Bt soybean plants.

Transgenic Bt soybean plants have been developed to control insect pests, such as Anticarsia gemmatalis and Chrysodeixis includens. This objective has been achieved successfully; however, recently, some authors claimed that Bt soybean plants have been more susceptible than non-Bt soybean to Bemisia tabaci MEAM1. In addition, it is unknown whether Bt soybean plants infested by B. tabaci become less resistant to target pests. Therefore, this study aimed to evaluate: (i) whether the previous infestation with B. tabaci can compromise Bt and non-Bt soybean resistance to C. includens; (ii) the effects of B. tabaci infestations on Bt and non-Bt soybean plant growth; and (iii) whether B. tabaci feeding reduces contents of chlorophyll and carotenoids of soybean plants. Bt and non-Bt soybean plants pre-infested with B. tabaci showed no changes in resistance to C. includens. Bt soybean plants infested with B. tabaci showed a lower plant height than uninfested plants. Differently, non-Bt soybean plants exhibited no reduction in plant growth due to B. tabaci feeding. Bt soybean plants suffered a reduction in dry matter only under double infestation (B. tabaci and C. includens), while non-Bt soybean plants experienced reduction in dry matter when infested with B. tabaci and C. includens or by C. includens only. B. tabaci feeding did not alter contents of chlorophyll and carotenoids, and perhaps the reduction in plant growth was related to salivary toxins. Concluding, both Bt and non-Bt soybean plants were susceptible to B. tabaci feeding, evidencing necessity of developing soybean cultivars resistant to B. tabaci.

The role of silicon in the mitigation of water stress in Eugenia myrcianthes Nied. seedlings.

Silicon (Si) is a beneficial element that can mitigate effects of water stress on photosynthetic metabolism and plant growth. Thus, the aimed was to evaluate the effect of Si in mitigating the stressful effect of water deficit and flooding in Eugenia myrcianthes Nied. seedlings. The seedlings received three silicon doses (0, 2, and 4 mmol) and were subjected to two water regimes (I - continuous irrigation and S - water fluctuation, characterized as water stress obtained by two cycles of water regimes: irrigation suspension and flooding). Each cycle was ended when the seedlings had a photosynthetic rate close to zero (P0) when the stressful irrigation condition was normalized until the photosynthetic rate reached the values of the control seedlings (REC). The evaluations were carried out in five periods: T0 - initial seedling condition; 1st and 2nd P0; and 1st and 2nd REC. The E. myrcianthes seedlings reached P0 at 22 and 50 days under water deficit and flooding, respectively. Water stress caused damage to photochemical activities in photosystem II. E. myrcianthes is a species sensitive to water stress, but capable of adjusting to water fluctuation, and the application of 2 mmol Si contributed to the regulation of gas exchange, photochemical yields, and growth of this species at the deficit and flooding phases. We emphasize that E. myrcianthes seedlings have potential for resilience due to physiological plasticity, regardless of the silicon application.

"Hybrid" and combined percutaneous and surgical intervention to treat selected cardiac patients: a new strategy.

The term "hybrid revascularization" describes the combined use of minimally-invasive surgery without cardiopulmonary bypass and percutaneous coronary revascularization in selected cases. The theoretical advantage of a less invasive surgical intervention must be weighted against the need for additional percutaneous procedures, with their own risks and limitations. We describe our initial experience with hybrid revascularization at the Istituto Clinico Humanitas in Milan. From 7/97 to 10/98, twelve patients underwent hybrid revascularization or a combined percutaneous and surgical intervention. A "classic" hybrid approach, consisting of minimally-invasive direct coronary artery bypass to the left anterior descending coronary artery and angioplasty or stenting of arteries in the right coronary artery or circumflex territories, was used in nine patients. In three patients, myocardial revascularization could be completed with percutaneous procedures after bypass surgery without cardiopulmonary bypass (in two patients because of severe aortic calcification) or valve surgery in a patient with two previous bypass operations. In-hospital complications were observed in three patients. Two required urgent median sternotomy (one for impending cardiac tamponade, one for conversion to bypass on extra-corporeal circulation). One patient developed atheroembolism after percutaneous intervention: after hospital discharge, there was a recurrence of symptoms, clinical deterioration with renal failure and eventually death. At a mean follow-up of 152 +/- 91 days (range 17 to 283) after minimally-invasive surgery and 166 +/- 122 days (range 13 to 397) after angioplasty, all surviving patients are well and free of anginal symptoms. Closer collaboration between surgical and interventional operators may offer a novel approach to effective treatment of difficult patient subsets. However, our initial experience suggests that a cautious evaluation of possible risks and benefits must carefully be entertained in each patient who may be considered a candidate for hybrid revascularization or combined percutaneous and surgical intervention.

[Benign mediastinal teratoma with pericardial symptoms. The utility of echocardiography in diagnosis]. / Teratoma benigno del mediastino a sintomatologia pericardica. Utilità diagnostica dell'ecocardiografia.

The authors describe the clinical case of a 21-year-old girl who was admitted to the hospital because of pericardial symptomatology. On admission, a transthoracic echocardiogram revealed moderate pericardial effusion and an anterior parenchimallike mediastinal mass, that extended as far as the main vessels and the anterior wall of the right ventricle. This report was subsequently confirmed by a computed tomography chest scan. Due to the rupture into the pericardial cavity, which was followed by considerable pericardial effusion, she was immediately taken to the operating room for pericardiocentesis and the decision was then made in order to excise the mass. The hystological diagnosis revealed "benign cystic mature teratoma of the mediastinum". The authors' literature data is included, and the article also emphasizes the importance of using echocardiograms in casualties in order to obtain a differential diagnosis of chest pain.

Impaired baroreflex sensitivity is correlated with hemodynamic deterioration of sustained ventricular tachycardia.

OBJECTIVES: The goal of this study was to evaluate clinical and autonomic variables (heart rate variability and baroreflex sensitivity) related to hemodynamic tolerability of VT in patients with sustained monomorphic VT and a healed myocardial infarction. BACKGROUND: Sustained ventricular tachycardia (VT) with hemodynamic deterioration is associated with a worse prognosis than that of well tolerated VT. The causes of hemodynamic deterioration of VT are incompletely understood. METHODS: Twenty-four consecutive patients with sustained monomorphic VT and a healed myocardial infarction (mean age +/- SD 66 +/- 8 years, left ventricular [LV] ejection fraction 37 +/- 11%) were assigned to group 1 if the VT was well tolerated (n = 11) or to group 2 if faintness or syncope occurred or if systolic blood pressure was < 90 mm Hg with clinical signs of shock (n = 13). RESULTS: No difference was found between the two groups in age, LV function, rate and duration of the VT or heart rate variability. However, patients in group 2 had a significantly lower baroreflex sensitivity (3.4 +/- 1.1 vs. 7.1 +/- 3.7 ms/mm Hg, p = 0.003). Multiple logistic regression analysis showed that only the value of baroreflex sensitivity (p = 0.0003)-but not age, LV ejection fraction, VT cycle length or SD of the RR interval (all p > 0.25)-correlated with the tolerability of the VT. Finally, LV ejection fraction (p = 0.0001) and baroreflex sensitivity (p = 0.0003)-but not age, cycle length of the tachycardia or SD of the RR interval-predicted cardiac death or unstable VT during follow-up. CONCLUSIONS: These data suggest that an impaired cardiovascular reflex response may play a key role in the hemodynamic deterioration of sustained VT and that the evaluation of baroreflex sensitivity in patients at high risk for sustained VT may become useful both in risk stratification and in the individualization of treatment.

[Acute anterior myocardial infarction in a patient with left atrial myxoma during pregnancy]. / Infarto miocardico acuto anteriore in paziente con mixoma atriale sinistro durante gravidanza.

It is a case report of a patient who had an acute anterior myocardial infarction during the 22th week of pregnancy, probably due to coronary embolization from a large left atrial myxoma. The patient had a previous operation for a right adrenal adenoma causing a Cushing Syndrome. It is hypotized an association between adrenal adenoma and atrial myxoma, like "Carney Syndrome".

Transfusion-transmitted human parvovirus B19 infection in a thalassemic patient.

BACKGROUND: Human parvovirus (HPV) B19 infection has been shown to be transmissible by clotting factor concentrates, most often resulting in asymptomatic seroconversion. So far, no case of B19 transmission due to single-donor transfusion has been documented. CASE REPORT: A case of transfusion-transmitted HPV B19 infection in a 22-year-old female thalassemia major patient is described. She presented with an aplastic crisis; this was followed 1 week later by transitory heart failure and acute tricuspid incompetence. The echocardiogram revealed a grade III tricuspid regurgitation and a floating vegetation on the atrial face of the tricuspid lateral leaflet. The tricuspid regurgitation and vegetation spontaneously disappeared within 15 days. Blood cultures for bacteria were repeatedly negative. IgM anti-HPV B19 seroconversion was documented in the acute phase. B19 DNA was detected by polymerase chain reaction and remained detectable up to 4 months after diagnosis. High-titer IgM anti-HPV and B19 DNA were also found in serum samples collected at the time of donation from one of the donors of the blood transfused before the onset of clinical symptoms. CONCLUSION: This case documents the transmission of HPV B19 by the transfusion of 1 red cell unit and the occurrence of possible transient cardiac involvement in this infectious complication.

[Acute and long-term effects of captopril in patients with left ventricular dysfunction and dilatation: evaluation of function and work capacity]. / Effetti acuti e a lungo termine del captopril in soggetti con disfunzione e dilatazione ventricolare sinistra: valutazione funzionale e capacità lavorativa.

To assess acute hemodynamic effects and exercise capacity of an intravenously administered single dose of captopril and to compare the acute response with chronic variation in hemodynamic and functional parameters after long-term oral administration, (in order to determine the profile of responders and non-responders) we studied 12 patients with chronic congestive heart failure due to primary dilated cardiomyopathy (11 pts) and ischemic heart disease (1 pt). Hemodynamic response was assessed using transthoracic electric impedance with cardiac output measurement. The exercise capacity was determined using multistage bicycle ergometer symptoms limited stress test. The hemodynamic and functional evaluation--resting cardiac output, exercise capacity (Ex. Dur.) and cardiac output rise at maximum workload (% CO)--were investigated at first as a control; after i.v. captopril administered in 10 min (25 mg) (acute); after captopril per os (25-75 mg for 30 days) (chronic) and after 5 days of withdrawal (wash out). (Table: see text). Improvement of left ventricular performance mainly during exercise after acute and chronic administration of captopril occurred, as evidenced from cardiac output increase at maximum work load, and rise of exercise duration. Moreover, our data suggest that captopril may have a sustained beneficial effect, for a few days, even after drug withdrawal. Nevertheless, the lack of correlation in single cases between acute and chronic response, also indicates that captopril deserves further study to determine its role in acute and/or chronic management of congestive heart failure in order to choose the ideal strategy.

Reeducation strategies in conduction aphasia.

This article proposes a reeducation program for conduction aphasics with reproductive difficulties. The characteristics of the program are analysis and manipulation of visual stimuli (written words and syllables); suppression of the compensation effect of the spared lexical-semantic system; and progressive increase in length and complexity of phonological and syntactic construction of words and sentences. The aim of this program is to teach patients to control phonemic production. Results of the reeducation of three conduction aphasics are presented.

[The Italian Group for the Study of Streptokinase in Myocardial Infarct: Analysis of intrahospital causes of death]. / G.I.S.S.I.: Analisi delle cause di morte intraospedaliera.

Aim of the present study was to analyse the causes of death of the patients admitted to the G.I.S.S.I. Study. Clinical records of the 1386 in-hospital deaths were centrally analysed by two independent clinicians, who were not aware of the performed treatment and based their classification criteria upon clinical and anatomic data. Death causes were classified as follows: cardiac failure, electromechanical dissociation, cardiac rupture, sudden death and extracardiac deaths. Cardiac failure was the most frequent cause of mortality, as 725 pts out of the 1386 (52%) died from this complication in the whole group. 392 pts were part of the control group (6.7%), while 333 had received SK (5.6%): the difference was significant. No difference was observed between treated patients and control group for what concerns the remaining causes of death. Mortality from cardiac failure was strikingly reduced in a few groups of patients: females (from 11.4 down to 8.7%); age less than 65 years (from 4.1 down to 3.2%); early treated pts (up to 3 hrs): from 6.3 down to 5.2%; anterior location of AMI (9.2 down to 7.4%); first AMI episode (from 5.9 down to 4.7%). Such a reduction was remarkable for patients who remained alive after the 7th day from onset of symptoms: cardiac failure was the cause of death in 65 out of 5385 treated patients, and in 100 out of 5333 control group patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Controlled study of the haemodynamic effects of isosorbide 5-mononitrate in acute myocardial infarction.

In view of the favourable results of the short-term therapy of acute myocardial infarction (AMI) with glyceryl-trinitrate (GTN) infusion, we undertook a randomized study to test the hypothesis whether the administration of a single dose of isosorbide 5-mononitrate (IS 5-MN) given orally would have the same favourable haemodynamic effect as observed with GTN infusion. For this purpose we evaluated the haemodynamic effects of IS 5-MN compared to isosorbide dinitrate (ISDN), observed in the same group of patients. 10 patients (8 males, 2 females) aged 50-76 years (mean 63) with AMI (7 anterior, 3 inferior) admitted to the coronary care unit within 48 h from onset of symptoms were entered into this single-blind randomized study; at the time of study entry, 8 patients were in Killip class I, and 2 patients in Killip class II. All drugs with haemodynamic effects were withdrawn 12 h before the study started. Both the haemodynamic profile and the clinical status were stable in all patients. Haemodynamic parameters were recorded with a Swan-Ganz thermodilution catheter, cardiac output was measured by the thermodilution method, and the left ventricular ejection time was calculated according to the Weissler method. The echo left ventricular end-diastolic diameter was measured by evaluation of the M-mode echocardiographic recording.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of amrinone in refractory cardiac insufficiency: clinical and hemodynamic evaluation]. / L'impiego dell'amrinone nell'insufficienza cardiaca refrattaria: valutazione clinica ed emodinamica.

UNLABELLED: Amrinone is a nonadrenergic, nonglycosidic agent with combined positive inotropic and vasodilator properties. To determine its clinical and hemodynamic effects we treated 14 patients (12 men and 2 women ranging in age from 36 to 78 years, mean 56) with severe chronic heart failure (New York Heart Association functional class IIIa or IVa) not controlled by conventional therapy. Drug administration: 1 mg/Kg intravenous bolus followed by infusion of 10 mcg/Kg/min over 24 hours; in 11 patients, upon termination of long term infusion, oral therapy was begun (100 mg tid) for a period of four weeks. After bolus and during infusion dyspnea, pulmonary and jugular vein congestion, hepatomegaly rapidly improved, and increase of diuresis was noted. All patients responded with a substantial reduction in central venous pressure (CVP 9.64 +/- 5.96----4.79 +/- 5.66 mmHg, P less than 0.01), wedge pressure (WP 26.3 +/- 4.6----19.00 +/- 4.66 mmHg, P less than 0.01), pulmonary and systemic vascular resistances (PVR 212.07 +/- 121.08----127.64 +/- 50.37 dyne. sec. cm-5; SVR 1687 +/- 301----1297 +/- 357 dyne. sec. cm-5; P less than 0.01); these changes were accompanied by an increase of cardiac index (CI 1.96 +/- 0.38----2.84 +/- 0.83 L/Min/m2; P less than 0.01), stroke index (SI 23.43 +/- 5.85----31.64 +/- 8.86; P less than 0.01) and left ventricular stroke index (LVSWI 22.36 +/- 8.45----34.50 +/- 12.29 g.m/b/m2; P less than 0.01). These positive clinical and hemodynamic effects were not maintained in long term therapy. Moreover we observed adverse effects: fever, nausea and vomiting, thrombocytopenia, liver enzyme elevation, tachycardia and ventricular arrhythmias. CONCLUSIONS: good efficacy and tolerability during short term intravenous therapy in emergency conditions; no clinical improvement and sometimes adverse effects in oral long term therapy.

Hemodynamic effects of clonidine in patients with acute myocardial infarction complicated by hypertension.

Arterial hypertension complicating acute myocardial infarction (AMI) may aggravate myocardial damage, possibly through an increase in myocardial oxygen demand. This study reports the effects of clonidine in patients with hypertension complicating acute myocardial infarction. Forty patients (37 men and three women, average age 53 years) with acute myocardial infarction, admitted to the coronary care unit not more than 24 h after the onset of symptoms, were studied. Thirty-four had anterior myocardial infarction and six had inferior myocardial infarction. All patients were in Forrester I [WP less than 18 mm Hg, cardiac index (CI) greater than 2.21 L/min/m2] or II (WP greater than 18 mm Hg, CI greater than 2.21 L/min/m2) hemodynamic subset. Blood pressure limits were systolic blood pressure greater than or equal to 150 mm Hg and diastolic blood pressure greater than or equal to 95 mm Hg. Clonidine was administered intravenously in a dose of 5 micrograms/kg over a 5-min period. Hemodynamic parameters (Swan-Ganz thermodilution catheter), systolic time intervals (Weissler), and calculated hemodynamic indexes were measured both before and 60 min after cessation of intravenous injection. Blood pressure fell from 161 +/- 20 to 126 +/- 19 mm Hg (systolic) and from 105 +/- 7.6 to 84.7 +/- 9 mm Hg diastolic. Overall, clonidine produced a decrease in total systemic resistance (-21%). Cardiac index did not change significantly (-3%). Left ventricular stroke work index was significantly reduced (-21%, p less than 0.001), as was the triple product, suggesting a favorable effect of clonidine on myocardial oxygen supply/demand ratio. This may result in a reduction in infarct size.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of intravenous diltiazem in acute myocardial infarction: hemodynamic evaluation]. / Effetti del diltiazem per via endovenosa nell'infarto miocardico acuto: valutazione emodinamica.

The acute hemodynamic effects of intravenous Diltiazem were studied in 20 pts. with acute myocardial infarction, admitted to Coronary Care Unit within 24 hours from onset of Symptoms--19 men, 1 woman, aged from 46 to 83 years, 14 with anterior myocardial infarction, 6 with inferior myocardial infarction. All, but one, where at the time of their admission to CCU in first Forrester's hemodynamic subset (CI greater than 2.2 L/min/m2, WP less than 18 mmHg); in the last patient WP was 21 mmHg, CI 2.6 L/min/m2. Hemodynamic measurements were performed before (no drugs with hemodynamic effects were allowed during 4-6 hours before the study protocol) and after the administration of Diltiazem, 0,3 mg/kg i.v. administered in 2 min. (bolus) in 12 patients, Group A. In 8 pts--Group B--the bolus was followed by continuous infusion of Diltiazem at the rate of 5 mcg/Kg/min for three hours. The hemodynamic measurements were repeated: in Group A 2-5-30-60-120 min. after the end of the bolus; in the Group B at the same time as Group A, at the end of infusion (180 min) and 60 min after the end of infusion. Diltiazem induced no significant changes of HR, CVP, WP, CI, LVSWI and Triple product, in both groups of pts., at any time. Systolic and diastolic blood pressure decreased significantly (P less than 0.01) only 2 min. after Diltiazem administration (Group A: SBP 125.0 +/- 15.8----114.0 +/- 16.0 mmHg, DBP 85.4 +/- 6.5----76.6 +/- 10.5 mmHg; Group B: SBP 123.0 +/- 20.0----113.0 +/- 11.0 mmHg, DBP 78.1 +/- 7.0----75.0 +/- 4.9 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemodynamic effects of intravenous clonidine in patients with acute myocardial infarction]. / Effetti emodinamici della clonidina endovena nell'infarto miocardico acuto.

To assess the hemodynamic effects of Clonidine in hypertensive patients (pts) with an acute myocardial infarction (AMI), we administered the drug to 12 such patients either in a single bolus (75--150 micrograms in 5 min - 8 pts) or by continuous infusion (0.4--5 micrograms/min - 4 pts). Hemodynamic measurements were obtained by means of a Swan-Ganz thermodilution catheter, before and 60 min after the administration of the drug. Clonidine did not significantly affected Heart Rate (from 80.5 +/- 3.9 to 78.4 +/- 5.9 beats/min), Mean Pulmonary Arterial Pressure (from 18.6 +/- 1.7 to 15.1 +/- 1 mmHg), Mean Pulmonary Wedge Pressure (from 12.5 +/- 1.1 to 10.6 +/- 0.7 mmHg), central Venous Pressure (from 4 +/- 0.8 to 3 +/- 0.9 mmHg), Cardiac Index (from 2.6 +/- 0.07 to 2.6 +/- 0.7 L/min/m2), Stroke Volume (from 65.2 +/- 2.8 to 68.5 +/- 5.5 ml/b). Conversely Mean Arterial Pressure fell significantly from 127 +/- 3.1 to 96.2 +/- 7.2 mmHg (P less than 0.001). Left Ventricular Systolic Work Index was reduced from 62.3 +/- 3.3 to 50.4 +/- 4.4 gm/beats/m2 (P less than 0.025), Total Systemic Resistances from 1888 +/- 50 to 1412 +/- 117 dyne sec cm-5 (P less than 0.005) and Tension Time Index from 3536 +/- 495 to 2389 +/- 385 x 10(3) mmHg x sec/min (p less than 0.05). Clonidine is a safe and useful drug to obtain a fall of high blood pressure often complicating AMI, without depressing left ventricular performance, as suggested by no significant changes of CI, WP and LVSWI. The reduction of TTI suggests a beneficial effect on the balance between myocardial oxygen delivery and demand. Clonidine is a hypotensive drug which can be safely used in patients with AMI, without depressing the left ventricular performance.