Gender differences in device therapy for malignant ventricular arrhythmias.

BACKGROUND: Several recent reports have suggested a gender bias in the treatment of cardiovascular disease. It is not clear whether this is true in the treatment of malignant ventricular arrhythmias. OBJECTIVES: To perform a retrospective chart review of 130 patients evaluated for malignant ventricular arrhythmias between July 1990 and June 1992. To compare baseline cardiovascular and clinical parameters and treatment modalities, including cardioverter-defibrillator implantation rates, between women and men. RESULTS: There was no significant difference in the percentage of women and men who were advised to have cardioverter-defibrillator implantation (61% vs 53%) or who underwent cardioverter-defibrillator implantation (46% vs 52%). Women had a lower incidence of coronary artery disease than men (61% vs 85%, P < .01), a lower incidence of myocardial infarction (46% vs 75%, P < .01), and a higher mean left ventricular ejection fraction (38% vs 32%, P = .02). Of patients with indications for cardioverter-defibrillator implantation, significantly more women refused a device than men (19% vs 2%, P = .01), and significantly more women were considered medically ineligible for cardioverter-defibrillator implantation despite having less severe heart disease as a group (12% vs 0%, P = .04). This resulted in significantly fewer women receiving a defibrillator than men with similar indications (18 of 26 women vs 47 of 48 men, P < .01). Of patients who received defibrillators, significantly more women received investigational devices (50%) than men (21%) (P < .05) (35% of women and 19% of men with indication for cardioverter-defibrillator implantation). In-hospital mortality was low in both groups (women, 0%; men, 4%). The 30-month mortality in patients with indications for device intervention was similar in both groups (women, 21%; men, 19%). CONCLUSIONS: No evidence of difference was found between women and men in the rates of recommendation for, or implantation of, implantable cardioverter-defibrillators. Women refused device implantation more often than men, and they may be considered medically ineligible for device implantation more than men. This combination results in fewer women with medical indications for cardioverter-defibrillator implantation receiving defibrillators than men. This difference does not appear to be associated with increased short-term mortality.

Parietal lobe abscess after routine periodontal recall therapy. Report of a case.

This paper reports on a case of a 70-year-old physician diagnosed with a parietal lobe abscess following such treatment. After stereotactic biopsy and drainage and a 6-week course of intravenous antibiotic treatment, the patient recovered with minimal neurologic deficits. Although brain abscesses are not commonly encountered in practice, clinicians must be aware of the potential virulence of the anaerobic components of the periodontal pocket and the possibility of resulting systemic infection, which can produce a life-threatening situation.

Isolation, biochemical characterization and ultrastructural analysis of the limbic system-associated membrane protein (LAMP), a protein expressed by neurons comprising functional neural circuits.

The limbic system-associated membrane protein (LAMP) is a cell surface glycoprotein expressed by cortical and subcortical regions of the mammalian CNS that comprise or receive direct projections from limbic system structures. The early and restricted expression of LAMP has led to its postulated role in neural development. Purification and biochemical characterization of LAMP was performed in order to ascertain its relationship to other, well-defined cell surface proteins in the nervous system. Subcellular fractionation, immunoaffinity chromatography, and Western blots of rodent and bovine hippocampus revealed that LAMP is an integral membrane protein with a molecular mass of 64-68 kDa and a pI of 5.2-5.5. Deglycosylation of LAMP indicates that it contains N-linked high mannose or hybrid sugars and a minor amount of sialic acid. The LAMP protein exhibits an identical molecular mass in developing hippocampus and in several different brain regions in the adult. No cross-reactivity was obtained using the monoclonal antibody that recognizes the HNK-1 carbohydrate epitope, a complex sulfated moiety expressed on members of a large family of glycoproteins. Immunocytochemical analysis at the ultrastructural level reveals that LAMP immunoreactivity is exhibited by neurons in a stereotyped pattern throughout limbic system areas. Glial cells are not immunoreactive. In the adult, LAMP-immunoreactive membrane patches are present exclusively postsynaptically on neuronal somata and dendrites. Myelinated and unmyelinated axons are not stained in any brain region examined. Analysis of LAMP expression in the developing CNS during synaptogenesis demonstrates that LAMP is located on growing axons and both pre- and postsynaptically at forming terminal complexes. Double-labeling studies of the hippocampal neurons grown in vitro reveal that the LAMP epitope is extracellular and is expressed on neurofilament- and microtubule-associated protein 2-positive neurites. Cells expressing glial fibrillary acidic protein are not LAMP-immunoreactive. These results demonstrate that in the adult brain, LAMP is expressed almost exclusively by the postsynaptic (target) elements in limbic circuits, but that during development, all components of the surface of the growing neuron contain LAMP. The stereotyped anatomical pattern of expression of LAMP in the developing and mature brain and its biochemical characteristics suggest that LAMP is a unique, system-associated membrane glycoprotein that is distinct from previously identified, developmentally important cell surface proteins.

A unique membrane protein is expressed on early developing limbic system axons and cortical targets.

The limbic system-associated membrane protein (LAMP) is a 64 kDa protein that, in the adult brain, is present in cortical and subcortical regions comprising the limbic system (Levitt, 1984). The developmental expression of LAMP was studied in fetal rat brains to determine the specific patterns of distribution and the cellular elements that exhibit LAMP immunoreactivity. Light microscopic immunocytochemical analysis revealed that LAMP is expressed on neurons and their growing axons early in fetal development, at a time coincident with pathway formation and differentiation of limbic system nuclei. In the forebrain, where limbic system structures are heavily concentrated, immunoreactivity appears on subpopulations of axons in a temporal sequence that correlates with the time of formation of pathways carrying limbic system axons. Thus, staining is evident first at embryonic day (E) 15 on fibers within the internal capsule coursing from the diencephalon to cortex. LAMP immunoreactivity appears over the next 3 d in the anterior commissure, fornix, and corpus callosum. Ultrastructural immunocytochemical analysis reveals dense surface staining of fascicles of developing axons and growth cones. The axonal staining is transient, disappearing during the second postnatal week of development. In cerebral cortex, cells in presumptive limbic cortical regions such as lateral perirhinal sulcal cortex and prefrontal cortex are LAMP immunoreactive from the inception of the cortical plate. These cortical regions are clearly delineated from surrounding unstained nonlimbic areas as early as E15. Thus, LAMP expression in the cortex may represent one of the earliest markers of specific cytoarchitectonic areas.(ABSTRACT TRUNCATED AT 250 WORDS)