Pro-inflammatory cytokine expression studies of subclinical and clinical endometritis in endometrial tissues of buffaloes.

The objective of the study was to investigate the role of pro-inflammatory cytokines in the pathogenesis of endometritis in buffaloes, which can lead to early diagnosis of endometritis. The expression of CD14, TLR-4, and IL-1ß encoding gene in endometrium of buffaloes with subclinical endometritis were 1.87, 2.71, and 3.48-fold, while samples with clinical endometritis showed only 2.90, 4.76, and 8.02-fold for CD14, TLR-4, and IL-1ß, respectively, though numerical value of expression was higher in subclinical and clinical endometritis but it was at par with control. The expression profile for IL-6, IL-8, and TNF-α mRNA for subclinical endometritis were 11.95, 14.87, and 12.95-fold while for clinical endometritis, values were 18.17, 37.97, and 28.83-fold for IL-6, IL-8, and TNF-α mRNA, respectively, which were significantly higher in subclinical and clinical endometritis as compared to apparently normal samples at follicular phase. In the luteal group, the subclinical endometritis sample showed 2.13, 6.43, 14.52, 22.38, 18.64, and 2.82-fold respectively, for CD14, IL-1ß IL-6, IL-8, TNF-α, and TLR-4 mRNA. Except TLR-4, the values of expression were significantly higher when compared with apparently normal. Whereas, the expression values of clinical endometritic uteri were 4.01, 7.15, 17.20, 45.55, 52.58, and 32.95-fold respectively, for CD14, TLR-4, IL-1ß, IL-6, IL-8, and TNF-α mRNA which were significantly higher as compared to apparently normal uteri. An increase in the mRNA expression of CD14, TLR-4, and pro-inflammatory cytokines having higher diagnostic importance in uterine inflammation.

Evolution in the practice of primary angioplasty: effect of adjunctive coronary stenting and glycoprotein IIb/IIIa inhibitors on long-term outcomes.

Primary angioplasty strategies have evolved dramatically, including increasing adjunctive use of stents and glycoprotein (GP) IIb/IIIa inhibitors. The purpose of this study was to examine the specific effects of these adjunctive therapies on long-term outcomes after primary angioplasty. From 1996 to 1998, 257 unselected, consecutive patients underwent primary PTCI at our institution. In-hospital mortality was 5.4% (2.9% for patients without cardiogenic shock). The remaining 243 patients were followed for 2.0 +/- 0.7 years. Adjunctive stenting was associated with increased late mortality (8.7% vs. 2.3%, P = 0.02). GP IIb/IIIa inhibitors were associated with reduced late mortality among patients receiving stents (6.9% vs. 21.4%, P = 0.07), but not in those patients treated with balloon angioplasty alone (2.9% vs. 0%, P > 0.20). Coronary stenting remained a significant predictor of late mortality (hazard ratio 5.6, 95% CI 1.5-21.2) after adjustment for other established risk factors. In this unselected series, adjunctive coronary stenting was associated with higher late mortality among hospital discharge survivors. Concomitant GP IIb/IIIa inhibitors partially corrected for this increase. These results are limited by the small sample size and retrospective design of this study. Additional long-term studies are required to test these findings and evaluate for possible mechanisms.

Increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients. THROMBO Investigators.

Diabetes is an established risk factor for reinfarction and cardiac death in postinfarction patients. Since the underlying mechanism of diabetes-related risk is not fully understood we aimed to evaluate the association between lipids, thrombogenic factors and diabetes in postinfarction patients. The study population consisted of 1,045 postinfarction patients (846 non-diabetic, 125 non-insulin- and 74 insulin-requiring diabetics) with the following blood tests performed 2 months after an index myocardial infarction: lipoprotein (a), apolipoprotein-B, apolipoprotein-A, cholesterol, HDL cholesterol, triglycerides, insulin, von Willebrand factor (vWF), fibrinogen, factor VII, D-dimer, and plasminogen activator inhibitor (PAI-1). After adjustment for relevant clinical covariates, non-insulin-requiring diabetes was significantly (p < 0.05) associated with elevated levels of (odd ratios per 1 log unit increase in parenthesis) vWF (1.74) and PAI-1 (1.42) whereas insulin requiring diabetes was associated with even more elevated levels of vWF (4.68), but not with increased levels of PAI-1. No significant differences in lipid levels were observed among three groups. In conclusion, increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients, suggesting that endothelial damage is the primary mechanisms contributing to an increased occurrence of vascular and cardiac events in diabetic postinfarction patients.

Late stent thrombosis without antecedent brachytherapy: confirmation and treatment with rheolytic thrombectomy.

We describe two cases of late stent thrombosis (> 30 days postprocedure) following stenting without brachytherapy. Stent thrombosis was confirmed after successful treatment by catheter-based rheolytic thrombectomy. Predictors of stent thrombosis are reviewed and issues concerning the duration of combination antiplatelet therapy after stenting are discussed.

Double-chambered right ventricle in an adult patient.

A 65-year-old male was referred for to our facility for right and left heart catheterization and coronary angiography for evaluation of a ventricular septal defect and to rule out significant coronary artery disease. During the procedure, the patient was diagnosed with a double-chambered right ventricle (DCRV). Most DCRV cases are diagnosed at a young age; presentation in an adult is extremely rare.

Tuberculous gumma (cutaneous metastatic tuberculous abscess) with underlying lymphoma.

Cutaneous tuberculosis is an infrequent first sign of disseminated tuberculosis. We describe a patient with 2 cutaneous ulcerations that grew Mycobacterium tuberculosis. Despite an initial response to antimycobacterial therapy, the fever relapsed. After several months, biopsy of a single cervical lymph node showed a T cell-rich B cell lymphoma. Our patient had metastatic tuberculous abscesses (tuberculous gummas), which are secondary to disseminated tuberculosis, and an underlying occult lymphoma, both believed to be sequentially presenting as a fever of unknown origin.

Gender-related differences in thrombogenic factors predicting recurrent cardiac events in patients after acute myocardial infarction. The THROMBO Investigators.

Thrombosis contributes to recurrent coronary events in patients after acute myocardial infarction (AMI), but prognostic significance of thrombogenic factors by gender is unknown. This study aimed to determine gender-related differences in the prognostic significance of thrombogenic factors for predicting cardiac events (nonfatal reinfarction or cardiac death) in postinfarction patients. Blood levels of the following factors were measured 2 months after AMI in 791 men and 254 women: fibrinogen, von Willebrand factor, factor VII and VIIa, plasminogen activator inhibitor, D-dimer, cholesterol, apolipoprotein A-1, apolipoprotein B, lipoprotein(a), triglycerides, and high-density lipoprotein cholesterol. After adjustment for clinical covariates, levels of apolipoprotein A, high-density lipoprotein cholesterol, fibrinogen, and factor VIIa were significantly higher in postinfarction women than men. During a mean 26-month follow-up, there were 67 cardiac events (8.5%) in men and 14 (5.5%) in women (p = 0.11). In the multivariate Cox model, elevated levels of factor VIIa were a significant predictor of cardiac events in women (p = 0.022) but not in men (p = 0.80), with significant gender-related effect (hazard ratio 2.80 vs 0.92, respectively; p <0.05). D-dimer had prognostic value in men (p = 0. 006) but not in women (p = 0.36), although the difference between hazard ratios for men and women was not significant (2.35 vs 1.58, respectively; p = 0.49). In conclusion, elevated levels of factor VIIa are associated with an increased risk of recurrent cardiac events in postinfarction women, but not in men. D-dimer is more predictive for cardiac events in postinfarction men than women. These observations indicate possible gender-related differences in the pathophysiologic mechanisms of recurrent cardiac events.

Utility of thallium-201 scintigraphy in detecting right ventricular dysfunction in pulmonary embolism.

Acute right ventricular dysfunction has been established both as a diagnostic and prognostic indicator in pulmonary embolism. This report illustrates the utility of thallium-201 scintigraphy as an adjunctive noninvasive test in the diagnosis of pulmonary embolism by demonstrating increases in regional right ventricular perfusion and its subsequent resolution with treatment presumably as a result of decreased pressure work.

Ability of the exercise electrocardiogram test to detect ischemia in stable coronary artery disease patients with ST-segment depression on the resting electrocardiogram.

BACKGROUND: The appearance of ST-segment depression on the exercise electrocardiogram (ETT) generally indicates myocardial ischemia. Disorders that produce ST-segment depression on the resting electrocardiogram can confound the results of the ETT. The purpose of this study was to assess the reliability of exercise ST-segment depression as an indicator of ischemia in patients with a resting electrocardiographic ST depression, presumably caused by coronary disease. METHODS: We studied 882 patients 1 to 6 months after a hospitalization for myocardial infarction or unstable angina as part of the Multicenter Study of Myocardial Ischemia. An ETT and thallium-201 perfusion scan were performed in all patients. For the purpose of this study, the perfusion scan was considered the "gold standard" for ischemia. We correlated the ETT ST-segment responses with the perfusion scan in a group with a normal electrocardiogram baseline ST segment (NO ST DEP group) and in a group with resting electrocardiographic ST depression > or =0.5 mm (ST DEP group). RESULTS: Although the frequency of ischemia by perfusion scan was similar in the ST DEP group (48%) to that in the NO ST DEP group (40%), the ST DEP group had a significantly higher (p = 0.03) sensitivity (54%) in detecting ischemia than the NO ST DEP group (35%). The ST DEP group, however, had a lower (58% vs 74%) specificity than the NO ST DEP group (p = 0.056). Baseline characteristics of the two groups probably account for these differences. The overall diagnostic accuracy is similar (58% vs 56%) in the two groups. CONCLUSION: We conclude that in a stable population with known coronary disease, the presence of ST depression on the resting electrocardiogram does not impair the detection of ischemia by the ETT, but may be associated with a higher false-positive rate.

Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy.

To assess whether the presence of mitral regurgitation has a protective effect on left ventricular thrombus formation in a heterogeneous group of patients with dilated cardiomyopathy, a group of 103 patients with dilated cardiomyopathy identified by means of echocardiographic criteria was assembled over 1 year. The purpose of the study was to define a subgroup of patients with dilated cardiomyopathy from whom long-term anticoagulation might be withheld. Each echocardiogram was evaluated for the presence of left ventricular thrombus, presence and severity of mitral regurgitation, and ejection fraction. The role of clinical factors and clotting factors in left ventricular thrombus formation was assessed. Left ventricular thrombus was not present in 91 patients (group A) and was present in 12 patients (group B). Group B had larger left atrial and left ventricular systolic dimensions and decreased left ventricular systolic function. Mitral regurgitation jet area and ratio between mitral regurgitation jet area and left atrial area were lower (signifying less severe mitral regurgitation) among patients in group B. Although mitral regurgitation was equally present in group A and group B, severe mitral regurgitation was found only in group A patients ( 11 of 91 patients). Among patients with dilated cardiomyopathy, left ventricular ejection fraction is the factor most associated with left ventricular thrombus formation. The presence of severe mitral regurgitation may have a protective role in left ventricular thrombus formation.

Barium influx mediated by the cardiac sodium-calcium exchanger in transfected Chinese hamster ovary cells.

We examined Ba2+ influx using isotopic and fura-2 techniques in transfected Chinese hamster ovary cells expressing the bovine cardiac Na+/Ca2+ exchanger (CK1.4 cells). Ba2+ competitively inhibited exchange-mediated 45Ca2+ uptake with a Ki approximately 3 mM. Ba2+ uptake was stimulated by pretreating the cells with ouabain and by removing extracellular Na+, as expected for Na+/Ba2+ exchange activity. The maximal velocity of Ba2+ accumulation was estimated to be 50% of that for Ca2+. When the monovalent cation ionophore gramicidin was used to equilibrate internal and external concentrations of Na+, Ba2+ influx was negligible in the absence of Na+ and increased to a maximum at 20-40 mM Na+. At higher Na+ concentrations, Ba2+ influx declined, presumably due to the competition between Na+ and Ba2+ for transport sites on the exchanger. Unlike Ca2+, Ba2+ did not appear to be taken up by intracellular organelles. Thus, 133Ba2+ uptake in ouabain-treated cells was not reduced by mitochondrial inhibitors such as-Cl-CCP or oligomycin-rotenone. Moreover, intracellular Ca2+ stores that had been depleted of Ca2+ by pretreatment of the cells with ionomycin (a Ca2+ ionophore) remained empty during a subsequent period of Ba2+ influx. Ca2+ uptake or release by intracellular organelles secondarily regulated exchange activity through alterations in [Ca2+]i. Exchange-mediated Ba2+ influx was inhibited when cytosolic [Ca2+] was reduced to 20 nM or less and was accelerated at cytosolic Ca2+ concentrations of 25-50 nM We conclude that (a) Ba2+ substitutes for Ca2+ as a transport substrate for the exchanger, (b) cytosolic Ba2+ does not appear to be sequestered by intracellular organelles, and (c) exchange-mediated Ba2+ influx is accelerated by low concentrations of cytosolic Ca2+.