Surgery for aortic arch thrombosis.

A localized thrombus involving the ascending aorta and arch rarely occurs in the absence of an underlying etiology such as chest trauma, atherosclerosis, a hypercoagulable state or instrumentation. A review of the literature between 1966 - 2003 yielded 38 reported cases of localized aortic arch thrombi, 21 of which were treated by surgical excision of the thrombus using different approaches. In this communication, we describe this clinical entity, with its diagnosis and management. The technical details that are important to ensure the safe conduct of the procedure are discussed.

Combinations of variations in multiple genes are associated with hypertension.

The genetic analysis of hypertension has revealed complex and inconsistent results, making it difficult to draw clear conclusions regarding the impact of specific genes on blood pressure regulation in diverse human populations. Some of the confusion from previous studies is probably due to undetected gene-gene interactions. Instead of focusing on the effects of single genes on hypertension, we examined the effects of interactions of alleles at 4 candidate loci. Three of the loci are in the renin-angiotensin-system, angiotensinogen, ACE, and angiotensin II type 1 receptor, and they have been associated with hypertension in at least 1 previous study. The fourth locus studied is a previously undescribed locus, named FJ. In total, 7 polymorphic sites at these loci were analyzed for their association with hypertension in 51 normotensive and 126 hypertensive age-matched individuals. There were no significant differences between the 2 phenotypic classes with respect to either allele or genotype frequencies. However, when we tested for nonallelic associations (linkage disequilibrium), we found that of the 120 multilocus comparisons, 16 deviated significantly from random in the hypertensive class, but there were no significant deviations in the normotensive group. These findings suggest that genetic interactions between multiple loci rather than variants of a single gene underlie the genetic basis of hypertension in our study subjects. We hypothesize that such interactions may account for the inconsistent findings in previous studies because, unlike our study, prior studies almost always examined single-locus effects and did not consider the effects of variation at other potentially interacting loci.

Serum lipid and lipoprotein levels in Ghanaians with diabetes mellitus and hypertension.

Both diabetes mellitus and hypertension alter lipid and lipoprotein metabolism and increase the risk of coronary artery disease. We have reported previously on lipid and lipoprotein levels in healthy Ghanaians, and this study deals with the levels of these biochemical parameters in Ghanaians with diabetes mellitus and hypertension. Fasting serum lipoproteins were determined on blood samples drawn from healthy male and female Ghanaians as well as age-matched individuals with either diabetes or hypertension. Cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, and fasting blood glucose were measured. Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were derived. Total serum cholesterol levels were 4.43 +/- 0.22 mmol/L and 4.67 +/- 0.26 mmol/L for diabetic males and females, respectively. High-density lipoprotein was 1.55 +/- 0.09 mmol/L and 1.50 +/- 0.09 mmol/L for male and female diabetics, respectively. Lipid and lipoprotein levels in the hypertensive patients did not differ from the above values. The levels of cholesterol and lipoprotein obtained in Ghanaians with hypertension and diabetes mellitus were similar to those of their age-matched healthy controls. These results suggest a reduced risk of coronary artery disease from the atherogenic effects of cholesterol in Ghanaians with diabetes mellitus and hypertension.

The profile of the African smoker: the Ghana smoking studies.

PIP: The prevalence of cigarette smoking in Ghana was assessed by examining the data on smoking from 2 World Health Organization sponsored studies of blood pressure and cardiovascular disease. The 2 studies were the Civil Servants Hypertension Project, which surveyed a sample of approximately 20% of all civil servants and included 486 male and 202 female respondents, and the Mamprobi Survey, which sampled the general population and included 3745 respondents, aged 14-64 years. Additional data from 2 other studies was also examined. Overall, the studies found that the proportion of smokers in Ghana was small and that most of those who smoked were not heavy smokers. The smoking prevalence rate among civil servants was 32% for males and 5.9% for females. Among the respondents in the Mamprobi Survey, the respective rates were 24% and 0.8%. For those aged 15-19 years, the prevalence rates in the 2 studies ranged from 4.6%-7.8% for males and was 0.0% for females. In another recent study of 2493 respondents from the general population, the proportion of smokers was only 15.1%. The proportion of smokers was similar among those who earned low and high salaries. In the Civil Servants Study the mean number of cigaretters smoked/day among the civil servants was 7 for the males and 4.7 for the females. In the Mamprobi Survey, the respective mean numbers were 8.4 and 3.0. Among civil servants, professional and administratie personnel smoked an average of 12 cigarettes/day while lower salaried workers smoked an average of 7 cigarettes/day. Only 3.7% of all the smokers in the 2 studies combined smoked 20 or more cigarettes/day. All of the studies indicate that 97%-99% of those who smoked/used cigarettes. Among civil servants, 91% of the smokers and 60% of the nonsmokers used alcohol. The studies indicate that the typical smoker in Ghana is an urban male, between 20-29 years of age, who began smoking as an adolescent. He is just as likely to belong to a high income group as a low income group; however, if he belongs to the former group, he is more likely to smoke more than the average number of cigarettes/day. Available information on smoking should be used to launch a public health campaign to reduce smoking in Ghana. At the present time, only a minority of the population smokes, few individuals are heavy smokers, and teachers and educators are showing considerable interest in combating smoking. Currently, educated and professional groups have a relatively high proportion of smokers. If these groups can be motivated to stop smoking, they might serve as effective role models for other segments of the population. Factors which may increase the smoking problem in Ghana are the growing number of young people who smoke and the ambivalence of the government toward smoking. Voluntary organizations and health professionals should assume more active roles in educating the public about the hazards of smoking.^ieng

[Pregnancy in women with atrioventricular block. 13 cases]. / La grossesse chez les femmes ayant un bloc auriculo-ventriculaire. 13 observations

Thirteen women aged between 18 and 37 years and suffering from atrio-ventricular block had 36 pregnancies. Foetal prognosis was excellent and the pregnancy quite unaffected by the block in 9 cases. In 4 women, Stokes-Adams attacks occurred. In one case from some time ago therapeutic abortion was necessary. Temporary pacing at the time of delivery was used in one case and a permanent pacemaker in one patient. The problems posed by the insertion of a pacemaker in a woman of childbearing age are discussed.