Comparison of secondary prevention of heart disease in Europe: lifestyle getting worse, therapy getting better in Ireland.

We compared the implementation of secondary prevention some 18 months following acute myocardial infarction or coronary artery bypass surgery in Ireland in 1994 to that in 15 European countries, including Ireland, in 2000. While there were substantial improvements in the use of statins, b-blockers and the availability of rehabilitation programmes since the early 1990s, more patients now smoke, take no exercise and are overweight. The prevalence of non-insulin dependent diabetes has increased by 70%. In comparison with other European countries, we have the highest use of aspirin and the highest prevalence of smoking in women. Despite a considerable improvement in the use of drug therapy we will not achieve the full potential of secondary prevention unless lifestyle factors, including smoking, overweight and exercise receive greater attention by patients with coronary heart disease.

GC/MS analysis of volatile organic selenium species produced during phytoremediation.

The use of plants and microorganisms that can naturally volatilize selenium and remove it from the soil or water has been studied with promising results. It has been shown that selenium can be removed from soils by plant uptake and accumulation, plant volatilization, and removal in the rhizosphere. Preliminary studies indicated that Hydrilla verticillata Royle removed selenium by means of phytovolatilization. Therefore, studies were conducted to examine the volatile products produced during phytoremediation of selenium by hydrilla. Samples were obtained and analyzed by GC/MS. Organoselenium compounds found were dimethyl selenide, dimethyl diselenide, and diethyl diselenide.

New ways to ventilate newborns in acute respiratory failure.

Out treatment options for acute neonatal failure have expanded greatly in the last 20 to 30 years. This article reviews patient-triggered ventilation, high frequency ventilation, negative extrathoracic pressure ventilation, nitric oxide therapy, liquid ventilation, extracorporeal membrane oxygenation, and advances in pulmonary function monitoring. The authors present background theories, describe equipment, review clinical strategies, and the results of recent trials.

Ethical decisions in the delivery room.

Avoidance of futile therapies that only prolong suffering and the high emotional and economic cost to family and society justifies an attempted differentiation of infants whose defects are so extensive or whose prognoses are so poor that CPR should be withheld. This article discusses the ethical bases for decision making in the DR and the three most common diagnoses in which CPR decisions are most difficult: infants with severe congenital defects, extremely low birthweight infants, and infants with severe perinatal asphyxia.

Early results with a new procedure for hypoplastic left heart syndrome and aortic atresia.

One patient with hypoplastic left heart syndrome and another with aortic atresia and a complex form of functional single ventricle, who were candidates for the Norwood operation, received a new palliative procedure. This involved anastomosis of the dome of the pulmonary artery to the undersurface of the transverse arch of the aorta with placement of a fenestrated patch in the main pulmonary artery to divide the systemic and pulmonary circulations. Both patients have survived this initial procedure and will receive second stage palliation at 6 months of age. Shorter circulatory arrest and cardiopulmonary bypass times are required, and this procedure may be a safer alternative than the Norwood for neonates with hypoplastic left heart syndrome and aortic atresia.

Psychological aspects of parenting critically ill neonates.

This study was designed to objectively examine depression and distress levels in parents of ill versus parents of healthy neonates by utilizing two well-validated questionnaires, the Beck Depression Inventory (BDI) and Kellner Symptom Questionnaire (KSQ). In addition, morbidity of infants was assessed by the Minde-Whitelaw Neonatal Morbidity Scale, and parents completed a socioeconomic questionnaire. Analysis of mean BDI and KSQ scores revealed significant differences between parents of ill neonates and parents of healthy neonates in BDI, total KSQ scores, KSQ anxiety, and depression scale scores. Within these groups, respondents whose scores fell into moderate to severe ranges of distress on either questionnaire were referred for counseling. The BDI and KSQ can be tools for better understanding about distress levels in parents of ill and healthy neonates.

Human monocytes generate basophil histamine-releasing activities.

Human peripheral blood monocytes generated activities during 24-h culture that were capable of triggering histamine release from 17 of 18 human basophil donors. Monocytes and their in vitro transformed macrophages continued to elaborate these basophil histamine-releasing activities for at least 3 wk in culture. In the 18 basophil donors tested, maximum histamine release induced by monocyte supernatants was 33.8 +/- 5.9% (mean +/- SEM) of total basophil histamine content; optimum anti-IgE-induced release was 38.8 +/- 6.2%. Basophil histamine release in response to monocyte activities was optimal at 37 degrees C and at calcium concentrations of 2 to 5 mM. Release was greater than 90% complete 1 min after challenge and was inhibited by anti-allergic drugs. The mechanism of release appeared to be independent of IgE binding. Gel filtration of supernatants derived from both day 1 (monocyte stage) and day 14 (macrophage stage) cultures demonstrated activity peaks with approximate m.w. of 12,000 and 30,000. In contrast to the marked responsiveness of basophils, only 2 of 10 human lung mast cell preparations responded; release in those preparations was low: 3% and 13% histamine release, respectively. Thus, monocytes produce potent histamine-releasing activities with differential actions on basophils and mast cells.