Beneficial effect of HEPES buffer in repeated coronary reperfusion.

BACKGROUND: We have demonstrated previously that, when repeated reperfusion is performed after reocclusion, there is a decrease in the amount of myocardial salvage, despite early reperfusion. Treatment with nisoldipine induced a beneficial effect by reduction of infarct size in this experimental model. OBJECTIVE: To study the effect of HEPES buffer on infarct size, using a repeated-reperfusion model. METHODS: The left anterior descending coronary artery was occluded in anesthetized dogs. Thirty minutes after the occlusion, dogs were allocated randomly to either the treatment group (n = 7; HEPES 0.64 mmol/l infused intravenously throughout the experiment) or the control group (n = 8; saline). Occlusion was maintained for 2 h, followed by 1 h of reperfusion, then 1 h of reocclusion and 2 h of second reperfusion. An in-vivo area at risk was determined by gentian violet staining, and infarct size was defined and quantitated by triphenyl-tetrazolium chloride staining. RESULTS: Hemodynamic measurements were similar in both groups. Mass of necrosis/mass at risk was significantly smaller in the HEPES group (30.7 +/- 1.6%, mean +/- SEM) compared with controls (50.6 +/- 3.8%, P < 0.001). CONCLUSION: Treatment with HEPES induces a beneficial effect by reduction of infarct size in repeated coronary reperfusion.

Beneficial effect of nisoldipine in repeated coronary reperfusion.

BACKGROUND: We have demonstrated that when repeated reperfusion is performed after reocclusion, there is a decrease in the amount of myocardial salvage, despite early reperfusion. It is unknown whether this deleterious effect of repeated reperfusion can be antagonized. Therefore, we studied the effect of nisoldipine (a dihydropyridine calcium antagonist) on infarct size, using a repeated-reperfusion model. METHODS: The left anterior descending coronary artery was occluded in anaesthetized dogs. Thirty minutes after occlusion, dogs were allocated randomly to either the treatment group (n = 6; 6 micrograms/kg per min nisoldipine infused intravenously throughout the experiment) or the control group (n = 8; saline). Occlusion was maintained for 2 h, followed by 1 h of reperfusion, then 1 h of reocclusion and 2 h of second reperfusion. An in vivo area at risk was determined by gentian-violet staining, and infarct size was defined and quantitated by triphenyl-tetrazolium-chloride staining. RESULTS: Haemodynamic measurements were similar in both groups. Mass of necrosis/mass at risk was significantly smaller in the nisoldipine group (33.3 +/- 5.8%, mean +/- SEM) compared with controls (46.8 +/- 4.8%; P < 0.05). CONCLUSION: Treatment with nisoldipine induces a beneficial effect by reduction of infarct size in repeated coronary reperfusion.

Medical aspects of the Iraqi missile attacks on Israel.

During the period 18 January-28 February 1991, a total of 39 Iraqi modified Scud missiles landed in Israel, most of them in the densely populated Tel Aviv area. There were 23 missile attack alerts. These attacks caused 1,059 cases of injury; there were two deaths and 232 patients were admitted to emergency rooms for injuries directly related to the explosions, only one of which was severe. A survey among 91 of the injured showed that 46.6% of the wounds were caused by glass splinters, 31.1% were blunt contusions, and 22.2% were acute psychological reactions. No case of blast injury was reported. Inappropriate injection of atropine was reported in 230 cases. Acute anxiety was the reason for admission of 544 patients to emergency rooms. Another 40 patients sustained various traumas while rushing to the sealed room. The relatively low number of injured people is striking in view of the density of population in the areas hit. Various explanations are discussed.

Symptomatic pericardial effusion in breast cancer patients: the role of fluid cytology.

Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1-219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis. The survival probability is a function of the extent of extracardiac disease; among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival.

Diagnostic and prognostic value of oral dipyridamole test using echocardiography.

The diagnostic and prognostic value of the oral dipyridamole test using echocardiography was evaluated in 47 consecutive patients undergoing coronary arteriography. The results of the tests were not communicated to the physicians treating the subjects during a 1-year follow-up. The test had a sensitivity of 54% and a specificity of 100% for predicting severe (greater than or equal to 70% luminal stenosis) coronary artery disease. Neither ST-T segment changes nor chest pain during the test were associated with the presence of severe coronary artery disease. In the subgroup of 34 patients with severe coronary artery disease, the appearance of left ventricular segmental systolic dysfunction or ST-T segment depression (greater than or equal to 1 mm) during the test has a strong predictive value for subsequent cardiac events during a 1-year follow-up.

A simple procedure for the extraction of double-stranded RNA from virus-infected plants.

A simple procedure for the isolation of double-stranded (ds) RNA from virus-infected plants is described. The method is based on grinding plant tissue in 4% p-aminosalicylic acid and recovery of ds RNA by phenol extraction and precipitation with 30% ethanol. The presence of both negative and positive virus RNA strands in RNA fractionated in agarose gels was verified by Northern blot hybridization with polynucleotide kinase labelled genomic RNA or complementary DNA (cDNA) probes. The procedure enabled detection of three major ds RNA species (MWs 4.2, 1.05 and 0.48 X 10(6)) and at least 4 minor bands with estimated MWs of 3.5, 2.5, 2.2 and 2.0 X 10(6) in Nicotiana tabacum plants systemically infected with tobacco mosaic virus (TMV). Cucumber mosaic virus (CMV)-infected Pachystachys coccinea plants contained 2 minor bands of MWs 0.49 and 0.35 X 10(6) in addition to the previously described 4 major ds RNAs and ds CARNA 5 (MW 0.22 X 10(6)). The patterns of ds RNA are useful for diagnosing natural infections of CMV and TMV in N. glauca plants and of citrus tristeza virus in Citrus spp.

Prognostic implication of detecting vegetations by M-mode echocardiography.

The prognostic significance of finding vegetations by M-mode echocardiography in patients with infective endocarditis remains controversial because many such patients are referred for early surgery. We detected vegetations in 7 of 25 consecutive subjects with active infective endocarditis (28.1%) studied by M-mode echocardiography. 11 patients died within 1 year and only 1 underwent surgery. Patients with vegetations had a higher likelihood of developing serious complications such as death, congestive heart failure or "severe congestive heart failure' when compared with patients without vegetation. This study validates previously reported series including a high percentage of patients "requiring surgery' and points to the serious prognostic implication of finding a vegetation by M-mode echocardiography.

HLA-DRw4 in pemphigus vulgaris patients in Israel.

Pemphigus vulgaris (PV) is relatively common in Jews. Three HLA antigens were significantly more frequent in 39 Israeli Jewish PV patients than in controls A26 - 59% vs 20%; Bw38 - 61% vs 20%; and DRw4 - 90% vs 38%. The joint occurrence of A26-Bw38-DRw4 was observed in 46% of PV patients and in 10% of controls. Similar results were recently reported for Jews in the Los Angeles area. Yet, when our patient sample was grouped into Ashkenazi and non-Ashkenazi Jews, it was evident that each of the three antigens had a higher frequency both in Ashkenazi patients and controls as compared to non-Ashkenzai. The relative risk for DRw-4 in Ashkenzim was 33.8 as compared to 14.4 in the total sample of Israeli PV patients. The phenotype A26-Bw38-DRw4 was present in 57% of Ashkenazi patients and in 13% of controls. Ashkenazi Jews have the highest prevalence of PV, and HLA associations were strongest with Ashkenazi PV patients. These associations were with three antigens, all of high frequency in that group.