[Familial aortic dissection; cases involving a father, mother, and son].

The occurrence of familial aortic dissection is rare in cases that are not linked to Marfan syndrome. We report the 3 cases of acute aortic dissection, involving both parents and their son. Case 1 (father case): 79-year-old male visited a nearby doctor complaining of severe chest and back pain. He was diagnosed as acute aortic dissection (Stanford type A). An emergency operation was carried out and he had an artificial vascular replacement of ascending aorta and arch portion. Case 2 (mother case): 73-year-old female was treated for hypertension. Suddenly, she had a terrible epigastralgia and back pain. The contrast enhanced chest computed tomography (CT) revealed an acute aortic dissection (Stanford type A). The ascending aortic aneurysm ruptured in the ambulance while she was transferred to our hospital. She arrived at our hospital after cardiac and respiratory arrest. We attempted to perform cardiac massage, but we could not bring her back to life. Case 3 (son case): 48-year-old male was transferred to our hospital diagnosed with acute aortic dissection (Stanford type A). The ascending aorta replacement was performed on the same day. We were able to save cases 1 and 3 by performing surgery. Aortic dissection is thought to be the disease of medial degeneration. Hereditary links to aortic dissection are not well understood, with the exception of Marfan syndrome cases. The investigation of genetic mechanisms related to aortic dissection will be expected in the future.

[A case of bone metastases from carcinoma of the lung demonstrating increased uptake of 99mTc-ECD].

A 48-year-old man with carcinoma of the lung had loss of consciousness during radiation therapy and underwent 99mTc-ethyl cysteinate dimer (99mTc-ECD) SPECT to evaluate brain tumor seen on CT scan. Incidentally 99mTc-ECD SPECT imaging showed intense accumulation in the frontal and occipital bone. The tumor in the occipital bone had been histologically proven to be a metastasis from carcinoma of the lung. We presented a very rare case of bone metastasis demonstrating increased uptake of 99mTc-ECD.

Long-term effects of the angiotensin-converting enzyme inhibitor enalapril on chronic heart failure. Examination by 123I-MIBG imaging.

To examine the long-term effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril on chronic heart failure, 10 patients (7 men and 3 women, mean age: 62 +/- 11 years) with chronic stable heart failure, classified as New York Heart Association (NYHA) functional class 2-3 for more than 3 months, and a left ventricular ejection fraction less than 45% were treated with 2.5-5.0 mg of enalapril once a day for 3-15 months (mean 7 months). The causes of heart failure were old myocardial infarction (n = 7), hypertension (n = 2), and atrial fibrillation (n = 1). Radioiodinated metaiodobenzyl guanidine (123I-MIBG) imaging, radionuclide angiography, and treadmill exercise test were performed before and after the treatment. With enalapril treatment, (1) left ventricular ejection fraction (LVEF) increased significantly from 38.3 +/- 6.9% to 47.5 +/- 14.7%; (2) sub-maximal exercise time increased significantly from 205 +/- 112 to 272 +/- 120 seconds; (3) the heart to mediastinum (H/M) ratio of 123I-MIBG increased significantly (early image: 1.99 +/- 0.38 versus 2.20 +/- 0.50; delayed image: 1.86 +/- 0.44 versus 2.09 +/- 0.51); and (4) the washout rate of 123I-MIBG decreased slightly from 29.1 +/- 9.1% to 25.4 +/- 7.0%. The improvement rate of LVEF was significantly correlated with the improvement rates of the H/M ratio and washout rate after treatment with enalapril. Thus, the long-term effects of enalapril can be observed in the cardiac sympathetic nervous system, and 123I-MIBG imaging appears to be useful for evaluating the therapeutic effects of enalapril on the cardiac sympathetic nervous system in patients with chronic heart failure.

[The determination of antibodies to the human immunodeficiency virus type 1 (HIV-1) in samples of dried blood on filter paper]. / Determinación de anticuerpos al virus de la inmunodeficiencia humana tipo 1 (VIH-1) en muestras de sangre seca en papel de filtro.

The possibility of detecting HIV-1 antibodies by an immunoblotting kit is studied in a panel of 125 known specimens of dried blood spotted on filter paper and their corresponding serum samples. No differences were observed in the patterns of bands with both types of samples or in the sensitivity and specificity, where 100% figures were attained, allowing to conclude that the blood specimen taken on filter paper may be used for the detection of HIV-1 antibodies by the DAVIH-BLOT system and may be kept at 4 degrees C during 30 weeks.

[Search for antibodies against human T-cell lymphotropic virus type I (HTLV-I) in blood donors and risk groups]. / Pesquisaje de anticuerpos contra el virus linfotrópico de células T humanas tipo I (HTLV-I) en donantes de sangre y grupos de riesgo.

It was studied the presence of HTLV-I antibodies in 3,774 sera, 1,409 of them were from blood donors, 1,444 were from patients who had suffered from some sexually transmitted disease recently, and 921 from transfused patients. The DAVIH HTLV I (ELISA) and DAVIH BLOT HTLV I (Western Blot) systems produced at the DAVIH Laboratories (Havana, Cuba) were used for screening and confirmation, respectively. Of the 68 reactive sera utilized in the ELISA test, it was confirmed the presence of HTLV I/II antibodies in 2, whereas 12 were considered as undetermined by the Western Blot.

[Evaluation of a western blot system (DAVIH-BLOT) for the confirmation of HIV-1 antibodies]. / Evaluación de un sistema de western blot (DAVIH-BLOT) para la confirmación de anticuerpos al VIH-1.

It is reported the evaluation of the DAVIH-BLOT system (DAVIH Laboratories, Cuba) against the proficiency panels sent to the National AIDS Reference Laboratory by the World Health Organization (WHO) in order to ensure the quality in the diagnosis of HIV antibodies during 1989, 1991 and 1993. The system is also compared with those of the Dupont and Diagnostic Pasteur firms in a group of 467 positive sera by ELISA. On studying the WHO's samples, the system proved to be highly sensitive and specific. In the comparison made with the HIV-1 Western Blot IgG version 1.2 (Dupont company, USA) and with the LAV-blot 1 (Diagnostic Pasteur, France), there was a coincidence of 100 and 97%, respectively.

[Eight cases of intracranial arteriovenous malformations treated by conventional radiation therapy].

We conducted radiotherapy in 8 cases of intracranial arteriovenous malformation that had difficult embolectomy and other surgery from 1983 to October, 1988. The results in 6 cases of dural arteriovenous malformation at the cavernous sinus were "marked effect" in 4 cases, "relapse" in 1 case, and "no effect" in 1 case. One case of dural arteriovenous malformation at the sigmoid venous sinus demonstrated only slight irradiation effect. No irradiation effect was observed in 1 case of cerebral arteriovenous malformation.

[Investigation of the remaining lung function after lung surgery using ventilation and perfusion scintigraphy].

The lung function after lung resection was studied in 18 patients using ventilation and perfusion scintigraphy. All patients underwent posterolateral thoracotomy. Scintigraphy was performed before and 1 month after surgery in 8 lobectomized patients and in 4 partially resected ones. Another 8 patients underwent scintigraphy 6.5 to 43 months after lobectomy. Mean transit time (MTT) on scintigraphy was used to estimate a regional washout function in lung. The value of MTT on the operated side minus MTT on the contralateral side increased after surgery. This change was more remarkable in lobectomized patients than in partially resected ones. MTT on the operated side lung was even more prolonged after operation. Reduction of %V and %Q was observed on the operated side of remaining lung after surgery, and Q decreased more than V after lobectomy.