Alteration of the serum biomarker profiles of visceral leishmaniasis during treatment.

Until recently, chemotherapy for visceral leishmaniasis (VL; also known as kala-azar) was severely limited by factors such as high cost, route of administration, generation of side effects and potential for resistance. Although largely effective, chemotherapies have become available with the introduction of new drugs and multi-drug regimens for VL. These could be further improved by the identification of biomarkers that are altered during effective treatment. The identification of such biomarkers in the circulation would also simplify efficacy trials. In this study, we determined immunological signatures within the serum of ethnically and geographically distinct VL patients (from Bangladesh and Brazil). Our results indicate that inflammatory and regulatory cytokines (IFNγ, TNFα, IL-10, IL-17), as well as levels of growth factors (FGF, VEGF), are elevated within the serum of VL patients from these sites. The examination of samples from Brazilian VL patients during and beyond standard treatment with meglumine antimoniate identified multiple parameters that revert to levels comparable to those of healthy endemic control individuals. The consolidation of these results provides a 'response to treatment' signature that could be used within efficacy trials to rapidly and simply determine successful interruption of VL.

Correlation between inflammatory periodontal diseases and cardiovascular diseases.

AIMS: Since cardiovascular diseases can exhibit a possible connection with chronic periodontal diseases, the aim of the present study was to examine the presence of periodontal impairment in patients with coronary heart diseases (CHD). METHODS: For this purpose periodontal charts were raised for 101 patients (78 male, 23 female, mean age 61.8 +/- 10.5 years) with cardiovascular diseases; comparison was drawn between theses charts and those for a control group of 101 healthy patients (59 male, 42 female, mean age 56.6 +/- 9.9 years). Over and above the dental diagnosis (probing depth [mm], vitality, tooth mobility, plaque index (PI), inclination towards sulcus bleeding) each related to 6 characteristic teeth, various habitual aspects (diet, smoke and drink patterns, stress, body weight) were recorded. RESULTS: Within the CHD-group the periodontal chart revealed for all teeth examined a mean probing depth of 3.4 +/- 1.1mm, with the corresponding reading for the control group being 2.8 +/- 0.9 mm. The mean bleeding index (Van-der-Weiden) read 1.1 +/- 0.7 for the CHD-group and 0.7 +/- 0.6 for the control group. The mean plaque index reading was 1.4 +/- 0.9 for the group suffering from heart diseases and 0.7 +/- 0.8 for the control group. Comparison of these periodontal charts showed statistically significant differences (p<= 0.01), whereas mean degrees of tooth mobility did not differ in a statistically significant way. In summary, the results described hint at a correlation between an existent coronary heart disease and the presence of a periodontitis. CONCLUSION: However, also for consideration below are further influential factors, such as diet, individual life conduct, smoking habits, Body-Mass-Index or microbiological aspects.

High-resolution two-dimensional echocardiography improves the quantification of left ventricular function.

It is not clear if newer echo technology prevents underestimation of ejection fraction in comparison with cineventriculography (CVG). Before undergoing CVG, 48 patients were studied with state-of-the-art, high-resolution two-dimensional echocardiography with a 3.5 MHz transducer, 96 crystals, and digital storing (slow motion and cine-loop). These data are compared with results published by us in 1983 (37 patients). Volumes were calculated using the biplane method of discs in a single area length. Exclusion criteria in 1990 were poor two-dimensional echocardiography quality (n = 6) and extra-systole during CVG (n = 4). The difference between the mean values of the angiography and echocardiography data in the new study (1990) were 4.7 ml/m2/body surface area (BSA) for the end-diastolic volume, 0.1 ml/m2 for the end-systolic volume, and 1.5% for the ejection fraction (all NS). The mean difference between both methods in the old study (1983) were -39.1 ml/m2/BSA (p less than 0.001) for end-diastolic volume, -17.4 ml/m2 (p less than 0.001) for end-systolic volume, and -7.2% for ejection fraction (p less than 0.001). The regression equation for determination of ejection fraction was y = 0.606x + 13, r = 0.803 for the old study, and y = 0.935x + 2.5; r = 0.935 for the new study. These results indicate that state-of-the-art, high-resolution two-dimensional echocardiography prevents the systematic underestimation of left ventricular volume and ejection fraction, most likely because of better delineation of endocardium in end-systole.

Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study.

Balloon coarctation angioplasty (BCA) was performed in eight patients (five male and three female) who were 14-49 years old (mean, 27.3 years) with isolated discrete unoperated coarctation of the aorta (n = 7) and postoperative recoarctation (n = 1). BCA was successful in seven of eight patients, resulting in a decrease in the gradient (64 +/- 19 to 16 +/- 13 mm Hg, p less than 0.01), an increase in the diameter at the coarctation site (0.9 +/- 0.4 to 1.6 +/- 0.4 mm, p less than 0.01). Follow-up (6 months) has demonstrated continued gradient relief (6 +/- 9 mm Hg) and diameter increase (1.6 +/- 0.2 cm). Monitoring was performed by transesophageal echocardiography (TEE) during BCA, and before and after BCA angiography and after BCA computed tomography. In three of seven patients, immediately distal to the BCA site, intimal flaps (1-2 cm) could be detected by TEE but not by angiography or computed tomography. Follow-up TEE showed spontaneous healing in two and persistence in one patient. By TEE and computed tomography in one of eight patients during follow-up, intima and media dissection was found with pleural effusion and spontaneous healing. In one female patient, aortic dissection occurred after successful uneventful BCA, detected by TEE at the 6-month follow-up study and subsequently confirmed by biplane angiography, not detected by computed tomography and previous monoplane angiography. Because of the significant morbidity of BCA in this group of patients, its role in the management of adults with coarctation has yet to be determined. Further long-term follow-up studies will demonstrate whether the observed intima and media dissection by TEE after BCA are related to aneurysm formation.

[Dilatation of supravalvular pulmonary stenosis in transesophageal echocardiographic monitoring--the kissing-balloon technic]. / Dilatation einer supravalvulären Pulmonalisstenose bei--transösophagealem echokardiographischem Monitoring Kissing-Balloon-Technik.

A successful dilatation of a supravalvular pulmonary stenosis after banding operation is described in a 19-year-old male. The dilatation was performed during transesophageal echocardiographic monitoring. Dilatation with a 15-mm and a 19-mm valvuloplasty catheter was not successful. Using the "kissing-balloon" technique with a 15 and 19 mm balloon together, the pressure gradient could be reduced from 59 mm Hg to 10 mm Hg (mean 41 and 8 mm Hg). Pulmonary artery diameter increased from 17 to 24 mm without intima damage or dissection. Thus pulmonary artery stenosis caused by banding operation can be dilated successfully. Monitoring during the procedure quickly demonstrates the changes in the dilated vessel. Angiography 6 months later showed slight restenosis of the dilated vessel with a maximum pressure gradient of 27 mm Hg (mean 17).

Systemic and renal effects of angiotensin II in the freshwater turtle Pseudemys scripta elegans.

This study examined the renal and systemic effects of angiotensin II (ANG II) in the freshwater turtle, Pseudemys scripta elegans. We infused [Asn1, Val5]ANG II at doses of 1, 10, 100, and 500 ng X kg-1 X min-1 in conscious turtles while monitoring blood pressure, glomerular filtration rate (GFR), urine volume, and plasma and urine electrolytes. Saline (0.6%) was infused for two 1-h control periods at 1 ml X kg-1 X h-1 followed by a 1-h infusion of saline with ANG II added. Saline alone was then infused for either two or three 1-h recovery periods. Control values before ANG II infusion averaged 21 mmHg for blood pressure, 1.8 ml X h-1 for urine volume, and 8.0 ml X kg-1 X h-1 for GFR. At 1 (n = 7) and 10 ng X kg-1 X min-1 (n = 6) ANG II produced no significant changes in blood pressure or renal function. Angiotensin infusion at the higher rates of 100 (n = 6) and 500 ng X kg-1 X min-1 (n = 11) significantly elevated blood pressure during ANG II infusion (29 and 44 mmHg, respectively), while electrolyte excretion remained unchanged. Despite the increased blood pressure, GFR and urine volume tended to decrease. At all infusion rates, plasma electrolytes remained unchanged. The results suggest that ANG II is a potent constrictor of preglomerular vessels in the kidney of the turtle.