Subject(s)
Graft vs Host Disease/drug therapy , Graft vs Host Disease/immunology , Hematopoietic Stem Cell Transplantation/adverse effects , Immunosuppressive Agents/therapeutic use , Adolescent , Adult , Female , Graft vs Host Disease/prevention & control , Hodgkin Disease/therapy , Humans , Leukemia/therapy , Male , Middle Aged , Multiple Myeloma/therapy , Primary Myelofibrosis/therapy , Retrospective Studies , Transplantation, Homologous/adverse effects , Transplantation, Homologous/immunologyABSTRACT
Rapid atrial activation causes electrical remodeling that promotes the occurrence and maintenance of atrial fibrillation. The aim of this research was to compare the relationship between mechanical remodeling and atrial electrophysiology. Eight dogs (beagles) were subjected to rapid atrial pacing (AP) at 400 beats/min for 16 days. After a complete recovery of electrical variables and left ventricular function evaluated by echocardiography, they underwent high-rate ventricular pacing (VP) at 240 beats/min of equal duration. In half of them, the study was started by VP and in the other half by AP. Left atrial systolic function was assessed by transesophageal echocardiography. Atrial effective refractory period (AERP) at a basic cycle length of 400 ms decreased significantly after either type of pacing (AP: 115 +/- 17 ms, VP: 136 +/- 22 ms) compared with baseline values (153 +/- 23 ms); the difference between tachycardias was significant too (p < 0.02). Significant increases (p < 0.05) in left atrial dimensions (LA-A) (AP: 2.41 +/- 0.23 cm ,VP: 2. 43 +/- 0. 34 cm vs. basal: 2. 16 +/- 0. 21 cm) indicated atrial dilatation after either type of pacing, the differences between two groups being insignificant. Atrial reversal pulmonary venous flow (AR velocity) decreased in AP (-0.13 +/- 0. 02 m/s) and VP (-0. 17 +/- 0. 04 m/s). The difference was highly significant as compared to basal values (-0.25 +/- 0.05 m/s) and also with respect to both tachycardias (p < 0.01). In both groups, atrial remodeling occurred in a relatively short period of time. The echocardiographic findings suggested that left atrial systolic function was significantly more disturbed in the AP group than in the VP group. Mechanical changes are an important substrate of electrical remodeling, yet the deterioration of electrical variables was more pronounced in AP than in VP.
Subject(s)
Atrial Fibrillation/physiopathology , Atrial Function, Left/physiology , Systole/physiology , Animals , Atrial Fibrillation/diagnostic imaging , Disease Models, Animal , Dogs , Echocardiography, Transesophageal , Heart Atria/physiopathology , Heart Conduction System/physiology , Pacemaker, Artificial , Ventricular Function , Ventricular Remodeling/physiologyABSTRACT
Iron deficiency in patients with end stage renal disease (ESRD) treated by haemodialysis (HD) is difficult to diagnose. The reticulocyte hemoglobin content (CHr) and the percentage of hypochromic red cells (%hypo) are sensitive novel assays for the detection of functional iron deficiency in patients treated with erithropoietin (EPO). In our study thirty-nine chronically hemodialyzed patients were evaluated to determine the value of these two parameters in comparison to the conventional biochemical indicators of iron metabolism. There were significant correlations between CHr and transferrin saturation, CHr and weekly dosage of EPO, and also between %hypo and weekly dosage of EPO. Our data represent superior value of %hypo and CHr to the transferrin saturation and ferritin concentration in detecteng of iron deficiency in HD patients.
Subject(s)
Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/diagnosis , Iron/blood , Kidney Failure, Chronic/blood , Adult , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/etiology , Female , Ferritins/blood , Hemoglobins/analysis , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Predictive Value of Tests , Renal Dialysis , Reticulocytes/chemistry , Transferrin/metabolismABSTRACT
Myelokathexis is a very rare form of chronic hereditary neutropenia resulting from impaired neutrophil releasing mechanism in the bone marrow. The recombinant human granulocyte-macrophage (molgramostim) and granulocyte (filgrastim, lenograstim) colony stimulating factors release the mature granulocytes from the bone marrow. We describe a 43-year-old woman suffering from myelokathexis, with the absolute neutrophil count ranging between 0.03 and 1.35 x 10(9)/L. In the period before the introduction of cytokines, the patient had more than 80 major infectious episodes. Since 1991, infections in this patient have been treated with cytokines, given in conjunction with antibiotics. Initially, she received molgramostim in a daily dose of 5 microg/kg subcutaneously, which stimulated the release of granulocytes from her bone marrow, thereby allowing successful treatment of infection. After the development of hypersensitivity, molgramostim was substituted with filgrastim. Finally, lenograstim was given a trial. With all three cytokines, the patient's neutrophil count always attained normal values already 4 hours after subcutaneous application of the drug in a dose of 5 microg/kg, the highest neutrophil levels were measured at 24 hours post-injection, and the neutrophil count was again close to the baseline value 72 hours after the treatment. A slight neutropenia was present 48 hours after the application of filgrastim. We believe that all three cytokines are equally effective in increasing the neutrophil count in venous blood of patients with myelokathexis.
