Hyperbaric oxygen and neutrophil accumulation/tissue damage during permanent focal cerebral ischaemia in rats.

The use of hyperbaric oxygenation (HBO) for the treatment of severe brain ischaemia remains controversial. The HBO may interfere with destructive neutrophil (PMN) infiltration following ischaemia/reperfusion. The effects of HBO on PMN accumulation and the area of ischaemic tissue damage were investigated in rats having permanent focal ischaemia (4 h). The right middle cerebral arteries of a group of Wistar rats were permanently occluded. The rats were then randomly divided into those ( n=7) to be treated with HBO at 2 atm for 230 min and those ( n=8) to breathe air at atmospheric pressure for an equivalent period. The HBO had no effect on permanent ischaemia, as there was no significant difference in the area of ischaemic tissue damage between HBO-treated [mean (SD)] [331 (88) mm(3)] and non-treated animals [322 (111) mm(3)]. Moreover, the increase in myeloperoxidase [5.4 (4.1) compared to 2.4 (1.2) pg x g(-1) wet weight of brain] was not significantly different. The results indicate that HBO did not reduce tissue damage during 4 h of permanent focal ischaemia.

Diagnostic utility of the polymerase chain reaction in 2 cases of suspected Whipple disease.

We describe 2 patients with a diagnosis of Whipple disease in whom the usual antibiotic therapy failed. A polymerase chain reaction-based test was used to identify the recently described Whipple bacillus, Tropheryma whippelii. In one case, the diagnosis was confirmed, whereas in the second case, which had been histologically diagnosed as Whipple disease of the brain, the process was identified as a monocyte-derived histiocytosis. In conclusion, Whipple disease can be distinguished from other diseases with similar histological features with the use of a polymerase chain reaction-based test.

[Non-typhoid Salmonella aortitis]. / Ikke-tyfoid salmonellaaortitt.

Non-typhoid Salmonella enteritis may be complicated by aortitis. Three cases of Salmonella enteritidis aortitis are described. One patient, who survived, was operated with resection of the infected part of the aorta. An axillo-femoral bypass was made. The patient was treated for 18 months with antibiotics. The two patients who died were only treated with antibiotics. Aortitis is diagnosed by means of blood-cultures and topographic examination of the aorta with CT-scanning, ultrasonography or angiography. The treatment of Salmonella aortitis is a combination of surgery and long-term administration of antibiotics.

[Antibiotic prevention of bacterial endocarditis]. / Antibiotikaprofylakse mot bakteriell endokarditt.

Bacterial endocarditis is a serious condition with high lethality. The authors review the etiology of the disease and conditions and procedures associated with increased risk, and give recommendations on choice and dosage of effective antibiotics. Most cases of endocarditis are caused by gram-positive cocci of the genera Streptococcus, Enterococcus or Staphylococcus. The number of cases caused by staphylococci has increased in recent decades. Risk of acquiring endocarditis is higher, for example, in patients with prosthetic cardiac valves and in patients with a previous history of endocarditis. Interventions associated with increased risk include various procedures in the mouth, throat and upper airways, since this is where the bacteria most often causing endocarditis are to be found. A single oral dose of amoxycillin is recommended for standard prophylaxis, and ampicillin in combination with an aminoglycoside for parenteral use. In cases of penicillin allergy, a single oral dose of clindamycin is recommended in patients at risk of bacteriemia from the respiratory tract, with trimetoprim as an alternative for genito-urinary and gastrointestinal procedures. Vancomycin or vancomycin plus aminoglycoside is recommended as a parenteral regimen in cases of penicillin allergy.

Ciprofloxacin versus a tobramycin/cefuroxime combination in the treatment of serious systemic infections: a prospective, randomized and controlled study of efficacy and safety.

Sequential intravenous and oral ciprofloxacin (CF) was compared with a combination of tobramycin and cefuroxime (T/C) in the treatment of serious systemic infections. Altogether 310 patients were randomized, 160 receiving CF and 150 T/C, the 2 groups being reasonably well balanced. 29 patients without infection were excluded from the analysis. Complete clinical resolution was obtained in 75% (107/143) patients receiving CF and in 78% (107/138) receiving T/C; the difference was not statistically significant. The rate of bacterial eradication in septicaemia was 72% (95% confidence interval (95% c.i.): 58-86%) for patients treated with CF and 87% (95% c.i.: 77-96%) when T/C was given, while the eradication rates in urinary tract infection were 72% (95% c.i.: 54-90%) and 45% (95% c.i.: 23-67%) for CF and T/C, respectively. Significant differences in bacteriological response for other diagnoses were not detected. Also for lower respiratory tract infections (LTRI) the clinical and bacteriological responses were quite similar, although relatively more failures occurred in CF treated patients with LRTI caused by pneumococci. The frequencies of adverse reactions were comparable, but the reactions were less serious following CF treatment. Our results indicate that CF may be used for empirical treatment of serious infections. However, if pneumococcal etiology is likely, alternative antibiotics should be used, and if necessary, coverage against anaerobic bacteria should be added.

Noninvasive evaluation of the effect of timolol on left ventricular performance after myocardial infarction and the consequence for prognosis.

Left ventricular performance was evaluated noninvasively in 111 patients participating at one study center in the Norwegian Multicenter Study on Timolol After Myocardial Infarction. Systolic time intervals were measured in 55 patients treated with timolol and in 56 patients receiving placebo. Measurements were made before randomization, and after 1, 3 and 12 months of treatment. During the treatment period, the pre-ejection period/left ventricular ejection time ratio was significantly lower in the timolol-treated group, indicating better left ventricular function than in the placebo-treated patients. In the 27 patients who died during the follow-up period of 50 to 72 months, there was a significant increase in the pre-ejection period/left ventricular ejection time ratio from baseline to the last performed recording, indicating a deterioration in left ventricular performance in these patients. No such change occurred in the group that survived the entire follow-up period. Deterioration of left ventricular function is related to a high long-term mortality rate after myocardial infarction, and left ventricular function is better preserved in patients treated with timolol than in patients receiving placebo.

Strut fracture in the new Bjørk-Shiley mitral valve prosthesis.

The case of a patient with the new type Bjørk-Shiley aortic and mitral valve prosthesis is described. Three months after implant she suffered acute heart failure and died. Post-mortem examination revealed a fractured outlet strut in the mitral valve prosthesis with dislocation of the disc. The fracture was regarded as due to excessive brittleness caused by demonstrated deposition of chromium-tungsten-carbide.

Intrahepatic pressures measured during laparoscopy.

Intrahepatic pressure measured during laparoscopy were all correlated to occluded hepatic vein pressures and thereby to the portal vein pressures. Assessment of the intrahepatic pressures increases the diagnostic yield of laparoscopy, and should be used whenever it is important to quantitate the pressure in the portal circulation.

Non-invasive assessment of cardiac function in meningitis.

Non-invasive registration of systolic time intervals (STI) and ECG were used in evaluating cardiac function in 12 patients with bacterial and 16 with viral meningitis. On admission, 14 (50%) of the patients had abnormal STI. The preejection period (PEP) was prolonged in 11 patients, while left ventricular ejection time (LVET) was prolonged in two and shortened in four. The PEP/LVET index was increased in eight patients. At discharge PEP was still prolonged in eight patients; seven of these were from the viral meningitis group. LVET increased significantly (p less than 0.02) from the first to the last registration. In the patients with abnormal PEP and PEP/LVET on admission, there was a significant fall (p less than 0.05 and p = 0.02, respectively) to discharge. There was no difference in STI between the patients with viral or bacterial meningitis. Eighteen (64%) of the patients had abnormal STI on one or more registration. ST-T changes in ECG and prolongation of the Q-T interval were found in three patients. Cardiac affection in meningitis seems to occur more often than can be shown by ECG.

Change in P wave terminal force and systolic time intervals during exercise in patients with coronary artery disease.

P wave terminal force (Ptf) and systolic time intervals (STI) were determined non-invasively from electrocardiogram, phonocardiogram and carotid pulse wave in fifteen men with coronary artery disease, before and during exercise. Left ventricular end diastolic pressure (LVEDP) and stroke volume (SV) were determined at catheterization simultaneously with the non-invasive recordings. Pre-ejection period (PEP) shortened in eleven patients, left ventricular ejection time (LVET) shortened in eight and Ptf and PEP/LVET decreased in ten patients during exercise. Ptf was significantly correlated to LVEDP both at rest (r = -0.66) and during exercise (r = -0.79). The change in Ptf and LVEDP was less correlated (r = -0.52). The change in LVET (r = -0.50), the change in PEP (r = 0.62) and in the index PEP/LVET (r = 0.65) was correlated to the change in SV. The use of both Ptf and STI may be of value in estimating left ventricular function during exercise in patients with coronary artery disease.

Mean electromechanical delta P/ delta t and systolic time intervals in coronary artery disease.

Mean electromechanical deltaP/deltat and systolic time intervals were measured in 30 patients with coronary artery disease. Total electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP) were measured and PEP/LVET calculated. Systolic time intervals were obtained noninvasively. Mean electromechanical deltaP/deltat was calculated by means of systemic diastolic blood pressure, pulmonary wedge pressure and PEP. Left ventricular ejection fraction (EF), pulmonary wedge pressure and stroke index were determined by catheterization and left ventriculography. PEP (r = -0.69) and PEP/LVET (r = -0.68) were better correlated to EF than mean electromechanical delatP/deltat (r = 0.63). Patients with previous myocardial infarction were found to have significantly longer PEP (P less than 0.02) and higher PEP/LVET (P less than 0.01) than patients without infarction. Neither of the methods showed significant differences between the groups of patients with 1-, 2- and 3-vessel disease. Although systolic time intervals cannot be used in predicting invasive measurements such as EF, the findings indicate that PEP and PEP/LVET may be useful supplement to clinical examination in evaluating left ventricular function in coronary artery disease.

Cardiac performance in patients with anorexia nervosa.

The heart function in 15 female patients with anorexia nervosa was examined by means of systolic time intervals. In 3 patients, pulmonary wedge pressure and cardiac output were measured. The findings indicate impaired myocardial contractility in patients with anorexia nervosa.

Non-invasive assessment of cardiac function in poisoning with drugs.

Systolic time intervals (STI) have been used in evaluating cardiac function in 21 patients who had taken an overdose of drugs. Registrations were made in all patients on arrival at the hospital and on the third day. On arrival STI was abnormal in 16 patients (76%). At the second registration it was still abnormal in ten (48%). Prolongations of total electromechanical systole (QS2) and preejection period (PEP) were the most frequent findings. The patients with abnormal STI at the first registration showed a significant improvement in QS2 (p less than 0.01) and PEP (p less than 0.05) from the first to the third day. Two of the four patients who had taken amitriptyline in a slow release form showed a prolongation of PEP and an increase in PEP/LVET from the first to the third day, and on patient has a further prolongation of the fifth day. The findings may be explained by a reduction of cardiac contractility caused by the membrane-stabilizing effect of the drugs.

Systolic time intervals in cardiac tamponade.

Systolic time intervals (STI) have been measured in three patients with cardiac tamponade. The left ventricular ejection time (LVET), the preejection period (PEP) and the ratio PEP/LVET deviated significantly from the normal values. All three parameters improved immediately after pericardiocentesis and aspiration. The total electromechanical systole changed to only a minor degree. Measurement of STI may be a valuable tool in the diagnosis and treatment of cardiac tamponade.

Systolic time intervals in acute myocardial infarction.

Systolic time intervals (STI) have been measured in 50 individuals without heart disease. Electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP), but not PEP/LVET, were correlated to heart rate (HR). Regression equations were made and used when correcting STI for HR in two groups of patients: a) 51 patients with acute myocardial infarction (AMI) b) 22 patients with chest pains, but no AMI. STI was measured on the first 4 days, on the 7th day, on the day of discharge and at a control about 60 days later. In the AMI group there was a reduction in left ventricular performance from the 1st to the 4th day, and the difference in shortening of LVET was significant (p less than 0.001), while PEP and PEP/LVET increased from the 1st to the 3rd day (p less than 0.001). Between the AMI and the control groups there were significant differences (p less than 0.001) in LVET and PEP/LVET on the 3rd, 4th and 7th day, and in PEP on the 3rd and 4th day. STI was not found to separate clinical groups with heart failure of different severity. The survivors had a lower (p less than 0.05) PEP/LVET on the 1st day than those who died. The various localization of the infarction made no difference in STI. LVET was found to be strongly correlated (p less than 0.001) to the hydroxybutyric dehydrogenase values.