Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease.

BACKGROUND: Firm evidence exists for reduction in mortality and morbidity by lipid-lowering therapy in patients with coronary artery disease (CAD), yet a significant proportion remain untreated. This prospective study determined the effectiveness of a planned strategy of management using a cardiac rehabilitation nurse in achieving (1) lower 6-month low-density lipoprotein (LDL) levels and (2) a higher proportion of patients on pharmacologic therapy. METHODS: A cardiac rehabilitation nurse arranged for the lipid profiles and initiated pharmacologic therapy as soon as possible after the diagnosis of CAD. In phase 1, this planned-strategy intervention group (n = 80) was compared with the usual-care control group (n = 189), where the management was left at the discretion of the attending cardiologist with the assignment to the 2 groups based on the weekly on-call rotations of the attending cardiologists in a nonrandomized manner. In phase 2 of the study all patients (n = 366) were enrolled in the planned strategy of management. RESULTS: There were no significant differences in the baseline lipid values between the control and intervention groups. The 6-month cholesterol and LDL values and the percentage of patients on lipid-lowering medications were significantly better in the intervention group (P =.01). In phase 2 the results obtained in the intervention group were duplicated in a much larger group of consecutive patients. The 6-month (millimoles per liter) results in the control, intervention, and phase 2 groups (respectively) were cholesterol 4.92 +/- 0.06, 4.60 +/- 0.07, 4.30 +/- 0.05; low-density lipoprotein 2.91 +/- 0.06, 2.68 +/- 0.07, 2.4 +/- 0.06; high-density lipoprotein 1.18 +/- 0.07, 1.12 +/- 0.09, 1.10 +/- 0.01; triglycerides 1.89 +/- 0.12, 1.78 +/- 0.09, 1.70 +/- 0.05; and on medications 49%, 83%, and 84%. CONCLUSION: A planned strategy of management with use of early pharmacologic therapy with a cardiac rehabilitation nurse assigned to obtain and follow lipid profiles and initiate therapy is more effective in controlling dyslipidemia than leaving the management to the cardiologist.

Feasibility of direct discharge from the coronary/intermediate care unit after acute myocardial infarction.

OBJECTIVES: This investigation was designed to determine the feasibility and cost-effectiveness of direct discharge from the coronary/intermediate care unit (CICU) in 497 consecutive patients with an acute myocardial infarction (AMI). BACKGROUND: Although patients with an AMI are traditionally treated in the CICU followed by a period on the medical ward, the latter phase can likely be incorporated within the CICU. METHODS: All patients were considered for direct discharge from the CICU with appropriate patient education. The 6-week postdischarge course was evaluated using a structured questionnaire by a telephone interview. RESULTS: There were 497 patients (men = 353; women = 144; age 63.5 +/- 0.6 years) in the study, with 29 in-hospital deaths and a further 11 deaths occurring within 6 weeks of discharge. The mode length of CICU stay was 4.0 days (mean 5.1 +/- 0.2 days): 1 to 2 (12%), 3 (19%), 4 (21%), 5 (14%), 6 to 7 (19%) and > or = 7 (15%) days, respectively with 87.2% discharged home directly. Of the 425 patients surveyed, 119 (28.0%) indicated that they had made unscheduled return visits (URV) to a hospital or physician's office: 10.6% to an emergency room, 9.4% to a physician's office and 8.0% readmitted to a hospital. Of these URV, only 14.3% occurred within 48 h of discharge. Compared to historical controls, the present management strategy resulted in a cost savings of Cdn. $4,044.01 per patient. CONCLUSIONS: Direct discharge from CICU is a feasible and safe strategy for the majority of patients that results in considerable savings.

Aneurysm of the membranous ventricular septum producing subpulmonic outflow tract obstruction.

The authors report the case of a 31-year-old asymptomatic male who, following investigations for cardiac murmur, was found to have congenitally corrected (status solitus of the atria, left looping of the ventricles, leftward aorta in relation to the pulmonary artery [S,L,L]) transposition of the great vessels with significant right-sided ventricular outflow tract obstruction due to a large aneurysm of the membranous ventricular septum. Diagnosis was made with transesophageal echocardiography and confirmed during corrective surgery. The authors review the literature with regard to aneurysms of the membranous ventricular septum and their association with congenital heart disease, and they discuss the use of noninvasive tests aiding the diagnosis.

In vivo interference between pathogenic and non-pathogenic viruses.

The interference among viruses is a well-documented biological phenomenon, both in animals and tissue culture systems. In two of our previous in vivo experiments and in four independent animal experiments, which are described in this presentation, interferences were successfully used to influence the outcomes of viral diseases by using non-pathogenic viruses. In this study, four pathogenic viruses were studied in their natural hosts, and against these viruses, in different combinations, 15 non-pathogenic viruses were tested. There was great variation in mutual effects among pathogenic and non-pathogenic viruses. In our four experiments, the viruses were either simultaneously inoculated or the non-pathogenic viruses were preinoculated. Newcastle disease vaccine (Strain H) had remarkable effects in the development of mouse ascites-associated lymphoma virus. The 50% mortality rate in mice caused by a vaccine strain of rabies virus was reduced to 15% using avian encephalitis virus. The clinical manifestations of rabbit myxoma virus effects were significantly delayed by Newcastle disease vaccine (Strain H). The 72% mortality rate due to Rous sarcoma virus in chickens was decreased to 33.3% when the animals were preinoculated with avian bursa virus vaccine.

Interference between human hepatitis A virus and an attenuated apathogenic avian virus.

The effect of an attenuated apathogenic avian bursa virus on the course of human hepatitis A viral infection was studied in marmoset monkeys. The monkeys were infected with human hepatitis A virus, then superinfected with avian bursa virus one and three weeks after initial inoculation with human hepatitis A virus. The superinfected monkeys did not show the characteristic serum glutamic pyruvic transaminase (SGPT) elevation. Also their liver biopsies showed no pathologic changes. The virus control animals exhibited six times higher SGPT enzyme elevation than the superinfected groups, and hepatitis was detected by histopathology. This experiment, as known to us, is the first in which a definite interference was documented using a nonpathogenic virus against a highly pathogenic and clinically significant human virus. This should be considered a successful experiment demonstrating that the use of an apathogenic virus for the cure of a virus-induced disease is a realistic possibility.

Comparative toxicity of polychlorinated biphenyl and polybrominated biphenylin the rat thyroid gland: light and electron microscopic alterations after subacute dietary exposure.

The comparative toxicity of polychlorinated biphenyl (PCB) and polybrominated biphenyl (PBB) in thyroid glands was studied in male Holtzman rats. Four-week-old animals were fed at dietary levels of 0, 5, 50, and 500 ppm for 5 weeks and then sacrificed. PCB and PBB produced similar dose-dependent ultrastructural lesions in thyroid follicular cells of rats. The daily administration of 5 ppm of either PCB or PBB resulted in the accumulation of large membrane-limited colloid droplets and electron-dense lysosomal bodies within the cytoplasm of follicular cells. Microvilli were short and abnormally branched, and unique cytoplasmic processes extended from the apical surface of follicular cells into the luminal colloid. Similar but more severe ultrastructural changes were observed in thyroid glands of rats administered 50 and 500 ppm of either PCB or PBB. Many follicular cells were distended with large abnormal lysosomal bodies and colloid droplets. Mitochondria were often vacuolated with disrupted cristae. Microvilli were blunt with abnormal branching or absent from areas of the luminal surface of follicular cells. Processes of apical cytoplasm often extended into the follicular lumen in areas devoid of microvilli. Follicular cells remained responsive after the feeding of either PCB or PBB and underwent moderate compensatory hypertrophy and hyperplasia. Thyroid follicles were smaller than in controls and were lined by more columnar cells that occasionally formed papillary projections into the follicular lumens. PCB and PBB produced similar ultrastructural lesions in thyroid follicular cells which appeared to interfere with the synthesis and secretion of thyroxine.

Comparative toxicity of polychlorinated biphenyl and polybrominated biphenyl in the rat liver: light and electron microscopic alterations after subacute dietary exposure.

The comparative toxicity of polychlorinated biphenyl (PCB) and polybrominated biphenyl (PBB) in livers was studied in male Holtzman rats. Four-week-old animals were fed at dietary levels of 0, 5, 50, or 500 ppm for 5 weeks and then sacrificed. The mean liver-body weight ratios of the 50 and 500 ppm groups were increased. Histopathologic examination of the livers revealed fatty degenerative change associated with both compounds. This change was more marked at 500 than at 50 ppm. Various sized lamellar cytoplasmic inclusions were detected in livers of animals fed 500 ppm of either compound. However, the inclusions were more numerous in the PBB-treated rats. Several animals fed 50 ppm PBB had a few inclusions. In rats that received 500 ppm PBB, hypertrophic degenerative hepatocytes were present around the central veins. On the periphery of this change there were occasionally multinucleated hepatocytes. Electron microscopic examination at a dose level of 5 ppm in both the PCB and PBB groups showed a slight proliferation of smooth endoplasmic reticulum (SER), a moderate increase of lipid droplets and some liposomes, and a marked proliferation of Golgi condensing vesicles containing lipoprotein particles. A decreased number of mitochondria and lysosomes was also observed. At 50 ppm, similar but more marked ultrastructural alterations were seen. In addition, an increased number of branched and cup-shaped profiles of mitochondria and a decreased number of Golgi condensing vesicles containing lipoprotein particles were observed. Concentric membranous cytoplasmic whorls were encountered only in the 50 ppm PBB-treated rats. At 500 ppm the number of mitochondria decreased in both groups. There was also a marked increase in the number of SER and liposomes concomitant with a decreased number of Golgi condensing vesicles containing lipoprotein granules. Membranous whorls were also present in the 500 ppm groups.

Effect of polychlorinated biphenyl (PCB) on the thyroid gland of rats. Ultrastructural and biochemical investigations.

Polychlorinated biphenyls (PCB) produced ultrastructural lesions in thyroid follicular cells and reductions in serum thyroxine levels in rats that were time- and dose-dependent. The acute effects (4 week) of PCB (50 and 500 ppm) consisted of an accumulation of lysosomal bodies and colloid droplets in follicular cells with abnormalities of microvilli on the luminal surface. The chronic administration (12 week) of PCB (50 and 500/250 ppm) resulted in a striking distention of many follicular cells with large lysosomal bodies with strong acid phosphatase activity and colloid droplets, blunt and abnormally branched microvilli, and mitochondrial vacuolation. These ultrastructural alterations in follicular cells were associated with a highly significant reduction in serum thyroxine with both the low and the high dose of PCB. Follicular cells remained responsive to the lowered thyroxine level after feeding PCB for 4 and 12 weeks and underwent moderate compensatory hypertrophy and hyperplasia. Thyroid follicles were smaller than in controls and were lined by more columnar cells that occasionally formed papillary projections into the colloid. Residual ultrastructural alterations persisted for 12 weeks following cessation of feeding the compound, and serum thyroxine levels were significantly lower than in control rats. However, 35 weeks after discontinuing PCB, thyroid follicular cells were similar to those in controls and serum thyroxine levels had returned to normal. The striking ultrastructural lesions in follicular cells produced by feeding PCB to rats appeared to contribute to the lowering of serum thyroxine levels, in combination with the known stimulation of peripheral thyroxine metabolism by these compounds. Certain metabolic alterations produced by PCB intoxication in experimental animals and human beings may be related to an alteration in thyroid function.

Hepatitis B antibodies in hospital personnel.

Sera from 544 hospital personnel members with different degrees of exposure to the agent of hepatitis B were tested for HB8Ag and anti-HB8 by counterelectrophoresis, radioimmunoassay and passive hemagglutination. The laboratory staff and persons having direct contact with patients exhibited a significantly higher prevalence of anti-HB8 (16.2%) as compared with the other groups: administrative staff (4.4%), healthy persons (4.6%) and blood donors (7.9%). These data prove the relationship between exposure to HB8Ag and anti-HB8 prevalence, more obvious in the laboratory staff handling human serum and plasma specimens (anti-HB8 incidence--25%).

Acute, subacute, and residual effects of polychlorinated biphenyl (PCB) in rats. I. Biologic half-life in adipose tissue.

Sprague-Dawley rats were fed diets containing Aroclor 1254 at o, 5, 50, or 500 ppm for 4 wk. The biologic half-life of Aroclor 1254 in adipose tissue of rats fed 500 ppm, as determined by a gas chromatographic method, was 8 wk in males and 12 wk in females. These results are in line with sex-linked differences reported previously for other chlorinated hydrocarbons. It appears that the lower chlorine homologs in the Aroclor mixture are metabolized while those with higher chlorine content are lost more slowly.

Acute, subacute, and residual effects of polychlorinated biphenyl (pcb) in rats. II. Pathology and electron microscopy of liver and serum enzyme study.

This study was undertaken to determine the residual effects of a polychlorinated biphenyl (Aroclor 1254) fed to male rats at dietary concentrations of 0, 5, 50, and 500 ppm in diet. The animals were treated for 4 wk (acute and subacute phase), then observed for periods of up to 50 wk following termination of exposure (residual phase). The most significant histopathologic alteration was fatty degenerative change in the liver, which was most marked at 9 wk. Forty-six weeks postexposure, more than 50% of the rats fed 500 ppm still demonstrated fatty degenerative changes. On electron microscopic examination, marked increases in lipid vacuoles and smooth endoplasmic reticulum (SER) occurred with a concomitant decrease in rough endoplasmic reticulum (RER) profiles in the animals receiving 50-500ppm for 4 wk. Thirty-seven weeks following the exposure period, rats dosed with 50 ppm showed partial recovery toward control morphology (less lipid, less SER, more RER), while those receiving 500 ppm did not. Persistent morphologic alterations included an increase in SER and medium-density lipid material within cisternae of Ser, Golgi and Golgi-condensing vesicles, as well as a decrease in parallel arrays of RER. The persistence of ultrastructural alteration throughout the 46-wk residual phase emphasizes the long-lasting effects of 4-wk exposure to polychlorinated biphenyl.

Distribution of hepatitis B virus subtypes in Romania.

The higher incidence of HB8Ag/ayw (71%) in sera collected from acute viral hepatitis cases, as well as from patients with chronic active hepatitis, healthy carriers and blood donors of 20 Romanian counties emphasizes the local prevalence of the ayw determinant in our country.