[Blood cholesterol in the acute phase of myocardial infarct].
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Biomedical subjects
Publications and source records attributed to C Molina.
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To study right ventricular function, we performed cardiac catheterization, and right and left cineventriculograms in 60 chagasic patients and 15 non-chagasic, non-heart disease patients. Chagasic patients with normal electrocardiograms and left cineventriculograms also had normal right ventricular function. Nine of 14 chagasic patients with normal Ecg's and early left ventricular damage had right ventricular dilatation and/or segmental inferior-apical asynergy. Fourteen of 19 chagasic patients with abnormal Ecg's and advanced left ventricular damage, but without signs of congestive heart failure, and all chagasic patients with congestive heart failure, had marked right ventricular dilatation, severe right contractility depression and abnormal right apical or para-apical motion. These findings indicate that Chagas disease is a diffuse cardiomyopathy in which the left ventricle seems to be affected earlier and to a greater extent than the right ventricle. Since segmental abnormalities were predominantly observed in apical and para-apical areas of the ventricles, performance of right and left cineventriculograms is recommended before implantation of cardiac pacemakers.
Hypersensitivity pneumonitis is one model of environmental pulmonary disease. If the clinical and radiological pictures are now well established the risk of allergic disorders in the community can only be appreciated by large epidemiological enquiries which ought to be carried out with the utmost vigor, yet may be deceptive. As regards diagnosis, one should take note on the one hand of: --respiratory function tests showing the involvement of the alveoli and the interstitium in the pathological process but also that of the peripheral bronchioles, that is the distal lung as a whole. --On the other hand systemic immunological studies (search for precipitating antibodies to allergens, always considered to be a diagnostic test of major value) may nonetheless be reinforced by cell counts lymphocytes) or skin tests and even provocation tests. --The study of bronchoalveolar lavage yields very important information: An increase in the number of cells, notably " T " lymphocytes, biochemical disturbances characterized by an increase in protein and lipid levels with qualitative changes in the phospholipids: a fall in the lecithin and a rise of the other fractions which lead to an increase in the microviscosity of alveolar liquid. Finally an aetiological study is required to identify the allergen in the ambient atmosphere of the patient or worker and if possible, an experimental study trying to reproduce the pathological lesions and the immunological disturbances. Finally the treatment should consist of excluding the offending agent. Steroid therapy is justified in acute situations with disturbed function, but this does not prevent a final outcome of irreversible fibrosis.
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The relapse rate after short course chemotherapy is usually assessed by cases that are available for analysis, with a delay which rarely exceeds 3 years from the time of instituting therapy. This level may be disputed if too many are lost to follow up or non-compliers appearing late. To understand the true failure rate we strove to trace every patient in a trial carried out between 1969 and 1973, consisting of three groups of patients treated with the same chemotherapy: Isoniazid (450 mg/day), Rifampicin (600 mg/day) given every day but for differing durations: 6 months (Group A), 9 months (Group B), 12 months (Group C), with either daily Ethambutol or Streptomycin in addition for the first three months. Amongst the 356 patients in the trial 86 were eliminated for failure to comply with the protocol, either due to a mishap or change of treatment. Amongst the 270 remaining patients, 248 were traced with a mean delay of post-therapy follow up of 101 months for patients still living and of 72 months for patients who had died in the intervening period, but of non-tuberculous disease. In the 242 old patients whose disease could be evaluated, the number of bacteriological relapses was 4/81 (6.2 %) in group A, and 2/85 (2.3 %) in group B and 2/76 (2.6 %) in group C. There was no significant differences between the groups. From these results it is seen that the Isoniazid/Rifampicin combination given daily for 6 months is a powerful combination with few failures. Maintaining such chemotherapy for 12 months does not seem to yield substantial gains. In conclusion nine months of chemotherapy with this regime offers a sufficiently ample guarantee of cure.
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The acetylator phenotype of 204 tuberculous patients was assessed (152 men and 52 women aged between 15 and 90). The INH dose was adjusted according to Vivien's protocol, measuring the index of inactivation of Isoniazid I3, three hours after the oral dose. In fixing the transition zone of I3 at 0.50 the distribution between slow and rapid acetylators was 53% and 47% respectively. There was no difference for sex, age or ethnic group. The dosage used according to this protocol varied greatly, going from 1.64 mg/kg/day to 13.3 mg/kg/day with a mean value of 2.74 mg/kg/day for slow acetylators and 6.13 mg/kg/day for rapid acetylators. The usual dose advised is 5 mg/kg/day, which may lead equally to over or under treatment though the former is more likely in our experience. Adjusting the dosage is an important feature in good tolerance of the treatment: indeed only 4 of 86 subjects whose dosage has been adjusted showed elevated transaminases, whereas 34 of 118 patients had raised transaminases in the control group on a standard dose before the adjusted treatment was introduced. The difference was significant between the two groups.
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The results of a survey conducted in a company employing 1850 persons working in air-conditioned premises are reported. One hundred and five persons were examined, including 790 who mostly complained of respiratory disorders and 20 controls. Regular check-ups during the last two years have failed to reveal any serious disease. The most frequent complaints were rhinitis and tracheitis, especially among female employees. No alveolitis was observed. The finding of Bacillus subtilis in samples of ambient air and air-conditioner filters in conjunction with the presence of precipitating antibodies against crude extracts from these samples, suggested that the respiratory disorders might have been due to this microorganism. A multifactorial analysis demonstrated a statistically significant correlation between clinical symptoms and immunological disorders. The air-conditioner disease, therefore, may present as a benign condition.
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Occupational allergic alveolitis may be observed in agricultural or industrial environment. The presence of serum precipitins to specific antigens remains a valuable symptom. But other immunologic tests, such as inhibition of leucocyte migration, may be performed in doubtful cases or for retrospective diagnosis. It shows the role of delayed hypersensitivity in the pathogenesis of the disease. The functional investigation confirms the alveolar involvement but also reveals in some cases (by flow/volume curves and compliance tests) evidence of small airways disease. The broncho-alveolar lavages show the high percentage of lymphocytes (mainly T lymphocytes) in in the cell population recovered and a very typical phospholipid profile in the supernatant (total absence of lecithin whereas the two other fractions phosphatidyl-inositol and phosphatidyl-ethanolamine are considerably enhanced). The tensioactive properties of the phospholipids were investigated by fluorescence polarisation technique. High values of microviscosity were found in patients. These findings provide a new diagnostic guidance and a new therapeutic approach of these diseases.
The purpose of this investigation was to identify early left ventricular (LV) cineangiographic signs of myocardial damage and to study the evolution of the characteristic lesions in 126 chronic chagasic patients, divided into three groups. Group I patients had no clinical, ECG, or radiologic evidences of heart disease; 41% of them manifested apical or anterior apical asynergy, suggestive of early subclinical myocardial damage. Group II patients had abnormal ECG findings and no clinical signs of heart failure. Extensive asynergy, LV dilatation, decreased distensibility, and depressed contractility were found in 98% of these cases. Group III patients presented with congestive heart failure, a greatly dilated, hypokinetic LV chamber, and a 40% incidence of large apical aneurysms, 20% with thromboses within the LV. The performance of a left cineventriculogram in our chagasic patients enabled us to diagnose early myocardial damage and to detect potentially resectable lesions, such as ventricular aneurysms and apical thromboses.
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The leukocyte migration inhibition test (LMIT) was studied in 20 patients with farmer's lung (FL) and in 24 asymptomatic farmers. In the first group, the test proved to be 95% positive (19/20), whereas it was positive in only 44% (11/25) of the control group; this difference was statistically significant (p less than 0.005). The LMIT was also studied in eight patients with FL who had not been in contact with the antigen during the year prior to testing and was found to be 87% positive (7/8). The test therefore proved to be more effective in the diagnosis of FL compared with tests for specific antibodies, even when subjects had not been in contact with the antigen for 1 yr.
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Bronchoalveolar lavages were studied in control subjects and patients with extrinsic allergic alveolitis. Phospholipids, fatty acid composition of the different phospholipid species found and cholesterol were investigated. In allergic alveolitis, the phosphatidylcholine was absent, whereas two usually minor components in lung surfactant, phosphatidylethanolamine and phosphatidylinositol, were considerably enhanced. The tensio-active properties of the phospholipids present in fluids were investigated by a fluorescence polarization technique. Microviscosity of the phospholipids was studied, using 1,6-diphenyl-1,3,5-hexatriene. High values for the microviscosity were encountered in samples from patients. Phosphatidylethanolamine present at a high level exhibits the highest microviscosity. Saturated fatty acids in phospholipids and cholesterol are rigidifying factors contributing to the high microviscosity values found in allergic alveolitis. Moreover, one very important point microviscosity values found in allergic alveolitis. Moreover, one very important point brought out by the this technique is its full independence from the fluid volume recovery.
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