Guidelines for prescribing combined oral contraceptives.
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Contraceptives, Oral, Combined↗
Biomedical subjects
J Elias
Publications and source records attributed to J Elias.
Diagnostic clues from the surface ECG to identify idiopathic (fascicular) ventricular tachycardia: correlation with electrophysiologic findings.
INTRODUCTION: An RS interval > 100 msec in precordial leads has been recently described for the diagnosis of ventricular tachycardia (VT). The aim of this study was to assess the value of this criterion when applied to patients with right bundle branch block pattern, left-axis deviation (fascicular) VT sensitive to verapamil. METHODS AND RESULTS: Eleven patients (mean age 31 +/- 11 years; range 16 to 51) had a mean heart rate of 164 +/- 37 beats/min (range 107 to 230) during VT. The QRS complex axis was -92 degrees +/- -15 degrees (range -80 to -115). The mean QRS duration was 121 +/- 9 msec (range 105 to 140). The mean RS interval was 67 +/- 9 msec (range 60 to 80). Fusion beats were present in 2 patients (18%), and AV dissociation confirmed by electrophysiologic study was found on ECG in 8 (73%) of 11. During tachycardia, the QRS-H' interval was 19 +/- 10 msec (range 10 to 30) in 6 of 11 patients. In seven patients, a fast, unique (or double) presystolic potential lasting 32 msec (range 12 to 40) occurring before the onset of the QRS complex was found at the site of origin of VT, localized in the inferior apical left ventricular septum. In all cases, VT was successfully treated by catheter ablation. CONCLUSION: A wide QRS complex tachycardia with right bundle branch block and left-axis deviation sensitive to verapamil observed in a young patient without structural heart disease should not be confused with supraventricular tachycardia with aberrancy but rather suggests the presence of fascicular VT. As opposed to VT associated with structural heart disease, the RS interval is < 80 msec in all precordial leads in all cases. Independent of this parameter, AV dissociation detectable on surface ECG has a sensitivity of 73%, which increases to 82% in the presence of fusion beats.
Adolescent↗
Time- and frequency-domain analyses of the signal-averaged ECG in patients with arrhythmogenic right ventricular dysplasia.
BACKGROUND: Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by recurrent ventricular tachycardia of right ventricular origin and a cardiomyopathy with hypokinetic areas involving the free wall of the right ventricle. Subjects have a risk of sudden cardiac death, particularly during sports and strenuous exercise. Routine clinical examinations may be normal, but fragmented or delayed electrograms are usually recorded in the right ventricle of these patients. However, the frequency with which late potentials are detected by conventional time-domain analysis of the signal-averaged ECG (SAECG) is not high. This study evaluated the usefulness of the frequency-domain analysis of the SAECG in addition to the conventional time-domain analysis for a screening test to detect patients with ARVD. METHODS AND RESULTS: SAECG was recorded by using a bipolar X, Y, and Z lead system in 28 patients with ARVD (mean age, 38 +/- 13 years) and 35 age-matched normal subjects (mean age, 35 +/- 11 years). The conventional time-domain analysis of the SAECG was performed at two different high-pass filter settings, 25 and 40 Hz, and the low-pass cutoff frequency was fixed at 250 Hz. The fast-Fourier transform analysis of SAECG was performed using a Blackman-Harris window. Area ratio 1 (area of 20 to 50 Hz)/(area of 0 to 20 Hz) and area ratio 2 (area of 40 to 100 Hz)/(area of 0 to 40 Hz) were calculated. In the conventional time-domain analysis, 20 (71%) and 18 (64%) patients had positive criteria at filter settings of 25 and 40 Hz, respectively. In the frequency-domain analysis, 18 (64%) and 20 (71%) patients had abnormal values in area ratios 1 and 2, respectively. Combining the time- and frequency-domain analyses, all patients were judged positive, with a sensitivity of 100% and a specificity of 94%. CONCLUSIONS: Each result of the time- and frequency-domain analyses revealed that both methods had equivalent value. Combining the two domain analyses improved the sensitivity without reducing the specificity. These findings suggest that combining the time- and frequency-domain analyses of the SAECG may be useful as a screening test to detect patients with ARVD.
Adult↗
Detection of specific mRNAs in routinely processed dermatopathology specimens.
To determine the effect of different fixatives on the recovery and detection of mRNAs from archival histopathology specimens, biopsies of normal skin were fixed in neutral and alcohol-buffered formalin, acetone, Carnoy's fixative, methacarn, and Bouin's solution. Tissue was routinely processed, and sections were either mounted for in situ hybridization or deparaffinized for RNA extraction. Extracted mRNA was reverse-transcribed using random hexamers, and the resulting cDNA was amplified by the polymerase chain reaction using primers specific for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and beta-actin. Amplification products of both GAPDH and actin could be detected by gel electrophoresis from tissues processed in all fixatives except Bouin's. A parallel study of formalin-fixed, paraffin-embedded archival biopsies accessioned since 1990 gave similar results. Less abundant mRNAs, such as those encoding interleukin-11 or the T-cell receptor beta-chain, could be detected by Southern blotting and hybridization with labeled oligonucleotide probes or by cloning and sequencing. In situ hybridization studies using oligonucleotide probes were most successful with tissue fixed in formalin, including both the experimentally fixed tissues and the archival biopsy samples. Thus, mRNAs may be isolated from and localized in formalin-fixed, paraffin-embedded archival material. Because dermatopathology laboratory archives typically contain samples from a wide spectrum of diseases that can be accessed without Human Investigation Committee approval, these laboratories represent a logical starting point for studying gene regulation and expression in skin.
Acetates↗
Optimal high-pass filter settings of the signal-averaged electrocardiogram in patients with arrhythmogenic right ventricular dysplasia.
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Adult↗
Usefulness of percutaneous balloon commissurotomy for mitral stenosis during pregnancy.
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Adult↗
Evaluation of waste anesthetic gases, monitoring strategies, and correlations between nitrous oxide levels and health symptoms.
The release of waste anesthetic gases (WAG) in hospital operating rooms (ORs) was evaluated to determine if staff exposure to nitrous oxide exceeded the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) and investigate possible correlations between symptoms and nitrous oxide exposure. The monitoring strategy consisted of nitrous oxide measurements by personal monitoring of the anesthetists and scrub nurses, and area monitoring at the exhaust grills. In addition, room ventilation rates and carbon dioxide concentrations were measured. Self-administered questionnaires were given to both the operating room personnel and staff on control wards. Nitrous oxide levels exceeded the current TLV of 50 ppm in 4 of 12 ORs. Anesthetists typically received the highest nitrous oxide exposure. There was a strong correlation (r2 = 0.90) for nitrous oxide dosimetry results between anesthetists and scrub nurses, and a fair correlation (r2 = 0.35) between area monitoring results and the anesthetists' personal exposures. Carbon dioxide levels commonly exceeded 1000 ppm on control wards. A correlation between reported symptoms and nitrous oxide exposure was not demonstrated. Reported symptoms more closely correlated with carbon dioxide levels. Nitrous oxide dosimetry of the anesthetists appears to be the only accurate strategy for monitoring human exposure to WAG in an operating room.
Air Pollutants, Occupational↗
[Coronary angioplasty: methods of evaluation].
Coronary angioplasty is sometimes thought to be insufficiently validated considering the considerable development it has undergone and its place in modern cardiological practice. Nevertheless, several randomised clinical trials comparing angioplasty with medical therapy in stable angina (ACME) and with surgical treatment in stable and unstable angina (RITA) have provided more scientific support for the technique. The serious perioperative complications have become rare, the limiting factor being restenosis which is responsible for a large number of clinical recurrences and the reappearance of documented myocardial ischaemia. It is therefore logical to make restenosis the first objective of evaluation of PTCA. There are two possible approaches to this problem. The first relies on automatic quantitative operator-independent angiography as a gold standard. However, this method is methodologically complex, technically fastidious and only takes into consideration the anatomical appearances, the correlations with clinical outcome and prognosis of which are poor. It allows measurement of the amplitude of the process which is an unquestionable advantage, but it is only a partial view of the problem. The second method considers that only stenosis causing ischaemia is significant and that the criterion of evaluation should be the rate of new events and that the necessity of repeated attempts at revascularisation is the criterion of failure of the method. This overlooks the possibility of an anti-restenosis drug producing clinical results independents of its anatomical effect. Both methods have their advantages and drawbacks, which necessitates using them both in all trials of new tools or new molecules designed to prevent restenosis.
Angina Pectoris↗
[Percutaneous mitral commissurotomy during pregnancy].
This report analyses the efficacy and tolerance of percutaneous mitral commissurotomy (PMC) in 10 pregnant women with severe mitral stenosis. Pregnancy was the cause of decompensation of the mitral stenosis and surgery was not considered because of the foetal risk. PMC was undertaken after an average of 26 +/- 4 weeks of gestation (range 23-33 weeks). The average age of the patients was 28 +/- 6 years (range 20-41 years). Six patients were in NYHA Class III and 4 in Class IV despite medical treatment. Five patients had mild mitral regurgitation. Foetal protection was ensured by covering the mother's abdomen with a lead apron. The double balloon technique was used in 4 cases and Inoue's balloon in 6 patients. The average duration of fluoroscopy was 17 +/- 10 minutes (range 6-37 minutes). After PMC, the mean pulmonary artery pressure decreased from 47 +/- 12 mmHg to 31 +/- 11 mmHg (p = 0.005); two dimensional echocardiography showed an increase in mitral valve surface area from 1 +/- 0.2 cm2 to 2 +/- 0.3 cm2 (p = 0.005). There were no complications related to the procedure. The foetal heart rate was monitored continuously and no significant modification suggestive of foetal distress was recorded. The abdominal cutaneous dose of irradiation was less than 0.2 millisievert, which was minimal. All patients experienced a functional improvement after PMC. Nine delivered after an average gestation of 38 +/- 2 weeks (range 36-42 weeks) without cardiac decompensation. The average birth weight of the babies was 3.1 +/- 0.3 kg (range 2.9-3.7 kg).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Progestin stimulates the biosynthesis of fibronectin and accumulation of fibronectin mRNA in human endometrial stromal cells.
Fibronectin is a major component of decidual basement membrane. In the present study, we have investigated the effect of progestin on the synthesis and secretion of fibronectin in human endometrial stromal cells. Stromal cells were isolated during the menstrual cycle and cultured in RPMI-1640 with 2% fetal calf serum supplemented with progesterone or medroxyprogesterone acetate (MPA) in a long-term culture system. Indirect immunofluorescent staining showed that fibronectin was uniformly distributed in the intracellular and extracellular regions of stromal cells treated with MPA for 14 days. The biosynthesis and secretion of this protein and the accumulation of cellular fibronectin mRNA were studied after various culture periods. Cells were pulse-labelled with [35S]methionine to determine the amount of newly synthesized fibronectin secreted into the culture medium. A monoclonal antibody (Mab) identified human fibronectin on SDS-polyacrylamide gel electrophoresis (SDS-PAGE), showing a predominant band (Mr 230-250 kDa) which migrated with authentic fibronectin run in parallel. In six endometrial specimens, the amount of radioactivity incorporated as [35S]fibronectin was increased by progestin. Maximal stimulation occurred after 6 days treatment with MPA. Culture beyond 16 days reduced the rate of synthesis and secretion to 40% of the maximum. The effect of progestin was dose dependent with 0.02, 0.2 and 1 microM progesterone, producing 2.0, 3.8 and 11-fold increases respectively, over the control. Medroxyprogesterone acetate was more effective than progesterone, the maximal response (10-fold increase) being achieved at 0.02 microM MPA.(ABSTRACT TRUNCATED AT 250 WORDS)
Cells, Cultured↗
Serum beta-2-microglobulin in the differential diagnosis of monoclonal gammopathies.
Serum beta-2-microglobulin (B2m) concentrations were determined in 43 southern African black patients with multiple myeloma (MM), in 130 black patients with monoclonal gammopathy of undetermined significance (MGUS) and in 70 control subjects. The results showed median values for serum B2m in patients with MM, MGUS and the control group to be 8.10 mg/l, 3.05 mg/l, and 2.35 mg/l, respectively; these values differed significantly from one another (P less than 0.01), even when patients with normal renal function (serum creatinine value less than 110 mumol/l) were considered separately. The median serum B2m concentration for IgG MM (22 cases) was 4.3 mg/l, for IgA MM (8 cases) 7.3 mg/l, and 24.2 mg/l for Bence Jones MM (12 cases). These differences were also significant (P = 0.001), but not in the restricted group of MM patients with normal renal function. In the 43 MM patients serum B2m concentrations had a significant positive correlation with serum creatinine (r = 0.706; P less than 0.005) and a significant negative correlation with haemoglobin values (r = -0.459; P = 0.006). In 28 MM patients with normal renal function, serum B2m values had a significant negative correlation with serum albumin (r = -0.602, P = 0.003). Sixty-five per cent of the 43 MM patients and 18.5% of the MGUS patients had raised serum B2m values (greater than 4.7 mg/l). An optimum cut-off value for serum B2m of 6.9 mg/l for differentiating MM from MGUS was determined using a classification rule. Despite lacking specificity, serum B2m measurement was useful in differentiating MM from MGUS, and was the best second choice variable in relation to serum albumin and haemoglobin in patients with normal renal function.
Creatinine↗
Ventricular tachycardia associated with Lyme carditis.
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Aged↗
The noise hazard in a large health care facility.
A noise-level survey, dosimetry, and audiometric testing were conducted in a large health care facility to determine the areas with hazardous noise levels, the number of employees at risk, and the prevalence of noise-induced hearing loss (NIHL) among the exposed. Nine high-risk areas were identified, with readings of up to 110 dBA recorded. In the work force of approximately 6,000 employees, 321 were identified as exposed to potentially hazardous noise levels. Abnormal hearing patterns were observed in 59 (19%) of the 308 workers screened, with 36 cases of NIHL documented. The findings showed that noise is a serious hazard in many areas, that some cases of NIHL have developed from occupational exposure in this hospital, and that a control program is essential.
Audiometry, Pure-Tone↗
Evaluation of CA 125 as a serum marker of hepatocellular carcinoma.
Serum CA 125 concentrations were raised in 90.4% of 115 southern African black patients with hepatocellular carcinoma. Seventy-four percent of 62 patients with amebic hepatic abscess, 60% of 40 patients with chronic hepatic parenchymal disease (chronic hepatitis or cirrhosis), and 60.9% of 41 patients with acute viral hepatitis also had raised values. The median serum CA 125 concentration for patients with hepatocellular carcinoma differed significantly from the benign hepatic disease groups analysed (p less than 0.0002). Serum alpha-fetoprotein levels were raised in 90.4% of the 115 hepatocellular carcinoma patients. CA 125 is thus a highly sensitive marker for hepatocellular carcinoma, but lacks specificity.
Acute Disease↗
Differential proliferative response to linoleate in cultures of epithelial cells from normal human breast and fibroadenomas.
Human breast epithelial cells isolated from normal breast tissues of premenopausal women demonstrated direct evidence of a proliferative effect by linoleate (18:2 omega 6) or prostaglandin E2 (PGE2) in the presence of insulin and epidermal growth factor in serum-free cultures within a collagen gel matrix. Neither epidermal growth factor nor 18:2 omega 6 by itself was capable of stimulating growth but together they stimulated proliferation synergistically. Epithelial cells isolated from fibroadenomas on the other hand failed to exhibit any growth stimulation due to 18:2 omega 6 or PGE2. The linoleate-stimulated growth in normal breast epithelial cells was inhibited by indomethacin, a cyclooxygenase inhibitor, which however could be reversed by PGE2. The proliferative response of normal breast epithelial cells to 18:2 omega 6 was accompanied by a greater conversion of [14C]18:2 omega 6 to arachidonic acid and [14C]20:4 omega 6 to prostaglandins than that seen in epithelial cells from fibroadenomas. The turnover of [14C]18:2 omega 6 in the phospholipids of normal cells was higher than in fibroadenomas indicating a possible role of phospholipids in mediating the 18:2 omega 6 effect in normal cells. Both normal and fibroadenoma cells can proliferate in response to cholera toxin and glucocorticoids when supplemented to the insulin- and epidermal growth factor-containing medium. From the results it appears that, unlike normal cells, fibroadenoma cells may have a specific defect in the PGE2-responsive cyclic AMP-generating mechanism whereas cholera toxin-induced mechanism is operative in both types of cells.
Adenofibroma↗
Production of interleukin 1 activity by cultured human melanoma cells.
A panel of melanoma cell lines derived from 7 primary and 20 metastatic lesions was tested for the production of interleukin 1 (IL-1) in standard mouse thymocyte costimulation assays. Constitutively produced IL-1 activity was found in the conditioned media of 4 of 7 primary and 5 of 20 metastatic melanoma cell lines tested. Four of 9 cell lines secreting IL-1 were also shown to contain cell-associated activity in their lysates. Melanoma-conditioned media were, however, unable to support the growth of CTLL, an interleukin 2-dependent cell line. The secreted IL-1 activity was significantly inhibited by antibodies to recombinant IL-1 alpha (3 of 3 lines), but not antibody to recombinant IL-1 beta. When conditioned medium from one cell line was fractionated on a Superose 12 column by fast protein liquid chromatography, a major peak of activity eluted at Mr 22,500-27,500. The presence of 2.2-kilobase mRNA hybridizing a probe for IL-1 alpha and 1.6-kilobase mRNA hybridizing a probe for IL-1 beta was detected by Northern blot in 3 of 4 secreting cell lines but not in a nonsecreting line. Taken together, these results suggest that cultured melanoma cells produce the cytokine IL-1 alpha, although the relationship between melanoma IL-1 and monocyte IL-1 is unclear. The production of IL-1 by melanoma cells is of interest because of its potential roles in the biology of melanoma through direct effects on tumor growth or through indirect effects on adjacent stromal and endothelial cells and infiltrating lymphoid cells.
Antibodies, Monoclonal↗
The rapid and sensitive diagnosis of tuberculous meningitis by the detection of tuberculostearic acid in cerebrospinal fluid using gas chromatography-mass spectrometry with selective ion monitoring.
Tuberculostearic acid (10-Methyloctadecanoic acid) is a lipid component of the mycobacterial cell wall and its presence in cerebrospinal fluid can serve as a diagnostic marker for tuberculous meningitis. Using gas chromatography-mass spectrometry with selective ion monitoring, tuberculostearic acid (TBSA) was detected in nine different mycobacterial reference strains. Analysis of derivatised cerebrospinal fluid specimens from 35 patients showed the presence of TBSA in 5/6 culture-positive samples and 0/19 negative control patients (diagnosed as bacterial or viral meningitis). In addition 4/10 clinically suspected cases of tuberculous meningitis showed the presence of TBSA in the absence of other confirmatory laboratory results. A routine method has been developed for the detection of TBSA, which allows the fast and sensitive diagnosis of tuberculous meningitis within 5 h of receiving the cerebrospinal fluid specimen, compared to the 3 to 8 weeks required to culture the bacteria.
Gas Chromatography-Mass Spectrometry↗