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Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function.

INTRODUCTION: We hypothesized that simultaneous right and left ventricular apical pacing would result in improvement in left ventricular function due to improved coordination of segmental ventricular contraction. Structural changes in ventricular muscle present in dilated cardiomyopathy compromise ventricular excitation and mechanical contraction. METHODS AND RESULTS: Eleven patients with depressed left ventricular function having cardiac surgery underwent epicardial multisite pacing with continuous transesophageal echocardiographic imaging. Quantitative measurement of percent fractional area change was performed, and segmental changes in contraction sequence resulting from simultaneous right and left ventricular pacing were assessed by application of phase analysis to recorded transesophageal images. There was no statistically significant difference between the paced QRS duration achieved with simultaneous right and left ventricular apical pacing and the native QRS duration (139+/-39 msec vs 106+/-18 msec, P = NS), but all other paced modes resulted in longer QRS durations. Percent fractional area change improved with simultaneous right and left ventricular apical pacing but not with other paced modes (41.5+/-11.9 vs 34.3+/-9.7, P < 0.01). Phase analysis demonstrated a resequencing of segmental left ventricular activation/contraction when compared to baseline ventricular activation. CONCLUSION: Simultaneous right and left ventricular apical pacing results in acute improvements in global ventricular performance in patients with depressed ventricular function. Improvements may result from pacing-induced global coordination through recruitment of left and right ventricular apical and septal segments critical to effective ventricular contraction.

Cardiac Pacing, Artificial↗

Functional selectivity of nociceptin/orphanin FQ peptide receptor partial agonists on cardiovascular and renal function.

The opioid-like peptide nociceptin/orphanin FQ (N/OFQ) produces marked cardiovascular and renal responses after central or peripheral administration in rats. Due to their ability to behave as full/partial agonists or antagonists in different cellular and tissue assays, the present studies were performed to determine how compounds classified as N/OFQ peptide (NOP) receptor partial agonists ([F/G]N/OFQ(1-13)-NH(2), Ac-RYYRIK-NH(2), and Ac-RYYRWK-NH(2)) affect cardiovascular and renal function in vivo. In conscious Sprague-Dawley rats, intracerebroventricular (i.c.v.) administration of each of the three NOP receptor ligands produced profound cardiovascular (depressor), renal excretory (water diuresis), and renal sympathetic nerve activity (inhibitory) responses that were similar to those produced by i.c.v. injection of the native ligand N/OFQ. In contrast, in other groups of rats, the intravenous (i.v.) bolus injection of these same NOP receptor ligands produced responses unlike N/OFQ; N/OFQ evoked an immediate and profound bradycardia and hypotension with no change in urine output, whereas all purported NOP receptor partial agonists elicited a subtle slow onset hypotension, no change in heart rate, and a marked water diuresis. In other studies, i.v. bolus pretreatment of rats with NOP receptor partial agonists prevented/attenuated the cardiovascular depressor effects produced by a subsequent i.v. bolus N/OFQ challenge without affecting the cardiovascular responses to i.c.v. N/OFQ. Together, these findings demonstrate that in conscious rats, NOP receptor partial agonists produce functionally selective effects on cardiovascular and renal function ranging from full agonist (i.c.v., cardiovascular depressor; i.c.v. and i.v., water diuresis), partial agonist (i.v., submaximal hypotension) to antagonist (i.v., blockade of N/OFQ-evoked bradycardia and hypotension) behavior.

Animals↗

[Relative renal function based on DMSA uptake corrected for volume: normalized relative renal function].

OBJECTIVE: Relative renal function (RRF) quantification based on dimercaptosuccinic acid (DMSA) uptake is an established method for determining differential renal function. An abnormal kidney size may lead to an alteration in its RRF value, although it has no dysfunction. Therefore, it is useful to correct RRF values taking into account relative renal volumes, thus obtaining the normalized relative renal function (NRRF). The feasibility of the method used for volume correction, differences with respect to usual quantification and different normality intervals were studied. MATERIAL AND METHODS: A total of 187 DMSA renal scintigraphies (130 children and 57 adults) were studied. RRF was quantified and volume corrected to obtain NRRF. Patients were classified as normal or pathological using various normality intervals for NRRF. A second classification was performed depending on how the diagnostic changed after volume correction. RESULTS: An increase of pathological diagnosis was observed after volume correction, mainly in children. Using an intermediate estimation for the normality interval, 53% of the initially pathological diagnosis for children may be caused simply by different renal volumes. CONCLUSIONS: NRRF provides complementary information to RRF and helps to distinguish between a smaller kidney and a really hypofunctioning one in cases with abnormal RRF.

Adolescent↗

Left ventricular function at 3 months after successful thrombolysis. Impact of reocclusion without reinfarction on ejection fraction, regional function, and remodeling.

BACKGROUND: After successful thrombolysis for acute myocardial infarction, reocclusion is observed in about 30% of patients after 3 months and usually occurs without reinfarction. We studied the impact of reocclusion without reinfarction on global and regional left ventricular function and on remodeling during that period. METHODS AND RESULTS: The patients for this analysis constituted a subset of those enrolled in the APRICOT-trial, which was designed to study the efficacy of antithrombotics on the prevention of reocclusion. Patients were selected who had a left anterior descending- or right coronary artery-related myocardial infarction, had an angiographically patent infarct-related vessel when studied < 48 hours after intravenous thrombolysis, and underwent repeat cardiac catheterization at 3 months. Paired contrast ventriculograms of quality sufficient to analyze regional wall motion, global ejection fraction, and ventricular volumes were analyzed in 129 patients. Enzymatic infarct size and baseline left ventricular function as well as other baseline characteristics were similar in patients with (n = 34) and without (n = 95) reocclusion. Ejection fraction improved in anterior infarction without reocclusion from 47 +/- 10% to 54 +/- 13% (P = .0001) but not with reocclusion (baseline, 48 +/- 13%; 3 months, 48 +/- 16%). No improvement was seen in inferior infarction with or without reocclusion. Persistent patency allowed preservation of end-systolic volume index (ESVI) at 3 months (37 +/- 14 mL/m2) to baseline level (38 +/- 13 mL/m2), with a better chance for improvement of > 10 mL/m2 without reocclusion in those with baseline values > 40 mL/m2. After reocclusion, in contrast, ESVI increased from 37 +/- 14 to 43 +/- 20 mL/m2 (P = .08). Comparable mean changes of ESVI in response to persistent patency or reocclusion were seen in anterior versus inferior infarction. Recovery of infarct zone contractility was impaired by reocclusion, both in terms of abnormality of segment shortening and expressed in the number of segments showing abnormal wall motion. In anterior but not in inferior infarction, infarct zone contractility was better with good collaterals to the reoccluded artery compared with poor collaterals. CONCLUSIONS: After successful thrombolysis for acute myocardial infarction, reocclusion without reinfarction withholds salvaged myocardium from regaining contractility. This has deleterious consequences for regional and global left ventricular function and for remodeling. To further optimize prognosis in patients after thrombolysis, future research should focus on the prevention of reocclusion and should evaluate revascularization therapy in patients with reocclusion.

Collateral Circulation↗

Left ventricular function after extended hypothermic preservation of the heart is dependent on functional coronary capillarity.

BACKGROUND: A growing body of knowledge has led to the hypothesis that injury to the microcirculation during hypothermic myocardial preservation may result in decreased contractility of hearts upon reperfusion. METHODS AND RESULTS: To test this hypothesis, we examined the relationship between no-reflow and left ventricular function after hypothermic cardiac preservation after reperfusion with solutions containing dilute whole blood (DWB) or washed red blood cells (K2RBC). Rat hearts were arrested with high-potassium cardioplegia, then flushed and stored for 6 hours in low-potassium cardioplegia at 4 degrees C. Hearts were reperfused at a constant flow rate (4 mL/min) with K2RBC for 60 minutes (group 1, n = 5) or DWB for 7 minutes followed by 53 minutes of K2RBC (group 2, n = 5). Left ventricular developed pressure (LVDP) was measured with an intraventricular balloon. Immediately after functional assessment, hearts were perfused with an india ink solution to mark flow, then glutaraldehyde. Morphometric techniques were used to determine the degree of capillary compression [delta d(c)], perfused capillary number per fiber area [QA(0)P], and perfused capillary surface area per fiber volume [Sv(c,f)P]. Capillaries were moderately compressed in both groups after reperfusion (group 1, 19 +/- 1%; group 2, 20 +/- 1%). QA(0)P and Sv(c,f)P were highly correlated with delta d(c) in hearts reperfused with K2RBC (r = .92 and r = .92; P < .01). Although statistically significant, the correlation was not as strong in DWB-reperfused hearts (r = .66 and r = .67; P < .05). LVDP was correlated to QA(0)P and Sv(c,f)P (r = .86 and r = .87, respectively) for groups 1 and 2. CONCLUSIONS: The weaker correlation between capillary perfusion and capillary compression in DWB-reperfused hearts suggests that factors other than compression contribute to no-reflow after hypothermic preservation. Regardless of the composition of the reperfusate, recovery of left ventricular function after hypothermic ischemia is directly related to coronary capillary perfusion upon reperfusion.

Animals↗

Determination of cognitive hemispheric lateralization by "functional" transcranial Doppler cross-validated by functional MRI.

BACKGROUND AND PURPOSE: Changes of blood flow velocity in the right and left middle cerebral artery (MCA) induced by cognitive demands are detectable by means of "functional" transcranial Doppler sonography (fTCD). Functional MRI (fMRI) is an alternative method for mapping brain activity. The purpose of this study was to determine whether fTCD can detect hemispheric lateralization and to cross-validate fTCD with fMRI. METHODS: Bilateral continuous MCA monitoring of 14 healthy, right-handed subjects with TCD was performed while the subjects underwent a visuospatial task, and the hemispheric blood flow velocity shift was calculated. Identical stimulus and response patterns were used in fMRI. Blood oxygenation level-dependent fMRI was performed with the use of a gradient-echo echo-planar sequence on a 1.5-T scanner. Statistical maps were computed on a voxel-by-voxel basis, hemispheric ratios for activated pixels were computed, and a group study was performed separately for the male and female subgroups. RESULTS: Statistical analyses (t test) showed a significantly higher mean peak blood flow velocity increase (P<0.05) of the right MCA (111.3+/-7.0%) compared with the left MCA (107.1+/-6.1%). fMRI demonstrated bilateral activation in the superior parietal lobulus (Brodmann area 7) with a right/left ratio of 1.95. Concordant differences between the female and male subgroups could be visualized with both methods. CONCLUSIONS: Both methods succeeded in discriminating a blood flow shift to the right hemisphere induced by a complex cognitive visuospatial task. fMRI cross-validates the findings of fTCD. Our study suggests that fTCD can investigate the close relationship between brain activity and blood flow and lateralize higher cognitive functions reliably.

Adult↗

Maximal expiratory flows at functional residual capacity: a test of lung function for young children.

Maximal expiratory flows at functional residual capacity were measured noninvasively from partial expiratory flow-volume curves in 65 awake, healthy children, 4 to 6 years of age. The variabilities within and between subjects were nearly identical to those reported for flows low in the vital capacity obtained from older subjects. This test of maximal expiratory flow at functional residual capacity has the advantage that the subject does not have to inspire to total lung capacity, exhale to residual volume, or make a maximal effort, and it is therefore applicable to the testing of young children who cannot perform a vital capacity maneuver. Measurement of this flow rate in 20 patients of the same age with lung disorders of varying severity revealed abnormal flow rates in more than 50 per cent of patients. Functional residual capacity was measured by the closed-circuit helium-equilibration method. When flow rates in liters per sec were compensated for lung size, girls had significantly larger flow rates than did boys. This suggests that the lungs of young children may grow differently according to genetic determinants related to sex.

Adolescent↗

Transfection of cells from patients with leukocyte adhesion deficiency with an integrin beta subunit (CD18) restores lymphocyte function-associated antigen-1 expression and function.

Leukocyte adhesion deficiency (LAD) is an inherited immunodeficiency disease that is characterized by the deficient expression of the leukocyte adhesion glycoproteins lymphocyte function-associated antigen-1 (LFA-1), Mac-1, and p150,95. This loss of expression is attributed to heterogeneous defects in the common beta subunit shared by these glycoproteins. Here we demonstrate that expression of the LFA-1 alpha beta heterodimer in EBV-transformed B lymphoblastoid cells from LAD patients can be recovered after transfection with the beta subunit cDNA contained in an EBV-based vector. Four patients with differing severities of LAD comprising three distinct classes of mutations were studied. Flow cytometry analysis of stably transfected patient cells revealed near normal levels of expression of both the alpha and beta chains of LFA-1, and immunoprecipitation studies confirmed that fully processed alpha and beta chains were being expressed at the cell surface. In addition, Northern analysis of mRNA expression also demonstrated that the transfected LAD patient cells were expressing high quantities of exogenous beta subunit mRNA. Functional studies such as homotypic adhesion and adhesion to a purified counterreceptor for LFA-1, intracellular adhesion molecule-1, demonstrated that LFA-1 function had been restored in the stably transfected LAD patient cell lines. These studies unequivocally show that the defect in cells from patients with LAD is in the leukocyte integrin beta subunit.

Animals↗

Endothelial function, carotid artery intima-media thickness, epicardial adipose tissue, and left ventricular mass and function in growth hormone-deficient adolescents: apparent effects of growth hormone treatment on these parameters.

OBJECTIVE: The purpose of this study was to determine whether GH-deficient (GHD) adolescents have abnormalities of cardiac and vascular function detectable during the teenage years. DESIGN/METHODS: Ten GHD children on GH treatment with a chronological age (CA) of 14.6 +/- 1.7 yr and 12 untreated GHD adolescents with a CA of 15.0 +/- 3.0 yr were studied. Cardiac mass and function, carotid artery intima-media thickness, flow-mediated endothelium-dependent vasodilation (percent change from baseline diameter during hyperemia), and hyperemia-induced blood flow increase of the brachial artery (percent change from baseline) and epicardial adipose tissue were evaluated by echocardiography. Fourteen healthy adolescents served as controls. RESULTS: Untreated GHD adolescents present with a reduced left ventricular mass when compared with controls (P < 0.05) and a lower flow-mediated endothelium-dependent increase in the diameter of the brachial artery during hyperemia than both controls and treated GHD subjects (P < 0.02), whereas their epicardial adipose tissue is significantly higher than that of healthy controls (P < 0.02). Interventricular septum thickness, posterior wall thickness, left ventricular ejection fraction, and carotid artery intima-media thickness were similar in all three groups. Hyperemia-induced blood flow increase was greater in treated GHD adolescents than both untreated subjects and controls (P < 0.001). Body mass index correlated positively with epicardial adipose tissue in all three groups and with carotid intima-media thickness in treated and untreated GHD adolescents. CONCLUSIONS: GHD adolescents have a reduced left ventricular mass and vascular abnormalities manifested by lower flow-mediated endothelium-dependent vasodilation. These findings together with an increase in epicardial adipose tissue, a good indicator of abdominal/visceral fat, may contribute to an increased cardiovascular risk in the long term. An improvement in endothelial function and a reduction in arterial stiffness appear to occur after GH replacement.

Adipose Tissue↗

[Maximal functional capacity and diastolic function in patients with cardiomyopathy due to Chagas' disease without congestive heart failure].

PURPOSE: To identify early cardiac dysfunctions in asymptomatic patients with Chagas' cardiomyopathy. METHODS: We studied 38 male individuals: control group consisting of 20 sedentary normal individuals and Chagas' group, of 18 asymptomatic patients with Chagas' disease, with suggestive electrocardiographic alterations and normal fractional shortening (FS) on echocardiogram. Both groups were submitted to evaluation of the maximal functional capacity, with measurements of maximal O2 consumption (VO2max), O2-pulse rate (PO2max), maximal ventilation (VEmax), maximal heart rate (HRmax), and anaerobic threshold of the VO2max (VO2-AT). Left ventricular diastolic function was evaluated by conventional echocardiography (E wave, A wave and E/A ratio). RESULTS: No significant differences occurred between the two groups with regard to FS (p = 0.212) and age means (p = 0.060). The 2 groups were significantly different (p < 0.001) regarding the parameters VO2max, PO2max, VEmax, HRmax and VO2-AT, E wave and E/A ratio. There was no difference (p = 0.520) in A wave. CONCLUSION: Impaired ventricular function may account for the above mentioned differences, a consequence of both systolic and diastolic dysfunctions.

Adult↗

Impact of initial exposure to calcineurin inhibitors on kidney graft function of patients at high risk to develop delayed graft function.

We conducted a retrospective analysis of the influence of full doses of calcineurin inhibitors [8-10 mg kg-1 day-1 cyclosporine (N = 80), or 0.2-0.3 mg kg-1 day-1 tacrolimus (N = 68)] administered from day 1 after transplantation on the transplant outcomes of a high-risk population. Induction therapy was used in 13% of the patients. Patients also received azathioprine (2 mg kg(-1) day(-1), N = 58) or mycophenolate mofetil (2 g/day, N = 90), and prednisone (0.5 mg kg(-1) day(-1), N = 148). Mean time on dialysis was 79 +/- 41 months, 12% of the cases were re-transplants, and 21% had panel reactive antibodies > 10%. In 43% of donors the cause of death was cerebrovascular disease and 27% showed creatinine above 1.5 mg/dL. The incidence of slow graft function (SGF) and delayed graft function (DGF) was 15 and 60%, respectively. Mean time to last dialysis and to nadir creatinine were 18 +/- 15 and 34 +/- 20 days, respectively. Mean creatinine at 1 year after transplantation was 1.48 +/- 0.50 mg/dL (DGF 1.68 +/- 0.65 vs SGF 1.67 +/- 0.66 vs immediate graft function (IGF) 1.41 +/- 0.40 mg/dL, P = 0.089). The incidence of biopsy-confirmed acute rejection was 22% (DGF 31%, SGF 10%, IGF 8%). One-year patient and graft survival was 92.6 and 78.4%, respectively. The incidence of cytomegalovirus disease, post-transplant diabetes mellitus and malignancies was 28, 8.1, and 0%, respectively. Compared to previous studies, the use of initial full doses of calcineurin inhibitors without antibody induction in patients with SGF or DGF had no negative impact on patient and graft survival.

Adult↗

Intraoperative monitoring of the corticospinal motor evoked potential (D-wave): clinical index for postoperative motor function and functional recovery.

The corticospinal motor evoked potential was investigated as a monitoring index of motor function to perform maximal resection of brain tumors located around the motor cortex in 37 patients with glioma. Tumor resections were performed under general anesthesia with muscle relaxant and completely controlled ventilation. No special arrangements for anesthesia were required. Direct cortical stimulation revealed that if one electrode was placed on the posterior half of the precentral gyrus, the D-wave could be recorded even when using an electrode separation of 10 mm, and the amplitude was larger with anodic rather than cathodic stimulation. Monitoring of the D-wave enabled the function of the corticospinal tract to be evaluated selectively. Postoperative persistent motor disturbance remained in six patients who had a decrease of over 30% in amplitude of the D-wave during tumor resection. A decrease of less than 30% may indicate postoperative preservation of motor function, including transient motor disturbance with subsequent complete recovery. Intraoperative monitoring of the D-wave is suitable for open cranial surgery with general anesthesia, can detect the primary motor cortex, and allow maximal resection of brain tumors located around the motor cortex.

Brain Neoplasms↗

Recovery of kidney function after cessation of graft function or prolonged dialysis treatment.

The occurrence of recovery of kidney function after cessation of graft function or prolonged dialysis treatment has been studied retrospectively, and the frequency was found to be roughly 1%, inasmuch as 8 of approximately 750 patients could dispense with dialysis after 10-131 weeks of treatment. The causes of recovery of kidney function are discussed, as the importance of keeping this possibility in mind.

Adult↗

The effect of milrinone on the right ventricular function in patients with reduced right ventricular function undergoing off-pump coronary artery bypass graft surgery.

This investigation evaluated the effect of continuous milrinone infusion on right ventricular (RV) function during off-pump coronary artery bypass graft (OPCAB) surgery in patients with reduced RV function. Fifty patients scheduled for OPCAB, with thermodilution RV ejection fraction (RVEF) <35% after anesthesia induction, were randomly allocated to either milrinone (0.5 microg/kg/min) or control (saline) group. Hemodynamic variables and RV volumetric data measured by thermodilution method were collected as follows: after anesthesia induction (T1); 10 min after heart displacement for obtuse marginal artery anastomosis (T2); after pericardial closure (T3). Cardiac index and heart rate increased and systemic vascular resistance significantly decreased in milrinone group at T2. Initially lower RVEF of milrinone group was eventually comparable to control group after milrinone infusion. RVEF did not significantly change at T2 and T3 in both groups. RV end-diastolic volume in milrinone group consistently decreased from the baseline at T2 and T3. Continuous infusion of milrinone without a bolus demonstrated potentially beneficial effect on cardiac output and RV afterload in patients with reduced RV function during OPCAB. However, aggressive augmentation of intravascular volume seems to be necessary to maximize the effect of the milrinone in these patients.

Aged↗

The inhibition of autoreactive T cell functions by a peptide based on the CDR1 of an anti-DNA autoantibody is via TGF-beta-mediated suppression of LFA-1 and CD44 expression and function.

Systemic lupus erythematosus (SLE), which is characterized by the increased production of autoantibodies and defective T cell responses, can be induced in mice by immunization with a human anti-DNA mAb that expresses a major Id, designated 16/6Id. A peptide based on the sequence of the CDR1 of the 16/6Id (human CDR1 (hCDR1)) ameliorated the clinical manifestations of SLE and down-regulated, ex vivo, the 16/6Id-induced T cell proliferation. In this study, we examined the mechanism responsible for the hCDR1-induced modulation of T cell functions related to the pathogenesis of SLE. We found that injection of hCDR1 into BALB/c mice concomitant with their immunization with 16/6Id resulted in a marked elevation of TGF-beta secretion 10 days later. Addition of TGF-beta suppressed the 16/6Id-stimulated T cell proliferation similarly to hCDR1. In addition, we provide evidence that one possible mechanism underlying the hCDR1- and TGFbeta-induced inhibition of T cell proliferation is by down-regulating the expression, and therefore the functions, of a pair of key cell adhesion receptors, LFA-1 (alphaLbeta2) and CD44, which operate as accessory molecules in mediating APC-T cell interactions. Indeed, T cells of mice treated with hCDR1 showed a TGF-beta-induced suppression of adhesion to the LFA-1 and CD44 ligands, hyaluronic acid and ICAM-1, respectively, induced by stromal cell-derived factor-1alpha and PMA. The latter suppression is through the inhibition of ERK phosphorylation. Thus, the down-regulation of SLE-associated responses by hCDR1 treatment may be due to the effect of the up-regulated TGF-beta on the expression and function of T cell adhesion receptors and, consequently, on T cell stimulation, adhesion, and proliferation.

Animals↗

[Function of sensorimotor equilibrium function in elderly patients on the basis of vestibular evoked myogenic potentials (m.p.p.w.)].

Observed elderly had general weakness of motor and mental function. The slower reactions to environment stimulus in elderly above 60 years result first of all from weakness of sensory receptors as visible, hearing, smell and taste. In this age group disturbing of balance system function demonstrated vertigo, dizziness, darkness of visible, disequilibrium was more encountered. Up to now there is not specified that "presbyequilibrium" (presbyvertigo, presbyastasis) as physiology ageing process causes this condition or destructive processes, infections, vascular insufficiency and neoplastic processes in inner ear and acoustic tracts and centres. Vestibular symptoms often are related to age by the doctors so for that reason basic and sometimes dangerous disease may be missed. Proposition of this paper is estimation of reflex function of balance system in connection with ageing process. To this end VEMPs were used and latencies and amplitudes of ipsilateral and contralateral VEMP recordings were calculated in young and elderly groups. Lower reflex efficiency in elderly disclosed longer latencies and lower aptitudes of p14 n21 of VEMPs than young people but without significant differences.

Adolescent↗

[Prescription of thyroid function tests in adults as a function of clinical circumstances and of patient management].

A group of experts composed of clinicians and biologists in 7 University Hospitals in the Aquitaine and Paris regions working within the framework of the Coordination Committee for Clinical Evaluation and Quality in Aquitaine (CCECQA) have developed prescription guidelines for thyroid function tests to be performed in adults. The goal was to determine strategies for prescribing thyroid hormones (T3 and T4) and thyroid stimulating hormone (TSH) to screen for thyroid function disorders and follow thyroid function. The resulting recommendations were based on a review of the literature and a consensus among the experts. The first part of the guidelines concern recommended prescriptions in different clinical situations (early diagnosis of hypothyroidism, early diagnosis of hyperthyroidism, follow-up of anti-thyroid drug treatments, follow-up of levothyroxin replacement therapy, institution and follow-up of treatments susceptible of inducing dysthyroidism, pregnancy and post-partum dysthyroidism, palpation of a thyroid nodule). The second part of the guidelines are devoted to prescriptions according to the therapeutic setting (emergency care, psychiatric care, geriatric care).

Adult↗

[Functional conditions of the respiratory system and work site pollution. II. Prevalence of respiratory function changes in workers employed in bichromate and chromic acid production (author's transl)].

The authors report the prevalence of respiratory function changes in two groups of workers employed in bichromate and chromic acid production. In the first group (82 subjects) examined at the Institute of Occupational Medicine, the following tests were performed: filling out of a questionnaire for cronic bronchitis; chest x-ray; spirometry; pulmonary diffusing capacity (DLco) measurement; blood gas analysis on arteriolized capillary; He and CO2 rapid expiratory curves determination. No environmental pollution data were available. In the second group (180 subjects) examined at the working site, the following tests were performed: filling out of a questionnaire -or chronic bronchitis; spirometric determination. Environmental pollution data were available. A causal connection is hypothesized by the authors between either roentgenologic or respiratory functional changes and chromium exposure, and an increased proportion between lung function changes and exposure length is stressed.

Adult↗