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Surgical repair of residual shunt after transcatheter closure of secundum atrial septal defect with an amplatzer septal occluder: a case report.

Secundum atrial septal defect is the most common congenital heart defect in adulthood. As an alternative to surgery, the transcatheter occlusion appears to be safe. We herein report a case of a residual shunt after transcatheter closure of ASD of a 66 year old man. Surgical repair was indicated. Real and potential problem with device closure of ASD are discussed.

Aged↗

Open versus arthroscopic subacromial decompression: a prospective, randomized study of 34 patients followed for 8 years.

In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.

Acromion↗

Nutritional value of raw and autoclaved kabuli and desi chickpeas (Cicer arietinum L.) for growing chickens.

1. Two experiments were carried out to determine the effect of inclusion of raw (kabuli and desi) and autoclaved (desi) chickpea seeds in wheat-based starter diets in chickens grown to 28 d of age on the performance, digestive organ sizes, nitrogen-corrected apparent metabolisable energy (AMEn), ileal apparent protein and starch digestibilities (APD and ASD) and intestinal alpha-amylase and trypsin activities. 2. In the first experiment, diets were formulated to contain 0, 150, 300 and 450 g/kg of raw kabuli chickpea seeds. Increasing the proportion of seed in the diet negatively influenced body weight gain, food intake and food efficiency. The relative weights of the pancreas, liver and gizzard and the relative lengths of duodenum, jejunum, ileum and caeca were increased significantly when the chickpea seeds were included in the diets. Correspondingly, APD, ASD, alpha-amylase and trypsin activities and AMEn were reduced significantly when the chickpea seed was incorporated in the diets. 3. In the 2nd experiment, diets were formulated to contain 75 and 150 g/kg of raw and autoclaved desi chickpea seeds. Weight gain and food intake of the chicks given desi chickpea diets were significantly reduced compared with those fed on the control diet. Increasing the proportion of seed in the diet negatively influenced body weight gain, food intake and food efficiency. Moreover, a significant increment in the relative weights of liver and pancreas, and in the relative lengths of duodenum, ileum and caeca was observed when the concentration of chickpea seeds in the diets was increased. Feeding autoclaved seeds significantly increased the weight gains and the food intakes. However, food efficiency was not modified by the autoclaving. Relative weights of gizzard and liver and relative lengths of ileum were decreased significantly by the inclusion of autoclaved desi chickpea in the diet. 4. We concluded that the inclusion of kabuli (up to 450 g/kg) and desi (up to 150 g/kg) chickpea seeds produced a negative effect on the performance of the birds, and an increment in the relative weights and lengths of the digestive organs. In addition, the incorporation of kabuli chickpea produced a reduction of protein and starch digestibilities, alpha-amylase and trypsin activities, and AMEn of food compared with the birds given the control diet. Autoclaved treatment of desi chickpea improved the performance of the birds.

Animals↗

Treatment of adult Still's disease with dexamethasone, an alternative to prednisolone.

We successfully treated three cases of adult Still's disease (ASD) with dexamethasone. High dose prednisolone, which was initially used to treat these patients, failed to remit the disease in all cases. Although they were resistant to prednisolone, all these patients had remarkable improvements in clinical and laboratory findings after switching to an equivalent dose of dexamethasone. We propose using dexamethasone as an alternative for treating ASD before adding immunosuppressants or disease modifying anti-rheumatic drugs (DMARD), when prednisolone therapy does not suppress disease activity sufficiently.

Adolescent↗

Effect of disparities in birth weight on differences in postnatal growth of monozygotic and dizygotic twins.

Influence of intrapair differences in birth weight (IDBW) on the patterns of postnatal growth of MZ and DZ twins from middle/late childhood to adolescence were studied in 49 MZ, 40 DZ male and 40 MZ, 35 DZ female pairs coming from the Wrocław Longitudinal Twins Study. Intrapair differences in the patterns in postnatal growth were expressed in several indices: average differences in standardized values (ASD Height, ASD Weight); absolute average differences in standardized values (ABSD Height, ABSD Weight); average Euclidean distances coefficient (EUCD Height, EUCD Weight); coefficient of shape differences (SHC Height, SHC Weight); measure of deviation (MD Height, MD Weight) and correlation coefficient for the standardized attained values (CORC Height, CORC Weight). Relationships between IDBW and indices were based on the means of Spearman Rank Order Correlation. Additionally for 40 MZ, 35 DZ male and 25 MZ, 18 DZ female pairs, the relationships between IDBW and intrapair differences in biological parameters derived from Preece Baines model 1, describing differences in time (DT1), height (DH1), velocity (DV1) at the beginning of the adolescent growth spurt, differences in time (DT2), height (DH2), velocity (DV2) at peak height velocity and differences in adult height (DAH) were examined. The results showed that only in MZ girls did dissimilarity in birth weights significantly impair the subsequent growth in stature. Furthermore, the results revealed that birth weight influences the parameter describing adult stature in MZ girls. It is concluded that the lack of relationship in DZ twins is due to their unique genotype, which strongly determines the postnatal growth. Three possible interpretations are given as explanations of the results obtained in this study: male excess neonates mortality, 'third factor' and programmed of growth in utero.

Adolescent↗

Analysis and study of the variation of splitting in the second heartbeat sound of wavelet transform.

The second heart sound, S2, consists of two acoustic components, A2 and P2. The former is due to the closure of the aortic valve and the latter is due to the closure of the pulmonary valve. The aortic valve usually closes before the pulmonary valve, introducing a time delay known as the 'split'. A technique based on discrete wavelet transform (DWT) and continuous wavelet transform (CWT) is developed in this paper to measure the split. To quantify splitting, two components in S2 (i.e. A2 and P2) are identified, and the delay between the two components can be estimated. One normal case and three pathological cases (mitral stenosis, pulmonary stenosis and atrial septal defect) are considered in this study. The split is measured for each S2 sound of the considered signals. The split normally varies in duration over the cardiac cycle. In certain pathologies such as ASD (atrial septal defect) or PS (pulmonary stenosis), the split becomes fixed over the cardiac cycle. The main part of this paper consists of the identification and measurement of the S2 split. The study confirms the notion of 'variable splitting' for normal phonocardiogram and 'fixed splitting' for ASD and PS cases. This paper relates also to the establishment of statistical parameters to make a distinction between normal and pathological cases of phonocardiogram signals.

Aortic Valve↗

Late postoperative respiratory function in adults after surgical correction of atrial septal defects. Analysis of respiratory dysfunction patterns.

Respiratory function after repair of atrial septal defect (ASD) was analysed in 44 adults (> 40 years), 21 of whom had preoperative respiratory dysfunction, 14 of restrictive type, defined as % vital capacity (% VC) less than 80% of predicted value, 3 with an obstructive pattern, defined as % forced expiratory volume/1 s (% FEV1) less than 70% of predicted value, and 4 patients with a mixed pattern. Increased % VC was found postoperatively in all 14 patients with restrictive respiratory dysfunction, with normal values in 8 out of the 14. Although the three patients with obstructive, and the four with mixed-pattern respiratory dysfunction improved preoperatively in % VC or % FEV1, or both, none had normalized values. We conclude that preoperative restrictive respiratory dysfunction in ASD patients frequently normalizes postoperatively, but not dysfunction of obstructive or mixed restrictive-obstructive type.

Adult↗

Fatal pulmonary embolism after atrial septal defect closure in a paediatric patient.

A four-year-old girl died of massive acute bilateral pulmonary embolism 11 days after direct closure of a secundum atrial septal defect (ASD II), despite postoperative anticoagulation until the patient was ambulatory. An autopsy showed thrombotic deposits on the suture line of the ASD closure, bilateral 90% occlusion of the pulmonary arteries, and haemorrhagic ulcerative ischaemic colitis of the descending colon and the sigmoid.

Anticoagulants↗

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: a prospective study of 50 patients.

BACKGROUND: Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective. METHOD: We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27-72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists. RESULTS: A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery. INTERPRETATION: ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.

Activities of Daily Living↗

STUDIES ON ARTIFICIAL ANTIGENS. II. THE ANTIGENICITY IN GUINEA PIGS OF ARSANILIC ACID CONJUGATES OF COPOLYMERS OF D- OR L-ALPHA-AMINO ACIDS.

An effort was made to immunize guinea pigs with arsanilic acid conjugates of copolymers of D- and L-alpha-amino acids; ASD-GAT and ASL-GAT. An immune response was observed only in the case of ASL-GAT. Antibodies specific for the arsanilic acid hapten were produced which could also react with ASD-GAT or ASGPA. These findings indicate that the proper metabolism of the antigen may be essential to the induction of the immune response.

Alanine↗

Risperidone in preschool children with autistic spectrum disorders: an investigation of safety and efficacy.

INTRODUCTION: Early intervention in autism spectrum disorders (ASDs) appears promising and may represent a window of opportunity for more effective treatment. Whereas the safety and efficacy of risperidone have been established for children aged 5 and older, they has not been adequately tested in preschool children. METHODS: A randomized placebo-controlled study of risperidone in preschool children was conducted in a sample of young children, most of whom were also undergoing intensive behavioral treatment. RESULTS: Preschool children tolerated low-dose risperidone well with no serious adverse effects observed over a 6-month treatment period. Weight gain and hypersalivation were the most common side effects reported, and hyperprolactinemia without lactation or related signs was observed. Significant differences between groups found at baseline complicated the analyses; however, controlling for some of these differences revealed that preschoolers on risperidone demonstrated greater improvements in autism severity. The change in autism severity scores from baseline to 6-month follow up for the risperidone group was 8% compared to 3% for the placebo group. Notably, both groups significantly improved over the 6-month treatment period. CONCLUSIONS: Study findings suggest that risperidone is well tolerated in preschoolers over a 6-month period, but that only minimally greater improvement in target symptoms was evident in the risperidone group, possibly due to the differences between groups at baseline or due to the small sample size. Although these findings are not sufficient to direct treatment, they suggest that larger-scale, double-blind, placebo-controlled investigations of risperidone in preschoolers with ASDs should now be conducted.

Antipsychotic Agents↗

Simulating social interaction to address deficits of autistic spectrum disorder in children.

Autistic spectrum disorder (ASD) is diagnosed on the basis of impairment in reciprocal social interaction and language, and rigidity of behavior. This brief paper describes the development of an experimental intervention for preschool children newly diagnosed with ASD. The rationale for this intervention is the hypothesis that failure to attend to social cues in very early life, of itself, may bear a large share of responsibility for core social and communicative deficits. The intervention, therefore, uses eye-tracking to monitor and trigger rewards for attention to facial expression and direction of gaze.

Autistic Disorder↗

A morphologic and cytochemical study of acute myelomonocytic leukemia with abnormal marrow eosinophils associated with inv(16)(p13q22).

Nineteen patients with acute nonlymphocytic leukemia were found to have a pericentric inversion of chromosome 16. All were classified as having acute myelomonocytic leukemia (M4) according to French-American-British Cooperative Group (FAB) criteria. Consistent abnormalities of marrow eosinophils were present. In 15 of the 19 patients, the number of eosinophils was increased. Morphologic abnormalities of eosinophils were present in all patients, the most striking being the presence of large basophilic staining granules in 18 of the 19 patients. In most cases we also found a population of cells with morphologic features of both eosinophils and monocytes. Eosinophils showed atypical cytochemical reactions with PAS in ten of ten cases studied, with naphthol ASD Chloroacetate in ten of ten cases, and with combined naphthol ASD Chloroacetate esterase- chlorazol fast pink in seven of nine cases tested. The presence of inv(16) defines a distinct subset of ANLL with consistent morphologic and cytochemical features.

Adolescent↗

Characterisation of normal human myocardium by means of morphometric analysis.

A morphometric analysis of ventricular myofibres, in specimens taken at necropsy from ten normal hearts, was performed to determine the distribution of fibre and nuclear diameters and their dependence on sampling position within the heart (group a). To assess the significance of the findings, two control groups of specimens were subjected to the same analysis: b) specimens from the hearts of four patients who had died of African cardiomyopathy; c) biopsies taken from the left ventricles of two hearts undergoing surgical repair of atrial septal defects (ASD), in which the myocardium is considered normal. Although mean values for the left ventricle were 13% greater on average than those for the right, a linear correlation, independent of sampling position, was found between nuclear and fibre diameter. Mean fibre and nuclear diameters for specimens from the normal and ASD control groups followed the same correlation as for individual normal fibres, whereas there was a significant deviation in the case of the cardiomyopathy specimens. The relationship between nuclear and fibre diameters was found to distinguish between normal and pathological specimens more clearly than the mean values of either dimension considered separately. It is suggested that this relationship is a more sensitive criterion of ventricular fibre normality or pathology than the parameters used in previous studies of this nature.

Adolescent↗

Cardiac complications relating to pregnancy and recurrence of disease in the offspring of women with atrioventricular septal defects.

AIMS: In most pregnancy reports, atrioventricular septal defects (AVSD) are not differentiated from more simple septal defects, thus underestimating the risks of pregnancy. To investigate the magnitude and determinants of risk during pregnancy in female patients with balanced AVSD. METHODS AND RESULTS: Using a nation-wide registry (CONCOR), 79 female patients with balanced/isolated AVSD were identified. A total of 29 patients had 62 pregnancies, including 12 miscarriages (19%) and two elective abortions. Detailed recordings of each completed (>20 weeks gestation) pregnancy (n=48, 26 women) were obtained. Cardiovascular events complicated almost 40% of the completed pregnancies. In particular, post-partum persistence of pregnancy-related New York Heart Association (NYHA) class deterioration [23% mainly patients with residual atrial septal defects (ASD)] and deterioration of pre-existing left AV-valvular regurgitation (17%) were frequently recorded. Additional cardiac complications were arrhythmias (19%) and symptomatic heart failure (2%). Congenital heart disease (CHD) recurred in six children (12%): AVSD (n=4, three with left-sided hypoplasia), patent ductus arteriosus (n=1), and ASD (n=1). Three children died including two children with left-sided hypoplasia. CONCLUSION: Pregnancy is not always well tolerated in women with AVSD, predominantly due to NYHA class deterioration and worsening of pre-existing AV-valvular regurgitation. Offspring mortality is high (6.3%), primarily due to recurrence of complex CHD.

Adult↗

Sexual development genes of Neurospora crassa.

The filamentous fungus Neurospora crassa undergoes a complex program of sexual development to form a fruiting body composed of several kinds of specialized tissue. Subtractive hybridization was used to isolate genes that are expressed preferentially during this sexual phase. Many such sexual development (sdv) genes were identified in a cosmid library of Neurospora genomic DNA. Fourteen of the sdv genes were subcloned, and their expression in mutant strains and under crossing and vegetative growth conditions was examined. All of the regulated transcripts were less abundant (and in many cases not detectable) in strains grown under vegetative (high nitrogen) conditions, suggesting that nitrogen starvation is required for their synthesis. The expression of most of the sdv genes also required a functional A mating type product, even under crossing growth conditions, suggesting that this product functions as a master control in sexual development. To determine if the products of the sdv genes play essential roles in the sexual cycle, a reverse-genetic approach (based on RIP (repeat-induced point mutation)-mediated gene disruptions) was used to create mutations in the genes. A mutant strain (asd-1) with a recessive crossing defect (apparently caused by the RIP process) was isolated; in this strain, early development is normal and may asci are formed, but ascospores are never delineated. A second recessive mutant strain (asd-2) was apparently created by ectopic integration of the transforming DNA into a gene required for the sexual process; in this strain the sexual process was blocked at an early stage, and the ascogeneous tissue underwent little development.

Cell Differentiation↗

Lipopolysaccharide and peptidoglycan share binding sites on human peripheral blood monocytes.

p73, a binding site for lipopolysaccharide (LPS) on human peripheral blood monocytes was identified using the radiolabeled photoaffinity cross-linker sulfosuccinimidyl 2-(p-azidosalicylamido)ethyl-1,3'-dithiopropionate (SASD). The 125I-labeled conjugate of SASD and LPS (125I-labeled ASD-LPS) was bound to monocytes and UV cross-linked, and the cellular extracts were analyzed with two-dimensional SDS-PAGE and autoradiography. In addition to the major binding site on human monocytes at 73 kDa, isoelectric point 5.95, there were multiple minor binding sites that recognized both smooth and rough LPS. Binding of 125I-labeled ASD-LPS to monocytes is concentration dependent, decreased in the absence of calcium and magnesium, and inhibited by either excess LPS or the low-molecular-weight soluble isolate of bacterial cell wall peptidoglycan (sPGN). However, sPGN only minimally stimulates tumor necrosis factor (TNF) secretion by human peripheral blood mononuclear cells. In contrast, the relatively insoluble high-molecular-weight peptidoglycan significantly stimulates TNF secretion.

Azides↗

Influence of genetics and diet on the development of diabetes in Yucatan miniature swine.

The intent of this study was to examine the effect of a diet nutritionally similar to that consumed by most Americans on Yucatan miniature swine that have been bred for enhanced and impaired glucose tolerance. Seventeen Yucatan miniature pigs from the glucose-intolerant line (low K) and 17 from the glucose-tolerant line (high K) were selected. The oral glucose tolerance (OGT) of both groups of pigs was determined. After the OGT test (OGTT), 13 low K pigs and 12 high K pigs were placed on the American Swine Diet (ASD). The remaining animals were left on the regular swine diet. After 5 months, the pigs were again tested with an OGTT. Mean plasma glucose levels observed during the OGTT showed significant differences between the low K and high K groups on ASD at all time intervals from 60 to 150 minutes postdosing. Serum insulin levels in the high K group were significantLy elevated over those in the low K group during the OGTT at 10, 20, and 30 minutes prediet, and at 10 minutes after 5 months on diet. Both low and high K groups showed a dietary effect with aN elevated plasma glucose response to an OGTT, although the mean increase was not significant in the high K group. In the low K group, plasma glucose levels were significantly elevated (P less than 0.05) over prediet values at 20, 30, 60, 90 and 120 minutes. In addition, 7 out of the 10 low K pigs tested at 5 months developed insulin resistance, and noninsulin-dependent diabetes.

Animals↗