bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic Intracardiac Thrombi and Primary Antiphospholipid Syndrome
Authors: Granel B. , Garcia E. , Serratrice J. , Christides C. , Swiader L. , Pache X. , Caus T. , Disdier P. , Weiller P.J.
Published: April 2003

Intracardiac thrombi have rarely been reported in patients with the antiphospholipid syndrome. We describe a new case revealed by systematic echocardiography in an asymptomatic woman who consulted for mild thrombocytopenia. Our case is characterized by a past history of migraine, fetal loss and psychiatric disturbances and by a high level of antiphospholipid antibodies (anticardiolipin, anti-β2-glycoprotein I and lupus anticoagulant). Echography, in the absence of any cardiovascular symptom, showed bulky right intra-atrial thrombi requiring surgical excision. Histopathological analysis revealed the fibrino-cruoric nature of the lesion without myxoma. This case shows that, when faced with a mild thrombocytopenia associated with antiphospholipid antibodies, echocardiography may reveal a life-threatening and completely asymptomatic intracardiac thrombosis.
Is It Safe to Administer Thrombolytic Therapy to Myocardial Infarction Patients Soon after Laparoscopic Cholecystectomy?
Authors: Kobal Sergio , Orlov Genadi , Gilutz Harel , Cafri Carlos , Battler Alexander , Leor Jonathan
Published: April 2003

Thrombolytic therapy is usually contraindicated after abdominal surgery because of the risk of bleeding. We report a case of a 73-year-old woman who was admitted because of anterior wall acute myocardial infarction (AMI) two weeks after laparoscopic cholecystectomy. She was treated with streptokinase, aspirin and heparin and subsequently developed a hematoma at the site of the removed gallbladder. Our observation suggests that thrombolytic therapy for anterior AMI, two weeks after laparoscopic cholecystectomy, should be considered as a relative contraindication and an optional treatment in this life-threatening situation.
Scintigraphic Predictor of Left Ventricular Size after Acute Myocardial Infarction
Authors: Abe Yoshiteru , Sugiura Tetsuro , Suga Yutaka , Takehana Kazuya , Kamihata Hiroshi , Karakawa Masahiro , Inada Mitsuo , Iwasaka Toshiji
Published: April 2003

The aim of this study was to evaluate the relation between thallium-201 scintigraphic indices and left ventricular size after acute myocardial infarction. Forty-seven patients with acute myocardial infarction underwent rest-redistribution thallium-201 scintigraphy at 2 weeks and left ventriculography at 4 weeks, after the onset of myocardial infarction. Percent (%) fixed defect, %redistribution and %reverse redistribution, calculated as a percentage of whole left ventricular area, were quantified with computer-generated unfolded map method of the myocardial radioactivity. Despite no significant difference in peak plasma creatine phosphokinase between the two groups, patients with anterior myocardial infarction (28 patients) had larger %fixed defect (p < 0.01), which was associated with higher end-diastolic pressure (p < 0.05) and larger end-diastolic volume index (p < 0.01) than those with inferior myocardial infarction (19 patients). End-diastolic volume index was not related to %redistribution and %reverse redistribution, but there was a good relation between end-diastolic volume index and %fixed defect in anterior (r = 0.79, p < 0.001) and in inferior (r = 0.73, p < 0.001) myocardial infarction. However, left ventricular end-diastolic volume index in anterior myocardial infarction was larger than that of inferior myocardial infarction at any given %fixed defect. Thus, site as well as size of fixed defect at 2 weeks after the onset of acute myocardial infarction was related to left ventricular end-diastolic volume at chronic phase.
Endothelium-Dependent Vasodilator Response Is Augmented in Peripheral Resistance Vessels of Patients with Vasospastic Angina
Authors: Nakamura Motoyuki , Yoshida Hiroaki , Arakawa Naoshi , Hiramori Katsuhiko
Published: April 2003

Although the mechanism underlying coronary conduit artery spasm in vasospastic angina (VAP) remains unknown, coronary endothelial dysfunction has been suggested as playing an important role. However, it remains unknown whether this endothelium-mediated abnormal vasomotion is uniformly evident irrespective of site of vascular bed or vessel size. Plethysmographic studies were carried out to measure changes in forearm resistance vessel blood flow (FBF) induced by acetylcholine (Ach), sodium nitroprusside, and 10-min occlusion-induced reactive hyperemia in 12 patients with VAP, 14 patients with atherosclerotic (>75% fixed stenosis) coronary artery disease (CAD), and 16 healthy controls. FBF responses induced by the endothelium-dependent vasodilator Ach were significantly augmented in patients with VAP compared to controls, whereas this type of FBF response in patients with CAD was significantly blunted (at the maximum dose: VAP, 24.1 ± 3.0; controls, 17.2 ± 1.9; CAD, 12.8 ± 1.9 ml/min per 100 ml; p < 0.01). However, there were no significant differences in FBF responses during infusion of sodium nitroprusside among the three subject groups. Reactive hyperemic FBF which represents maximum vasodilatory capacity did not differ among the three. To assess the role of nitric oxide in the augmented endothelium-dependent response in VAP, Ach-induced FBF response was determined before and after administration of the nitric oxide synthase inhibitor NG-monomethyl-L-arginine in another VAP group (n = 7). After nitric oxide synthase inhibition, the peak FBF response induced by Ach decreased from 23.3 ± 3.2 to 14.1 ± 1.6 ml/min per 100 ml (p < 0.05). In conclusion, the above data suggest that endothelium-dependent vasomotor response to Ach in limb resistance vessels is augmented in patients with vasospastic angina. It seems unlikely that endothelial function is consistently depressed in any area of the vascular bed in this disorder.
ACE Inhibitors Suppress Ischemia-Induced Arrhythmias by Reducing the Spatial Dispersion of Ventricular Repolarization
Authors: Wang Lexin
Published: April 2003

The effect of angiotensin-converting enzyme (ACE) inhibitors on ischemia-induced spatial dispersion of ventricular repolarization was investigated in 12 pentobarbitone-anesthetized sheep. The obtuse marginal coronary artery was occluded in the pretreated animals (enalapril maleate, 0.4 mg/kg, i.v., n = 6) and controls (normal saline, i.v., n = 6). The activation-recovery intervals were determined from the unipolar ECGs acquired from the ischemic region. There was a significant increase in the pooled activation-recovery interval dispersion in both groups at 30 min of coronary occlusion (p < 0.01), however, the increase in the treatment group was smaller than that of the controls (15.9 ± 9.7 vs. 43.6 ± 19.9 ms, p < 0.01). Ventricular ectopic beats were observed in the 6 controls and in only 1 pretreated animal. Conclusions: ACE inhibitors suppress the spatial dispersion of ventricular repolarization and this may be attributed to, at least in part, its antiarrhythmic effect.
The Prognostic Implications of Negative T Waves in the Leads with ST Segment Elevation on Admission in Acute Myocardial Infarction
Authors: Herz Izhak , Birnbaum Yochai , Zlotikamien Bruria , Strasberg Boris , Sclarovsky Samuel , Chetrit Angela , Wagner Galen S. , Barbash Gabriel I.
Published: April 2003

We assessed the prognostic significance of negative T waves on admission in leads with ST elevation in 2,853 patients with acute myocardial infarction treated with thrombolysis. Patients were classified into 2 groups based on the presence of negative (T–) or positive (T+) T waves in the leads with ST elevation on admission. T+ and T– waves on admission were detected in 2,601 (91%) and 252 (9%) patients, respectively. T– waves were observed in 6.7 and 9.6% of patients admitted ≤2 and 2–6 h after onset of infarction, respectively. There was a difference in prognosis between patients admitted ≤2 and >2 h after symptom onset. T– patients admitted ≤2 h after onset had no hospital mortality (0/52 patients), as compared to a 5.0% mortality rate in T+ patients (36/726 patients; p = 0.19). T– patients treated >2 h after onset suffered higher mortality (20/196 patients; 10.2%) than T+ patients (100/1,836 patients; 5.4%; p = 0.01). Multivariate analysis of the data on patients treated >2 h after onset demonstrated T– waves to be associated with mortality (OR 1.86; 95% CI 1.07–3.25; p = 0.017). T– waves in leads with ST elevation upon admission are associated with adverse prognosis in patients presenting >2 h after symptom onset, whereas in patients presenting ≤2 h after first symptoms, T– waves may be associated with better prognosis.
On the Interrelation of Exercise Blood Pressure and Heart Rate
Authors: Jager Ernst H.
Published: April 2003

Formulas are presented which establish a meaningful interrelationship between blood pressure and heart rate during exericse, describing both of them as functions of one variable and a set of common parameters, namely, a quantity interpreted as a no-load effort, and the rest values of heart rate and of systolic and diastolic blood pressure. The formulas can be used, in the place of graphic representations, to define the ranges of normal blood pressure and heart rate quite generally, or for specific populations. They can also be used to define the degree of hypertension of individuals or groups of individuals. The specific formulas and the ranges of normal values presented here, apply to men aged 20–50 years; they may have to be modified for other age groups.
Early Time Course of Heart Rate Variability after Thrombolytic and Delayed Interventional Therapy for Acute Myocardial Infarction
Authors: Lotze Ulrich , Özbek Cem , Gerk Ulrich , Kaufmann Holger , Heisel Armin , Bay Wolfgang , Figulla Hans Reiner
Published: April 2003

In 89 of 97 consecutive patients with myocardial infarction (MI) undergoing thrombolysis and delayed early coronary angiography with PTCA, if indicated, heart rate variability (HRV) in time domain was evaluable 40 ± 11 h after the onset of chest pain using 24-hour ECG recordings. Patients with anterior MI (n = 40) had lower values for HRV and left ventricular ejection fraction (p < 0.05). The mean of all 5-min standard deviations of RR intervals (SDNNi) and the root-mean-square difference of successive RR intervals (rMSSD) decreased significantly (p < 0.001 each), whereas the standard deviation of all normal RR intervals and the percentage of absolute differences between successive RR intervals only showed a tendency to lower values 4 weeks after MI (p = 0.20 and 0.08, respectively). The decreases in SDNNi and rMSSD were more evident in inferior than in anterior MI. The time course of HRV following MI was similar in patients with and without PTCA. These results indicate an initial vagal hyperactivity in inferior MI, which is quickly predominated by sympathetic activation and a prolonged recovery of the cardiac autonomic imbalance after MI despite a successful combined reperfusion therapy.
Cold Pressure Test Producing Coronary Spasm, Coronary Thrombosis and Myocardial Infarction in a Patient with IgM Antibodies against Coxsackie B Virus
Authors: Haberbosch Werner , Roerich Norbert , Neuzner Joerg
Published: April 2003

Several lines of evidence have shown that viral infections are capable of causing coronary spasm and precipitating or mimicking clinical myocardial infarction. Here we report the case of a 41-year-old woman with recurrent angina who was admitted to our hospital because of ventricular tachycardia. Laboratory examination revealed positive IgM titers against Coxsackie B virus. Coronary angiography showed normal coronary arteries, but following a cold pressure test severe spasm of all coronaries with thrombotic occlusion of the second marginal branch of the circumflex artery occurred. We conclude that coronary spasm should be clinically suspected in patients with chest pain and ventricular arrhythmia in combination with IgM antibodies against Coxsackie B virus. In these patients, a cold pressure test should be avoided, and antithrombotic and antispastic therapy is recommended.
Aetiology of Heart Failure as Seen from a National Cardiac Referral Centre in Africa
Authors: Amoah A.G.B. , Kallen C.
Published: April 2003

572 consecutive patients with heart failure referred to the National Cardiothoracic Centre, Accra, Ghana, over a 4-year period were evaluated for the aetiology of heart failure using two-dimensional Doppler echocardiography with colour flow. The mean age of the subjects with heart failure was 42.3 ± 0.9 years. The male to female ratio was 1.2:1.0. Combined heart failure was seen in 50.5% of subjects. Peak incidence of heart failure occurred in the 5th decade. The main causes of heart failure were hypertension (21.3%; n = 122), rheumatic heart disease (20.1%; n = 115) and cardiomyopathy (16.8%; n = 96). Congenital heart disease and coronary artery disease accounted for 9.8 and 10% of cases, respectively. The commonest rheumatic valvular lesion was mitral regurgitation (78%). Dilated cardiomyopathy was the commonest form of idiopathic cardiomyopathy (67.7%; n = 65). Endomyocardial fibrosis and hypertrophic cardiomyopathy accounted for 22.9% (n = 22) and 9.4% (n = 9), respectively, of cardiomyopathies.
Prognostic Role of On-Line Vectorcardiography as Regards Repeat Revascularization after Successful Coronary Angioplasty
Authors: Jensen Jens , Eriksson Sven V. , Lindvall Bo , Lundin Peter , Sylvén Christer
Published: April 2003

This study evaluated the prognostic significance of continuous on-line vectorcardiography (VCG) during elective coronary angioplasty (percutaneous transluminal coronary angioplasty, PTCA). Patients (n = 192, mean age 58 ± 10), treated with elective and initially successful PTCA, were included. VCG monitoring was started before start of the PTCA procedure and was carried out during the entire procedure. ST vector magnitude (ST-VM) was monitored. A 6-month follow-up was obtained. Main outcome measures were the frequency of cardiac events and revascularization during follow-up. During follow-up, 1 patient died, 6 suffered a nonfatal myocardial infarction and 50 were revascularized. Angiography revealed restenosis in 88% of the patients who had a revascularization. In the total patient group, the VCG predictor of revascularization was the total ischemic time of all ST-VM episodes (p = 0.05). Clinical predictors of revascularization were diabetes mellitus (p < 0.01), a more severe type of lesion (type B; p < 0.01), percent post-PTCA stenosis (p < 0.05), nominal balloon size (p < 0.01), maximum balloon pressure (p < 0.05) and no stent implanted (p < 0.001). In a multivariate analysis all the above significant univariate variables of revascularization were entered. Total ischemic time of ST-VM (p < 0.01) was the best variable giving independent prognostic information. In the nonstent group, total ischemic time of ST-VM (p < 0.01) was the only independent predictor of a further revascularization. In conclusion, VCG monitoring during elective PTCA gives on-line information that identifies patients at an increased risk of a revascularization during 6 months after the initial procedure.
Utility of Positron Emission Tomography in Predicting Improved Left Ventricular Ejection Fraction after Coronary Artery Bypass Grafting among Patients with Ischemic Cardiomyopathy
Authors: McFalls Edward O. , Baldwin Douglas , Kuskowski Michael , Liow Jeih-San , Chesler Elliot , Ward Herbert B.
Published: April 2003

The objective of this study was to determine whether preoperative estimates of regional myocardial uptake of 18-F-fluorodeoxyglucose (FDG) could predict postoperative improvement in ejection fraction in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy. 20 consecutive patients [left ventricular ejection fraction (LVEF) ≤27%] were referred for preoperative positron emission tomography (PET) to measure regional myocardial FDG uptake and were deemed candidates for CABG. All individuals had technically adequate vessels and significant viability. The left anterior descending (LAD) coronary artery was severely diseased in all patients. Because of the importance of the anterior wall to overall ventricular performance, FDG uptake was semiquantitated in those regions and related to postoperative LVEF. 17 patients underwent CABG with an uneventful recovery. LVEF increased from 22 ± 4 to 26 ± 7% 2 weeks postsurgery (p < 0.05), with ≥5% change noted in 7 patients (group 1) and <5% noted in 10 patients (group 2). No preoperative or perioperative clinical variable could predict those with improved ventricular function. The relative amount of FDG uptake in the anterior wall was higher in group 1 compared with group 2 (93 ± 9 vs. 81 ± 13%; p < 0.05) and correlated with the change in LVEF post-CABG (r = 0.50; p < 0.05). >88% of FDG uptake in the LAD region had a positive predictive accuracy of 67% and negative predictive accuracy of 88% for improved LVEF postbypass. Late follow-up estimates of LVEF (median of 10 months) showed that early changes in function were sustained. In summary, among patients with severe coronary artery disease and depressed LVEF, ventricular function may improve early postrevascularization. PET estimates of relative FDG uptake in the anterior wall help predict those individuals who are likely to have the greatest increment in LVEF.
Extensive Thrombus Formation in the Right Ventricle due to a Rare Combination of Arrhythmogenic Right Ventricular Cardiomyopathy and Heterozygous Prothrombin Gene Mutation G20210 A
Authors: Attenhofer Jost Christine H. , Bombeli Thomas , Schrimpf Carsten , Oechslin Erwin , Kiowski Wolfgang , Jenni Rolf
Published: April 2003

Arrhythmogenic right ventricular cardiomyopathy is a rare heart muscle disease characterized by right and often left ventricular myocardial atrophy and fibrofatty replacement. Heart failure, arrhythmias and sudden death are characteristic complications. We observed a female in whom arrhythmogenic right ventricular cardiomyopathy was diagnosed due to presyncopes and dyspnea on exertion. A left ventricular thrombus was found echocardiographically, which disappeared with oral anticoagulation. Subsequently, however, extensive thrombus formation in the dilated akinetic right ventricle occurred which was resistant to combined treatment with heparin and oral anticoagulation. Thrombophilia screening showed a mutant prothrombin 20210A allele which is an inherited coagulopathy associated with increased plasma levels of prothrombin and increased risks of mainly venous thrombosis. The patient developed endstage biventricular heart failure and underwent heart transplantation within 3 months after thrombus formation in the right ventricle was diagnosed. In the explanted heart, the thrombus in the right ventricle was impressively large and calcified. In patients with unusual thrombus formation in the heart, coagulopathy may be associated and should be excluded.
Impact of Blood Pressure Control on Prevalence of Left Ventricular Hypertrophy in Treated Hypertensive Patients
Authors: Cuspidi C. , Lonati L. , Sampieri L. , Macca G. , Michev I. , Salerno M. , Fusi V. , Leonetti G. , Zanchetti A.
Published: April 2003

Aim: The aim of the present study was to evaluate (1) the prevalence and patterns of left ventricular hypertrophy (LVH) and (2) the impact of blood pressure (BP) control, assessed by clinical and 24-hour ambulatory BP monitoring (ABPM) criteria on the persistence of LVH in a representative sample of treated patients attending our Hypertension Clinic. Methods: One hundred consecutive essential hypertensives (61 m/39 f, age 56± 9 years) regularly followed up by the same medical team (average period 52 months, 12–156 months) were included in the study and underwent 24-hour ABPM and complete echocardiographic examination. Results: Twenty-eight of the 100 patients were found to have LVH [left ventricular mass index (LVMI) >125 g/m2 in men and >110 g/m2 in women]; LVH was eccentric in 20 patients and concentric in the remaining 8. LVMI did not correlate with clinical BP values but only with ABPM values (mean 24 h systolic r = 0.34, p <0.01; diastolic r = 0.37, p <0.01). The prevalence of LVH in patients controlled according to clinical BP criteria (n = 43, BP <140/90 mm Hg) was 19%, in patients controlled according to ABPM criteria (n = 30, BP during daytime <132/85 mm Hg) 17%, and in those controlled with both criteria (n = 16) 6% (p <0.01). Conclusions: The results of this study suggest that the eccentric type of LVH is the prevalent pattern in chronically treated patients. The persistence of LVH is significantly dependent on BP levels achieved during treatment; indeed the prevalence of LVH is very low in patients with an optimal BP control, whereas it is elevated (37%) in uncontrolled patients.
Circulating Interleukin-6 and Interleukin-6 Receptors in Patients with Acute and Recent Myocardial Infarction
Authors: Kanda Tsugiyasu , Inoue Masahiro , Kotajima Nobuo , Fujimaki Shuku , Hoshino Yoichi , Kurabayashi Masahiko , Kobayashi Isao , Tamura Jun’ichi
Published: April 2003

Interleukin-6 (IL-6), a proinflammatory cytokine, plays a key role in the pathogenesis of coronary artery disease (CAD). We investigated circulating IL-6 and its receptors in patients with CAD. We evaluated 39 Japanese patients with CAD (30 males and 9 females aged 36–79 years), measuring their plasma levels of IL-6 and IL-6 receptors α and β (IL-6Rα, IL-6Rβ). Circulating levels of IL-6, IL-6Rα and IL-6Rβ were measured by an enzyme-linked immunosorbent assay. Blood was sampled immediately after admission and again after 1, 2, 3, 6 and 9 h, then every 12 h for 5 days. Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) were measured on day 3 after symptom onset. Plasma levels of IL-6 and IL-6Rs were significantly increased in 28 patients with acute myocardial infarction (AMI) compared with 15 normal controls. However, neither IL-6 nor IL-6Rs showed an increase in 6 patients with angina pectoris. We observed two peaks for circulating IL-6 in AMI, the first of which showed a significant correlation with ANP as well as BNP. These results may help to explain why the amount of IL-6 produced is closely related to the severity of myocardial dysfunction in patients with CAD.
Infiltrative Nonamyloidotic Monoclonal Immunoglobulin Light Chain Cardiomyopathy: An Underappreciated Manifestation of Plasma Cell Dyscrasias
Authors: Buxbaum Joel N. , Genega Elizabeth M. , Lazowski Piotr , Kumar Asok , Tunick Paul A. , Kronzon Itzhak , Gallo Gloria R.
Published: April 2003

Background: Infiltrative cardiomyopathies are characterized by diastolic dysfunction. In monoclonal plasma cell dyscrasias, organ compromise may be produced by tissue deposition of monoclonal immunoglobulins or their constituent peptides independently of the effects of unbridled plasma cell proliferation. The deposits may be fibrillar, as in light chain amyloid (AL) or nonfibrillar, as in light chain deposition disease (LCDD). AL disease of the heart is a restrictive cardiomyopathy. We hypothesized that, despite differences in physical properties, nonamyloidotic light chain deposition in the myocardium could produce similar clinical and physiological abnormalities. Methods: Cardiac tissue from five patients with LCDD and cardiac dysfunction was examined by immunohistochemical and electron microscopic techniques. Hospital charts, electrocardiograms, echocardiograms and cardiac catheterization results were reviewed. In two cases, the original echocardiograms were reanalyzed. Results: The five patients with nonamyloidotic light chain deposits in the myocardium had either mechanical or electrocardiographic abnormalities. In four with adequate clinical documentation, the diastolic dysfunction and conduction abnormalities were similar or identical to that described in cardiac AL disease. Conclusions: Although nonamyloidotic immunoglobulin light chain deposits in the myocardium differ in distribution and ultrastructural organization from the fibrillar deposits of AL disease, an analogous pattern of diastolic dysfunction and conduction disturbances results. The diagnosis should be considered in patients with a plasmacytic dyscrasia and restrictive cardiomyopathy in whom Congo red staining of endomyocardial biopsy tissue is negative. The diagnosis can be established by using the appropriate immunohistochemical and ultrastructural tissue examinations.
The Impact of Risk Factors for Atherosclerosis on the Vasomotor Effects of Inhibition of Nitric Oxide Synthesis in Patients with Normal Angiograms
Authors: Tentolouris Costas , Tousoulis Dimitris , Davies Graham , Stefanadis Christodoulos , Trikas Athanasios , Goumas George , Toutouzas Pavlos
Published: April 2003

We assessed the impact of systematic risk factors on the vasomotor effects of inhibition of nitric oxide synthesis. NG-monomethyl-L-arginine (LNMMA) was infused intracoronarily at 4, 8 and 16 μmol/min followed by intracoronary bolus administration of 250 μg nitroglycerin. Computerized angiography was used to assess the changes in the diameter of coronary segments. During the LNMMA infusions there was no significant difference in LNMMA response between smokers and non-smokers (–5.5 ± 0.8 and –6.6 ± 0.6%, respectively) or between hypertensives and normotensives (–6.4 ± 1.1 and –6.1 ± 0.6%, respectively), but the response was less in hypercholesterolaemic patients (–4.5 ± 0.7 vs. –8.0 ± 0.6%, p < 0.05). Thus, the reduced nitric oxide activity is related to hypercholesterolaemia but not to smoking and hypertension.
Formulas for Dynamic Exercise Heart Rate and Blood Pressure
Authors: Jager Ernst H.
Published: April 2003

Formulas are proposed for the ranges of normal heart rate and blood pressure during dynamic exercise. They apply to normotensive men and women approximately 20–50 years old. The numerical values of the parameters may have to be modified for other populations, partial populations or other age groups.
Fatal Dilated Cardiomyopathy Associated with a Mitochondrial DNA Deletion
Authors: Moslemi Ali-Reza , Selimovic Nedim , Bergh Claes-Håkan , Oldfors Anders
Published: April 2003

A 27-year-old man was admitted to hospital because of severe cardiac failure. Investigation revealed dilated cardiomyopathy with a left ventricular ejection fraction of 15–20%. During adolescence the patient had been investigated for growth retardation and he also had progressive external ophthalmoplegia. There had been no symptoms of cardiac disease until 2 weeks before admittance. An endomyocardial biopsy showed cardiomyocytes deficient in cytochrome c oxidase (COX) in a mosaic pattern. A skeletal muscle biopsy showed mitochondrial myopathy with COX-deficient ragged-red fibers. Molecular genetic analysis revealed a heteroplasmic, 3.8-kb, mitochondrial DNA (mtDNA) deletion in heart and muscle. PCR-based quantification of the proportion of mtDNA with deletion showed 47% mutated mtDNA in the myocardial biopsy and 68% in muscle. In spite of treatment, the condition deteriorated and the patient died 5 days after admittance. This case demonstrates that mtDNA deletions may occasionally be the cause of severe dilated cardiomyopathy, and that morphological and molecular genetic diagnosis may be obtained by endomyocardial biopsy.
In vitro and in vivo Antibacterial Activities of a New Carbapenem BO-2727 for Use in Obstetrics and Gynecology
Authors: Mikamo Hiroshige , Kawazoe Kyoko , Izumi Koji , Sato Yasumasa , Tamaya Teruhiko
Published: April 2003

The antibacterial activity of BO-2727 against 100 clinical isolates of Streptococcus agalactiae (20 strains), Escherichia coli (20 strains), Peptostreptococcus magnus (20 strains), Bacteroides fragilis (20 strains) and Prevotella bivia (20 strains) was compared with those of imipenem, panipenem, meropenem, biapenem and ceftazidime (CAZ). Minimal inhibitory concentrations (MICs) for 50% of tested strains (MIC50s) of BO-2727 against S. agalactiae, E. coli, P. magnus, B. fragilis and P. bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively. MIC90s of BO-2727 against S. agalactiae, E. coli, P. magnus, B. fragilis and P. bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively. The efficacy of BO-2727 was evaluated using a polymicrobial pyometra model (E. coli and B. fragilis) in rats. Both the inflammatory changes in the uterus, from the point of view of neutrophil accumulation, and the bacteriological response in the treated group were milder than those in either the nontreated group or the CAZ-treated group. These results indicate that BO-2727 may be useful for the treatment of polymicrobial infections in patients with pyometra.
Phagocytosis and Intracellular Killing of Rokitamycin-Exposed Staphylococci by Human Polymorphonuclear Leukocytes
Authors: Braga P.C. , Sala M.T. , Mancini L. , Dal Sasso M.
Published: April 2003

The exposure of bacteria to antibiotics at even sub-minimum inhibitory concentrations (sub-MICs) induces physicochemical and biochemical modifications that facilitate phagocytosis and intracellular killing by polymorphonuclear leukocytes (PMNs). These PMN functions were investigated by exposing Staphylococcus aureus strains to different sub-MICs (1/2 to 1/32 MIC) of rokitamycin (RKM). Although phagocytosis and the index of phagocytosis of the antibiotic-exposed staphylococci were not significantly modified with respect to controls, the percentage of killing significantly increased after exposure to 1/2 and 1/4 MIC by 31 and 22%, respectively. Taking into consideration the other aspect of a possible direct interaction between RKM and PMNs, it was observed that up to 10 µg/ml of RKM did not interfere with phagocytosis but significantly enhanced killing activity by up to 33%. This effect can be correlated with the high uptake of RKM by PMNs (cellular/extracellular ratio ≃30.5). The relevance of these in vitro observations to clinical situations remains to be further investigated.
Interaction between Levofloxacin and Vancomycin in Rats – Study of Serum and Organ Levels
Authors: Mori Hideki , Nakajima Toshihiro , Nakayama Atumu , Yamori Motoo , Izushi Fumio , Gomita Yutaka
Published: April 2003

The changes of pharmacokinetic parameters when levofloxacin (LVFX) and vancomycin (VCM) were administered concomitantly were studied in rats. There was an increase in the AUC and Tmax of LVFX with concomitant administration, but no effect on Cmax. There was also an increase in the AUC and T½ of VCM with concomitant administration, while Vd was reduced. Concomitant administration had no effect on the correlation between the serum and hepatic tissue concentrations of LVFX, but it markedly decreased the correlation between the serum and renal tissue concentrations of VCM. BUN was increased at 8 h after the administration of VCM. There have been reports that renal dysfunction can be caused by VCM, and our findings suggested that concomitant administration of LVFX and VCM must be performed with caution.
Effect of Magnesium Sulphate on Adriamycin-Induced Clastogenic and Biochemical Changes in Swiss Albino Mice
Authors: Al-Shabanah Othman A.
Published: April 2003

Magnesium sulphate (magnesium), an essential anti-oxidant macromineral, was evaluated for its effects on the clastogenic and biochemical changes induced by Adriamycin (ADM) in Swiss albino mice. Male mice were treated orally with different doses (125, 250 and 500 mg/kg body weight/day) of magnesium sulphate for 7 days. Some of these mice were injected intraperitoneally with ADM (8 mg/kg body weight). Multiple samplings (12, 24 and 48 h) were carried out after the last treatment in different experiments. The animals were sacrificed under ether anaesthesia. The concentrations of magnesium were determined in plasma and liver tissue. Femoral marrow cells were collected and screened for the frequency of micronuclei and the ratio of polychromatic erythrocytes to normochromatic erythrocytes. Furthermore the proteins, nucleic acids, malondialdehyde (MDA) and non-protein sulphydryl (NPSH) levels were estimated in hepatic cells. The magnesium sulphate treatment did not affect the magnesium concentrations in plasma and liver tissue. The treatment also failed to cause any significant clastogenic, cytotoxic and biochemical changes. Pretreatment with magnesium sulphate showed no alterations in plasma and hepatic tissue levels of magnesium. Nevertheless the pretreatment was found to inhibit the ADM-induced micronuclei without any alteration in its therapeutic efficacy. The proteins, DNA, RNA and MDA levels in the hepatic cells of these animals were increased and the NPSH concentrations were reduced. The anticlastogenic nature of magnesium sulphate appears to be related to its pretreatment which might have averted the free-radical-mediated pathogenesis induced by ADM.
Stenotrophomonas (Xanthomonas) maltophilia: In vitro Susceptibility to Selected Antimicrobial Drugs, Single and Combined, with and without Defibrinated Human Blood
Authors: Traub Walter H. , Leonhard Birgit , Bauer Dierk
Published: April 2003

Sixteen selected isolates of Stenotrophomonas maltophilia  varied in susceptibility to the combined phagocytic/serum bactericidal activity of fresh defibrinated human blood (65 vol%). Four representative isolates (X1, X11, X25, and X50), which differed in susceptibility to cefepime, ceftazidime, rifampin, and timentin, were subjected to checkerboard microtiter broth dilution tests involving combinations of cefepime plus timentin, ceftazidime plus ofloxacin, cotrimoxazole plus timentin, rifampin plus polymyxin B, and rifampin plus polymyxin B nonapeptide; all combinations yielded additive or synergistic effects against all four strains. Unexpectedly, the combination of cefepime plus timentin was bactericidally active against the two cefepime-resistant isolates. This finding was substantiated by blood/broth plus combined antimicrobial drug assays. Cefepime plus timentin effectively killed all four test strains. Ofloxacin combined with ceftazidime was bactericidally active against the test strains, including two isolates (X11, X50) with intermediate ofloxacin sensitivity. Cotrimoxazole plus timentin in blood, but not in broth, was bactericidal for the timentin-resistant isolate X25. As expected, various triple combinations of chemotherapeutic agents in blood and broth revealed polymyxin B plus rifampin, regardless of the third combination partner, to exert bactericidal activity against all test strains. Similarly, rifampin combined with ofloxacin and ceftazidime was bactericidally active in blood and broth. The observation that timentin combined with cefepime was effective against cefepime-resistant strains of S. maltophilia might prove of clinical relevance with regard to chemotherapy of nosocomial infections due to multiple-antibiotic resistant strains of this opportunistic pathogen.
Comparative in vitro Activity of Vancomycin and Other Antimicrobial Agents against Methicillin-Resistant Staphylococcus aureus and Enterococcus faecium in the Tohoku District of Japan
Authors: Lutfor Afzalunnessa Binte , Kikuchi Toru , Tokue Yutaka , Takahashi Hiroshi , Shoji Satoru , Fujimura Shigeru , Nukiwa Toshihiro , Watanabe Akira
Published: April 2003

Susceptibility patterns of methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium obtained from various hospitals of the Tohoku district were documented. MICs of 6 antimicrobial agents against a total of 480 strains (380 strains were MRSA and 100 were E. faecium) were estimated. All MRSAs were susceptible to vancomycin, teicoplanin and quinupristin/dalfopristin, but all of them were resistant to ampicillin and benzylpenicillin. None of the E. faecium strains were found to be resistant to vancomycin, teicoplanin and quinupristin/dalfopristin. Excluding these, almost all strains of E. faecium were resistant to the remaining drugs. These data suggest that despite the emergence of vancomycin resistance to E. faecium in Europe and in the United States, vancomycin, teicoplanin and quinupristin/dalfopristin will nevertheless provide effective bactericidal activity in the Tohoku area of Japan.
Effect of Cefamandole, Cefuroxime and Cefoxitin on Yeast Fecal Flora of Surgical Patients
Authors: Thomakos N. , Maraki S. , Liakakos T. , Macheras A. , Kanavaki S. , Marinis E. , Sehas M. , Margioris A.N. , Samonis G.
Published: April 2003

Aim of the present study was to evaluate the effect of cefamandole, cefuroxime and cefoxitin on the level of gastrointestinal (GI) colonization by Candida albicans in humans. Twenty-eight adult patients received one of these three cephalosporins for 10 days, as treatment of infection, and were studied prospectively. Quantitative stool cultures for yeasts were performed immediately before, at the end, and 1 week after discontinuation of treatment. All three antibiotics caused an increase of the yeast concentration in the fecal flora. The increase caused by cefoxitin was the highest (2.5 log10 CFU/g of stool). Our results suggest that the cephalosporins tested cause minor increases of the colonization of the GI tract by C. albicans.
Comparative Study on the Effectiveness of Antifungal Agents in Different Regimens against Vaginal Candidiasis
Authors: Mikamo Hiroshige , Kawazoe Kyoko , Sato Yasumasa , Hayasaki Yoh , Tamaya Teruhiko
Published: April 2003

Objective: A study was carried out to compare three treatment regimens for vaginal candidiasis. Methods: A total of 150 women with clinical and mycological evidence of vaginal candidiasis were randomized to receive daily a 200-mg dose of oral itraconazole for 3 days (50 women), a single oral 150 mg dose of fluconazole (50 women), or daily 100 mg dose of intravaginal clotrimazole for 6 days (50 women). They were assessed at 5–15 days (short-term assessment) and again at 30–60 days (long-term assessment) after discontinuation of the treatment. Results: At the short-term or long-term assessment, Candida species were completely eradicated from the vagina in 80 or 74% in the 3-day oral itraconazole group, 76 or 70% in the single oral fluconazole group, and 72 or 60% in the intravaginal clotrimazole group, respectively. The rates of clinical effectiveness were 92 or 88% in the 3-day oral itraconazole group, 80 or 76% in the single oral fluconazole group, and 72 or 58% in the intravaginal clotrimazole group, respectively. Treatment-related side effects were not found in any group. Conclusions: Our study suggests that the treatment of vaginal candidiasis with oral itraconazole or oral fluconazole would be effective and that an oral itraconazole or fluconazole therapy might be one choice in the treatment of vaginal candidiasis.
Mecillinam Activity Compared to Ampicillin, Trimethoprim/Sulfamethoxazole, Ciprofloxacin and Nitrofurantoin against Urinary Tract Isolates of Gram-Negative Bacilli
Authors: Zhanel George G. , Karlowsky James A. , Schwartz Brian , Jensen Signe Birk , Hoban Daryl J.
Published: April 2003

Recent Canadian, American and European studies have reported increased ampicillin and trimethoprim/sulfamethoxazole resistance among urinary tract isolates of Escherichia coli. This trend suggests that a reevaluation of first- and second-line therapies for the treatment of community-acquired urinary tract infections is necessary. Mecillinam, a β-lactam with preferential activity against gram-negative penicillin binding protein 2 (unlike other β-lactams which preferentially bind gram-negative penicillin binding proteins 1a, 1b or 3), may offer clinically significant activity against ampicillin-resistant and trimethoprim/sulfamethoxazole-resistant E. coli. To test this assertion, the activity of mecillinam was compared with ampicillin, trimethoprim/sulfamethoxazole, nitrofurantoin and ciprofloxacin against 258 consecutive gram-negative urinary tract isolates collected at a Canadian tertiary care hospital. Mecillinam demonstrated significantly better activity than ampicillin and trimethoprim/sulfamethoxazole and significantly less activity than ciprofloxacin and nitrofurantoin against the 258 isolates tested. Against E. coli isolates specifically, mecillinam was significantly more active than ampicillin and trimethoprim/sulfamethoxazole (p < 0.001) and as active as ciprofloxacin and nitrofurantoin. Mecillinam was active against 91.9% of ampicillin-resistant E. coli and 95.9% of trimethoprim/sulfamethoxazole-resistant E. coli. We conclude that mecillinam should be reevaluated for potential use in the treatment of community-acquired urinary tract infections.
Reduction of Mucoid Staphylococcus epidermidis Adherence to Intraocular Lenses by Selected Antimicrobial Agents
Authors: Kadry Ashraf A. , Tawfik Abdel-Kader F. , Abu El-Asrar Ahmed A. , Shibl Atef M.
Published: April 2003

The effect of low concentrations of various antimicrobial agents on the adherence of mucoid Staphylococcus epidermidis to intraocular lenses was investigated. Adherent growth of S. epidermidis on to polymethylmethacrylate lenses was greatly diminished by ciprofloxacin and clindamycin (>75%), followed by ceftazidime (≈50%) and less affected by gentamicin and vancomycin (<25%) compared to the adherent growth of control untreated cells. The reduction in adherence growth was concentration-dependent and found to be due to the inhibition of slime production since no growth inhibition was observed at the concentrations used. Cell surface hydrophobicity was markedly reduced in parallel to the inhibition of adherence as compared to the control cells. The differential effect of antibiotics on adherence, regardless of their antimicrobial activity, may have a clinical significance in reducing the incidence of postoperative endophthalmitis and intraocular inflammation due to the reduction of cell adherence.
Therapeutic Effect of Oral Levofloxacin, Ciprofloxacin, and Ampicillin on Experimental Murine Pneumonia Caused by Penicillin Intermediate Streptococcus pneumoniae for Which the Minimum Inhibitory Concentrations of the Quinolones Are Similar
Authors: Ishida Yoshihisa , Kurosaka Yuichi , Murakami Yoichi , Otani Tsuyoshi , Yamaguchi Keizo
Published: April 2003

The therapeutic efficacy of oral treatment with levofloxacin, ciprofloxacin, and ampicillin on an experimental pneumonia caused by the penicillin-intermediate Streptococcus pneumoniae for which the minimum inhibitory concentrations (MICs) of the quinolones are similar was assessed in immunocompetent CBA/J mice. Levofloxacin exhibited a dose-dependent therapeutic effect, and achieved complete eradication of S. pneumoniae from the lungs at 120 mg/kg/day, whereas ciprofloxacin and ampicillin were hardly effective at all. A pharmacokinetic study in infected mice revealed good oral absorption and lung tissue penetration of levofloxacin (peak lung concentration: 5.95 µg/g of lung), low oral absorption of ciprofloxacin in spite of a good penetration into lung tissue (1.10 µg/g of lung), and low lung tissue penetration of ampicillin despite rather good oral absorption (1.71 µg/g of lung). In an in vitro time-kill study that simulated the peak concentration of drugs in the lungs of infected animals, the killing activity of levofloxacin was found to be greater than that of ciprofloxacin and ampicillin. These data suggest that the therapeutic efficacy of levofloxacin in this model is attributable to both its potent bactericidal activity and excellent pharmacokinetic profile.
European Surveillance of Infections in Cancer Patients – ESIC
Authors: Karthaus M. , Buchheidt D. , Hiddemann W. , Donnelly J.P. , Krcmery V. , Schiel X. , Wilhelm M. , Helmerking M.
Published: April 2003

Major advances in cancer therapy result from development of multidrug chemotherapy regimens. Besides death from tumor progression, infections are currently one of the major causes of mortality and morbidity. Because of the risk of complications and mortality, the treatment for febrile neutropenia is admission to hospital and administration of broad-spectrum antibiotics. Response rates of initial antimicrobial treatment vary considerably (40–92%). Due to the heterogeneity of populations in randomized studies, comparison of efficacy and identification of risk factors is limited. This is the main reason why the European Society of Biomodulation and Chemotherapy (ESBiC) is conducting a surveillance study that concentrates more on the evaluation of risk factors than on the therapeutic outcome of prospective randomized antimicrobial regimens: European Surveillance of Infections in Cancer Patients (ESIC). The present contribution is to determine which cancer patients are at low risk for fever, and can benefit from first-line treatment with treatment options such as monotherapy as well as on an outpatient basis.
Minimum Inhibitory and Minimal Lethal Concentration against Chlamydia trachomatis Dependent on the Time of Addition and the Duration of the Presence of Antibiotics
Authors: Notomi Takashi , Ikeda Yurika , Nagayama Ariaki
Published: April 2003

The purpose of this study was to investigate the properties of several antimicrobial agents found to be effective against Chlamydia trachomatis and to verify the eradication therapy schedule. The in vitro activities of two quinolones (sparfloxacin, ofloxacin), of three macrolides (azithromycin, erythromycin, clarithromycin) and of a tetracycline (doxycycline) against C. trachomatis were evaluated by several methods for the determination of the minimum inhibitory concentration (MIC) and minimal lethal concentration (MLC). MLC of azithromycin was only 2 times higher than that of MIC. On the other hand, MLCs of other antibiotics were 4–16 times higher than their respective MICs. When all antimicrobial agents were added to the infected culture at different times, we found that the quinolones even at a concentration of 64 μg/ml could not inhibit the formation of inclusion if they were added after 20 h from the start of infection. The corresponding period for macrolides and doxycycline was 24 h. When the antibiotics were removed at 8 h after the start of the infection, all antibiotics except azithromycin and clarithromycin were needed at a concentration much higher than their MLCs to inhibit the formation of inclusion. We consider macrolides, especially azithromycin, to be an excellent anti-C. trachomatis drug because of its lower MICs and MLCs values which were also closer together.
In vitro Antibacterial Activity of Men 10700, a New Penem Antibiotic
Authors: Varotto Fabio , Parravidini Elena , De Luca Massimo , Casini Alessandro , Fraschini Franco
Published: April 2003

We report here the antibacterial activity of the new penem antibiotic Men 10700 against a total of 740 gram-positive and gram-negative clinical isolates, in comparison to imipenem, meropenem, cefotaxime, ceftriaxone, ciprofloxacin and gentamicin. Men 10700 has shown a wide spectrum of antibacterial activity, with a potent activity both against gram-positive species (with the exception of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis) as indicated by minimal inhibitory concentration (MIC90) values ≤0.5 mg/l, and gram-negative species, with MIC90 values generally ≤2 mg/l. Men 10700 was the most potent antibiotic against methicillin-susceptible S. aureus and S. epidermidis, while the overall spectrum of activity resembled that of imipenem; meropenem was more active against most gram-negative species. In comparison with third-generation cephalosporins, Men 10700 demonstrated superior activity against methicillin-susceptible S. aureus and S. epidermidis and some gram-negative species such as Morganella morganii, Serratia spp. and Enterobacter cloacae; moreover, in contrast to third-generation cephalosporins, Men 10700 showed moderate activity against Enterococcus spp. The activity of Men 10700 against penicillin-resistant Streptococcus pneumoniae (10 strains) and some gram-negative strains selected for their resistance to cefotaxime (20 strains) was particularly interesting.