Intravenous immunoglobulin attenuates mesenteric ischemia-reperfusion injury.

Intravenous immunoglobulin (IVIG) has been found useful in the treatment of various clinical entities and its effect has been associated with inhibition of complement-mediated tissue damage. The aim of this study was to determine the ability of IVIG to protect against mesenteric ischemia-reperfusion (IR)-induced local and remote injury. Rats received vehicle or IVIG (150-600 mg/kg) 5 min prior to sham operation or 30 min of superior mesenteric artery occlusion, followed by 5, 120, or 240 min of reperfusion.

Catastrophic antiphospholipid syndrome complicating orthotopic liver transplantation.

Catastrophic antiphospholipid syndrome (CAPS) is an acutely devastating situation characterized by widespread thrombotic microangiopathy in the presence of elevated titers of antiphospholipid antibodies. We describe a 57-year old woman who underwent liver transplantation for primary sclerosing cholangitis and developed this malignant variant of the antiphospholipid syndrome.

F(ab)'2-mediated neutralization of C3a and C5a anaphylatoxins: a novel effector function of immunoglobulins.

High-dose intravenous immunoglobulin (IVIG) prevents immune damage by scavenging complement fragments C3b and C4b. We tested the hypothesis that exogenous immunoglobulin molecules also bind anaphylatoxins C3a and C5a, thereby neutralizing their pro-inflammatory effects. Single-cell calcium measurements in HMC-1 human mast cells showed that a rise in intracellular calcium caused by C3a and C5a was inhibited in a concentration-dependent manner by IVIG, F(ab)2-IVIG and irrelevant human monoclonal antibody.

Liposome-induced pulmonary hypertension: properties and mechanism of a complement-mediated pseudoallergic reaction.

Intravenous injection of liposomes can cause significant pulmonary hypertension in pigs, a vasoconstrictive response that provides a sensitive model for the cardiopulmonary distress in humans caused by some liposomal drugs. The reaction was recently shown to be a manifestation of "complement activation-related pseudoallergy" (CARPA; Szebeni J, Fontana JL, Wassef NM, Mongan PD, Morse DS, Dobbins DE, Stahl GL, Bünger R, and Alving CR. Circulation 99: 2302-2309, 1999).

A reversible bilateral renal artery stenosis in association with antiphospholipid syndrome.

We describe a 26-year-old white female with a history of Raynaud phenomenon, erythema nodosum, polyarthralgias, migraine, vertigo, seizures, transient ischemic attacks, one fetal loss, and false positive VDRL, who developed milk hypertension without overt lupus nephritis. She had positive antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) antibodies. The lupus anticoagulant test (LAC) and cardiolipins antibodies (aCL) were positive.

Epidural hematoma following epidural catheter placement in a patient with chronic renal failure.

Purpose: We report a case of epidural hematoma in a surgical patient with chronic renal failure who received an epidural catheter for postoperative analgesia. Symptoms of epidural hematoma occurred about 60 hr after epidural catheter placement.

Clinical Features: A 58-yr-old woman with a history of chronic renal failure was admitted for elective abdominal cancer surgery.

Sevoflurane has no effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolff-Parkinson-White syndrome during alfentanil/midazolam anesthesia.

Background: The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures.

Methods: Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied.

[A Polish multicenter survey of antimicrobial susceptibility and prevalence of beta-lactamase production among bacterial pathogens isolated from hospitalized and ambulatory patients].

The aim of the study was to establish the frequency of occurrence of bacterial pathogens with beta-lactamase activity, and pattern of resistance among aerobic and anaerobic strains isolated from: respiratory tract, urinary tract, skin and soft tissues (hospitalized patients) and throat swabs (ambulatory patients). The study was conducted in 1994 year in 6 bacteriological laboratories in four Polish towns (Warszawa, Kraków, Katowice, Gdańsk) according to the protocol. Sensitivity of bacteria was tested by the disc method on the Müeller-Hinton agar or chocolate agar according to NCCLS, activity of beta-lactamase was tested with nitrocephin.

The importance of the left atrioventricular interval during atrioventricular sequential pacing.

During atrioventricular (AV) sequential pacing from the right heart, the interval between the left atrium and ventricle may vary from the programmed AV interval depending on the position of the atrial and ventricular electrodes and interatrial and interventricular conduction. The aim of this study was to determine the hemodynamic effects of altering the left AV interval while keeping the programmed AV interval constant. Four male and 17 female patients, aged 49 +/- 15 years were studied.

Current role of pharmacologic therapy for patients with paroxysmal supraventricular tachycardia.

Intravenous antiarrhythmic drugs will continue to have an important role in the acute management of SVT. Long-term antiarrhythmic drug therapy is often effective in preventing or reducing frequency and severity of arrhythmic episodes. The cost, adverse effects, and inconvenience of long-term drug therapy will result in the increasing use of curative ablation for most individuals with problematic SVT.

Progressive anterior ablation in the coronary sinus region: evidence to support the presence of a 'slow pathway' input in normal patients?

Background: AV node modification is an emerging approach to rate control in patients with medically refractory atrial fibrillation. The mechanism of benefit of this procedure is not completely understood.

Methods And Results: Twenty-two patients (age, 65+/-11 years; 16 women) with medically refractory paroxysmal atrial fibrillation referred for complete AV node ablation underwent serial ablations beginning at the level of the coronary sinus os progressing in a superior and anterior direction toward the His bundle.

Effect of phenylephrine infusion on atrial electrophysiological properties.

Objective: To determine the effect of changes in autonomic tone induced by phenylephrine infusion on atrial refractoriness and conduction.

Design: Left and right atrial electrophysiological properties were measured before and after a constant phenylephrine infusion designed to increase sinus cycle length by 25%.

Subjects: 20 patients, aged 53 (SD 6) years, undergoing electrophysiological study for investigation of idiopathic paroxysmal atrial fibrillation (seven patients) or for routine follow up after successful catheter ablation of supraventricular tachycardia (13 patients).

Safety of slow pathway ablation in patients with atrioventricular node reentrant tachycardia and a long fast pathway effective refractory period.

Radiofrequency catheter ablation is an accepted primary therapy for atrioventricular (AV) node reentrant tachycardia (AVNRT). There is concern that slow pathway ablation in patients with a long anterograde fast pathway effective refractory period (ERP) may potentially impair subsequent node conduction. Eighteen patients (14 women; age 53 +/- 20 years) with symptomatic AVNRT, whose fast pathway ERP at baseline was > or = 500 ms, underwent slow pathway ablation.

Randomized trial of a hospital-based exercise training program after acute myocardial infarction: cardiac autonomic effects.

Objectives: This study sought to determine whether a moderate intensity supervised exercise training program, performed immediately after an uncomplicated acute myocardial infarction, improves recovery in cardiac autonomic function compared with standard advice about activity at home.

Background: Exercise training has beneficial effects on cardiac autonomic function and may improve prognosis after acute myocardial infarction.

Methods: Thirty-nine male and 10 female patients, mean (+/-SE) age 57 +/- 1 years, with an uncomplicated acute myocardial infarction were randomized to either a 6-week moderate intensity supervised hospital-based exercise training program (exercise group) or to an unsupervised low intensity home walking program (control group).

Utility of full electrophysiological study before accessory pathway ablation in Wolff-Parkinson-White syndrome.

Background: A single catheter technique has been described for ablation in patients with Wolff-Parkinson-White syndrome. It is unknown how often omission of a standard electrophysiological study would lead to misdiagnosis based on an assumption that the manifest accessory pathway is responsible for clinical tachycardia.

Objectives: To examine the contribution of the standard electrophysiological study versus an abbreviated, single catheter approach in patients with Wolff-Parkinson-White syndrome and an overt delta wave electrocardiographically.

Increased in vitro uptake of the complement C3b in the serum of patients with Guillain-Barré syndrome, myasthenia gravis and dermatomyositis.

To examine the role of complement in certain autoimmune neuromuscular diseases, we used an in-vitro quantitative complement uptake assay that allows measurement of the capacity of patients' sera to deposit fragments of the third complement component onto sensitized targets. C3 uptake was significantly higher in patients with active dermatomyositis, Guillain-Barré syndrome and myasthenia gravis, compared to inclusion body myositis and controls. The in-vitro C3 uptake assay supports the role of C3b neoantigen and Membranolytic Attack Complex deposition in the target tissues and may be a useful tool to monitor disease activity in patients with complement-mediated neurological disorders.

[Bacterial flora of the respiratory tract in artificially ventilated patients].

Patients treated in ICUs are at particular risk for nosocomial infections. Within this group a ventilator-associated pneumonia still constitutes a major problem. Highly virulent hospital strains, existing in ICUs, can colonize patients' upper respiratory tract.

Cardiovascular findings in self-reported healthy elderly. The Elite Seniors Study.

Background: A descriptive study of self-reported healthy elderly in Newcastle was undertaken for an adequate understanding of the normal characteristics of the elderly.

Aims: We sought to determine the frequency of abnormal clinical, laboratory and echocardiographic findings in a self-reported healthy elderly population.

Methods: Volunteers aged greater than 75 years were recruited from active members of the region's bowling clubs.

Modulation of complement-mediated immune damage by intravenous immune globulin.

High-dose intravenous immune globulin (IVIG) exerts a beneficial effect in a variety of immune disorders. One possible underlying mechanism of this effect could be interference with the complement system. This conclusion was based on the results obtained in animal models of complement-mediated pathology, in vitro complement assays and studies on related human diseases.

Sotalol proarrhythmia: a report of five cases and an audit of the use of a sotalol in a teaching hospital.

Background: Polymorphic ventricular tachycardia is an uncommon complication of sotalol use.

Aims: The aims of this study were: (1) to report five cases of sotalol proarrhythmia and (2) to audit the use of sotalol in a teaching hospital population.

Methods: Five patients with sotalol proarrhythmia (defined as new ventricular arrhythmias associated with sotalol administration) were identified over an 18 month period.

Production and characterization of the monoclonal antibody against SGP120, a novel serum protein.

A monoclonal antibody designated B1.9.E-2 was produced and characterized to facilitate study of the immunizing antigen-a serum glycoprotein of 120 kDa (sgp 120) of unknown function.

Further identification of human plasma glycoproteins interacting with the galactose-specific lectin Jacalin.

In this report we show that Jacalin binds the heme-binding protein hemopexin and the C4b-binding protein sgp120 in human plasma. The interaction of Jacalin with hemopexin confirms that a single O-linked oligosaccharide is sufficient to mediate binding of a protein to this lectin. Retention of sgp120 by immobilized Jacalin demonstrated that this protein was O-glycosylated and, therefore, clearly different from another C4b-binding protein, the complement protein C2 which is physicochemically similar but exclusively N-glycosylated.