摘要:

Address of the 2002 President of the Southern Society for Clinical Investigation.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundFindings of atherosclerotic plaques in adolescents, in the context of current epidemics of obesity and type 2 diabetes in youth, demand investigation into early cardiovascular risk development. Left ventricular hypertrophy has been linked to hypertension, obesity, and insulin resistance.MethodsInsulin resistance syndrome characteristics (fasting glucose and insulin; systolic blood pressure; waist girth) were measured in 70 normotensive, normoglycemic young people (60% male, 62% black; included 13 twin pairs; age mean ± SD, 19 ± 2.6 years). Left ventricular mass indexed by height2.7(LVMI) was obtained via ultrasound. Twin pairs were clustered to satisfy the assumption for independent observations.ResultsLVMI was regressed on insulin after controlling for race, gender, and systolic blood pressure. Insulin was a significant (P= 0.02) independent predictor of LVMI (R2change = 0.09,P< 0.01). Waist girth accounted for an additional 4% variance of LVMI (P= 0.05). A one-factor model comprising waist (factor loading = 0.83), insulin (0.59), glucose (0.42), and LVMI (0.46) showed good fit [&khgr;2(2) = 0.41,P= 0.81; root-mean-square error of approximation = 0.0].ConclusionsA subclinical metabolic syndrome is detectable early in life, before abnormal fasting glucose or high blood pressure appear. Evidence of excessive load on the heart is associated with the metabolic syndrome even after accounting for the effects of race, gender, and blood pressure. Cardiac structure seems as closely associated with this syndrome as fasting glucose level. Based on this evidence, we propose that increased left ventricular mass is a part of insulin resistance syndrome and adds to the need for preventive public health measures to improve health behaviors and cardiovascular risk status in US youth.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundWith the proliferation of cocaine abuse, increased incidence of catastrophic cardiovascular events such as angina pectoris, myocardial infarction, ventricular arrhythmias, or sudden death are reported. Many of these patients also drink alcohol before and after cocaine use, leading to a high frequency of simultaneous exposure to both the drugs. Cocaine and ethanol’s independent effects on cardiodynamics are well documented, but their combined effects on complete cardiovascular hemodynamics remain unknown. Are effects additive, synergistic, or antagonistic?MethodsSixteen dogs were instrumented to pass cardiac catheters into right and left ventricles. After they recovered from the effects of anesthesia, experiments were performed. In phase I, 18 experiments (6 dogs) established the dose by dose response curve. In phase II and III, another 10 dogs, subjected to 30 experiments, were given i.v. cocaine followed by ethanol and vice versa to study their effects on hemodynamics and coronary flow reserve.ResultsPhase I: doses of cocaine (2 mg/kg) and ethanol (400 mg/kg) were established. Phase II: cocaine increased heart rate, blood pressure and dP/dt but ethanol administered after cocaine attenuated these effects [first derivative of the left ventricular pressure (dP/dt) < 2052 ± 104 from 2614 ± 110 mm Hg/sec;P< 0.04)]. Phase III: alcohol mildly increased hemodynamic parameters. Cocaine’s administration as the second drug had synergistic excitatory effects (dP/dt > 3300 ± 160 from 2854 ± 142 mm Hg/sec;P< 0.004).Conclusion:Cocaine increased heart rate, blood pressure, and dP/dt but reduced CFR. Alcohol mildly increased the hemodynamic variables and CFR. Combined cocaine and alcohol attenuated the excitatory effects of cocaine significantly. A reversed drug combination (ie, alcohol then cocaine) generated synergistic excitatory effects on the cardiovascular system of the dogs.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The advent of symptomatic therapies for Alzheimer disease has placed increasing emphasis on early diagnosis of the dementia syndrome and its various types. This article reviews the definition and epidemiology of the condition that affects up to 50% of all Americans over the age of 80. Also discussed are the main causes of dementia, focusing on those that are not Alzheimer disease and a diagnostic approach that is based on guidelines recently published by the American Academy of Neurology.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis. Herein we describe documented skeletal and pericardial involvement by ECD producing cardiac tamponade in a 30-year-old woman. The diagnosis of ECD was established by histopathology, immunocytochemistry, and by radiologic studies demonstrating diffuse, bilateral, symmetrical osteosclerosis of the long bones, sparing the epiphyses and axial skeleton. Scintography using methyl diphosphonate showed increased uptake in involved bone. The patient presented with jaundice and hepatic congestion produced by cardiac tamponade. Pericardial biopsy revealed xanthogranulomatous lesions comprised of foamy and lipid-laden macrophages, multinucleated giant cells, monocytes, and lymphocytes in a mesh of fibrosis. Immunohistochemical staining was positive for CD68 and negative for CD1a, consistent with ECD rather than with the much more common Langerhans cell form of histiocytosis.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Relapsing polychondritis (RP) is a disease characterized by inflammation and the destruction of cartilage. The detection of antibodies to native type II collagen (CII) in the sera of some patients with relapsing polychondritis suggests that autoimmunity to this cartilage specific protein plays a role in the pathogenesis of the disease. RP is so rare that controlled therapeutic trials have not been carried out. We describe herein a child with RP who had amelioration of symptoms and a deviation in the cellular immune response to CII after being treated with daily oral CII as a toleragen.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 57-year-old man presented with a 1-month history of progressive abdominal pain and weight loss. A palpable, nonpulsatile, firm abdominal mass was felt below the xiphisternum down to the pelvis. A pregnancy test performed on a urine sample was positive. Testicular examination and testicular ultrasound were normal. Computerized tomography of the abdomen revealed a retroperitoneal mass measuring 30 × 21 × 13 cm. Serum &bgr;-human chorionic gonadotropin (&bgr;-HCG) was serially increased (19.71-22.71 mIU/mL). Results of histopathology tests confirmed the diagnosis of leiomyosarcoma. The level of serum &bgr;-HCG decreased to < 0.2 mIU/mL after chemotherapy. &bgr;-HCG is usually increased in germ-cell tumors but few reports in the literature describe &bgr;-HCG–secreting leiomyosarcomas. The incidence of increased levels of &bgr;-HCG in sarcomas in general, and its potential role as a tumor marker, is not known. A simple urine pregnancy test may be done in the work-up of abdominal masses.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID