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Chylothorax is the presence of chylus in the pleural cavity and is due to the damage or blockage of the thoracic duct. Surgery or trauma is the most common cause of chylothorax. Malignant lymphoma is the most common cause among nontraumatic etiology. Whenever a chylothorax of unknown etiology occurs, we should rule out underlying malignant lymphoma. Here, we present a case of lymphoma presented with bilateral chylothorax.

Patients with chest wall tumors present diagnostic and therapeutic challenges. The differential diagnosis of these tumors is broad because they can present a heterogeneous spectrum of diseases such as primary benign or malignant tumors, metastasis, local extension of adjacent tumors, and infectious or inflammatory conditions. Among that, primary chest wall tumors are rare.

Lipoid pneumonia is a rare condition that accounts for 1%–2.5% of all pneumonia. There are two types – exogenous and endogenous. In recent days, exogenous lipoid pneumonia has been on an increasing trend due to the exponential use of vaping. Exogenous lipoid pneumonia usually presents with cough, fever, breathlessness, chest pain, and weight loss. Usually, it is a diagnosis of exclusion and the presence of lipid-laden macrophages is required for its diagnosis. Here, we present a case of lipoid pneumonia which showcased the importance of detailed clinical history elicitation, approach, and management of lipoid pneumonia.

Objective: Off pump coronary artery bypass grafting (OPCAB) is claimed to reduce the operative morbidity and mortality in high risk patients. It was the aim of the study to compare the outcome of OPCAB patients classified as high- and low risk according to the EuroSCORE. Methods: Medical records of patients undergoing off pump coronary artery bypass grafting (n=126) at our institution between 1998 and 2001 were retrospectively reviewed. We classified them into two subgroups: low risk (EuroSCORE≤5, n=72, male 58 (81%), female 14 (19%), age 61 (37–78) years) and high risk (EuroSCORE >5, n=54, male 32 (59%), female 22 (41%), age 73 (42–83) years). Results: EuroSCORE high risk patients showed significantly higher rates of blood transfusion (70 vs 31%; P<0.0001), intraaortic balloon pump insertion (16 vs 3%; P=0.013), atrial fibrillation (43 vs 22%; P=0.014), and renal failure (13 vs 3%; P=0.028). ICU length of stay was significantly longer in the high risk group (25 vs 22 h; P=0.002). There was also a higher perioperative mortality in the high risk group (9 vs 0%; P=0.008). Conclusion: From these data we conclude that using off pump coronary artery bypass grafting results as predicted by the EuroSCORE can be achieved. OPCAB is safe for low risk patients. Major complications seem to occur preferentially in the high risk group. [Copyright &y& Elsevier]

Beta-blockers, nitrates, aspirin and thrombolytic drugs have each separately been shown to reduce mortality in acute myocardial infarction, but the effect of these treatments combined during routine coronary care has not been assessed. The coronary care unit at Östra Hospital services a stable community of 250 000 inhabitants. Since 1984 all patients have been entered into a computerized database. In addition, information on age, sex, discharge diagnosis and hospital outcome is also available for patients admitted between 1979 and 1983. In 1984, routine treatment with intravenous beta-blockers was introduced, to be followed in 1986 by intravenous nitroglycerin and in 1988 by aspirin in all patients without contraindications. Since 1988, intravenous thrombolytic treatment has been also given routinely to all patients with ST-elevation and chest pain <6 h. Despite a similar number of patients and an increasing median age, the in-hospital mortality has declined from 18·5% in 1979 to 11·8% in 1990 (P<0·01). It is concluded that mortality from acute myocardial infarction has declined by almost 40% since 1979. This reduction cannot be explained by a single major therapeutic intervention but may be attributed to the combined use of multi-lead monitoring, early use of beta-blockers, nitroglycerin, aspirin and thrombolytic agents. [ABSTRACT FROM PUBLISHER]

Changes in the QRS segment during exercise have repeatedly been suggested to provide diagnostic information with respect to ischaemic heart disease, but the subject is controversial. In order to study the possibly confounding effects of gender, age, resting ECG and exercise performance, 50 healthy subjects were investigated with computerized vectorcardiography during a maximal ergometer exercise test. The overall change in the QRS complex decreased significantly with age and female gender (P>0·001). However, these responses were better explained by baseline QRS size, change in heart rate and systolic blood pressure (adjusted T>0·70, vs adjusted T>0·41). Effects of age were seen in the Y-lead, and gender effects in the X- and Z-leads (P <0·0001). In multivariate analyses, X- and Y-lead alterations correlated negatively to change in heart rate and resting QRS size (X-lead; adjusted r0·50, Y-lead; r0·44). Z-lead alterations correlated negatively with female gender and resting Z-lead QRS size (adjusted r 0·31). ST changes correlated with QRS changes in the X-and Y-leads (P<0·05). QRS changes immediately after exercise correlated with alterations during exercise (P<0·004), maximal load (P<0·01) and time to hypotension post-exercise (X- and Z-lead; P<0·02). In conclusion, QRS changes appear to be related to baseline QRS size, change in heart rate and ST change, factors which may have important confounding effects. Consideration of these factors may help in resolving the controversy surrounding QRS changes. [ABSTRACT FROM PUBLISHER]

The assessment of ecological quality in freshwater ecosystems is a key issue in many countries, but conditions for the development of assessment methodologies are often country-specific. This study proposes a simple methodology for the assessment of the ecological potential of reservoirs based on fish communities using a dataset covering major environmental and pressure gradients in reservoirs in the Czech Republic. Fish data obtained by gillnet sampling were correlated with a proxy of eutrophication as a key indicator of anthropogenic pressure for selecting appropriate fish-based indicators, establishing scoring criteria and developing the index of ecological quality. Expert judgement was also used to select potential fish indicators. Nine indicators were selected for the final fish-based index, fulfilling the criteria required by the Water Framework Directive. Two steps were used to validate the fish-based index quantification of its inter annual stability and sensitivity analysis of individual indicators. Finally, the index was compared to a previously developed general index for Central and Western Europe. Our study demonstrates that a combination of expert judgement and strict validation methods can result in an informative assessment of the ecological conditions, which can help identify conservation and restoration priorities.

The roles of wind protected bays, presence of littoral vegetation and light attenuation in the water column on spawning site selection and depth of egg strands deposition by perch Perca fluviatilis was studied in Římov Reservoir, Czech Republic, in the years 2007 and 2011 using boat observation and SCUBA divers. The data were compared with results from Chabařovice Lake, Czech Republic, where similar monitoring took place in 2007–2010 and 2012. In shallow water of Římov Reservoir, the density of egg strands was significantly higher in grass bays compared to both rocky bays and the main reservoir body. Most egg strands were deposited in water less than 0.5 m deep on reed canarygrass Phalaris arudinacea. In year when the littoral vegetation was absent perch were forced to spawn significantly deeper on various types of woody structures. In Římov Reservoir, which is less vulnerable to wind, 91.1% of egg strands were spawned in water ≤3 m deep. In contrast, in the wind exposed Chabařovice Lake, even in the presence of littoral vegetation, 90.5% of egg strands were found at depths greater than 3 m. In Chabařovice Lake, the light penetrated to three times greater depth compared to Římov Reservoir and, similarly, the depth limit to which 95% of egg strands were spawned was three times greater in this lake compared to Římov Reservoir. This study is the first contribution showing the role of water transparency in controlling the depth distribution of perch egg strands in lakes and reservoirs.

The reproduction biology of perch Perca fluviatilis was studied in relation to lake hydrology, spawning substrate and female size using SCUBA divers during late April and mid-May 2009 in Chabařovice Lake, Czech Republic. An extreme displacement of water mass, induced by a long-lasting strong wind, caused the abundance of egg strands to differ significantly between individual parts of the lake. On average, 91% of perch spawning activity occurred at depths greater than 3 m. The mean concentration of dissolved organic carbon (DOC) indicated that the lake belongs to the category where DOC influencing the penetration of ultraviolet radiation, is not responsible for the deep deposition of egg strands by perch. Most probably, the avoidance of shallow depths (

Background: Corroborating evidence for use of hypothermic oxygenated machine perfusion (HOPE) prior to orthotopic liver transplantation (OLT) suggests a beneficial effect in regards to biliary complications. Here, we aim to evaluate whether perfusion via portal vein alone (sHOPE) or via additional perfusion of the hepatic artery (dHOPE) have diverging impact on outcomes after OLT when compared to use of static cold storage (SCS)., Methods: Consecutive patients undergoing OLT at Medical University of Vienna (2018 to 2023) were retrospectively analyzed. Donor organs were procured using SCS, or subjected to end-ischemic sHOPE or dHOPE. Severity of biliary complications was classified according to degree of therapeutic intervention (endoscopic retrograde cholangiopancreatography or surgical revision)., Results: 247 patients were included (69 SCS, 76 sHOPE, 102 dHOPE). Hospitalization was shorter for patients after HOPE (median in days: SCS=25 vs HOPE=20, P=0.019). Biliary complications were less frequent in patients after HOPE (SCS=37.7% vs HOPE=22.5%, P=0.015). A significantly lower incidence of surgical revisions for biliary complications was observed in the HOPE cohort (24.6% vs 11.8%, P=0.012). When evaluating outcome according to HOPE-modality, a significant reduction in biliary complications (P=0.006) and surgical revisions (P=0.002) was only observed in dHOPE patients in comparison to SCS. Further, only dHOPE was significantly associated with reduced need for surgical revision for biliary complications upon uni- and multivariable logistic regression (odds ratio=0.336, P=0.011)., Conclusion: HOPE leads to a reduction of biliary complications and associated surgical revisions. This effect seems to be primarily associated with use of dHOPE, while both methods appear as feasible options for preconditioning of donor grafts prior to OLT., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Induction therapy with depleting antibodies in the setting of liver transplantation (LT) is discussed controversially to this day. The rabbit antithymocyteglobulin (ATG) Thymoglobulin (rATG) was introduced as early as 1984 and was frequently used as a standard regime for induction therapy after LT. There are no public reports characterizing Grafalon (ATG-F), a novel ATG, as an induction agent after LT. Objectives : The aim of this observational non-interventional study was to investigate the safety and efficacy of Grafalon induction therapy and characterize its clinical effects in the setting of LT. Methods : A cohort of 80 patients undergoing deceased donor LT at the Medical University of Vienna and receiving Grafalon as part of the clinical standard immunosuppressive regimen was prospectively included between March 2021 and November 2022. Patients were monitored closely for leukocytopenia and thrombocytopenia during the first postoperative week and followed up for incidence and severity of biopsy-proven acute rejection (BPAR), overall survival, and bacterial infections in the first year after LT. Results : The incidences of thrombocytopenia and leukocytopenia following Grafalon treatment peaked on postoperative day four, with 64% and 31%, respectively. However, there were no cases of severe leukocytopenia after the first postoperative week. Induction therapy with Grafalon resulted in a rate of localized bacterial infections and bacteremia of 28% and 21%, respectively. The rate of BPAR was 12.5% in the first year after LT; the one-year survival rate in this cohort was 90%. Conclusions : Overall, this study provides evidence of the safety and efficacy of Grafalon as an induction agent. Further studies investigating the potential long-term effects of Grafalon, as well as comparison studies with different immunosuppressive regimens, are needed in order to draw further conclusions.

Introduction: The aim of In this study was to verify the relationship among clinical indicators of patellofemoral pain syndrome (PFPS) and the results of modifying radiological investigation. Previous research suggests that there is a poor association between them. Therefore we have employed a technique for the functional evaluation of PFPS based on measuring the stiffness of the knee joint during passive flexion (biorheometry)., Method: The correlation between clinical examination and a standardized Lysholm score, radiological and biorheometric measures was investigated in the 28 knee joints of 14 subjects exhibiting clinical features of PFPS. A modified axial radiological projection of the patellofemoral articulation in 90° of flexion provided the parameters quantifying the anatomical - morphological arrangement of the patellofemoral joint. The biorheometric properties of the knee were evaluated using a custom made measuring apparatus during passive flexion and extension of the knee., Results: Our results confirm that the link between the clinical findings and the X-ray imaging examinations was not evident. On the contrary, the biorheometric examination proved to correlate well with the clinical symptoms of PFPS. Parameters were identified which can characterize the biorheograms of people suffering PFPS., Conclusions: Analysis of the relationship among the clinical, radiological and biorheometric examinations leads to the recommendation that biorheometric examination is an effective method for the objective assessment of PFPS., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Sorfova Monika reports administrative support was provided by Charles University. ], (Copyright © 2023 Elsevier B.V. All rights reserved.)

Ligula intestinalis (Linnaeus, 1758) is a tapeworm parasite with a worldwide distribution that uses a wide variety of fish species as its second intermediate host. In the present study, we investigated the prevalence and population genetic structure of plerocercoids of L. intestinalis in five common cyprinoid species, roach Rutilus rutilus (Linnaeus), freshwater bream Abramis brama (Linnaeus), white bream Blicca bjoerkna (Linnaeus), bleak Alburnus alburnus (Linnaeus), and rudd Scardinius erythrophthalmus (Linnaeus), collected in six water bodies of the Czech Republic (Milada, Most, Medard, Jordán, Římov and Lipno). Of the six study sites, the highest frequency of parasitism was recorded in Lake Medard (15%). The overall prevalence rate among the species was as follows: roach > rudd ≥ freshwater bream > bleak > white bream. Two mitochondrial genes (cytb and COI) were used to compare the population genetic structure of parasite populations using selected samples from the five fish species. The results of the phylogenetic analysis indicated that all populations of L. intestinalis were placed in Clade A, previously identified as the most common in Europe. At a finer scale, haplotype network and PCoA analyses indicated the possible emergence of host specificity of several mtDNA haplotypes to the freshwater bream. Moreover, pairwise Fixation indices (F ST ) revealed a significant genetic structure between the parasite population in freshwater bream and other host species. Parasite populations in roach not only showed the highest rate of prevalence but also depicted a maximum number of shared haplotypes with populations from bleak and rudd. Our results suggest that recent ecological differentiation might have influenced tapeworm populations at a fine evolutionary scale. Thus, the differences in prevalence between fish host species in different lakes might be influenced not only by the parasite's ecology, but also by its genetic diversity.

Background: Blue light photodynamic therapy (PDT) is effective for actinic keratosis, but many patients experience stinging pain during illumination., Objective: To compare a conventional regimen (1 hour of 5-aminolevulinic acid [ALA] preincubation, followed by blue light) versus a new modified regimen in which blue light is started immediately after ALA application., Methods: A clinical trial with a bilaterally controlled, intrapatient study design was conducted with 23 patients. Topical 20% ALA was applied to the entire face and/or scalp. On 1 side of the body, blue light was started immediately and continued for either 30, 45, or 60 minutes (simultaneous PDT). On the contralateral side, the blue light began 1 hour after ALA application and lasted 1000 seconds (conventional PDT). Pain was evaluated on a scale from 0 to 10. Actinic keratosis lesion counts were determined by clinical examination and photography., Results: All patients experienced significantly less pain during simultaneous illumination than during the conventional regimen. At 3 months after treatment, lesion clearance was nearly identical on the 2 sides, as determined by statistical testing of noninferiority ± 15% margin., Limitations: Although bilaterally controlled, the study was relatively small. Additional studies are recommended., Conclusion: The modified PDT regimen is essentially painless, yet it provides treatment efficacy similar to a conventional regimen., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Actinic keratoses (AK) are precancerous lesions that can progress to squamous cell carcinoma. Photodynamic therapy (PDT) and topical 5-fluorouracil (5FU) are commonly used agents for AK. Empirical reports suggest that combining them can improve the therapeutic response. However, the optimal combined regimen was not clear in terms of proper sequence, timing, and mechanism. This clinical study explored mechanisms of action for neoadjuvantal 5FU and PDT for treatment of AK. Patients and Methods: A bilaterally controlled trial (17 patients) was performed. One side of the body (face, scalp, forearms) received 5FU pretreatment for 6 days, whereas the other side served as no-pretreatment control. Methylaminolevulinate cream was applied to both sides for 3 hours, and protoporphyrin IX (PpIX) levels were measured by noninvasive fluorimetry and skin biopsy. After red light illumination, lesion clearance was assessed at 3, 6, 9, and 12 months after PDT. Results: PpIX levels were increased 2- to 3-fold in 5FU-pretreated lesions versus controls. Altered expression of heme-synthetic enzymes (coproporphyrinogen oxidase and ferrochelatase) and induction of p53 were observed, probably accounting for increased PpIX and subsequent cancer cell death. Relative clearance rates after PDT with or without 5FU pretreatment were 75% versus 45% at 3 months, and 67% versus 39% at 6 months, respectively; these differences were statistically significant. Conclusions: Serial 5FU and PDT improve AK clearance by at least two mechanisms, enhanced photosensitizer accumulation and p53 induction. Because 5FU and PDT are FDA-approved modalities, the combined regimen can be readily employed in clinical practice to reduce AK burden and reduce SCC risk. Clin Cancer Res; 24(13); 3026-35. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Aims: The main aim of this study was to provide an estimate of the incidence and prevalence of spasticity following stroke in the internal carotid artery territory for Regional Stroke Centers in the Czech Republic. A secondary goal was to identify predictors for the development of spasticity., Methods: In a prospective cohort study, 256 consecutive patients with clinical signs of central paresis due to a first-ever stroke were examined in the acute stage. All patients had primary stroke of carotid origin and paresis of the upper and/or lower limb for longer than 7 days after stroke onset. All were examined between 7-10 days after the stroke. We evaluated the degree and pattern of paresis, spasticity using the Modified Ashworth scale and the Barthel Index, baseline characteristics and demographic data., Results: Of 256 patients (157 males; mean age 69.9±12.4 years), 115 (44.9%) patients developed spasticity during the first 10 days after stroke onset. Eighty-three (32.5%) patients presented with mild neurological deficit (modified Rankin Scale 0 - 2) and 69 (27.0%) patients were bedridden., Conclusion: Spasticity was noted in 44.9% patients with neurological deficit due to first-ever stroke in the carotid territory in the first 10 days after stroke onset. Severe spasticity was rare.

Expression of MHC class II by donor-derived APCs has been shown to be important for allograft rejection. It remains controversial, however, whether nonhemopoietic cells, such as vascular endothelium, possess Ag-presenting capacity to activate alloreactive CD4(+) T lymphocytes. This issue is important in transplantation, because, unlike hemopoietic APCs, allogeneic vascular endothelium remains present for the life of the organ. In this study we report that cytokine-activated vascular endothelial cells are poor APCs for allogeneic CD4(+) T lymphocytes in vitro and in vivo despite surface expression of MHC class II. Our in vitro observations were extended to an in vivo model of allograft rejection. We have separated the allostimulatory capacity of endothelium from that of hemopoietic APCs by using bone marrow chimeras. Hearts that express MHC class II on hemopoietic APCs are acutely rejected in a mean of 7 days regardless of the expression of MHC class II on graft endothelium. Alternatively, hearts that lack MHC class II on hemopoietic APCs are acutely rejected at a significantly delayed tempo regardless of the expression of MHC class II on graft endothelium. Our data suggest that vascular endothelium does not play an important role in CD4(+) direct allorecognition and thus does not contribute to the vigor of acute rejection.

Mesenchymal progenitor cells, isolated from adult bone marrow, have been shown to have utility for autologous tissue engineering. The possibility of isolating from the fetal hematopoietic system a cell population with similar potential, which could be used for autologous reconstruction of prenatally diagnosed congenital anomalies, has not been explored to date. Liver stromal cells isolated from a portion of the right lateral hepatic lobe of midgestation fetal lambs were expanded in vitro. Passage 1 cells displayed a uniform fibroblast-like morphology but could be induced to differentiate into skeletal muscle, adipocytes, chondrocytes, and endothelial cells by selective medium supplementation. By manipulating the extracellular matrix in vitro, spontaneously contracting cardiac myocyte-like cells could be generated as well. Multilineage differentiation was confirmed by morphology, protein expression, and upregulation of lineage-specific mRNA. The potential for engineering myocardial tissue was then investigated by transplanting early-passage progenitor cells, organized on a three-dimensional matrix, into the ventricle of an immunocompromised rat utilizing a previously described model of left ventricular tissue engineering. Survival, incorporation into the host myocardium, and cardiomyocytic differentiation of the transplanted cells were confirmed. We have demonstrated that mesenchymal progenitor cells with multilineage potential can be isolated from the fetal liver and have potential utility for autologous tissue engineering.

Ischemic cardiomyopathy leading to congestive heart failure remains the leading source of morbidity and mortality in Western society and medical management of this condition offers only palliative treatment. While allogeneic heart transplantation can both extend and improve the quality of life for patients with end-stage heart failure, this therapeutic option is limited by donor organ shortage. Even after successful transplantation, chronic cardiac rejection in the form of cardiac allograft vasculopathy can severely limit the lifespan of the transplanted organ. Current experimental efforts focus on cellular cardiomyoplasty, myocardial tissue engineering, and myocardial regeneration as alternative approaches to whole organ transplantation. Such strategies may offer novel forms of therapy to patients with end-stage heart failure within the near future.

Study Objectives: To detect an adverse effect of chronic inhalative molybdenum trioxide (MoO3) exposure in a group of symptomatic MoO3 exposed workers., Participants: 43 inhalatively MoO3 exposed workers of a metal plant and 23 non-exposed controls were included in this study. Among the workers, 33 suffered from respiratory symptoms while 10 individuals were asymptomatic., Interventions: Chest x-ray, spirometry and bronchoalveolar lavage (BAL) were performed using standard equipment., Measurements and Results: Neither symptomatic nor asymptomatic MoO3 exposed workers showed firm radiological signs of interstitial lung disease. In lung function testing, symptomatic MoO3 exposed workers did not differ from their asymptomatic colleagues. Employees of the metal plant had a higher percentage of predicted forced expiratory volume in 1 second (FEV1 %) and a higher percentage of predicted forced vital capacity (FVC %) than controls (p<0.05). In BAL cytology, symptomatic MoO3 exposed workers showed higher percentage counts of lymphocytes (p < 0.001) and neutrophils (p < 0.01), and higher T4/T8 ratios (p < 0.01) than asymptomatic MoO3 exposed workers. Furthermore symptomatic workers showed higher percentage counts of lymphocytes (p < 0.05) and neutrophils (p < 0.05) than individuals of the control group., Conclusion: The results of BAL cytology in symptomatic workers may be interpreted as a MoO3 induced subclinical alveolitis. This may indicate an adverse effect of chronic inhalative MoO3 exposure. It remains unclear whether symptomatic MoO3 exposed workers are at risk for the development of an interstitial lung disease in the future.

Despite several studies examining the contribution of allorecognition pathways to acute and chronic rejection of vascularized murine allografts, little data describing activation of alloreactive T cells by mouse vascular endothelium exist. We have used primary cultures of resting or IFN-gamma-activated C57BL/6 (H-2(b)) vascular endothelial cells as stimulators and CD8(+) T lymphocytes isolated from CBA/J (H-2(k)) mice as responders. Resting endothelium expressed low levels of MHC class I, which was markedly up-regulated after activation with IFN-gamma. It also expressed moderate levels of CD80 at a resting state and after activation. Both resting and activated endothelium were able to induce proliferation of unprimed CD8(+) T lymphocytes, with proliferation noted at earlier time points after coculture with activated endothelium. Activated endothelium was also able to induce proliferation of CD44(low) naive CD8(+) T lymphocytes. Activated CD8(+) T lymphocytes had the ability to produce IFN-gamma and IL-2, acquired an effector phenotype, and showed up-regulation of the antiapoptotic protein Bcl-x(L). Treatment with CTLA4-Ig led to marked reduction of T cell proliferation and a decrease in expression of Bcl-x(L). Moreover, we demonstrate that nonhemopoietic cells such as vascular endothelium induce proliferation of CD8(+) T lymphocytes in a B7-dependent fashion in vivo. These results suggest that vascular endothelium can act as an APC for CD8(+) direct allorecognition and may, therefore, play an important role in regulating immune processes of allograft rejection.

Background: Cytotoxic T lymphocyte (CTL)-mediated destruction of allogeneic vascular endothelium is important in the pathogenesis of both acute and chronic allograft rejection. Despite the importance of this phenomenon, the effector mechanisms responsible for endothelial cell killing are not well defined, and conflicting conclusions have been reached based on variation in experimental methodology., Methods: We used a recently described method for isolating mouse vascular endothelium to evaluate endothelial cell lysis by CTLs. Endothelial cell destruction was assessed in vitro both by 51Cr release and DNA fragmentation using wild-type and lpr (Fas deficient) endothelium of C3H/HeJ (H2(k)) mice by MHC alloantigen-specific T cells of wild-type, gld (Fas ligand deficient), and perforin-deficient mice on a C57BL/6 (H2(b)) background., Results: Although maximal lysis of 56.6+/-0.8% was seen when using wild-type targets and effectors, only a moderate decrease in apoptosis to 37.6+/-4.0% was detected when the Fas/Fas ligand death receptor pathway was eliminated. This decrease in cytotoxicity occurred despite the preserved functional capacity of this pathway. Alternatively, a significant decrease in cytotoxicity to 17.4+/-4.7% was seen when the perforin/granzyme exocytosis pathway was eliminated., Conclusions: These data indicate that CTLs destroy vascular endothelium primarily by the perforin/granzyme exocytosis pathway with only a minor contribution to apoptosis by the Fas/Fas ligand death receptor pathway. These data are critical for the proper interpretation of studies evaluating acute and chronic allograft rejection and for the design of rational strategies to ameliorate vascular injury concomitant to the rejection process.

Background: Operative mortality after acute aortic dissection type A is still high, and prolonged stay at the intensive care unit is common. Little has been documented about factors influencing the intensive care unit length of stay. The aim of this study was to determine such variables., Methods: During a 10-year period, 67 patients (47 male, 20 female) were operated on for acute aortic dissection type A. In 42 patients (63%), an ascending aortic replacement was performed, 23 patients (34%) underwent a Bentall procedure, and 2 patients (3%) received a valve-sparing David type of operation. In 14 of these cases (20%), an additional partial or total arch replacement was performed., Results: Hospital mortality was 9 of 67 (14%). Median postoperative intensive care unit length of stay was 5 days (range, 1 to 72 days). Intensive care unit stay was in univariate analysis significantly influenced by the following factors: age (p = 0.008), body mass index (p = 0.039), cardiopulmonary bypass time (p = 0.018), aortic cross-clamp time (p = 0.031), postoperative low cardiac output syndrome (p < 0.001), and postoperative lactate levels (p = 0.01). By multivariate analysis, age (p = 0.012), cardiopulmonary bypass time (p = 0.037), and the presence of a postoperative low cardiac output syndrome (p < 0.001) significantly influenced intensive care unit stay., Conclusions: Stay in the intensive care unit after operation for acute aortic dissection type A seems to be determined by age, cardiopulmonary bypass time, and the postoperative presence of a low cardiac output syndrome.

Changes in the QRS complex during exercise may provide information with respect to ischaemic heart disease. The intention with present investigation was to shed light on mechanisms behind QRS changes and to study the possibly confounding effects of beta-blockade on such alterations with exercise. Placebo or propranolol respectively was infused in randomized and double-blinded order in seven young healthy men before a maximum exercise test. Advanced computerized vectorcardiography and impedance cardiography was recorded continuously together with blood pressures and blood samples. The Y-lead magnitude increased significantly with propranolol infusion (P < 0.05), but it tended to decrease in the Z-lead (P < 0.07). While the serum potassium concentrations increased (P < 0.0005), the spatial QRS magnitude tended to decrease irrespective of treatment (P < 0.07). These changes correlated with changes in QR-duration (adj r2 > 0.58). With exercise, the mean spatial QRS magnitude decreased with similar amounts irrespective of treatment. However, propranolol made the magnitude decrease earlier (P < 0.01). No effect of treatment was detected on the decrease in QRS-duration. Immediately after exercise, the QRS complex continued to change as during exercise in the placebo investigations, but did not with propranolol (P < 0.05). These different patterns were most obvious in the first half of the QRS complex in the Y-lead. It is concluded that acute beta-blockade modifies QRS alterations both during and after exercise in healthy subjects. This indicates that such drugs may have confounding effects in evaluations of the diagnostic value of QRS alterations.

Background: The relation between QRS changes during exercise and ischemic heart disease is controversial. The present investigation addressed whether exercise QRS changes are related 1) to myocardial ischemia or necrosis, 2) to possibly confounding factors such as baseline QRS size and changes in heart rate and ST magnitude during exercise, and 3) to the location of scintigraphic defects., Methods: Advanced computerized vectorcardiography (MIDA1000, Ortivus Medical AB, Sweden) was recorded in 71 consecutive patients referred for 201TI exercise myocardial scintigraphy. Maximal exercise tests were performed in the sitting position on a bicycle ergometer. Planar scintigraphic images were obtained immediately after exercise and 4 hours later in three projections, and were evaluated blindly., Results: Exercise QRS changes correlated to baseline QRS size (X, Y, and Z leads; P < 0.005), change in heart rate (X and Y leads; P < 0.01), and ST change at J + 20 ms (X, Y, and Z leads; P < 0.0001). Increased QRS magnitudes in the Y and Z leads correlated to late perfusion defects (P < 0.0001). These correlations remained after correction for baseline QRS size and changes in heart rate and ST magnitude at J+20 ms during exercise (P < 0.0001). No consistent relationships were observed between the location of myocardial perfusion defects and the stress-induced alterations in QRS., Conclusions: Baseline QRS size and changes in heart rate and ST magnitude may have important confounding effects on the QRS response to exercise. However, even after consideration of these factors, the QRS response to exercise was related to late (4 h) scintigraphic myocardial perfusion defects. The findings suggest that the presence of myocardial infarctions or long-lasting ischemia after exercise is associated with increased QRS magnitudes during exercise.

Despite intensive medical treatment to control chest pain, about one-third of patients with unstable angina have an unfavourable outcome within a period of 1 to 2 months. Holter monitoring can identify patients with silent myocardial ischaemia that are at a high risk of sustaining a major cardiovascular event. The present paper describes the use of dynamic, continuous, computerized on-line vectorcardiography for real-time monitoring of QRS-complex and ST-segment changes in patients with unstable coronary disease. In many patients a pattern of frequent repetitive episodes of QRS change was observed, with or without concomitant ST change. Whereas no patient had episodes of ST-vector change without also having episodes of significant QRS change, 15 patients had several episodes of QRS changes without any episode of significant ST change. The number of episodes of significant increase of the QRS vector difference correlated weakly but significantly with the number of episodes of significant ST-vector magnitude change (r = 0.34, p less than 0.05). The present study suggests that myocardial ischaemia will influence the QRS complex as well as the ST segment. The mechanism behind the QRS changes observed is not clear but episodes of QRS change without ST change or chest pain, may reflect sudden depressions of left ventricular function, as has been reported by others to occur in patients with coronary artery disease. Dynamic vectorcardiography offers the opportunity to monitor all parts of the QRST complex in real time.