Search

* Objective: To evaluate the effects of long-term intravenous infusion of prostacyclin on exercise capacity, hemodynamics, and survival in patients with primary pulmonary hypertension. * Design: Open, multicenter, uncontrolled trial. * Setting: Four referral centers. * Patients: 18 patients with primary pulmonary hypertension: 1 New York Heart Association (NYHA) class II patient, 13 NYHA class III patients, and 4 NYHA class IV patients. * Interventions: Continuous intravenous prostacyclin administered by portable infusion pumps. All patients were treated with anticoagulant agents. * Measurements and Main Results: With the 6-minute walk used to evaluate exercise capacity, patients could walk on average more than 100 meters farther after prostacyclin therapy was initiated (distance at 6 months, 370 [+ or -] 119 meters compared with 264 [+ or -] 160 meters at baseline; P < 0.001; distance at 18 months, 408 [+ or -] 138 meters; P = 0.02 compared with baseline). Hemodynamics were improved at 6 months: The cardiac index increased 18% (95% CI, 0.1% to 36.7%; P = 0.02), and mean pulmonary artery pressure and total pulmonary resistance decreased 9% (CI, 1.4% to 15.7%; P = 0.03) and 26% (CI, 6.1% to 46.3%; P = 0.02), respectively, compared with baseline. The improvements in cardiac index and total pulmonary resistance were maintained at 12 months (27% increase (CI, 1.3% to 51.9%; P = 0.05] and 32% decrease [CI, 9.7% to 53.6%; P = 0.02] compared with baseline, respectively). Survival was improved in NYHA class III and IV patients who received continuous prostacyclin (n = 17; follow-up, 37 to 69 months) when compared with historical controls who received standard therapy (National Institutes of Health Primary Pulmonary Hypertension Registry, n = 31, P = 0.045). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates for the patients treated with prostacyclin were 86.9%, 72.4%, and 63.3%, respectively, compared with 77.4%, 51.6%, and 40.6% for the historical control group (hazard ratio, 2.9 [CI, 1.0 to 8.0; P = 0.045]). Serious complications attributable to the drug and delivery system included two deaths and seven episodes of nonfatal sepsis in three patients. * Conclusions: Continuous intravenous prostacyclin resulted in sustained clinical and hemodynamic improvement and probably in improved survival in patients with severe primary pulmonary hypertension. Despite potentially serious complications, long-term prostacyclin may be especially helpful in seriously ill patients awaiting transplantation., Continuous intravenous prostacyclin treatment may prolong survival in patients with severe pulmonary hypertension. Pulmonary hypertension is elevated pressure in the pulmonary artery which leads to heart failure. If medical treatment is not effective, patients may require heart-lung or lung transplants. Prostacyclin is a vasodilator, or agent that expands the blood vessels. Eighteen patients with severe pulmonary hypertension received continuous prostacyclin infusion from a portable pump into a catheter implanted into a vein. The prostacyclin dose started at 2 to 8 nanograms per kilogram (ng/kg) of body weight, but increased respective to hemodynamic measurements until the average dose at three years was 53 ng/kg. Hemodynamic measurements, including cardiac index and pulmonary resistance, improved by one year. Four patients died during the study, two from disease progression and two from complications of the infusion therapy. Eight patients had transplantation, and six were still receiving prostacyclin, from 50 to 69 months after initiation of the study.

Objective: To determine the prevalence of measles seronegativity among infants younger than 6 months and to ascertain their serologic response to measles vaccine. Design: Cross-sectional measles antibody survey during the 1989 measles epidemic in Chicago, Ill. Setting: Inner-city perinatal center. Participants: Two hundred three infants younger than 6 months who had been admitted to the neonatal intensive care unit at birth; 130 (64%) of these infants were premature. Transplacental antibody transfer was evaluated in a subset of 89 mother-newborn pairs. Intervention: Administration of measles monovalent vaccine to seronegative infants. Measurements/Results: Measles IgG antibody was measured using indirect fluorescent assay. At birth, 19 (38%) of 50 neonates born at less than 3 7 weeks' gestation had antibody titers that were twofold to fourfold lower than those of their mothers compared with three (8%) of 39 neonates born at more than 37 weeks' gestation (P, Whether a child has immune protection against measles at age six months or younger depends primarily on gestational age at birth, chronological age, and mother's age at the time of the birth. During a 4-month period of 1989, a group of 203 infants admitted to neonatal intensive care at Cook County Hospital in Chicago were evaluated for measles immune status. This was during a measles outbreak, and immunization was being recommended for infants six months and older. At birth, 38% of preterm newborns lacked immunity versus 8% of full-term newborns. At birth, 4% of newborns lacked immunity versus 74% of infants four to five months old. Mothers of 88% of infants lacking immunity were born after 1963, when mass immunization against measles began. When infants lacking immunity were immunized, 79% developed immunity.

Objective: Although the Global Deterioration Scale has been widely used since its publication in 1982, its stages are based on implicit assumptions about the linearity, temporality, and interdependence of cognitive, functional, and behavioral impairment in Alzheimer's disease. The authors evaluated the validity of these assumptions and tested the hypothesis that psychopathology and functional impairment would occur in earlier stages than the Global Deterioration Scale predicts. Method: The analyses were based on data on 324 patients with Alzheimer's disease who were selected from a registry of such patients. Data analyses included 1) descriptive statistics on the frequency of psychiatric symptoms and difficulties with activities of daily living and 2) logistic regression, with symptoms and functional impairment as independent variables, to test for significant changes in patients' status between stages of the Global Deterioration Scale. Results: More than 50% of the patients at stage 2 displayed psychopathology, and 32% had two or more symptoms. The significant increase in psychiatric symptoms occurred between stages 3 and 4, not between stages 5 and 6 as predicted by the Global Deterioration Scale. Impairment in functional status was observed at all stages, and significant increases occurred between stages 3 and 4 as well as between stages 5 and 6. Conclusions: Psychiatric symptoms and functional impairment occur earlier than predicted by the Global Deterioration Scale, and the rate of change is also different from that specified in the scale. Separate scales to describe cognitive, clinical, and functional status may be the best way to describe the illness until better multidimensional instruments are developed.

Adult Population Estimates Obtained from Measurements of Chest Roentgenograms from the NHANES II Survey Stuart Rich, M.D., F.C.C.P.;(*1) Eva Chomka, M.D.;(*1) Lawrence Hasara, M.D.;(*1) Kimberly Hart, R.N.;(*1) Terence Drizd, B.S.;[unkeyable] [...]