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High density lipoprotein (HDL) cholesterol changes were followed in 45 men with coronary heart disease who underwent 12 weeks of monitored aerobic exercise. Twenty-five patients who were taking a nonselective beta-receptor blocking drug (Group 1) did not demonstrate a significant change in HDL cholesterol after exercise (mean difference 2.8 +/- 11.5 mg/dl), whereas patients who had not received a beta-blocking drug for greater than or equal to 3 months (Group 2) showed a significant increase (mean difference 8.4 +/- 5.5 mg/dl; p less than 0.05). However, for those patients in each group who had an initial HDL cholesterol level less than 35 mg/dl before exercise, there was a significant increase in HDL cholesterol levels (mean difference 8 +/- 6.9 mg/dl [p less than 0.02] and 11 +/- 3 mg/dl [p less than 0.001] for Group 1 and Group 2, respectively) and a significant decrease in the low density lipoprotein (LDL/HDL cholesterol ratio (mean difference -1.2 +/- 1.6 [p less than 0.05] and -0.9 +/- 0.57 [p less than 0.001], respectively). Patients in both groups who started exercise with an HDL cholesterol level greater than 35 mg/dl did not show a significant change after exercise. Patients in Groups 1 and 2 achieved similar levels of exercise training after 12 weeks and were closely matched in age, medications, alcohol intake and smoking. The results indicate that among high risk patients (with an abnormally low HDL cholesterol level) exercise training can induce an augmentation of HDL cholesterol in those receiving a beta-blocking drug similar to that of patients not receiving such a drug.

Incorporating prognostically related auscultatory, M-mode, 2DE and recent Doppler echocardiographic features, the following strict criteria for establishing the diagnosis of mitral valve prolapse (MVP) have been advanced: 1. auscultatory; mid-to-late systolic clicks and a late systolic murmur at the apex or mid-to-late systolic clicks at the apex which move appropriately with maneuvers that alter LV volume or late systolic murmur at the apex in young patients (coinciding that a similar murmur in elderly population is non-specific for MVP); 2. two-dimensionally "targeted" M-mode criterion: marked (greater than 3 mm) late systolic buckling posterior to C-D line (moderate 2 mm late systolic buckling or 3 mm holosystolic displacement "arouse suspicion" but do not establish MVP); 3. two-dimensional echocardiographic criteria: severe bowing of leaflet(s) on the parasternal long axis and four-chamber view (mild to moderate bowing alone are unacceptable) or left atrial coaptation point; 4. Doppler echocardiographic criteria: moderate or severe Doppler mitral regurgitation with any degree of leaflet bowing or mild Doppler mitral regurgitation with at least moderate bowing of one leaflet (mild leaflet bowing and mild mitral regurgitation can be regarded as "probable MVP"). The concept of mitral valve prolapse syndrome encompasses that which was earlier described in patients with a high prevalence of symptoms. In controlled studies, however, it has become apparent that cardiac and psychiatric symptoms can be found as frequently in normal subjects as in those with MVP. These results indicate that clinicians may have erroneously diagnosed patients with MVP because of premature acceptance that MVP is the cause of a distinctive syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

For many years, from the discovery of X-ray up today, medical morfological diagnosis has been based on the analysis of radiographic image. Having regard to the potential risks of ionizing radiations, radiological exploration can not be taken into account as they are harmful, and in some cases they can become dangerous. Authors point out that an abusive using of radiological exploration exists in our country. As for children, a negligent use of radiology can reach very concerned limits. Ultrasound systems which are currently available, used before radiology in a systematical manner, can resolve a morfological diagnostic in many cases, in a sure and faster way, with the great advantage to be a risk-less procedure because ultrasounds are mechanical not ionizing waves. Six cases are shown as an example of the diagnostic possibilities of ultrasound in pediatrics.

The present study was performed in ten cases of hyperparathyroidism with a history of recurrent renal colic with or without passing calculi. Most of these patients had undergone stone surgery. Diagnosis was based on patient history, and metabolic and radiologic work up, and confirmed histologically following surgical exploration of the neck and removal of the pathologic parathyroid gland.

The article reports on a survey conducted in Colombia to evaluate the part played by the nurse in the functions covered by what has come to be called "the expanded role of nursing." According to the survey, there are 2,213 practicing nurses, who are clustered in the principal cities of the country. Those who participated in the study are young nurses holding staff positions in such institutions as university and social security hospitals. Their training is mostly at the university level, and they have had five years or less of experience. The article notes that, to perform the duties of the expanded role, the nurse must participate in accordance with her training, interest and motivation. The participation may be conditioned by factors in the nurse herself (prior knowledge, former training, previous participation, and responsibility) and by factors in the working environment (the person who instructed her on her role, the post she holds, her length of service/length of her work day, permission received from the institution to exercise her function, and the medical and nursing agreement). Parodoxically, the nurse is being made a participant in new functions at hospitals where there are medical resources and not in regions and places where those resources are scarce or nonexistent. The expanded role of nursing opens to the nurse a range of activities that enable her to provide quality care to the patient and to his or her family and community, to extend the coverage of health services, and offer treatment effectively.

A case of osseous lymphangiectasis in a girl is presented and a review of existing literature is made. We include this illness in the group of complex vascular displasis. We mainly focus our attention on radiographic examination which is characteristic, even if not specific. Diagnosis was confirmed by osseous biopsy which is not easy to perform successfully but produced a positive result in our case. It was not possible to perform lymphography.