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EB-virus-specific IgM and IgG antibodies (to virus capsid and soluble complement fixing antigens) were estimated in sera from mothers and sibs of children with acute lymphoblastic leukaemia, from patients with infectious mononucleosis, and from control induviduals. IgM antibodies were present in 12 of 16 mothers and 3 of 4 sibs of children with acute lymphoblastic leukaemia. They were also present in 14 of 16 patients with infectious mononucleosis, but in only 1 of 12 control individuals. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronisation therapy improves peak oxygen uptake (peak VO2) 3-9 months after device implantation. In chronic heart failure, total isovolumic time (t-IVT) is a major determinant of peak VO2 and of cardiac output at peak dobutamine stress. In selected patients, resynchronisation can instantaneously shorten t-IVT. We sought to determine the acute effect of resynchronisation on exercise performance and deter- mine, with pharmacological stress echocardiography, the mechanism underlying this effect. Methods and results: Twenty-two patients with resynchronisation were studied within 3 months after device implantation. On a single study day, sequential cardiopulmonary exercise tests were performed during native activation (left bundle branch block) and resynchronisation (atrio-biventricular pacing) in random order. Total-IVT and cardiac output (at rest and peak dobutamine stress) were then measured in each activation mode. Resynchronisation acutely increased peak VO2 by 1.6 (SD 1.5) mI/kg/mm (p<0.001) and shortened peak stress t- IVT by 10 (SD 7) s/mm (p<0.001), with the effects in individual patients showing a correlation (r = -0.46, p<0.05). Amongst all measurements during native activation, the best predictor of gain in peak VO2 from resynchronisation was peak stress t-IVT (r = 0.71, p<0.001) with every increment of 5 s/min of peak stress t-IVT during native activation predicting an 8% gain in peak VO2. No conventional measures during native activation at rest or on stress (including QRS duration, Tei index, tissue Doppler intraventricular delay, and resting t- IVT) added significant additional information. Conclusions: In eligible patients, resynchronisation can acutely augment peak VO2, possibly through a mechanism of t-IVT shortening. Under native activation, long t-IVT during peak stress is the single best predictor of acute resynchronisation-mediated increment in peak VO2. [ABSTRACT FROM AUTHOR]

There are many treatment modalities available and most are very expensive. With poor evidence base, it is important therefore for all cases to be discussed and managed within a multidisciplinary team. The patient should have information available with which to make rational choices about various treatments. This information can be obtained through centres who regularly treat these patients UKNET is an organisation set up to discuss management of carcinoid and gastroenteropancreatic NETs. Contact is the UKNETWORK website: www.uk-network.org.uk The patient support group can be contacted at livingwithcarcinoid.org.uk (website under construction). [ABSTRACT FROM AUTHOR]

Objective: To define the responses to head up tilt in a large group of normal adult subjects using the most widely employed protocol for tilt testing.Methods: 127 normal subjects aged 19-88 years (mean (SD), 49 (20) years) without a previous history of syncope underwent tilt testing at 60 degrees for 45 minutes or until syncope intervened. Blood pressure monitoring was performed with digital photoplethysmography, providing continuous, non-invasive, beat to beat heart rate and pressure measurements.Results: 13% of subjects developed vasovagal syncope after a mean (SD) tilt time of 31.7 (12. 4) minutes (range 8.5-44.9 minutes). Severe cardioinhibition during syncope was observed less often than is reported in patients investigated for syncope. There were no differences in the age or sex distributions of subjects with positive or negative outcomes, or in the proportions with cardioinhibitory and vasodepressor vasovagal syncope compared with previously reported patient populations. Subjects with negative outcomes showed age related differences in heart rate and blood pressure behaviour throughout tilt.Conclusions: False positive results with tilting appear to be common. This has important implications for the use of diagnostic tilt testing. The magnitude of the heart rate and blood pressure changes observed during negative tilts largely invalidates previously suggested criteria for abnormal non-syncopal outcomes. [ABSTRACT FROM AUTHOR]

Paraneoplastic limbic encephalitis is a rare cause of subacute dementia. A patient with limbic encephalitis and small-cell lung carcinoma is reported in whom the onset of subacute cognitive impairment was obscured by concurrent Alzheimer's disease. MRI revealed increased T2 signal in medial temporal lobes which corresponded to inflammatory pathology demonstrated at necropsy. High titres of antineuronal antibody (type II, anti-Hu) were present at death. Direct immunofluorescent staining of necropsy tissue revealed IgG bound to most remaining neurons in the temporal lobe. Antineuronal antibody screening and MRI are important in detecting limbic encephalitis. [ABSTRACT FROM AUTHOR]

Human brain cells were examined for the presence of herpes simplex virus type 1 (HSV1) DNA sequences by in situ hybridisation. Viral genome was detected in immunosuppressed patients with virological evidence of past HSV infection but not in immunosuppressed patients with no such evidence. In patients who had not been immunosuppressed, no HSV DNA sequences were detectable. [ABSTRACT FROM AUTHOR]

, , 603-607. Twenty-five patients in the National Heart Hospital have had aortic valve replacement with unsupported autologous fascia lata and have been followed for two to three and a half years. Three patients died before leaving hospital. Nine of the 22 survivors required re-operation for severe aortic regurgitation and the other 13 developed aortic incompetence. In 11, regurgitation dated from the operation and progressed; and in 11 it appeared later and progressed. In view of the disappointing results which were obvious within six months unsupported autologous fascia lata valves have not been used for aortic valve replacement since December 1970. [ABSTRACT FROM PUBLISHER]

Objective: To assess possible ECG changes caused by dobutamine stress and their relation to wall motion disturbances in patients with coronary artery disease.Design: Prospective recording and analysis of 12 lead ECG at rest and during each stage of dobutamine stress echocardiography, and correlation with wall motion changes.Setting: A tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress tests.Subjects: 27 patients, mean (SD) age 60 (8) years, with documented evidence of coronary artery disease in whom dobutamine stress echo was clinically indicated, and 17 controls of similar age.Results: In controls, all ECG intervals shortened with increasing heart rate but in the patient group only PR and QT intervals shortened while QRS duration broadened and QTc interval prolonged progressively. In the 27 patients, 16 developed chest pain, 15 with reduced left ventricular long axis systolic excursion (p < 0.001), and all showed reduced peak lengthening rate; ST segment shift appeared in 16, 13 of whom developed chest pain, but did not correlate with reduction of either systolic long axis excursion or peak lengthening rate; QRS duration broadened in 20, 16 with reduction of long axis excursion (p < 0.02) which was more often seen at the septum (p < 0.005); QTc interval prolonged in 19, all of whom had associated reduction of peak long axis lengthening rate (p < 0.02).Conclusions: QRS duration and QTc interval both normally shorten with dobutamine stress, while in coronary artery disease they both lengthen: changes in QRS duration correlate with systolic and QTc interval with diastolic left ventricular wall motion disturbances. ST segment shift also occurred in most patients, but without consistent correlation with wall motion abnormalities. It was thus less discriminating than the other two abnormalities in this respect. [ABSTRACT FROM AUTHOR]

AIMS: To develop and validate an analytical procedure for the quantitation of pepsins and gastricsin in human gastric juice and to assess its potential in a controlled gastric secretory study. METHODS: High performance ion-exchange chromatography was used to separate human pepsin 1, 3a, 3b, 3c and gastricsin from gastric juice. Computed chromatographic areas for each enzyme were quantified by relation to a known amount of a secondary standard porcine pepsin. The assay procedure was validated by recovery and analytical precision studies. Gastric secretions after pentagastrin and insulin stimulation from 10 patients with portal hypertension were used to assess the potential of the analytical procedure. RESULTS: The assay precision varied from 1.5 to 9.0% within batch and 7.5 to 18.1% between batch, with about 100% recoveries of porcine pepsin A from human gastric juice over the assay range 0.025-0.5 mg/ml. A fourfold increase in combined pepsin and gastricsin concentration was observed following pentagastrin and insulin stimulation. The mean percentage content of pepsins 3a, 3b, 3c, and 1 in non-stimulated gastric juice were 4%, 72%, 12% and 1.4%, respectively, and did not change significantly after gastric stimulation. An approximate doubling of the percentage of gastricsin (10% to 20%) relative to the pepsins was observed, however, after both insulin and pentagastrin stimulation. CONCLUSIONS: This procedure for quantifying individual human pepsins and gastricsin in gastric juice is simple and reliable. It may be of considerable importance in determining the mechanisms involved in the control and secretion of these digestive enzymes in man, including the effect of anti-ulcer drugs and our understanding of the pathophysiology of peptic ulcer disease. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--To evaluate the effect of permanent pacing in cardioinhibitory malignant vasovagal syndrome. PATIENTS AND METHODS--37 patients with permanent pacemakers for cardioinhibitory malignant vasovagal syndrome. All presented with syncope (median six episodes, median frequency two episodes a year) and after conventional investigation and invasive electrophysiological assessment they remained undiagnosed, and without a generally accepted indication for pacemaker implantation. In all vasovagal syncope with cardioinhibition (heart rate at syncope < 60 beats/min) developed during tilt tests performed according to the Westminster protocol (head up tilt at 60 degrees with a footplate support for 45 minutes or until syncope intervenes). Dual chamber pacemakers were implanted in 35 (95%) and VVI pacemakers in the remaining two (5%). RESULTS--Over a mean (SD) follow up since implantation of 50.2 (23.9) months symptomatic improvement occurred in 89%: 62% remained free of syncope and 27% were completely symptom free. The collective syncopal burden of these 37 patients was reduced from 136 to 11 episodes each year. During follow up three patients died from unrelated causes. Patients who become asystolic during the tilt test (sinus pause of at least four seconds) experienced no greater benefit from pacing than those with less extreme cardioinhibition. Patients who remained free of syncope since implantation were younger than those who continued to experience syncope. Patients who remained completely symptom free after implantation were younger, more likely to be male, and had had fewer syncopal episodes before implantation than those who continued to experience syncope or presyncope. No other demographic, clinical, investigative, or pacing variable suggested a more favourable outcome after implant. CONCLUSIONS--This retrospective and uncontrolled experience suggests a possible role for permanent pacing in selected patients with cardioinhibitory malignant vasovagal syndrome. Improved acquisition of tilt test data may enable better selection of patients who are suitable for permanent pacing. A randomised prospective study to compare permanent pacing with no treatment or with medical treatment in cardioinhibitory malignant vasovagal syndrome is indicated. [ABSTRACT FROM PUBLISHER]

The effects of DDD (fully automatic) and VVI (ventricular demand) pacing modes on exercise tolerance, symptom diary cards, and Holter monitoring were investigated in a randomised double blind crossover study of 16 patients who had had DDD pacemakers implanted because of frequent syncope. Eight patients presented with sick sinus syndrome and, with one exception, retrograde atrioventricular conduction and eight age and sex matched patients presented with 2:1 or complete atrioventricular block. Maximal symptom limited exercise in those with atrioventricular block was significantly higher after one month of DDD pacing than after VVI pacing. In those with sick sinus syndrome, however, maximal effort tolerance was not significantly different for the two pacing modes. In all but one patient with sick sinus syndrome sinus rhythm developed during exercise in VVI pacing. For both VVI and DDD modes maximal atrial rates were significantly lower in those with sick sinus syndrome. Palpitation and general wellbeing were significantly improved during DDD pacing in the eight patients with sick sinus syndrome. Shortness of breath was improved by DDD pacing in the eight patients with atrioventricular block but not in those with sick sinus syndrome. Holter monitoring showed that sick sinus syndrome patients remained in paced rhythm, either DDD or VVI, for most of the 24 hour period. DDD pacing was better than VVI pacing in sick sinus syndrome with retrograde atrioventricular conduction. Despite their ability to show sinus rhythm and inhibit their pacemakers on exercise patients with sick sinus syndrome are just as likely to have symptomatic benefit from DDD pacing as patients with atrioventricular block. [ABSTRACT FROM PUBLISHER]

A within patient double blind prospective study of symptoms and exercise tolerance was designed to determine the preferred pacing mode in 10 patients with programmable dual chamber pacemakers who also had angina pectoris. Patients were randomly allocated to one month in each of the following modes: ventricular pacing at 70 beats/min (VVI) or atrioventricular synchronous upper rate 150 beats/min (DDD 150) or 100 beats/min (DDD 100). Medications were unchanged throughout the study; none was taking beta blockers. At the end of each month patients underwent an exercise test. During each month patients recorded symptoms and their preferred pacing mode. DDD 100 was the preferred mode (seven patients). There was significantly less chest pain with this mode than with either of the other modes. There were significantly more episodes of dizziness in VVI, and two patients who developed pacemaker syndrome were unable to complete the pacing period. Three patients developed angina during exercise testing in DDD 150. Atrial synchronous ventricular pacing is better than ventricular pacing for the control of symptoms in patients with angina pectoris provided that the upper atrial tracking rate is limited. [ABSTRACT FROM PUBLISHER]

Thirteen patients have completed a randomised double blind cross over study to compare the effects of chronic ventricular and atrial synchronous pacing on exercise capacity and symptoms. Maximal symptom limited exercise was significantly increased after one month of atrial synchronous pacing compared with ventricular pacing. Symptomatic assessment (by diary card and monthly symptom scores) of "shortness of breath", "palpitation", and "general well-being" was significantly improved during the physiological pacing mode. Atrial synchronous pacing has been shown to be superior to ventricular pacing. [ABSTRACT FROM PUBLISHER]

Seventy patients have been paced for carotid sinus syndrome over four years. Twelve patients had persistent symptoms despite adequate ventricular pacing. Patients with persistent symptoms were found to have a significant vasodepressor response, a significant hypotensive response to ventricular pacing (pacemaker effect), and a severe hypotensive response to carotid sinus massage with introduction of ventricular pacing, which reproduced symptoms in all patients. A group of 14 asymptomatic paced carotid sinus patients was found to have a significantly lower vasodepressor response, pacemaker effect, and combined vasodepressor response plus pacemaker effect than the group with persistent symptoms. Atrioventricular sequential pacing was shown to eliminate the hypotensive effect of ventricular pacing and is considered to be the treatment of choice for patients with carotid sinus syndrome who have both cardioinhibitory and significant vasodepressor responses. [ABSTRACT FROM PUBLISHER]

Three hundred and fifteen transvenous pacing leads of various modern designs have been assessed over a period of three years. Of these, 103 were implanted in the atrium and 212 in the ventricle. Screw-in leads in the right atrial appendage and short tined leads in the ventricle have resulted in the virtual elimination of lead displacement, and a very low incidence of other lead related problems. In two lead systems it has been found advantageous to have both leads constructed of urethane. [ABSTRACT FROM PUBLISHER]

Attention has recently been drawn to the relatively poor prognosis of middle aged patients paced for chronic atrioventricular block when age-linked expectation of life is taken into account, and it has been suggested that this may be the result of underlying coronary artery disease, despite the absence of symptoms to suggest this. It was the purpose of this study to determine the incidence of unsuspected coronary artery disease in middle aged patients presenting with chronic atrioventricular block. Studies were made on a consecutive series of 30 patients aged 45 to 65 (mean age 56 years) with chronic atrioventricular disease who had been referred for pacing. Patients presenting with acute myocardial infarction or angina or with sinuatrial disease without atrioventricular disease were excluded. Coronary arteriography disclosed the presence of severe coronary artery disease in 13 patients. Of the remaining 17 patients, four had congestive cardiomyopathy, two had hypertrophic cardiomyopathy, one had aortic stenosis, and in 10 patients the aetiology of the heart block was unknown. Myocardial revascularisation was undertaken in six patients with paroxysmal atrioventricular block caused by coronary artery disease. Operation did not result in any sustained improvement in atrioventricular conduction. [ABSTRACT FROM PUBLISHER]

A fundamental description of pacemaker systems which are commercially available or in clinical validation is given as a background for their application in a series of 62 consecutive patients presenting over a period of 1 year for permanent cardiac pacing. The patients (23 (37%) sick sinus syndrome, 38 (61%) atrioventricular block, and 1 ventricular tachycardia) were studied electrophysiologically and haemodynamically to allow the appropriate application of a pacemaker system. In sick sinus syndrome, 8 patients had permanent atrial pacing, 14 ventricular pacing, and 1 atrioventricular sequential pacing; in atrioventricular block, 8 patients had atrial synchronous ventricular inhibited pacing and the remaining 30 had ventricular pacing. A high incidence of atrial fibrillation, 9 patients, and abnormal sinus node function, 15 patients, precluded wider use of atrial synchrony. The results show benefit in acute haemodynamic studies of using systems including atrial sensing and/or pacing, and with greater availability of atrioventricular sequential and still more advanced pacemakers with dual sensing as well as dual pacing the majority of patients may be offered this benefit. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to evaluate the need for permanent pacing in patients who have survived the effects of anterior myocardial infarction with complete heart block and have returned to sinus rhythm but who are left with impairment of intraventricular conduction. We have reviewed 52 patients with complete heart block complicating recent anterior myocardial infarction. Temporary pacing was instituted in all patients. There were 25 hospital survivors who were followed for an average of 49 months. Long-term pacing was established in 4 patients. Of the 21 patients in sinus rhythm, 14 had partial bilateral bundle-branch block with either right bundle-branch block and left anterior hemiblock or right bundle-branch block and left posterior hemiblock; at the end of the follow-up period, 10 of these 14 were alive and well. Furthermore, permanent pacing failed to prevent sudden death in 2 patients. At the present time, therefore, we conclude that long-term pacing is not justified in patients, otherwise asymptomatic, with partial bilateral bundle-branch block persisting after transient complete heart block in anterior myocardial infarction. [ABSTRACT FROM PUBLISHER]

Mitral reguritation is a relatively common finding in coronary heart disease. In this series of 127 patients, selected with a view to coronary or left ventricular surgery on the basis of severity of symptoms, the incidence was 39 (31%). Mitral regurgitation is significantly more common in patients with a history or electrocardiographic evidence of previous myocardial infarction. Clinically it may present as a pan- or late systolic or even a mid-systolic, ejection type murmur at the apex or at the left sternal edge; but in 39 per cent of the patients with angiographic mitral regurgitation no murmur was present. Angiographically important mitral regurgitation (grades 2-4/4) was usually associated with a systolic murmur; this finding was independent of ejection fractions. Left ventricular enlargement clinically or radiographically is likely to accompany mitral regurgitation but left atrial enlargement (electrocardiographically or on chest x-ray) is a more reliable pointer to mitral regurgitation and pulmonary venous hypertension is even more strongly suggestive of its presence. The electrocardiographic signs of papillary muscle infarction were rare in this series (15%) and were not related to angiographic mitral regurgitation. There was no difference in the incidence of mitral regurgitation in association with anterior or inferior myocardial infarction or in distribution of coronary artery disease. There is, however, a higher incidence of mitral regurgitation in more severe coronary arterial disease (P less than 0-05). The incidence of mitral regurgitation is significantly higher with reduction in left ventricular ejection fraction (P less than 0-001), with rise in the left ventricular end-diastolic pressure (P less than 0-02), and with abnormal contraction patterns, but the severity of mitral regurgitation is not significantly related to these findings. [ABSTRACT FROM PUBLISHER]

Changes in haemodynamics and in systolic time intervals, early after valve replacement, were studied in a group of 15 patients. Though all the haemodynamic measurements were within normal limits at 44 hours after operation, there was a persistent change in systolic time intervals (shortening of left ventricular ejection time and electromechanical systole, and prolongation of pre-ejection period and increase in the ratio PEP/LVET). The effect of periods of myocardial ischaemia during cardiopulmonary bypass on myocardial function is suggested as the explanation for the changes observed. [ABSTRACT FROM PUBLISHER]

Evidence of asymptomatic EB virus infection was sought in healthy medical students and nurses following the observation that 1·4% possessed heterophile antibodies. The proportion of subjects with EB virus antibodies rose with age and there was evidence of recent infection in 19%. Smooth muscle antibodies were detected in 13 individuals and recent infection with EB virus was probable in six of these. Subclinical EB virus infections, in some cases associated with some disturbance of immunological function, may therefore be not uncommon in young adults. [ABSTRACT FROM PUBLISHER]

The plasma magnesium concentration has been determined in 73 patients with primary hyperparathyroidism. In most patients it lay within the normal range (1·7-2·3 mg./100 ml.), but in five it was less than 1·6 mg./100 ml. These patients had relatively high urinary magnesium outputs, and one of them, studied in greater detail, failed to retain parenterally administered magnesium. Hence hypomagnesaemia in hyperparathyroidism may be associated with a defect in renal magnesium conservation, which may be reversible. [ABSTRACT FROM PUBLISHER]

A continuous cell culture line, derived from a nurse with infectious mononucleosis, is described. Electron microscopic and immunofluorescent examination suggested that it was substantially free from detectable complete virus particles, although the presence of a soluble complement-fixing antigen showed the persistence of other antigenic components of the EB virus. [ABSTRACT FROM PUBLISHER]

Complement-fixing antibodies against an antigen prepared from the EB3 line of cultured Burkitt tumour cells were studied in various groups of patients and control individuals. Higher antibody titres were observed in patients with Burkitt's tumour than in African patients with other diagnoses. Significantly more medical students and nurses with a history of infectious mononucleosis possessed antibodies than those with no such history. Low levels of antibody were observed in patients during the acute phase of infectious mononucleosis and these levels were significantly lower than those in patients admitted to the same hospital with other diagnoses. During the early months following the acute phase of illness, EB complement-fixing antibodies remained stationary or apparently declined in titre but, in patients tested one or more years later, significantly higher antibody levels were observed. [ABSTRACT FROM PUBLISHER]

A strain of adenovirus type 7 was recovered from cultured brain cells, taken at necropsy from a patient aged 71 years with chronic schizophrenia. This recovery may indicate the reactivation of a latent infection with one of the few adenoviruses that has regularly-if rarely-been associated with clinical encephalitis. [ABSTRACT FROM AUTHOR]

Examines the aspects of tachycardia in a patients with paroxysmal supraventricular tachycardia and polyuria during electrophysiological analysis. Discovery on the characteristics of tachycardia; Mechanism of polyuria in patients with tachycardia; Causes on the development of polyuria in tachycardia.

Only four cases of tricuspid stenosis related to endocardial pacemaker leads have been reported. Two further cases associated with perforation of a tricuspid valve leaflet by a pacemaker lead are presented: a 46 year old woman and a 60 year old man. It is possible that tricuspid valve disease related to endocardial pacemaker and non-thoracotomy defibrillator leads is underrecognized. Diagnosis requires clinical suspicion and the use of Doppler echocardiography. Recent evidence of fibrosis affecting the tricuspid valve in hearts from patients who have had non-thoracotomy defibrillator implants suggests that this problem could be more common in the future. [ABSTRACT FROM AUTHOR]

A patient dependent on a pacemaker and with a rate responsive unit presented with symptomatic ventricular tachycardia despite drug treatment. He was managed with a third generation implantable cardioverter defibrillator, while rate responsive pacing was maintained. [ABSTRACT FROM PUBLISHER]

A female patient with a three year history of Crohn's disease of the colon developed myasthenia gravis. Despite diversion of the faecal stream by an ileostomy, and total colectomy, the patient had continuing problems with perineal and perianal abscesses and fistulas. Her myasthenia gravis became unresponsive to anti-cholinergics so a thymectomy was performed. The perineal and perianal disease improved subsequently. This case supports the theory that functional disturbances of the thymus may have a role in the pathogenesis of inflammatory bowel disease. [ABSTRACT FROM PUBLISHER]

Intracellular activation of both trypsin and cathepsin B is known to occur early in the course of acute pancreatitis. This study aimed to determine the time course and subcellular location of: such activation and its relationship to abnormal Ca[sup 2+] signalling. Isolated mouse pancreatic acinar cells were loaded with 10 µM IPR-CMAC (a fluorescent substrate specific for trypsin) and/or (FR)2-R110 (specific for cathepsin B), together with fura-2 for measurement of cytosolic Ca[sup 2+] ([Ca[sup 2+]],) and were then perifused with stimuli. Enzyme activation was visualised by confocal microscopy, and changes in cellular morphology by electron microscopy. Cells exposed to 10nM CCK or 2 pM thapsigargin showed a rapid rise in [Ca[sup 2+]], followed by a modest sustained elevation. Within 300 seconds of application of: the stimulus, fluorescence appeared within multiple discrete rounded compartments approximately 1 pm in diameter within the granular pole of the cell. These gradually enlarged with continued stimulation and became less distinct. By 60 min, typical vacuoles were apparent on electron microscopy. The fluorescence from both enzyme substrates developed within spatially indistinguishable compartments at the apical pole of the cell but trypsinogen activation preceded cathepsin B activation by a mean of 85 ± 34s. Trypsinogen activation occurred more rapidly and reached a plateau 200 seconds earlier than that from cathepsin B. Attenuation of the abnormal [Ca[sup 2+]][sub i] signals with the Ca[sup 2+] chelating agent BAPTA prevented both trypsinogen activation and vacuolisation. These findings build on our previous findings (PNAS 2000;97:13126-31) and confirm the crucial role of abnormal cytosolic Ca[sup 2+] signals in the initiation of intracellular enzyme activation. Trypsinogen activation occurs within zymogen granules, which then become vacuoles. These results are consistent with the central role trypsinogen activation is thought to play in... [ABSTRACT FROM AUTHOR]

Examines the use of sutures on patient with primary closure of pretibial laceratios. Use of skin grafting for flap lacerations; Methodology of the treatment; Efficacy of the treatment on pretibial lacerations.

Examines the effect of dual chamber pacing on raised plasma atrial natriuretic peptide concentrations in complete atrioventricular block. Increase of atrial pressures; Restoration of the normal sequence of atrial and ventricular contraction; Protection against the development of overt cardiac failure.