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  • 1
    ISSN: 1615-2573
    Keywords: Tedral-Teratogens-Drug combination-Fetus ; Drug effects-Truncus arteriosus ; persistent ; drug effects-Theophylline
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We recently performed a detailed anatomicopathologic examination on an aborted human embryo whose mother had taken four tablets of Tedral (one tablet of Tedral contains 130 mg theophylline, 25 mg ephedrine, 8 mg phenobarbital) for an upper respiratory tract infection when the embryo was at approximately 30 days of development. On the same day, the mother developed acute chest pain and a fast, irregular heart beat. The abortion occurred at approximately 80 days of gestation. The heart of the fetus showed truncus arteriosus (Van Praagh type Al). Although no direct cause and effect relationship was proven in this case, the possibility of a teratogenic effect of Tedral during early pregnancy is considered.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Our recent survey of the Japanese literature, actual case experience, and previous studies revealed the following results. Fifty-three cases were reported in which the main cause of death in sarcoidosis was congestive heart failure (11 of 17 cases, 64.7%) and not sudden death as was previously believed. ECG analysis revealed that third degree AV block, bundle branch block, and ventricular arrhythmias were the most frequent findings indicating the presence of cardiac sarcoidosis. It was recognized that in the Japanese population fatal myocardial sarcoidosis or clinical diagnosed cardiac sarcoidosis occurred most frequently in females over the age of 40 years. It is suggested that myocardial changes progress independently of granulomatous changes. This is due to the detection of a high incidence of basal lamina layering of myocardial capillaries (14 of 18 cases, 77.8%) and is considered to play a significant role in the progression of this disease. Radionuclide studies showed that thallium scintigraphy or technetium ventriculography were positive in those cases where ECG abnormalities are prominent, indicating the presence of myocardial disease. Previous therapeutic studies of cardiac sacoidosis have shown a decrease in the incidence of sudden death; death due to congestive heart failure occurred more frequently despite pacemaker implantation. Control of congestive heart failure is thus regarded as the most important aspect of improved treatment and prognosis.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Heart and vessels 1 (1985), S. 77-78 
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The rather widespread adoption of endomyocardial biopsy in the USA has occurred mainly due to newer and safer techniques and the need to study more completely an increasingly prevalent population of patients presenting with idiopathic myocardial disease. Investigators caution, however, that without firmer knowledge the technique of biopsy may be limited to detection of allograft rejection, grading of anthracycline toxicity, and uncovering of occasional, very rare myocardial conditions, a few of which are treatable. Myocarditis, in particular, is the subject of much interest and at the same time, much controversy. Many feel that myocarditis is quite common, but figures show that incidence varies greatly depending upon pathologic interpretation. For this reason, a consensus opinion as to diagnostic histopathologic criteria is being generated by expert workers in the field. In addition, several workers are attempting to develop broader and deeper probes into ways in which biopsy tissue may be used. These include immunochemical staining, enzymatic and biochemical measurements, quantitative techniques using electron microscopy, and the in vitro use of biopsy-obtained myocardium for studies in mechanical function, beta-adrenergic receptor profiles, and immunologic reactions. Further development of instruments continues. This includes the use of a special sheath to allow sampling from the right ventricular septal endomyocardium from femoral vein access. Also, a disposable bioptome assembly is now marketed. The original Stanford-developed internal jugular approach remains the most well-known and widely practiced technique.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Heart and vessels 1 (1985), S. 91-96 
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In acute myocardiopathy and pericardiopathy, Coxsackie virus B infections are increasingly recognized as a cause of primary myocardial disease and may cause chronic cardiovascular disease. With other viruses, such as cytomegaloviruses and rubella virus, transplacental infection during pregnancy may occur, and this can cause the congenital rubella syndrome, which involves heart abnormalities. Other viruses are now under study. Myocarditis was observed in a newborn infant infected with Coxsackie virus B3, which was isolated by tissue culture methods. Experimental infection of Coxsackie virus A and B was studied in suckling mice and the histopathologic changes in heart muscle were observed. Laboratory findings of viral infection are very useful for clinical diagnosis, however care needs to be taken with respect to the obtaining of specimens, diagnostic procedures, and the assessment of results.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Fifty-seven patients with unexplained dilated hearts and congestive heart failure were studied clinically and by endomyocardial biopsy of the left ventricle. Of the patients, 61% had histologic evidence of active lymphocytic myocarditis. The sudden onset of heart failure, often with arrhythmias, if preceded by a viral-like illness indicated a high chance of finding inflammatory infiltration in the biopsy material. No abnormal accumulation of immunoglobulin was found in these patients with dilated cadiomyopathy and myocarditis. Immunosuppressive therapy did not always bring about improvement.
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  • 6
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Segmental wall motion abnormalities are common in patients with myocarditis. Left ventricular (LV) regional wall motion was assessed in six patients with myocarditis by two-dimensional echocardiography. Some of our patients demonstrated regional thinning of the wall, similar to myocardial infarction. Therefore, segmental wall motion abnormalities with or without regional wall thinning detected by two-dimensional echocardiography cannot be used to differentiate myocarditis from coronary artery disease. Nevertheless, echocardiography can be performed repeatedly and is useful for evaluating the severity of myocarditis by assessing LV regional wall motion abnormalities, changes in LV wall thickness and cardiac pump function during the course of the disease.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Heart and vessels 1 (1985), S. 130-132 
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The morphologic critera in diagnosing myocarditis are detailed. In fulminant cases, apart from the inflammatory infiltrate which often consists of chronic inflammatory cells, necrosis is found, frequently in the form of myocytolysis. Two groups of patients are analyzed. The first consisted of 214 cases who were clinically suspected of suffering from myocarditis. In 50% of these cases, the clinical suspicion was confirmed by morphologic examination of tissue obtained by endomyocardial biopsy. The other group of patients were suspected of having dilated cardiomyopathy and consisted of 1200 patients; in 300 of these patients, myocarditis was diagnosed morphologically by biopsy. Following sequential biopsies monitoring the response to treatment with corticosteroids and immunosuppressive agents, a classification into active, ongoing, resolving (healing), or resolved (healed) forms has been advanced. The different stages depend on the severity of the inflammatory infiltrate, the site of the inflammatory cells, the presence or absence of necrosis of adjacent myocardial fibers, and the degree of fibrosis. It has been emphasized that clear concepts and a uniform approach are essential in diagnosing myocarditis, not only to achieve precise diagnosis, accurately monitoring the response to therapy, but also in helping to establish the pathogenetic pathways for certain forms of cardiomyopathy.
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  • 8
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to observe the characteristics of interstitial cellular proliferation in cases with myocarditis of possible viral origin, a systematic ultrastructural analysis of the cell components in the interstitium was made employing endomyocardial biopsy at the acute (0–10 days after onset), subacute (11–25 days), and convalescent stages (26–167 days) of the disease in ten cases. For comparison, myocardial specimens from cases with myocardial infarction were taken from early autopsy cases or from tissue obtained during surgery. The dominant interstitial cells observed in the acute stage of myocarditis were fibroblasts (38.3%±17.5%, mean ±SD), macrophages (23.3%±12.1%), and lymphocytes (18.0%±18.1%); at the convalescent stage, fibrocytes (44.6%±20.2%) and fibroblasts (22.5%±8.0%) were commonly seen. In myocardial infarction, the dominant cells were macrophages (35.0%±16.0%) and neutrophils (26.0%±13.9%) at the acute stage, and lymphocytes (30.0%±17.8%), plasma cells (27.1%±20.0%), and macrophages (26.4%±11.4%) at the late stage. Thus, some differences between the two diseases could be recognized.
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  • 9
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Immunofluorescent and electron-microscopic studies were performed to determine the distribution of viral antigens and particles and to clarify the relationship to myocardial lesions in two autopsy cases with generalized infection of Coxsackie virus B3 (CVB3) or cytomegalovirus (CMV). Case 1 was a full-term newborn female infant, without any congenital anomalies, who died of cardiac failure 10 days after birth. CVB3 was isolated from the blood before death. Necrosis of the muscle fibers was observed, frequently accompanying calcification. Numerous histiocytes and a few lymphocytes and neutrophils had infiltrated in and around the necrotic areas. Immunofluorescent study (IF) revealed CVB3 antigen in the muscle fibers and vascular endothelial cells. Case 2 was a female infant, born at 28 weeks of gestation, who died of fatal arrhythmia 50 days after birth. The infant had hemocephalus and a history of idiopathic respiratory distress and underwent an operation for patent ductus arteriosus. Cytomegalic cells were frequently found in the vascular endothelial cells in the myocardium and occasionally in muscle fibers. IF showed the presence of CMV antigen in both endothelial cells and muscle fibers. CVB3 and CMV antigens were detected predominantly in vascular endothelial cells rather than in the muscle fibers. Blood flow disturbance due to endothelial damage is a cause of the myocardial lesion in addition to the direct invasion of the muscle fibers by the virus.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Heart and vessels 1 (1985), S. 5-7 
    ISSN: 1615-2573
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Research in cardiomyopathy and myocarditis is currently proceeding along several lines in the United States. Cardiomyopathy is becoming much better recognized on a clinical basis, and the various forms of myocardial disease are probably much more common than was ever before realized. Likewise, a great deal of interest has been kindled in the topic of myocarditis. A relative clarification of nomenclature and gradual adoption of the international terminology and classification of the cardiomyopathies is also occurring in the USA. Research into the possible etiologies of cardiomyopathies is most intense in the theory of infectious-immune causation of dilated cardiomyopathy. But also of great interest are studies into the role of vasculopathy, toxins, and the autonomic nervous system in the development of myocardial disease. Investigations into the infectious-immune theory involve both animal and human studies. Animal studies include viral infections with different strains to try and obtain a more suitable model for the human disease. Basic research in animals has also advanced our understanding of immunologic mechanisms of tissue injury in postinfectious phases, including the discovery of possible myocardial neoantigens eliciting an immune response. Human research continues in immunologic reactions in dilated cardiomyopathy patients, genetic makeup, and familial predispostions. Suppressor and natural killer cell function both appear abnormal in dilated cardiomyopathy patients. Endomyocardial biopsy is perhaps now more used and accepted than ever. Its use in research is pivotal from the standpoint of the elucidation of possible progression from myocarditis to cardiomyopathy, the biochemical and enzymatic constitution of diseased myocardium, beta receptor density, and immunologic reactions.
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