Showing papers by "Maastricht University published in 1990"

Assessment of the distensibility of superficial arteries.

Abstract: Doppler signal processing cannot only be employed to detect the local blood velocity as function of time, but also to assess transcutaneously the displacement of the arterial walls during the cardiac cycle (distension waveform) and, hence, the time-dependent changes in arterial diameter relative to its initial diameter at the start of a cardiac cycle. The distension waveform normalized with respect to the local pulse pressure provides useful information about the local elasticity of the arterial wall. The displacement of the arterial wall can be obtained by processing the RF-signals within a sample volume coinciding with the arterial wall. To evaluate this method a dedicated high-speed memory system has been developed storing the RF-signal, as obtained with a conventional echo-imager in M-mode, over a number of successive sweeps covering a selected depth range. The data are transferred line after line to a personal computer (PC) and processed on the fly, thereby relieving the memory requirements of the PC. It can be concluded that a RF-signal memory in combination with a PC provides a useful tool to extract detailed diameter waveforms from the RF-signals obtained. Although the system does not process the signals in real-time the process can be considered to be on-line since the results become available within one minute after the acquisition of the data is completed.

Redistribution of myocardial fiber strain and blood flow by asynchronous activation.

Abstract: Hearts of 11 anesthetized open-chest dogs were paced from the right atrium (RA), right ventricular outflow tract (RVOT), and left ventricular apex (LVA). Maps of the sequence of electrical activati...

Gamma-carboxyglutamate-containing proteins and the vitamin K-dependent carboxylase.

Abstract: Vitamin K functions as a cofactor during the posttranslational modification of proteins. The reaction in question is the carboxylation of glutamate (Glu) residues into γ-carboxyglutamate (Gla). The discovery of vitamin K in 1935 and the identification of Gla in the early 1970s have been reviewed elsewhere and will not be detailed in this paper. Here we intend to summarize the recent advances in vitamin K research.

Nerves and nerve plexuses of the human vertebral column

Abstract: The origin, distribution, and termination pattern of nerves supplying the vertebral column and its associated structures have been studied in the human fetus by means of an acetylcholinesterase whole-mount method. The vertebral column is surrounded by ventral and dorsal nerve plexuses which are interconnected. The ventral nerve plexus consists of the nerve plexus associated with the anterior longitudinal ligament. This longitudinally oriented nerve plexus has a bilateral supply from many small branches of the sympathetic trunk, rami communicantes, and perivascular nerve plexuses of segmental arteries. In the thoracic region, the ventral nerve plexus also is connected to the nerve plexuses of costovertebral joints. The dorsal nerve plexus is made up of the nerve plexus associated with the posterior longitudinal ligament. This nerve plexus is more irregular and receives contributions only from the sinu-vertebral nerves. The sinu-vertebral nerves originate from the rami communicantes and, in the cervical region, also from the nerve plexus of the vertebral artery. Thick and thin sinu-vertebral nerves are found. Most frequently three types of thick sinu-vertebral nerves are observed, i.e., ascending, descending, or dichotomizing ones. Finally, the distribution of the branches of the ventral and dorsal nerve plexuses and of the sinu-vertebral nerves is described.

Risk factors for carpal tunnel syndrome

Abstract: Between September 1983 and July 1985, a case-control study was performed of carpal tunnel syndrome risk factors in the general population of Maastricht, The Netherlands, and some surrounding villages. Twenty-eight of the 501 participants were found to suffer from carpal tunnel syndrome. These 28 were added to a series of 128 consecutive carpal tunnel syndrome patients from the same area. The 156 (131 women and 25 men) subjects in whom carpal tunnel syndrome had been diagnosed on the basis of clinical history and neurophysiologic testing were compared with the remaining 473 (310 women and 163 men) subjects. After adjustment for age and sex, the following carpal tunnel syndrome risk factors could be identified: activities with a flexed wrist or with an extended wrist (exposure-related increased risk), hysterectomy without oophorectomy, last menstrual period in menopausal women 6-12 months ago, height, weight, Quetelet index, slimming courses, and in men, varicosis. Associations between carpal tunnel syndrome and the use of oral contraceptives, age at menopause, diabetes, thyroid dysfunction, rheumatism, typing, and pinch grasp could not be demonstrated.

Are hypertension or cardiac embolism likely causes of lacunar infarction

Abstract: We tested the hypothesis that hypertension is more common and cardiac embolism less common in patients with lacunar infarction than in patients with other types of cerebral infarction. We studied risk factor profiles in a series of 102 consecutive patients with a lacunar infarct and 202 consecutive patients with a carotid artery-distribution infarct involving the cortex registered in the Oxfordshire Community Stroke Project, a community-based study of first-ever stroke. The two groups did not differ in the prevalence of prestroke hypertension (defined in a number of ways) or in the prevalence of markers of sustained hypertension. The presence of atrial fibrillation and a history of myocardial infarction, particularly during the 6 weeks before the stroke, were significantly more common in the group with carotid-distribution infarcts involving the cortex. There was no significant difference in the prevalence of other accepted risk factors for ischemic stroke, including previous transient ischemic attack, cervical bruit, diabetes mellitus, peripheral vascular disease, or cigarette smoking. Our results suggest that hypertension is no more important in the development of lacunar infarction than it is in the development of other types of ischemic stroke that are presumed to be due to atherosclerotic thromboembolism in a major cerebral artery. Our data support the autopsy evidence that cardioembolic occlusion is an unusual cause of lacunar infarction.

Helicobacter pylori and gastric carcinoma.

Abstract: A retrospective study was performed on gastric carcinomas to establish the prevalence of Helicobacter pylori infection in gastric epithelium adjacent to the tumour. A total of 105 carcinomas were studied. The overall prevalence of Helicobacter pylori infection was 59%. The prevalence in different age cohorts from patients with gastric carcinoma was compared with that in patients suffering from non-ulcer dyspepsia and, based on serological testing, with that in healthy blood donors. The presence of Helicobacter pylori in cancer patients aged 41-50 and 51-60 was significantly higher than in blood donors. No difference was seen in comparison with non-ulcer dyspepsia patients. The presence of Helicobacter pylori showed an inverse correlation with the extent of intestinal metaplasia. The intestinal type of carcinoma was associated with a higher bacterial load than the diffuse type. These data suggest that the presence of Helicobacter pylori in gastric mucosa could play a role in the pathogenesis of gastric carcinoma, especially in the young age group.

Quantification of spatial inhomogeneity in conduction and initiation of reentrant atrial arrhythmias.

Abstract: In isolated superfused left atria of the rabbit, inhomogeneity in conduction was quantified using the activation times measured with a high-density mapping system. At each recording site, the maximal difference with neighboring activation times (i.e., phase difference) was calculated. Local phase differences were plotted in a phase map, revealing the spatial distribution of inhomogeneities in conduction, and from each map a total index of inhomogeneity was calculated. During slow pacing (2 Hz) local differences in conduction velocity, depending on the direction of propagation, were found already. Inhomogeneity in conduction increased significantly during single early premature beats (inhomogeneity index increased from 2.3 to 3.1; P less than 0.001). The application of multiple premature beats further increased inhomogeneity in conduction, whereas rapid pacing induced the highest level of inhomogeneity (inhomogeneity index 5.3; P less than 0.001). An analysis of the spatial distribution of maximal phase differences revealed that during premature beats inhomogeneities in conduction were limited to an area of 6 mm around the point of origin of the premature impulse, whereas during rapid pacing inhomogeneities in conduction were found throughout the whole preparation. Phase maps constructed during the initiation of reentrant tachyarrhythmias showed that reentry occurred at sites with the highest phase differences. Quantification of spatial inhomogeneities in conduction is a useful tool to evaluate the vulnerability of the myocardial substrate for reentrant arrhythmias.

Mental precursors of myocardial infarction.

Abstract: Both cardiologists and psychiatrists have observed that the onset of myocardial infarction is often preceded by feelings of decreasing energy, general malaise, and minor depression. This paper describes these observations and tries to integrate the findings. It is proposed that the mental state preceding myocardial infarction can be best described as 'vital exhaustion'.

Metabolism of branched-chain amino acids and ammonia during exercise: clues from McArdle's disease.

Abstract: Patients with McArdle's disease (myophosphorylase deficiency) cannot use muscle glycogen as an energy source during exercise. They therefore are an ideal model to learn about the metabolic adaptations which develop during endurance exercise leading to glycogen depletion. This review summarizes the current knowledge of ammonia and amino acid metabolism in these patients and also adds several new data. During incremental exercise tests in patients with McArdle's disease, forearm venous plasma ammonia concentration rises to a value between 200 and 500 microM. Femoral arteriovenous difference studies show that muscle produces the ammonia. The leg release of both ammonia and glutamine (in mumol/min) has been estimated to be five- to tenfold larger in one of these patients than in healthy individuals exercising at comparable relative work load. Patients with McArdle's disease have a larger uptake of branched-chain amino acids (BCAA) by exercising leg muscles and show a more rapid activation of the muscle branched-chain 2-oxo acid dehydrogenase complex, a key enzyme in the degradation of the BCAA. In general, supplements of BCAA taken before the exercise test lead to a deterioration of exercise performance and a higher increase in heart rate and plasma ammonia during exercise, whereas supplements of branched-chain 2-oxo acids improve exercise performance and lead to a smaller increase in heart rate and plasma ammonia. At constant power output, patients with McArdle's disease show a rapid increase in heart rate and exertion perceived in the exercising muscles, which peak within 10 min after the start of exercise and then fall again ("second wind"). Peak heart rate and peak exertion coincide with a peak in plasma ammonia. Ammonia production during exercise in these patients is estimated to exceed the reported breakdown of ATP to IMP and therefore most likely originates from the metabolism of amino acids. Deamination of amino acids via the reactions of the purine nucleotide cycle and glutamate dehydrogenase are possible pathways. Deamination of glutamine, released by muscle, by glutaminase present in the endothelial cells of the vascular system may also contribute to the ammonia production. The observations made in these patients have led to the hypothesis that excessive acceleration of the metabolism of BCAA drains 2-oxoglutarate in the primary aminotransferase reaction and thus reduces flux in the citric acid cycle and impedes aerobic oxidation of glucose and fatty acids. This draining effect is normally counteracted by the anaplerotic conversion of muscle glycogen to citric acid cycle intermediates, a reaction which is severely hampered in these patients due to the glycogen breakdown defect.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of dehydration on gastric emptying and gastrointestinal distress while running.

Abstract: Gastrointestinal distress is commonly reported by athletes after ingestion of a beverage. We speculate that ingestion may be occurring after dehydration has taken place. The high prevalence of GI disorders in marathon runners who have lost greater than or equal to 4% body weight supports this theory. To test this theory, the effects of dehydration, and dehydration in combination with endurance running, on gastric emptying (GE) and frequency of gastrointestinal (GI) complaints were tested in this experiment. A complete cross-over study was designed. Sixteen subjects ingested 8 ml.kg BW-1 of a 7% carbohydrate (296 mOsm.kg-1), solution after a euhydration or dehydration regime. Dehydration (4% BW loss) was produced by 60% maximal speed running at 30 degrees C or by intermittent sauna exposure at 100 degrees C. Euhydration experiments were conducted with a 2 h rest period with water administered at 20 and 40 min. Gastric drink volumes were measured every 10 min for 40 min. Emptying curves were compared using semi-log transformation of the percentage emptying data and simple linear regression. The slope of each line was used as a measure of average GE rate. Dehydration-exercise resulted in slower GE than in all other treatments (P less than 0.05). ANOVA revealed significant effects of dehydration (P less than 0.05) and exercise (P less than 0.05), these two effects being additive in delaying GE. GI complaints were reported by 37.5% of the subjects during dehydration-exercise experiments. No GI disturbance was reported in other tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific sensitivity of patients with panic attacks to carbon dioxide inhalation.

Abstract: One inhalation of 35% CO 2 in oxygen was administered to 36 patients with anxiety disorders and 14 healthy controls. Eighteen patients had a diagnosis of panic disorder (PD) and 18 of obsessive-compulsive disorder (OCD). As a placebo control for CO 2 , compressed air was administered in a double-blind design. Immediately before and after the inhalation, levels of anxiety and DSM- III-R symptoms of panic were assessed. CO 2 elicited high levels of subjective anxiety in the PD group. Patients with OCD were hardly affected by the inhalation, and did not differ from healthy controls. These results suggest that CO 2 challenge should be considered as a specific probe for subjects with panic- anxiety. It is speculated that CO 2 may trigger some as yet undefined mechanisms, possibly linked to ventilation control, which demarcate panic from other types of pathological anxiety.

Cellular fatty acid-binding proteins: current concepts and future directions

Abstract: At least three different proteins are implicated in the cellular transport of fatty acid moieties: a plasmalemmal membrane and a cytoplasmic fatty acid-binding protein (FABPPM and FABPC, respectively) and cytoplasmic acyl-CoA binding protein (ACBP). Their putative main physiological significance is the assurance that long-chain fatty acids and derivatives, either in transit through membranes or present in intracellular compartments, are largely complexed to proteins. FABPC distinguishes from the other proteins in that distinct types of FABPC are found in remarkable abundance in the cytoplasmic compartment of a variety of tissues. Although their mechanism of action is not yet fully elucidated, current knowledge suggests that the function of this set of proteins reaches beyond simply aiding cytoplasmic solubilization of hydrophobic ligands, but that they can be assigned several regulatory roles in cellular lipid homeostasis.

Gastric emptying with repeated drinking during running and bicycling.

Abstract: The high prevalence of gastrointestinal complaints in long-distance runners makes the movements specific to this type of exercise suspected of causing a disruption of normal gastrointestinal function. Gastric emptying rate is one indicator thereof. In the present study trained volunteers performed similar repeated fluid ingestion tests while running and while bicycling for 80 min at 70% VO2max. Control tests at rest were also conducted. Two drinks containing carbohydrate were tested, one hypertonic, and one isotonic. Artificially sweetened water was used as a control. Gastric emptying rate of the isotonic drink, expressed as a percentage of the volume in the stomach at the beginning of each measurement period, did not differ between cycling and running during the first 40 min and was faster during cycling than during running between 40 and 80 min. With the hypertonic drink no differences between cycling and running were observed. In comparing gastric emptying rates after each sequential bolus, at rest, the isotonic drink was observed to maintain a high emptying rate, equal to that of water, whereas the hypertonic drink emptied more slowly after the first 20-min period. A similar pattern was observed during both running and cycling. The isotonic drink continued to empty quickly after the initial 20 min, whereas GE rate of the hypertonic drink decreased after the initial 20 min.

Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography.

Abstract: A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.

Polynomial-time inference of all valid implications for Horn and related formulae

Abstract: This paper investigates the complexity of a general inference problem: given a propositional formula in conjunctive normal form, find all prime implications of the formula. Here, a prime implication means a minimal clause whose validity is implied by the validity of the formula. We show that, under some reasonable assumptions, this problem can be solved in time polynomially bounded in the size of the input and in the number of prime implications. In the case of Horn formulae, the result specializes to yield an algorithm whose complexity grows only linearly with the number of prime implications. The result also applies to a class of formulae generalizing both Horn and quadratic formulae.

Physical exercise and menstrual cycle alterations. What are the mechanisms

Abstract: The prevalence of menstrual cycle alterations in athletes is considerably higher than in sedentary controls. There appears to be a multicausal aetiology, which makes it extremely difficult to dissociate the effects of physical exercise on the menstrual cycle from the other predisposing factors. From cross-sectional studies it appeared that physical training eventually might lead to shortening of the luteal phase and secondary amenorrhoea. Prospective studies in both trained and previously untrained women have shown that the amount and/or the intensity of exercise has to exceed a certain limit in order to elicit this phenomenon. We hypothesise, therefore, that apart from a certain predisposition, athletes with a training-induced altered menstrual cycle are overreached (short term overtraining, which is reversible in days to weeks after training reduction). Menstrual cycle alterations are most likely caused by subtle changes in the episodic secretion pattern of luteinising hormone (LH) as have been found in sedentary women with hypothalamic amenorrhoea as well as in athletes after very demanding training. The altered LH secretion then, might be caused by an increased corticotrophin-releasing hormone (CRH) secretion which inhibits the gonadotrophin-releasing hormone (GnRH) release. In addition, increased CRH tone will lead to increased beta-endorphin levels which will also inhibit the GnRH signaller. Finally, the continuous activation of the adrenals will result in a higher catecholamine production, which may be converted to catecholestrogens. These compounds are known to be potent inhibitors of GnRH secretion. In conclusion, menstrual cycle alterations are likely to occur after very demanding training, which causes an increase secretion of antireproductive hormones. These hormones can inhibit the normal pulsatile secretion pattern of the gonadotrophins.

An animal model for therapeutic intervention studies of CMV infection in the immunocompromised host.

Abstract: An experimental rat model to study acute cytomegalovirus infections is described. Eight-week old male Brown Norway rats, immunosuppressed by total body irradiation, were infected with rat cytomegalovirus (RCMV). The effects of infection were determined by survival rates and the presence of virus or viral components in different organs was assayed by plaque test, immunoperoxidase staining, dot-blot DNA hyridization and in situ DNA hybridization. At days 10-post infection nearly 90% of the animals had died. Spleen, liver and bone marrow were heavily infected. Interstitial pneumonia was observed. Pathological findings strongly resembled the full scale of lesions in human CMV infections. Anti-RCMV hyperimmune serum was effective against mortality from RCMV infection and viral spread to lungs and liver was prevented. This model is appropriate for studies on the pathogenesis and antiviral therapy of CMV infections in the immunocompromised host.