Detection of patent foramen ovale by contrast echocardiography is based on transient inversion (right atrial pressure higher than left atrial pressure) of the interatrial pressure gradient. Therefore, the presence of left-sided heart disease with potential elevation of left atrial pressure might obscure the diagnosis of patent foramen ovale. Accordingly, 150 patients (88 men, 62 women; mean age 51.7 +/- 15.2 years) were evaluated for a patent foramen ovale by transesophageal contrast echocardiography. Additionally, atrial septal motion during normal respiration and during the Valsalva maneuver was analyzed. Patency of the foramen ovale was observed in 20 (27%) of 74 patients without left-sided heart disease and with previous arterial embolism, in none (0%) of 25 patients with left-sided heart disease and embolism, in 7 (39%) of 18 patients without left-sided heart disease and without embolism and in 3 (9%) of 33 patients with left-sided heart disease and without embolism. The detection rate of patent foramen ovale was lower in patients with than without left-sided heart disease (5% vs. 29%, p = 0.0007) but was similar in patients with and without embolism (20% vs. 19.5%, p = NS). Abnormal atrial septal motion was more frequently observed in patients with left-sided heart disease (p = 0.0003) and was inversely correlated to detection of patent foramen ovale (p = 0.0003). Multivariate analysis revealed an independent association between the absence of left-sided heart disease and the detection of patent foramen ovale (p = 0.0003). These data suggest that in patients with left-sided heart disease, patency of the foramen ovale may be missed even by transesophageal contrast echocardiography.
The following replaces the time indicated on p 419 under Methods: The event took place on day 3 of the survival training between 1400 hours and 1500 hours .... The following replaces the section on p 422 of Results: fc response versus age The fo .... attained during the parachute jump at night showed a significant correlation (r =-0.74; P = 0.022) to the age of the S. This relationship was not significant in the guerilla slide (Fig. 4).
This study found a high frequency of enteric viruses and a high risk of person-to-person transmission associated with diarrhea. Eating at the military mess or staying in a temporary encampment conferred a protective effect. In addition to food-borne disease prevention, stringent hygiene measures are required to break transmission of diarrhea during military deployments.
A possible relationship between aerobic fitness (AF), measured by maximal cycle ergometry (CE) and sympatho-adrenal response to acute, short lasting psycho-emotional stress was investigated by monitoring heart rate (fc) and excretion of catecholamines. The activation of the sympatho-adrenal system was characterised by the noradrenaline: adrenaline ratio. A group of 11 healthy men [22.8 (SD 2.52) years] lived under identical environmental conditions; their mean maximal oxygen uptake (VO2max) was 47.1 (SD 3.9) ml.min-1.kg-1. After the physiological and psychological laboratory tests had been completed the fc of the subjects was monitored continuously during the "guerilla slide" and "parachute jump by night", two emotionally stressful military tasks. Maximal fc (fc, max) attained during these events was 84.5% and 83% of fc, max during CE (fc, max, CE), respectively. A significant relationship (r = -0.92, P < 0.0002) between fc, max reached during the stressful tasks and VO2max was found only for the guerilla slide, which was preceded by physical strain, sleep deprivation and energy deficit. One subject with some prior experience in parachuting showed the lowest fc response and the lowest sympatho-adrenal activation in both events, independent of the degree of AF. In conclusion, AF was found to influence the sympatho-adrenal and fc response to acute, short-lasting emotional stress when the stressful event was aggravated by preceding physical strain, the magnitude of the stress response depending largely on individual experience and effective mechanisms for coping with specific stimuli.
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