A CBT intervention program decreases the risk of recurrent CVD and recurrent acute myocardial infarction. This may have implications for secondary preventive programs in patients with coronary heart disease. Trial Registration clinicaltrials.gov Identifier: NCT00888485.
Cardiac ultrasound investigation of 68 prospectively studied patients with histologically proven midgut carcinoid tumors showed right heart disease in 66%. The abnormal findings included morphologic and functional aberrations of the tricuspid valve in 52% and 83%, respectively, right atrial and ventricular enlargement in 53% and 30%, and paradoxical systolic septal contractions in 19%. The patients with the most pronounced right heart disease had significantly higher (p<.01) plasma levels of the tachykinins neuropeptide K and substance P as well as higher (p<.001) urinary excretion of the serotonin metabolite 5-hydroxyindoleacetic acid. These patients also had the most extensive tumor disease. The occurrence of echocardiographic abnormalities of the left heart was similar to that in healthy individuals of the same age, but abnormalities were less frequent among the patients with severe right heart disease. Electrocardiographic changes were nonspecific. Right heart disease thus seems to be present more often than previously reported in patients with malignant midgut carcinoid tumors. The severity of cardiac involvement does not seem to be related to the duration of carcinoid disease but more to the extent of the disease, i.e., higher plasma levels of serotonin and tachykinins. Circulation 77, No. 2, 264-269 1988. PATIENTS with carcinoid syndrome often develop a characteristic heart disease previously reported to occur in 19% to 53% of cases. l-6 In a majority of the patients the endocardial fibrous lesions considered to be pathognomonic of carcinoid heart disease2' 7-10 involve the cavities and valves of the right heart. Only a small number of cases with typical changes of the left heart have been reported. l -13 In many patients with carcinoid heart disease, the predominant terminal symptoms and death may be attributed directly to the cardiac disease.1' [14][15][16][17] ever, none of these substances has been found responsible for the characteristic cardiac lesions.The present study was designed to investigate prospectively the extent of cardiac disease in patients with carcinoid tumors by means of ultrasound investigation. In an effort to study possible etiologic agents the urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA) and the plasma levels of the tachykinins neuropeptide K (NPK) and substance P (SP) were compared in patients with midgut carcinoid tumors and different degrees of carcinoid heart disease. MethodsStudy population. Cardiac ultrasound studies were performed in 68 consecutive patients (36 women and 32 men) with a midgut type of malignant carcinoid tumor admitted to the Department of Internal Medicine, University Hospital, Uppsala, Sweden, over a 6 year period (1979)(1980)(1981)(1982)(1983)(1984)(1985). The diagnosis of a carcinoid tumor was histologically proven by the Grimelius and Mason silver-staining techniques18' 19 on tumor tissue obtained at biopsy or operation. The patients median age was 64 years (range 38 to 83) and at the time of the cardiac investigation, carcinoid...
In East and Central Africa the protozoan parasite Theileria parva causes a disease of cattle called East Coast fever (ECF). In Kenya alone between 60,000 and 85,000 cattle die from ECF every year. Infected animals can recover from ECF either naturally or after treatment with tetracyclines or menoctone and are subsequently able to resist challenge with the homologous strain of parasite. That this acquired resistance is due to cell-mediated rather than humoral immunity has been suspected but never decisively shown. A major difficulty in studying immunity to ECF has been the lack of inbred animals for studying Theileria-specific immunity in the absence of allogeneic histocompatibility barriers. We have avoided this problem by measuring cell-mediated immune responses in a syngeneic system in vitro. Unidirectional mixed lymphocyte cultures (MLC) were set up using bovine peripheral blood lymphocytes (PBL) as responder cells and autologous cell lines transformed in vitro by T. parva as stimulator cells. In these cultures, DNA synthesis was induced in PBL from both normal and Theileria-immune animals. However, cytotoxic lymphocytes were induced only in cultures containing responder lymphocytes from Theileria-immune cattle. The results show that Theileria-transformed cells express antigens which are recognized by effector cells and provide evidence that cell-mediated cytotoxic mechanisms function in immunity to ECF.
Using a wide range of experimental conditions, several kinds of T lymphocyte responses in spleen cell populations from trypanosome-infected mice were studied. Lymphocyte stimulation after culture with the mitogen concanavalin A or with histoincompatible cells differing at H-2 or minor lymphocyte-stimulating loci was reduced or abolished in spleen cells from infected mice when compared with responses of spleen cells from uninfected controls. In addition, cytotoxic lymphocytes were not generated in mixed lymphocyte cultures which contained spleen cells from infected animals. Allogeneic skin grafting experiments performed with normal and infected mice showed that a decreased T lymphocyte response also occurs in vivo. The depressed immune responses were not simply due to low numbers of T lymphocytes in spleens of infected animals, but reflected a generalized immune depression which was not antigen-specific.
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