Hemodynamic effects of various modes of cardiac pacing after operation for idiopathic hypertrophic subaortic stenosis

The hemodynamic effects of varying heart rate and pacing site were studied in 6 patients with idiopathic hypertrophic subaortic stenosis following operative relief of outflow obstruction. Ventricular pacing (117 beats per minute) resulted in a 26% decrease in cardiac output (p less than 0.02), a 54% increase in pulmonary capillary wedge pressure (p less than 0.03), and a 23% decrease in mean blood pressure (p less than 0.05), compared with normal sinus rhythm (88 beats per minute). Slow atrial pacing (112 beats per minute) did not significantly alter any hemodynamic variable compared with normal sinus rhythm. Rapid atrial pacing (143 beats per minute) produced a similar degree of hemodynamic impairment as ventricular pacing. This study demonstrates that ventricular pacing at heart rates commonly used clinically and rapid atrial rates result in a significant fall in cardiac output. Preservation of atrial systole at heart rates that allow adequate diastolic ventricular filling of a hypertrophied, noncompliant ventricle is stressed. In addition, atrial electrodes are useful to record atrial electrograms or induce rapid atrial stimulation to treat supraventricular tachyarrhythmias.     

Coronary Arteriotomy with Cardioplegia

A technique for improved visualization of the coronary vessels during cardiac arrest is described. The method involves dissecting the epicardial fat from the vessel involved, marking the fat for future reference, and applying traction at the acute margin of the right ventricle. Cardioplegic solution can be infused both before and during the time of each arteriotomy.     

Postemetic hematomas: a variant of the Mallory-Weiss syndrome.

Of forty-four patients with the Mallory-Weiss syndrome, nine (20 per cent) had endoscopic evidence of small submucosal hematoma(s) lying in or adjacent to the region of the the tear. These small hematomas are believed to occur most commonly as a variant of the Mallory-Weiss lesion.     

Hostility conflict and the effect of chlordiazepoxide on change in hostility level

Dimascio, Shader, Salzman and their colleagues^1–5 conducted a series of experiments providing evidence that chlordiazepoxide produced a significantly greater increment in self-reported and behaviorally expressed hostility over a 1-week interval than did placebo in groups of college age normal male volunteers. Rickels and Downing⁶ presented data indicating that a group of anxious, nonpsychotic outpatients treated with chlordiazepoxide in 4-week double-blind drug trials showed greater decrements in physician rated irritability and hostility and in self-assessed anger-hostility than did placebo treated patients. These latter findings were considered to strongly suggest that caution be exercised in generalizing results obtained in samples of asymptomatic volunteers to psychiatric patient groups.Kochansky et al.³ have suggested that the ratings employed by Rickels and Downing to assess clinical hostility may focus upon “manifest angry affects” rather than hostility as “inner motivational or arousal level;” Kochansky et al. employed the Buss Durkee Hostility Inventory (BDHI) to assess such arousal level. The present study examines 4-week changes in hostility in anxious neurotic outpatients treated with either chlordiazepoxide (CDZ) or placebo using four scales from the BHDI (verbal hostility, indirect hostility, irritability, and resentment) in an effort to assess hostility as an inner motivational level. An Hostility Conflict Scale⁷ intended to assess the level of conflict or guilt about the expression of hostility was also administered. It was felt that the potential for CDZ-facilitated hostility increase might be greater among patients with greater amounts of conflict associated with hostility expression since the drug might be expected to allay anxiety associated with such conflict.     

A multiparametric approach to tumor markers detectable in serum in patients with carcinoma of the ovary or uterine cervix

A comparison of several serum tumor markers (lactate dehydrogenase (LDH), sialyltransferase (ST), carcinoembryonic antigen (CEA), β₂ microglobulin (β₂M), γ-chain fetal hemoglobulin (HbF), immune complexes (ImCp), and spermine (Spm)) was made in patients with carcinoma of the ovary or cervix uteri and healthy control subjects. The greatest positive results were obtained with the markers LDH (40%) and β₂M (46%) for patients with carcinoma of the cervix and ovary, respectively. However, based on false positive results, the most suitable single marker for patients with carcinoma of the cervix was Spm (30%). When a multiparametric approach was taken, a combination of four of the seven markers resulted in an increase in the positive results, that is, the cancer patients were positive for one of the four markers. This was 76% for patients with carcinoma of the cervix using the markers LDH, ST, Spm, and β₂M and 79% for patients with carcinoma of the ovary using the markers ST, CEA, HbF, and β₂M. All markers in both groups of cancer patients were elevated above control levels with the exception of ST which was decreased in patients with carcinoma of the ovary. ST, CEA, and HbF were found to be associated by multilinear regression analysis in the ovarian cancer group. As the ST approached normal levels CEA and HbF became elevated. Similarly there was a linear relationship between β₂M and ImCp demonstrating positively at similar times.