Myocardial infarction in diabetics (author's transl)]

In 160 patients admitted during the first 8 days following myocardial infarction during the period November 1st 1974 - March 15th 1975, the prevalence of diabetes was 17%. Among 655 patients treated for a month in a convalescence centre following the acute phase of myocardial infarction during the period January 1st 1974 - March 15th 1975, the prevalence of diabetes was 17.5%. Mortality rate during the first 8 post infarction days was 28% in diabetics and 13% in non-diabetic patients in the coronary care Unit; over the subsequent month, the mortality rate was 7.7% in diabetics and 3.7% in non-diabetics while at the convalescence Centre. The higher mortality rate from myocardial infarction in diabetics could not be contributed to a greater severity or more wide spread nature of the coronary artery disease as evidenced by the results of coronary cineangiography performed in diabetic and non-diabetic patients with severe ischaemic heart disease. In the cases in which an aorto-coronary by-pass was performed, there was no apparent difference in the response of diabetics compared to non-diabetic subjects. Despite progress in intensive treatment of myocardial infarction, mortality rate of this disease in diabetics remain very high. Reduction of the incidence of ischaemic heart disease in diabetics requires early identification and reversal of all of the many risk factors for arterial disease.     

Clinical coronarographic characteristics and pathogenetic mechanism of angina pectoris with s-t elevation (author's transl)]

The study of 46 patients with frequent anginal episodes characterized by S-T elevation (so called "variant angina pectoris") demonstrated that this type of electrocardiographic pattern does not characterize a homogeneous group of patients. In fact, while in some patients angina occurred only at rest, in others it occurred also on exercise. Sometimes ecgraphic alterations characterized by S-T depression were observed on the same leads which on other occasions had shown S-T elevation. The angiographic picture revealed: absence of significant coronary alterations in 10% of cases, stenosis greater than 75% in one main branch in 29%, in two branches in 39% and in three branches in 22% of cases. The hemodynamic monitoring carried out on 14 of these patients demonstrated that the ecgraphic modifications occur before the onset of the hemodynamic parameters which control myocardial O2 consumption. This suggests a primitive reduction of regional myocardial blood supply as a cause of the ischaemic episodes. The study of the regional myocardial perfusion with 201Tl technique in 6 patients confirmed this hypothesis. Coronary angiography carried out during an ischemic episode showed that the reduction of myocardial blood supply was caused by a spasm of a large coronary artery involving a long segment of the vessel, reversible by nitroglycerin administration. Aorto-coronary by-pass operation performed on 6 patients was followed by the disappearance of pain in two patients, even though the "by-pass" patency was angiographically proved in two patients.     

A new biopsy device (author's transl)]

The author describes a pistol-like biopsy-sampling instrument by means of which most rapidly tissue cylinders--after a pre-destinable size in length and width--can be taken exactly and towards all sides with sharp edges without causing any contusion effects. The largest possible prevention of any damage to the adjacent tissue is guaranteed by a special shape of the cutting-knife. Besides, the tissue material taken can be put into a fixation fluid immediately after the sampling in one and the same working process without having to avail of an additional instrument. Correspondingly, the histological slides of such tissue samples are intact in their structure also in their marginal parts. The tissue samples are particularly suited also for electron-optical examinations, as they are kept live-fresh due to their immediate fixation.     

Myocardial infarction and diabetes (author's transl)]

30 diabetic patients with myocardial infarction were compared with 30 non-diabetic myocardial infarction patients during their hospitalization in an Intensive Care Unit, to observe possible differences at the onset and throughout the course of the infarction syndrome. Myocardial infarction in diabetic cases has an oligosymptomatic onset, often painless, which evolves towards cardiocirculatory decompensation. The frequence of arrhythmias is higher, especially in serious or mortal arrhythmias. Possible pathogenetic reasons for this are briefly discussed.     

Osteomalacia in hyperphosphoethanolaminuria without hypophosphatasia (author's transl)]

Increased urinary excretion of phosphorylethanolamine (P.E.A.) is one of the salient features of hypophosphatasia. This inherited disorder is generally transmitted as an autosomial recessive trait and is characterized by abnormal mineralization of bone, premature loss of deciduous teeth and reduced tissue and serum alkaline phosphatases (A.P.) levels. The authors report a series of patients presenting with pains of skeletal origin attributed to an osteomalacia syndrome on the ground of a bone biopsy. These patients had no history of rickets during childhood but complained of early severe caries of the permanent dentition before the age of twenty. They had neither malabsorption nor renal tubular abnormalities. Their serum 25 OH vitamin D was normal and their serum A.P. levels were within the normal range with a normal isoenzyme distribution. All these patients had increased excretions of urinary P.E.A. and the latter correlate significantly with the degree of osteomalacia. Control patients with a malabsorption syndrome, showing osteomalacia and serum A.P. of the same degree of magnitude as the patients of the first group, have a normal P.E.A. excretion and no correlation appears between the degree of osteomalacia and the P.E.A. excretion. The cases with increased P.E.A. excretion may correspond to adult pseudohypophosphatasia. The signification of increased P.E.A. excretion is discussed.     

Myocardial revascularization combined with endoarterectomy (author's transl)]

The paper summarize a personal experience in myocardial revascularization combined with endoarterectomy for diffuse coronary artery disease. From Feb. 1977 to June 1978 at Harefield Hospital 60 patients had 138 grafts. In 32 patients, 42 endoarteriectomies were performed (30% of all grafted vessels); of these 19 (45%) were to LAD; 4 (10%) to CX and 19 (45%) to RC. The overall mortality was of 1 patient. Symptomatic evaluation shows that 26 patients (84%) are asmptomatic and 5 (16%) are improved. Restudy of 24 (32 endoarterectomies) shows a patency rate of 75%.     

Adrenergic receptors in coronary arteries (author's transl)]

The relations between adrenergic nerve fibers and related receptors in the wall of the coronary arteries have been studied in man. On sections of these vessels morphological observations (H.E.) were carried out: histochemical staining of adrenergic mediators (Eranko reaction for norepinephrine, and Hillarp reaction for cathecolamines), and of beta-receptors by means of a beta-blocking fluorescent drug (pindolol-Visken LB 46). Our observations provide evidence of the presence of beta-receptors in the wall of the coronary arteries, but they are particularly concentrated in the periadventitial connective tissue, in the adventitia and in the intima-media transitional zone. Beta-adrenergic receptors are above all present in the most richly innervated part of the vascular wall, and are therefore in close rapport with adrenergic nerve fibers.