Percutaneous myocardial and pericardial biopsy with the Menghini needle

A simple, safe method of obtaining myocardial or pericardial tissue for analysis by light or electron microscopy or for culture has obvious application. The Menghini needle has been demonstrated to be a safe and effective instrument for the aspiration biopsy of liver and kidney. Therefore, application of aspiration biopsy with a 17 gauge Menghini needle to the heart by means of the left ventricular apical percutaneous approach has been evaluated in humans in 27 myocardial and 8 pericardial biopsies. Adequate tissue was obtained in all except one pericardial and two myocardial biopsy attempts. Of the eight pericardial biopsies, the diagnosis of tuberculous pericarditis was made in two cases and carcinomatous invasion of the pericardium was made in another two cases. Three cases showed nonspecific pericarditis. Of the 27 myocardial biopsies, 6 were examined by light microscopy and 21 were examined by electron microscopy. Light microscopy revealed no specific findings. However, electron microscopy showed moderate to severe intracellular abnormalities, the significance of which remains to be determined. Biopsy procedure takes 5 minutes or less under local anesthesia following mild premedication. Pneumothorax occurred in two patients and transient mild pleuritic chest pain occurred in four patients. Both complications were well tolerated. The technique seems effective and safe. Its utility and application remain to be determined.     

Association of a chromosomal abnormality with lymphocytes having both T and B markers in a patient with lymphoproliferative disease.

The lymphocytes of a patient with leukemic lymphosarcoma were found to have an unusual surface phenotype in that they bound both sheep erythrocytes (a T cell marker) and complement-coated erythrocytes (a B cell marker) but lacked other B cell surface characteristics. Marker chromosomes were present in these cells, but not in other, phenotypically normal cells from the same patient. This case may provide a clue to the chromosomal origin of some lymphocyte surface markers in man.     

M-mode and two-dimensional echocardiographic correlation with findings at catheterization and surgery in patients with mitral stenosis

Thirty-two consecutive patients referred to our institution for evaluation of rheumatic mitral stenosis were studied with M-mode echocardiography (M-mode E), two dimensional echocardiography (2DE), and cardiac catheterization. Twenty-three of these patients underwent mitral valve surgery, 11 requiring mitral valve replacement, and 12 requiring open mitral commissurotomy. Clinical and noninvasive parameters were assessed in order to predict catheterization-determined mitral valve areas as calculated by the Gorlin formula, and to predict the choice of operation in patients selected for surgery. For the prediction of valvular area, 2DE planimetry correlated highly (r = 0.89, p less than 0.01) with Gorlin formula results. The presence or absence of pericardial effusion, the anterior-posterior valve leaflet separation (M-mode E), and the left atrium-aortic index (2DE) correlated poorly with the degree of mitral stenosis as determined by the Gorlin formula. The most useful predictors of type of mitral surgery were age over 50 years, 2DE valve classification, the presence or absence of calcium at fluoroscopy, and degree of anterior leaflet-septal separation (M-mode E).     

Erythromycin compared with a combination of ampicillin and amoxycillin as initial therapy for adults with pneumonia including Legionnaires' disease

In a double blind trial erythromycin was compared with a combination of ampicillin and amoxycillin for treating adults admitted to hospital with primary pneumonia. The clinical course of 42 patients treated with ampicillin and amoxycillin was similar to that of the 49 in the erythromycin group. Fall in temperature, symptomatic recovery and radiographic improvement were similar (two-thirds made an uncomplicated recovery). Infusion-related phlebitis was more common with erythromycin. Otherwise adverse reactions were unusual. The outcome was related principally to the cause of the pneumonia with bacteraemic/antigenaemic pneumococcal pneumonia, Legionnaires' disease, other bacterial pneumonias and psittacosis having a poor prognosis. Both forms of antibiotic therapy gave similar results but we suggest that a combination of erythromycin with ampicillin may be logical initial treatment for severe pneumonia of unknown cause.     

Serum chromium in patients with recent and old myocardial infarction

The serum chromium in 45 subjects with no clinical evidence of ischemic heart disease was found to be 1.71 parts per billion (ppb) (S.E. ± 0.14). In 34 patients with a previously documented myocardial infarction, it was 1.84 ppb (S.E. ± 0.18). The difference was not significant nor was there any difference with age or sex. In 37 patients with acute myocardial infarction the serum chromium level rose to a mean of 6.36 ppb (S.E. ± 0.51; p < 0.001) during the first five days following the infarct, returning to normal over the next five days. There was no correlation between the serum chromium and blood glucose levels in these patients or in a further 14 patients who were receiving glucose infusions (chest pain without electrocardiographic or enzyme changes) or who were diabetics.     

C型逆转录病毒和自身免疫病的关系

我们以电子显微镜和免疫萤光技术测定C型逆转录病毒,共测试90例,包括正常对照50例,自身免疫疾病40例。结果正常人C型逆转录病毒抗原全部阴性,自身免疫病患者阳性率25％,两组有十分显著的差异(P相似文献   

A patient with bilateral superior and inferior caval veins

We present a case with a very uncommon form of anomalous connection: a normal systemic venous connection to the right atrium existing in combination with left superior and inferior caval veins draining into the left atrium (associated with a large ostium primum atrial septal defect). To our knowledge the present report concerns the third case with this very rare congenital anomaly diagnosed during life.     

Cardiac sarcoidosis: Diagnosis with endomyocardial biopsy and treatment with corticosteroids

A 27 year old woman was hospitalized for progressive dyspnea, fatigue and retrosternal chest pain. She had progressive cardiac enlargement with clinical and laboratory confirmation of a dilated cardlomyopathy. Transvenous percutaneous right ventricular endomyocardial biopsy yielded a specimen showing a noncaseating granuloma. The patient's dyspnea responded dramatically to steroid therapy with corresponding Improvement in radiographic and echographic measures of ventricular performance. This case illustrates the problem of diagnosing cardiac sarcoidosis when there is no apparent evidence of other organ Involvement.     

Metabolic interactions of glucagon and cortisol in man--studies with somatostatin

The metabolic response to pathophysiologic concentrations of glucagon, induced by glucagon infusion, has been examined in normal man before and after 36-60 hr hypercortisolaemia, induced by administration of tetracosactrin-depot. Glucagon alone increased serum insulin levels twofold but blood glucose was unaltered. Plasma NEFA and blood ketone body concentrations were decreased by glucagon infusion. Tetracosactrin produced a threefold rise in serum cortisol levels and caused mild fasting hyperglycemia and hyperinsulinaemia. Subsequent glucagon infusion had no effect on circulating insulin, glucose, NEFA or ketone body concentrations. Simultaneous infusion of somatostatin, to produce partial insulin-deficiency, unmasked a hyperglycemic action of glucagon (+ 3.8 +/- 0.2 mmol/l at 90 min, p less than 0.02). This glucagon-induced rise in blood glucose was diminished by prior tetracosactrin administration. Tetracosactrin revealed a mild lipolytic action of glucagon in partial insulin deficiency, not apparent in the euadrenal state. Glucagon was equally hyperketonemic during somatostatin infusion before and after tetracosactrin. Thus the hyperglycemic and hyperketonemic actions of glucagon at pathophysiologic levels are restricted to insulin deficiency. Hypercortisolaemia reveals a lipolytic action of glucagon in insulin-deficient man but does not potentiate the hyperglycemic or hyperketonemic effects.     

Immunopathologic features of a patient with glomerulonephritis and pulmonary hemorrhage

Described here is a patient who had pulmonary hemorrhage associated with glomerulonephritis. Serologic data revealed the presence of circulating cold agglutinins, a positive Coombs test and positive antinuclear factor. Serum total hemolytic complement levels and serum complement component Clq levels were low throughout the patient's course. The patient also exhibited precipitating antibodies against calf thymus nuclear extract and rabbit liver ribosomes. In addition, rheumatoid factor precipitable material was detected in the serum early in the patient's course. Immunofluorescent studies revealed deposition of immunoglobulin G (IgG) on the glomerulus in a pattern analogous to that which occurs in experimental “immune-complex” induced glomerulonephritis. Our findings suggest that the patient's disease was associated with circulating and deposited antigen-antibody complexes. The pathogenesis of the renal lesion in this instance is therefore distinctive from that previously described in patients with pulmonary hemorrhage and nephritis and said to have Goodpasture's syndrome, which is usually associated with antiglomerular basement membrane antibodies.     

Clinical characteristics,electrocardiographic and enzyme correlations,and long-term prognosis of patients with chest pain associated with ST depression and/or T wave inversion

The clinical characteristics, electrocardiographic changes, and long-term prognosis were studied in 50 patients suffering nontransmural myocardial infarctions. It is concluded that nontransmural myocardial infarcts tend to occur in older patients with known coronary atherosclerosis and these infarctions are frequently preceded by a period of unstable angina. The clinical course is often complicated with congestive heart failure and other major management problems. Three different groups of electrocardiographic changes were noted and all four in-hospital deaths showed the same pattern of electrocardiographic changes. The prognosis of patients suffering nontransmural myocardial infarctions is not good, as evidenced by a death rate similar to reported patients suffering transmural myocardial infarction and a significant incidence of cardiovascular disability in those who survive.     

Hemolytic anemia associated with multiple autoantibodies and low serum complement

A 37 year old woman with extravascular hemolytic anemia had a positive Monospot test associated with positive antiglobulin and anticomplement Coombs' tests, cold agglutinins and warm autoantibodies. IgG-kappa (κ) antibodies, which reacted with all panel red cells at 37 °C, were eluted from her circulating red cells. However, neither immunoglobulins nor C3 was detected after her serum was adsorbed with heterologous red cell stroma at 37 °C and eluted at the same temperature in glycine buffer. In contrast, IgM-κ and IgM-Iambda (λ), IgG3-κ, IgG4-λ, IgA-λ and C3 were eluted at 37 °C from heterologous red cell stroma after adsorption with her serum at 0 °C. Thus, antibodies of several types, which were present in the patient's serum, reacted optimally with red cell antigens at low temperature. Cold-reactive IgG3-κ antibodies, which were also capable of interacting with red cells at 37 °C, probably accounted for the IgG-κ antibodies eluted from the patient's circulating red cells.The patient's serum C4 titers were decreased, with low normal to moderately depressed C3 and low normal C5, indicating that the anti-red cell IgM and/or IgG3-κ antibodies probably fixed complement.A localized cold stress test resulted in a transient increase in plasma hemoglobin and a decrease in serum C3 titer. These findings, and the beneficial clinical response obtained with small doses of prednisone, suggest that both the cold-reactive antibodies and the IgG-κ on circulating red cells were pathophysiologically significant.This is the first report of a patient with multiple red cell autoantibodies in whom serum complement component titers were determined in conjunction with characterization of the anti-red cell immunoglobulins. Subclinical infectious mononucleosis may have preceded the prolonged hemolytic episode. Clinical evidence of systemic lupus erythematosus has not appeared.     

Acute hemodynamic effects of combined therapy with digoxin and nifedipine in patients with chronic heart failure

The acute hemodynamic effects of combining administration of digoxin (DIG) (0.01 mg/kg intravenously) with nifedipine (NFP) (10 mg sublingually) were compared with those of DIG and NFP considered alone in 12 patients with chronic congestive heart failure due to coronary artery disease (CAD, seven patients) or primary congestive cardiomyopathy (CCM, five patients); four patients also had mitral regurgitation (MR). NFP significantly reduced systolic and diastolic blood pressure (BP), systemic vascular resistance (SVR) from 1925 ± 400 (mean ± SD) to 1333 ± 256 dyne · sec · cm^?5 after 30 minutes (p < 0.00001), and left ventricular filling pressure (LVFP) from 19 ± 7.5 to 15.6 ± 4.2 mm Hg (p < 0.005). The cardiac index (CI) increased from 2.16 ± 0.47 to 2.81 ± 0.63 L/min/m² (p < 0.00001). DIG induced a significant reduction in LVFP from 18.1 ± 7.7 to 14.3 ± 5.4 mm Hg after 90 minutes (p < 0.005) and a slight increase in stroke volume index; no significant change in BP, Cl, and SVR was seen. The combination of DIG and NFP produced a significant increase in Cl from control value of 2.2 ± 0.48 to 2.95 ± 0.44 L/min/m² (p < 0.00001), and a significant reduction in LVFP from 18.1 ± 7.7 to 13 ± 4.7 mm Hg (p < 0.00001), and in SVR. Simultaneous administration of DIG and NFP resulted in an augmentation in cardiac performance greater than that achieved with either agent considered alone. The combination produced a greater output increase and a greater LVFP reduction, indicating a shift upwards and to the left to a more improved left ventricular function curve. No significant difference was seen between the hemodynamic response to the three drug regimens in patients with CAD versus patients with CCM. NFP produced a greater improvement in cardiac performance in patients with MR when compared with those without MR.     

Sodium intake and furosemide administration in hypertensive patients with renal insufficiency

The effects of various levels of sodium intake and loop diuretic (furosemide) administration upon arterial pressure and renal function were studied in 11 patients with impaired renal function and essential hypertension. The patients were hospitalized in a metabolic ward and continued taking their usual antihypertensive medications. After a stabilization period, all patients followed the following regiments for 5 to 7 days: period I, 20 mEq sodium diet without diuretic administration; period II, 80 mEq sodium diet and furosemide, 80 mg daily; and period III, 200 mEq sodium diet and furosemide, 240 mg daily. Supine diastolic pressure was lower (P is less than 0.05) during period II than during period I and both supine and standing systolic and diastolic pressures were significantly lower in period III than in period I (P is less than 0.01). No significant differences in the renal clearance of inulin were noted between any of the study periods. In patients with essential hypertension and impaired renal function, consumption of a moderate or liberal sodium diet combined with administration of a loop diuretic agent (furosemide) appears to result in better control of arterial pressure without significant changes in renal function than does strict sodium restriction without diuretic administration.