Correlation of electrocardiographic and pathologic findings in anteroposterior infarction

The findings in the Wilson precordial leads and in the standard and Goldberger limb leads have been analyzed and correlated with the pathologic findings in fifty-two cases of coexistent infarction of the anterior and posterior walls of the left ventricle. Autopsy revealed a recent infarct involving the apical one-third or more of the anterior wall and continuing through the septum and around the tip of the left ventricle into the apical one-third or more of the posterior wall in twenty cases, and an old healed infarct of similar distribution in sixteen cases. The pathologic findings were the result of the confluence of independent anterior and posterior infarcts in at least three of these thirty-six cases, and were attributed to simultaneous anteroposterior infarction in the other thirty-three cases because of the anatomical continuity of the lesions and the uniformity in age. Five additional cases were observed with pathologic evidence of simultaneous anteroposterior infarction, complicated by a separate posterobasal lesion. The eleven remaining cases had anatomically separate anterior and posterior lesions.     

Is alcohol a carcinogenic risk?

Consumption of alcoholic beverages has been implicated as a risk factor for the development of various cancers including oesophageal, oral, pharyngeal, laryngeal, liver and breast cancers. This article is a commentary on an earlier paper entitled ‘Alcohol: a carcinogenic risk? which challenges some of the evidence relating alcoholic beverage consumption to risk for these cancers. In the course of commenting on this paper, evidence is reviewed which shows a relationship between these cancers and consumption of alcoholic beverages, which is often found to be dose-related.     

Entrainment Onset in Atrioventricular Reciprocating Tachycardia: Value in Bypass Tract Localization and Relationship to the Preexcitation Index

The timing of entrainment onset has been shown to correlate with the conduction time to critical elements of a tachycardia circuit in a pacemaker model of reentrant ventricular tachycardia (VT). The utility of this method in evaluating clinical reentrant tachycardias was there/ore evaluated in 24 patients with symptomatic Wolff-Parkinson-White syndrome and single bypass tracts (left free wall in 17, posteroseptal in 5, anteroseptal in 1, and right free wall in 1). Right ventricular apex (RVA) pacing during orthodromic atrioventricular reentrant tachycardia (oAVRT) at 10–70 msec less than tachycardia cycle length demonstrated concealed entrainment of the tachycardia in all patients studied. An entrainment index (EI), defined as the minimal prematurity of the ventricular stimulus that first resulted in atrial reset, was calculated from multiple entrainments in each patient. The El was 121 ± 25, 83 ± 19, and 55 msec for left free wall, septal, and right free-wall bypass tracts, respectively (P = 0.004 for difference between left free wall and septal). A corrected EI, derived by subtracting the amount of atrial reset from the EI, gave values of 108 ± 22 and 71 ± 17 msec for left free wall and septal bypass tracts (P = 0.001). These values were compared to the preexcitation index (PI) by linear regression analysis in these patients. The PI correlated closely with both the EI and the corrected EI (r = 0.90 and 0.93, respectively), but the PI could only be derived in 12/17 (71%) left free-wall tachycardias versus the El in 17/17 (100%) (P < 0.05). Thus, the timing of entrainment onset can be used to calculate a relative conduction time to the tachycardia circuit in oAVRT, thus localizing the bypass tract. This may prove useful in localizing critical components of the reentrant circuit in other clinical tachycardias.     

Variation in Mortality from Ischaemic Heart Disease between England and Scotland

A Comparison of mortality from ischaemic heart disease underthe age of 60 for 1980 to 1981 between the Grampian Health Boardand the North Staffordshire Health Authority has been made.A total of 993 deaths was notified by death certificate fromthe two areas of similar population of which 434 were from Grampianand 559 from North Staffordshire. After examination of generalpractitioner and hospital case notes, autopsy reports and deathcertificates, nearly all (532) of the North Staffordshire deathswere accepted as being due to ischaemic heart disease but onlythree-fifths (263) of the Grampian deaths could be begin besubstantiated as there was inadequate information for the remainder.Deaths from ischaemic heart disease seem apparently to be twofoldgreater in North Staffordshire than Grampian but much of thisdiscrepancy could be attributed to a widely different autopsyrate and to unavailability of case notes. Experience of thissurvey suggests that the results of other epidemiological investigationsmay be equally or even more unreliable.     

Four unusual cases of Spinal Cord Compression

Four cases of spinal cord compression are presented, the causes being tuberculoma, haemangioma, gouty tophus and exophytic glioma; the first three being extradural, extraosseous in location. A short discussion follows. These cases are presented to remind the reader to keep less common causes in mind when dealing with a case of spinal cord compression.