Incidence of conduction disorders in patients who underwent surgery for hypertrophic obstructive cardiomyopathy

Thirteen non-consecutive patients, aging 7 to 61 (average 27) years, underwent left ventricular myotomy-myectomy for a severely symptomatic idiopathic hypertrophic subaortic stenosis (IHSS). In all patients the resting ECG before surgery showed P-R less than 0.18 sec, QRS duration less than 0.11 sec, QRS axis ranging from +10 to +80 degrees. In the immediate post-surgical period 3 patients has complete heart block and 1 had 2nd degree type 2 atrio ventricular block. Lesion was infra-Hisian in 3 patients and intra-Hisian in 1 patient. In the remaining 9 patients an immediate post-surgical left bundle branch block appeared; in 3 out of these patients ECG and an electrophysiologic study documented severe infra-Hisian conduction impairments after an average period of 4 years from surgery. During follow-up 3 patients died suddenly.     

The use of colonoscopy in the study of synchronous colorectal neoplasms

Over a 5-year period, 185 patients with primary colorectal carcinoma were studied by colonoscopy for synchronous neoplasms. Twenty-eight patients had incomplete examinations due to obstructing tumors, and 157 had total colonoscopy. Sixty patients (35.9%) had synchronous neoplasms, of which 43 (25.7%) were adenomatous polyps, 5 (3%) were villous polyps, and 12 (7.2%) were carcinomas. The planned surgical procedure was altered on 7 of 12 synchronous cancers (58.3%), 10 of 38 adenomatous polyps, and 17 of 157 (10.8%) patients who underwent total colonoscopy. Preoperative colonoscopy is deemed essential for the optimal management of the patient with colorectal carcinoma.     

Denzimol, a new anticonvulsant drug. II. General pharmacological activities

The paper reports on the pharmacological properties of N-[beta-[4-(beta-phenylethyl)phenyl]-beta-hydroxyethyl]imidazole hydrochloride (denzimol, Rec 15-1533), a compound endowed with anticonvulsant properties, and its possible side effects. Effects on the CNS, effects on vigilance and general motility are similar to those of phenytoin and occur at doses much above anticonvulsant levels. The drug has good in vitro antihistamine, anticholinergic and anti-5-HT activity which accounts for the effects on the gastrointestinal system e.g. inhibition of gastric secretion and motility and anti-ulcer properties. There was no significant effect on the cardiovascular system or respiration, except an interesting antiarrhythmic activity.     

Small primary de novo adenocarcinoma of the colon with mesenteric lymphatic metastasis

It is felt that the majority of colorectal carcinomas develop by malignant degeneration of previously benign adenomatous polyps. A small primary colon carcinoma, thought to have developed de novo directly from the colonic mucosa without the usual polyp-cancer sequence, is reported. This small nonulcerated lesion did not have the gross endoscopic appearance of a carcinoma and was associated with lymphatic metastasis. The need to include fiber-optic colonoscopy as part of the routine preoperative work-up and postoperative follow-up to rule out synchronous and metachronous lesions not detected by barium contrast x-ray studies is stressed.     

Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality

The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population. Blood pressure levels exceeding 160/95 mm Hg had been recorded in about one third of the men and half the women who died and a clear trend was found between overall mortality and arterial pressure. Symptoms of effort pain and ECG abnormalities compatible with myocardial ischaemia, both of which were unexpectedly common, appeared to have independent prognostic significance. The prognosis of each was worse when associated with hypertension; hypertension unaccompanied by either effort pain or ECG “ischaemic” abnormality, on the other hand, caused no excess mortality in either sex within the period of follow-up. Although classical myocardial infarction was confirmed to be relatively infrequent, myocardial disorders with many of the features of ischaemic heart disease are an important cause of death in rural Jamaicans.     

Analysis of the mode of transmission of right ventricular dysplasia

A formal analysis of the mode of transmission of right ventricular cardiomyopathy was performed in seven families with this condition. Ninety-six subjects (81 family members, 15 connected) were studied. The index cases were family members who had died suddenly in their youth with autopsy evidence of massive fibrous-adipose right ventricular myocardial replacement. Pedigree analysis showed that 58 per cent of the family members were affected, with a male predominance (63% of men vs 53% of women). The kindreds were all normal and in none of the families were both parents affected. Carrier states were observed in both males and females and vertical transmission was demonstrated. Clinically, the disease was very variable with some cases showing widespread right ventricular involvement with or without cardiomegaly, and other cases showing localised right ventricular abnormalities. These data are consistent with a congenital disease with an autosomal dominant mode of inheritance with incomplete penetrance and variable expression.     

Left ventricular mural thrombus in acute anterior myocardial infarct

Fifty-six consecutive patients with acute anterior infarction were studied by two-dimensional echocardiography to determine the incidence and complications of left-ventricular thrombosis. Mean follow-up period was 4.4 months. Left-ventricular thrombus was demonstrated in 14 patients (25%) between 25 and 54 days after infarction (group A), in 42 patients (group B) it was not demonstrated. Apical and septal dyskinesis, and Forrester's hemodynamic subset-III were significantly (P less than 0.02) associated with thrombus development. Ten patients of group A received heparin (6.6 days mean); the remaining four patients received aspirin and dipyridamole. Thrombi formation were not significantly prevented with both treatments (chi 2 = 0.635). During follow-up period, thrombus persisted in 6 patients of group A, all of them with apical and septal dyskinesis. Three patients had a cerebrovascular accident (5.3%), one of them of group A; no heparin anticoagulation was administered in two. We conclude that apical and septal dyskinesis during acute anterior infarction is generally associated with mural thrombi development. Due to the embolic risk therapeutic anticoagulation must be considered in these patients.     

Effect of heat inactivation and sheep erythrocyte adsorption on the titer of anticardiolipin antibodies in primary antiphospholipid syndrome and healthy blood donors' sera.

The standard enzyme linked immunosorbent assay (ELISA) currently in use for detection of anticardiolipin antibodies (ACA) was used to evaluate the influence of heat inactivation and sheep erythrocyte adsorption on individual optical density (OD) of sera from healthy blood donors or patients with primary antiphospholipid syndrome. Each sample was tested after single or combined maneuvers as follows: adsorbed, adsorbed and inactivated, only inactivated, and compared to basal readings. A significant increase of ACA titers did occur after inactivation of normal sera, but adsorption had no effect. In contrast, neither inactivation nor adsorption changed ACA titer in primary antiphospholipid syndrome sera as a group, although in certain sera there were changes. This observation may suggest the presence in normal serum of a thermolabile factor which modulates ACA binding to its antigen and the reactivity of the anticardiolipin antibodies of the primary antiphospholipid syndrome with sheep erythrocyte membrane phospholipids.