Changes of the RR Interval and the QRS Morphology in AV Nodal Tachycardia: Further Evidence for Extranodal Involvement

A young patient wilh AV nodal tachycardia was referred for ablation. During electrophysiological testing, a stable succession of up to four different RR intervals with comcomitantly changing QRS morphologies were recorded. This observation might reflect the conduction of the reentry circuit through different extranodal "pathways" in the low right atrium. Radiofrequency current was applied near the ostium of the coronary sinus; this abolished conduction through the slow pathway, as dual AV conduction was no longer present. She remains free of recurrences for a follow-up period of 8 months.     

Contrasting effects of angiotensin converting inhibitor and alpha-1-antagonist on albuminuria in insulin-dependent diabetes mellitus patients with nephropathy

Abstract. Objective . The main aim of this study was to examine the effects of an angiotensin converting inhibitor, enalapril, and an alpha-1 (α-1) antagonist, doxazosin, on albumin excretion, renal haemodynamics and tubular function in insulin-dependent diabetes mellitus patients with nephropathy. Design . The study consisted of a four-week run-in period, a four-week active treatment period, a four-week wash-out period and a second four-week active treatment period. Setting . The study was performed in the out-patient clinic at a university hospital. Subjects . Ten patients with insulin dependent diabetes mellitus with macroalbuminuria (> 200 μg min^?1), mild to moderate hypertension (diastolic blood pressure 85–115 mmHg) and serum creatinine level below 200 μmol L^?1 were included in the study. Main outcome measures . The effect of the drugs on albumin and total protein excretion, β-2-microglobulin, proximal tubular enzyme markers and renal haemodynamics. Results . Systolic and diastolic blood pressure were equally reduced by both drugs. Enalapril reduced albumin excretion from 1090 ± 281 μg min^?1 to 742 ± 246 μg min^?1 (P < 0.01) and total protein excretion from 2.0 ± 0.4 g per 24 h to 1.3 ± 0.4 per 24 h whereas doxazosin was without effect. Glomerular filtration rate and effective renal plasma flow were unchanged by either drug. Doxazosin increased filtration fraction from 0.21 ± 0.02 to 0.23 ± 0.01 (P < 0.05). The urinary excretion of the proximal enzyme markers N-acetyl-beta-glucosaminidase and alkaline phosphatase were elevated as well as urinary excretion of β-2-microglobulin. However, neither the excretion of β-2-microglobulin nor the enzyme markers were affected by either drug. Conclusions . Enalapril, but not doxazosin, reduces albuminuria in insulin dependent diabetes mellitus patients with nephropathy. The drugs exert differential effects on renal haemodynamics.     

Negative affect, alcohol expectancies and alcohol-related problems

Using data from the first epidemiological study of mainland Puerto Rican drinking, the authors explore the relationships between negative affect, alcohol expectancies and drinking problems. Results revealed that the co-occurrence of depressed mood and drinking problems was strongly moderated by alcohol expectancies. More specifically, the co-occurrence was strongest among those Puerto Ricans who most expected alcohol to elevate their mood. Findings are discussed in terms of their explication of the co-morbidity of depressive symptomatology and alcohol abuse.     

The importance of zinc to cell proliferation in endochondral growth sites in the white rat

abstract – The possible importance of zinc to cell proliferation in endochondral growth sites in the white rat was studied using zinc-deficient feeding and light microscopic autoradiography with tritiated thymidine. Eight experimental rats were given a zinc-deficient diet ad libitum and eight paired-fed controls were given the same diet plus zinc supplement. After 3 weeks on the experimental diet, at which time the animals were 6 weeks old, they were injected with H³-thymidine. Two rats from each group were killed after 1 h, and 1, 3 and 6 d. Tissue specimens were taken from the mandibular condyle, the proximal epiphysis of the humerus and the costo-chondral junction of the rib. The autoradiographs indicated a reduction, as compared to the control rats, of cell proliferation in the three endochondral growth areas in the experimental rats.     

Treatment of cervical intraepithelial neoplasia (CIN) by radical electrocoagulation diathermy; 5 years' experience

Summary. During the first 5 years of a colposcopy clinic established in a London teaching hospital 653 new patients were seen, usually referred because they had had an abnormal cervical smear report suggesting cervical intraepithelial neoplasia (CIN). Of 490 women treated within the district for CIN, 361 (73.7%) underwent radical electrocoagulation diathermy, 91 (18.6%) were treated by cone biopsy, 34 (6.9%) underwent hysterectomy and the other four patients were treated by cryocau-tery. Of the 245 women treated by radical electrocoagulation diathermy who have been followed for at least 12 months, persistent or recurrent disease has been found in only 15, a first time treatment success rate of 93.9%.     

Studies on the endoanesthetic effects of lidocaine and benzonatate on non-medullated nerve endings in the left ventricle

The blocking (endoanesthetic) effects of lidocaine (Xylocaine®) and benzonatate (Tessa-Ion®) on cardiac ventricular, non-medullated endings were tested in cats. Lidocaine was found to cause an effective and long-lasting partial blockade of the cardiovascular reflex responses to stimulation of the ventricular receptors. This effect was obtained at plasma concentrations of 2.5-4.7 μg/ml, which is within the concentration range seen in patients with myocardial infarction treated with lidocaine because of its antiarrhythmic properties. Tessalon also markedly attenuated the reflex response, normally obtained when the ventricular receptors are excited, but the effect was very shortlasting when doses, producing no side effects, were used. Recordings of impulse traffic from the left ventricular receptors showed that the impaired reflex responses after lidocaine and Tessalon were due to a blockade at the receptor level. Thus both the receptor response to ventricular distension and to injection of protoveratline (Bezold-Jarisch reflex) was markedly attenuated after infusion of lidocaine (2–4 mg/kg) or a bolus injection of Tessalon (0.2-1 mg/kg).     

Prevalence of Coronary Artery Disease in Patients with Valvular Heart Disease

ABSTRACT. To evaluate the usefulness of preoperative coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost-benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut-off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.     

An unusual presentation of Trichophyton violaceum infection

A case with encapsulated Tricophyton violaceum abscesses in the skin is recorded. Defective cell mediated immunity was shown in the patient and in his two cousins. This defect combined with malnutrition, hypoadrenalism and griseofulvin resistance gave unusual lesions and chronicity. A probable genetic factor for the defective cell mediated immunity is postulated.