Impaired vagal heart rate control in coronary artery disease.

Heart rate variation in deep breathing, a sensitive non-invasive measure of cardiac parasympathetic activity, was measured in 63 patients with coronary artery disease, in 22 patients with atypical chest pain, and in 20 healthy symptom free volunteers. There was significantly less heart rate variation in deep breathing in the patients with coronary artery disease than in the healthy subjects. Twenty patients (32%) with coronary artery disease had lower than normal variation in heart rate. The patients with chest pain showed an intermediate heart rate response to deep breathing. Sinus arrhythmia in the patients with coronary artery disease was not related to the functional class, medication, number or location of narrowed vessels, or to the left ventricular ejection fraction, and end diastolic pressure. These results suggest that impairment of the parasympathetic nervous function is common in coronary artery disease.     

Short term cyclosporin A treatment of Beh?et's disease.

Eleven separate three-month courses of cyclosporin A, an oral solution 10 mg/kg/day, were administered to eight patients with Behçet''s disease with sight-threatening posterior uveitis. It was found to be effective in arresting the inflammatory activity in the eye as well as the mucocutaneous lesions of Behçet''s disease. Improvement in visual acuity was observed within one week of starting therapy. Severe exacerbations in the ocular and mucocutaneous lesions occurred on withdrawal of the drug. At this dosage side effects included hirsutism in all women, and a slight rise of serum bilirubins in two patients and of blood urea in one patient. The latter two conditions responded rapidly to dose adjustment.     

Flip-flop phenomenon and dissection of extracranial carotid artery

A case of extracranial carotid artery dissection investigated both by conventional brain imaging and by arteriography is presented. The radionuclide angiogram showed a flip-flop phenomenon on the left hemisphere. The implications, including clinical features, pathogenesis, diagnosis, and treatment are discussed. Dissection of extracranial carotid artery is a cause of carotid hypoactivity, and this phenomenon is associated directly with a flip-flop phenomenon on brain imaging.     

Changes in biochemical parameters during complete thyroid hormone deficiency of short duration in athyreotic patients

The effect of withdrawal of suppressive therapy with thyroid hormones (200 micrograms L-thyroxine/day) on serum biochemical profiles and blood cell counts were studied in ten athyreotic thyroid carcinoma patients. After 14 days off therapy, all patients but one were still clinically and biochemically euthyroid. Twenty-eight days without thyroid hormones resulted in severe clinical and biochemical (TT4, TSH) hypothyroidism. At that time, the following parameters changed significantly: CPK activities increased (in five of ten patients above normal) as well as activities of SGOT, SGPT, and LDH (means and s.d.s within the respective normal ranges). Total cholesterol and triglycerides increased within the normal range. There were minimal but significant increases of serum creatinine and of mean corpuscular volume of erythrocytes as well as decreases of serum sodium and calcium. Our study underlines the importance of further investigation if pathologic biochemical or hematologic parameters are obtained in athyreotic patients after 4 wk withdrawal of thyroid hormone therapy.     

Suicide among Swedish dentists. A ten-year follow-up study

In the present study, we have followed a national cohort of dentists, academics, i.e. people with three or more years of post-high school education, and the general population for a period of ten years, and identified all cases of recognized suicide during the period 1961 to 1970. The aim of the study was to assess whether suicide rates are higher among dentists even after adjustment for socioeconomic factors. Results show an elevated standardized mortality ratio (SMR) for male dentists compared to other male academics. Female dentists did not exhibit any increased risk. It is suggested that enhanced interest should be given to the possible etiologic role of not only psychosocial factors but also to psychoorganic consequences of mercury exposure among dentists.     

pH dependence of the blocking activity of carbisocaine and its derivatives

The blocking activity and pH dependence of carbanilate local anaesthetics, carbisocaine and its homologues, were tested on isolated rat sciatic nerves at pH 6.0, 7.2 and 8.4. Carbisocaine blocked the compound action potential more strongly than the derivatives with shorter alkoxysubstituents. The blocking potency of shorter derivatives increased with the rise of external medium pH, whereas the activity of carbisocaine increased with decreasing external pH. Quaternary compounds applied in the external medium were able to block the action potential, but in higher concentrations and with a longer half-time than their tertiary analogues. The blocking potency of quaternary derivatives correlated well with the length of the alkoxysubstituent and thus also with their lipophilicity. Extracellular pH did not consistently change the inhibitory effect of quaternized derivatives. These observations support the view that the lipophilicity of local anaesthetics is one of the possible factors determining their anaesthetic activity and the pH dependence of their effect.     

Zur Behandlung der Luxationen und Luxationsfrakturen im Lisfrancschen Gelenk

Zusammenfassung Aus der Vielzahl der Verrenkungsbrüche desLisfrancschen Gelenkes werden einige besondere Formen herausgegriffen, die mit gleichzeitiger Verrenkung in anderen Fu?wurzelgelenken kombiniert sind. Die prim?re Fixierung dieser unstabilen Verrenkungsbrüche mit gekreuzten Bohrdr?hten wird empfohlen. Bei veralteten F?llen ist die Arthrodese oder Keilresektion des Gelenkes angezeigt.

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Summary Among the numerous types of fracture-dislocations in the tarso-metatarsal joints some special cases are described, associated with simultaneous dislocations of other tarsal joints. In these unstable fracture-dislocations primary osteosynthesis by means of crossed drill-wires is recommended. In old cases arthrodesis or wedgeosteotomy of the joint is indicated.

     

Hierarchy of prognostic factors for corneal allograft survival

The results of analyses of 1218 consecutive corneal transplants performed in a single centre reveal that the most important prognostic factors for corneal allograft survival are recipient corneal vascularisation, graft diameter, HLA-A and B matching especially for high risk patients, organ culture storage of donor corneas prior to transplantation and donor age.     

The glaucoma suspect: Differentiation of the future glaucoma eye from the non-glaucomatous suspect eye

Visual-field areas to a I_2e stimulus were measured planimetrically using an X-Y digitizer and a computer program. Sampling of normal subjects and patients suspected of having glaucoma was done at two points in time. Calculations of eye-wall stress were done using ultrasonic data and intra-ocular pressure (IOP) measurements from patient records. For those suspected of having glaucoma who developed chronic open-angle glaucoma (COAG), the time of transition was the second point in time. The visual field area was regressed against patient age at the two points in time. No difference in the regression slopes was found for the normal subjects and unchanged patients. The patients who did develop glaucoma were significantly different. The mean annual rate of visual-field change (rate of decay) was calculated and found to be 28.5 mm²/year for the normals, 153.5 mm²/year for the suspects, and 376.4 mm²/year for those patients who developed glaucoma. The rate of visual-field decay only correlated with patient age (P = 0.03) and eye-wall stress (P < 0.01) in the patients who developed glaucoma.