The prognostic value of maximal exercise testing soon after first myocardial infarction

The prognostic value of ST-segment depression during maximalexercise test performed in the third to fourth week after acutemyocardial infarction (AMI), was studied in 126 consecutivepatients with no evidence of previous myocardial infarction,unstable angina pectoris or severe heart failure. All patientson average increased their pressure-rate product by 2.6 andno complications occurred. Within the first year of follow-up,major cardiac events occurred in 9 patients (20%), and werefatal in 6 (13%), of the 46 patients who developed ST-segmentdepression during exercise. Only 3 major cardiac events (4%)occurred in the 80 patients without exercise induced ST-segmentdepression. Depression of the ST-segment on maximal exercisewas a significant predictor of subsequent cardiac events inthese survivors of first AMI.     

Ventricular tachycardia as a complication of annular subvalvular ventricular aneurysm in a Caucasian woman

A Caucasian female patient with repetitive attacks of ventriculartachycardia and fibrillation caused by annular submitral leftventricular aneurysm is reported. During a follow-up periodof six years after aneurysmectomy, the patient remained symptom-free.     

Deleterious effects of low-dose oestrogen theraphy on coronary status in patients with prostatic cancer

The effects of oestrogen therapy and of orchidectomy on coronarystauts, as reflected by exercise ECG-testing before and afteryear of tretment, were assessed in a randomized study of patients(N=100) prostatic cancer. Oestrogen was given as polyestradiolphosphate 80 mg i.m. per month in combination with 150 µgor in pre-traetment exercise test results Twelve months afterstart of therapy the oestrogen group showed a significantlygreater depression of the ST-segment during maximal exercisein leads CH₂ (P<0.0005) and CH⁵)P<0.01) compared withthe pre-treatment depression. Twenty-five per cent (N=13) ofthe patients in the oestrogen group suffered cardiovascularcomplications during the yera the of therapy, whereas no suchcomplications were observed in the orchidectomy group. However,even the patients in the oestrogen group who had not sufferedcardiovascular complications had significantly greater depressionsof the ST-segment during exercise both in lead CH₂ (P<0.0005)and in CH₅ (P<0.05). There was no significant change in theST-segment level in the orchidectomy group twelve months aftersurgery. In summary, we found of an induction of myocardialishaemia during treatment with exogenous oestrogens at low dosagein patients with prostatic. This deleterious effect of oestrogenon the coronary status argues against oestrogen therapy, sinceoedtrogen has not been shown to be more beneficial than orhidectomyagainst prostatic carcinoma.     

Anterior displacement of the mandible for better exposure of the distal segment of the extracranial carotid artery

Summary Anterior displacement of the mandible (ADM) was performed in 34 patients undergoing surgery for malformations or atheromatous lesions of the distal segment of the extracranial internal carotid artery (ICA). This procedure greatly facilitates surgical access to the upper cervical region and has several advantages over mandibulotomy-mandibulectomy, namely: A shorter operating time, sparing of the inferior alveolar nerve and of the mandibular branch of cranial nerve VII, with no need for post-operative immobilization of the mandible. ADM permits the correction of ICA lesions extending as far as the first cervical vertebra. For lesions extending into the carotid canal ADM needs to be supplemented by various other procedures via the base of the skull.     

“Cross-over” duplication of middle cerebral artery,agenesis of internal carotid artery and saccular aneurysms

Summary The authors describe a patient with anomalous branches of the left internal carotid artery, cross-over duplication of its middle cerebral artery and agenesis of the contra-lateral internal carotid artery associated with two aneurysms successfully clipped. Pertinent literature is reviewed.     

Dysphagia lusoria: proposal of a new treatment

Summary Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.     

Plasma concentration and vascular effect of β-endorphin in spontaneously hypertensive and Wistar Kyoto rats

Summary In order to find out whether -endorphin (-E) is involved in the development of hypertension, we performed two series of experiments. Firstly, spontaneously hypertensive rats (SHR) and their normotensive Wistar Kyoto controls (WKY) were submitted to ether stress. Plasma concentrations of -endorphin-like immunoreactivity (-EI), adrenocorticotropin (ACTH) and -melanotropin (-MSH) were measured by radioimmunoassay. The basal concentration of -EI was similar in WKY and SHR, whereas WKY had higher levels of ACTH and lower levels of -MSH than SHR. In both strains acute stress enhanced the plasma concentration of -EI to the same extent and with a similar time-course. The increase of plasma -El coincided with a rise in ACTH but not -MSH. Gel chromatography of -EI revealed that plasma extracts contain similar amounts of -lipotropin- (-LPH) and -E-sized immunoreactive components, and that acute stress elevated both forms of -El. Secondly, isolated tail arteries of SHR and WKY were perfused and field stimulated with two pulses at 1 Hz. -E depressed stimulation-evoked vasconstriction with the same potency in both strains. Thus, basal and stress-induced levels of -EI did not differ in SHR and WKY. Moreover, in the tail artery of both strains the sensitivity of presynaptic opioid receptors towards -E was almost identical. If the -E sensitivity of these receptors in other arteries of WKY and SHR is also similar, a major role of the circulating peptide in the development of hypertension is rather unlikely.This work was partly supported by the Deutsche Forschungsgemeinschaft (SFB 325) Send offprint requests to B. Bucher at the above address     

Age-related changes in the response to vasoconstrictor and dilator agents in isolated beagle coronary arteries

Summary Responses to vasoactive agents were compared in helical strips of coronary arteries isolated from beagles of 30 days, 3 months, 2 years and 12 years old. Serotonin contracted the arterial strips dose-dependently, the contraction being greater in the arteries of proximal portion than in the distal arteries. The contraction increases with age from 3 months to 12 years, although EC50 values did not differ. Angiotensin II contracted distal coronary arteries to a greater extent than the proximal ones. Age did not alter the peptide-induced contraction. In prostaglandin F₂-contracted coronary arteries, acetylcholine-induced relaxations, dependent on endothelium, were less in the arteries from senescent beagles than in those from adult beagles (2 years old). Histamine relaxed the infant beagle arteries to a lesser extent than the adult and senescent beagle arteries. Histamine-induced relaxations were attenuated selectively by cimetidine. Relaxations caused by adenosine and prostaglandin I₂ did not differ in coronary arteries from beagles of different ages. It may be concluded that greater responsiveness to serotonin of senescent beagle coronary arteries is due preferentially to increased function of serotonergic receptors rather than impaired function of the arterial endothelium responsible for the release of relaxing factor(s), although some impairment of the function is supposed, on the basis of interferences with acetylcholine-induced relaxation in the aged beagle arteries. Histaminergic H₂ receptor function appears to develop in beagle coronary arteries until 3 months of age. Send offprint requests to N. Toda     

The membrane potential of vascular smooth muscle appears to modulate uptake2 of 3H-isoprenaline

Summary Segments of the rabbit main pulmonary artery and of its two branches were exposed for 10 min to 50 nmol/l ³H-(±)-isoprenaline, and the accumulation of tritium in the tissue was determined; COMT was inhibited in all experiments. 1. The accumulation of the tritium label was sensitive to 3-O-methyl-isoprenaline (OMI), showing that this vascular smooth muscle possesses uptake₂. 2. In the presence of 0.01 to 1 mol/l (–)-noradrenaline, the accumulation of tritium was depressed (in a concentration-dependent manner). This decline involved the OMI-sensitive accumulation of ³H-isoprenaline. 3. The presence of any one of three selective alpha₁-adrenoceptor antagonists (1 gmol/l prazosin, 1 mol/l WB4101, 10 gmol/l corynanthine) prevented the effect of 1 mol/l (–)-noradrenaline on the accumulation of tritium. However, in the absence of (–)-noradrenaline, the three antagonists failed to affect the accumulation of tritium. 4. 10 mol/l nicorandil caused the accumulation of tritium to increase. 5. As stimulation of alpha₁-adrenoceptors is known to result in depolarization, and as nicorandil is known to hyperpolarize this smooth muscle, it is concluded that the resting membrane potential modulates uptake₂. Send offprint requests to U. Trendelenburg at the above address     

Volume/pressure curve of total respiratory system in paralysed patients: artefacts and correction factors

The volume/pressure (V/P) curve of the total respiratory system in paralysed patients is drawn assuming that volume changes of the respiratory system (V resp) equals volume displacement of the measuring apparatus (V syr), usually a supersyringe. However, in 93 VP curves we found that O₂ removed from the lung-syringe system during the procedure (proportional to the time) largely exceedes the CO₂ added to the lung-syringe system (V gas). This results in a net loss of volume from the system (V resp相似文献