The presence of epsilon waves in a patient with acute right ventricular infarction

Epsilon wave is an unusual electrocardiographical finding, which may appear in other pathological conditions besides the arrhythmogenic right ventricular dysplasia, particularly in the acute myocardial infarction of the right ventricle, the inferior, or the posterior wall of the left ventricle. Its real incidence in these acute coronary syndromes remains unknown and will be probably difficult to assert, since it may be unnoticed by inexperienced physicians because of its little voltage. The outstanding interest of this case lies in the clear electrocardiographical images and in the step-by-step differential diagnosis discussed by the authors.     

Cobalamin deficiency and subacute combined degeneration after nitrous oxide anesthesia: a case report

We report on a diabetic man in his early forties with a history of disabling left-hemisphere stroke and hyperhomocystinemia who developed new sensorimotor symptoms and urinary incontinence 4 weeks after prolonged exposure to nitrous oxide (N(2)O) related to arterial occlusive disease and amputation. Physical examination at rehabilitation hospital admission showed preexisting severe nonfluent multimodality language impairment, new ataxic quadriparesis superimposed on static spastic right hemiparesis, diffusely blunted muscle stretch reflexes, impaired cutaneous sensation and proprioception, diminished alternating motion rates, and impaired truncal balance. Laboratory tests revealed low serum cobalamin and hyperhomocystinemia. Magnetic resonance imaging of the spinal cord showed dorsal T2-signal hyperintensity. Treatment included vitamin replacement and comprehensive rehabilitation. His response to hospital-based and outpatient treatment led to successful prosthetic fitting. This case shows the importance of screening for and treating cobalamin deficiency before exposing patients with known risk to N(2)O and highlights the potential diagnostic and therapeutic challenges of subacute combined degeneration when it occurs with a setting of preexisting disabling neurologic impairment.     

Automated colorimetric determination of α-tocopherol

A rapid and convenient automated procedure for the determination of α-tocopherol is described. As little as 0.3 ml of serum or plasma can be used at a sample rate of 20 per hour and carry-over is negligible. Within-batch precision was 4.71% at 5.0 mg α-tocopherol per 1, and 3.68% at 20 mg/l, compared with a between-batch precision of 6.98% at 10 mg/l. Using this procedure α-tocopherol has been found to be distributed in a log-normal manner and on that basis the range of values for 80 haematologically normal subjects was calculated to be 4.0 to 16.0 mg/l. In pregnancy the α-tocopherol was elevated, ranging from 6.7 to 24.0 mg/l. During the first year of life normal infants ranged from 2.0 to 16.0 mg/l which was higher than a small group with various disorders whose values ranged from 1.2 to 8.3 mg/l. The cord blood level was approximately one-fifth of the maternal level.     

Elevated Serum Vitamin B12 in Cystic Fibrosis

ABSTRACT. In 62 patients with cystic fibrosis the serum vitamin B12 concentration ranged from 160–2 600 pmol/l with a mean of 1105 pmol/l. Both vitamin B12-binding proteins in the serum, transcobalamin II and R-binders, carried increased amounts of vitamin B12, but showed relatively normal levels of unsaturated vitamin B12-binding capacity. This combination is rather typical for hepatic dysfunction, although the recurrent pulmonary infections might exert an upward effect on plasma R-binder concentration through increased turnover of myeloid cells. A significant positive correlation between transcobalamin II-vitamin B12 and serum alkaline phosphatase suggests that transcobalamin H-bound vitamin B12 might be an early indicator of focal biliary cirrhosis, which is known to occur in these patients.     

Fibromatosis of dura presenting as infantile spasms

A 6-month-old boy developed emprosthotonic infantile spasms and right hemiparesis. CT scan revealed a large mass related to a distended right temporal horn which on craniotomy proved to be a hard white tumour of the tentorium cerebelli which could be only incompletely resected. Microscopically and ultrastructurally, this lesion proved to be a typical fibromatosis containing myofibroblasts which invaded the brain. The child made an excellent recovery and is well a year after surgery. This case is another example which argues for full investigation of cases of infantile spasms which usually carry such a dismal prognosis.     

Clinical and pathophysiological evaluation of esophageal reconstructions using gastric tube and pedicled colon segment

Pathophysiological and nutritional conditions were compared after esophageal reconstruction in 15 patients with a gastric tube and in 12 patients with a pedicled colon segment for the treatment of esophageal cancer. There was no significant difference in the postoperative nutritional index, iron and vitamin B₁₂ metabolisms. On the other hand, the long gastric tube from the greater curvature of the stomach used as an esophageal substitute retained some secretory functions of both exocrine and endocrine although the effect of truncal vagotomy may have to be taken into consideration. Presented at the 28th Annual Meeting of the Japanese Association for Thoracic Surgery, November 26, 1975, Osaka. This study is supported partly by the Cancer Research Grant No. 75-8, the Ministry of Health and Welfare, Japanese Government.     

Dietetic Habits and Quality of Semen in Indian Subjects

Eßgewohnheiten und Qualität des Spermas bei Indern
In einer kurzen Mitteilung wird nachgewiesen, daß die Eßgewohnheiten einen signi-fikanten Einfluß auf die Vitamin-B₁₂-Werte des Spermaplasmas besitzen. Bei Normozoo-, Oligozoo- und Azoospermie fanden sich signifikant niedrigere B₁₂-Werte in der Lakto-vegetarischen Gruppe gegenüber der nichtvegetarischen Gruppe. Bei der Azoospermie ergaben sich eindeutig niedrigere B₁₂-Werte als in den anderen beiden Gruppen.