ALCOHOL-RELATED DISEASES ASSOCIATED WITH ISCHAEMIC HEART DISEASE: A THREE-YEAR FOLLOW-UP OF MIDDLE-AGED MALE HOSPITAL PATIENTS

Mortality and morbidity from ischaemic heart disease (IHD) wasstudied in 5404 Finnish males aged 35–64 years who hadbeen hospitalised for alcohol-related disease in 1972 withoutany admissions for IHD during that same period. By record-linkage,morbidity and mortality were followed up to the end of 1975.The mortality of patients with alcohol-related diseases wascompared to 1120 patients with acute appendicitis by calculatingindirectly age-standardised mortality ratios (SMR). The mortalityand morbidity of 5963 patients with acute myocardial infarctionor angina pectoris was also studied. The following SMRs forIHD mortality, non-fatal-MD-hospitalisation and for mortalityfrom all causes respectively, were found: acute myocardial infarction11.6, 7.2 and 7.2; alcohol intoxication 6.0, 4.5 and 4.5; anginapectoris 5.2, 10.5 and 3.4; liver cirrhosis 2.2, 2.5 and 11.8;alcoholism 1.9, 1.9 and 3.6; pancreatitis 1.8, 1.2 and 4.4;alcohol psychosis 1.7, 2.5 and 4.2. IHD mortality and morbidityappeared to be more prevalent in patients hospitalised withalcohol intoxication than in patients with other alcohol-relateddiseases. This suggests that rapid drinking predisposes bothto serious intoxication and to fatal disturbances of cardiacrhythm     

Labetalol does not alter the placental and fetal blood flow or maternal prostanoids in pre-eclampsia

Summary. The effect of intravenously administered labetalol (1 mg/kg) on placental and fetal blood flow was studied in 13 pre-eclamptic women. Although the maternal blood pressure decreased, no changes occurred in the blood flows in the intervillous space, the umbilical vein or the fetal descending aorta, nor did the indices of peripheral vascular resistance in the fetal aorta change, but the placental vascular resistance did decrease. Labetalol had no effect on prostacyclin or thromboxane A₂ as measured by urinary 6-keto-prostaglandin F_1α and serum thromboxane B₂ respectively. These findings are clinically relevant since they suggest that labetalol reduces maternal blood pressure without interfering with the placental or fetal blood flow.     

PLACENTAL BLOOD FLOW DURING CAESAREAN SECTION PERFORMED UNDER SUBARACHNOID BLOCKADE

Subarachnoid blockade using 0.5% bupivacine after a "preload"of Ringer's lactate solution 1500–2000 ml i.v. was studiedin nine patients undergoing elective Caesarean section. Ephedrineinfusion 50 mg in 500 ml was instituted at the first signs ofmaternal hypotension in seven patients. Although significantdecreases in mean maternal systolic, mean and diastolic arterialpressures were recorded, the individual decreases in pressurewere less than 30 mm Hg in all except two patients. In generalplacental blood flow did not change, although there was a markedincrease in one patient with toxaemia and a decrease in onewoman with diabetes mellitus. The babies were unaffected atdelivery. Preventive measures, especially the "preload" infusion,are important in the maintenance of adequate placental perfusionin patients undergoing Caesarean section under subarachnoidblockade.     

The Performance of the Probability Density Function in Differentiating Supraventricular from Ventricular Rhythms

The ability of the probability density function (PDF) of an automatic implantable cardioverter defibrillator (AICD) to reject supraventricular arrhythmias being recognized as ventricular was evaluated in 12 patients who were treated with an AICD (Ventak P 1600). The PDF criterion was monitored via telemetry with the sinus rate during exercise test. PDF was satisfied in seven patients at a rate of 75-144/min (mean 109/min), and not in the remaining five patients (mean rate 141/min). PDF was fulfilled in five of ten patients at a lower heart rate than predicted by the duty cycle index, derived from the ventricular patch lead electrogram at the implantation. Thus PDF is often fulfilled already at a moderately elevated sinus rate. If used to prevent inadvertent AICD discharges during rapid supraventricular rhythms, its performance should be tested in the individual patient.     

Decreased clearance of uraemic and mildly carbamylated low-density lipoprotein

Abstract. Low-density lipoprotein (LDL) was in vitro carbamylated with potassium cyanate and the clearance was studied in man. A minor carbamylation of LDL decreased the clearance of LDL by 41% (94% of amino groups free) and by 18% (90% of amino groups free). When LDL was extensively carbamylated its clearance was substantially accelerated. Moreover, the clearance of LDL isolated from 14 haemodialysis patients (uremic-LDL) was studied in rabbits. Uraemic-LDL, injected into rabbits simultaneously with the LDL of a healthy control subject, was cleared more slowly than the control-LDL (difference in fractional catabolic rate –6·5%, P = 0·02). We also examined the lipid peroxidation of the carbamylated LDL by measuring the amount of thiobarbituric-acid reactive substances (TBARS) and formation of conjugated dienes during exposure of carbamylated LDL to 5 μ M Cu²⁺. The carbamylated and native LDL had similar lipid peroxidation and propensity for oxidation. In summary, both the uraemic-LDL and minimally carbamylated LDL had a decreased clearance in vivo , which may contribute to the accelerated atherosclerosis in uraemic patients.     

EFFECT OF EXTRADURAL ANALGESIA USING BUPIVACAINE AND 2-CHLOROPROCAINE ON INTERVILLOUS BLOOD FLOW DURING NORMAL LABOUR

The effect of lumbar extradural analgmig on intervillous bloodflow (IBF) during labour was studied in 26 healthy parturientsusing an i. v. bolus injection of xenon-133. There was a 19%decrease (n.s.) in mean IBF in six parturients (non-extraduralcontrol group). Mean IBF increased by 37.5% when 0.25% bupivacaine10 ml was used and by 35.2% when 2% 2-chloroprocaine 10 ml wasused (n.s.). When the two extradural groups were combined, themean difference between IBFi and IBF2 was 45± 112 mlmin dl^–1. This increase is statistically significant (P<0.05). The improvement in IBF after extradural block was consideredto be a result of the decreased uterine vascular resistance,as no significant changes were observed in arterial pressure,utenne activity or uterine tone.     

Electroanatomic Mapping of the Right Coronary Artery: A Novel Approach to Ablation of Right Free-Wall Accessory Pathways

Background: Catheter ablation of right free-wall (RFW) accessory pathways continues to be associated with lower success and higher recurrence rates compared with other pathway locations. Reliably identifying the precise location of RFW accessory pathways often contributes to the difficulty in ablating these pathways. Improved localization of RFW accessory pathways has been described utilizing multielectrode right coronary artery (RCA) catheterization. This approach has not been widely adopted, in part due to concerns of prolonged catheter placement within the RCA. We describe the technique of creating a 3-D electroanatomic map of the right atrioventricular groove, limiting the duration of a microcatheter within the RCA, to facilitate ablation of RFW accessory pathways.
Methods and Results: Following intracardiac identification of a RFW accessory pathway, an octapolar microcatheter was placed in the RCA. A 3-D electroanatomic map of the RCA was created during retrograde accessory pathway conduction using ventricular pacing. Immediately following creation of the map, the RCA catheter was removed. Endocardial mapping and ablation of the RFW accessory pathway was performed using the RCA electroanatomic map as a guide. This technique was used in four pediatric patients. The microcatheter was within the RCA for less than 1 min in all patients. Radiofrequency catheter ablation of the RFW accessory pathways were successfully performed with two lesions. There were no complications or recurrences at follow-up.
Conclusions: The creation of a 3-D electroanantomic map of the RCA effectively localizes RFW accessory pathways and facilitates successful ablation. This technique minimizes the duration of RCA instrumentation.     

Drinking habits and detection of heavy drinking among middle-aged women

Little is known about alcohol consumption and the efficiency of alcohol questionnaires among women. In the present study 40-year-old (n= 90) and 45-year-old (n= 75) women participating in a health screening gave a self-report about their alcohol consumption and filled out the Malmö modified Michigan Alcoholism Screening Test (Mm-MAST) and the CAGE questionnaires. Teetotallers comprised 11% of the 40-year-old group and 8% of the 45-year-old women. CAGE, but not Mm-MAST -worked with the traditional cut-off point of two recommended for men. When the criterion for heavy drinking was a self-reported consumption ≥140g of absolute alcohol per week or a positive (≥ 2) finding in the CAGE or ≥4 ‘yes’ answers in the Mm-MAST, 20% of the 40-year-old and 17% of the 45-year-old group (together 19%) proved positive. Neither of the two questionnaires nor self-report atone worked perfectly for identifying eke heavy drinker group (n = 3l) screened. Using the three above criteria; of the heavy drinkers 52% were detected by self-report, 55% by CAGE, and 45% by Mm-MAST. CAGE in combination with self-report detected 90% and this combination, being short and simple, can be recommended for clinical practice.