Atrial Flutter with 1:1 Atrioventricular Conduction Caused by Propafenone

We describe a case of 1:1 atrial flutter in a patient with coronary disease taking propafenone. In atrial flutter, the atrial rate is usually about 300 beciis/min with 2:1 AV conduction and a ventricular rate of 150 beats/min. Class IA antiarrhythmic drugs, especially quinidine and disopyramide, may cause 1:1 AV response because they reduce atrial rate and are vagolytic. However, propafenone is a Class IC agent and has no anticholinergic properties, and the occurrence of 1:1 AV conduction at a rate of about 250 beats/min is an important side, effect that, although uncommon, should be recognized.     

INFLUENCE OF DEXTRAN ON THE ABSORPTION OF ADRENALINE-CONTAINING LIGNOCAINE SOLUTIONS: A PROTECTIVE MECHANISM IN LOCAL ANAESTHESIA

The effect of adding 6% dextran to a lignocaine solution containingadrenaline was studied in 27 neurosurgicalpatients during modifiedneurolept-anaesthesia. Before trepanation they received infiltrationanaesthesia of the scalp at the site of the proposed operation.For a period of 1 h following injection plasma concentrationsof adrenaline were measured by high pressure liquid chromatographyand serum concentrations of lignocaine by gas chromatography.The addition of dextran caused a significant reduction in theabsorption of both adrenaline and lignocaine from the injectionsite. It is concluded that the dextran adjuvant constitutesa protective mechanism against toxic systemic side effects inlocal anaesthesia using adrenaline-containing anaesthetic solutions.This effect is particularly significant in patients with pre-existingcardiovascular disease and when local anaesthetic solutionsare used in combination with volatile anaesthetics.     

Further study on the vascular basis for the reimplantation of the hand amputated through the palm

Summary Based on the anatomic data obtained from earlier studies on the vascular anatomy of the hand, the vascular architecture in the palm of the hand was studied on 60 sides of unembalmed adult upper extremities. Each palm was divided into 64 squares by 8 sagittal and 8 transverse sections. The vascular architecture in these squares and the arterial relations between them were observed and measured by angiography, operative microscopic dissection and computerised three-dimensional reconstruction. According to the pattern of the blood-vessels, the amputated palms can be classified into 4 types. The anatomic basis for the vascular anastomosis in each type is defined. There are three key-areas for the blood-supply of the palm and their significance is discussed. Apart from the 4 types of transversely amputated palms, the repair programe of the blood-vessles in 4 types of common obliquely amputated palms are also discussed.

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Etude complémentaire de l'anatomie vasculaire de la main pour la réimplantation des amputations transpalmaires

Résumé Sur la base de données anatomiques obtenues lors de précédents travaux sur l'anatomie vasculaire de la main, l'architecture vasculaire palmaire a été étudiée sur 60 extrémités supérieures de cadavres d'adultes, non embaumés. Chaque paume a été divisée en 64 carrés par 8 sections sagittales et 8 sections transversales. L'architecture vasculaire à l'intérieur des carrés et les relations artérielles entre eux ont été étudiées et mesurées par angiographie, dissection au microscope opérateur et reconstruction computérisée en 3D. Les paumes amputées ont été regroupées en 4 types d'après la distribution des vaisseaux sanguins. Les données anatomiques concernant les anastomoses vasculaires sont précisées. Il existe trois zones clés pour l'irrigation de la paume. Leur importance quant à l'irrigation de la main est exposée. Outre la division des paumes amputées transversalement en 4 types, le programme de réparation de vaisseaux dans les 4 types d'amputations obliques communes de la paume et aussi discuté.

     

Prospective evaluation of a prostacyclin-sparing aspiring formulation and heparin/warfarin in aspirin users with unstable angina or non-Q wave myocardial infarction at rest

The aim of this trial was to compare the efficacy of combinationantithrombotic therapy with a prostacyclin-sparing aspirin plusanticoagulation versus conventional aspirin plus anticoagulation,when added to antianginal therapy, in patients with unstableangina or non-Q wave myocardial infarction already being treatedwith aspirin. In a double-blind (for the aspirin) study, 144prior aspirin users were randomized; 72 patients received controiled-release,prostacyclin-sparing aspirin 75 mg daily plus anticoagulation(intravenous heparin followed by warfarin to maintain the internationalnormalized ratio at 2–3), and 72 patients received conventionalaspirin 75 mg daily plus the same anticoagulation. Controlled-releaseaspirin was formulated to preserve endothelial cell prostacyclinsynthesis. Trial therapy was begun by 13.2 ± 12.3 h ofqualifying pain, and continued for 12 weeks. The frequency of recurrent angina with electrocardiographicchanges, myocardial infarction, or death, was analysed by intentionto treat. At 12 weeks, events were     

Successful treatment of autoimmune neutropenia with recombinant human granulocyte-colony stimulating factor (R-metHuG-CSF)

Autoimmune neutropenia (AIN) is characterized by antibody mediated peripheral destruction of neutrophils. Since there is no effective treatment, antibiotics have to be used frequently for recurrent infections. Five selected patients with serologically proven AIN were treated with r-metHuG-CSF at 5–8 μg/kg body weight (300–480 μg) daily; the dose and frequency of r-metHuG-CSF was reduced after neutrophil counts above 1.0×10⁹/l were obtained. R-metHuG-CSF is effective in AIN and causes a sustained rise in ANC which can be maintained on a low dose administered twice or thrice weekly.     

REDUCED FREQUENCY OF LUTEINIZING HORMONE PULSES IN WOMEN WITH WEIGHT LOSS-RELATED AMENORRHOEA AND MULTIFOLLICULAR OVARIES

We have studied pulsatile secretion of LH in 10 women with secondary amenorrhoea and multifollicular ovaries (MFO). This group of patients have a history of mild to moderate, or partially recovered weight loss. They have normal basal LH concentrations but evidence of oestrogen deficiency suggesting a hypothalamic abnormality of gonadotrophin regulation. The results of gonadotrophin pulse analysis were compared with those in normal women during the early follicular phase of the cycle. The mean LH concentration during the 8 h study (5.0 +/- 0.9 [SD] U/l) was not significantly different from that in normal women (5.7 +/- 2.5). There was no difference between the groups in mean LH pulse amplitude (2.1 +/- 0.5 in MFO; 2.2 +/- 1.3 in normal women). The frequency of LH pulses was, however, significantly lower in women with MFO (2.8 +/- 1.6 vs 4.8 +/- 1.5, P less than 0.05). Two women with MFO had LH pulses of normal frequency. One subsequently developed a normal pattern of ovarian follicles. The other showed a sleep-related rise in LH concentrations during a 24 h profile which was similar to the pattern of gonadotrophin secretion normally observed during late puberty. These results show that women with MFO have a hypothalamic disturbance of gonadotrophin regulation with slowing of LH pulses without a diminution of pulse amplitude.