Regional myocardial function at rest and after rapid ventricular pacing in patients after myocardial revascularization by coronary bypass graft or by collateral vessels.

The relation between the anatomy of the left anterior descending coronary artery and regional myocardlal function was studied at rest and after rapid ventricular pacing in 194 patients with proximal disease of this artery. Sixty patients were restudied 4 months after coronary bypass surgery. All of these patients had a graft to the left anterior descending coronary artery after operation. Twenty-two persons with normal coronary arteriograms served as control subjects. Coronary obstruction was measured with quantitative coronary artertography and was classified as critical stenosis (75 to 99 percent luminal narrowing) or occlusion (100 percent). Regional wall motion was defined by hemiaxls shortening. Four groups were established: group A, obstruction without revascularization; group B, obstruction with revascularization by collateral vessels; group C, obstruction with revascularization by a patent graft; group D, obstruction with revascularization by a stenosed or occluded graft. At rest, regional motion diminished in group A with critical stenosis and further with occlusion (from 39 to 25 percent and to 5 percent, P < 0.001, P < 0.001); in group B, with critical stenosis (from 39 to 24 percent, P < 0.001) but not with occlusion (from 24 to 19 percent, P > 0.05). In contrast, in group C motion remained unchanged (from 39 to 31 percent and to 32 percent, P > 0.05, P > 0.05). After pacing, regional motion became akinetic in groups A and B with critical stenosis and remained unchanged with occlusion. In contrast, in group C wall motion remained normal after pacing with critical stenosis and with occlusion. Results in group D were comparable with those in group B. Ejection fraction showed parallel and left ventricular end-diastolic pressure inverse changes as compared with regional motion.When coronary stenosis progresses to occlusion without revascularization, myocardial contractility becomes depressed at rest and after pacing. Revascularization by collateral vessels preserves resting function in coronary occlusion to some extent but is ineffective after pacing. Successful surgical revascularization prevents loss of function at rest and after pacing in critical stenosis and in occlusion.     

Treating migraine by training in temporal artery vasoconstriction and/or cognitive behavioral coping: A one-year follow-up

A one-year follow-up on 16 chronic migraine patients treated with vasoconstriction biofeedback of the temporal arteries (VT) or cognitive behavioral stress coping training (CT), or one of two serial variations of them, is reported: there were four experimental groups EG-1a: VT, 10 sessions; EG-1b: VT, 5 sessions and CT, 5 sessions; EG-11a: CT, 10 sessions; EG-11b: CT, 5 sessions and VT, 5 sessions. Another group of 4 migraine patients was assigned to a waiting control. All treatment groups decreased the frequency, duration and intensity of headaches, as well as amount of medication from baseline to the one-year follow-up. However, there were no differences between the groups (the controls were not followed-up). During treatment, but not at follow-up 1 (two months after therapy), voluntary vasoconstriction was higher in EG-1a than in EG-11a, although all EGs vasoconstricted. Voluntary vasoconstriction was not tested at one-year follow-up. The cognitive training groups improved more in self-ratings of irritability, depression and positive self-evaluation than the biofeedback or control groups on follow-up 1, but this difference was not maintained at one year. All treatment groups showed deterioration in measure of excitement and depression, returning to pre-treatment levels. Improvements in irritability and positive self-evaluation were however sustained at one year follow-up.     

Contact allergy to 4-isopropyl dibenzoylmethane and 3-(4''-methylbenzylidene) camphor in the sunscreen Eusolex 8021

10 cases of contact allergy from the sunscreen Eusolex 8021 are reported. 5 patients were sensitized to a lipstick, 4 to a sunscreen cream, and 1 reacted to several cosmetic creams. Of 9 patients tested with the 2 ingredients of Eusolex 8021, 5 proved to be allergic to both (chemically unrelated) constituents: 4-isopropyl-dibenzoylmethane and 3-(4'-methylbenzylidene) camphor; 4 were allergic to 4-isopropyl-dibenzoylmethane only. Contact allergy to this recently introduced broad spectrum sunscreen may not be rare. The relevant literature is reviewed.     

Carnitine and carnitine esters in plasma and adipose tissue of chronic uremic patients undergoing hemodialysis

carnitine concentrations were measured in the plasma and adipose tissue of seven chronically uremic and hyperlipidemic patients undergoing hemodialysis. Plasma levels of carnitine had dropped by the end of dialysis. The clearance of free carnitine was greater than that of acylcarnitine. Fasting plasma free carnitine, long-chain acylcarnitine, d-β-hydroxybutyrate and free fatty acid concentrations were normal but short-chain acylcarnitine values were elevated. In adipose tissue, total carnitine concentrations were normal but long-chain acylcarnitine concentrations were increased. These findings may indicate a hypermetabolic state in which the acute removal of carnitine during hemodialysis may lead to a critical shortage of this substance.