Maximal revascularization (reperfusion) in intact conscious dogs after 2 to 5 hours of coronary occlusion.

Acute infarction was produced in intact conscious dogs by inflating a previously implanted balloon cuff around the left anterior descending coronary artery was occluded in 26 control dogs and reperfused by deflating the balloon cuff after 2 hours of occlusion in 19 dogs (group II) and after 5 hours in 11 dogs (group III). Serial studies were performed and repeated after 48 hours and 7 days. All three groups revealed hemodynamic and metabolic deterioration with coronary occlusion and infarct production. Immediately after reperfusion, arrhythmias developed in groups II and III and persistent ventricular tachycardia was present 2 to 3 hours after reperfusion in 74 percent of animals in group II and 82 percent of those in group III compared with 6 percent and 13 percent incidence rates at corresponding times in control dogs. Q waves developed in 83 percent of animals in group II and 100 percent of those in group III but in only 12 and 27 percent of control animals at corresponding times. Hemodynamic deterioration was accelerated in the postreperfusion period in both groups II and III. Angiographic assessment revealed improvement in 42 percent of dogs in group II, but in none of those in group III after reperfusion. Myocardial oxygen extraction diminished to subnormal levels after reperfusion, indicating either reactive hyperemia or shunting effect. Mortality was not significantly influenced by reperfusion. Infarct size was more than 15 percent of ventricular mass in 92 percent of control dogs and in 100 percent of dogs in group III, but in only 50 percent of those in group II. The data indicate that reperfusion in conscious dogs representing early, noninvasive maximal revascularization under ideal circumstances fails to prevent deterioration or death; instead it hastens the development of arrhythmias and myocardial injury. Reperfusion, although deleterious in the first hours, can reduce infarct size if performed after 2 hours, but not after 5 hours, of occlusion.     

Is the treadmill exercise test useful for evaluating coronary artery disease in patients with complete left bundle branch block?

To aid in the study of coronary artery disease, 57 patients with complete left bundle branch block underwent clinical evaluation, treadmill exercise testing and cardiac catheterization. The patients were classified into two groups according to coronary anglographic findings: 30 patients with significant stenosis (70 percent or greater luminal narrowing) of at least one major vessel and 27 with no significant coronary artery disease. There was no difference in age, presenting symptoms or previous medical treatment between the two groups. There were more men in the group with coronary artery disease. Exercise-induced S-T changes were similar in the two groups; the sensitivity and specificity of these changes for the diagnosis of coronary artery disease were unacceptable irrespective of the criterion chosen. With additional S-T depression of either 1 or 2 mm below the baseline value, the predictive accuracy was only 53 percent. Combined exertional chest pain and 1 mm S-T depression increased the predictive accuracy of exercise testing to 71 percent. These data indicate that exercise-induced electrocardiographic changes do not facilitate detection of coronary artery disease in patients with complete left bundle branch block.     

Immunoglobulin E levels and antisperm antibody titers in infertile couples

Immunoglobulin E (IgE) levels and antisperm antibody titers were determined in samples of serum and seminal plasma from 25 fertile men (Group A), 18 infertile men without measurable immunity to sperm (Group B), and 42 infertile men autoimmune to sperm (Group C), and in samples of serum and cervical and vaginal secretions from 25 fertile women (Group D), 28 infertile women without measurable immunity to sperm (Group E), and 32 infertile women isoimmune to sperm (Group F). Among the men, IgE levels in the serum, measured in international units per milliliter, were elevated in Group C (230 ± 41, mean ± SEM) as compared with Groups B (94 ± 33, P < 0.05) and A (55 ± 8, P < 0.001). In contrast, IgE levels in the seminal plasma in Group C (180 ± 44) were not significantly different from those in Group B (48 ± 21), but were higher than those in Group A (8 ± 2, P < 0.05). In the women, serum IgE levels were higher (P < 0.001) in Group F, with isoimmunity to sperm (472 ± 55), than in Groups E (219 ± 32) and D (76 ± 16). Wives of autoimmune husbands had somewhat, though not significantly, higher serum IgE levels (406 ± 55), than had wives of nonautoimmune husbands (247 ± 97). These results provide evidence for an elevated IgE response in subjects with significantly elevated antisperm antibody titers.     

Antibiogram of Pseudomonas aeruginosa strainsisolated from Zaria, Nigeria

Antimicrobial sensitivities of 100 strains of Pseudomonas aeruginosa, isolated from various clinical specimens and the environment, were done for gentamicin, carbenicillin, amikacin, polymyxin B sulphate and tetracycline, using standard techniques.Amikacin followed by carbenicillin and polymyxin B sulphate were found to be currently the drugs of choice for the treatment of P. aeruginosa infections in Zaria.The usefulness of monitoring antibiogram and the judicious use of effective antimicrobialagents in the therapy of Pseudomonas infections is stressed.     

Application of passive hemagglutination for evaluation of antisperm antibodies and a modified coombs'' test for detecting male autoimmunity to sperm antigens

A rapid, specific, and sensitive assay using passive hemagglutination and Coombs' tests has been established for detecting male autoimmunity and female isoimmunity to sperm antigens. Antisperm antibody titers evaluated by this method were similar in 156 normal females, 400 pregnant females, 25 gonadal dysgenetics, 43 users of Oracon (an oral contraceptive), and 25 normal males. In contrast, in the evaluation of 50 couples with unexplained infertility, 16 males were found to have significantly elevated Coombs' autoantibody titers (primarily IgG) and correspondingly higher antisperm antibody titers in their serum and seminal plasma; another 28 had low autoantibody titers and low serum and seminal plasma antibody titers; and 6 had intermediate titers. The wives of 63% of the males with high autoantibody titers were found to be ‘isoimmune’, as compared with 7% of those with low titers. The isoimmune females had significantly higher antisperm antibody titers than did those with normal titers. In general, comparable titer values were obtained whether sperm extract or seminal plasma was used as the erythrocyte coat for passive hemagglutination. The titers were consistently higher in the seminal plasma than in the serum of males. Very little crossreactivity was apparent between anti-Candida and antisperm antibodies, and antibodies to blood group antigens did not appear to influence the results. When the results obtained by passive hemagglutination were compared with those obtained by immunofluorescence, Franklin-Dukes, and hanging drop interface methods, only those of the passive hemagglutination and Coombs' test correlated well with the results of postcoital tests and seminal analysis.