Pseudopericardial effusion: echocardiographic and computed tomographic correlations

The findings of small anterior and posterior relatively echo-free spaces adjacent to the epimyocardium by echocardiography is more often indicative of pseudopericardial effusion due to subepicardial fat deposition rather than true pericardial effusion (PE), at least in older obese and Type II diabetic patients. This conclusion was based on the echo and computed tomography (CT) correlation performed in 10 consecutive patients (8 women, 2 men). The mimicry of various extracardiac and cardiac causes resulting in confusion with anterior and posterior PE is emphasized. Subepicardial fat deposition is one of the most common causes which mimic presence of small PE on echo and can be confirmed easily by limited CT of the chest. Age, sex, obesity, and diabetes mellitus (Type II) appear to be the most common predisposing factors for the accumulation of excess subepicardial fat.

Childhood familial pheochromocytoma. Conflicting results of localization techniques

Childhood familial pheochromocytoma was investigated in four patients by abdominal computed tomographic scan, [131I]metaiodobenzylguanidine scan, and vena caval catecholamine sampling. Results conflicted with surgical findings. Computed tomographic scan identified all four adrenal tumors but missed two midline tumors in one patient. [131I]metaiodobenzylguanidine scan identified two of three adrenal tumors but also suggested extra-adrenal tumors not confirmed at operation in two of three patients. Vena caval sampling for catecholamines confirmed all adrenal tumors but suggested additional tumors not verified at operation in two of three patients. All patients are asymptomatic and have normal urinary catecholamines 15 to 51 months after operation. Because of the frequency of multiple tumors in familial pheochromocytoma, different diagnostic techniques were employed. False-positive results were more frequent with [131I]metaiodobenzylguanidine and vena caval sampling. Reinterpretation of the [131I]metaiodobenzylguanidine scans at a later date led to less false-positive interpretation, although the false-negative rate remained unchanged. More pediatric experience with [131I]metaiodobenzylguanidine scans and vena caval sampling in familial pheochromocytoma is needed. Confirmation of tumor and its localization rest with meticulous surgical exploration.

Acute and chronic pulmonary thromboembolism: current perspectives. Part I: Glossary of terms, historic evolution and prevalence

Despite considerable medical as well as surgical advances, the problem of pulmonary thromboembolism, both acute and chronic, continues to plague clinicians of all medical disciplines. Approximately 650,000 to 700,000 patients per year suffer from acute pulmonary thromboembolism in the United States. Of these, approximately 60,000-70,000 die as a direct result of it. Our knowledge of the etiology, pathology, pathogenesis of pulmonary infarction, pathophysiology, accurate diagnosis, proper management (including both primary and secondary prophylaxis) of deep vein thrombi and pulmonary thromboemboli has advanced considerably during the past 15 years. These advances, which have now been adopted in the clinical practice, have already begun to indicate that not only more cases of acute and chronic pulmonary thromboembolism are being recognized than before, but also the morbidity and mortality of this disease process is declining. This is likely to improve further as our quest for safe, accurate, noninvasive and inexpensive diagnostic methods continues. Medical thromboembolectomy using thrombolytic therapy is fast replacing the surgical thromboembolectomy for patients with acute massive pulmonary thromboembolism. Better thrombolytic agents, such as tissue plasminogen activator, which selectively lyses the thromboemboli without producing significant systemic lytic state and now undergoing clinical investigation, is likely to revolutionize the management of both acute and chronic pulmonary thromboembolism because of its propensity to dissolve plasminogen-bound thrombi of any age. The majority of the patients who suffer from acute pulmonary thromboembolism recover most of their lost lung function unless cardiopulmonary reserve was compromised prior to the onset of the acute episode.(ABSTRACT TRUNCATED AT 250 WORDS)

Ligand binding to heme proteins: relevance of low-temperature data

Binding of carbon monoxide to the beta chain of adult human hemoglobin has been studied by flash photolysis over the time range from about 100 ps to seconds and the temperature range from 40 to 300 K. Below about 180 K, binding occurs directly from the pocket (process I) and is nonexponential in time. Above about 180 K, some carbon monoxide molecules escape from the pocket into the protein matrix. Above about 240 K, escape into the solvent becomes measurable. Process I can be observed up to 300 K. The low-temperature data extrapolate smoothly to 300 K, proving that the results obtained below 180 K provide functionally relevant information. The experiments show again that the binding process even at physiological temperatures is regulated by the final binding step at the heme iron and that measurements at high temperatures are not sufficient to fully understand the association process.

Vascular manifestations of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a well-known acute and/or chronic multisystem disease of complex autoimmune nature, having predilection for cardiovascular system. While its cardiac manifestations have been adequately studied, there is paucity of information on its vascular manifestations. Accordingly, we studied the incidence of vascular manifestations in 50 consecutive SLE patients seen at our institutions and in private practice during the past 12 years. Systemic hypertension (44%) was the most common vascular manifestation followed by vasculitis (30%), Raynaud's phenomenon (26%), telangiectasis (20%), premature coronary atherosclerosis (6%), digital ulceration (6%), thrombophlebitis (6%), pulmonary hypertension (4%) and portal hypertension (4%). Diffuse systemic vasculitis similar to polyarteritis nodosa was rare (2%). Often more than one lesion was found in the same patient. The clinical diagnosis of these vascular manifestations in the context of the primary disease (SLE) usually does not pose any difficulty except when they antedate it. We also studied the pathology and pathogenesis of some of these vascular lesions in both autopsy and biopsy specimens by both light microscopy and immunofluorescent techniques. Our results as well as those of others who also studied these lesions indicate that immune complex deposition and subsequent complement activation play an important role in the pathogenesis of vasculitis, coronary arteritis and premature coronary atherosclerosis. Corticosteroids and vasodilators remain the drugs of choice for the management of the majority of the symptoms arising from the vascular lesions of SLE.

M-mode echocardiography in supine and standing position in control subjects and patients with auscultatory evidence of mitral valve prolapse but negative supine echocardiography: does sensitivity improve?

Approximately 10-20% of patients with auscultatory evidence of mitral valve prolapse (MVP) have "false negative" echocardiograms. Pharmacological maneuvers do not significantly improve the sensitivity and may cause side effects. It is well known that auscultatory features of MVP change and not uncommonly can be heard only in the standing position. Therefore M-mode echo was performed in both supine and standing positions in 10 normal control subjects and 25 patients of comparable age and sex who had auscultatory evidence of MVP but negative echo in supine position. All 10 control subjects had normal echo in both supine and standing positions. No instance of false positive MVP was noted. Of the 25 patients with "false negative" supine echo, 5 showed evidence of MVP (3 pansystolic and 2 late systolic) in standing position. Based on these results the following conclusions were reached. In normal individuals the MVE remains uninfluenced by change in posture. There is modest (20%) improvement in sensitivity of detecting MVP when M-mode echo is performed in standing position in addition to supine position. Change in posture is preferable to the use of pharmacological maneuver to improve the sensitivity of detecting MVP because it is physiological, devoid of any cost, and does not produce side effects. M-mode echo in standing position or two-dimensional echo in supine position can be used to confirm the diagnosis of MVP in those patients who have "false negative" and/or nondiagnostic supine echo in the presence of auscultatory features of midsystolic click and mid- or late-systolic murmurs.

Protein states and proteinquakes

After photodissociation of carbon monoxide bound to myoglobin, the protein relaxes to the deoxy equilibrium structure in a quake-like motion. Investigation of the proteinquake and of related intramolecular equilibrium motions shows that states and motions have a hierarchical glass-like structure.

Cardiovascular manifestations of systemic lupus erythematosus: current perspective

Cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute fibrinous pericarditis and pericardial effusion. Echocardiography has demonstrated an increased incidence of pericardial effusion, even in those who have minimal symptoms. Chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely. While myocarditis is commonly noted at autopsy, it is often silent clinically. Diagnosis during life can be confirmed only by endomyocardial biopsy. Electrocardiographic changes are often nonspecific. Endocarditis with superimposed nonbacterial verrucous vegetations (Libman-Sacks) is noted in more than 40% of hearts at autopsy, but is rarely diagnosed during life. Valve dysfunctions, such as aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency, occasionally manifest during life and rarely may necessitate surgery. Atrial and ventricular arrhythmias, first degree AV block, and acquired CHB occur in association with pericarditis, myocarditis, vasculitis, and myocardial fibrosis, respectively. CCHB developing in newborns of mothers with SLE, particularly those who have an antibody to soluble tissue ribonuclear protein RO(SS-A), is increasingly being appreciated by both pediatric cardiologists and rheumatologists. Recently, severe coronary atherosclerosis resulting in angina pectoris and/or myocardial infarction in young adults has been noted, particularly in those who had developed risk factors such as hypertension and hyperlipidemia while receiving prolonged corticosteroid therapy. Rarely, coronary arteritis may produce similar symptoms. Congestive heart failure of either single or multiple etiologies carries an ominous prognosis. It remains a cause of high morbidity and mortality unless recognized early and treated properly. Extracardiac vascular manifestations of SLE include telangiectasia, vasculitis, livedo reticularis, Raynaud's phenomena, and thrombophlebitis, all of which may occur either alone or in different combinations. Evidence is now slowly accumulating that substantiates that immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for the majority of the cardiovascular manifestations of SLE, for example, pericarditis, myocarditis, endocarditis, coronary arteritis, coronary atherosclerosis, and systemic and pulmonary vasculitis.(ABSTRACT TRUNCATED AT 400 WORDS)

The "straight back" syndrome: current perspective more often associated with valvular heart disease than pseudoheart disease: a prospective clinical, electrocardiographic, roentgenographic, and echocardiographic study of 50 patients

Fifty consecutive patients (36 male, 14 female, mean age 28 years) who had heart murmurs and clinical and radiographic evidence of straight upper dorsal spine (straight back syndrome, SBS) underwent detailed clinical, electrocardiographic, roentgenographic, and echocardiographic evaluation. Palpable systolic thrill noted in one (2%) and widened S2 with persistent splitting in 2 (4%) patients were uncommon. Murmurs were invariably systolic in nature. Those located at the base of the heart in 19 (38%) patients were ejection in type and best heard during expiration. Those located at the apex in 26 (52%) patients were either mid-, late-, or pansystolic, and often associated with midsystolic click. Five (10%) patients had both types of murmurs. Diastolic murmurs were not heard in any patient. EKGs were normal in the majority. Cardiomegaly (C:T greater than 55%) was present in only 5 (10%) and dilatation of the main pulmonary artery in 2 (4%) patients. Thus the incidence of pseudoheart disease (PsHD) was small (14%). Echocardiograms were normal in 18 (36%) and abnormal in 32 (64%) patients. There was evidence of mitral valve prolapse (MVP) in 29 (58%) patients and 3 (6%) had evidence of bicuspid aortic valve (BAV). In a control group of 40 age- and sex-matched patients (26 male, 14 female, mean age 29.5 years), who also had heart murmurs but lacked straight upper dorsal spine, only 7 (17.5%) had MVP and none had BAV. The difference is both clinically and statistically significant (p less than 0.001). It is concluded that SBS is more often associated with valvular heart disease (MVP and BAV) than PsHD. Therefore, the diagnosis of SBS should remain presumptive until echocardiography has been performed to exclude MVP and BAV. SBS patients who have valvular heart disease should receive infective endocarditis prophylaxis.

Heart disease in systemic lupus erythematosus: diagnosis and management

Most patients suffering from systemic lupus erythematosus develop secondary heart disease at some time during the course of the primary illness. The most common forms of this type of heart disease are acute fibrinous pericarditis and hypertension. By means of echocardiography, an increased incidence of pericardial effusion has been demonstrated. Although commonly noted at autopsy, myocarditis is often clinically silent. However, endomyocardial biopsy may confirm its presence during life. Libman-Sacks endocarditis, although encountered in 40 to 50% of hearts at autopsy, is rarely diagnosed during life. When significant valve dysfunction such as aortic insufficiency or mitral regurgitation develops during the course of systemic lupus erythematosus, then Libman-Sacks endocarditis should be strongly suspected. Cardiac arrhythmias, first degree AV block, and acquired complete heart block may develop either de novo or in association with lupus pericarditis, myocarditis, vasculitis, etc. Complete congenital heart block has been reported in newborns of mothers with systemic lupus erythematosus, particularly those who have an antibody to a soluble tissue ribonucleoprotein antigen called RO(SS-A). Coronary arteritis and premature coronary atherosclerosis manifesting in either angina pectoris or myocardial infarction in young adults, particularly women suffering from systemic lupus erythematosus, have received attention recently. The development of hypertension and hyperlipidemia while such patients are receiving prolonged corticosteroid therapy has been incriminated as the significant risk factor in premature coronary atherosclerosis. Longstanding hypertension and congestive heart failure have unfavorable prognoses. This report is based on a cumulative review of 50 patients with acute and chronic systemic lupus erythematosus seen at our institution and in private practice during the last 10 years.

Mallory-Weiss syndrome. Experience in a community hospital

The Mallory-Weiss syndrome is characterized by repeated bouts of retching and/or vomiting followed by the sudden onset of hematemesis or melena. Bleeding arises from linear, nonperforating mucosal lacerations at the cardia, cardioesophageal junction, distal esophagus, or a combination of these sites. Hiatal hernia is often a coexisting finding. Severity of hemorrhage can vary from mild to severe (100 to 2,000 ml). The clinical course is usually benign. The diagnosis can be suspected from the history and confirmed by upper gastrointestinal endoscopy. In the majority of patients, medical management controls the bleeding. About 10% to 20% of unselected patients require surgical intervention. With the proper, prompt use of fiberoptic endoscopy in the diagnosis of upper gastrointestinal hemorrhage has come an increase in the number of cases of Mallory-Weiss syndrome being identified. This is true even in community hospitals. The result has been a decrease in surgical intervention and overall mortality.

Rapid differentiation of bacterial meningitides by direct gas-liquid chromatography

Rapid identification of Haemophilus influenzae and other bacillary meningitides was attempted by gas-liquid chromatography (GLC) of the metabolic by-products in broth cultures and in cerebrospinal fluid (CSF) samples obtained from experimental meningitis produced in New Zealand White male rabbits. These results were correlated with the GLC of CSF of meningitis patients. A major peak with retention time of succinic acid was found in the broth cultures of all bacilli tested including H. influenzae, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Proteus mirabilis, Citrobacter freundii, Pseudomonas aeruginosa, and Listeria monocytogenes. Succinic acid was also found in the CSF of experimental meningitis and in the CSF of all patients with H. influenzae and Esch. coli meningitis. This peak was not detected in the blood samples of experimental animals. It was also absent in the broth cultures of all of the gram-positive and gram-negative cocci tested, such as Streptococcus pneumoniae and Neisseria meningitidis. Succinic acid, which appears to be a by product of fermentation, persisted as a clear cut marker in H. influenzae meningitis for at least 3 d after the initiation of treatment. In one patient, the succinic acid peak disappeared during treatment and reappeared with a clinical relapse. Clearly, the presence of succinic acid that can be rapidly detected by GLC in the CSF excludes pneumococcal or meningococcal meningitis and strongly suggests H. influenzae or other bacillary meningitides.

Immunogenetic studies in essential hypertension among black patients. I. Correlative studies of serum autoantibody formation

Serum antinuclear antibody (ANA) and HLA phenotype frequency were studied in 100 black subjects with essential hypertension and 100 normotensive black controls matched for age and sex. 11% of hypertensive individuals had a positive serum ANA test compared with 2% of controls (p less than 0.01). Among the hypertensive patients, positive serum ANA test was seen exclusively in patients who were receiving treatment with methyldopa. Although ANA also correlated with hypertensive vascular damage as assessed by retinal and EKG abnormalities, this was believed to have been due to the higher dose of methyldopa that may have been required to treat hypertension in these more severe cases. A statistically significant correlation of HLA-A11 and HLA-B12 with hypertension was observed, but only studied when uncorrected for the number of HLA specificities. It was concluded that autoantibody formation in essential hypertension is most likely to have been a consequence of antihypertensive drug therapy. In addition, further studies using larger number of patients and controls might more clearly establish the question of whether or not HLA is associated with essential hypertension.

Myoglobinuric acute renal failure in phencyclidine overdose: report of observations in eight cases

Eight cases of myoglobinuric acute renal failure that developed following exposure to phencyclidine were seen in the emergency department of the Martin Luther King Jr. General Hospital during a period of 36 months. All eight survived with complete recovery of renal function. Dialysis was necessary in three patients. Acute renal failure is an uncommon complication of phencyclidine abuse.

Fracture of distal medial femoral epiphysis with subluxation of the knee joint

A case of complete posterior displacement of a Salter-Harris Type III distal medial femoral epiphysis fracture with posterior subluxation of the knee is reported. Invagination of the gastrocnemius muscle by the displaced fragment was blamed for failure of closed reduction. No significant ligamentous injury of the joint occurred.

Identification of species of Candida, Cryptococcus, and Torulopsis by gas-liquid chromatography

Gas-liquid chromatography was used to identify species of Candida, Cryptococcus, and Torulopsis by fatty-acid analysis of the whole-cell hydrolysate. Candida albicans characteristically revealed 2-OH C14:0 and C19:0 (chain length:number of double bonds); these were absent in other organisms. Candida curvata was characterized by a ratio of C16:1 to C16:0 of greater than 1.0. Candida guilliermondii contained C10:0, and Candida tropicalis had no C12:0, these features were used for their identification. Cryptococcus was characterized by the absence of C16:1. Torulopsis was characterized by a C16:1 to C16:0 ratio of greater than 10 accompanied by the presence of one unidentified fatty acid. These data suggested that certain Candida, Cryptococcus, and Torulopsis (the clinically important yeast-like organisms) may be identified by gas-liquid chromatography.

Serum angiotensin converting enzyme activity in patients with chronic renal failure on long term hemodialysis

Serum angiotensin converting enzyme activity was assayed by a spectrofluorometric method in 19 patients with chronic renal failure on long term hemodialysis and 19 control subjects. Converting enzyme activity was increased in 11 of 19 (58%) patients compared with the controls (p less than 0.005). There was no correlation between serum converting enzyme activity and plasma renin activity or blood pressure in the patients. Possible mechanisms responsible for the increased converting enzyme activity are discussed.

Radiopharmaceuticals XXVII. 18F-labeled 2-deoxy-2-fluoro-d-glucose as a radiopharmaceutical for measuring regional myocardial glucose metabolism in vivo: tissue distribution and imaging studies in animals

18F-2-Deoxy-2-fluoro-D-glucose (18FDG) is rapidly extracted by the mouse heart, and the radioactivity in heart (3-4% per organ) remains relatively constant for 2 hr post injection. The brain uptake (2-3% per organ) remained relatively constant throughout the time course of the study. Liver, lungs, kidneys, small intestine, and blood all showed a rapid clearance of radioactivity after injection of 18FDG. At 120 min the heart-to-lung ratio was 12 and heart-to-liver ratio was 32. Urinary excretion of activity was approximately 16% of the injected dose at 60 min. The uptake of radioactivity by dog heart following the intravenous administration of 18FDG was 2.8-4.1% at 60 min and 2.4% at 135 min; it was regionally distributed, the areas of highest activity being the left ventricle and the interventricular septum. The brain activity was 2.1-3.5% at 120 min, with a ratio of gray matter-to-white matter of 2-3:1. Urinary excretion in dogs was 16% and 50% of the injected dose at 60 and 135 min. The chemical form of the activity in the urine, although unidentified, was not 18F-. Cross-sectional images of the myocardium of the dog after intravenous injection of 18FDG were obtained using emission tomography.

Leukocyte antigens and disease: III. Association of HLA-B8 and HLA-BW 15 with insulin-dependent diabetes in three different population groups

The distribution of 20 HLA antigens in 382 diabetic and 184 control subjects of white, Mexican-American, and black ancestry was studied. In all three populations, the incidence of antigens BB and BW15 was higher in the insulin-dependent diabetics than in the controls. The differences fell short of statistical significance when corrections were made for the number of antigens studied. When the results of previous studies were combined with our own, there was a highly significant association of insulin-dependent diabetes and the antigens BB and BW15 in the white population. It seems highly likely that this association would also hold true for the Mexican-American and the black diabetics if a sufficient number of patients were studied.

Antibody-mediated secondary eosinophilic response to Taenia taeniaeformis in the rat

Normal rats were given intravenous doses of either immune serum or immunoglobulin fractions 24 hr before oral challenge with 1,000 eggs of Taenia taeniaeformis. Total eosinophil counts per mm3 were performed for 3 days prior to and 6 days after challenge. Sensitized rats usually showed sharp peaks of eosinophilia 2 to 6 days after this dose. The pattern of the eosinophilic response was similar to that which occurs after challenge of immune infected rats. The differences in peripheral eosinophil levels in passively immunized and normal rats were statistically significant. Immunoglobulin fractions containing protective IgG2alpha were most effective, but a fraction containing reaginic antibody activity also sensitized rats to give secondary eosinophilic responses. The findings are discussed in relation to the probable contribution of antigen-antibody reactions to the production of secondary eosinophilic responses in experimental cysticercosis.

The eosinophilic response of the rat to infection with Taenia taeniaeformis

Rats were dosed with eggs of Taenia taeniaeformis and hematologic parameters were measured throughout the course of primary infection. There was no evidence of anemia but differential leukocyte counts revealed distinct and reproducible patterns of white blood cell changes. A lymphocytosis developed at the end of the 1st and 5th weeks postinfection (p.i.). Neutrophil counts peaked 8 days p.i., although at that time there was no marked neutrophilic infiltration of the tissues. Eosinophil counts began to rise during the 2nd week p.i., and reached a peak during the 3rd week, followed by a decline and then another peak during the 5th week p.i. Eosinophilic infiltration of the tissues was remarkable during the period of peripheral eosinophilia. A wide zone of eosinophils surrounded the developing larvae at 22 days p.i. and persisted in some cases for a further 2 weeks. Eosinophils remained in lesser numbers in the connective tissue capsule throughout the infection, often in association with plasma cells. After oral challenge with 1,000 eggs infected rats showed brisk secondary eosinophilic responses 3 to 7 days later but other hematologic parameters were unaffected. Average peripheral eosinophil counts at 3 and 4 days post-challenge were significantly higher than those in unchallenged controls (P less than 0.05 and P less than 0.01, respectively). There was no detectable increase in eosinophilic infiltration of small intestinal tissues in challenged rats. These results are discussed in relation to current understanding of the mechanisms of eosinophil chemotaxis in vitro and the possible causes of local eosinophil accumulation in parasitic infections in vivo.

Hemodynamic changes associated with angina pectoris induced by maximal treadmill exercise: effect of sublingual isosorbide dinitrate on systolic time intervals

A technique for the study of patients with angina pectoris has been described, in which systolic time interval (STI) measurements are obtained at intervals after the onset of stress-induced angina. The technique is uniquely suited to the evaluation of anti-anginal drugs. Sublingual isosorbide dinitrate (SISD) was randomly alternated with a placebo (P) tablet in a double-blind study of 20 patients with stable angina pectoris. After SISD, compared to placebo, a highly significant shortening of Q-S2 and LVET occurred (p less than 0.001) which lasted throughout the entire 120 minute study period. The hemodynamic basis for these differences was felt to be improved myocardial contractility secondary to a reduction in systemic vascular resistance and reduced venous return induced by the SISD. A significant prolongation of PEP occurred at 60 minutes post-SISD (p less than 0.01). This was attributed to an increase in the gradient between LVEDP and aortic diastolic pressure resulting from reduced venous return after SISD. The PEP/LVET ratio was significantly increased up to 60 minutes after SISD (P less than 0.05). Heart rate was uniformly higher post-SISD, compared to post-placebo values; the differences were highly significant up to 60 minutes (P less than 0.001) and remained significant at 120 minutes (p less than 0.05). The time to angina was significantly longer (immediately post SISD, p less than 0.05; 30 min, p less than 0.001; 60 mins, p less than 0.05; 120 mins, p less than 0.05); and the work load greater, for 120 minutes following SISD: the increase in the latter was highly significant for 30 minutes after SISD (p less than 0.001) and remained significant up to 120 minutes (60 mins, p less than 0.05; 120 mins, p less than 0.05). These observations were attributed to an improvement in myocardial function due to the sublingual isosorbide dinitrate. A high degree of correlation was found to exist between heart rate and the STI. This correlation was negative for the QS2 interval (-0.996) and LVET (-0.993) and positive for PEP (+0.817) and the PEP/LVET ratio (+0.950).

Mallory-Weiss syndrome--revisted

Six patients (three women and three men) who had upper gastrointestinal hemorrhage due to Mallory-Weiss syndrome are described. Retching was the most common precipitating factor (5/6) followed by vomiting (2/6). Basic underlying causes for either retching or vomiting were probable excess alcohol consumption (3/6), side-effects of oral or parentral medication (2/6) and over-indulgence in eating after partial gastrectomy (1/6). The two most important factors leading to confirmation of the diagnosis were: 1. History of events prior to the onset of upper gastrointestinal hemorrhage and 2. early panendoscopy. One noted feature of the present series is the high incidence of other silent co-existing pathological lesions at the time of endoscopic examination. Upper gastrointestinal hemorrhage was characterized as mild to moderate (300-500 cc.) in three patients and moderate to severe (1,000-2,000 cc.) in another three patients. All recovered under medical management and none required surgical intervention. It is becoming increasingly evident that such a benign outcome in Mallory-Weiss syndrome is more common than previously recognized.

Note on the distribution of iodine-123-labeled indocyanine green in the eye. XVIII

Indocyanine green was excitation labeled with radioactive iodine-123 and the distribution of the labeled dye in the eye structures of animals was determined.