Familial occurrence of sinus bradycardia, short PR interval, intraventricular conduction defects, recurrent supraventricular tachycardia, and cardiomegaly

Four members of a family presenting with sinus bradycardia, a short P-R interval, intraventricular conduction defects, recurrent supraventricular tachycardia (SVT), syncope, and cardiomegaly had His bundle studies and were found to have markedly shortened A-H intervals (30 to 55 msec.) with normal H-V times (35 to 50 msec.). Right atrial pacing at rates as high as 170 to 215 per minute failed to increase the A-H or H-V intervals significantly. The data are compatible with the presence of an A-V nodal bypass tract (James bundle) or even complete absence of an A-V node. Ventricular pacing and spontaneous ventricular premature beats resulted in a short ventriculoatrial conduction time (110 msec.) suggesting that if A-V nodal bypass tracts exist, they are utilized in an antegrade and retrograde fashion. None of the features of WPW syndrome was present. The mechanism of syncope in the mother and daughter was intermittent third-degree heart block. Both went on to develop permanent complete heart block despite electrophysiologic studies demonstrating 1:1 A-V conduction at extremely rapid atrial pacing rates and both required implantation of permanent pacemakers. The mechanism of syncope in the two brothers was possibly marked sinus bradycardia, but transient complete heart block has not been ruled out. Permanent pacemaker therapy was recommended for both. The nature of the cardiomegaly, which was mild in three patients, is not known. Although not well documented, several maternal relatives have had enlarged hearts, SVT, complete heart block, and syncope.

Phytosterols in aortic tissue in adults and infants

Relationships between aortic tissue phytosterols and cholesterol in five adults, five infants, two neonates, and one 30 week abortus were studied. In the normal aortic tissue of the abortus and two neonates, tissue cholesterol levels were 0.67, 0.08, and 0.89 mg. per gram of wet weight, respectively; tissue phytosterol levels were as follows: compesterol (0.94, 0.62. 1.8), stigmasterol (0.18, 0.54, 0.80) and beta-sitosterol (0.78, 1.84, 2.80) mug per gram of wet weight. In 11 aortic tissue samples from five infants studied at 3, 4, 6, 6, and 36 months of age, all having been on phytosterol-rich formulas, mean aortic cholesterol was 0.66 mg. per gram, campesterol 3.57, stigmasterol 9.22, and beta-sitosterol 8.93 mug per gram. In the 11 aortic samples from five infants, mean (+/-S.E.) tissue stigmasterol (9.2+/-2.7) and beta-sitosterol ((8.9+/-1.3) were greater than mean levels (0.51+/-0.18 and 1.8+/-0.6) in the four aortic sections from the abortus and two neonates. Mean (+/-S.E.) cholesterol in the 11 aortic sections from five infants (0.66+/-0.11) was not significantly higher than cholesterol (0.55+/-0.24 mg. per gram) in the four aortic sections from the abortus and two neonates, but was considerably higher than the tissue cholesterol level of 0.08 mg. per gram in one of the two neonates. Mean (+/-S.E.) cholesterol in 11 normal aortic tissue sections from five adults (3.4+/-0.7 mg. per gram) was higher than in the five infants, whereas mean compesterol, stigmasterol, and beta sitosterol, respectively 14, 13, and 16 mug per gram, were somewhat higher but generally comparable to infant levels. In five aortic tissue samples from mature atheromatous plaques in two adults, cholesterol was 54 mg. per gram and mean campesterol, stigmasterol, and beta-sitosterol were, respectively, 112, 167, and 236 mug per gram. In 15 aortic tissue samples from five adults, cholesterol correlated closely with stigmasterol, r=0.865, beta-sitosterol, r=0.918, and with total phytosterols, r=0.938, p less than 0.01, but not with campesterol, r=0.448. In 11 aortic tissue samples from five infants, cholesterol did not correlate with campesterol, r=0.005, stigmasterol, r=0.006, beta-sitosterol, r=-0.099, or total phytosterols, r=-0.045. Prior to birth some phystosterols apparently cross the placenta. In the first several months of life, vegetable-oil formula-fed infants accrue plant sterols in their aortic tissues. Moderate amounts of phytosterols are present in mature atheromatous lesions in adults. The implications of these findings are unknown and their relationship to deposition of cholesterol in atheromatous and in normal aortic tissues remains to be elucidated.

The theory, feasibility and accuracy of an ultrasonic method of estimating fetal weight

We present the theory, method, feasibility and accuracy of estimating fetal weight by measuring the fetal volume using compound ultrasonic scanning. The two parameters had a very high coefficient of correlation (0-9794), and the standard error in one series of 20 patients was only +/- 106 g. The correlation coefficient achieved by one of us who was new to ultrasound techniques was 0-82, which compared favourably with correlations between fetal weight and biparietal diameter measurements (r = 0-26). A discussion as to the correction factors required to allow for the unknown value of the velocity of ultrasound in fetal tissues, the clinical use of this method, and the possible means by which the accuracy of estimating fetal weight may be further improved is included.

Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.

Simultaneous determination of propranolol and 4-hydroxypropranolol in plasma by mass fragmentography

A quantitative method for the simultaneous determination of propranolol and its active metabolite 4-hydroxypropranolol in human plasma is described. Plasma samples are extracted at pH 9.6 with ethyl acetate after the addition of sodium bisulphite and the internal standard oxprenolol. The extracts are derivatized with trifluoroacetic anhydride before separation on a gas chromatograph--mass spectrometer. Detection and quantitation of the trifluoroacetyl derivatives are made by single-ion monitoring. The minimum detectable concentration of propranolol is 1 ng/ml and of 4-hydroxypropranolol 5 ng/ml using 1-ml plasma samples. No interferences from normal plasma constituents or from drugs commonly prescribed together with propranolol were detected.

Effect of methylprednisolone on predicted myocardial infarction size in man

Therapeutic manipulations designed to conserve myocardium in patients with acute myocardial infarction appear to improve prognosis. To assess the role of glucocorticoids given in pharmacologic dosage in the early treatment of patients with acute myocardial infarction, serial serum creatine phosphokinase (CPK) were obtained every 1-2 hours in 39 consecutive patients admitted with acute myocardial infarction. Determination of completed infarction size (ISc) was made using all available CPK values (range 70-160 hours). Predicted infarct size (ILp) was based on early data following the rise in CPK from baseline values: projected CPK values were obtained over a 160 hour period using a curve fitting procedure based upon nonlinear Gauss-Newton stepwise iterations. In 13 uncomplicated control patients ISp was 43.2 +/- 11.6 (mean +/- SE) CPK-gram-equivalents (CPK-q-eq), based on data from the first 7 hours following the rise in serum CPK, while ISc was 44.7 +/- 11.4 CPK-geq (r = .99, n = 13). In 7 additional control patients whose hospitals courses were complicated by clinical extension ISp was 71.8 +/- 18.0 CPK-g-eq while ISc was 118.6 +/- 31.0 CPK-g-eq (p less than .03). In 19 patients treated with 3 grams of methylprednisolone 7-14 hours following the rise in serum CPK from baseline, data from early CPK determinations (7 hours) indicated an ISp of 118.5 +/- 24.1 CPK-g-eq while total CPK data indicate an ISc of 89.6 +/- 13.2 CPK-g-Eq (p less than .04). The exponential clearance of CPK (kd) was approximated in the controls (kd = .00095 +/- .00007 min-1) and glucocorticoid treated patients (kd = .00099 +/- .00006 min-1) and found to be similar. Thus, administration of a pharmacologic dose of methylprednisolone 7-14 hours following rise in serum CPK from baseline in a group of patients with acute myocardial infarctions has resulted in salvage of myocardium.

Estimating heroin use in an urban area

The purpose of this pilot project was to develop a verifiable method of empirically estimating heroin usage in a defined geographic area. If such a methodology could be constructed, appropriate officials could employ the procedure to promote planning, prevention, and education projects, and to evaluate on-going programs. Thus, should such a technique be developed, it could replace more traditional and empirically unconfirmed methods. Employing data furnished by local law-enforcement social, and medical agencies, a questionnaire was developed, pretested, and applied to a selected sample of the stipulated population.

The Iowa 500: follow-up of 225 depressives

In previous studies we have suggested that there are two types of depressive illness (4, 5). The first of these is depressive spectrum disease which has as its prototype the early-onset female depressive; the second type is pure depressive disease, the prototype of which is the late-onset male depressive. Other family studies support the differences between these two prototypes (1, 8). The early-onset females have a considerable amount of alcoholism and probably sociopathy in their male first-degree relatives. The late-onset males have an ordinary amount of these illnesses in their male relatives. In the families of early-onset females, female relatives outnumber male relatives for the presence of depressive illness; this is not seen in late-onset males, where male and female relatives have equal amounts of depressive illness.

Serum digitalis and arrhythmia in patients undergoing cardiopulmonary bypass

To assess the possible role of digitalis in the etiology of arrhythmia following cardiopulmonary bypass, serum digoxin or digitoxin was determined serially by radioimmunoassay in 24 chronically digitalized patients undergoing open-heart surgery. After an initial fall during bypass probably secondary to intraoperative fluid, serum digitalis rebounded, rising to or surpassing the preoperative value in 21 of the 24 patients studied. Peak rebound serum digitalis occurred an average of 13 hours following onset of bypass. Eight patients receiving maintenance digoxin developed arrhythmia postbypass at or near the peak of the rebound. The arrhythmia subsided as the peak was passed. Mean serum digoxin at the time of arrhythmia was 1.3 ± 0.2 ( sd ) ng/ml. A significantly higher ( P < 0.001) value than the value of 0.07 ± 0.03 ng/ml found in patients without arrhythmia. Occurrence of arrhythmia could not be correlated with diagnosis, clinical status, cardiac size, blood gas, or serum electrolyte values. In 77 control subjects with ECG evidence of digoxin toxicity, mean serum digoxin level was 3.1 ± 0.9 ( sd ) ng/ml. Since arrhythmia occurred at serum levels of digitalis lower than those observed in patients toxic to the drug who had not undergone cardiopulmonary bypass, and since the arrhythmia subsided as the serum level declined, and since the levels were higher in patients who had arrhythmia postbypass than in those who did not, this study suggests that myocardial sensitivity to the toxic effects of digitalis is increased in the first 24 hours following cardiopulmonary bypass.

Modulation transfer characteristics of an acoustooptic deflector

The modulation transfer function of an acoustooptic deflector is described in terms of device parameters. The transfer function is calculated with the autocorrelation theorem assuming a truncated gaussian pupil function.

Placental localization by isotope and ultrasound scanning

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