Runaway pacemaker in seven patients: a persisting problem

Runaway pacemaker has been encountered in 7 patients during the past 7 years at the Texas Heart Institute. In this series, 4 patients with fixed-rate pacemakers experienced pacemaker arrhythmias because of battery depletion, and 3 had arrhythmias because of component failure. Battery deterioration was heralded by an increase in cardiac rate. Ventricular tachycardia, rapidly followed by ventricular fibrillation, occurred in 2 patients. Prompt surgical exteriorization of the failing pulse generator and connection to an external pacemaker resulted in prompt recovery in all patients. Elective generator change should be performed routinely after 24 to 30 months unless reliable serial observations of ventricular rates can be attained. This at least will reduce the lethal complications attributed to battery exhaustion. Increasing developments in the design of generators and sources of power, as well as data from pacemaker clinic follow-up and telephone pulse transmittal, are expected to decrease the frequency of this complication.

Pulmonary artery compression due to acute dissecting aortic aneurysm: clinical and angiographic diagnosis

Clinical and angiographic features simulating acute massive pulmonary embolism, the result of compression of the right and main pulmonary arteries by a dissecting hematoma, are described in a 52-year-old white woman.

Treadmill exercise testing in the presence of digitals therapy or nonspecific ST-T changes: correlation with coronary angiography

Treadmill exercise test results were studied in 93 patients with chest pain who had received digitalis therapy or had nonspecific ST-T changes in the resting electrocardiogram. Results of the treadmill test were correlated with the findings of coronary angiography. A positive treadmill result was defined as horizontal or down-sloping ST segment depression greater than or equal to 1.0 mm. Of the 40 patients with no or insignificant coronary artery disease, 15 had taken digitalis; 4 of the 15 demonstrated a positive response on the treadmill test. Of the 53 patients with coronary artery disease, 21 had taken digitalis; 15 of the 21 displayed a positive response. Among the remaining 32 not on digitalis, 20 had a positive response. The specificity of the treadmill exercise test was 96% in patients with coronary artery disease not on digitalis and whose resting electrocardiogram showed nonspecific ST changes. The specificity of the treadmill test in patients who had received digitalis was 73%. Sensitivity was 63% and 71%, respectively. By utilizing more stringent criteria in the interpretation of the treadmill exercise test (greater than or equal to 1.5 mm ST depression), among the patients on digitalis only 6.7% (1/15) with normal coronary arteries and 48% (10/21) with coronary artery disease had a positive response. With the use of the latter criterion the test was specific in 93% (14/15) of the patients and is usually indicative of coronary artery disease.

Evaluation of different antibiotic actions combined with rifampicin. In vitro synergism against Pseudomonas and Proteus

Associations of penicillin, streptomycin, tetracycline and polymyxin B with rifampicin were tested for synergism against Pseudomonas and Proteus pathological strains. The combination of rifampicin and polymyxin B was clearly synergistic for all strains as it was evaluated by isobolograms and killing curvesmthe bactericidal action of this association, without any cross-resistance between its components, may eradicate gram-negative bacteria infections with marked polyvalent drug resistances.

Image analysis using enhanced spatial correlation functions

By enhancing the high frequencies of the irradiance spectrum of a scene, it is possible to reconstruct an enhanced self-correlation function that clearly delineates its nondifferentiable regions. The technique has application in image analysis and pattern recognition. By way of example, the enhanced self-correlation function of a certain random process is furnished. Easily discernible are certain periodicities not apparent in the sample functions of the original process.

Use of a diffuser for producing texture masks for image processing

The use of a diffuser in synthesizing binary texture-variance masks for applications in image processing is investigated. The binary texture-variance masks are used to separate various objects in an image on the basis of their spatial texture variance. The diffuser is required to reduce the speckling present in the mask. The reduction in speckling is described quantitatively as a reduction of the misclassification probability associated with the separation of the objects into several texture classes. General results are furnished for the statistics of the field scattered by the diffuser, and these are used to obtain expressions for the misclassification probabilities in the presence of a diffuser. Some applications are furnished.

The training and generalization of a conversational speech form in nonverbal retardates

Differential reinforcement and imitation were used with two retarded children to train three sequential verbal responses associated with the display of a picture and questions related to that picture. Each response consisted of a three-word chain in sentence form; combined with verbal responses from the experimenter, this trained sequence formed a short conversational unit. Three experimenters measured the use of each sentence in settings different than the one in which training took place, and with pictures different than those used during training. Two types of generalization sessions were used: (1) General sessions, during which 10 pictures never used during training were displayed to the subject with reinforcement delivered on a noncontingent basis, and (2) Intermixed sessions, during which 10 pictures never used during training were displayed to the subject, but a picture having received training was also displayed, and correct responses to this picture were reinforced on a variable schedule. Both subjects learned the sentences being trained. However, little generalization was evident from this training when all experimenters conducted General probe sessions. Generalization occurred with one experimenter only after that experimenter conducted Intermixed probe sessions. Generalization to a third experimenter was then observed (i.e., after the first two experimenters had conducted Intermixed probe sessions) without the use of Intermixed probe sessions by this third experimenter.

Coronary artery bypass

From October 1969 through March 1972, 1,276 patients underwent coronary artery bypass at the Texas Heart Institute. Associated conditions included simultaneous valve replacement and resection or repair of ventricular aneurysms or ascending aortic aneurysms. Among the series were 1,105 patients who underwent bypass surgery alone, with or without endarterectomy.

Factors affecting outcome were analyzed and revealed adverse influences including concomitant endarterectomy, female sex, age, evidence of left ventricular failure or serious ventricular dysfunction, and previous myocardial infarction within the month before surgery, but more importantly within the week prior to surgery. Functional class III and IV angina was significantly decreased or totally relieved in a high percentage of patients after bypass surgery, and remains the major indication at this time for myocardial revascularization. Progressive reduction in surgical risk and improvement in patient selection allow coronary artery bypass to be performed currently with an early mortality risk of only 3.7%.

Atresia of the left coronary artery ostium. Repair by saphenous vein graft

Symptoms and electrocardiographic changes of acute myocardial ischemia in a 10-year-old boy resulted from congenital atresia of the ostium of the left coronary artery. At 14 years of age persistence of symptoms and a positive exercise test prompted surgical treatment by aortocoronary artery saphenous vein bypass graft. Two months postoperatively, the symptoms and the abnormal findings on exercise test had subsided and forward flow through the graft to the left coronary artery was demonstrated by contrast angiography.

Variance measurements by a coherent optical method, with application to image processing

A procedure for measuring the point-to-point local variance of a spatial random scene is discussed. The relations that are required between the second-order statistics of the random process and the parameters of the optical configuration to furnish accurate and stable variance estimates are established. The procedure is experimentally verified by using calibrated samples of the random checkerboard and the overlapping circular grain models. A modification of the procedure enables the generation of spatial masks that are useful in automatic image processing. The spatial masks are used as binary spatial gates to isolate certain classes of objects within a scene and reject all others. Typical masks are synthesized and their applications illustrated.