Polymyositis as a cause of malabsorption. A case report

We report on a patient with polymyositis which caused a malabsorption syndrome. The radiological findings included marked dilatation of the oesophagus and small intestine. The malabsorption syndrome appears to arise from bacterial overgrowth associated with intestinal stasis. The literature is reviewed. Polymyositis or dermatomyositis, like scleroderma, may involve the small bowel and cause the malabsorption syndrome.

The significance of fetal electrocardiography in the diagnosis of intrauterine bradyarrhythmia

From 11 cases of fetal bradycardia diagnosed by monitoring of 130 fetal electrocardiograms (ECG's) in high-risk pregnancies we have presented our experience in three selected cases of fetal bradyarrthythmia. Case 1 revealed on ECG blocked atrial premature beats simulating an extreme sinus bradycardia sequentially followed by conducted atrial premature beats. In case 2 we diagnosed ventricular premature beats in the form of persistent bigeminy which was controlled by intravenous propranolol. The last case illustrated the phenomenon of aberrant ventricular conduction known to occur in adult cardiology. The electrophysiologic basis of the variable arrhythmias was discussed. Detailed analysis of repeated direct fetal ECG's provided us with the diagnosis and understanding of the electrophysiologic mechanisms underlying the rhythm disturbances. This consequently determined the pharmacologic therapy and the obstetric approach relevant to each case. We have shown that by direct fetal electrocardiography it is possible to analyze accurately the rhythm disturbances. Persistent fetal bradycardia does not always signify fetal distress. We hope that this will lead to closer teamwork between the obstetrician and the cardiologist which will give an impetus to the future development of "fetal cardiology," thereby enhancing our understanding of the electrophysiology of the fetal heart.

Noninvasive evaluation of ventricular hypertrophy in professional athletes

Athletes often exhibit ECG findings which are considered to be abnormal. Therefore, we used noninvasive graphic methods to study 42 active professional male basketball players, ranging in age from 21 to 31 years, without clinically evident heart disease. Of the 42, 11 (25%) met the Romhilt-Estes ECG voltage criteria for left ventricular hypertrophy, and 12 (29%) satisfied VCG criteria for left ventricular enlargement; nine (21%) had left ventricular hypertrophy by both methods. In 33 subjects (79%) the 0.04 sec vector in the horizontal plane was anterior, and 29 of these exhibited one or more standard criteria for right ventricular enlargement; the ECG and VCG were concordant for right ventricular hypertrophy in 16 subjects (38%). Submaximal treadmill exercise tests (Bruce protocol) were normal in eight athletes, while in one subject ventricular premature beats occurred during the test. In 24 of 25 athletes (96%) from whom phonocardiograms were obtained a third heart sound was recorded, while in 14 (56%), a fourth heart sound was present. Of the 14 athletes who had a fourth heart sound, 12 (86%) had either ECG or VCG evidence of ventricular hypertrophy. Only four of 23 athletes had an increased cardiothoracic ratio (greater than .50) on routine chest X-ray. Ten athletes and ten control subjects matched for height, weight and body surface area had echocardiograms satisfactory for analysis. The left ventricular end-diastolic dimension in the athletes averaged 53.7 +/- 1.3 (SE) mm compared with a value of 49.9 +/- 0.7 mm in the control subjects (P less than 0.02), and was increased (greater than or equal to 56 mm) in four. Left ventricular posterior wall thickness averaged 11.1 +/- 0.6 mm, compared with a value of 9.8 +/- 0.5 mm in the control subjects (P less than 0.05), and was increased (greater than or equal to 11 mm) in six athletes. The right ventricular end-diastolic dimension averaged 20.8 +/- 1.1 mm compared with a value of 12.9 +/- 2.2 mm in the controls (P less than 0.004), and was increased (greater than or equal to 23 mm) in four athletes. No athlete or control subject exhibited paradoxical septal motion. In the athletes, ejection fraction (cube method) averaged 79 +/- 2.0% and mean Vcf averaged 1.13 +/- 0.04 circ/sec; these values did not differ from those of the control subjects. Thus, both right and left ventricular enlargement ("physiological hypertrophy") are often present in the well-trained athlete, but left ventricular performance remains normal in the basal state in such individuals. We condlude that these individuals represent a selected subgroup of subjects who are variants of normal.

Influence of middle-sized molecule aggregates from dialysate of uremic patients on lymphocyte transformation in vitro

It was found that middle-sized molecules obtained from dialysate of uremic patients caused suppression of PHA-induced lymphocyte transformation. This was expressed by the lowering of labeled leucine incorporation and by the suppression of lymphocyte transformation as morphologically assessed. In view of the presented data middle-sized molecules seem to be biologically active substances.

An eclectic approach to quality control in fee-for-service health care: The New York City Medicaid Experience

A computer-based system for evaluating the quality of fee-for-service health care in the New York City Medicaid Program is described. Specific information is sought for use in educational, enforcement and managerial activities to improve health care quality. The gathering of this information necessitates coordinated assessment of the structure, process and outcome of health care, through inspection of offices, computerized analysis of patterns of practice as revealed by billing forms, and reexamination of patients. The program's focus on patterns of practice, its use of multiple assessment techniques, and its concentration on unequivocally substandard care circumvent several limitations on current evaluation technology. Implications for Professional Standards Review Organizations and national health insurance are explored.

New bacteriophages of Staphylococcus epidermidis

Fifty-six phages designated the U-series and 34 phages designated the Ph-series were carefully examined. The spectrum of activity was established for 183 strains of Staphylococcus epidermidis from different countries and for 258 strains of Staphylococcus aureus. All 90 phages were active against strains of both species, but some differences in sensitivity were noted. Sixteen of the 90 phages were selected for phage typing of S. epidermidis. With use of a routine test dilution of phage (the highest dilution that yields confluent lysis of the propagation strain), 71.6% of 183 coagulase-negative staphylococci tested were sensitive to the phages; 42 phage patterns were observed. The results indicate that phage typing of S. epidermidis can be recommended for epidemiological and ecological purposes.

Use of propranolol in dysfunctional labour

Labour pains associated with fear and anxiety increase the blood level of catecholamines. This in turn causes dysfunctional labour due to the weak uterine contractions which follow stimulation of uterine adrenergic beta receptors. Intravenous propranolol was administered to ten primigravidae with typical dysfunctional labour. This was shortly followed by normal uterine activity and delivery without any significant maternal or fetal complications. To the best of our knowledge this is the first attempt to treat dysfunctional labour by the intravenous administration of a beta-blocking agent, and our preliminary results are encouraging.

Intrauterine diagnosis and control of fetal ventricular arrhythmia during labor

A very rare case of a sustained fetal ventricular arrythmia in the form of bigeminy, trigeminy, and quadrigeminy during labor is described. The rhythm distrubance failed to respond to sedatives and narcotics but was successfuly reverted to sinus rhythm following the administration of intravenous propranolol to the mother. The significance and possible mechanism of the arrhythmia is discussed.

[Findings in the fundus oculi in gangrene]

A case of gas gangrene is described where gas was seen in retinal vessels. The suspicion of gas gangrene in this case arose through ophthalmoscopy.

Isolation and characterization of thermosensitive Escherichia coli mutants defective in deoxyribonucleic acid replication

Thermosensitive deoxyribonucleic acid replication-defective mutants have been isolated by using an autoradiographic selection method. The mutants have been analyzed genetically and biochemically. Some of the mutants show thermosensitivity of in vitro deoxyribonucleic acid replication. These can be classified into three groups according to their behavior in in vitro complementation assays. This classification is congruent with that obtained by genetic mapping by using cotransduction frequencies with selected markers in P1 transduction analysis.