Subacute rupture of the left ventricular free wall after acute myocardial infarction. Three cases of long-term survival without emergency surgical repair

Rupture of the left ventricular free wall after acute myocardial infarction (AMI) has been regarded as uniformly fatal unless emergency surgical repair is performed. Among 2,862 patients admitted with AMI to our ICU during the last 8 years, 107 patients developed rupture of the left ventricular free wall. Twenty-nine patients had a subacute course and three of them survived for prolonged periods without having to have emergency surgical repair. At the onset of rupture on day 1 through 7 after AMI, the three survivors developed sudden hypotension accompanied by a new pericardial effusion. They were initially managed with hemodynamic support. Two patients had elective open-heart surgery 2 to 3 months after AMI, whereas one patient did nt require surgery. All three survived 1 1/2 to 8 1/2 years after AMI. This report indicates that a small subset of patients with subacute ventricular free wall rupture has a benign course that may allow for prolonged survival without having to have emergency surgical repair.

Dietary mercury intake and human exposure in an Adriatic population

A study was conducted to examine human exposure to mercury through dietary mercury intake in a population living in an industrially non-polluted area of the Adriatic Sea. The results have shown that approximately 20% of the subjects had a weekly dietary mercury intake above the provisional tolerable weekly intake (PTWI), primarily those consuming fish and other seafood > 6 times/week. The estimated seafood consumption corresponding to a mean intake of PTWI of 300 micrograms total mercury was 1559 g, and 1365 g for a PTWI of 200 micrograms methylmercury. However, the total mercury content in hair in individuals consuming total mercury above the PTWI was in the range of 1.3-12.9 micrograms/g, whereas the methylmercury content in hair in subjects consuming methylmercury above the PTWI was between 1.1-10.8 micrograms. Thus, the mercury content in hair did not reach the critical level at which toxic effects of mercury could be expected. The results, particularly those related to methylmercury exposure, did not differ significantly from data reported earlier from an industrially polluted area, thus indicating that the mercury content of fish and consequent human exposure to mercury reflects primarily the general ecological characteristics of the Adriatic, rather than the impact upon a specific local pollution.

Coincident timing by nondisabled, mentally retarded, and traumatic brain-injured individuals under varying target-exposure conditions

Coincident timing by 15 nondisabled individuals, 15 mentally retarded and 15 traumatically brain injured was measured under varying target-exposure conditions. Absolute constant error, constant error, and variable error were analyzed in separate repeated-measures analyses of variance for early performance (first block of practice), late performance (last block of practice), and retention (last block of retention). Subjects with mental retardation displayed the least accurate and most variable coincident-timing responses. Nondisabled subjects were most influenced by target-exposure time; subjects with traumatic brain injury were most influenced by target-viewing distance; and subjects with mental retardation were most influenced by a combination of target velocity and target-viewing distance. Subjects with mental retardation displayed a too-early response bias, while nondisabled subjects tended to have a too-late response bias. Individuals with traumatic brain injury had a variable response bias.

No indication of in vivo methylation of inorganic mercury in chloralkali workers

It has been shown in vitro that human oral and intestinal bacteria are able to methylate inorganic mercury (Hg) to methylmercury (MeHg). In vivo methylation has been reported for guinea pigs, and several studies have found higher levels of organic Hg in blood of workers exposed to inorganic Hg. In search for indications of in vivo methylation of Hg, we determined total Hg in urine (U), plasma (P), and erythrocytes (Ery), and MeHg in erythrocytes, in 22 chloralkali workers exposed to inorganic Hg, and in 22 age-matched referents. The subjects in both groups ate fish not more than once a week. MeHg was determined using ion exchange separation and cold vapor atomic absorption spectrometry. The mean concentrations of total mercury in chloralkali workers and referents were 26 vs 2.3 micrograms/g creatinine (U-Hg), 9.7 vs 1.8 ng/g (P-Hg), and 11.4 vs 5.6 ng/g (Ery-Hg). The mean Ery-MeHg concentrations were 3.0 vs 3.7 ng/g, and there were no correlations between Ery-MeHg on the one hand and U-Hg or P-Hg on the other. Our results indicate no significant in vivo methylation of inorganic Hg in man. Contradictory results from previous studies may be due either to bias owing to fish consumption or to analytical shortcomings.

Intratester reliability of the Nicholas Manual Muscle Tester on individuals with intellectual disabilities by a tester having minimal experience

The purpose of this investigation was to determine the intratester reliability of measurements obtained with the Nicholas Manual Muscle Tester (NMMT) by a tester having minimal experience on individuals with intellectual disabilities. Seventeen individuals classified as moderately mentally retarded between the ages of 14 and 24 (mean = 18.65) were evaluated with the NMMT using a test-retest reliability procedure after a familiarization session. Test-retest strength score relationships for dominant and nondominant elbow flexors and extensors revealed intraclass correlation coefficients from .83 to .86 (p < .001); whereas a series of paired t-tests revealed no significant differences between test and retest values. Finally, intraclass correlation coefficients ranging from .98 to .99 were evident in comparing the first trial to mean of three trials from the first testing session. It was concluded that testers with minimal experience with the NMMT could obtain reliable measurements with the NMMT for determining isometric force of elbow flexors and extensors in individuals with intellectual disabilities.

Simultaneous determination of mercury speciation in biological materials by GC/CVAFS after ethylation and room-temperature precollection

We developed a method for the simultaneous determination of monomethyl mercury (MMHg), inorganic mercury [Hg(II)], and total mercury (THg) in biological materials. A variety of biological materials can be digested in methanolic KOH solution. The MMHg and Hg(II) present are converted to volatile ethyl derivatives, methylethyl mercury and diethyl mercury, by an aqueous-phase ethylation reaction with sodium tetraethylborate. The ethyl derivatives are precollected onto a trapping column at room temperature, in case of disconnection with the separation/detection system, and then thermally desorbed into a packed isothermal gas chromatography (GC) column. Eluted organo-Hg compounds from the GC column are decomposed into Hg0, and detection is completed by cold vapor atomic fluorescence spectrometry (CVAFS). Pure standard solutions can be used for calibration. The sum of MMHg and Hg(II) obtained by this method equals the THg value obtained by digestion with HNO3 and H2SO4, reduction with SnCl2, and single-stage amalgamation/CVAFS for all biological materials studied. Absolute detection limits are 0.6 pg and 1.3 pg of Hg as MMHg and Hg(II), respectively, corresponding to 0.3 ng and 0.6 ng/g (wet) of sample.

Simultaneous determination of mercury speciation in biological materials by GC/CVAFS after ethylation and room-temperature precollection

We developed a method for the simultaneous determination of monomethyl mercury (MMHg), inorganic mercury [Hg(II)], and total mercury (THg) in biological materials. A variety of biological materials can be digested in methanolic KOH solution. The MMHg and Hg(II) present are converted to volatile ethyl derivatives, methylethyl mercury and diethyl mercury, by an aqueous-phase ethylation reaction with sodium tetraethylborate. The ethyl derivatives are precollected onto a trapping column at room temperature, in case of disconnection with the separation/detection system, and then thermally desorbed into a packed isothermal gas chromatography (GC) column. Eluted organo-Hg compounds from the GC column are decomposed into Hg0, and detection is completed by cold vapor atomic fluorescence spectrometry (CVAFS). Pure standard solutions can be used for calibration. The sum of MMHg and Hg(II) obtained by this method equals the THg value obtained by digestion with HNO3 and H2SO4, reduction with SnCl2, and single-stage amalgamation/CVAFS for all biological materials studied. Absolute detection limits are 0.6 pg and 1.3 pg of Hg as MMHg and Hg(II), respectively, corresponding to 0.3 ng and 0.6 ng/g (wet) of sample.

Magnitude and reliability of measurements of muscle strength across trials for individuals with mental retardation

The purpose of this investigation was to examine the magnitude and reliability of strength measures on the Nicholas Manual Muscle Tester for individuals with mental retardation. 17 subjects were given six trials with the dominant and nondominant flexor and extensor muscle groups. No significant differences were found between dominant and nondominant muscle groups by side or by muscle group. Interclass correlations ranged from .96 to .98 for six and three trials, respectively. It was concluded that the test was appropriate for reliably assessing strength in this population and that these individuals can achieve a sufficient magnitude on three trials for a reliable measure of strength.

Preliminary study of the effects of some physical parameters on the stability of methylmercury in biological samples

The effects of storage conditions (long-term storage of wet samples in a deep-freeze or thermal cycling), freeze-drying and gamma-irradiation at 1 and 5 Mrad on the stability of methylmercury in some biological samples were investigated. Methylmercury was determined by volatilization separation followed by gas chromatography and by ion-exchange separation of inorganic and organic species followed by measurement by cold vapour atomic absorption spectrometry (CVAAS). Total mercury was determined by CVAAS. Biological samples studied included fish and shellfish tissues, human hair and blood samples and appropriate reference materials. From the preliminary results obtained it can be concluded that fresh and dried fish muscle and fish certified reference materials show good stability with time and against temperature cycling. Shellfish and blood should not be repeatedly frozen and unfrozen otherwise possible losses of methylmercury can occur. Losses of methylmercury of up to 30% from wet mussels occurred on prolonged storage in a deep-freeze. Gamma-irradiation reduced the methylmercury content of the fish and shellfish only for hake (Merluccius merluccius). Further experiments should be carried out to confirm this and to investigate if this effect is species dependent. Apparent losses of methylmercury on freeze-drying of blood need to be reconfirmed on further samples.

Investigation of mercury speciation in lichens

Epiphytic lichens have long been considered to be reliable bioindicators of air pollution. In the present study only one lichen species, Hypogymnia physodes (L.) Nyl., was chosen; this species is very often used for biomonitoring in Europe. Total mercury and methylmercury were determined in lichens taken from various polluted and unpolluted locations in Slovenia, including a mercury mining area around Idrija. Additionally, total gaseous mercury in air was also determined at several sampling points.

[Self-help groups--a fashion trend or objective requirement?]

The role and the significance of the self-help groups in the modern medicine are described. The authors propose that the medical profession should actively support the formation and the activity of such groups with the aim to improve the quality of life of many groups of patients.

The mortality of childhood falls

Falls accounted for 5.9% of the childhood deaths due to trauma in a review of the medical examiner's files in a large urban county. Falls represented the seventh leading cause of traumatic death in all children 15 years of age or younger, but the third leading cause of death in children 1 to 4 years old. The mean age of those with accidental falls was 2.3 years, which is markedly younger than that seen in hospital admission series, suggesting that infants are much more likely to die from a fall than older children. Forty-one per cent of the deaths occurred from "minor" falls such as falls from furniture or while playing; 50% were falls from a height of one story or greater; the remainder were falls down stairs. Of children falling from less than five stories, death was due to a lethal head injury in 86%. Additionally, 61.3% of the children with head injuries had mass lesions which would have required acute neurosurgical intervention. The need for an organized pediatric trauma system is demonstrated as more than one third of the children were transferred to another hospital, with more than half of these deteriorating during the delay. Of the patients with "minor" falls, 38% had parental delay in seeking medical attention, with deterioration of all. The trauma system must also incorporate the education of parents and medical personnel to the potential lethality of "minor" falls in infants and must legislate injury prevention programs.

A comparison of the psychological characteristics of male and female able-bodied and wheelchair athletes

The purpose of this study was to compare selected psychological characteristics between male and female able-bodied and wheelchair athletes. All subjects completed the Profile of Mood States (POMS). Morgan (1980) has reported that based on the POMS elite able-bodied male and female athletes possess superior mental and emotional health compared to the general population. Based on this investigation, this result can now be extended to male and female wheelchair athletes.

Use of the State-Trait Anxiety Inventory for visually impaired athletes

This report detailed the reliability of the State-Trait Anxiety Inventory when the test statements were presented verbally and in the traditional manner to undergraduates, 19 men and 17 women, who were physical education majors. In the standardized manner subjects read the statements silently to themselves; in the other administration statements were read aloud. The inventory then was administered twice verbally to 15 elite visually impaired women athletes. Both the state and trait subscales of this inventory are reliable if presented across or within modalities. The inventory, when presented verbally, might be appropriately used by visually impaired athletes in psychological preparation prior to competition.

Arrhythmias with brief, high-dose intravenous streptokinase infusion in acute myocardial infarction

Cardiac arrhythmias are described during the first 2 h after brief, high-dose, intravenous streptokinase infusion in 23 patients with evolving myocardial infarction was given. A control group consisted of 22 similar patients with acute myocardial infarction not treated with streptokinase infusion. On the basis of an early peak of creatine kinase activity successful reperfusion was achieved in 60.9% of patients. Significantly more ventricular premature complexes (P less than 0.01) and paroxysms of idioventricular rhythm (P less than 0.05) were noticed in the treated group. Premature ventricular complexes did not predict any severe ventricular arrhythmia. Accelerated idioventricular rhythm appears to be the most specific arrhythmia encountered with thrombolytic therapy of acute myocardial infarction. We propose that in routine clinical work it can be used as a bedside sign of successful reperfusion.

Electrophysiological effects of ethmozin on sinus nodal function in patients with and without sinus node dysfunction

The electrophysiological effects of intravenously administered ethmozin (1 mg kg-1) on sinus node function were examined in 32 patients. Based on their clinical data and the results of the initial study, patients were subdivided into group A (n = 12), those with sick sinus syndrome and sinus node recovery time (SNRT) greater than 1500 ms, and group B (n = 20), those without overt sinus node dysfunction and a normal SNRT. The mean sinus cycle length did not change significantly in either group after ethmozin . SNRT was prolonged by ethmozin in group A whereas in group B the increase of SNRT was not significant. Corrected SNRT increased after ethmozin in both subgroups but with a much more pronounced increase in group A. Sinoatrial conduction time was not significantly changed in any group. The lengthening of SNRT in the majority of patients with sick sinus syndrome implies that ethmozin might prolong post-tachycardia pauses in these patients. This drug should therefore be administered cautiously to persons with signs indicative of dysfunction of the sinus node.

Sotalol-induced torsade de pointes

A case of sotalol-induced polymorphous ventricular tachycardia (torsade de pointes) is presented. The patient had moderately prolonged Q-T interval before medication with sotalol with further prolongation after application of this drug. Electrophysiological study during rechallenge with sotalol demonstrated a uniform ventricular tachycardia with a somewhat polymorphous onset; whether or not this tachycardia represented replication of the patient's spontaneous arrhythmia is questionable. Without antiarrhythmic drugs and during medication with pindolol ventricular tachycardia was not inducible.

Latent sinoatrial conduction disturbances in symptomatic patients with Wolff-Parkinson-White syndrome

Sinoatrial conduction abnormalities were studied in fourteen patients with Wolff-Parkinson-White (WPW) syndrome and frequent attacks of supraventricular paroxysmal tachycardia. Sinoatrial conduction time (SACT), obtained by the method of constant atrial pacing, was prolonged in all but two patients. The mean value was 277 +/- 56 ms (mean +/- SD). SACT was measured in the same way in sixteen patients without signs of pre-excitation or sinoatrial disease; SACT was significantly shorter (p less than 0.001) than in the WPW group of patients. The prolongation of SACT in patients with WPW syndrome was confirmed by measuring SACT by the alternative method of programmed atrial stimulation. SACT was found to be prolonged in eight patients (mean +/- SD = 239 +/- 47 ms). Whether our results should be attributed to WPW syndrome or frequent supraventricular tachycardias--both being a characteristic feature of our patients--remains uncertain. The results of this study, however, indicate that in symptomatic patients with WPW syndrome and frequent episodes of supraventricular tachycardia, sinoatrial conduction is frequently impaired. Slackening of the sinoatrial conduction is a possible predisposing factor for initiation of tachycardias in the WPW syndrome.

Induced concealed dissimilar atrial rhythms

Electrophysiologic studies, including intra-atrial recordings and atrial stimulation, were performed in two patients with suspected sick sinus syndrome. Premature atrial stimuli induced atrial flutter in both patients. The arrhythmia was concealed, i.e., it was recordable only by intracavitary electrogram and invisible on surface electrocardiogram. In one case, simultaneous atrial fibrillation could be recorded in a segment of the right atrium. In this patient, the rhythm on the surface electrocardiogram changed during the study to "upper nodal" rhythm, though the atrial electrogram showed continuation of A waves at the same rate as before during sinus rhythm. It seems that atrial changes, which are frequently encountered in sick sinus syndrome, are a predisposing factor for spontaneous or inducible concealed atrial arrhythmias.

Diabetic retinopathy in pregnancy: a 12-year prospective survey

A prospective study extending over 12 years has surveyed 107 latent diabetics and 172 clinical diabetics during pregnancy. Among the clinical diabetics background retinopathy was evident or developed during pregnancy in 40 cases. Eleven cases showed proliferative changes, only 1 such case appearing de novo during gestation. There was a higher incidence of fetal loss in the diabetic than the latent diabetic group, and this loss was highest in those with proliferative retinal disease. Pregnancy was to associated with any increased risk to the mother of progression of retinal changes and visual loss. The only known direct relationship, namely, that between duration of diabetes and ocular complications, is confirmed.

Optimal labelling conditions for thymidine incorporation in PHA- and PPD-stimulated human lymphocytes--effect of adherent cells

An attempt was made to define factors important in choice of labelling conditions for thymidine incorporation into DNA as a means of quantitatively assessing DNA synthesis in human lymphocyte cultures stimulated by PHA and PPD. The effect of adherent cells on attaining and maintaining optimal labelling conditions was studied. It was found that the presence of adherent cells in PHA-stimulated cultures strongly affects requirements for exogenous thymidine, but has no effect in PPD-stimulated cultures.

Serum cortisol, plasma free fatty acids, and urinary cathecholamines as indicators of complications in acute myocardial infarction

Levels of serum cortisol, plasma free fatty acids (FFA), and urinary catecholamines were collected in 31 patients with acute myocardial infarction on the day of admission to the coronary care unit (samples obtained from 15 patients with diseases other than myocardial infarction were considered as controls). These values were correlated with the presence or subsequent development of left ventricular failure, arrhythmias, shock, or death. Sixteen of 17 infarction patients without the above complications had cortisol levels less than 20 µg%; 10 of 12 patients with complications had higher cortisol levels. All of the infarction patients without complications had plasma FFA levels less than 1100 µEq/liter, while six of nine patients with complications had levels of 1100 µEq/liter or higher. Fourteen of 16 patients without complications had urinary catecholamines less than 12.5 µg%, while seven of 10 patients with complications had levels greater than this. Of interest were a few patients without complications on admission, but with elevated cortisol or FFA levels, who developed complications on the following day. The results of the present study suggest that the generalized metabolic stress of acute myocardial infarction results in elevations of cortisol, FFA, and catecholamines as measurable biochemical indicators and/or predictors of the severity of the infarction.

Effect of oxygen breathing on pacing-induced angina pectoris and other manifestations of coronary insufficiency

Eleven patients with arteriographically confirmed coronary artery disease and normal arterial oxygen saturation were studied. The angina threshold was determined first by successive elevation of heart rate at increments of 10 and 5 beats/min by right atrial pacing while the patients were breathing air via a close-fitting mask. The mask was then connected to an oxygen tank without the patient's knowledge. After 5 min of oxygen breathing, the heart rate was again raised to the previously determined threshold level. In nine of 11 patients angina did not recur. The absence of angina was associated with improvement in myocardial lactate extraction from -17 ± 15 to +18 ± 10% ( P < 0.025), in S-T abnormalities in six of seven patients, and in pulsus alternans in three of five patients.

The pacing rate was then raised at increments of 5 beats/min until angina recurred. With oxygen breathing, angina developed at higher pacing rates (129 ± 7 beats/min with air and 137 ± 6 beats/min with oxygen, on the average; P < 0.005), at higher rate-pressure product (18.0 ± 0.8 and 19.5 ± 0.9 x 10 3 mm Hg/min, respectively; P < 0.01), and at higher left ventricular oxygen consumption (21.3 ± 1.1 and 24.6 ± 1.1 ml/min, respectively; P < 0.005). The results indicate that oxygen breathing permits the heart to do more work before coronary insufficiency develops.

Mitogenic factor and migration inhibitory factor in supernatants of serum-free human lymphocyte cultures stimulated with concanavalin A

Incubation of human peripheral blood lymphocytes with Concanavalin A (Con A) in serum-free media results in the generation of soluble active substances which induce DNA synthesis in autologous and allogeneic lymphocytes (mitogenic factor – MF) and inhibit macrophage migration (migration inhibitory factor – MIF). Both substances retain their activity after removal of Con A by binding of Con A to highly polymerized dextrans. Using Sephadex column chromatography, MF and MIF show different elution profiles and can be completely separated from each other. The heterogeneity of MF and the similarity of MIF in molecular weight induced in Con A and PPD stimulated cultures is discussed.