Differentiation of posterior myocardial infarction from right ventricular hypertrophy and normal anterior loop by echocardiography

The differentiation of posterobasal myocardial infarction (PMI) from either right ventricular hypertrophy (RVH) or normal subjects displaying an anterior loop (AL) by electrocardiography (ECG) or vectorcardiography (VCG) is difficult. M-mode echocardiography (echo) via the anterior and subxiphoid methods has been helpful in defining cardiac chamber size and wall motion abnormalities. We tested whether this relatively more direct method would better separate these entities compared with the other two techniques. ECG and VCG using established criteria failed to distinguish the three conditions effectively. By echo, distinguishing characteristics were observed in each of the groups. Thus, right ventricular diastolic dimension and wall thickness were significantly increased only in the RVH group, echo dimensions and wall motion were normal in the AL group and the posterior left ventricular systolic thickening response and ejection phase indices were significantly reduced only by the subxiphoid method in the PMI group. To test the specificity of the latter finding, posterior wall motion in three infarction groups (posterior, combined posteroinferior and inferior) were examined and suggested that the target of the subxiphoid beam focuses on a more superior posterobasal left ventricular segment than the anteriorly placed transducer. Echocardiography can differentiate PMI from either RVH or AL more directly than ECG or VCG, and may be of practical clinical importance.

Infective aneurysm of the left ventricle: angiographic and echocardiographic features

A 17-year-old man with staphylococcal endocarditis of the mitral valve developed an infective aneurysm of the posterior left ventricular wall. Echocardiography revealed an echo-free space posterior to the posterior left ventricular wall. This echo-free space undoubtedly represented the aneurysmal sac, because it could be temporarily obliterated by injecting saline into it and was no longer detectable following surgical closure of the sac. Thus echocardiography may be helpful in the detection of an infective aneurysm of the left ventricle.

A rapid, sensitive method for accurate analysis of individual bile acids in biological fluids by high performance thin-layer chromatography and densitometry

1. A rapid new micromethod for quantitative analysis of individual bile acids in duodenal juice by high performance thin-layer chromatography (HPTLC) and densitometry is described and evaluated by comparison with standard TLC and spectrophotometry. 2. Advantages of HPTLC over TLC include more rapid separation, better resolution and more sensitive detection (5 - 10 fold), without the need for prior extraction. Densitometry provides simple, direct and rapid quantitation. 3. The method is accurate and reliable over a range of bile acid concentrations. In the 0.5 mM range, recovery was greater than 89%, and coefficients of variation for within-day analysis were 2 - 12% and for between-day analysis were 6 - 18% for the individual bile acids. Twenty analyses can be performed by one worker in a single day. 4. We conclude that the method offers several advantages over most currently described techniques, is suitable for routine use and is deserving of wider application.

Rapid loss of factor XII and XI activity in ellagic acid-activated normal plasma: role of plasma inhibitors and implications for automated activated partial thromboplastin time recording

Rapid prolongation of the aPTT of normal plasma upon incubation with ellagic acid containing aPTT reagents was observed. The aPTT prolongation was not due to time-dependent changes in pH in the incubation mixture or loss of activity of the labile coagulation factors VIII and V but occurred as a result of rapid progressive inactivation of ellagic acid-activated factors XII and XI. Prolongation of the aPTT and loss of contact factor activities was not observed in plasma incubated with particulate activator reagents. This finding seemed to indicate that adsorption of factors XII and XI to larger particles during the activation process might protect these factors from inactivation by naturally occurring plasma inhibitors. Evidence is presented which supports previous findings that C1-INH, alpha1-AT, and antithrombin (in the presence of heparin) contribute to factor XIIa and XI a inactivation in ellagic acid-activated plasma and that plasma albumin may compete with factor XII for ellagic acid binding. The data indicate that ellagic acid-containing aPTT reagents have unfavorable properties which seriously limit their usefulness in the clinical laboratory, particularly in respect to recording of the aPTT with certain fully automated clot timers.

Characterization of alpha-galactosidase isoenzymes in normal and Fabry human-Chinese Hamster somatic cell hybrids

The alpha-galactosidases in normal man-Chinese hamster somatic cell hybrids were investigation with antibodies specific for human alpha-galactosidase A and antibodies specific for Chinese hamster alpha-galactosidase. It was found that an isoenzyme in hybrid cells, which has an electrophoretic mobility between that of human alpha-galactosidase A and Chinese hamster alpha-galactosidase, contains immunologic determinants of both human and Chinese hamster origin, suggesting that it is a heteropolymeric molecule. Moreover, the locus for human alpha-galactosidase, which was found to be X-linked, is the locus coding for alpha-galactosidase A. Hybrids isolated after fusion of Chinese hamster cells with cells of a patient with Fabry's disease did not express human alpha-galactosidase A or the heteropolymeric molecule even in the presence of the active human X chromosome, indicating that the deficiency of alpha-galactosidase A in Fabry's disease is probably due to a mutation in a structural gene resulting in the inability to form immunologically detectable and functionally active molecules of alpha-galactosidase A.

[Intranasal skin grafting for Osler's disease (author's transl)]

Between 1965-1972, 12 patients with Osler's disease of the nose were treated surgically by a modification of the method suggested by Saunders. The mucosa of the entire nasal septum and entire floor of the nose up to the insertion of the inferior turbinate was removed without interference to the perichondrium or periosteum. The denuded area was covered with split thickness skin graft taken from the thigh. Haemorrhage, which was never severe, occassionally occurred. In all patients, there occurred crusting and foetor, which was controlled by nasal douching. Patients with Osler's disease should be treated as early as possible in order to curtail the work disability.

Epidemiologic investigation of an outbreak of Shiga bacillus dysentery in an island population

An epidemic of dysentery broke out in St. Martin island during May through July 1973. The epidemic was caused by Shigella dysenteriae type 1. The dysentery could not be controlled by conventional antibiotics and other antidysenteric drugs. The average attack rate was 32.9%. The age specific attack rate was highest in the age group 1-4 years (52.2%). The attack rates were higher in smaller families. The rates were not greatly different amongst people using different sources of water. The overall death rate was 2.1%. The overall infection-to-death rate was 6.4% but amongst children less than a year old, it was 41.1%. A common source outbreak was unlikely. The higher attack rate in smaller families suggested limited possibility of person to person spread. No particular water source could be implicated with higher attack rate. Flies may have played an active role in transmission.

Cirrhosis of liver in Bangladesh. (A preliminary report)

The incidence of cirrhosis of liver in Bangladesh, its possible aetiological factors and clinical features have been studied. This being the initial report, embraces the population of only two hospitals in Dacca viz., Institute of Postgraduate Medicine and Research (P.G. Hospital) and Sir Salimullah Medical College Hospital situated three and a half kilometers apart. In a population of 5889, a total of 154 cases (2.6%) of cirrhosis of liver have been recorded. Nutritional deficiency has been considered to be the important aetiological factor whereas alcoholism does not appear to have any significant role. Almost all the cases (94.2%) were non-alcoholic. Pattern of clinical features have been compared with those of other authors and variations recorded. Further study on an elaborate scale has been suggested.

Biosynthesis of digalactosyl diglyceride in Vicia faba leaves

Developing and mature leaf tissue from Vicia faba plants were pulse-fed 14-CO2. The lipids were extracted at intervals after exposure to light, and the galactolipids monogalactosyl diglyceride (MGDG) and digalactosyl diglyceride (DGDG) were separated. After methylation and methanolysis, gas-liquid chromatography was used to separate the two galactose units of DGDG and the galactose of MGDG. The specific activities of the galactoses and the changes over the time period of the experiment were determined. The results support the view that DGDG is formed by galactosylation of MGDG. This does not take place by a rapid two-enzyme system reaction but more slowly in two phases: galactosylation of a pool of newly formed MGDG and a more random galactosylation of MGDG. There is no evidence of a high turnover of galactose in these lipids.