Angiographic and pathologic correlations in Prinzmetal variants angina

The coronary-arteriographic and pathologic findings in a case of Prinzmetal's angina are reported. Right coronary arteriograms performed in the absence of pain showed only minor stenotic changes, whereas those performed during an anginal attack revealed a spastic occlusion involving almost the entire vessel. Anatomic examination revealed obstructive lesions of the right coronary artery, more pronounced at the site where spasm had started, due to concentric atherosclerotic thickening of the inner wall, whereas the elastic fibers and the muscular ring of the tunica media were preserved. These findings suggest (1) the need for great caution before assuming on purely angiographic bases that spasm may affect a normal coronary artery and (2) the possibility that spasm occurs in a markedly diseased and stenotic segment of a coronary artery as long as the contractile tissue of the tunica media is preserved.

Involvement of the cardiac conducting system in panarteritis nodosa

Histopathological observations on the conduction system of the heart were carried out in three cases of panarteritis nodosa. This specialized tissue was involved in each case secondary to ischemia and/or periarterial extension of the inflammatory process affecting the nutrient arteries of the conducting system. The high risk of disturbances in impulse formation and conduction in patients with panarteritis is emphasized as well as the need for appropriate clinical investigation (protracted cardiac monitoring and control by catheter recording and stimulation) in order to secure early detection and prevention of life-threatening arrhythmias.

A case of surgically corrected Wolff-Parkinson-White syndrome. Clinical and histological data

A case of type B Wolff-Parkinson-White syndrome, with intractable atrial fibrillation, underwent surgical division of a right-sided accessory atrioventricular bundle of Kent. Pre-excitation and complicating tachyarrhythmias were henceforth abolished for 6 weeks, when the patient died of infective endocarditis. Histological examination showed a divided Kent's accessory atrioventricular pathway and apparently functionless James and Mahaim fibres.

[Plasma levels of diphenylhydantoin (DPH) and phenobarbitone (PB) in epileptic patients resistant to drug treatment (author's transl)]

The Authors present and discuss the results obtained by assaying plasma DPH and PB in 123 patients chronically treated with antiepileptic drugs. The subjects examined were considered resistant to medical therapy and were all at their first laboratory control. The data obtained show: 1) the very poor correlation existing between the doses of drugs administered and their actual plasma levels; 2) the very high percentage of patients with DPH and PB plasma levels not in the therapeutic range of these drugs. The Authors discuss some of the most frequent errors in planning chronic therapy with DPH and barbiturates due to the lack of knowledge of drug blood levels.

Dysrhythmias and sudden death in acromegalic heart disease. A clinicopathologic study

A clinicopathologic investigation was carried out in a patient with acromegaly from acidophylic adenoma of the hypophysis. Pronounced cardiomegaly and disturbances in impulse formation and conduction led to sudden death. The problem of acromegalic cardiomyopathy has been reviewed. Particular attention has been focused on the histopathologic findings in the working and specific myocardium, and in the intrinsic nervous supply to the sinoatrial node, which were correlated with the electrocardiographic features of atrioventricular conduction delay and sick sinus syndrome.

The conduction system in corrected transposition with situs inversus

The location and course of the conduction system were investigated by serial section in two hearts with corrected transposition of the great arteries in situs inversus. In the first case, characterized by dextrocardia, the interventricular septum was intact, while in the second case with levocardia, a high ventricular septal defect was associated with pulmonary atresia. In both hearts, a regular posterior connecting AV node was present, left-sided in one case and right-sided in the other. The bundle branches were distributed in the morphologically appropriate ventricles. Extensive hemorrhage and coagulation necrosis of the common bundle and bundle branches were observed in the first case, being consequent upon surgical replacement of the right-sided tricuspid valve. The common bundle ran below the membranous septum in this case. In the heart with ventricular septal defect it was related to the postero-inferior rim of the defect. In both cases, an accessory AV node was located anteriorly in the interatrial septum but did not connect with the ventricular musculature. The different position of the atrioventricular conducting tissue in corrected transposition, between cases in situs solitus and situs inversus, is emphasized.

Long-term administration of DDT or phenobarbital-Na in Wistar rats

In lifespan studies, outbred male and female Wistar rats were given either technical DDT mixed into the diet at a dose of 500 parts per million (ppm) or phenobarbital-sodium dissolved in drinking water at a dose of 500 ppm. Liver-cell tumors developed in treated animals but not in controls. The incidence of liver tumors was 45% in the DDT-treated group and 44% in the phenobarbital-sodium-group. When evaluated by sex, DDT-treated females and males had incidences of 56% and 35%, respectively, while in the phenobarbital-sodium group, the respective incidences were 32% and 59% in females and males. These data show a varying susceptibility between the sexes, with regard to induction of liver-cell tumors by the two compounds. In both treated groups, the number of nodular tumors per rat and the average size increased with age and were greater in females. None of these tumors and metastasized. Histologically, the liver tumors were nodular growths, which compressed surrounding parenchyma did not infiltrate it. The total incidence of extrahepatic tumors was higher in controls than in treated animals. In this connection, we must mention the apparent, but not significant, reduction of adrenal tumors in treated rats compared to the controls.

Histopathology of conducting system in left anterior hemiblock

In 8 cases of left anterior hemiblock, combined with right bundle-branch block in 7, serial sections of the conducting system of the heart were examined histologically. In all cases there were pathological changes in the left bundle-branch but the anterior part of it was predominantly affected in only 2 cases. Acute changes were found in 6 cases of early myocardial infarction, and fibrosis in 2 cases of chronic heart disease. Reversible lesions may have a pathogenetic role in acute hemiblocks. The right bundle-branch was disrupted by fibrosis in 6 of the 7 cases with right bundle-branch block, and minor changes in the AV node were observed in 1. The widespread damage to the left bundle-branch in the majority of the present cases does not seem to be consistent with the limited clinicopathological correlation implied by the terms anterior fascicular block or hemiblock. Other cardiac lesions within the left bundle-branch and outside it may contribute to this electrocardiographic pattern.

Histopathological findings in two cases of torsade de pointes with conduction disturbances

Histological studies were made of the conducting system and the myocardium in two cases of torsade de pointes with complex disturbances of impulse conduction and formation. A fairly similar clinicopathological pattern was seen, consisting of an unusual association of non-interruptive, widespread damage to the conducting system with the intermittent and variable electrocardiographic disorders. The inherent desynchronization of cardiac action and the bilateral, uneven, and partial disruptions of the bundle-branches have been tentatively correlated, pathophysiologically, with the re-entry circuit, or mechanism, which is held to be responsible for the cyclic fluctuation of QRS axis, peculiar to torsade de pointes.

[Motor nerve conduction velocity in arterial hypertension]

Motor nerve conduction velocity was studied in a group of 44 hypertensive patients; velocity was measured at the level of the median and external popliteal sciatic nerves. From the series were excluded those hypertensive subjects with renal insufficiency, diabetes mellitus and peripheral arterial disease. No significant differences were observed in MNCV values compared to controls. Within the hypertense group, no appreciable variations were observed depending on the duration and degree of hypertension, and signs of visceral damage (assessed at myocardial and retinic levels). The results do not confirm previous published data suggesting the existence of MNCV reduction during arterial hypertension, the reduction being considered an subclinical expression of peripheral neuropathy and an index of the gravity of visceral damage during hypertensive disease.

Multiple lesions of the conduction system in a case of cardiac rhabdomyosarcoma with complex arrhythmias. An anatomic and clinical study

Anatomic and electrocardiographic correlations in a case of primary cardiac rhabdomyosarcoma are examined. Interatrial and atrioventricular conduction disturbances were associated with multiple lesions involving the alleged internodal pathways, together with atrial-atrioventricular nodal connections. The clinicopathologic findings seem to be consistent with the hypotheses of the functional and morphologic value of Bachmann's fascicle, and of the inherent pathways of interatrial and internodal conduction in health and disease.

[Correlation between serum values of copper, ceruloplasmin, SMAO, SDAO, in health- subjects, in pregnant women and in some pathological conditions (author's transl)]

Copper directly reactive with diethylditiocarbamate, ceruloplasmin, monoamine oxidase (SMAO) and diamine oxidase of the serum (SDAO) were studied in healthy subjects, in nine months pregnant women and in some pathological conditions. Increased values of copper were found in pregnancy. Ceruloplasminaemia was increased in hyperthyroidism, congestive hearth failure, Hodgkin's disease, and in pregnancy. Ceroluplasminaemia was strongly reduced in Wilson's disease. SMAO was increased during pregnancy. Statistical analysis showed no correlations between the variations of the data in different pathological conditions. In healthy subjects and in pregnant women, correlation was found between the values of ceruloplasmin obtained using both enzymatic and KCN methods. Statistical analysis of regression lines obtained in both groups of patients showed significative differences between slopes and elevations. It is possible that ceruloplasmin in pregnant women has different composition compared with healthy controls.

The roles of age at treatment and dose in carcinogenesis in C3Hf/Dp mice with a single administration of N-nitroso-N-methylurea

C3Hf/Dp mice were given a single i.p. injection of 50, 25 or 5 mug/g N-Nitroso-N-Methylurea (NMU) at either 1 or 70 days of age or 50 mug/g at 21 days of age. They were observed until death or until 120 weeks of age. The two highest doses of NMU produced tumours in a wide spectrum of organs, including the thymus, forestomach, lung, liver (only in males), kidneys, ovaries and orbital glands. The only two tumour types which appeared to be closely related to the occurrence of death were thymic lymphomata (most of which were found in mice dying before 40 weeks after treatment) and carcinomata of the forestomach. Lifetime analyses are presented concerning the occurrence of these two tumour types as well as the occurrence of any tumour after 40 weeks of age or since treatment. Incidences of thymic lymphomata were 67.6%, 39.0% and 21.2% in mice receiving 50 mug/g NMU at 1, 21 and 70 days respectively and 17.1% in mice receiving 25 mug/g at 1 day. In the other groups the incidence of thymic lymphomata was zero or negligible. The rate of progression of thymic lymphomata until death was related to both earliness of treatment and dose. On the contrary, incidences and progression of carcinomata of the forestomach were unrelated to age at treatment. Since breakdown of NMU is very rapid and does not require enzymes, these results are considered as evidence that host-tumour interaction differs from organ to organ. No excess of tumours over the controls was found in mice receiving 5 mug/g either at 1 or 70 days of age.

[Diaminoxidase of the blood and blister fluid in burned patients]

Serous diaminoxidase (DAO) was measured in 28 patients affected by burns of various extents 3-8 hours after the lesion. In 32.1%, increases in DAO were encountered and these were greater and more frequent in more extensively affected subjects. After 7-10 days, DAO values were back to normal. Measuring DAO simultaneously in the serum and in the phlyctena fluid, it was observed that the latter constantly contains greater concentrations of the enzyme. This suggests that DAO is released or newly formed at lesional level although it cannot be excluded that the internal organs may also play a part in the release and neoformation of DAO as happens in experimental burns, after i.v. injection of heparin and after subcutaneous inflammation due to terpentine.

Left posterior hemiblock in acute myocardial infarction

Fifteen cases of left posterior hemiblock associated with acute myocardial infaction were studied. In 5 cases the left posterior hemiblock was the only intraventricular conduction defect, while in the other 10 cases it was associated with complete right bundle-branch block. Left posterior hemiblock proved to be an early complication, appearing within a few hours from the onset of the acute episode, and an ominous sign, since hospital mortality rate was 87 per cent. Cause of death was mainly pump failure. In most of these cases ther was electrocardiographic evidence of infarction involving both anterior and inferior ventricular walls. Infarction of most or all of the ventricular septum was a common finding in the cases examined anatomically. Histologically, acute changes involving mainly the posterior septal and midseptal fibres were observed in 6 of the 8 cases studied. On the basis of these findings and of other published findings an alternative physiopathological mechanism for so-called left posterior hemiblock is proposed.

[Toxic polyneuropathy in shoe-industry workers. A longitudinal electromyographic study (author's transl)]

A longitudinal electromyographic study was carried out on fifteen shoe-industry workers (one man and fourteen women) affected with toxic polyneuropathy. The mean values of age, duration of exposure and lenght of the follow-up period were 23.2 years, 4.2 years and 12.2 months, respectively. Twelve subjects (80%) had a sensory-motor involvement of both upper and lower limbs; in the remainder, only the latter were affected. From a clinical standpoint, the polyneuropathy was classified as mild in seven subjects (46.6%), moderate in four (26.7%) and severe in four. On the basis of electromyographic criteria (maximal motor nerve conduction velocity; features of voluntary contraction tracings; existence of spontaneous activity recorded in different points of the same muscle), the polyneuropathy could be defined as mild in two patients (13.3%), moderate in three (20%) and severe in 10 (66.7%). In eight subjects (53.3%) the electromyographic abnormalities disappeared completely, through a gradual improvement in six and alternative phases of improvement and worsening in two. As for the remainder patients (7, viz. 46.6%), improvement and worsening in two. As for the remainder patients (7, viz. 46.6%), four showed a reduction of their electromyographic abnormalities, whereas no significant changes occurred in the last three. The obtained results are discussed and the following conclusions drawn: 1. the lower limbs are mostly affected, both clinically and electromyographically; 2. the clinical symptoms do not parallel the electromyographic findings; 3. the course of the disease appears to be independent of the initial electromyographic pattern; 4. recovery appears to occur in most instances within approximately eighteen months since the onset of symptoms, generally without significant residual deficit. Finally, the role of electromyography in the diagnosis and the follow-up study of the observed toxic polyneuropathy is underlined.