Clinical and hemodynamic results with the St. Jude Medical cardiac valve prosthesis. A three-year experience

Two hundred thirty-two consecutive patients (October 3, 1977, through December, 31, 1980) underwent aortic (AVR), mitral (MVR), or double (DVR) valve replacement with the St. Jude Medical (SJM) prosthesis. Operative mortality for the entire group was 7.3%. There was 100% follow-up. Warfarin (Coumadin) anticoagulation was recommended for all patients. There were no cases of mechanical failure. The incidence of thromboembolism was 0.6/1,000 patient-months for those with AVR, 3/1,000 patient-months for those with MVR, and 0% for those with DVR. Thrombosis of a prosthesis occurred in two patients with DVR. Clinically significant hemolysis occurred in three patients with paravalvar leaks following MVR. Late postoperative prosthetic infection has not occurred. Postoperative catheterization studies in 33 patients revealed no transvalvular gradient at rest in 21 patients. The remainder of the patients catheterizd had low transvalvular gradients. There was a minimal increase in transvalvular gradient with exercise. The SJM cardiac valve is a viable alternative in the surgical therapy of valvular heart disease.

Prostatic cancer. I. 6-Methylene-4-pregnen-3-ones as irreversible inhibitors of rat prostatic delta 4-3 ketosteroid 5 alpha-reductase

Some derivatives of 6-methylene-4-pregnen-3-one were studied as inhibitors of delta 4-3-ketosteroid 5 alpha-reductase. Maximum inhibitory activity was shown by 17-acetoxy-6-methylene-4-pregnene-3,20-dione (AMPD). Irreversible inactivation was observed following preincubation of the enzyme with NADPH and AMPD. This inactivation was found to occur only in the presence of NADPH. As such enzyme inactivation was not due to the formation of a more inhibitory metabolic product, or to the formation of superoxide via a cytochrome P-450/NADPH pathway, it seemed likely that the observed inactivation was derived from an irreversible combination of the enzyme with AMPD. That this was probably the case was established by kinetic studies which revealed a pattern compatible with a kcat type of mechanism.

Electrocardiogram made on ascending the Mount Qomolangma from 50 m a. s. l

In May 1975, one female mountaineer and eight male mountaineers of our country once more climbed onto the highest peak of the world Mount Qomolangma from the north slope. At the same time, we recorded 15 electrocardiograms while they were climbing from 7,600 m to the peak(8,848.13m) through radio-operated electrocardiography. In this report we mainly analyze the characteristics of electrocardiogram of six mountaineers who ascended the peak at the stage from 50 m a. s. l. to over 8,200m a. s. l. The result proves that although obvious changes after reaching an altitude above 8,200 m from the plain region should be those of indexes of heart rates, the QRS axis, Q-TR, Q-T/T-Q, P wave and T wave, there is no T wave diphasic, inverted, flat or abnormal shifting of S-T segment in the electrocardiogram of these outstanding mountaineers. This fully proves that those summit climbers are of excellent constitution and good adaptation ability to hypoxia. This also shows that the people who have been trained and acclimatized under hypoxia conditions (including permanent altitude residents and native lowlanders) can maintain normal physiological functions under ultra-anoxia for quite a long time.

The effect of lithium carbonate on leukopenia after chemotherapy

To evaluate the efficacy of lithium carbonate in ameliorating leukopenia, 37 patients (3 to 26 years old, mea (less than or equal to 1,000/mm3) over 40% of the time were designated at random on the last day of 82 separate chemotherapy courses to receive lithium or no treatment. Four could not take the drug because of the size of the capsules. There were 39 controls and 39 patients given lithium. Blood levels were maintained at 0.2 to 1.2 mEq/1 (median 0.7). The median drop of WBC in the treated group was 3,400/mm3 with a nadir of 1,800/mm3 vs 5,000 and 1,400, respectively, for the untreated patients (P LESS THAN 0.01). Eight patients (21%) in the lithium-treated group became severly leukopenic (less than or equal to 1,000/mm3) while 14 (36%) in the control group became leukopenic to that extent. Twenty-four patient days were spent with the WBC less than or equal to 1,000/mm3 after lithium and 57 days in the control group. Three patients required admission for 24 hospital days for fever while leukopenic after lithium, whereas seven patients spent 62 days in the hospital in the control group. Lithium reduces the period of leukopenia after chemotherapy during which time the patients may acquire infections.

Circulating immune complexes, complement and complement component levels in childhood Hodgkin's disease

Serum levels of circulating immune complexes (CIC) assayed by the Raji cell radioimmunoassay, total haemolytic complement (TCH50), Clq and C3 were correlated with clinical stage, histological type, age, sex and treatment of eighty-six children with Hodgkin's disease over a period of 4 years. Most significant findings were the changes of levels of CIC, TCH50, Clq and C3 during disease activity and following treatment. Significant perturbations were also seen in association with relapse. Levels of C and CIC were significantly elevated (P less than 0.001) at the time of diagnosis prior to splenectomy and/or any treatment. In the group before treatment, 81 percent of CIC levels were above 16 micrograms/ml with a maximum value of 1120 micrograms/ml. During treatment 33 percent were still above normal with a maximum of 320 micrograms/ml. Within 1 year after cessation of treatment, 37 percent also remained above normal levels with a maximum of 240 micrograms/ml. At relapse prior to treatment, 63 percent were again elevated with a maximum of 1280 micrograms/ml. The most significant difference on TCH50 levels relates to treatment periods. Sera of patients with active disease who are previously untreated show elevation of TCH50 levels (P less than 0.001) (average 127 CH50 mu/ml. During and after treatment eht TCH50 levels drop to 96 and 102 CH50 mu/ml, as compared to normal control of 100 CH50 mu/ml. In sera of patients at the first, second or third relapse, the combined TCH50 levels are significantly different from controls and across treatment periods (P less than 0.005).

A new method of treatment of congenital tibial pseudoarthrosis using free vascularised fibular graft: a preliminary report

This paper reports our experience of using Vascularised Fibular Transfer in Treatment of Congenital Pseudoarthrosis of tibia in 12 cases. Although the preliminary results of bony union are encouraging, the long term results can only be assessed after skeletal maturity.