Multiple esophagogastric fistulas resulting from reflux esophagitis

A case of multiple esophagogastric fistulas is reported along with the endoscopic and radiological findings. The literature is reviewed. There is only one other case report of multiple, isolated esophagogastric fistulas described by Mullen, et al (1975). In that individual the etiologic factor was previous esophageal surgery for stricture. In the patient reported here, the long history of reflux symptoms and endoscopic and biopsy findings strongly suggest a causal relationship. Fistula formation may be an additional complication of prolonged gastroesophageal reflux.

Measurement of diastolic events by apexcardiogram: correlation with hemodynamic state and prognosis after myocardial infarction

Apexcardiograms and hemodynamic studies were performed in 32 postmyocardial infarction patients. Group 1 patients (5) had markedly elevated left ventricular end diastolic (LVED) pressures but normal LVED volumes; apexcardiograms included tall A waves (31 percent of the E to O points), prolonged A-wave durations of 134 msec or greater, short rapid filling wave durations (55 msec) and slow-filling waves replaced by plateaus in three patients. Group 2 patients (10) had markedly elevated LVED pressures and elevated LVED volumes, and had similar apexcardiographic findings: A-wave heights had a mean of 23.4 percent of E to O points, A-wave durations were 113 msec or more, rapid filling wave (RFW) durations were 93 msec and diastolic plateaus occurred in five patients. Group 3 patients (11) had intermediate hemodynamic findings and the apexcardiograms were varied; three patients with mild congestive heart failure (CHF) had apexcardiograms similar to Group 1 and five without CHF had apexcardiograms similar to those in Group 4. Group 4 patients (6) had normal hemodynamic findings; the mean A-wave height was 6 percent of the E to O point height, A-wave durations 90 msec or less RFW durations were 117.5 msec or more and the slow-filling wave duration (SFW) was normal in the configuration. Fourteen of 15 patients in Groups 1 and 2 developed CHF and six died on follow-up. Group 4 patients showed no evidence of CHF on follow-up and there were no deaths. Group differences were significantly different for A-wave height and duration, and for RFW duration at 0.05 or 0.01.Tall prolonged A waves and short RFWs were associated with poor left ventricular (LV) compliance and dysfunction, and diastolic plateau immediately following the RFW when present were confirmatory. Thus, the apexcardiogram is a reproducible useful noninvasive tool for clinical assessment, and predicting prognosis in postmyocardial infarction patients.

Postmyocardial infarction syndrome. Unusual mode of presentation

The postmyocardial infarction syndrome usually presents weeks after acute myocardial infarction as pericarditis associated with fever, leukocytosis, high sedimentation rate and pulmonary infiltrations. The unusual feature of the case discussed here was severe left shoulder pain resembling subdeltoid bursitis. Subsequently signs of pleuritis appeared prior to the classical picture of Dressler's syndrome. There was a dramatic response of steroid therapy.

Splenic vein thrombosis: an unusual case of gastric bleeding

Acute and/or recurrent gastrointestinal bleeding due to ruptured gastric varices from an isolated thrombosed splenic vein is a distinct entity. Incidence of this syndrome is probably less than 1%. Typical clinical features of this syndrome include evidence of splenic hypertension without liver disease and no demonstrable cause of gastrointestinal hemorrhage. Diagnosis can easily be missed unless the surgeon is familiar with this syndrome. Typical findings at the time of surgery are an enlarged spleen, varicose veins usually involving the upper third of the stomach, and pancreatic and peripancreatic inflammation. Portal vein and portal pressure will be normal. Meso-portography is a convenient and safe procedure and will lend support to suspicion when a retrograde nonfilling of the splenic vein is present. Splenectomy offers the expectation of a long-range cure. A representative case of a 39-year-old man is discussed. He had at least six episodes of gastric bleeding in less than 3 years. At a previous laparotomy, the cause of bleeding could not be determined. A splenectomy in December 1970 has been able to control the gastric bleeding since then.

Synthesis of new steroid haptens for radioimmunoassay. Part III. 15beta-Carboxyethylmercaptosteroid-bovine serum albumin conjugates. Specific antisera for radioimmunoassay of 5alpha-dihydrotestosterone, 5alpha-androstane-3beta, 17beta-diol and 5alpha-androstane-3alpha, 17beta-diol

The syntheses of 15beta-carboxyethylmercapto-5alpha-dihydrotestosterone, 15beta-carbosyethylmercapto-5alpha-androstane-3beta, 17beta-diol and 15beta-carboxyethylmercapto-5alpha-androstane-3alpha, 17beta-diol and the preparation of their bovine serum albumin (BSA) conjugates are described. These conjugates were employed for the generation of specific antisera suitable for radioimmunoassay (RIA) of 5alpha-dihydrotestosterone (5alpha-DHT), 5alpha-androstane-3beta, 17beta-diol (3beta-diol) and 5alpha-androstane-3alpha, 17beta-diol (3alpha-diol).

Potential central nervous system antitumor agents. Aziridinylbenzoquinones

A series of 15 2,5-diaziridinyl-3,6-bis(alkylamino)-1,4-benzoquinone derivatives was synthesized and evaluated as central nervous system antitumor agents in the murine intracerebral L1210 and ependymoblastoma brain tumor systems. Intraperitoneal activity was evaluted in the leukemia L1210, P388, and B16 melanocarcinoma tumor models. The more hydrophilic hydroxyalkylamino compounds were the most effective in the intraperitoneal ascites systems (L1210, P388) with the dihydroxypropylamino (18) and hydroxyethylamino (17) analogues producing long-term survivors. The simple, more lipophilic mono- and dialkylamino derivatives were most effective in the intracerebral systems. Multiple long-term survivors were obtained with the methyl (13), ethyl (14), and dimethylamino (20) compounds in the ependymoblastoma brain tumor system. The parent amino analogue 12 was very active in several tumor models. The relationship between structure, activity, and water solubility are discussed.

Value of serial apexcardiograms during and after myocardial infarction

Apexcardiograms were systematically recorded serially in 40 patients after acute myocardial infarction, in an additional 21 patients with proven aneurysms, and in 18 patients with good ventricular performance following myocardial infarction. Abnormalities of the "A" wave and systolic waves of the apexcardiogram correlated well with akinesia or dyskinesia proven by cinefluoroscopic and cineangiographic studies. Third and fourth heart sounds and apical systolic murmurs also correlated well with evidence of ventricular dysfunction. This study indicates that the apexcardiogram is a good qualitative tool for serially assessing patients following acute myocardial infarction and that the results on invasive study may be predicted in most patients.

Electrophysiological studies in left bundle branch block as a result of procainamide therapy

A patient of coronary heart disease with depressed intraventricular conduction who developed left bundle branch block upon administration of procainamide instead of the usual nonspecific widening of qrs is presented. The possible mechanism of genesis of this very rare side effect of procainamide is discussed and the review of the literature revealed this patient to be the first documented, electrophysiologically studied case with this side effect of procainamide.

Potential central nervous system antitumor agents. Aziridinylbenzoquinones. 1

A series of 3,6-substituted 2,5-diaziridinyl-1,4-benzoquinones was prepared as potential CNS antitumor agents. Activity was evaluated in the murine leukemia L1210 system. The diurethane derivative 9 was found to have significant activity in that system as well as in the intraperitoneal P388 and B16 tumor models. Marginal Lewis lung activity was observed. Reproducible activity was seen in the intracerebral L1210 and P388 systems. Multiple cures were observed in the murine ependymoblastoma brain tumor model. The effect of substituent type on aziridinylquinone activity is discussed.

Prinzmetal angina. Normal arteries and multifocal electrocardiographic changes

A 40-year-old man with severe angina had electrocardiographic changes typical of Prinzmetal angina during his attacks of chest pain. ST segment elevations in leads II, III, and aVF occurred intermittently with elevations in leads I and aVL, and with T wave flattening in V1, suggesting myocardial ischemia in areas supplied by the right coronary artery and by the circumflex branch of the left coronary artery. However, the coronary arteries appeared normal when arteriograms were made, suggesting that a reversible event caused the attacks.

Pacemaker Wenckebach phenomenon due to antiarrhythmic drug toxicity

Two patients with intractable ventricular arrhythmia were managed with ventricular pacing and antiarrhythmic drugs. Toxic levels of these drugs results in unusual conduction disturbances at the level of Purkinje ventricular junction which caused pacemaker Wenckebach phenomenon and marked QRS prolongation. Sodium bicarbonate and sodium lactate infusion improved the conduction velocity probably by hyperpolarizing the membrane and reversed the conduction disturbance.

Active antitumor components in a decomposed amino sugar I: Effect of sugar structure on activity

While pure methyl 5-(2-chloroethylamino)-5-deoxy-2,3-O-isopropylidene-beta-D-ribofuranoside hydrochloride has no L-1210 leukemia activity, a decomposed sample was found to be very active. One of several approaches taken to determine the nature of the active component involved a study of how sugar structure affects antitumor activity. A number of aminoribose derivatives were prepared and tested against the murine L-1210 and P-388 leukemia and the B-16 melanoma tumor systems. Compounds were tested as pure materials and as synthetically degraded mixtures. Both the beta-haloethyl group and a secondary amine were required for highest activity.

The influx of uric acid and other purines into everted jejunal sacs of the rat and hamster

The in vitro transport of [2-14-C]uric acid, [8-14-C]hypoxanthine, and [8-14-C]xanthine, each dissolved in Krebs--Ringer bicarbonate buffer, was studied with everted jejunal sacs from rat and hamster. No evidence could be obtained for the development of a concentration gradient between the intracellular fluid and the incubation medium or between the sac contents and the incubation medium, for any of the three oxypurines. Inhibitiors of active transport, such as anaerobiosis for dinitrophenol, had no significant effect on the rate of transport. A large percentage of hypoxanthine and xanthine was oxidized to urine acid in the sac-wall homogenate, sac contents, and incubation medium during the course of the incubation. This oxidation could be prevented by addition of allopurinol (3 mM) to the incubation medium, but concentration gradients were still not obtained. No active transport mechanism could be demonstrated for uric acid, hypoxanthine, or xanthine in rat or hamster jejunum.

Atrial dissociation

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