[The fate of patients with stenosis of the trunk of the left coronary artery]

We have studied the fate of 49 patients with stenosis of the trunk of the left coronary artery of more than 50%. The follow-up period extends from 1,5 years to 5 years (with a mean of 33.83 +/- 13.55 months). The clinical picture was not characteristic. Unstable angina was found in 59% of cases. The exercice test (29 patients) was positive in 100%, with a mean depression of 3.3 mm. Stenosis of the trunk, which is rarely an isolated condition (8% of cases), is usually associated with disorders of the other main coronary vessels. Twenty six patients underwent surgery. Thirteen patients who were operable were treated medically. The performance of the left ventricle and the degree of involvement of the coronary arteries were comparable in these two groups. Seven inoperable patients were treated medically. Actuarial survival curves show a significant difference (p less than 0.01) in survival after two years between the operated cases (88%), the operable cases treated medically (60%), and the inoperable cases (57%). The decreased mortality of the operated cases corresponds also with a greater functional capacity in the survivors compared with that of the cases treated medically.

Failure to mourn a stillbirth: an overlooked catastrophe

The reasons for the difficulty of mourning a stillbirth and the therapeutic management of this mourning process are outlined. A case is described of failed mourning of a stillbirth which gave rise to a profound disturbance in mothering of a subsequent live baby. A psychotherapeutic technique is discussed which facilitates the failed mourning of a stillbirth.

Outpatient management of intercostal tube drainage in spontaneous pneumothorax

In a series of 226 patients with spontaneous pneumothorax, 167 (74%) were managed successfully on an outpatient basis by observation (20%) or by intercostal tube drainage and a flutter valve (54%). Only 59 patients (26%) were hospitalized, and 42 of these were treated surgically (18.6%). Outpatient management with a flutter valve has proved to be safe, efficient, and economical.

[Electrocardiographic abnormalities during meningeal hemorrhage]

The electrocardiogram (E.C.G.) was recorded in 100 cases of meningeal hemorrhages. The most frequent abnormalies encountered were bradycardia (32%) and inversion of the T wave (34%). Rhythm and conduction problems were less frequently found. Bradycardia was frequently and T wave inversion rarely found in cases without disturbances of consciousness and those with favourable prognosis. The contrary was found in comatous patients and cases with lethal outcome. The existance of an aneurysm and the location of it did not influence the type of electrocardiographic abnormalies. The influence of the parasympathetic and especially the sympathetic nervous systems is emphasized.

Premature opening of aortic valve in severe aortic regurgitation

Premature opening of the aortic valve in late diastole has been demonstrated by echocardiography in a patient with severe aortic regurgitation. Valve opening coincided with the end of the diastolic murmur and equalization of aortic and left ventricular diastolic pressures. Echocardiography of the aortic valve in severe aortic reflux may, therefore, provide valuable information about the underlying haemodynamic disturbance.