Plaque herniation through an intracoronary stent.

We present a case where a Wiktor intracoronary stent was inserted for 'poor angiographic result' following balloon angioplasty. Despite appropriate positioning and repeated dilation of the stent a suboptimal result was achieved because of plaque herniation through the stent. The case emphasizes that the choice of stent used is important and will become more so as the number of choices available increases.

Monitoring anticoagulation following intracoronary procedures: which method?

We have assessed bedside kits for monitoring the activated partial thromboplastin time and the activated clotting time by comparing them with laboratory activated partial thromboplastin time values. To determine the accuracy of anticoagulation we have concurrently measured the plasma heparin concentrations, and plasma prothrombin fragment F1 + 2 concentrations. Serial samples were taken from patients undergoing elective percutaneous transluminal coronary angioplasty (n = 14). Readings were taken pre-procedure, 30 min after administration of a heparin bolus (10,000 U) and 1, 2 and 3 h after commencement of a constant heparin infusion (15 U/kg/h) postprocedure. Activated partial thromboplastin time results obtained with the bedside kit compared reliably with laboratory values (r = 0.8), were rapidly available and were reflected by appropriate changes in prothrombin fragment F1 + 2 and heparin concentrations. However, the relationship between activated partial thromboplastin time values and activated clotting time was less precise (r = 0.59). Therefore, for routine and frequent monitoring of anticoagulation with heparin, a bedside activated partial thromboplastin time kit provides adequate control of therapy but in instances were particularly tight control of anticoagulation is required, use of prothrombin fragment F1 + 2 concentrations may be more appropriate.

The relationships between maternal HbA1, maternal size and fetoplacental size in Indian pregnancies.

A study of pregnant Punjabi, Indian women was carried out to establish whether or not there was a relationship between maternal HbA1 at term and birth weight of the baby. Measurements were made on the mother, placenta and baby. The regression of birth weight on placenta weight gave a correlation (r = 0.7, P less than 0.01, n = 59). No correlation was found between HbA1 and birth weight, birth weight corrected for placenta weight, or placenta weight. However, there was a weak but significant correlation between HbA1 and an adjusted placenta weight, expressed as a ratio Bwt'/Plwt', (r = 0.27, P less than 0.05, n = 56).

Cervical and vestibular afferent control of oculomotor response in man.

Oculomotor response in the absence of vision has been compared in a group of 12 normal humans in two experimental conditions testing (a) the vestibulocular reflex by whole-body oscillation on a turntable, and (b) the cervico-ocular reflex by oscillation of the body with the head held stationary. The stimulus was a sinusoidal oscillation (peak angular velocity +/- 50 degrees/sec) at frequencies between 0.2 and 1.3 Hz. The slow-phase eye movements of the vestibulo-ocular response were compensatory for head movement and showed a mean gain of 0.54--0.90, increasing with frequency. The cervicoocular response was found to be very variable. The slow-phase eye movements were of low velocity (mean gain 0.05) and did not generally compensate for body movement. During neck torsion, some subjects exhibited large overall eye deviations composed of both slow and fast phase eye movements.

Glucose concentrations in parotid fluid and venous blood of patients attending a diabetic clinic.

Measurements of the glucose concentration in venous blood and parotid saliva taken from 31 diabetics attending a diabetic clinic showed values ranging respectively from 3.9 to 19.1 mmol/l and 0.06 to 0.83 mmol/l (means 9.6 mmol/l and 0.32 mmol/l respectively). Linear regression of salivary glucose on blood glucose gave a simple correlation coefficient of 0.18 (NS). Since salivary glucose levels did not reflect blood glucose levels, the possibility of diabetics regulating their metabolic control by the noninvasive technique of monitoring salivary glucose concentrations is not possible.

Failure of provision of antibiotic prophylaxis for 'at risk' cardiac patients: impetus for improvement required from cardiologists.

We conducted a survey by questionnaire to assess whether patients 'at risk' from infective endocarditis are aware of the need for good dental hygiene and antibiotic prophylaxis, and receive appropriate advice or treatment. Of 189 patients surveyed, half had told a dentist about their heart, 8% were aware of a dental problem, 12% had attended a dentist within one year, but 39% had not attended a dentist in 5 years. Only 21% accurately recalled instructions on prophylaxis and 44% recalled receiving antibiotics prior to treatment. Of replies from 262/480 general practitioners, half took a dental history but only 3% gave antibiotic advice in writing. Fifty-seven percent prescribed antibiotics recommended by the British Society for Antimicrobial Chemotherapy. Of the general practitioners and 72/240 dentists who replied, half were unaware of some of the cardiac conditions requiring prophylaxis, and did not receive adequate advice from their cardiac centre. We conclude most at-risk patients are unaware of the need for good dental hygiene and antibiotic prophylaxis. Communication needs to be improved to address these problems. A new 'endocarditis risk' card is proposed for patients to carry, with an identical 'sticker' to attach to medical notes.

Methotrexate-induced pericarditis and pericardial effusion; first reported case.

We report a case of methotrexate-induced pericarditis and pericardial effusion in a 22-year-old pregnant woman. These complications have not previously been described as isolated phenomena associated with methotrexate therapy.