Peripheral artery disease in patients with coronary artery disease.

The prevalence of peripheral vascular disease in patients with coronary artery disease has been investigated in many different ways and depends on the diagnostic methods and the definition of the atherosclerotic manifestations in the different vascular beds. In this study we used the non-invasive methods digital volume pulse plethysmography and ankle and toe blood pressure measurements to identify arterial abnormalities in the lower limbs in 58 patients (49 males and 9 females; age 37-72 years) examined with coronary angiography. The prevalence of peripheral artery disease was 22%, in agreement with the results of most previous investigations. There was a tendency towards increasing prevalence of peripheral artery disease with more advanced coronary artery disease: 14% of the patients with no or minimal coronary atheromotous lesions, 18% of the patients with moderate coronary atheromotous lesions and 32% of the patients with marked coronary atheromotous disease. For this reason a non-invasive investigation of the peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary heart disease. Toe pressure measurement appears to be the most appropriate technique being rather simple in management and also in evaluation of results.

Coronary artery thrombosis developing during angiography. A case report.

A case of coronary thrombosis developing during coronary arteriography is described. In spite of obstruction of a main coronary artery, only a small myocardial infarction developed. Increased coagulability probably contributed to the thrombus formation.

Physical dependence in the rat induced by slow release morphine: dose-response, time course and brain biogenic amines.

1. Physical dependence was induced in rats by administration of a slow release morphine emulsion (morphine SR), and assessed by scoring abstinence signs and temperature changes after i.p. administration of naloxone (5 mg/kg). Three groups of rats received doses of 75, 100 or 150 mg/kg of morphine SR. Dependence was evaluated in each of these groups after 24, 48 and 72 h. 2. The effect of these treatments at the different times on brain levels of serotonin, 5-hydroxyindoleacetic acid, noradrenaline and dopamine was determined. 3. A ceiling level of dependence was reached 24 h after 75 and 100 mg/kg and 48 h after 150 mg/kg of morphine SR. 4. These different treatments produced no significant effect on the brain levels of noradrenaline, dopamine or serotonin. The levels of 5-hydroxyindoleacetic acid were significantly raised in morphine-dependent rats and the changes correlated well with the changes in abstinence behaviour and temperature after naloxone. 5. The results suggest that a relationship exists between serotonin turnover and physical dependence on morphine.

Preoperative bacterial colonization of the upper airways does not predict postoperative airway infection in children.

The aim of this prospective non-interventional investigation was to study whether preoperative colonization of nasopharynx with potentially pathogenic airway bacteria carried an increased risk for the development of early postoperative bacterial airway infections after heart surgery in preschool children. Of the 91 patients studied, 62 (68%) were colonized preoperatively in the nasopharynx with Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae and/or Staphylococcus aureus. Nine children developed postoperative airway infections (four pneumonia, three bacterial bronchitis and two acute otitis media). Preoperative colonization was not significantly associated with increased risk for postoperative airway infection: 6/62 (10%) in colonized vs 3/29 (10%) in non-colonized children. Preoperative nasopharynx cultures in asymptomatic children should be avoided since it is unpleasant for the child, is not cost-effective, and may lead to unnecessary antibiotic treatment.

Peripartum cardiomyopathy--three cases.

Three cases of peripartum cardiomyopathy (PPCM) are presented, each illustrating a clinically important aspect of the disorder. One patient survived despite extreme haemodynamic deterioration, one died suddenly 2 months post partum although clinically recovered, and one died during a subsequent pregnancy. The cases demonstrate the severity and the unpredictable course of PPCM, which remains a challenge both to scientists and to clinicians.