Significance of "reciprocal" ST segment depression: left ventriculographic observations during left anterior descending coronary angioplasty.

To evaluate the significance of "reciprocal" ST segment depression resulting from coronary occlusion, 27 patients with single vessel coronary disease were studied with intravenous digital subtraction left ventriculography before and during angioplasty of the left anterior descending coronary artery. During balloon inflation, 13 patients developed inferior lead ST depression in addition to anterior lead ST elevation (Group 1), whereas the remaining 14 patients did not (Group 2). The degree of anterior lead ST elevation in Group 1 (5 mm) was greater than that in Group 2 (1.5 mm, p less than 0.001) as was the reduction in left ventricular ejection fraction (24% versus 13%, respectively; p less than 0.02). Anterior and apical regional shortening decreased in both groups similarly, but an additional decrease in anterobasal shortening was confined to Group 1 (from 38% to 21%; p less than 0.002). Despite the presence of inferior lead ST depression in Group 1, inferior regional shortening did not change and inferobasal contraction was enhanced (from 4% to 29%; p less than 0.01). Inferior lead ST segment depression during anterior descending coronary angioplasty reflects a greater degree of anterior wall ischemia. The concurrent preservation of inferior wall contraction and the augmentation of infero-basal shortening confirm that this electrocardiographic feature is a "reciprocal" phenomenon rather than a manifestation of remote ischemia.

Irregular coronary lesion morphology after thrombolysis predicts early clinical instability.

After successful thrombolytic treatment for acute myocardial infarction, recurrent ischemia and infarction may occur with little warning. Coronary lesion morphology was analyzed from angiograms performed in 72 consecutive patients at 1 to 8 days after streptokinase treatment for acute myocardial infarction and the data were evaluated in relation to the subsequent clinical course. All patients were clinically stable at the time of angiography and continued to receive heparin infusion for greater than or equal to 4 days after thrombolysis. The infarct-related artery was patent in 55 patients (76%). In the 10 days after angiography, 15 patients developed prolonged episodes of angina at rest; the condition of 4 stabilized with medical treatment, but 11 required urgent medical intervention (coronary angioplasty in 8 and bypass surgery in 3). There were no differences in age, gender, left ventricular function or extent of coronary artery disease between those patients who developed unstable angina and those who had a stable in-hospital course. However, the median plaque ulceration index of the infarct-related lesion was 6.7 (95% confidence limits 6.3, 10) in the 15 patients with an unstable course versus 3.3 (2, 4.4) in those with a stable course (p less than 0.001). There were no differences between the two patient groups in the severity of stenosis, length of diseased segment, symmetry/eccentricity, presence of a shoulder, location at branch point or bend, presence of globular or linear filling defects, contrast staining or collateral supply. These data show that after thrombolysis, the degree of irregularity of the infarct-related artery is a critical determinant of early clinical instability.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary lesion morphology in acute myocardial infarction: demonstration of early remodeling after streptokinase treatment.

Coronary lesion morphology was analyzed in 72 patients 1 to 8 days after streptokinase treatment for acute myocardial infarction and compared with lesion morphology in a control group of 24 patients with stable angina. In the streptokinase group the infarct-related artery was patent in 55 patients (76%). Compared with stenoses in the stable angina group, there were no differences in the stenosis length, severity, calcification or in the proportion located at an acute bend or at a branch point. However, lesions in the streptokinase group were more often irregular (p less than 0.005) and eccentric (p less than 0.01), had a shoulder (p less than 0.0001), globular filling defects (p less than 0.01), linear filling defects (p less than 0.00005) and contrast staining (p less than 0.05). Plaque ulceration index was higher in the streptokinase than in the stable angina group (6.2 +/- 7.9 versus 3.5 +/- 3.4, p less than 0.001). Of the 72 streptokinase-treated patients, 35 were maintained on heparin infusion until angioplasty 2 to 10 days later. At repeat angiography before angioplasty, globular lesion filling defects seen in eight patients had disappeared, whereas linear filling defects persisted in 7 of 14 cases. Fewer lesions were irregular (p less than 0.0001) and the ulceration index decreased from 7.4 +/- 10.4 to 3.0 +/- 1.6 (p less than 0.001). These data show that the lesion in the infarct-related artery after streptokinase treatment is irregular and often associated with filling defects, perhaps corresponding to plaque fissuring and intraluminal thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Relapse rates for former clients of alcoholism rehabilitation units who are drinking without symptoms.

A follow-up study of former clients of 17 alcoholism rehabilitation units of New York State shows that those clients drinking without symptoms at the first follow-up have higher relapse rates at the second than those who were abstaining at the first follow-up. This is true for all identifiable sub-groups of former clients.

A staff allocation model for mental health facilities.

This article describes a model for allocating staff within a large psychiatric hospital. The model provides an objective framework within which one can test alternative staff operating policies before making critical decisions concerning the employment of one category of personnel as opposed to another. It is based on objective data describing patient needs and staff functioning patterns, rather than subjective opinions concerning staff deployment. Besides being useful for the short-term deployment of staff and budgetary resources, it can also be used as a long-range planning tool for testing modifications in policy decisions and budget proposals. The algorithm employed, mixed-integer linear programming, is readily available; computer costs and running time are relatively minimal.

Fatigue, recovery, and low back pain in varsity rowers.

The purpose of this study was to determine whether surface electromyography (EMG) from the erector spinae muscles could correctly identify individuals with low back pain without a population of elite athletes. A similar technique had previously been successful in identifying low back pain patients within a non-athletic population. A Back Analysis System was used to compute the median frequency of the EMG power density spectrum to monitor metabolic changes in back muscles associated with muscle fatigue. Twenty-three members of a men's collegiate varsity crew team consisting of port (N = 13) and starboard (N = 10) rowers were tested in a laboratory during a fatigue-inducing isometric contraction sustained at a relatively high, constant force. Six of the rowers tested were further classified as having low back pain. A brief test contraction was repeated at a fixed interval following the fatiguing contraction to monitor recovery. A two-group discriminant analysis procedure correctly classified 100% of the rowers with low back pain and 93% of the rowers without back pain on the basis of the median frequency data. The median frequency parameters related to recovery were the best discriminators of back pain. A similar analysis correctly classified 100% of the port rowers and 100% of the starboard rowers on the basis of their spectral parameters. The best discriminating variables in this instance were the median frequency parameters relating to both fatigability and recovery. Results from this study demonstrate that low back pain and asymmetrical muscle function in rowers can be assessed on the basis of EMG spectral analysis.

Caregiving in virgin mice (Mus musculus): effects of biparental care and exposure to a second litter during preweaning development.

I examined the effects of early family unit conditions on later parenting behavior in laboratory mice (Mus musculus). I challenge previous studies that claim to show enhancing effects of biparental care on offspring parental responsiveness by raising mice with a male parent either present (MPP) or absent (MPA) during preweaning development. The results of those studies are confounded because MPP mice also have a second litter present (SLP) and MPA mice do not (SLA). Thus, the findings may have been due to the presence of second litter and not to the presence of the male parent. In this experiment I show that when offspring raised in different family units are tested as virgins with stimulus pups, more SLP mice are parental than SLA mice, and fewer SLP mice bite newborn pups than do SLA mice. Thus, results of previous studies are due to second litter exposure and not biparental care.

Computer-aided diagnosis of alcoholism.

A generalized mathematical diagnostic algorithm, using symptoms and a weighting system derived from the criteria of the National Council on Alcoholism, correctly identified all the alcoholics and two-thirds of the nonalcoholics of a previous study.

Deterioration in left ventricular performance during early coronary angioplasty after thrombolysis. Evidence for myocardial salvage.

To investigate the effects of controlled coronary artery reocclusion after successful thrombolysis, we studied 15 patients during early elective angioplasty of the patent infarct-related artery. Eight patients underwent left anterior descending artery dilation, and the other 7 had right coronary artery dilation. In 13 cases, ST-segment elevation developed during balloon occlusion. In all 15 cases, intravenous digital subtraction left ventriculography during balloon inflation showed that the ejection fraction decreased at least 5% (mean decrease, from 60% to 47%), despite preexisting Q waves overlying the infarct territory in 5 patients. Balloon inflation resulted in decreased apical segmental shortening in all 8 patients who underwent left anterior descending artery dilation; likewise, balloon inflation produced impairment of inferior-wall contraction in all 7 patients who had right coronary artery dilation. In this setting, a deterioration in left ventricular performance indicates that the restoration of coronary patency with thrombolysis has resulted in myocardial salvage. In patients with Q waves, such deterioration suggests that this electrocardiographic abnormality does not necessarily indicate a completed infarction.

Thrombolysis for myocardial infarction.

Treating myocardial infarction by dissolving occlusive thrombi in coronary arteries is an attractive idea. Although some thrombolytic agents have been available for many years their use in this role has only recently been critically examined. The place of thrombolysis in the management of myocardial infarction has yet to be determined.

Evolution of disability in coalworkers' pneumoconiosis.

Retrospective analysis of the results of serial ventilatory capacity tests (FEV 1-0), which had extended over an average period of almost 15 years, has been carried out in 215 miners and ex-miners who suffer with coalworkers' pneumoconiosis. All were unselected previously diagnosed cases who attend the Cardiff Pneumoconiosis Panel at regular intervals for re-assessment examinations. They consisted of 68 miners and 147 ex-miners and they were divided into three groups according to their radiological category at their most recent examination, carried out in either 1973 or 1974. There were 90 cases of category B progressive massive fibrosis (PMF), 50 cases of category A PMF and 75 cases of simple pneumoconiosis. Findings for the 38 life-long non-smokers within the 215 were compared with those for the smokers. All three groups showed progressive impairment of ventilation over the whole period of observation. This was most marked in the category B cases but this group had already acquired a substantial proportion of their eventual impairment while still classified radiologically as category A or as simple pneumoconiosis. These findings are not compatible with the view that coalworkers' pneumoconiosis does not cause significant impairment of ventilation until the category B radiological stage is attained; they suggest rather that cases destined to progress to serious disablement show evidence of progressive impairment of ventilation at very much earlier radiological stages. Non-smokers showed a pattern of impairment similar to that of the smokers but were less disabled; the differences, however, were slight and not statistically significant.

Relation between progressive massive fibrosis, emphysema, and pulmonary dysfunction in coalworkers' pneumoconiosis.

The correlations between progressive massive fibrosis (PMF), emphysema, and impairment of ventilation were studied in 108 dead coalminers, all of whom had suffered with complicated coalworkers' pneumoconiosis (radiological category B or C) during life. The findings indicated that both factors were contributing to impairment of ventilation in proportion to their size or extent, but these contributions were in the main independent of one another. A joint opinion on the types of emphysema found to be present in a random 50 out of the 108 cases was given by two pulmonary pathologists. They found that most of the emphysema was of the centrilobular variety, which appeared to be unrelated to the PMF. The distribution of the PMF throughout the lungs both radiologically and anatomically is shown.

A progressive diagnostic schema for alcoholism with evidence of clinical efficacy.

A diagnostic schema for alcoholism is described. Based upon the National Council on Alcoholism criteria for alcoholism diagnosis, this schema permits the classification of any client into one of five mutually exclusive diagnostic categories. The schema is applied to data from an independent study. A significant client-type by treatment-type interaction is reported as evidence of the schema's clinical utility. The discussion outlines the need for further diagnostic refinements within the criteria and suggests possible uses of the schema as a research tool.

Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children's elbows.

From 1991 to 1994, 375 supracondylar fractures had percutaneous pinning after closed or open reduction. Nineteen of these with normal preoprative neurologic examinations had postoperative ulnar nerve palsies. All but two of the 19 were followed up. These 17 patients had complete return of function. Only four of the 17 had the medial pins removed, and two others had explorations, which showed no interruption of the nerve. Many of these patients did not have complete return of function until after 4 months. From this and other studies, it is clear that ulnar nerve palsies occurring after percutaneous pinning of the supracondylar fracture usually resolve spontaneously.

Emphysema in coal workers' pneumoconiosis.

A correlation survey has been carried out between the pathological, physiological, and radiological findings pertaining to emphysema in 247 deceased coal miners and ex-miners, most of whom had been diagnosed as suffering from coal workers' pneumoconiosis during life. The pathological findings, which included large lung sections and detailed histology in every case, were compared with similar findings in a contrast non-mining population matched for age and sex.The results indicated that emphysema was much more common among the coal miners, both with simple and with complicated pneumoconiosis, than among the contrast group. In addition the extent of the emphysema as measured by a recognized "counting" method carried out on paper-mounted lung sections was remarkably closely related to ventilatory impairment as evidenced by the forced expiratory volume in one second.Extensive emphysema was more commonly found in those pneumoconiosis cases, both simple and complicated, showing the finer punctiform type of radiological change than in cases showing the larger micronodular and nodular opacities.

Pulmonary disability in coal workers' pneumoconiosis.

Results from a correlation survey which compared radiological and physiological findings during life with detailed morbid anatomical findings in the lungs of 247 deceased miners and ex-miners with pneumoconiosis were used to assess the extent and significance of their pulmonary disability.Coal workers' pneumoconiosis usually caused progressive impairment of ventilation, which in the simple type of disease was not related to radiological category. In such cases the presence of emphysema was found to be a more important factor in determining the impairment of ventilation than the radiological category of simple pneumoconiosis.