A combined arc-melting and tilt-casting furnace for the manufacture of high-purity bulk metallic glass materials.

An arc-melting furnace which includes a tilt-casting facility was designed and built, for the purpose of producing bulk metallic glass specimens. Tilt-casting was chosen because reportedly, in combination with high-purity processing, it produces the best fatigue endurance in Zr-based bulk metallic glasses. Incorporating the alloying and casting facilities in a single piece of equipment reduces the amount of laboratory space and capital investment needed. Eliminating the sample transfer step from the production process also saves time and reduces sample contamination. This is important because the glass forming ability in many alloy systems, such as Zr-based glass-forming alloys, deteriorates rapidly with increasing oxygen content of the specimen. The challenge was to create a versatile instrument, in which high purity conditions can be maintained throughout the process, even when melting alloys with high affinity for oxygen. Therefore, the design provides a high-vacuum chamber to be filled with a low-oxygen inert atmosphere, and takes special care to keep the system hermetically sealed throughout the process. In particular, movements of the arc-melting electrode and sample manipulator arm are accommodated by deformable metal bellows, rather than sliding O-ring seals, and the whole furnace is tilted for tilt-casting. This performance of the furnace is demonstrated by alloying and casting Zr(55)Cu(30)Al(10)Ni(5) directly into rods up to ø 10 mm which are verified to be amorphous by x-ray diffraction and differential scanning calorimetry, and to exhibit locally ductile fracture at liquid nitrogen temperature.

Comparison of current density viability imaging at rest with FDG-PET in patients after myocardial infarction.

The assessment of myocardial viability is a major diagnostic challenge in patients with coronary artery disease (CAD) after myocardial infarction. Novel threedimensional current density (CD) imaging algorithms use high-resolution magnetic field mapping to determine the electrical activity of myocardial segments at rest. We, for the first time, compared CD activity obtained with several algorithms to 18-F-fluoro-deoxyglucose positron emission tomography (FDG-PET) in evaluation of myocardial viability. Magnetic field maps were obtained in nine adult patients (pt) with CAD and a history of infarction. The criterion for non-viable myocardium was an FDG-PET uptake with less than 45% of the maximum in the respective segments. CD imaging was applied to the left ventricle by using six different methods to solve the inverse problem. Mean CD activity was calculated for a close meshed grid of 90 locations of the left ventricle. A cardiologist compared bull's eye plots of CD and FDG-PET activity by eye. Spearman's correlation coefficients and specificity at a given level of sensitivity (70%) were calculated. Bull's eye plots revealed a significant correlation of CD/PET in 5 pt and no correlation in 3 pt. One pt had a negative correlation. The six different CD reconstruction methods performed similar. While CD reconstruction has the principal potential to image viable myocardium, we found that the reconstructed CD magnitude was low in scar segments but also reduced in some segments with preserved metabolic activity under resting conditions. New vector measurement techniques, the use of additional stress testing and advances in mathematical methodology are expected to improve CD imaging in future.

Electrocardiographic assessment of left ventricular hypertrophy with time-voltage QRS and QRST-wave areas.

The sum of time-voltage QRS areas in the 12-lead electrocardiogram (ECG) has outperformed other 12-lead ECG indices for detection of left ventricular hypertrophy (LVH). We assessed indices of time-voltage QRS and T-wave (QRST) areas from body surface potential mapping (BSPM) for detection of and quantitation of the degree of LVH. We studied 42 patients with echocardiographic LVH (LVH group) and 11 healthy controls (controls). QRST area sums were calculated from 123-lead BSPM and from the 12-lead ECG for comparison. Leadwise discriminant indices and correlation coefficients were used to identify optimal recording locations for QRST area-based LVH assessment. BSPM QRS area sum was greater in the LVH group than in controls (3752 +/- 1259 vs 2278 +/- 627 microV s, respectively; P<0.001) and at 91% specificity showed 74% sensitivity for LVH detection. The 12-lead QRS area sum performed similarly. Taking T-wave areas into account did not improve the results. QRS area sum from two most informative leads (located in the upper and lower right precordium) also separated the LVH group from controls (61.1 +/- 23.5 vs 27.8 +/- 6.5 microV s, respectively; P<0.00001). This 2-lead QRS area sum showed 90% sensitivity with 100% specificity for LVH detection and maintained high correlation to indexed left ventricular mass (r=0.732; P<0.001). In conclusion, the BSPM QRS area sum compared to 12-lead QRS area sum does not substantially improve LVH assessment. The 2-lead QRS area sum may improve ECG QRS area-based LVH assessment.

Heart rate adjustment of magnetic field map rotation in detection of myocardial ischemia in exercise magnetocardiography.

AIMS: We studied the capability of heart rate (HR) adjusted change in multichannel magnetocardiogram (MCG) to detect exercise-induced ischemia. METHODS AND RESULTS: The MCG and 12-lead ECG were recorded simultaneously during supine exercise testing in 17 healthy controls and 24 patients with single vessel coronary artery disease (CAD). In the MCG analysis, we plotted the orientation of the magnetic field map (MFM) against the HR in each cardiac cycle during recovery. A regression line was fitted to the data and the line slope (degrees/bpm) was determined. In the ECG, the ST-segment depression vs HR (ST/HR) slope was evaluated. The HR adjusted MFM rotation was more extensive in the pooled CAD group, and in all subgroups with different stenosed vessel, than in the control group at the ST-segment (1.5 +/- 2.1 degrees/bpm vs 0.29 +/- 0.25 degrees/bpm, p < 0.0005) and at the T-wave apex (0.95 +/- 0.81 degrees/bpm vs 0.24 +/- 0.25 degrees/bpm, p < 0.0005). Areas under the receiver operating characteristic curves of the HR adjusted MFM rotation at the ST-segment (88.5%) and the T-wave (86.0%) were higher than the ones without HR adjustment (75.5% and 68.1%, respectively), and higher than the area of ST/HR slope in the ECG (80.2%). CONCLUSION: HR adjusted MFM rotation detects transient ischemia independent of the stenosed vessel. HR adjustment improves the performance of the MCG in ischemia detection by the analysis of the ST-segment and the T-wave. The MCG was superior to the 12-lead ECG.

Postmyocardial infarction patients susceptible to ventricular tachycardia show increased T wave dispersion independent of delayed ventricular conduction.

INTRODUCTION: Experimentally, both delayed ventricular conduction and nonhomogeneous ventricular repolarization contribute to reentrant arrhythmias. We tested the hypothesis that increased T wave dispersion is independent of delayed ventricular conduction associated with arrhythmia vulnerability in postmyocardial infarction (post-MI) patients. METHODS AND RESULTS: We studied 32 post-MI patients with clinical or inducible monomorphic ventricular tachycardia (VT group), 28 post-MI patients without arrhythmias (MI group), and 13 healthy controls, using magnetocardiographic (MCG) mapping with signal averaging. Twelve-lead ECG was the reference. Filtered QRS duration (fQRS) and T wave peak to T wave end interval (TPE) were used as measures of ventricular conduction and nonhomogeneity in ventricular repolarization, respectively. In MCG, the VT group showed the longest fQRS (135+/-34 msec vs 114+/-22 msec in the MI group; P = 0.012). Mean TPE and maximum TPE in VT versus MI groups were 78+/-9 msec versus 70+/-6 msec (P < 0.001) and 117+/-23 msec versus 104+/-19 msec (P = 0.020), respectively. Maximum TPE did not correlate with fQRS in the VT group (r = 0.063; P = NS) but did correlate in the MI group (r = 0.396; P = 0.037). For identification of post-MI patients prone to VT, selection of cutoff values for fQRS >140 msec and mean TPE >81 msec gave sensitivity and specificity of 41% and 89%, and 31% and 96%, respectively. Their combination increased sensitivity to 63% while maintaining 89% specificity. CONCLUSION: Post-MI patients susceptible to VT show increased T wave dispersion independent of delayed ventricular conduction.

ST-segment level and slope in exercise-induced myocardial ischemia evaluated with body surface potential mapping.

Body surface potential mapping (BSPM) is superior to 12-lead electrocardiography for detection of acute and old myocardial infarctions (MIs). We used BSPM to examine electrocardiographic criteria for acute reversible myocardial ischemia. BSPM with 123 channels was performed in 45 patients with coronary artery disease (CAD) and 25 healthy controls during supine bicycle exercise testing. Of the 45 patients, 18 patients had anterior, 14 had posterior, and 13 had inferior ischemia documented by coronary angiography and thallium scintigraphy. The ST amplitude was measured 60 ms after the J-point and the ST slope calculated by fitting a regression line from the J-point to 60 ms after it. The optimal locations for detecting ST depression and ST-slope decrease were identified. In the pooled CAD patient group, the optimal location for ST depression was 5 cm below standard lead V(5) (CAD group: -70 +/- 70 microV; controls: 70 +/- 80 microV, p <0.001). Using a cut-off value of -10 microV, the ST depression separated the patients with CAD from controls with a sensitivity of 84% and a specificity of 96%. The ST slope became more horizontal in the patient group than in the control group. The optimal location for ST-slope decrease was over the left side (CAD group: 20 +/- 20 microV/s; controls: 720 +/- 320 microV/s, p <0.001). Using a cut-off value of 320 microV/s, the ST slope separated patients with CAD from controls with a sensitivity of 93% at a specificity level of 88%. The area under the receiver operating characteristic curve of ST slope tended to be higher than the one of ST depression (97% vs 93%; p = 0.097). In conclusion, regions sensitive for ST depression and for ST-slope decrease could be identified in BSPM, despite variation in the location of ischemia and the presence or absence of a history of MI. ST slope is a sensitive and specific marker of transient myocardial ischemia, and might perform even better than ST depression.

Recording locations in multichannel magnetocardiography and body surface potential mapping sensitive for regional exercise-induced myocardial ischemia.

INTRODUCTION: This study aimed to identify the optimal locations in multichannel magnetocardiography (MCG) and body surface potential mapping (BSPM) to detect exercise-induced myocardial ischemia. METHODS: We studied 17 healthy controls and 24 coronary artery disease (CAD) patients with stenosis in one of the main coronary artery branches: left anterior descending (LAD) in 11 patients, right (RCA) in 7 patients, and left circumflex (LCX) in 6 patients. MCG and BSPM signals were recorded during a supine bicycle stress test. The capability of a recording location to separate the groups was quantified by subtracting the mean signal amplitude of the normal group from that of the patient group during the ST segment and at the T-wave apex, and dividing the resulting amplitude difference by the corresponding standard deviation within all subjects. RESULTS: In MCG the optimal location for ST depression was at the right inferior grid for the RCA, at the mid-inferior grid for the LCX, and in the middle of these locations for the LAD subgroup (mean ST amplitudes: CAD -80 +/- 360fT, controls 610 +/- 660fT; p < 0.001). In BSPM it was on the left upper anterior thorax for the LAD, left lower anterior thorax for the RCA, and on the lower back for the LCX subgroup (mean ST amplitudes: CAD -39 +/- 61 microV and controls 38 +/- 38 microV; p < 0.001). In MCG the optimal site for T-wave amplitude decrease was the same as the one for the ST depression. In BSPM it was on the middle front for the LAD, on the back for the LCX and on the left abdominal area for the RCA group. In accordance with electromagnetic theory, the largest ST segment and T-wave amplitude changes took place in MCG in locations orthogonal to those in BSPM. CONCLUSION: This study identified magnetocardiographic and BSPM recording locations which are sensitive for detecting transient myocardial ischemia by evaluation of the ST segment as well as the T-wave. These locations strongly depend on ischemic regions and are outside the conventional 12-lead ECG recording sites.

Magnetocardiographic and electrocardiographic exercise mapping in healthy subjects.

In 12-lead electrocardiography (ECG), detection of myocardial ischemia is based on ST-segment changes in exercise testing. Magnetocardiography (MCG) is a complementary method to the ECG for a noninvasive study of the electric activity of the heart. In the MCG, ST-segment changes due to stress have also been found in healthy subjects. To further study the normal response to exercise, we performed MCG mappings in 12 healthy volunteers during supine bicycle ergometry. We also recorded body surface potential mapping (BSPM) with 123 channels using the same protocol. In this paper we compare, for the first time, multichannel MCG recorded in bicycle exercise testing with BSPM over the whole thorax in middle-aged healthy subjects. We quantified changes induced by the exercise in the MCG and BSPM with parameters based on signal amplitude, and correlation between signal distributions at rest and after exercise. At the ST-segment and T-wave apex, the exercise induced a magnetic field component outward the precordium and the minimum value of the MCG signal over the mapped area was found to be amplified. The response to exercise was smaller in the BSPM than in the MCG. A negative component in the MCG signal at the repolarization period of the cardiac cycle should be considered as a normal response to exercise. Therefore, maximum ST-segment depression over the mapped area in the MCG may not be an eligible parameter when evaluating the presence of ischemia.

Beat-to-beat analysis method for magnetocardiographic recordings during interventions.

Multichannel magnetocardiography (MCG) during exercise testing has been shown to detect myocardial ischaemia in patients with coronary artery disease. Previous studies on exercise MCG have focused on one or few time intervals during the recovery period and only a fragment of the data available has been utilized. We present a method for beat-to-beat analysis and parametrization of the MCG signal. The method can be used for studying and quantifying the changes induced in the MCG by interventions. We test the method with data recorded in bicycle exercise testing in healthy volunteers and patients with coronary artery disease. Information in all cardiac cycles recorded during the recovery period of exercise MCG testing is, for the first time, utilized in the signal analysis. Exercise-induced myocardial ischaemia was detected by heart rate adjustment of change in magnetic field map orientation. In addition to the ST segment, the T wave in the MCG was also found to provide information related to myocardial ischaemia. The method of analysis efficiently utilizes the spatial and temporal properties of multichannel MCG mapping, providing a new tool for detecting and quantifying fast phenomena during interventional MCG studies. The method can also be applied to an on-line analysis of MCG data.

Current-density estimation of exercise-induced ischemia in patients with multivessel coronary artery disease.

Magnetocardiographic and body surface potential mapping data measured in 6 patients with multivessel coronary artery disease were used in equivalent current-density estimation (CDE). Patient-specific boundary-element torso models were acquired from magnetic resonance images. Positron emission tomography data registrated with anatomical magnetic resonance imaging data provided the gold standard. Discrete current-density estimation values were computed on the epicardial surface of the left ventricle from difference (stress-rest) ST-segment maps. The ill-posed inverse problem was regularized with 3 different methods (Tikhonov regularization with an identity or a surface Laplacian operator and a maximum a posteriori estimator). Comparisons with positron emission tomography studies showed that the maximum a posteriori estimator is superior to other regularizations, provided that a suitable a priori information is available. In general, good correspondence was found for segments of high and low amplitude in current-density estimations, and the viable and scar areas in positron emission tomography, respectively.

Multimodality MR imaging assessment of myocardial viability: combination of first-pass and late contrast enhancement to wall motion dynamics and comparison with FDG PET-initial experience.

PURPOSE: To combine three magnetic resonance (MR) imaging modalities-dobutamine stress cine, first pass, and late contrast material-enhanced T1-weighted imaging-and to compare the results with 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the assessment of unviable myocardium in coronary artery disease. MATERIALS AND METHODS: Ten patients with multivessel coronary artery disease underwent MR imaging before and 6 months after bypass surgery. Left ventricular cine MR imaging was performed at rest and during dobutamine infusion. Inversion-recovery gradient-echo images were obtained to study myocardial contrast enhancement at first pass and 5 minutes later. FDG PET was performed with orally administered acipimox before surgery. RESULTS: With dobutamine cine MR imaging, unviable myocardium was detected with a sensitivity of 79% and a specificity of 93%; postoperative wall thickening was the standard. First-pass analysis increased these values to 97% and 96%; analysis of late enhancement with T1-weighted imaging, to 62% and 98%. FDG PET had a sensitivity of 81% and a specificity of 86%. CONCLUSION: The combination of first-pass enhancement analysis and wall motion assessment with stress significantly increases the specificity of MR imaging in the detection of unviable sectors.

Body burden of aluminum in relation to central nervous system function among metal inert-gas welders.

OBJECTIVES: The relationship between elevated internal aluminum loads and central nervous system function was studied among aluminum welders, and the threshold level for adverse effect was defined. METHODS: For 65 aluminum welders and 25 current mild steel welders body burden was estimated, and the aluminum concentrations in serum (S-Al) and urine (U-Al) were analyzed with graphite furnace atomic absorption spectrometry with Zeeman background correction. Referents and low-exposure and high-exposure groups were defined according to an aggregated measure of aluminum body burden, the group median S-Al levels being 0.08, 0.14, and 0.46 micromol/l, respectively, and the corresponding values for U-Al being 0.4, 1.8, and 7.1 micromol/l. Central nervous system functions were assessed with a neuropsychological test battery, symptom and mood questionnaires, a visual and quantitative analysis of electroencephalography (EEG), and P3 event-related potentials with pitch and duration paradigms. RESULTS: Subjective symptoms showed exposure-related increases in fatigue, mild depression, and memory and concentration problems. Neuropsychological testing revealed a circumscribed effect of aluminum, mainly in tasks demanding complex attention and the processing of information in the working memory system and in the analysis and recall of abstract visual patterns. The visual EEG analysis revealed pathological findings only for aluminum welders. Mild, diffuse abnormalities were found in 17% of the low-exposure group and 27% of the high-exposure group, and mild to moderate epileptiform abnormalities at a frequency of 7% and 17%, respectively. CONCLUSIONS: Both objective neurophysiological and neuropsychological measures and subjective symptomatology indicated mild but unequivocal findings dose-dependently associated with increased aluminum body burden. The study indicates that the body burden threshold for adverse effect approximates an U-Al value of 4-6 micromol/l and an S-Al value of 0.25-0.35 micromol/l among aluminum welders.

Occupational exposure to lead and neuropsychological dysfunction.

OBJECTIVE: To evaluate the neuropsychological effects of current low level and previous higher levels of exposure to lead and evaluate the relation between effects of lead and bone lead. METHODS: A neuropsychological test battery was given to 54 storage battery workers with well documented long term exposure to lead. The effect was studied in two subgroups: those whose blood lead had never exceeded 2.4 mmol/l (the low BPbmax group, n = 26), and those with higher exposure about 10 years earlier (the high BPbmax group, n = 28). In both groups, the recent exposure had been low. Correlations between the test scores and the indices of both long term and recent exposure--including the content of lead in the tibial and calcaneal bone--and covariance analyses were used to assess the exposure-effect relation. Age, sex, and education were controlled in these analyses. RESULTS: Analyses within the low BPbmax group showed a decrement in visuospatial and visuomotor function (block design, memory for design, Santa Ana dexterity), attention (digit symbol, digit span), and verbal comprehension (similarities) associated with exposure to lead and also an increased reporting of subjective symptoms. The performance of the high BPbmax group was worse than that of the low BPbmax group for digit symbol, memory for design, and embedded figures, but there was no reporting of symptoms related to exposure, probably due to selection in this group. No relation was found between the output variables and the tibial lead concentration. The calcaneal lead concentrations were related to the symptoms in the low BPbmax group. CONCLUSIONS: Neuropsychological decrements found in subjects with high past and low present exposure indicate that blood lead concentrations rising to 2.5-4.9 mmol/l cause a risk of long lasting or even permanent impairment of central nervous system function. Milder and narrower effects are associated with lower exposures; their reversibility and time course remain to be investigated. History of blood lead gives a more accurate prediction of the neuropsychological effects of lead than do measurements of bone lead.

Effects of low level exposure to lead on neurophysiological functions among lead battery workers.

OBJECTIVES: Assessment of neurophysiological functions in workers with low level exposure to lead and evaluation of the efficacy of bone lead measurements in the prediction of effects of lead. METHODS: Exposure to lead of 60 workers from a lead battery battery factory was estimated from historical blood lead measurements and analysis of lead in the tibial and calcaneal bones with x ray fluorescence. Peripheral and central nervous system functions were assessed by measuring conduction velocities, sensory distal latencies, sensory amplitudes, and vibration thresholds as well as by quantitative measurement of the absolute and relative powers and mean frequencies of different electroencephalograph (EEG) channels. RESULTS: Sensory amplitudes, and to a smaller degree sensory or motor conduction velocities, showed a negative correlation with long term exposure to lead, most clearly with integrated blood lead concentration and exposure time. Vibration thresholds measured in the arm were related to recent exposure to lead, those measured in the leg to long term exposure. The alpha and beta activities of the EEG were more abundant in subjects with higher long term exposure to lead. Calcaneal lead content reflected short term exposure, tibial lead content reflected long term exposure. Blood lead history showed a closer relation with effects of lead than the tibial or calcaneal lead concentrations. CONCLUSIONS: Vibratory thresholds, quantitative EEG, and to a smaller extent the sensory amplitude, provide sensitive measures of effects of lead in occupationally exposed adults. Most accurate estimates of health risks induced by lead can be obtained from a good history of blood lead measurements. If such a history of blood lead concentrations is not available, analysis of bone lead may be used for the assessment of health risks.

Symptoms indicative of the effects of organic solvent exposure in Dutch painters.

The report describes the results of a cross-sectional study among two groups of young and older painters and two age-matched control groups. The study was intended to gather information on the occurrence of solvent-exposure symptoms among Dutch workers using a mailed questionnaire. Results indicated that among young painters and to a lesser extent among older painters what is commonly accepted as specific symptoms and additional solvent-related symptoms showed a higher frequency than among the controls. The most interesting observation was a significant relationship between the frequency of periods of heavy exposure and the severity of most symptom categories, whereas there was a lack of consistent relationships with other exposure parameters.

Internal load of aluminum and the central nervous system function of aluminum welders.

OBJECTIVES: Because the brain is the recognized target organ for aluminum toxicity, internal aluminum load and central nervous system functions were investigated among aluminum welders in a shipyard. METHODS: Seventeen male welders with a mean age of 37 (range 24-48) years and a history of about four years of metal inert-gas welding on aluminum were the subjects. Aluminum in serum (S-Al) and urine (U-Al) was analyzed with graphite-furnace atomic absorption spectrophotometry. Central nervous system functions were examined with neuropsychological tests, symptom and mood questionnaires, quantitative electroencephalography (QEEG), and P300 evoked responses. RESULTS: The mean S-Al concentration was 0.21 (range 0.03-0.64) mumol.l-1 and the mean U-Al was 2.8 (range 0.9-6.1) mumol.l-1. Although the welders performed normally on the neuropsychological tests, there was a negative association between all four memory tests and U-Al and a positive association between the variability of visual reaction times and S-Al. In the QEEG, the amount of delta and theta activity in the frontal region correlated positively and the amount of alpha activity in the frontal region correlated negatively with S-Al. CONCLUSIONS: The S-Al and U-Al measurements indicated increased internal loads of aluminum in most of the welders. This finding is compatible with slowly eliminated aluminum from tissues. The neuropsychological assessment suggested disturbing effects of aluminum on short-term memory, learning, and attention. In the QEEG, a corresponding exposure-effect relationship was found for activity in the frontal region. Further studies are needed on the possibility that exposure to aluminum welding fumes causes harm to human health.

A novel sensor for routine continuous spirometry of intubated patients.

Measurement of gas flow and airway pressure at the Y-piece of an endotracheal tube provides valuable information about airway integrity and basic pulmonary function. We describe the working principle and design of the D-lite sensor (Datex Division, Instrumentarium Corporation, Helsinki, Finland), which, in a single, lightweight adapter piece, encloses flow, airway pressure, and sidestream gas measurement. The main emphasis in the design of this instrument was on reliable and accurate operation during continuous monitoring with exposure to humidity and mucus. Therefore, a robust flow-restrictor element with a pick-off arrangement resembling a Pitot tube was employed. This arrangement has nonlinear characteristics with potential difficulties in the measurement of small flows. However, these inherent drawbacks, together with compensations required because of varying gas fractions and pressure, can be handled by sophisticated computer algorithms at the host-monitor end (Capnomac Ultima [Datex Division, Instrumentarium Corporation, Helsinki, Finland]). Validation methods with main results and a brief review of applications are given.

Behavioral effects of exposure to organic solvents in Dutch painters.

The report describes the results of a cross-sectional study of solvent-exposed young and older Dutch painters and two age-matched control groups. Both traditional and computerized neurobehavioral tests were applied. The study did not detect any major differences between the two groups of painters and their two age-matched control groups. It is argued that this absence of differences is probably not due to a lack of sensitivity of the tests applied or the size of the groups studied. The level of exposure was estimated to be within a range at which previous authors have reported solvent-induced CNS effects.

The effect of orally administered diazepam and midazolam on plasma beta-endorphin, ACTH and preoperative anxiety.

Ninety-five women undergoing induced abortion were randomly premedicated with oral diazepam, 5 or 10 mg, midazolam 15 mg, or intramuscular placebo, 40-60 min before the induction of anesthesia. Prior to premedication and again prior to the procedure, the women completed the questionnaire sheet for the Profile of Mood States (POMS), and plasma samples for immunoreactive beta-endorphin (ir beta-E) and ACTH were taken. The Oblique Tension-Anxiety (T-A) Factor scores derived from POMS correlated with plasma concentrations of ir beta-E and ACTH after premedication. The T-A scores decreased in women premedicated with diazepam, 5 and 10 mg, or midazolam, 15 mg, but not in women treated with placebo. The women premedicated with midazolam, 15 mg, became more fatigued after premedication. The changes in blood pressure after premedication correlated with T-A scores. A positive correlation was found between heart rate and plasma beta-endorphin concentration. The changes in ir beta-E and ACTH did not correlate with the changes in T-A scores. We conclude that POMS T-A scores are useful for assessment of preoperative anxiety and the effect of premedication. The present study did not provide any reliable proof to confirm the hypothesis of a relationship between plasma concentrations of ir beta-E or ACTH and preoperative anxiety. Since many factors modulate endorphin and ACTH secretion prior to operation, the measurement of endogenous opiates may be of limited value in assessment of the effects of preanesthetic medication.

Exposure to organic solvents and neuropsychological dysfunction: a study on monozygotic twins.

Twenty one monozygotic twins exposed to organic solvents were compared with their non-exposed cotwins by performance in psychological tests. A further 28 monozygotic twin pairs were examined as a reference group. The study used 11 tests, 10 of which had shown an effect in previous studies on the results of exposure to solvents. Paired comparisons of the test scores showed the exposed twins to have lower performance in associative learning, digit span, and block design. These results agree with two previous studies that used a similar set of tests. Contrary to some other studies, psychomotor speed was not affected, but the results indicated a marginal effect on the control of hand movements. Further comparison of subgroups with a low and a high exposure showed the prevalence of subtle neuropsychological dysfunction to be greater among the more exposed twins.