[Acute myocardial infarction in nocturnal paroxysmal hemoglobinuria]. / Infarto agudo de miocardio en el seno de hemoglobinuria paroxística nocturna.

The case of a 62-year-old diabetic and smoker male who was under study in another hospital due to anemia, thrombopenia and hematuria of several months of evolution is presented. The patient was admitted to the coronary unit for an acute extensive transmural myocardial infarction and treated with t-PA. A few hours later the patient presented hematuric urine, a decrease in hemoglobin and platelets and acute renal insufficiency. Hematologic study confirmed the diagnosis of paroxystic nocturnal hemoglobinuria. The evolution of the patient was poor despite intensive medical treatment requiring hemodialysis. The patient presented cardiac tamponade and died. The role of hematologic disease in acute myocardial infarction and the treatment and evolution of the coronary syndrome in the context of the disease are discussed.

[The absence of interference between GSM mobile telephones and implantable defibrillators: an in-vivo study. Groupe Systèmes Mobiles]. / Ausencia de interferencia entre teléfonos móviles GSM y desfibriladores implantables: estudio in vivo.

INTRODUCTION AND OBJECTIVES: The electromagnetic field created by mobile telephones can cause pacemaker dysfunction. Although implantable cardioverter defibrillators are also susceptible to electromagnetic interference, few studies have addressed this issue and compatibility with the GSM mode has not been tested. This study was developed to detect possible "in vivo" interference between GSM mobile telephones and implantable cardioverter defibrillators. MATERIAL AND METHODS: The study group is composed of 30 patients with 8 different models of defibrillators. Twenty six had endocardial leads and 4 epicardial. Three GSM mobile phones were used: Siemens S3 COM and Motorola 6200 in all cases and Ericsson GA 318 in one. The tests were performed under continuous electrocardiographic monitoring. All therapies were deactivated and sensitivities were set to maximal parameters. The telephones were positioned in close contact to the defibrillator can and precordium, in two different angles. Three situations were evaluated: calling, established contact for 15 seconds and ringing. The protocol was repeated during pacing to assess the possibility of pacemaker mode inhibition. RESULTS: No cases of electromagnetic interference were observed. One patient presented non-sustained ventricular tachycardia episodes during the tests that were detected by the defibrillator. CONCLUSIONS: These results suggest that electromagnetic interference by GSM mobile phones are not a probable cause of implantable defibrillators dysfunction.

Intracoronary platelet activation in ischemic heart disease: effects of ticlopidine.

Plasma levels of platelet factor 4 have been measured in the aortic and coronary sinus blood of 35 patients: group I (n = 12) with normal coronary arteriograms; group II (n = 15) with angiographically proven coronary artery disease; and group III (n = 8) composed of patients with ischemic heart disease who were being treated with the antiaggregant agent ticlopidine at the time of cardiac catheterization. The mean increase in platelet factor 4 levels through the coronary circulation was 27.4 +/- 21.9 ng/ml (mean +/- standard deviation) in group II, compared with -1 +/- 4.5 ng/ml in group I (p less than 0.01). In group III plasma levels of platelet factor 4 in aortic and coronary sinus samples were all within the normal range. Thus, we conclude that platelet activation constantly occurs in the coronary circulation of patients with stable coronary artery disease, and can be prevented with ticlopidine.

Interaction between anticoagulants and contraceptives: an unsuspected finding.

To assess the effects of oral contraceptives on anticoagulant treatment the prothrombin times of 12 patients were measured while they were taking both drugs simultaneously and while they were taking only anticoagulants. The mean prothrombin time ratio was significantly higher when patients were taking both drugs than when they were taking only anticoagulants and their doses of anticoagulant were significantly lower. During both periods most of the prothrombin values remained in the therapeutic range. These findings suggest that, contrary to the common belief that oral contraceptives diminish the effects of anticoagulants, contraceptives in fact potentiate the action of the anticoagulants.

PIP: Of 197 patients with heart disease on oral anticoagulant treatment (nicoumalone) 12 were simultaneously taking an estroprogestogenic oral contraceptive. The patients were aged 27-44 years old and anticoagulation control was maintained by measuring prothrombin activity. For 230 months the women took anticoagulant only. The mean prothrombin time ratio was significantly higher when the women were taking both the anticoagulant and the pill than taking only the anticoagulant, but the prothrombin values were in the therapeutic range during both periods. The oral contraceptive seems to potentiate anticoagulation activity not diminish their effect. It is suggested that the estrogen in the pill may produce enzymatic inhibition in microsomes of hepatic cells which potentiate anticoagulant activity through retarded metabolic degradation.

[Beneficial effect of morphine on the threshold of electrical fibrillation of the ventricle. Experimental study]. / Efecto beneficioso de la morfina sobre el umbral de fibrilación "eléctrico" del ventriculo.

The action of 2-3 mg/kg of morphine on the threshold of electrical fibrillation of the ventricle (TVF) in anesthetized dogs has been studied. The basal TVF was 10.5 +/- 4.9 mA, increased to 20.2 +/- 7.7 mA (P 0.005) with the administration of this drug. Comparatively, the effect of morphine on the TVF is similar to that of propranolol and bretilium and more effective than procainamide. The mechanism by which it acts is not well known. Perhaps it is due to a homogenization of refractory periods in the ventricle as well as a possible morphine-catacholamine interaction. Morphine in dosis of 2-3 mg/kg could occupy a place among the antiarrhythmic drugs of choice with antifibrillatory action, with important usefulness in the field of anestesiology of cardiopaths.