Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography.

To determine whether the site of acute myocardial infarction (AMI) can be predicted on the basis of a previous coronary angiogram, 184 consecutive angiograms obtained between March 1972 and August 1990 in 92 patients who had undergone coronary angiography both before and after AMI without intervening bypass surgery or angioplasty were evaluated. Median time between the first coronary angiography and AMI was 26 months (range 1 to 144). On the first angiogram, most patients (89%) had 1- or 2-vessel disease, and 56 (61%) had an abnormal ventriculography. Seventy-two segments (78%) responsible for a future AMI were not significantly stenosed. On the second angiogram, AMI was related to the previously most stenotic segments in only 29 patients (32%). For these patients, median time between first coronary angiography and AMI was slightly shorter (22 vs 28 months; p = 0.04). The severity of the narrowing on the first angiogram was a poor predictor of subsequent AMI. It is concluded that in a selected, medically treated cohort, AMI is frequently related to a segment that was not the most stenotic one or was not even significantly stenosed at previous angiography, particularly with a long interval between the first angiogram and AMI.

Recombinant human follicle-stimulating hormone treatment leads to normal follicular growth, estradiol secretion, and pregnancy in a World Health Organization group II anovulatory woman.

A first case of successful induction of ovulation with recombinant human FSH administered subcutaneously to a WHO group II anovulatory patient is reported. Using a chronic low-dose protocol, recombinant human FSH, a preparation with no LH activity, led to a clear and even supraphysiological increase of inhibin and E2 and the development of four follicles among which one was dominant. The treatment cycle resulted in an ongoing pregnancy.

Pacemaker malfunction due to subcutaneous emphysema.

We describe a pacemaker-dependent patient who presented with malfunction two days after implantation of a physiologic dual-chamber pacing system. The malfunction was due to subcutaneous emphysema produced by subclavian venepuncture. Accumulation of air within the generator pocket of the pacemaker resulted in insulation of the unipolar anodal plate and dysfunction of the device.

Multiple follicular development and ovarian steroidogenesis following subcutaneous administration of a highly purified urinary FSH preparation in pituitary desensitized women undergoing IVF: a multicentre European phase III study.

A multicentre, multinational study was carried out between November 1990 and February 1992 to assess the safety and efficacy of a new highly purified urinary human follicle stimulating hormone (FSH; Metrodin HP) which is practically devoid of luteinizing hormone (LH) activity. Metrodin HP was administered s.c. to stimulate multiple follicular development in women undergoing in-vitro fertilization (IVF) and embryo transfer. A total of 139 women were recruited from 10 participating centres. Of these, 135 underwent pituitary desensitization with a long gonadotrophin-releasing hormone (GnRH) agonist protocol and following determination of ovarian inactivity (mean +/- SD of 12.9 +/- 3.2 days), Metrodin HP s.c. stimulation was started; 122 patients were fully eligible for efficacy analysis and 118 of these (97%) received up to 10,000 IU human chorionic gonadotrophin (HCG) to induce final follicular maturation and timed oocyte recovery. Mean plasma LH concentrations at the beginning of Metrodin HP treatment were 1.6 +/- 0.8 mIU/ml and by the day of HCG administration were significantly (P < 0.001) reduced (1.2 +/- 0.8 mIU/ml). The mean plasma oestradiol and inhibin concentrations on the day of HCG were 6173 +/- 3567 pmol/l and 8.2 +/- 4.4 IU/ml respectively. There was a positive correlation (r = 0.49, P < 0.001) between individual oestradiol and inhibin concentrations on the day of HCG. In the 118 patients who received HCG, the mean number of oocytes recovered was 8.4 +/- 4.7 following stimulation with 36 +/- 10, 75 IU ampoules of Metrodin HP over 12.2 +/- 2.1 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Ventricular late potentials and spontaneous ventricular arrhythmias after surgical repair of tetralogy of Fallot: do they have prognostic value?

OBJECTIVE: To determine the prognostic significance of ventricular late potentials and spontaneous ventricular arrhythmias detected early after surgical repair of tetralogy of Fallot. DESIGN: Prospective observational. SETTING: Cardiology department of a teaching hospital. METHODS: Between June 1984 and June 1991, 104 children (63 boys, 41 girls) were studied by signal averaging and 24 hour ambulatory monitoring after surgical repair of tetralogy of Fallot. Mean (SD) age at operation was 6 (3) years, mean interval between operation and evaluation was 8 (25) months, and the follow up after evaluation was one to 88 (mean 30) months. RESULTS: Ventricular late potentials were detected in 24/104 patients (23%) and spontaneous ventricular arrhythmias in 39/96 patients (38%); usually (in 81%) these were unifocal and rare. Patients with ventricular late potentials were older at operation than patients without late potentials (9 (3) v 6 (3) years, P = 0.002). No correlation was found between the presence of ventricular late potentials and the presence or complexity of spontaneous ventricular arrhythmias early after operation. During the mean follow up of 2.5 years no case of sudden death or sustained ventricular tachycardia was found. CONCLUSION: Short-term prognosis after surgical repair of tetralogy of Fallot is good; ventricular late potentials and spontaneous ventricular arrhythmias are often detected shortly after operation, but in the medium term follow up they do not predict sudden death or serious ventricular arrhythmias.

[Effect of high-dose verapamil on systolic and diastolic cardiac function of non-cardiological patients and review of the literature]. / Effet du vérapamil oral à forte dose sur la fonction cardiaque systolique et diastolique de patients non cardiologiques et revue de la littérature.

We studied the effects of high doses of oral verapamil (480 mg daily) in a group of 28 patients undergoing intravenous drug therapy for terminal digestive tumor. One additional patient was prematurely withdrawn from the study due to the occurrence of second degree atrioventricular block, which regressed after the interruption of verapamil. Gated radionuclide angiocardiography was performed before and after treatment (mean duration 2 days). Verapamil induced a significant reduction of blood pressure and heart rate (132 +/- 19 mm Hg vs 124 +/- 18 mm Hg, p = 0.005 for systolic blood pressure, 80 +/- 13 mm Hg vs 76 +/- 9 mm Hg, p = 0.04 for diastolic blood pressure and 81 +/- 17 bpm vs 77 +/- 13 bpm, p = 0.02 for heart rate). Left ventricular ejection fraction and peak filling rate were not impaired (65 +/- 7% vs 64 +/- 7%, p = NS and 2.52 +/- 0.65 EDV/s vs 2.42 +/- 0.51 EDV/s, p = NS), while peak ejection rate decreased slightly (2.96 +/- 0.72 EDV/s vs 2.72 +/- 0.50 EDV/s, p = 0.01). Conversely, there was significant alteration of right ventricular systolic indexes (50 +/- 7% vs 46 +/- 7%, p = 0.01 for the ejection fraction and 2.06 +/- 0.53 EDV/s vs 1.88 +/- 0.44 EDV/s, p = 0.008 for the peak ejection rate), without change in the peak filling rate (1.54 +/- 0.46 EDV/s vs 1.46 +/- 0.46 EDV/s, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

In-hospital monitoring after coronary angioplasty.

At the University Hospital of Geneva there are three postcoronary angioplasty monitoring levels: (A) intensive care unit; (B) optional ECG monitoring (cardiology unit); and (C) no monitoring (other unit). To assess the adequacy of patient monitoring after coronary angioplasty, we studied the clinical outcome of 200 consecutive patients undergoing coronary angioplasty at different monitoring levels. Thirty-nine patients (20%) were in level A. Their outcome was 1 death, 1 emergency bypass operation, and 7 acute myocardial infarcts. Ninety-six patients (48%) were in level B: no major complication, no transfer of monitoring level, and mean hospital stay 2.7 +/- 1.3 days. Sixty-five patients (32%) were in level C: 1 death, 2 elective bypass operations, 6 transfers to level A, and mean hospital stay 5.9 +/- 4.6 days. Electrocardiogram monitoring of 135 patients yielded 23 significant findings (17%), 22 of which occurred in patients with complicated or failed procedure. In the 122 patients with successful coronary angioplasty without angiographic visible local complications and without clinical symptoms at the end of the procedure, no significant arrhythmia or acute myocardial infarction was documented. For this type of patient, ECG monitoring is not a prerequisite after coronary angioplasty. Surveying all patients after coronary angioplasty in the coronary care unit would not significantly reduce complications. Aftercare in a cardiology unit results in a shorter hospital stay.