Mass screening for coronary risk factors in 2,524 asymptomatic adults.

The prevalence of coronary risk factors was assessed in 2,524 asymptomatic adults in Long Beach, California. Hypercholesterolemia (serum cholesterol level greater than 250 mg/100 ml) was present in 725 subjects (28.8 per cent), hypertriglyceridemia (serum triglyceride level greater than or equal to 150 mg/100 ml) in 497 (19.7 per cent), and an abnormal lipoprotein pattern in 813 (32.2 per cent). Of the 2,524 subjects, 233 (9.2 per cent) had a blood pressure above 140/90 mm Hg and 116 (4.6 percent) had a blood pressure above 150/100 mm. There were 1,043 cigarette, cigar, or pipe smokers (41.3 per cent). Fifty subjects (2.0 per cent) had a fasting blood sugar level above 120 mg/100 ml, 48 (1.9 per cent) had abnormal triceps skinfold thickness, and 382 (15.2 per cent) weighed 20 per cent or more above the desirable weight. The electrocardiogram during rest was definitely above the desirable weight. The electrocardiogram during rest was definitely abnormal in 183 subjects (7.3 per cent). On the basis of these data it is evident that in many asymptomatic adults, risk factors predisposing to coronary disease are not being detected or treated.

The punctal apposition syndrome: a new surgical approach.

AIMS: To assess the punctal apposition syndrome (PAS) and its response to lateral canthal tendon (LCT) repair. METHODS: In this retrospective, interventional case series, five patients (seven symptomatic eyes) with PAS were managed. Lateral canthal tendon repair was performed in all seven eyes. The main outcome measure was correction of watery eye symptomatology. RESULTS: All five patients achieved symptomatic resolution. Conjunctivochalasis and functional nasolacrimal duct obstruction were associated with the PAS. CONCLUSION: This new surgical approach to the PAS, using a LCT repair, was successful in all patients. Two patients (three eyes) required conjunctivochalasis excision.

Predictive implications of stress testing. Follow-up of 2700 subjects after maximum treadmill stress testing.

Follow-up data on 2700 subjects who had had maximum stress tests were assembled in life tables. A positive test, characterized by ST-segment depression of 1.5 mm, 0.08 sec from the J point, predicted an incidence of some new coronary event of 9.5% a year, as compared with 1.7% in those with a negative test. The incidence of infarction and death was also significantly higher than in the negative responders. Early onset of ischemia occurring at moderate exercise (4 metabolic equivalents-METS) resulted in an incidence of all coronary events of 15% a year, while ischemia first manifested at the seventh minute of exercise (approximately 8 METS) results in an incidence of only 4% per year. The magnitude of ST depression and the age of onset of ischemia failed to influence the incidence of coronary events. A myocardial infarction previous to the test increased the incidence of events in both positive and negative responders. The positives with a previous infarction had more than double the incidence of coronary events than the positive responders with no pre-existing infarction. Those with chronotropic incompetence had a high incidence of coronary events even though the ECG response to exercise was normal.

The spectrum of presentation of silent sinus syndrome.

The general clinical, ophthalmologic, and radiologic features of three patients with silent sinus syndrome are presented. All three patients were treated surgically. The cases of these patients illustrate the spectrum of presentation of silent sinus syndrome, including enophthalmos, hypophthalmos, transient vertical diplopia, lid retraction, lagophthalmos, and blurred vision. All patients had sinus disease, and all patients improved after surgery using functional endoscopic sinus surgery techniques. The protean manifestations of silent sinus syndrome can be identified, thereby allowing appropriate management.