Heparin excretion in intact and hepatectomized rats.

Metabolism and kinetics of 3H-heparin were compared in intact and hepatectomized rats. Rats were divided into three groups: 1) intact rats with biliary fistulas and cystostomies 2) intact rats with only cystostomies and 3) hepatectomized rats with cystostomies. Radioactivity in blood, bile and urine besides anticoagulant activity in blood and urine were examined. In addition, column chromatography of urine was used to isolate possible metabolites. Seventy percent and 80% of the radioactive dose was found in the urine of intact rats at 24 hr and 48 hr. Close to 5% of the radioactivity was found in bile or rats with a biliary fistula after 48 hr. The APTT declined to near normal values at 1 hr whether rats had a biliary fistula or not. In contrast, only 25% of the radioactivity could be exerted into the urine of hepatectomized rats in 24 hr; the APTT did not decline as fast and at 5 hr, it was still 100 seconds. Only one radioactive component could be isolated on chromatography from all urines of these animals and appears to be similar to the original heparin. Thus, the liver has no important role to play in regulating the anticoagulant effects and excretion of heparin.

Evolution of cardio-pulmonary involvement in Friedreich's ataxia.

The evolution of 15 patients initially evaluated during Phase One of the Quebec Cooperative Study of Friedreich's ataxia has been studied approximately three years later. It is concluded that the deterioration of cardio-pulmonary function in Friedreich's ataxia is multifactorial. The neuromyopathy (or the underlying metabolic or cellular defect) appears to be the main contributing factor to the deterioration of cardio-pulmonary function, which is exacerbated by the scoliosis and varying severity of the cardiomyopathy.

Echocardiographic findings in Friedreich's ataxia.

Echocardiographic examination of 21 patients with Friedreich's ataxia (age 7 to 28 years) showed cardiac abnormalities in 90% of the cases. They were characterized by varying degrees of septal hypertrophy in 81%, left ventricular free wall hypertrophy in 61%, and a slight reduction of left ventricular internal dimension in 57% of the cases. Asymmetric septal hypertrophy (ASH) with a septal/left ventricular free wall ratio of over 1.3 was found in 29% of the cases, and systolic anterior motion (SAM) of the mitral valve in three patients. Two other patients showed evidence of a different type of cardiomyopathy with marked symmetric left ventricular hypertrophy and marked left ventricular enlargement.

Congenitally corrected transposition in a patient with situs inversus, atrioventricular discordance and mesocardia (I,D,D).

The clinical, hemodynamic and angiographic features of a patient with situs inversus, atrioventricular discordance, corrected transposition of the great arteries (I,D,D) and mesocardia are presented. A review of the literature concerning corrected transposition of the great arteries in situs inversus is included. The incidence of associated cardiovascular and electrocardiographic anomalies is compared with that found in corrected transposition of the great arteries in situs solitus; special surgical aspects of the above cases are also discussed.

Cardiac rehabilitation. Current status and future directions.

Comprehensive cardiac rehabilitation is more than exercise training for patients with coronary artery disease and now includes all aspects of secondary prevention. Exercise training is individually prescribed based on clinical status and therapeutic goals. Smoking cessation and abstinence and the treatment of hypercholesterolemia are integral to the rehabilitation process. Education and counseling are important adjuncts to treatment, especially soon after a coronary event. Vocational rehabilitation can be included simply and effectively in the rehabilitation process. Efficient and cost-effective cardiac rehabilitation is tailored to a patient's medical condition, risk factor evaluation, and vocational status. The future of cardiac rehabilitation will be linked to the success of training nonphysician health professionals to provide preventive services.

[Acute dyspnea following intravenous administration of vinblastine/mitomycin C]. / Akute Dyspnoe nach intravenöser Gabe von Vinblastin/Mitomycin C.

A 49 year old woman treated for metastatic adenocarcinoma of the breast suddenly developed the symptoms of acute pulmonary edema 90 minutes after infusion of mitomycin C/vinblastine. No other causes of dyspnea were found. This dangerous side effect of mitomycin C/vinblastine therapy has been described previously. The appearance of dyspnea after the injection of vinblastine in patients treated with the above-mentioned drug combination should always be considered an alarming symptom.

Gel chromatography of heparin.

It is assumed that heparin is a heterogeneous substance. In order to further investigate the purification of heparin, a column chromatographic technique for the fractionation of heparin is described using various diameters of bead form cross-linked dextran gels and an automated apparatus. It was observed that Sephadex G-50 resulted in the separation of three well formed peaks and provided superior resolution compared to all other gels. One of the peaks, representing 51% of the original material, possessed strong anticoagulant activity as measured by the recalcification time, partial thromboplastin time, thrombin time and the anti-Xa test. This peak also possessed strong metachromasia after electrophoresis as well as having a very potent anticoagulant effect in vivo. This technique may have a significant role in the purification of this agent from tissue sources.

Transmitting echocardiograms by telephone.

The feasibility of sending echocardiographic tracings to distant places by means of telephonic facsimile equipment has been investigated, and the quality of the transmitted copies was found to be acceptable. Three models were used for transmission, and although they presently have some technical limitations, use of satellites promises to enhance their capacity. Use of the already available technology will allow remotely located echocardiographers to benefit from the expertise of consultants in this field. Rapid telephonic access to referral centers, especially for difficult cases, will prevent potential interpretation errors and will give the referring physicians another tool for upgrading their interpretative skills. Transmission of echocardiographic tracings could thus become another means of continuing medical education in a constantly evolving field.

[Cryosurgery of lung metastases (author's transl)]. / Kryochirurgie von Lungenmetastasen

Cryosurgery achieves a local tumor destruction and at least in many experimental models it also produces an antitumor immunity. Cryosurgery was therefore applied to 15 patients with multiple lung metastases. In 2 cases a good palliation with a temporary standstill of tumor growth and in 3 cases of positive effect with a decrease and disappearance of metastases was noted. In two of these cases metastases of the contralateral lung also decreased or varnished. This can be explained by an immune mechanism. Big tumors and fibrosarcomas are not suited for cryosurgery, whereas hypernephroid renal carcinomas and malignant teratomas give more promising results.

Spontaneous regression in non-Hodgkin's lymphoma.

Two hundred and nine cases of non-Hodgkin's lymphoma have been analyzed retrospectively for the occurrence of spontaneous regression (SR). Complete, partial or minor SR was found in 18 out of 140 cases with nodular lymphoma and in 2 out of 69 cases with diffuse lymphoma. Thus, SR occurs far more frequently in nodular lymphoma than in the diffuse type. Within the nodular lymphoma group, SR is associated with long survival. It occurred in previously treated and untreated patients and in nodal and extranodal disease; the duration varied from a few weeks to many years but lasted one year or more in 7 cases with complete or partial SR.

[Two-dimensional exercise echocardiography. Comparison with electrocardiography, myocardial scintigraphy with thallium 201 and coronary angiography]. / Echocardiographie bidimensionnelle à l'effort. Comparaison avec l'électrocardiographie, la scintigraphie myocardique au thallium-201 et la coronarographie.

Biapical two-dimensional echocardiograms were obtained immediately before and after a bicycle exercise test in 54 patients referred for coronary angiography. Images of adequate quality were recorded in 47 cases (87%), 39 of whom had significant coronary artery disease. All patients also underwent a stress electrocardiogram. In 22 subjects echocardiography and bicycle stress test in the supine position were combined. 23 patients underwent scintigraphy with thallium-201. The sensitivity of rest and exercise echocardiography for the diagnosis of coronary artery disease was 90% and the specificity 63%, compared to 82% and 75% respectively for the electrocardiogram. The sensitivity for the detection of jeopardized myocardium, defined by angiographic criteria, was 75% for the exercise echocardiogram and 65% for the exercise electrocardiogram in the 28 patients without myocardial infarction. In 19 patients with infarction echocardiography detected jeopardized myocardium with a sensitivity of 73%, compared to 53% for the electrocardiogram. In the subgroup of 23 patients studied by thallium-201 scintigraphy, sensitivity for identification of multivessel disease (8 patients) was comparable for both rest and exercise scintigraphy (6/8) and echocardiography (7/8). The specificities were 88% and 94% respectively. Jeopardized myocardium was detected in this subgroup with a sensitivity of 82% by echocardiography, 76% by thallium scintigraphy and 65% by electrocardiography. In conclusion, this study demonstrates that two-dimensional echocardiography can be combined with exercise electrocardiography in one stress test. This improves the diagnosis of coronary artery disease, detection of jeopardized myocardium and identification of patients with multivessel disease.

Levels of antithrombin III, alpha 2-macroglobulin, and alpha 1-antitrypsin in acute ischemic heart disease.

Since measurements of AT III and other possible coagulation inhibitors might provide an index of hypercoagulability, the goal was to measure over a 3-month period individual changes in blood levels of AT III, alpha 2-microglobulin, and alpha 1-antitrypsin in 51 patients with acute ischemic heart disease who were admitted to a Coronary Care Unit with the following diagnosis: unstable angina (26 patients), acute transmural myocardial infarction (20 patients), or subendocardial myocardial infarction (5 patients). Some patients received prophylactic antithrombotic therapy. AT III was measured by the von Kaulla, Owen, Thrombo-Screen, chromogenic, immunodiffusion, and immunoelectrophoretic methods. Alpha 2-macroglobulin and alpha 1-antitrypsin were measured by immunodiffusion. All inhibitors were measured on three different occasions: (1) on admission to hospital, (1) day of departure from hospital, and (3) at 3 months after hospitalization. Alpha 1-antitrypsin showed a significant increase compared to the control and remained elevated during the 3-month interval. Compared to normal control values, AT III was found to be significantly diminished when measured by one functional method (von Kaulla) in all three blood samples from patients with unstable angina and transmural myocardial infarction and by one immunological method (immunodiffusion) in patients with unstable angina, transmural myocardial infarction, and subendocardial myocardial infarction. Most methods determining functional AT III detected a significant increase 3 months after the acute ischemic episode; this rise was observed more often in patients with myocardial infarction than in those with unstable angina. Stepwise discriminant analysis separated the patients of the three groups. Subcutaneous heparin has no significant effect on AT III levels. Unexplained discrepancies still exist between the results obtained by various functional and immunological methods for determining AT III. It appears, however, that methods measuring functional AT III seem to be more suited than immunological methods to detect changes in AT III levels that might occur during and after an acute episode of ischemic heart disease.

Effects of acute changes in load and inotropic state on the exponential rate of fiber shortening and other indices of myocardial contractility in the anesthetized intact dog.

The effects of an acute increase in preload, afterload, and inotropic state on several indices of left ventricular contractility were studied in 20 anesthetized intact dogs. The behaviour of the exponential rate of fiber shortening (ERFS), a newly described index, which is based on the instantaneous fiber length--time relationship through ejection, was compared with other classical ejection and isovolumic indices of left ventricular contractility. Acute volume overload by dextran 40 infusion produced a significant increase in preload as reflected by a 103% (p less than 0.01) increase in left ventricular end-diastolic pressure and a 121% (p less than 0.001) increase in end-diastolic circumferential wall stress. There was also a smaller but significant increase (p less than 0.05) of heart rate (30%) and of peak systolic circumferential wall stress (24%). None of the left ventricular contractility indices showed any significant change. Acute pressure overload, produced mechanically by an aortic balloon, increased the afterload significantly as reflected by a 33% (p less than 0.05) rise of end-systolic circumferential wall stress and a 43% (p less than 0.001) increase in systemic resistance. Stroke volume decreased significantly by 23% (p less than 0.05). All ejection indices, including ERFS, were significantly diminished by 30-37%; all isovolumic indices showed no significant changes. Positive inotropic intervention was induced by dopamine infusion, which caused a significant 28% (p less than 0.05) increase in cardiac output. End-diastolic and end-systolic circumferential wall stress were significantly diminished. All indices of left ventricular contractility increased significantly and ERFS showed the quantitatively greatest change.(ABSTRACT TRUNCATED AT 250 WORDS)