No abstract

No abstract

We studied survival rates among 767 men with good left ventricular function who participated in the European Coronary Surgery Study, 10 to 12 years after they were randomly assigned to either early coronary bypass surgery or medical therapy. At the projected five-year follow-up interval, we observed a significantly higher survival rate (+/- 95 percent confidence interval) in the group that was assigned to surgical treatment than in the group assigned to medical treatment (92.4 +/- 2.7 vs. 83.1 +/- 3.9 percent; P = 0.0001). During the subsequent seven years, the percentage of patients who survived decreased more rapidly in the surgically treated than in the medically treated group (70.6 +/- 5.8 vs. 66.7 +/- 5.3 percent at 12 years). Thus, the improvement in the survival rate among patients with stable angina who were treated surgically appears to have been attenuated after five years. However, the gradually diminishing difference between the two survival curves still favored surgical treatment after 12 years (P = 0.04), despite the fact that 136 patients in the medically treated group had coronary bypass surgery and 23 in the "surgically treated" group did not. The benefit of surgical treatment tended to be greater, but not significantly so, as assessed by interaction analysis in the subgroups of patients who were older or who had signs of ischemia or previous infarction on the resting electrocardiogram, a markedly ischemic response to exercise testing, peripheral arterial disease, an absence of hypertension, and proximal obstruction in the left anterior descending artery. The reasons for the loss of a beneficial effect of surgery after five years are unknown and merit further study.

Abstract. Free fatty acid turnover rate was measured by constant infusion of 1‐14C palmitic acid complexed to human albumin in eight extremely obese patients and in seven controls after a 12‐hour fast. In some of these patients these measurements were performed also during work, in a few of the obese patients before and after physical training. The results were expressed in relation to different body compartments. It was found that free fatty acid turnover rate was higher at rest in the obese than in controls. This difference disappeared when free fatty acid turnover rate was calculated per kg body weight or per kg body fat. When calculated per kg lean body mass, however, the obese patients again had higher values of free fatty acid turnover rate than the controls. During a standard work load the obese did not show lower free fatty acid turnover rates during work than the controls, even if the increase in two of the obese patients, who had a high turnover rate at rest, was small during work. The results thus give no evidence of a decreased fatty acid turnover rate in obesity. On the contrary, after fasting for 12 hours it seems to be higher than normal.

A thermodilution technique using a dual thermistor catheter introduced in the pulmonary artery was used for the determination of cardiac output at rest in 12 patients and for the same measurement during exercise in 6 patients with valvular disease. The correlation coefficient between thermodilution and the dye dilution technique is 0.98. The precision of the method assessed by multiple repeated determinations is 7.5% at rest and 6.9% during mild exercise. The reproducibility at rest indicates that a steady state has been maintained in an acceptable way. In one case of tricuspid insufficiency it was not possible to evaluate the cardiac output.