Conversion with direct current countershock was attempted in 215 patients with arrhythmias, the majority of whom (81.9%) had atrial fibrillation. There was a fairly high frequency of complicating ventricular arrhythmias (2.5%), probably due to medication with digitalis and/or quinidine. Thromboembolism was only noted in one case, and pulmonary edema in three cases.
Measurements of eosinophil cationic protein in serum (S-ECP) have been made in patients with acute myocardial infarction. In spite of low numbers of blood eosinophils in the acute phase of the disease S-ECP levels fluctuated widely with often markedly raised levels. Peak levels of S-ECP were significantly correlated (P less than 0.001) to peak numbers of blood eosinophils, although the former usually occurred within the first 2-3 d of illness and the latter usually after the sixth day. Intravenous injection of 0.5 g methylprednisolone in healthy individuals reduced blood eosinophil counts for at least 24 h, but S-ECP levels remained within normal limits. These results suggest that ECP is released from eosinophils in vivo. The raised levels of S-ECP in patients with acute myocardial infarction are probably due to the active participation of eosinophils in the inflammatory process.
T HE LEFT VENTRICLE may be catheterized from the aorta,1-3 from the left atrium by several routes,46 or may be directly punctured. Since 1958 we have performed left ventricular puncture in 142 cases for pressure measurements and contrast injection. It is the aim of this paper to report our complications together with a review of those reported by others.Material and Methods Our cases were 6 months to 56 years old, most between 30 and 40 years of age. The diagnoses are presented in table 1. The main indications for the procedure were aortic stenosis or mitral insufficiency, and our results with it were recently reported.7-9The investigation is performed with the patient in the fasting state, under penicillin prophylaxis with blood and necessary equipment for cardiac resuscitation in readiness. In adult patients general anesthesia is not used, only premedication with morphine and scopolamine. The puncture is performed by a thoracic surgeon in the presence of a cardiologist, an anesthesiologist, and a radiologist. We use the intercostal method of Brock et al. 10' 11 We only wish to stress that the needle used has a blunt end and a sharp mandrin. When the ventricular cavity is reached, the needle is locked by a screw so that it cannot be introduced farther. An electrocardiogram is continually monitored on a two-beam cathode-ray oscilloscope. The pressure curves from the left ventricle and a peripheral artery are recorded. The ventricular curve must be free and undamped up to the moment of contrast injection and during slight changes in the position of the needle, in order to avoid intramyocardial deposition of contrast medium. With an automatic pressure syringe we then inject 1 to 1.2 ml. per Kg. of body weight of 76 per cent Urografin, with a speed of about From the Department of Thoracic Surgery (Head:
Myoglobin has been measured in sera from 305 consecutive patients with suspected acute myocardial infarction (AMI) to study the clinical value in relation to other diagnostic methods. On admission the frequency of false negative (i.e. the diagnostic sensitivity) myoglobin values was 28% in the AMI group as compared with 60% for serum creatine kinase (CK) and 46% for serum aspartate aminotransferase (ASAT). Four hours after admission the corresponding figures were 2, 31 and 29%. This makes the diagnostic sensitivity of the myoglobin test 0.98, which is significantly higher (p<0.001) than that of the two enzyme tests. The predictive value of a negative myoglobin test was 0.97 and also significantly higher (p<0.001 and p<0.01) than for CK and ASAT. S‐myoglobin was further related to the number of complications and the prognosis of the patients, and high levels appeared to be an unfavourable sign, particularly in combination with an anterior wall infarct. This study has demonstrated and confirmed the superior diagnostic sensitivity of myoglobin determination in early AMI. The inclusion of S‐myoglobin in the routine diagnosis of AMI warrants serious consideration.
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