To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pinpoint the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R, and V6R) was routinely recorded on admission and every eight hours thereafter for three consecutive days. Thirty-six to 72 hours after the onset of chest pain a 99mtechnetium pyrophosphate scintigraphy and a dynamic flow study were performed to detect right ventricular involvement, which was found in 29 of the 67 patients (43%). ST segment elevation > 1 mm in leads V3R, V4R, V5R, and V6R is a reliable sign of right ventricular involvement. ST segment elevation , 1 mm in lead V4R was found to have the greatest sensitivity (93%) and predictive accuracy (93%). The diagnostic value of a QS pattern in lead V3R and V4R or ST elevation > 1 mm in lead V1 was much lower. ST segment elevation in the right precordial leads was short lived, having disappeared within 10 hours after the onset of chest pain in half of our patients with right ventricular involvement. When electrocardiograms are recorded in patients with an acute inferior wall infarction within 10 hours after the onset of chest pain, additional right ventricular infarction can easily be diagnosed by recording lead V4R.
A sex chromatin positive woman has stunted growth, primary amenor-rhoea, cubitus valgus, Madelung’s deformity and mental deficiency. A modal chromosome number of 46 was found in cultures from peripheral blood, skin and Fascia lata, but an abnormal very large metacentric chromosome and only 15 chromosomes in the X-6–12 group were observed in karyotypes from cells of all cultures. Large and characteristic bipartite bodies were often present in buccal and vaginal smears, and the size of the polymorphonuclear drumsticks was increased. Autoradiographically the abnormal chromosome was the only “hot” chromosome. The patient was Xga negative although her father was Xga positive. We conclude that the unpaired large chromosome in our patient is an abnormal X chromosome with a partial deletion and a translocation of a piece of an autosome or sex chromosome onto its short arm.
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