Blunt trauma to the chest resulting in coronary thrombosis and ST elevation myocardial infarction (STEMI) is a rare but well-described occurrence in adults. Angiography in such cases has generally disclosed complete epicardial coronary occlusion with thrombus, indistinguishable from the findings commonly found in spontaneous plaque rupture due to atherosclerotic disease. In all previously reported cases in which coronary interrogation with intravascular ultrasound (IVUS) was performed in association with acute revascularization, coronary artery dissection was implicated as the etiology of coronary thrombosis. We present the first case report of blunt trauma-associated coronary thrombosis without underlying atherosclerosis or coronary dissection, as documented by IVUS imaging.
S ummarx Drugs known to inhibit phenylethanolamine-N-methyltransferase (EC 2.1.1.28), the final enzyme in the epinephrine synthetic pathway were administered to rats and their effects on pituitary-arenal function studied. 2,3-Dichloro-a-methylbenzylamine (DCMB) produced dose-related increases in plasma corticosterone in basal and stressed rats. Evidence for the central nature of this tonic inhibitory effect of epinephrine was its continued presence in adrenal demedullated rats. 2-Chloro-3-trifluoromethyl-~-benzylamine (CTFMB) administration elevated plasma corticosterone and this effect was highly correlated to the decrease in hypothalamic epinephrine concentration in both sham operated and adrenal demedullated rats. These findings argue for tonic epinergic inhibition of pituitary-adrenal function.
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