SUMMARY To define the role of portable two-dimensional echocardiography (2-D echo) in the immediate diagnosis of acute chest pain syndrome, 80 consecutive patients were studied. Adequate 2-D echo studies were obtained in 65 (81%). Thirty-three patients had clinical evidence of transmural or nontransmural acute myocardial infarction (AMI), 18 infarction, which correlate well with pathologic data and with the site of infarction on the ECG. The purpose of this study was to investigate the role of twodimensional echocardiography in the immediate diagnosis of acute myocardial infarction in patients who present with acute chest pain to the emergency room. Materials and MethodsThe study population consisted of 80 consecutive patients with a symptom complex of prolonged chest discomfort occurring within 12 hours of admission to an intensive care unit. Patients with valvular heart disease, previous myocardial infarction, cardiomyopathy or significant periocardial effusion were excluded by clinical history, physical examination or echocardiography. M-mode and two-dimensional echocardiograms were obtained within 8 hours of admission. Fifty-four males and 26 females, ages 32-85 years, were studied. Myocardial infarction was diagnosed by a typical history of chest pain along with either characteristic electrocardiographic changes or a rise in serum CK-MB. ECGs were performed at least once daily and CK-MB was measured every 8 hours for the first 24 hours and then daily for at least 2 days. CK-MB was performed by the cellulose acetate electrophoretic method. A transmural myocardial infarction was diagnosed by the development of new Q waves > 0.04 second in more than one lead or an R: S ratio > 1 in lead V1 or V2 with at least abnormal repolarization in the inferior leads. A nontransmural myocardial infarction was diagnosed by an elevation of CK-MB enzyme without necessitating important ECG changes or classic evolution of deep symmetric T-wave inversions. The infarction was considered inferior if the Q waves or symmetrically inverted T waves occurred in leads 2, 3, or aVF; anterior if in leads V1-V,; and lateral if in leads 1, aVL or V,-V,.The clinical course was monitored in the intensive care unit and thereafter. A cardiac complication was

The helium distribution in June 1969 was studied by using data from the mass spectrometer on Ogo 6 (perigee, 400 km; apogee, 1100 km). After normalizing for altitude effects by use of the Jacchia model atmosphere, the densities show an order of magnitude difference between the southern (winter) hemisphere and the northern (summer) hemisphere, with the maximum density occurring near −55° latitude. The exact location of the maximum varies between −40° and −70° geographic latitude and is apparently correlated with the geomagnetic dipole latitude of −53°. This correlation is consistent with the idea that the helium distribution is quite sensitive to thermospheric winds.

With the expansion of European political power in the nineteenth century, international law became a global phenomenon. Britain and other European states insisted that their Asian counterparts accept international legal practices. Through systems of unequal treaties, international law became an important element in the semicolonial systems established in Qing China, the Ottoman Empire, and Siam, and it shaped the transformation of each of these states. Faced with intense pressure to uphold treaty agreements, Ottoman, Qing, and Siamese leaders initiated similar reforms to legal and administrative institutions. Furthermore, each adapted in different ways to the territorial construction of sovereignty enshrined in international law, and to related assumptions about national identity, as they sought to fit the European nation-state model.

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