1039 medium to anaerobic organisms that quickly invade the uterine cavity in the early puerperium.3 When a patient known to have fibroids develops symptoms and signs of endometritis after delivery she should be treated initially with antibiotics appropriate to anaerobic organisms. In some cases, such as in our case 1, specimens for culture cannot be obtained. Treatment should then be started on suspicion of anaerobic infection alone.We thank Professor W Gavin for allowing us to report case 1.

1.The heart-rate response during sustained hand grip was studied in four normal subjects before and after intravenous atropine, propranolol and combined cardiac autonomic blockade with both drugs. The results suggest that the increase in heart rate during the first 30 s is due to parasympathetic withdrawal, whereas the further increase between 30 s and 180 s is probably mediated by a combination of parasympathetic withdrawal and sympathetic stimulation.2. The increases in heart rate during each minute of sustained hand grip were compared in 26 normal subjects, 37 diabetic subjects without and 24 diabetic subjects with proven autonomic neuropathy. In the diabetic subjects with autonomic neuropathy the increase in heart rate during the first minute was impaired, whereas the increases during the second and third minutes were similar in all three groups.3. The initial increase in heart rate over the first 30 s of hand grip and the later increase between 30 's and 180 s were compared in nine normal subjects, ten diabetic subjects without and six diabetic subjects with autonomic neuropathy. The increase during thc first 30 s was impaired in the diabetic subjects with autonomic neuropathy, whereas the later phase of the response was similar in all three groups.

Abstract. 1. Praecordial acceleration was measured by a “pixie” strain gauge transducer in 14 dogs in whom an electromagnetic flow probe and pacing electrodes had been implanted. Peak acceleration of blood from the left ventricle (aortic max. dv/dt) was derived from the flow signal by differentiation. – 2. The amplitude of the major systolic complex (DE) of the praecordial accelerogram and aortic max. dv/dt were measured during stimulation of the heart with calcium gluconate and isoprenaline and depression of the heart with propranolol and halothane inhalation. – 3. Close linear correlations were found between the percentage change in the DE complex and the percentage change in aortic max. dv/dt during stimulation and depression of the heart. – 4. The amplitude of the DE complex was found to be sensitive to changes in left ventricular end‐diastolic pressure, systemic vascular resistance and increase in heart rate up to 150 beats per minute. – 5. It is concluded that changes in the amplitude of the DE complex of the praecordial accelerogram may be a useful index for non‐invasive assessment of changes in left ventricular function in the dog.

The effects of isometric exercise on the maximum amplitude of the praecordial accelerocardiogram (as represented by the DE deflection) have been compared in 6 normal subjects (group i), I2 Animal work has shown that peak acceleration of blood flow in the ascending aorta is highly sensitive to small changes in left ventricular contractility which are insufficient to cause changes in stroke volume or systemic blood pressure (Chung, Chamberlain, and Seed, I974; Noble, Trenchard, and Guz, I966a; Reuben and Littler, I973; Winter et al., I967). It has also been shown in the dog that changes in the maximum amplitude of the praecordial accelerocardiogram correlate closely with changes in peak aortic acceleration in response to a wide range of manoeuvres (Reuben and Littler, I973). Furthermore, it appears that both are relatively independent of heart rate and ventricular loading, at least in the intact organism (Noble et al., 1972; Noble, Trenchard, and Guz, I966a, b; Reuben and Littler, I973).

1 The metabolic, hormonal and haemodynamic effects of oral pirbuterol, a new 132-adrenoceptor agonist, were studied acutely (n = 19) and after 3 months treatment (n = 11) in patients with severe heart failure receiving chronic frusemide therapy. 2 In the acute study fasted patients (n = 10) showed reductions in plasma K+ (P < 0.005) and cortisol (P < 0.01) and increases in plasma glucose (P < 0.005), insulin (P < 0.01), lactate (P < 0.005) and pyruvate (P < 0.0025). These acute changes were less in unfasted subjects (n = 9). 3 Maximal increase in stroke volume occurred at approximately half the plasma pirbuterol concentration required for maximal effect on plasma insulin. 4 Treatment with pirbuterol for 3 months was associated with sustained increases in stroke volume and fasting plasma glucose and insulin, but there was loss of all other acute metabolic effects. 5 Despite concurrent frusemide and digoxin therapy acute hypokalaemia caused no adverse effects. Hypokalaemia did not occur with chronic pirbuterol administration.

1 We have performed a double-blind, randomized, 7-d cross-over study of the thromboxane synthetase inhibitor dazoxiben (UK 37248) in 20 patients with stable coronary heart disease. 2 All patients had a history of exertional angina of greater than two years duration and no patient had suffered a myocardial infarction in the preceding twelve months. 3 All patients had a positive exercise stress test for myocardial ischaemia and 15 had undergone coronary angiography. All these patients had a 50% narrowing in at least one vessel. 4 All patients were on conventional anti-anginal medication and the doses of their various therapies remained unchanged in the three months prior to and during the study period. 5 Therapy with dazoxiben 200 mg four times daily produced no alteration in the subjective or objective features of angina in these patients. There was no alteration in angina attack rate, glyceryl trinitrate consumption or duration of treadmill exercise. 6 Dazoxiben produced a highly significant reduction in both the resting and the post-exercise levels of serum thromboxane B2 levels, although there was no significant difference between the pre-exercise and post-exercise values. 7 Dazoxiben is an effective inhibitor of the synthesis of thromboxane but it has no effect on the subjective or objective features of stable coronary disease. This would suggest that the production of thromboxane and the development of circulating platelet aggregates play no part in the mechanism of angina in patients with stable coronary heart disease.

1 The cardiovascular responses to handgrip exercise have been studied in ten patients with uncomplicated essential hypertension in a randomized crossover study of propranolol and prazosin. 2 Isometric handgrip exercise was performed with a calibrated strain gauge dynamometer at 30% of maximum voluntary contraction for 3 min. 3 Blood pressure and heart rate were measured in the supine position at rest and in the last 10 s of the exercise period. 4 These exercise studies were undertaken at the end of a run-in period and at the end of 1 month's optimal therapy with the two drugs. 5 The active treatment periods were separated by a 2 weeks placebo washout period. 6 Both drugs lowered the supine and standing systolic and diastolic pressures and there was no difference between these drugs in their effect on these variables. 7 Propranolol lowered the resting heart rate and neither drug suppressed the pressor response to isometric exercise. 8 The degree of pressure rise was similar with both drugs but propranolol suppressed isometric exercise-induced tachycardia.

SUMMARYThe left ventricular response to the Valsalva manoeuvre was studied in 5 normal subjects (group 1), 6 diabetics without autonomic neuropathy (group 2), and 5 diabetics with autonomic neuropathy (group 3), using the maximum amplitude of the praecordial accelerocardiogram (DE) as a noninvasive index of left ventricular performance.During the Valsalva manoeuvre DE decreased in all 3 groups. In groups 1 and 2, DE increased significantly above the control value after release of the manoeuvre (DE overshoot) but this did not occur in group 3. It is suggested that the overshoot of DE in groups 1 and 2 reflects an increase in left ventricular contractility after release of the Valsalva manoeuvre and the absence of an overshoot in DE in the patients with autonomic neuropathy is the result of loss of cardiac adrenergic innervation.The ability to detect an abnormal cardiovascular response to the Valsalva manoeuvre using the non-invasive technique of praecordial accelerocardiography may be of practical value in the assessment of left ventricular function.