Cardiac Infarction-Sharland JRNAL MEDICAL JOUJRNAL that there has been a significant change in policy since 1936, when Levine recommended a period of six to eight weeks in bed, with an appropriate convalescent period. Alternatively, it is possible that there is an increasing occurrence or recognition of milder cases.While most would acknowledge the considerable psychological benefits which are seen in a patient who is able to resume work, there are very few data concerning the physical effects of resumption of work, and it is impossible to answer the oftput questions, " Will I do myself any harm if I go back to work? " or " Should I have another month's rest from work? " The data presented in this series do not provide an answer to these questions except with respect to the mortality (the crudest index) which compares favourably with that recorded in doctors (Morris, Heady, and Barley, 1952 ;McMichael and Parry, 1960)-the mortality at one year is 4.2 %, compared with 4% of the doctors (who survived the first month after infarction), and at three years is 14%, compared with 10% in the doctors' series.Cook, Tuttle, and Kodlin (1962) report from a cardiac workevaluation centre an attempt to establish whether work had any effects on the progress of heart disease. They graded the work capacity of their patients into five categories ranging from normal capacity to confinement to bed. By comparing their assessment at the initial visit with the actual work being carried out when the patients were seen at six-monthly intervals they were able to classify the men into those who complied with the original advice, those who did more than recommended, and those who did less. The mortality of patients suffering from "atherosclerotic heart disease" showed a gradient from 9 % in those who did excessive work, to 5 % in those who complied with advice, and to 3 % in those who did less work than advised. Further studies are needed to confirm if hard work has any adverse effect on those who have suffered from cardiac infarction.The possible role of psychological stresses has not been considered as it was not possible to measure them. Summary and ConclusionsThe return to work of 212 men under 60 years of age who have survived one episode of cardiac infarction showed that 55 % were back at work within three months and 82 % within six months.The major changes in employment " status " had generally been achieved within six months of the initial cardiac infarction, and the various employment subgroups at this stage were therefore studied more closely. (a) Part-time work was usually a temporary phase which was ultimately followed by a return to full-time work. (b) A change of job was more common in those in social classes IV and V and those normally undertaking active or heavy work. (c) A review of the social class, physical activity of work, and severity of initial infarction of the few men who were not at work at six months (and who had not suffered any further episodes of cardiac infarction) did not show any obvious distinguishing featu...

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Beta-adrenergic blockers are increasingly used in the treatment of angina pectoris (Hamer et al., 1964Srivastava, Dewar, and Newell, 1964; Gillam andPrichard, 1965, 1966;Keelan, 1965;Rabkin et al., 1966;Wolfson et al., 1966), cardiac arrhythmias (Stock and Dale, 1963;Ginn, Irons, and Orgain, 1965;Harrison, Griffin, and Fiene, 1965;Bath, 1966;Harris, 1966;Rowlands, Howitt, and Markman, 1965;Schamroth, 1966;Szekely et al., 1966), and some other less common conditions (Harrison et al., 1964). The danger of inducing or aggravating heart failure by beta-blockade remains a matter of controversy (Stephen, 1966). Whereas this risk has been considered as relatively small and acceptable by Snow (1965Snow ( , 1966, undesirable side-effects and sometimes severe complications related to the depressant action of propranolol on myocardial contractility have been reported, in isolated instances with fatal outcome (Fleckenstein et al., 1964;Vogel, 1965;Scheu, 1966;Luthy and Hegglin, 1966). This risk undoubtedly represents an important drawback to this kind of therapy.In the present study, propranolol was given intravenously to patients with organic disease of the left heart, and its circulatory effects were assessed during the course of standard pre-operative catheterization of the heart. In a second stage of this study, these effects were compared with those of CIBA 39,089-Ba, a new specific beta-adrenergic blocking agent. Fig. 1 shows the chemical structures of isoprenaline, propranolol, and CIBA 39,089-Ba. Fig. 2 shows that the two drugs are apparently equipotent beta-blockers in terms of their negative chronotropic effect. This study Received March 30, 1967. suggests that propranolol depresses myocardial contractility, and this effect correlates well with the severity of the heart disease. CIBA 39,089-Ba has a negative chronotropic effect fairly similar to that of propranolol, but produces a significantly less marked depression of myocardial contractility. RESULTSThe results are shown in Tables III and IV and in Fig. 3-7. Both drugs slowed the heart rate to much the same extent. At rest, the heart rate was reduced from 77 to 64 beats/min. (-16%) after BLE I

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Purpose Mandibular repositioning devices (MRDs) are an effective treatment option for obstructive sleep apnea syndrome (OSAS), particularly in patients who refuse or cannot tolerate continuous positive airway pressure (CPAP). However, sex differences in the response to therapy and predictors of response are not clearly defined. This analysis of data from the long-term prospective ORCADES trial compared MRD efficacy in men and women with OSAS. Methods The ORCADES study included patients with newly diagnosed mild-to-moderate or severe OSAS who refused or were non-compliant with CPAP. MRD therapy was titrated over 3–6 months. The primary endpoint was treatment success (≥ 50% decrease in apnea-hypopnea index (AHI)). Complete response was defined using a range of AHI cut-off values (< 5/h, < 10/h, < 15/h). Results Overall treatment success rates were 89% in women and 76% in men ( p = 0.019); corresponding rates in those with severe OSAS (AHI > 30/h) were 100% and 68% ( p = 0.0015). In women vs. men, overall complete response rates at AHI cut-off values of < 5/h, <10/h, and < 15/h were 49 vs. 34% ( p = 0.0052), 78 vs. 62% ( p = 0.016), and 92 vs. 76% ( p = 0.0032). On multivariate analysis, significant predictors of MRD treatment success were overbite and baseline apnea index in men, and neck circumference and no previous CPAP therapy in women. There were sex differences in the occurrence of side effects. Temporomandibular joint pain was the most common reason for stopping MRD therapy. Conclusions MRD therapy was effective in women with OSA of any severity, with significantly higher response rates compared with men especially in severe OSAS. Trial registration www.clinicaltrials.gov (NCT01326143).