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10,002,900 | The EP is well demonstrated as a useful indicator of subclinical demyelinating disease. Our study performed on patients well defined as MS and monitored closely for clinical exacerbations demonstrated an unexpectedly high occurrence of significant worsening in EP parameters. These changes occurred in the presence or absence of clinical worsening. The parameter changes may represent new demyelination or other pathologic or neurophysiologic changes in neuropathologically static lesions. | [
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10,002,901 | Course of visual evoked potentials in multiple sclerosis: electroclinical correlations and pathophysiological considerations in 25 patients. | [
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10,002,902 | Twenty-five MS patients had VEPs recorded at 1-year interval. Abnormal VEPs were observed at least once in 21 patients. They were the only means of assessing the lesional dissemination in nine patients. Their contribution in the diagnostic classification is such that the proportion of "definite" cases rises from 44 to 80% of the 25 cases. The degree of abnormality of the VEPs had no relation to the disability status or to the whole severity of the disease. The main feature was the variability of the VEP latencies at a 1-year interval: they seem to follow the remittent progressive course of the disease whether visual pathways are clinically affected or not. These results are interpreted in light of the pathophysiological data of the disease. In the cases with improvement of normalization of the second VEPs, in plaque edema may be an important mechanism, sometimes free of demyelination so that perfect restitutio ad integrum may occur. | [
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10,002,903 | Multimodal evoked potentials in multiple sclerosis: basal and follow-up data. | [
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10,002,904 | Variability on serial testing of visual evoked potentials in patients with multiple sclerosis. | [
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10,002,905 | The value of sequential evoked potential recordings in multiple sclerosis patients. | [
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] |
10,002,906 | Spatio-temporal study of visual evoked potentials in patients with homonymous hemianopia. | [
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10,002,907 | The visually evoked potential in retrochiasmatic lesions of the optic pathways: an attempt to interpret the responses obtained by flash pattern stimulation and the results of the calculation of the correlation coefficient between visually evoked potentials. | [
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10,002,908 | Correlations between visual evoked potential parameters of 5-year-old children and their neonatal neurological condition. | [
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10,002,909 | Headache: physiopathological and clinical concepts. | [
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10,002,910 | Personality aspects of headache patients. | [
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10,002,911 | Mechanisms of fever occurring in migraine. | [
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10,002,912 | Pain and emotion: their correlation in headache. | [
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10,002,913 | Prolonged benign exertional headache: clinical characteristics and response to indomethacin. | [
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10,002,915 | Multiple aspects of headache risk in children. | [
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] |
10,002,916 | Both epidemiological and pharmacoclinical research have been carried out on children suffering from headache. Two epidemiological trials were performed. In the first, 562 migrainous children were questioned about several clinical symptoms that affect child headache suffers, and the incidence of these symptoms was recorded. In the second, we divided 504 nonselected school children into three groups: headache sufferers and nonheadache sufferers with or without family headache history. The same clinical symptoms were studied. Statistical analysis showed that motion sickness, recurrent abdominal pain, sleeping troubles, hyperactivity, cyclic vomiting, dizzines, and limb pain have different incidences in the three groups. These clinical symptoms and family headache history may be considered HR factors and indicate a predisposition to headache in children. The pharmacoclinical study was carried out on 15 migrainous children, five hyperactive and 10 controls. An increased sensitivity of iris adrenergic receptor in both migrainous and hyperactive children was evidenced by measuring phenylephrine-induced mydriasis. The possible etiopathogenetic correlations among headache, hyperactivity, and other HR factors are discussed in accordance with the central theory of headache. | [
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10,002,918 | A new nonvascular interpretation of syncopal migraine. | [
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10,002,919 | Migraine suffers who experience spontaneous syncopes (syncopal migraine) during attacks exhibit a dramatic intolerance to bromocriptine, a dopamine agonist. An oral dose of this drug renders these patients unable to stand, even for some hours, because of precipitously falling of arterial blood pressure. Treatment with domperidone, a specific dopamine receptor antagonist, abolishes the syncopal effect of bromocriptine. This evidence is compatible with a supersensitivity of those dopamine receptors, which exert an inhibiting activity and are located on blood pressure regulating centers as well as on cardiovascular sympathergic neurons. | [
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10,002,920 | Sexuality and headache. | [
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10,002,921 | Ten percent of 362 headache sufferers reported sexual arousal during migraine attack. Clinical investigations on sexuality in 16 headache sufferers, according to some studies showing correlations between idiopathic headache and sexual behavior, were performed. Patients responding by questionnaire listed each sexual experience, headache attack, and number of sleeping hours every day for 1 month. In both men and women, the number of coiti, erotic dreams, and sleeping hours were similar in headache sufferers and controls, while the frequency of masturbation was significantly reduced in the former. Sexual excitement and fantasies appeared more often in female headache sufferers than in controls, while the opposite occurred in the male group. Among the clinical analogies between the crises of migraine and morphine abstinence, sexual arousal may be included. | [
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10,002,922 | What is a migraine? | [
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10,002,923 | The migrainous patient appears to differ in reaction to stress or environmental changes from nonmigrainous subjects quantitatively rather than qualitatively. An inherited pattern of monoamine metabolism may render the patient more susceptible to such changes, which represent a threat, real or imagined, to the integrity of the brain. The migraine attack may thus be interpreted as a neurohumoral reaction aimed at protecting the brain from some noxious influence by shunting blood away from the cortex. The headache itself may be a by-product of such a reaction, serving, like any pain, to alert the organism to potential danger. The predominantly unilateral site of migraine remains unexplained. A more comprehensive clinical classification of migraine is proposed in the hope that certain entities may prove to correlate with variations in pathophysiology and thus permit more selective therapy. | [
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10,002,924 | Existential deterrents to headache relief past midlife. | [
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10,002,925 | Blood platelet 5-hydroxytryptamine accumulation and migraine. | [
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10,002,926 | The use of platelet inhibitors in migraine. | [
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10,002,927 | Migraine as a blood disorder: preliminary studies. | [
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10,002,928 | A putative 5-HT central feedback in migraine and cluster headache attacks. | [
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] |
10,002,929 | 5-HT is considered to play a role in the migraine mechanism; its decrease in the midbrain during migraine attacks has been postulated. CSF TP and plasma and platelet 5-HT levels in migraine and cluster headache sufferers have been evaluated; the values registered were compared to those of neurological and carcinoid patients, respectively. The following results were obtained: (a) no significant difference in the time course of free and total TP after l-TP intravenous loading, (b) increased levels of CSF TP during migraine and cluster headache attacks, (c) impressively increased levels of plasma 5-HT only in carcinoid patients. These findings suggest the existence of a positive 5-HT central feedback mechanism during attacks of migraine and cluster headache and thus exclude peripheral 5-HT effects in the generation of pain. | [
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10,002,930 | Migraine and the mitral valve prolapse syndrome. | [
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10,002,931 | Platelet aggregation in migraine patients during the headache-free interval. | [
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10,002,933 | Characteristics of extravascular serotonin receptors in the brain. | [
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10,002,934 | At least three types of extravascular 5-HT receptors are present in the brain. Peripheral 5-HT antagonists mimic the inhibitory effects but block the excitatory effects 5-HT in the brain. Although the forebrain serotonergic system is apparently not involved in nociception, the MPR may be an important link in an antinociceptive system; this system may be activated by morphine. A decrease in the amount of 5-HT released by projections from the MPR to the trigeminal nucleus could be partially responsible for the pain experienced in migraine headache. Drugs useful in treating migraine headache may mimic 5-HT at synapses in the trigeminal nucleus that are associated with projections from the MPR. This possibility remains to be tested experimentally. | [
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10,002,935 | Pharmacology of arteriovenous anastomoses. | [
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10,002,936 | The evolution of thinking about the role and site of action of serotonin in migraine. | [
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10,002,937 | Agonists and antagonists of 5-hydroxytryptamine on venomotor receptors. | [
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10,002,938 | Some aspects of the dopaminergic action of ergot derivatives and their role in the treatment of migraine. | [
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10,002,939 | Paradoxical effects of frequent analgesic use. | [
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10,002,941 | Headache induced by freezing external carotid artery branches. | [
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10,002,942 | Hemicrania and lateralized cervicoscapular muscular hypertonicity. | [
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10,002,943 | Neurologic disorders of vitamin b12 deficiency. | [
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] |
10,002,944 | Neurologic complications associated with vitamin B12 deficiency include spinal cord degeneration, peripheral neuropathy and alteration of mental status. The possibility of vitamin B12 deficiency must be considered in all patients with these nervous system disorders, even in those who do not have anemia. If treatment is started early, most of the neurologic deficits will resolve. Delayed therapy usually halts the progression of the disease, but permanent sequelae may occur. | [
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10,002,946 | Campylobacter fetus ss. jejuni has recently been recognized as a very common cause of gastroenteritis. Symptoms of Campylobacter gastroenteritis include fever, diarrhea, abdominal pain, myalgia and headache. Bloody diarrhea occurs in about 50 percent of patients. This organism is now being isolated more frequently than Salmonella or Shigella in cases of diarrhea. Acute colitis mimicking Crohn's disease or ulcerative colitis on proctoscopic examination and on barium enema x-ray has been described. The drug of choice for therapy is erythromycin. | [
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10,002,947 | Confidentially and the family physician. | [
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10,002,948 | The principle of confidentiality is one of the clearest and firmest rules of professional ethics. However, situations can arise in which confidentiality ought to be abridged in favor of other, weightier values. In the case of a teenager who asks a family physician to prescribe birth control pills for her without informing her parents, the best interests of the family as a unit may justify a certain aggressive but oblique strategy abridging confidentiality. | [
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10,002,949 | Real-time diagnostic ultrasound in obstetrics. | [
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10,002,950 | Real-time B-scanning is a relatively inexpensive and effective diagnostic technique, applicable with some limitations to obstetrics. It produces images at high rates so that the display appears to change continuously with changes in transducer orientation or with motion of the structures imaged. It can be used in the office setting and rapidly provides information to the properly trained examiner. The ability to detect motion provides an important added dimension to ultrasound. | [
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10,002,951 | Tinea capitis. | [
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] |
10,002,952 | Trichophyton tonsurans is now a major cause of tinea capitis, affecting both children and adults. The characteristic lesions are pruritic, scaling patches with black dots; Wood's light examination is negative. Microsporum canis and Microsporum audouini, formerly the most frequent causes of tinea capitis, predominantly affect children and are Wood's light positive. Lesions caused by M. canis are inflammatory, while those of M. audouini are scaly. All three organisms respond to griseofulvin. | [
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10,002,954 | Automobile accidents are the most frequent cause of injury and death among young children. The number of injuries or deaths could be decreased by the use of child restraints. Counseling parents about car safety has a positive effect on increasing the use of restraints. Other important factors include passive protection, such as interior design and air bags, appropriate laws for enforcement of proper use and adequate safety testing of existing restraints. | [
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10,002,955 | Bowel edema due to acute mesenteric ischemia. | [
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10,002,956 | This is the first in a series of articles aimed at helping the family physician make urgent diagnostic decisions based on radiographic findings. | [
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10,002,957 | Cardiac drug overdose. | [
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10,002,958 | Toxicity from cardiac drugs is a particular management challenge since the manifestations of an acute overdose and the initial indications for the drug are often similar. Plasma drug levels are essential but must be interpreted in light of the clinical picture. Hypotension, due to either vasodilatation or decreased myocardial contractility, and arrhythmias are the principal cardiac manifestations, but noncardiac effects are sometimes more troublesome. An antiarrhythmic agent of the same class should not be used in treating an arrhythmia resulting from an overdose. | [
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10,002,959 | Drug dissolution of gallstones. | [
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10,002,960 | Diabetic neuropathy. | [
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] |
10,002,961 | Decompression sickness. | [
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] |
10,002,962 | Streptococcal vs. diphtheritic tonsillitis. | [
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10,002,964 | Problems resulting from cold exposure can be successfully treated when a coordinated emergency medical transport system and appropriate equipment are available, as well as medical personnel knowledgeable in the management of frostbite and hypothermia. Clinical suspicion of these disorders is essential. Profoundly hypothermic individuals with no recordable vital signs have been resuscitated after controlled, rapid rewarming measures and the use of emergency life-support systems. | [
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10,002,965 | Complications of cardiac valve replacement: characteristic abnormalities of prostheses pertaining to any or specific site. | [
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10,002,966 | Reduction of mortality from prehospital myocardial infarction by prudent patient activation of mobile coronary care system. | [
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10,002,967 | Vasospastic ischemic mechanism of frequent asymptomatic transient ST-T changes during continuous electrocardiographic monitoring in selected unstable angina patients. | [
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10,002,968 | Asymptomatic episodes of ST segment and/or T wave changes are often reported during Holter monitoring in patients with angina pectoris. However, the interpretation of such changes is debated relative to silent myocardial ischemia. We studied 11 patients admitted to the CCU because of frequent episodes of unstable anginal attacks who had undergone repeated periods of Holter monitoring, characterized by predominantly occurring asymptomatic episodes of ST segment and/or T wave changes associated with less frequent typical anginal attacks. In a total of 89 days of Holter monitoring, the patients evidenced 520 episodes of transient ECG changes including 180 of ST elevation, 73 of ST depression, and 267 of T wave alterations. Only 12% of episodes were symptomatic. Coronary injection during asymptomatic ST-T changes was performed in eight patients. In six it was possible to document spontaneous coronary spasm. In seven patients ergonovine administration induced anginal pain, ST-T changes, and coronary spasm. In all patients the anginal attacks completely disappeared with medical treatment and the asymptomatic episodes were abolished in six and reduced in four. Our findings support the hypothesis that in certain selected unstable anginal patients, transient asymptomatic ECG changes are caused by acute myocardial ischemia. | [
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10,002,969 | Two-dimensional echocardiographic features diagnostic of isolated pulmonic valve endocarditis. | [
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10,002,970 | Variable exercise capacity in variant angina and greater exertional thallium-201 myocardial defect during vasospastic ischemic ST segment elevation than with ST depression. | [
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10,002,971 | Successful conversion of out-of-hospital life-threatening arrhythmias with the implanted automatic defibrillator. | [
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10,002,972 | Immediate postoperative regurgitant malfunction of Björk-Shiley aortic valve due to interfering Teflon ventricular septal defect repair: Correction by rotation of prosthetic anulus. | [
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10,002,973 | Recent decline in coronary disease mortality in the United States: part of a general decline in mortality. | [
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10,002,974 | Hyperadrenergic-effected limb causalgia: relief by IV pharmacologic norepinephrine blockade. | [
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10,002,975 | Unstable angina pectoris: is it time to change our approach? | [
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10,002,976 | The necessity of a uniform definition of sudden coronary death: witnessed death within 1 hour of the onset of acute symptoms. | [
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10,002,977 | Frequency response characteristics of ambulatory ECG monitoring systems and their implications for ST segment analysis. | [
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10,002,978 | Because of the increasing interest in using ambulatory ECG monitoring equipment to study cardiac ischemia, we examined the frequency response characteristics and the reproducibility of a standard ST segment shift for equipment from eight manufacturers. Output/input amplitude versus frequency response curves, derived from input sine waves, were compared with American Heart Association (AHA) standards. Low- and high-frequency cutoffs (-3dB) were examined as well as flat response within the pass band. A new test based on Fourier analysis provided evaluation of phase shift versus frequency response and a more detailed analysis of the amplitude versus frequency response. By using a modified ECG simulator, flat-line ST segment depression from 0 to 10 mm (in 1 mm increments) was input to two or three recording devices for each manufacturer. The outputs from the scanners were evaluated for the amount of ST depression and the quality of the waveform reproduction. No system met all AHA standards for frequency response. Each system also had varying amounts of phase shift which could potentially distort the ECG signal. Although some manufacturers' equipment gave faithful reproductions of the simulated ST segment depression, others did not. We conclude that additional investigation is necessary to determine the clinical implications of our findings and to establish better standards for low- and high-frequency cutoffs, flat response within pass band, and phase shift for ambulatory ECG monitoring equipment. | [
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10,002,979 | Early pronounced ST segment depression with marked J point decline heralding acute lethal clinical myocardial infarction: Necropsy-electrocardiographic correlative study. | [
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10,002,980 | Marked ST segment depression (greater than or equal to 2 mm J point decline with horizontal or downsloping ST) was correlated with necropsy findings in 105 cases. Acute myocardial infarction (AMI) was most frequently (70%) responsible for development of the abnormal ST pattern, thereby indicating the diagnosis and severe prognosis of the AMI. In 23% of patients the ST segment depression pattern was associated with chronic heart disease without AMI; all were severely ill with 92% receiving digitalis. Sudden worsening of the basic heart disease or circulatory shock were frequently found to coincide with the abnormal ST pattern; necropsy revealed extensive old MI or myocardial fibrosis in these patients. Marked ST segment depression was also found in five patients without underlying heart disease at autopsy; an acute cerebral accident or circulatory shock was considered to have produced the abnormal ST segment pattern. | [
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10,002,981 | Continuous electrocardiographic monitoring in patients with unstable angina pectoris: Identification of high-risk subgroup with severe coronary disease, variant angina, and/or impaired early prognosis. | [
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10,002,982 | We assessed the value of two-channel Holter monitoring during the initial hours of hospitalization in patients with unstable angina pectoris (UAP) to identify those with severe coronary artery disease (CAD), variant angina, and/or poor prognosis over the next 3 months. Accordingly, 116 UAP patients had Holter monitoring for 27 +/- 7 (mean +/- SD) (range 12 to 50) hours following hospitalization. Of these, 24 evolved myocardial infarction (MI) during monitoring and 92 did not. Transient ST segment alterations occurred in 21 of the 92. Of these 21, 4 had variant angina, were treated with calcium antagonists, and did well. Each of the remaining 17 had severe fixed CAD (left main or three-vessel) (n = 12) and/or poor prognosis over the 3 months after discharge as manifested by death (n = 1), MI (n = 3), and/or severe angina (n = 3). In contrast, 71 patients did not demonstrate transient ST segment alterations: none had variant angina (p less than 0.001), nine had left main or three-vessel CAD (p less than 0.001), and 50 were alive and well 3 months after discharge (p less than 0.001). Ventricular tachycardia (VT) was demonstrated by Holter monitor in 5 of the 92 patients: four had three-vessel CAD and the other had severe persistent angina. Thus in patients hospitalized with unstable angina, transient ST segment alterations and/or VT on Holter monitor are specific predictors of "high-risk" subgroup UAP patients with left main or three-vessel CAD, variant angina, and/or impaired 3-month prognosis. | [
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10,002,983 | Evaluation of postresuscitation left ventricular global and segmental function by radionuclide ventriculography in sudden coronary death survivors of prehospital cardiac arrest: Correlation to subsequent short-term prognosis. | [
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10,002,984 | Previous data have shown that patients with significant left ventricular (LV) dysfunction, marked abnormalities in resting hemodynamics, and multiple vessel coronary artery disease (CAD) are at increased risk for sudden cardiac death. However, in-hospital assessment of ventricular function in the early postresuscitation period of out-of-hospital cardiac arrest has not been evaluated and related to short-term outcome. By using bedside radionuclide ventriculography (RNV) we evaluated LV ejection fraction (LVEF) and wall motion in 36 nonconsecutive patients within 24 hours of their episode of out-of-hospital cardiac arrest. There were 24 men and 12 women with mean age of 62.3 years (range 21 to 85 years). Total mortality of the entire group was 38.8% at 4 weeks. Eighteen patients had LVEF less than 0.30 and 18 had LVEF greater than 0.30. Mortality in the low LVEF group was 55.5% at 4 weeks versus 22.2% in patients with LVEF greater than 0.30 (p less than 0.05). Patients with normal LV wall motion had no short-term mortality (none of seven), while patients having abnormal LV wall motion had a significantly higher short-term mortality (14 of 29) (p less than 0.05). We conclude that out-of-hospital cardiac arrest survivors have a high incidence of severe LV dysfunction in the early postresuscitation period and that a significantly higher early mortality is seen in the group with LVEF less than 0.30. In addition, abnormalities of LV wall motion by RNV examination demonstrated poorer prognosis in the first 4 weeks than patients with normal LV wall motion. | [
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10,002,985 | Intracardiac electrophysiologic study of intravenous diltiazem and combined diltiazem-digoxin in patients. | [
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] |
10,002,986 | Fifteen patients without sinoatrial (SA) or atrioventricular (AV) node dysfunction underwent electrophysiologic study (EPS) before and after intravenous diltiazem: 0.20 mg/kg bolus followed by 0.0007 mg/kg/min infusion (seven patients) or 0.25 mg/kg bolus followed by 0.0012 mg/kg/min infusion (eight patients). In six patients intravenous digoxin (0.018 mg/kg) was given and 45 minutes later EPS was repeated while the diltiazem infusion continued. Diltiazem prolonged sinus cycle length (+7%, p less than 0.01), lengthened AH conduction time (+22% in constant rate atrial paced rhythm, p less than 0.001), prolonged AV node functional and effective refractory periods (+6%, p less than 0.01 and +16%, p less than 0.05, respectively), lengthened AV node Wenckebach cycle length (+13%, p less than 0.001), shortened atrial functional refractory period (-3%, p less than 0.05), and reduced mean arterial pressure (-8%, p less than 0.005 in constant rate atrial paced rhythm). Subsequently, intravenous digoxin further prolonged sinus cycle length (+12%, p less than 0.05), AH conduction time (+17%, p less than 0.05), AV node Wenckebach cycle length (+9%, p less than 0.05), and AV node functional refractory period (+7%, p less than 0.05), shortened atrial effective refractory period (-7%, p less than 0.05) and ventricular effective refractory period (-6%, p less than 0.05), and increased systolic arterial pressure (+6%, p less than 0.05). Diltiazem and digoxin have additive depressant effects on SA and AV node function without significant adverse effects. | [
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10,002,987 | Prolonged and decremental antegrade conduction properties in right anterior accessory connections: Wide QRS antidromic tachycardia of left bundle branch block pattern without Wolff-Parkinson-White configuration in sinus rhythm. | [
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10,002,988 | Four patients are described who had long conduction times and decremental conduction through right anterior accessory connections. None had Wolff-Parkinson-White syndrome on their ECG. Each had recurrent sustained wide QRS tachycardia due to antegrade conduction through the accessory connection. Three patients underwent epicardial mapping and successful surgical division of their accessory connection. Two of the three had a second accessory connection that was also divided surgically. Each of the three are free of tachycardia without medication. It is postulated that these accessory connections represent the remnants of anterior atrioventricular ring tissue described by Anderson. | [
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10,002,989 | Electrophysiologic effects of procainamide on sinus function in patients with and without sinus node disease. | [
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10,002,990 | To compare the effects of procainamide on sinus node (SN) function in the presence (seven patients) and absence (nine patients) of SN dysfunction, sinus cycle length (SCL), maximal corrected sinus recovery time (maximal CRST), paced cycle length yielding peak SN suppression (PCLp), and indirect sinoatrial conduction time (SACT) were determined before and after intravenous administration of 10 to 15 mg/kg procainamide in each patient. Plasma procainamide concentration was in the therapeutic range in all patients. The mean SCL did not change significantly in either group (-24 +/- 58 and -73 +/- 171 msec for patients with normal and abnormal SN function, respectively). The maximal CSRT shortened 136 +/- 112 msec (p less than 0.01) in the group with normal SN function (nine of nine patients)( but tended to lengthen 85 +/- 95 msec (p less than 0.10) in the group with SN dysfunction (six of seven patients). PCLp shortened in only two of nine of the normal group but tended (NS) to shorten in five of seven patients with SN dysfunction. We conclude that in the absence of SN disease, procainamide does not adversely affect SN function. In apparent contrast in patients with SN dysfunction, procainamide tended (NS) to prolong CSRT and seemed (NS) to enhance conduction in the sinoatrial junction (PCLp and SACT both declined). The occasional lengthening of CSRT implies that procainamide might prolong post-tachycardia pauses and thus could worsen symptoms in certain patients with the bradycardia-tachycardia syndrome. | [
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] |
10,002,991 | Assessment of oral quinidine effects on sinus node function in sick sinus syndrome patients. | [
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10,002,992 | The effects of therapeutic doses of orally administered quinidine sulfate on sinus rhythmicity and automaticity were observed in 11 patients with sick sinus syndrome (SSS). Evaluation of sinus node (SN) function was undertaken by assessing sinus nodal recovery time (SNRT), treadmill exercise testing, and 24-hour ambulatory ECG monitoring before and after quinidine administration (25 mg/kg) (range 800 to 1600 mg daily). Corrected SNRT ranged from 100 to 1320 msec (average 551) before quinidine and was not significantly (p greater than 0.05) altered after quinidine to 346 to 660 msec (average 481). Further, quinidine did not induce accelerated infrasinus pacemaker activity. Spontaneous sinus rate evaluated with ambulatory monitoring revealed average rate of 57 bpm (range 53 to 63) before quinidine without significant increase to average 59 bpm (range 52 to 80) after quinidine therapy. Similarly, the maximal SN response to exercise was not significantly affected by quinidine (average 129 bpm before and 129 bpm after drug therapy). It is concluded that therapeutic doses of quinidine do not exert adverse effects on SN function in SSS patients. Chronic oral quinidine therapy can therefore be used safely with caution in patients with chronic SN disease when indicated for control of tachyarrhythmias. | [
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10,002,993 | Prevalence and significance of reversible radionuclide ischemic perfusion defects in symptomatic aortic valve disease patients with or without concomitant coronary disease. | [
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10,002,994 | To determine the prevalence and significance of exercise-induced localized perfusion defects in symptomatic patients with aortic valve disease, thallium-201 rest and exercise studies were performed in a consecutive series of 29 such patients prior to left heart catheterization with coronary arteriography. Eight patients had repeat studies after aortic valve replacement. Twelve of 17 patients with predominant aortic regurgitation (AR) had distinct LV apical defects during exercise despite normal coronary arteries, while 10 of 12 patients with aortic valve disease and associated coronary artery disease (CAD) had localized perfusion defects in LV areas other than the apex. In patients with AR, reversible apical perfusion defects can occur without CAD; these apical defects are probably a reflection of severe LV volume overload in AR. LV perfusion defects in areas other than the apex are specific for CAD in aortic valve disease, and concomitant CAD may not provoke regional LV perfusion deficits in aortic stenosis patients with severe LV hypertrophy. | [
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10,002,995 | Variability of electrocardiographic responses to repeated ergonovine provocation in variant angina patients with coronary artery spasm. | [
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10,002,996 | We reviewed our experience with serial ergonovine provocative tests for coronary artery spasm (CAS) in ten variant angina patients with angiographically proved CAS. Of the 26 ergonovine tests performed in the ten patients, only four patients exhibited reproducible ECG response to ergonovine. The remaining six patients had variable and unpredictable ECG responses to ergonovine. All patients were in an active phase of their disease. The variability of ST segment directional response to ergonovine is considered to be on the basis of disparate sensitivity of the coronary circulation to intravenous ergonovine. Because of this variable response, the ECG response alone should not be considered as the standard indicator for CAS presence but should be utilized with other hemodynamic and angiographic criteria. | [
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10,002,997 | Electrophysiologic study demonstrating triple antegrade AV nodal pathways in patients with spontaneous and/or induced supraventricular tachycardia. | [
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10,002,998 | Ten patients are described with two discrete discontinuities in AV nodal conduction curves suggesting triple antegrade AV nodal pathways. This represents approximately 6% of patients seen in this laboratory with dual AV nodal pathways. Patients ranged in age from 18 to 63 (mean +/- SD, 48 +/- 15 years). Six of the 10 patients had organic heart disease and four did not. The effect of cycle length on triple pathways could be analyzed in 8 of 10 patients who had atrial extrastimulus testing at two or more cycle lengths. Three of these eight patients had triple pathways at all tested cycle lengths. Four patients had triple pathways only at shorter cycle lengths. One patient had triple pathways only at longer cycle lengths. Intact retrograde conduction was demonstrated in seven of ten patients, all of whom had atrial echoes (two patients) or inducible supraventricular tachycardia (SVT) (five patients). Echoes or SVT were induced on the slow pathway is all seven patients, but also on the intermediate pathway in three. However, sustained SVT usually reflected antegrade slow and retrograde fast pathway conduction. In conclusion, triple AV nodal pathways may be demonstrated in occasional patients during atrial extrastimulus testing. Thereby, functional longitudinal dissociation of the AV node is not limited to two pathways. | [
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10,002,999 | Quantitative axial oblique contrast left ventriculography: validation of the method by demonstrating improved visualization of regional wall motion and mitral valve function with accurate volume determinations. | [
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