The efflux of nor-epinephrine from platelets in genetic hypertension.

Platelets have been used as a model of sympathetic neurons to study the storage of nor-adrenaline in normotensive individuals belonging to families with essential hypertension for at least two generations. The efflux and initial efflux rate (K) of noradrenaline was determined in 36 young relatives (mean age 29.2 years) and in 20 young controls with no family history of hypertension (mean age 26.5 years). From the groups of relatives all those with definite hypertension had been excluded. Efflux and efflux rate K was significantly higher in young relatives (50.82 +/- 3.84 and 28.2 +/- 6.3) than in the controls (39.2 +/- 0.71 and 15.2 +/- 4.8). Of the relatives 25.2% had higher K values than any of the controls.

Use of captopril as an isolated agent for the management of stable angina pectoris--a double blind randomised trial.

In this double blind randomised placebo controlled study, we investigated the antianginal efficacy of oral captopril in 33 patients of angiographically documented coronary artery disease (chronic stable angina). Apart from sublingual nitrates, all other antianginal drugs were withdrawn. Patients were then evaluated both subjectively by questionnaire and objectively by treadmill stress test. No patient had more than mild hypertension and all patients had good left ventricular function. One group of patients received oral captopril while the other group was given placebo. A repeat assessment was done after six weeks and the results compared with baseline. Anginal attacks decreased from 20.11 +/- 1.86 per week on placebo to 9.92 +/- 1.38 (p < 0.01) on captopril as also the number of sublingual nitrates (18.84 +/- 3.01 to 11.14 +/- 2.94, p < 0.01). Assessment by the treadmill stress test showed that in comparison to the pretreatment test, captopril therapy resulted in a significantly increased exercise duration (6.26 +/- 0.21 to 6.98 +/- 0.31 minutes, p < 0.05), total work done (6.76 +/- 0.26 METS to 7.48 +/- 0.29 METS, p < 0.05). In addition there was a significant increase in time to angina (6.16 +/- 0.18 to 6.85 +/- 0.24 min, p < 0.05) and time to 1mm ST depression (5.18 +/- 0.26 to 6.46 +/- 0.30 min, p < 0.01). We conclude that captopril is an effective monotherapy for patients with chronic stable angina and has both antianginal as well as anti-ischemic effects, possibly secondary to direct coronary vasodilation.

Modified cephalic vein guide wire technique for permanent pacemaker implantation.

This report describes a modified cephalic vein guide wire technique used for implantation of 18 consecutive pacemakers using bipolar leads. The modified technique appears to be a safe and simple procedure for single chamber permanent pacing. Its use may also be extended in implanting dual chamber pacemakers.

The efflux of nor-epinephrine from platelets in essential hypertension.

The precise role of sympathetic nervous system in initiation and/or maintenance of essential hypertension is unclear even today. Platelets have been used as a suitable model for studying neuronal turnover of biogenic amines. The present study comprised of hypertensive subjects (23) and normotensive controls (10). Hypertensive subjects exhibited significantly enhanced norepinephrine efflux from platelets at both 30 minutes and 60 minutes (p less than 0.001). The percent norepinephrine efflux from platelets correlated with diastolic (r = 0.66 and 0.76) and mean arterial blood pressure (r = 0.54 and 0.65) but not with systolic blood pressure. The norepinephrine efflux rate (K) similarly correlated with diastolic and mean arterial blood pressure in hypertensive subjects studied. From the above findings it appears that operative sympathetic nervous system activity is enhanced in essential hypertension. The enhanced efflux of norepinephrine from platelets may also indicate activated state of platelets in hypertension. Both could be important in genesis and complications of essential hypertension.

Sites of right ventricular outflow tract obstruction in tetralogy of Fallot--a retrospective study.

Fifty one angiographically proved cases of tetralogy of Fallot (TOF) in the age group of 5-50 years were analysed retrospectively for the level(s) of right ventricular outflow tract (RVOT) obstruction. Mean age was 18.1 +/- 11 yrs. Subvalvular stenosis was found to be the commonest site of RVOT obstruction in 49 (96.1%) patients. Evidence of valvular pulmonary stenosis was seen quite commonly (42/51, 83.9% cases), mostly in association with obstruction at other sites. Supravalvular stenosis was also seen in 17 (33.3%) cases. Higher incidence of pulmonary valvular involvement in patients with TOF, in higher average age of patient population may represent valvular involvement to be an acquired phenomenon.

Clinical relevance of vegetations in infective endocarditis.

Two-dimensional echocardiograms of 58 patients with infective endocarditis were examined to determine if presence and/or size of vegetations on echocardiogram were predictive of morbidity and mortality. Group 1 (38 patients) with one or more vegetations, had a significantly higher rate of complications (emboli, congestive heart failure, need for surgery and death) than group 2 (20 patients) without vegetations (p less than 0.001). Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. In contrast, patients whose echocardiograms demonstrated vegetations on aortic valve had a significantly higher incidence of heart failure, embolisation, surgery and death than those with vegetations on mitral valve. Thus, the detection of vegetations on initial echocardiogram clearly identifies a subgroup at risk for complications, more so if vegetations are present on the aortic valve, but the vegetations size does not predict an adverse clinical outcome.

Surveillance of salmonellae in India for drug resistance.

Out of 3001 salmonella received during 1984-85, 2985 strains were tested for antibiotic resistance and R-pattern transfer. Multidrug resistance was observed in 73% of diarrhoeal and 43% of non-diarrhoeal isolates. Antibiotic resistance markers were transferable in 46.6% of diarrhoeal and 41.1% of non-diarrhoeal isolates. Two out of 4 salmonella sero-types isolated for the first time in India during this period were multidrug resistant.