[Ischemic left ventricular failure. Main stem coronary stenosis treated with angioplasty]. / Ischemisk betinget venstre ventrikkel-svikt. Hovedstammestenose behandlet med angioplastikk.

We describe a patient with stenosis on the left main stem and severe impairment of the left ventricular function. Because of reversible myocardial ischaemia in a patient whose clinical situation prohibited surgery, angioplasty on the left main stem was performed, leading to considerable improvement of the ventricular function. Improvement was slow, however, probably due to "stunning" of the myocardium. We underline the importance of early angiography in patients when it is suspected that a larger part of the myocardium is affected by severe, reversible ischaemia.

Myocardial blood flow and metabolism in the diving seal.

The adaptations of myocardial metabolism to diving asphyxia have been studied in 12 harbor seals (Phoca vitulina). Unanesthetized animals were submerged for periods of 10-16 min. Heart rate decreased from 135 to 12 beats/min. Myocardial blood flow decreased to an average of 10% of predive values and remained constant during the dive. The progressive reduction in arterial O2 content was associated with an increase in myocardial lactate and hydrogen ion production, but no change in glucose or free fatty acid extraction occurred. After restoration of breathing a reactive myocardial hyperemia and an immediate return to myocardial uptake of lactate were observed. Despite increased glycogenolytic activity throughout the dive, coronary flow distribution was fully controlled, and no evidence of ischemic dilatation of the left ventricle or S-T segment elevation in the electrocardiogram was observed. These adaptations to diving asphyxia in the seal myocardium permit a reduction of coronary blood flow comparable to that observed in the infarcted dog myocardium and therefore have relevance for therapeutic approaches to reduction of myocardial ischemic injury in humans.

A controlled clinical trial of streptokinase and heparin in the treatment of major pulmonary embolism.

Treatment with streptokinase or heparin was allocated randomly to 20 patients with major pulmonary embolism verified by angiography. In addition, 4 patients treated with streptokinase and 1 patient treated with heparin were included in the trial prior to the start of treatment. Streptokinase of heparin was given for 72 hours and pulmonary angiography was repeated. The angiographic evidence of thrombolysis was significantly greater (p less than 0.01) in the 14 patients treated with streptokinase than in the 11 treated with heparin. In the heparin group, 1 patient died from massive embolism 15 hours after the start of treatment. In another patient who died 4 weeks later from cerebral glibolastoma, persistent massive embolism contributed to the fatal outcome. In the streptokinase group, 1 patient with a metastatic pulmonary carcinoma died 3 weeks after the start of treatment from gangrene of both legs following thrombotic occlusion of the inferior vena cava. Bleeding was more common after treatment with streptokinase than with heparin, but was not a serious problem in any patient. It is concluded that patients with life-threatening pulmonary embolism should be offered the benefits of streptokinase.