Detection of the Candida antigen mannan in cerebrospinal fluid specimens from patients suspected of having Candida meningitis.

Cerebrospinal fluid samples from five patients from which Candida cells were cultured were tested for the presence of mannan. Samples from four patients categorized as having proven candidosis reacted positively. Samples from the remaining patient and from patients with other central nervous system infections were negative. Detection of mannan may be valuable in the diagnosis of Candida meningitis.

Which drug to choose for stable angina pectoris: a comparative study between bisoprolol and nitrates.

The choice between beta-blockade or nitrates as first line treatment for stable angina pectoris is based upon the different mechanisms of action and patient characteristics. We performed a clinical trial comparing the efficacy of the longacting beta-blocker bisoprolol once daily and the short acting nitrate, isosorbide dinitrate, three times daily in the reduction of anginal complaints in daily life and under stress. Thirty patients were enrolled in a double-blind randomised cross-over study. Both bisoprolol and isosorbide dinitrate were effective in reducing anginal attacks and nitroglycerin consumption significantly, but bisoprolol was significantly more effective than isosorbide dinitrate. Bisoprolol improved the workload during bicycle exercise testing significantly, but the improvement with isosorbide dinitrate was not significant. Despite the reduction in maximal rate pressure product, bisoprolol was significantly (P < 0.05) more effective at improving total workload and reducing the time to onset of angina than isosorbide dinitrate. The rate pressure product did not change significantly with isosorbide dinitrate. In this study, bisoprolol 10 mg once daily was more effective and caused less side effects than isosorbide dinitrate 20 mg three times a day. It seems questionable if monotherapy of isosorbide dinitrate 20 mg t.i.d is an adequate drug regime for stable angina pectoris.

Cross-over comparison of the fixed combination of hydrochlorothiazide and triamterene and the free combination of furosemide and triamterene in the maintenance treatment of congestive heart failure.

The fixed combination of hydrochlorothiazide 25 mg and triamterene 50 mg and the free combination of furosemide 40 mg and triamterene 50 mg were compared as maintenance treatment in patients who were in a stable condition after an episode of congestive heart failure. All the patients were on digitalis. The trial was of the cross-over design. The treatment order was randomized at each centre. Each treatment lasted for 8 weeks. Of the 37 patients entering the study 30 were suitable for analysis. Both treatments were equally effective in maintaining bodyweight at the same level and in influencing symptoms. The free combination decreased the blood pressure slightly more than the fixed combination, especially the systolic pressure. One-third of the patients were hypertensive at the outset (diastolic pressure greater than 95 mm Hg) and in them the effects of the two treatments were not significantly different. The majority of the patients (80%) preferred treatment with the fixed combination because it caused slower and less frequent micturition.

Maintenance therapy after i.v. administration of disopyramide with an oral sustained release preparation, a pharmacokinetic study.

The blood levels in 20 patients were studied during the change from parenteral administration of disopyramide to an oral sustained release preparation containing the same active substance. From this study it is concluded that 100 mg i.v. bolus injection of disopyramide can safely be followed by the immediate administration of one sustained release tablet containing 250 mg disopyramide. In case of an i.v. infusion (0.4 mg kg-1h-1) it seems wise not to start earlier with the administration of the sustained release preparation than at the moment of stopping the infusion.

Long-term prognosis in patients with bundle branch block complicating acute anteroseptal infarction.

In a previous study patients with bundle branch block complications acute anteroseptal infarction found to have a high incidence rate of sudden death and late ventricular fibrillation in the first 6 weeks after infarction. Forty-two such consecutive patients were therefore kept within the monitoring area during those 6 weeks. Eighteen (43 percent) of these 42 patients survived and were then followed up for an average of 13 months to assess long-term prognosis and to evaluate whether the in-hospital monitoring period should be extended over 6 weeks. In most of these 18 patients a bifascicular block developed in the acute stage of infarction and in 3 it progressed to transient high degree atrioventricular (A-V) block. Seven of the 18 survivors had potentially lethal complications during the first 6 weeks. Four of these seven underwent aneurysmectomy between 10 and 20 weeks after infarction, and one of them died of a surgical complication. Major cardiac events occurred in 3 of the 17 survivors. None of these patients died during the follow-up period. In one patient complete A-V block developed after aneurysm resection; this was the only patient treated with permanent pacing. Fifteen of the 17 patients were in functional class I or II. These results indicate that (1) patients with bundle branch block complicating acute anteroseptal infarction who survive the first 6 weeks after infarction have a good prognosis during the 1st year, and (2) extension of the in-hospital monitoring period is not necessary. The results further suggest that prophylactic permanent pacing does not affect prognosis in these patients.

Larvae of air-breathing fishes as countercurrent flow devices in hypoxic environments.

Larvae of the air-breathing teleost fish Monopterus are frequently exposed to periods of critical hypoxia, which they can survive because they have (i) dense capillary networks in the skin, (ii) a small blood-water barrier, (iii) an active pectoral fin mechanism that generates a posteriorly directed respiratory water current originating from the oxygen-rich surface layer, and (iv) a principal flow of blood that runs countercurrent to the water stream. Experimental data show that the larva as a whole is a functional analog of a fish gill lamella and that similar adaptive mechanisms are present in larvae of ancient fishes and some modern teleosts inhabiting permanently or periodically hypoxic waters.

Incidence and significance of heartmuscle antibodies in patients with acute myocardial infarction and unstable angina.

The incidence of heartmuscle antibodies was studied prospectively in 136 patients consecutively admitted for acute myocardial infarction (AMI) and in 95 patients with unstable angina. Heartmuscle antibodies were determined with the indirect immunofluorescence technique on days 1, 10, 20 and 30 in patients with AMI and on days 1 and 10 in patients with unstable angina. Heartmuscle antibodies were found in 16/136 AMI patients (12%) and in 3/95 (3%) with unstable angina. None of the AMI patients developed post-myocardial-infarction syndrome in the 2--4 weeks after infarction or during the one-year follow-up. The AMI patients with and without heartmuscle antibodies were comparable with respect to age, sex, site and size of infarction, incidence of early pericarditis and previous infarction.

Efficacy of lidocaine in preventing primary ventricular fibrillation within 1 hour after a 300 mg intramuscular injection. A double-blind, randomized study of 300 hospitalized patients with acute myocardial infarction.

The effectiveness of intramuscular lidocaine in preventing in-hospital primary ventricular fibrillation within 1 hour after injection of the drug in patients with acute myocardial infarction was assessed in a double-blind randomized study performed in 300 such patients admitted within 6 hours of myocardial infarction. Six of 147 patients treated with 300 mg of intamuscular lidocaine had ventricular fibrillation compared with 4 of 153 control subjects. The lidocaine blood level of the patients who experienced ventricular fibrillation was 1.4 +/- 0.7 microgram/ml (mean +/- standard deviation) at the time of fibrillation, a value not significantly different from that of treated patients who did not experience fibrillation. Lidocaine blood levels in the latter were 1.9 +/- 1.1, 2.1 +/- 1.1, 2.1 +/- 1.1 and 1.7 +/- 0.7 microgram/ml, respectively, 7, 15, 30 and 60 minutes after injection. In this study intramuscular lidocaine was ineffective in preventing ventricular fibrillation, possibly because the given dose, 300 mg, prevented attainment of adequqte blood levels of the drug.

Thallium-201 scintigraphy in unstable angina pectoris.

Thallium-201 scintigraphy was performed during the pain free period in 98 patients with unstable angina. Scintiscans were positive in 39 patients, questionable in 27 patients and normal in 32 patients. Eighty-one patients responded favorably to treatment (group I). Seventeen patients had complicated courses (group II) and despite maximal treatment with propranolol either developed infarction (six patients) or continued to have angina necessitating coronary surgery (11 patients). In group I during the pain free period 26 of 81 patients had positive thallium-201 scans, whereas 20 patients had an abnormal ECG at that time; during angina 18 patients had transient ECG changes. In group II during the pain free period 13 of 17 patients had positive scans, whereas two patients had abnormal ECG at that time; during angina 12 patients showed transient ECG changes. The sensitivity to recognize group II was 76% for thallium-201 scintigraphy, 11% for ECG during the pain free period; 70% for ECG during angina; 94% for the combination of either positive scans or abnormal ECG. Thus, 1) positive thallium-201 scans occur in patients with unstable angina, 2) positive scans can be obtained during the pain free period, 3) thallium-201 scans are more frequently positive in patients with complicated course.

Treatment and prevention of primary ventricular fibrillation complicating acute myocardial infarction.

Primary ventricular fibrillation especially occurs during the first hours after acute myocardial infarction and is often not preceded by premonitory ventricular premature beats. In hospital primary ventricular fibrillation can be prevented by an intravenous lidocaine regimen in a rather high dosage. By contrast the effectiveness of intramuscular lidocaine in preventing out-hospital primary ventricular fibrillation is unestablished. If recurrent attacks of primary ventricular fibrillation supervene, intervention with antiarrhythmic therapy and/or cardiac pacing is often unsuccessful. Repeated defibrillation should be carried out under these circumstances. If properly treated primary ventricular fibrillation is associated with a good short and long term prognosis.

Value and limitations of thallium-201 scintigraphy in the acute phase of myocardial infarction.

We examined the diagnostic usefulness of thallium-201 scintigraphy in 200 patients with acute myocardial infarction. The scintiscans showed a defect, suggesting infarction in 165. In all 44 patients studied iwthin six hours after onset of symptoms the scintiscans indicated a defect. Frequency of positive scans was significantly higher (90 of 96) in patients studied within 24 hours after onset than in those (75 of 104) studied later (p less than 0.01).