A 'sensitive heart' in a tennis player.

A 49-year-old man was evaluated because of exertional chest pain of 1 month's duration that began during vigorous tennis. Initially, the pain was substernal and lasted 1 to 2 minutes. Recurrent episodes were always exercise related, though the activity might be mild, and episodes were relieved by several minutes of rest. At times, the pain radiated to the left side of the neck.

Cardiac angiosarcoma: a case report.

Primary neoplasms of the heart are rare and difficult to diagnose prior to surgery, even with modern imaging techniques. Often, the tumors are diagnosed only at autopsy. Angiosarcoma is the most common malignant neoplasm. This disease is most commonly found in middle-aged men, and the tumor is most often located in the right atrium. It commonly causes blood flow abnormalities, extensively infiltrates cardiac structures, and may extend through the heart wall to involve adjacent structures. Metastatic spread at the time of diagnosis is common, and surgical mortality is high. We present a case of primary angiosarcoma involving the right ventricle of the heart. This tumor developed 6 months after the patient had undergone coronary artery bypass surgery. The patient was initially thought to have a massive thrombus within the right ventricle but at surgery was found to have a malignant neoplasm invading the myocardium. Subsequently, he was found to have pulmonary metastases. A debulking procedure was performed, and the patient was started on chemotherapy. Rather prompt improvement occurred after the debulking procedure, but subsequent studies have indicated progression of the pulmonary metastases despite ongoing chemotherapy.

Regional vasomotor responses to the somatopressor reflex from muscle.

The present study was performed to determine whether qualitative and quantitative differences are present in the regional vasomotor responses to the somatopressor reflex evoked by stimulation of muscle afferents. Studies were performed in vagotomized, chloralose-anesthetized dogs with the carotid baroreceptor reflex intact. Regional vasomotor responses were determined in the isolated, innervated, constant flow-perfused vascular beds of hindlimb muscle, hindpaw, kidney, gut (superior mesenteric), and heart (circumflex coronary). Somatic afferent fiber stimulation evoked a significant systemic pressor response (+ 42%) and increased heart rate (+ 30%). An initial vasoconstrictor response occurred in all vascular beds studied, with peak reflex responses as follows: muscle +41%, paw +6%, kidney + 17%, gut + 17%, and coronary + 8%. A late, reflex vasodilator effect occurred in the hindpaw and was caused by secondary carotid baroreflex inhibition of vasomotor tone. A late vasodilator component in the coronary bed appeared to be secondary to the inotropic and chronotropic effects of the somatopressor reflex, since coronary vasodilation was eliminated by constant rate pacing and beta-adrenergic blockade, and was unaffected by vagotomy. Primary venodilation occurred in the perfused lateral saphenous venous system. Additional experiments demonstrated that spontaneous blood flow to muscle and kidney were significantly increased during the somatopressor reflex despite the generalized vasoconstrictor response.

The risk of hepatitis B to hospital personnel. A prospective study among personnel exposed to patients without isolation precaution.

During a two-week period 54 ward personnel were exposed to two patients with severe type B hepatitis. No specific isolation precautions were used other than separate collection of hypodermic needles. During a 22-week follow-up period, there was no evidence of either overt or subclinical hepatitis in development of hepatitis B surface antigen or antibody to the surface antigen that could be attributed to exposure to the patients. This data does not support requirements for cumbersome and complicated isolation procedures during the care of patients with type B hepatitis.

Hemodynamic results of aortic valvular replacement with the porcine xenograft valve.

Twenty-three patients were evaluated by cardiac catheterization two to 12 months following aortic valve replacement with the porcine xenograft valve. These hemodynamic studies established a mean peak-to-peak systolic gradient across the prosthesis of 23 mm Hg with a range of 6-58 mm Hg. The mean effective orifice area was calculated to be 1.25 cm2. The effective orifice area increased with increasing valve size from 0.99 cm2 for the 19 mm prosthesis to 1.44 cm2 for the 25 mm prosthesis. While in general the hemodynamics of the porcine xenograft valve are comparable to other available prostheses, the exceedingly small orifice areas (0.99 cm2 and 1.03 cm2) calculated for the 19 mm and 21 mm prostheses render their use inadvisable.