Acute myocardial infarction: a rare presentation of pancreatic carcinoma.

Secondary neoplastic involvement of the heart is common but usually asymptomatic. Malignancy rarely presents as acute pericarditis, cardiac tamponade, and myocardial infarction in the same patient. We report a patient with unsuspected metastatic pancreatic adenocarcinoma who presented with acute pericarditis and cardiac tamponade and subsequently developed a myocardial infarction due to coronary artery occlusion secondary to a metastatic deposit around the left anterior descending artery.

Anomalous origins of the left coronary arteries from the right sinus of valsalva with an unusual course.

We report and attempt to classify a previously undescribed coronary artery anomaly. Our patient had all three coronary arteries arising from a common ostium in the right sinus of Valsalva, with an unusual distribution to the left coronary artery system: the anomalous left circumflex system taking an intraseptal (intramyocardial) course and the anomalous left anterior descending system taking an interarterial (between the great vessels) course.

Group C streptococcal arthritis.

Septic arthritis is a common disorder that is rarely caused by group C streptococci. This infectious process usually occurs in patients with a preexisting rheumatologic condition. Treatment consists of intravenous antibiotics, joint aspiration, and physical therapy. Prolonged recovery and septic complications are expected. This report describes a case typical of group C streptococcal arthritis.

Surveillance and control of aflatoxin contamination of dried figs and fig paste imported into the United Kingdom.

Samples of dried figs and fig pastes from Turkey supplied voluntarily by UK importers and retailers during the period November 1988 to January 1989 showed both a high incidence and high levels of contamination with aflatoxins. In the samples tested, 24% had total aflatoxin concentrations above 10 micrograms/kg, with the highest level being 165 micrograms/kg. More rigorous monitoring of the 1989 fig harvest was undertaken on bulk consignments for all figs from Turkey entering the UK. For whole dried figs 20 kg samples were taken (as 20 sub-samples), and for fig paste 5 kg samples were taken (again as 20 sub-samples). Figs were minced, blended with water and mixed prior to sub-sampling for analysis. Analysis was by immunoaffinity column clean-up with HPLC determination of aflatoxins with fluorescence detection. Examination showed that 11% of 112 consignments of fig paste and 9% of 93 consignments of whole dried figs were contaminated with total alfatoxin concentrations above 10 micrograms/kg, with the highest level of contamination being 40 micrograms/kg. As a result of this surveillance programme 14 consignments of figs were refused entry into the United Kingdom.

Transseptal catheterization technique: a simple safety procedure.

The major complication of transseptal catheterization, that of inadvertent perforation of other structures, can best be avoided by maintenance of the correct needle tip position during introduction and maneuvering of the assembly. The addition of a needle-stop to the transseptal needle shaft and a sterile ruler to check its present position assures the maintenance of the needle tip position, freeing the operator's concern for accurate location of landmarks. The method of utilizing and setting the needle-stop is described.

A clinical evaluation of an improved Holter monitoring technique for artificial pacemaker function.

This paper discusses shortcomings of conventional Holter monitoring in paced patients and describes a new technique which permits reliable detection of intermittent pacemaker malfunction and counts pacemaker activity during the recording period. Evaluation of the system of 64 consecutive patients revealed 15 with unsuspected episodic pacemaker dysfunction.

The nonsurgical retrieval of intracardiac foreign bodies--an international survey.

An international survey of nonsurgical retrieval of intracardiac foreign bodies provided data on 180 published and unpublished cases. The data was analyzed to evaluate the respective merits and drawbacks of the 3 basic retrieval techniques, the snare, the wire basket, and the endoscopy forceps, the routes and methods of insertion, the success rate, and the complications. Eighty percent of foreign bodies were polyethylene central venous pressure catheters, cut in two by the needle introducer. The site of lodgement of these fragments was predictable and determined by the site of entry and length of the fragment. The basic retrieval instruments and their modifications are described. Operating instructions are detailed together with adjunct methods of repositioning fragments for easier retrieval. Factors associated with the small percentage of unsuccessful retrieval attempts include fragments totally in the distal pulmonary artery, extravascular lodging sites, chronically-implanted fragments, and pacemaker-catheter fragments. For the vast majority of cases, however, these simple and uncomplicated techniques have been highly successful and widely utilized in the nonsurgical retrieval of intracardiac foreign bodies.

Resolution of an iatrogenic coronary artery thromboembolus.

A patient with an iatrogenic coronary thromboemboulus, sustained during selective left coronary catheterization is presented. The embolus was identified by angiography and its complete resolution was documented in the same manner three months later. Despite chest pain and elevation of the cardiac enzymes, the electrocardiogram showed only nonspecific changes and the absence of macroscopically identifiable infarction was demonstrated at thoracotomy. Thromboembolization may be a more common cause of complication with the Judkins technique than generally realized but may be compatible with complete recovery and be avoided by special catheterization practices.