Anomalous origin of the right coronary artery from the main pulmonary artery. A case report.

A fifty-nine-year-old, asymptomatic woman with anomalous origin of the right coronary artery from the main pulmonary artery is presented. The diagnosis was established by catheterization and angiocardiography. The indications for surgery in this condition are discussed, with special reference to asymptomatic patients. In this patient, surgery was not undertaken, because of the absence of signs of impairment of left ventricular perfusion and function. The patient remains asymptomatic after eight years of observation.

Effects of diltiazem, propranolol, and their combination in the control of atrial fibrillation.

The effect of the combined treatment with propranolol 20 mg tid and diltiazem 60 mg tid in patients with chronic atrial fibrillation treated with digoxin was evaluated. Thirteen patients entered a double-blind, three-phase crossover study. Heart rate was significantly reduced during rest and at maximal exercise (p less than 0.05) during combined treatment compared with treatment with any single drug. No significant changes in maximal work load, exercise time, systolic blood pressure at maximal work load, or subjective sensation of well-being could be demonstrated during combined drug treatment. The RR distribution pattern was unaffected by the addition of propranolol, diltiazem, or their combination to the chronic digoxin treatment. It is concluded that the combination of diltiazem and propranolol has no advantages over any of these drugs singly, in the moderation of heart rate in patients with atrial fibrillation even combined with basic digitalis treatment, and that the intrinsic AV nodal function is unaffected by these drugs or their combination.

Transdermal nitroglycerin (Transiderm-Nitro) in the treatment of unstable angina pectoris.

Eighteen patients, 13 male and five female, with unstable angina pectoris and who had greater than or equal to 3 anginal attacks/day despite treatment with beta- and/or Ca-blockers were treated for three days with transdermal nitroglycerin (Transiderm-Nitro 25 mg/24 hours) in a randomised, placebo-controlled trial. A significant reduction of anginal attacks (p = 0.03) was demonstrated only during the first day of treatment. The lack of significant effects during the following two days was ascribed partly to the possible development of nitrate-tolerance, partly to a declining number of anginal attacks in the placebo-group during the trial period, for which reason the difference between the actively treated and the placebo group became smaller and finally the consumption of nicomorphine was considerably greater in the placebo group.

Analgetic treatment in acute myocardial infarction. A controlled clinical comparison of morphine, nicomorphine and pethidine.

In a randomized double-blind study with flexible dosage, morphine, nicomorphine and pethidine were compared with regard to analgetic effect, dose requirements, dose intervals and adverse reactions. A total of 275 patients were included, and 28 patients were excluded due to adverse reactions (n = 16) and for practical reasons, etc. Acute myocardial infarction (AMI) was diagnosed in about 60% of the patients, and about 30% had ischemic heart disease without AMI. All three analgesics provided equally efficient pain relief in relative doses of morphine 10, nicomorphine 10 and pethidine 75 mg/ml. Severe adverse reactions were few (allergy 3 cases, respiratory insufficiency 4, severe bradycardia 4), whereas nausea was recorded in 20-30%, vomiting in 5-15% and dizziness in 10-30% of the patients, with no difference between the three drugs. Significant blood pressure drop (greater than 30 mmHg) was seen in 3-8% of the patients, with no significant differences between the drugs.

Pretransplant status of grafts and recipients. Treatment with dialysis and renal transplantation in diabetic nephropathy. Experiences through 11 years. Survival curves and causes of death.

An 11 year study is presented comprising 74 diabetic patients with terminal uraemia treated with dialysis and transplantation. The cumulative patient survival rate after one year is 45%. No difference is found between the survival rates of transplanted and dialysed patients. Sixty-six percent of the patients died from cardiovascular-, and 21% from infectious causes.