Isolated left posterior fascicular block: a reliable marker for inferior myocardial infarction and associated severe coronary artery disease.

The electrocardiographic (ECG) pattern of isolated left posterior fascicular block (LPFB) is a rare condition. It seems that true LPFB is often not recognized, whereas in cases of simple QRS axis of +60 degrees to +100 degrees in the frontal plane, the diagnosis of LPFB is made erroneously. Both facts rely on controversial and partially misleading opinions in the literature. Therefore, a retrospective and prospective study was performed in order to determine the prevalence of LPFB and to correlate its presence to the underlying disease. Retrospective study: Of a cohort of 830 patients referred in 1988 to a cardiologic laboratory for invasive investigation of certain or suspected coronary artery disease (CAD), 163 patients had an old inferior myocardial infarction (IMI). Nine patients (5.5%) showed the typical pattern of LPFB; eight of these had three-vessel disease. The diagnosis of IMI had been made only in one case before entry of the patient into the hospital, since LPFB generally masks IMI. Prospective study: 2502 ECGs were investigated, 1710 from a department of cardiology and 792 from two departments of internal medicine. Six LPFBs were detected (0.24%), all associated with IMI and four of them with three-vessel CAD. It is concluded that LPFB is a rare but clinically important intraventricular conduction disturbance. Its appearance is reliably connected with IMI and generally reflects severe three-vessel CAD, requiring invasive investigation.

[Nausea and vomiting during chemotherapy of malignant tumors]. / Nausea and Erbrechen bei der Chemotherapie maligner Tumoren.

Nausea and vomiting are frequent and unpleasant side effects of cancer chemotherapy. Current concepts of pathophysiology and clinical aspects of nausea and vomiting are reviewed. Individual and therapeutic factors are discussed which greatly modify the degree of vomiting. The commercially available antiemetics are tabulated and the individual classes of antiemetics are described. Finally, consideration is given to new approaches to the treatment of nausea and vomiting, including the search for new compounds and better use of currently available agents.