Dipyridamole may be used safely in patients with ischaemic heart disease.

It is thought that up to 50% of patients with cerebrovascular disease will have concurrent ischaemic heart disease. Dipyridamole co-formulated with aspirin has been shown to increase the relative reduction in risk of second stroke in patients with prior stroke/transient ischaemic attack beyond that obtaining with aspirin alone. We have sought to resolve the question of whether dipyridamole treatment increases the risk of cardiac adverse events in patients with co-existing ischaemic heart disease. The published literature, periodic safety update reports, the randomised controlled trials of antiplatelet agents in stroke prevention and those including dipyridamole in cardiovascular indications, have been reviewed and analysed. The early reports of serious adverse cardiac effect attributable to dipyridamole occurred in patients with severe coronary artery disease using dipyridamole as a stress test adjunct to cardiac imaging. The randomised controlled trials databases show no evidence of mortality and only isolated cases of significant cardiac morbidity attributable to dipyridamole at recommended oral doses in patients with ischaemic heart disease. We conclude that patients with cerebrovascular and mild to moderate concomitant ischaemic heart disease may be treated safely with dipyridamole for the secondary prevention of stroke.

[Does early high dosage dipyridamole in prevention of secondary stroke induce cardiac events?]. / Führt hochdosiertes Dipyridamol in der sekundären Schlaganfallprävention zu kardialen Ereignissen?

In a post hoc analysis of the European Stroke Prevention Study 2 (ESPS2), we investigated whether dipyridamole given as antiplatelet drug in patients with TIA or stroke increases the risk of cardiac events. ESPS2 was a secondary prevention trial including 6602 patients with TIA or stroke. Patients were randomized into one of four treatment arms: 2 x 25 mg acetylsalicylic acid (ASA), 2 x 200 mg slow release dipyridamole (DP), the combination of DP and ASA and placebo. DP did not result in a higher number of cardiac events, e.g., angina pectoris, myocardial infarction or death. The combination of ASA plus DP was superior to either drug alone in the prevention of strokes.

Cardiac safety in the European Stroke Prevention Study 2 (ESPS2).

The second European Stroke Prevention Study investigated the prevention of stroke and/or death in 6602 patients with transient ischaemic attack or stroke with aspirin (25 mg b.d.), dipyridamole (400 mg b.d.), the combination of aspirin and dipyridamole or placebo. This post hoc analysis investigated cardiac events in patients with coronary heart disease or myocardial infarction (MI) at entry. Dipyridamole did not result in a higher number of cardiac events, e.g. angina pectoris, MI, or death from all causes. The combination of aspirin plus dipyridamole was superior to either drug alone in the prevention of stroke.

Respiratory gas exchange indices used to detect the blood lactate accumulation threshold during an incremental exercise test in young athletes.

The time course of changes in blood lactate concentration and ventilatory gas exchange was studied during an incremental exercise test on a cycle ergometer to determine if the lactate accumulation threshold (LT2) could be accurately estimated by the use of respiratory indices (VT2) in young athletes. LT2 was defined as the starting point of accelerated lactate accumulation. VT2 was identified by the second exponential increase in VE and the ventilatory equivalent for O2 uptake with a concomitant nonlinear increase in the ventilatory equivalent for CO2 output. Twelve trained subjects, aged 18-22 years, participated in this study. The initial power setting was 30 W for 3 min with successive increases of 30 W every minute except at the end of the test when the increase was reduced. Ventilatory flow (VE), oxygen uptake (VO2), carbon dioxide output (VCO2), and ventilatory equivalents of O2 and CO2 were determined during the last 30 s of every minute. Venous blood samples were drawn at the end of each stage of effort and analysed enzymatically for lactate concentration. After each test, LT2 and VT2 were determined visually by two investigators from the graphic results using a double-blind procedure. The results [mean (SEM)] indicate no significant difference between LT2 and VT2 expressed as VO2 [43.98 (1.70) vs 44.93 (2.39) ml.min-1 x kg-1], lactataemia [4.01 (0.28) vs 4.44 (0.37) mM.l-1], or heart rate [171 (3.36) vs 173 (3.11) min-1]. In addition, strong correlations were noted between the two methods for VO2 (r = 0.90, P < 0.001), lactataemia (r = 0.75, P < 0.01), and heart rate (r = 0.96, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age and training effects on the lactate kinetics of master athletes during maximal exercise.

To study the effects of age and training on lactate production in older trained subjects, the lactate kinetics of highly trained cyclists [HT, n = 7; 65 (SEM 1.2) years] and control subjects with low training (LT, n = 7) and of similar age were compared to those of young athletes [YA, n = 7; 26 (SEM 0.7) years], during an incremental exercise test to maximum power. The results showed that the lactacidaemia at maximal oxygen uptake (VO2max) was lower for HT than for LT (P < 0.05) and, in both cases, lower than that of YA (P < 0.001). The respective values were HT: 3.9 (SEM 0.51), LT: 5.36 (SEM 1.12), and YA: 10.3 (SEM 0.63) mmol.l-1. At submaximal powers, however, the difference in lactacidaemia was not significant between HT and YA, although the values for lactacidaemia at VO2max calculated per watt and per watt normalized by body mass were significantly lower for HT (P < 0.001) and LT (P < 0.02). These results would indicate that the decline in power with age induced a decline in lactacidaemia. Yet this loss in power was not the only causative factor; indeed, our results indicated a complementary metabolic influence. In the older subjects training decreased significantly the lactacidaemia for the same submaximal power (P < 0.01) and from 60% of VO2max onwards (P < 0.05); as for YA it postponed the increase and accumulation of lactates. The lactate increase threshold (Thla-,1) was found at 46% VO2max for LT and at 56% VO2max for HT.(ABSTRACT TRUNCATED AT 250 WORDS)

The Sequoia circular fixator for limb lengthening.

With the Sequoia fixator, lengthenings can be achieved based on the clinical facts of the case. The device is a modular apparatus that can perform corrections in several planes, and, if necessary, in a septic environment. In our opinion, a "lengthener surgeon" is one who can foresee problems and take appropriate steps to prevent them. Likewise, the surgeon must act as the coordinator of an entire team. A successful lengthening is 5% surgery and 95% postoperative nursing and physiotherapy care. In the future, a number of changes will simplify postoperative management: 1. Composite carbon rings will make the frames radiolucent and one third lighter than those made of stainless steel. Automatic tensioners will help maintain steady tension on the wires. 2. Digital analysis of the callus will provide norms of consolidation, allowing faster fixator removal and conversion to an orthosis. 3. Incorporating the foot in the frame to overcome equinus will eliminate the need for tenotomy. We believe that monolateral and ring fixators can work together in certain locations. That is why we proposed, at the 18th Societé Internationale de Chirurgie Orthopédique et Traumatologique meeting, a combined monolateral-ring construct that can be used for lengthening throughout the proximal femoral metaphysis.

[Ectopic openings of the common bile duct. A contribution to the physiological study of the sphincter of Oddi (author's transl)]. / Les abouchements ectopiques du cholédoque. Contribution à l'étude de la physiologie du sphincter d'Oddi.

Two cases of ectopic openings of the common bile duct are reported. In one case there was a congenital short duct opening into DI, the presence of a spontaneous duodenobiliary reflux due to absence of the papilla being demonstrated by clinical and radiological examinations. The other patient had a long duct opening into D3 and no duodenobiliary reflux, but with an intact sphincter of Oddi explored in detail by means of combined choledochoduodenal manometry. These two cases demonstrate that the duodenal wall has only a moderate effect in preventing duodenobiliary reflux. The essential element is the sphincter of Oddi: if present, there is no reflux, if absent, reflux occurs.

Progress of infants fed Karitane Milk Food compared with those on breast or homogenised milk.

A study was made of three groups of babies, one breast fed, one having Karitane Milk Food, the third homogenised milk. Blood sodium and urea were measured in the neonatal period. The urea levels were significantly higher in babies having homogenised milk compared with those fed Karitane or breast milk. Haemoglobin was measured in the neonatal period, and at 3, 6, 10 1/2 and 18 months. At six months, haemoglobin levels were significantly higher in Karitane milk fed than in homogenised milk fed babies. Serum cholesterol and triglyceride were measured in cord blood, and at 6 and 18 months of age. Serum triglyceride levels in babies on Karitane Milk Food were significantly higher than those on homogenised milk. Increments in weight, height and head circumference were compared. Karitane milk fed babies gained significantly more weight than breast fed between three and six months of age.

Osteoplastic frontal sinusotomy: an analysis of 250 operations.

The operative approach and findings of 250 osteoplastic frontal sinusotomy operations performed from 1956 through 1972 at the Massachusetts Eye and Ear Infirmary are reviewed. Indications for surgery were symptomatic and/or complicated disease of the frontal sinus, including primary chronic sinusitis and osteoma or trauma with or without associated infection. Immediate postoperative complications were minor. Follow-up of at least three years was obtained in 83% of the patients, and 93% of these have no significant symptoms to date. A distressing problem of persistent postoperative frontal pain is discussed in detail. Revision surgery has been performed in 6% of patients due to recurrent frontal sinus infection. The reasons for failure are anlyzed, and recommendations are made to minimize the possibility of recurrence.