Neutralization of the effects of captopril by the use of ibuprofen in an elderly woman.

This case report demonstrates that the antihypertensive effects of captopril were neutralized by the concomitant administration of ibuprofen. If elderly patients on ACE inhibitors show evidence of a "noncompliant" worsening of their hypertension, a thorough review of all the patient's medications, including the use of over-the-counter ibuprofen, should be undertaken.

Physical standards for high-performance fighter aircraft pilots.

The new generation of high-performance aircraft has clearly emphasized man's physiological limitations to withstand sustained high G loading. The selection and retention standards required to function in this environment have not been completely defined. The authors will offer a format of standards and screening tests, placing special emphasis on the detection of subclinical disease, particularly coronary artery disease. Cases which illustrate the spectrum of asymptomatic coronary disease will be presented. Other entities discussed will include conduction defects, mild valvular lesions, arrhythmias, and degenerative joint disease of the spine. An overall approach based on age, screening milestones, and specialized tests will be presented. Finally, a data repository on all pilots with chronic high G exposure will be discussed.

Lymphomas associated with a tolerant lymphocytic choriomeningitis virus infection in mice.

On each of 2 occasions when a tolerant lymphocytic choriomeningitis (LCM) virus infection was introduced experimentally by a natural route into breeding stock of the Pirbright P(SD) mouse strain, and a comparison made with genetically identical controls, where was in successive generations an overall 15-fold increase in the incidence of lymphomas. Most of these were recognized clinically after the age of 16 months. The same observation was made in mice of the P(H) strain from which the P(SD) strain had been surgically derived. The finding is interpreted as the activation of an endogenous viral oncogene by the LCM infection. It was concurrently observed that the incidence of mammary tumours in the P(H) strain mice before the age of 16 months was markedly lower in the animals infected with LCM.

A nomogram to predict lean body mass in men.

A simple three scale nomogram is presented to predict lean body mass in men from two anthropometric measurements: height and the circumference of the flexed biceps. The prediction equation used in constructing the nomogram was established from data collected on 198 USAF aircrewmen. Lean body mass was determined on these men by a standard tritium dilution technique. The equation was validated on a total of 65 additional flyers, comparing measurements obtained by tritium dilution (r = 0.91), 40K wholebody counter techniques (r = 0.90), and water-displacement techniques (r = 0.86). A second nomogram demonstrates the flexibility in using this anthropometric-type prediction of body composition to arrive at personalized weight standards.

The electrocardiographic response to maximal treadmill exercise of asymptomatic men with left bundle branch block.

This study presents the results of maximal treadmill testing and coronary angiography in 31 asymptomatic USAF aircrewmen with acquired left bundle branch block. There were two subgroups: 26 men with normal coronary angiography and five men with significant angiographic coronary angiography and five men with significant angiographic coronary artery disease. The mean amount of maximal ST-segment depression induced by treadmill exercise was --0.5 mv. for both groups and the range in the normal subgroup was --0.3 to --1.0 mv. No significant differences were found between the groups. We concluded that apparently healthy, asymptomatic men with acquired left bundle branch block can have considerable ST-segment depression in response to maximal treadmill testing and that their ST-segment response cannot be used to make diagnostic decisions about them.

Fibrosarcomas induced by cobalt chloride (CoCl2) in rats.

Hyperlipaemia persisted for more than 12 months in rats treated with cobalt chloride, 9 of 20 treated rats and 1 control rat died within the first year, and 8 of the surviving animals developed fibrosarcomas--in 4 of these the tumour was far removed from the injection sites. The results are discussed with reference to the use of cobalt chloride treatment for anaemia in patients with chronic renal failure.

Angiographic findings in asymptomatic aircrewmen with electrocardiographic abnormalities.

Cardiac catheterization was used to evaluate 298 asymptomatic, apparently healthy aircrewmen with electrocardiographic abnormalities. These men were identified from annual electrocardiograms and exercise tests used to screen for latent heart disease. Data from 27 additional symptomatic aircrewmen who underwent cardiac catheterization because of mild probable angina pectoris are also included. The men were grouped according to major reason for cardiac catheterization. The order of groups by increasing prevalence of coronary artery disease was as follows: abnormal treadmill test (labile lead only), supraventricular tachycardia, right bundle branch block, left bundle branch block, abnormal treadmill test, ventricular irritability, probable infarct and angina. Approximately 60 percent of the men were completely free of angiographic coronary artery disease. Risk factors and other possible causes for the electrocardiographic abnormalities are discussed. The electrocardiographic abnormalities studied have a poorer predictive value for coronary artery disease in asymptomatic apparently healthy men than in a hospital or clinic population.

Body fat: its relationship to coronary heart disease, blood pressure, lipids and other risk factors measured in a large male population.

Obesity is variably considered to be a major contributor to hypertension and hyperlipidemia, and its treatment is recommended in the management of coronary heart disease. Total body fat was measured by tritium dilution in a large male population and its relationship to age, blood pressure, serum lipids, uric acid and the diagnoses of coronary heart disease, hypertension and glucose intolerance was examined. In addition, three commonly used weight: height indices of obesity were correlated with each of these parameters. The correlation of body fat with blood pressure, serum cholesterol and triglycerides, although statistically significant, was of only small magnitude. Mean levels of body fat were not significantly different between patients with coronary disease and control subjects, whereas serum cholesterol and, to a lesser extent, systolic blood pressure were potent risk factors for the disease. It is concluded that obesity is only a minor determinant of blood pressure and lipid level, and that its contribution to coronary heart disease is small or nonexistent.

A comparison of two bipolar exercise electrocardiographic leads to lead V5.

ST-segment depression and slope were compared in three lead systems (V5, CC5, and CM5) and in two groups of patients using both visual analysis of electrocardiographic paper and computerized techniques. Bipolar lead CC5 was found to be comparable to lead V5 when visual analysis of electrocardiographic recordings was utilized. Bipolar lead CM5 was found not to be comparable to lead V5 and to be less sensitive if classic criteria for slope were used. The technique of computerized analysis mad measurements of slope and amplitude to a reproducible level not possible with the standard technique. Statistically significant differences were found between the exercise electrocardiographic leads utilizing computerized electrocardiographic analysis . We conclude that computerized techniques of electrocardiographic analysis require new criteria for defining an abnormal repolarization response. The criteria must be specific for different electrocardiographic leads if the repolarization changes in these leads are to have comparable diagnostic significance.

Heat stroke: a review.

Heat stroke is a complex clinical picture caused by extreme elevation of body temperature and is especially prevalent in hot climates. The danger of heat stroke has apparently always accompanied unacclimatized man on his way through arid zones, and was often the cause of man's fatal adventures in the desert. Large numbers of unacclimatized urban dwellers have suffered when the urban areas have been involved in heat waves. Heat stroke has also been a major problem in hot industrial environments. This paper is a review of pertinent literature on this subject.

Value of exercise testing for screening asymptomatic men for latent coronary artery disease.

Treadmill exercise testing identifies a group of men at high risk for coronary atherosclerotic heart disease. However, the predictive value and sensitivity limitations are obvious. An abnormal electrocardiographic response does not absolutely predict the presence of coronary atherosclerotic heart disease, and a normal response does not rule out this possibility. Thus in appropriate instances when the minimal risk of coronary angiography is justified this procedure can be used to determine the anatomic correlation of exercise-induced functional ST-segment changes.

Interpretation of an abnormal oral glucose tolerance test encountered during multiphasic laboratory screening.

We have studied 162 healthy male flyers who had repeat glucose tolerance tests at intervals of 6 months to 2 years. On the premise that an abnormal oral glucose tolerance test (OGTT) was not reproducible because standard criteria were not strict enough, we evaluated 11 different criteria for diagnosing an abnormal OGTT. The number of abnormal tests varied according to the criteria but, no matter how the criteria were varied, the best reproducibility of any abnormal test on repeat testing was 50%. Factors affecting the reproducibility of an abnormal test are discussed. We conclude that a single, standard 2-h oral glucose tolerance test should be considered only as a screening test for diabetes mellitus, and that a final diagnosis of chemical diabetes mellitus should be made only if the carbohydrate in-tolerance consistently worsens or if insulin curves show hypofunction of the Islets of Langerhans. Our recommendations for followup studies of a patient with an initial abnormal OGTT are outlined. This study illustrates the importance of basic definitions of diagnostic criteria for diseases which have a long-term effect on the health of the flying population.

Antihypertensive drug therapy in USAF flying personnel.

The reviewed data concerns hypertensive USAF aircrew members, as available from the WAVR File (July 1973) and the records of the Aeromedical Consultation Service at USAFSAM (1 July 1972-30 June 1973). Of over 6,500 entries in the WAVR File, hypertension was listed as a diagnosis for 754 individuals. Drug therapy had been instituted in 379 cases (50.3%) of the total. Statistics regarding ranks, age groups, and aeronautical ratings are presented. The group included 520 pilots, of whom 268 were receiving drug therapy. Associated medical conditions, e.g., abnormal EKG findings, carbohydrate intolerance, and hyperuriciemia, are presented. Similar data are reviewed for the 84 patients evaluated on the Aeromedical Consultation Service (USAFSAM).

Influence of primary bile acid feeding on cholesterol metabolism and hepatic function in the rhesus monkey.

In three healthy rhesus monkeys fed chenodeoxycholic (chenic) acid, there was no consistent increase in the total exchangeable cholesterol pool or input to the cholesterol pool. In three similar monkeys fed cholic acid, the total exchangeable pool increased in all animals and input to the cholesterol pool increased in two. Serum glutamic-pyruvic transaminase (SGPT) increased transiently in two animals in each group. Morphologic abnormalities (triaditis with atypical ductular proliferation) were noted in one animal; this animal was ingesting chenic acid but had normal liver test results at the time of biopsy. Biliary bile acids contained 8 to 14 percent lithocholic acid in the chenic acid group and 48 to 72 percent deoxycholic acid in the cholic acid group.