The acute effects of induced tachycardia on coronary sinus and arterial plasma levels of atrial natriuretic peptide and on arterial catecholamines.

Atrial natriuretic peptide (ANP) was measured in coronary sinus (CS) plasma in seven patients with induced tachycardia. Right atrial pressure (RAP) and femoral artery (FA) levels of ANP, noradrenaline (NA) and adrenaline (A) were measured before and after 5 min with tachycardia. During tachycardia, ANP in CS plasma increased from 381 +/- 273 (mean +/- SD) to 1376 +/- 1191 pmol l-1 (p < 0.0001), and ANP levels in FA plasma from 89 +/- 48 to 231 +/- 151 pmol l-1 (p < 0.005). A significant increase was observed for peak RAP, whereas mean RAP remained unaltered. While no correlation existed between the increase in CS plasma ANP level and RAP, significant correlations were found between the changes in FA plasma ANP and RAP, and between FA plasma levels of ANP and NA. Following tachycardia, significant correlations were found both between ANP in CS and FA plasma and between the changes in these plasma levels. Whereas the changes in FA plasma levels of ANP during tachycardia seems dependent of RAP and arterial plasma levels of NA, the CS plasma ANP level appears to be independent of the two factors, probably because CS plasma ANP are drained mainly from the left side of the heart.

[Emergency admissions to a department of internal medicine. Are departments of internal medicine used optimally, and how would observation units affect the management of the department?]. / Oyeblikkelig hjelp-innleggelser i indremedisinsk avdeling. Brukes medisinske avdelinger riktig, og hva kan en observasjonsenhet bety for driften av avdelingen?

279 consecutive emergency admissions to our Department of Internal Medicine were reviewed. Admission was appropriate for 58%. These patients consumed 88% of the "ward-days" during the period studied. Of the remaining patients, 22% could have been treated adequately in an observation unit, 10% need not have been hospitalized, and 10% should have been admitted to a different department. All stays in hospital lasting more than 50 days were due to lack of a place in a nursing home. If no patient had to wait more than 50 days, this would release 23% of the total "ward-day" capacity. The pressure on Departments of Internal Medicine could be reduced substantially by establishing observation units, and reducing the waiting time for a place in a nursing home.

The influence of supine relaxation on blood pressure, heart rate and atrial natriuretic peptide in normal subjects.

The effect of recumbent rest on plasma atrial natriuretic peptide (ANP) concentration, mean blood pressure (MBP) and heart rate was studied in 26 normal human volunteers. Plasma ANP concentration, MBP and heart rate were determined after 10 min sitting and after 2, 5, 8, 15 and 30 min of recumbency. During the first 5 min of recumbency there were significant decreases in both MBP (p less than 0.001) and heart rate (p less than 0.001) compared with sitting. There was a small but significant fall in plasma ANP concentration (p = 0.02) after 30 min of recumbency compared with sitting. No further reduction in MBP or heart rate occurred after 5 min supine. The level of MBP following 5 min supine correlated significantly (r = 0.44; p = 0.02) with the plasma ANP concentration 25 min later. Blood pressure and heart rate are highly dependent on posture and relaxation, and plasma ANP concentration in lesser degree. It is necessary to wait for stable baseline values to develop before any comparisons between blood pressure and plasma ANP are done. If it is assumed that a causative relation exists between blood pressure and plasma ANP level, it appears there may be a delay of 20-30 min between a change in blood pressure and the physiological response of plasma ANP level. This observation may have implications for the interpretation of the relation between blood pressure and plasma ANP concentration in healthy individuals.

Hydrops foetalis in 3 infants of a mother with acquired chronic pure red cell aplasia: transitory red cell aplasia in 1 of the infants.

A young woman with acquired chronic pure red cell aplasia (PRCA) gave birth to 3 infants with foetal hydrops. The 1st infant died shortly after birth, while the 2nd was stillborn with severe anaemia. Both had signs of increased erythropoiesis at autopsy. The 3rd infant was saved by foetal intrauterine red cell transfusions into the hepatic part of the umbilical vein. This infant had red cell aplasia lasting for about 3 months after birth, but then recovered. We believe that antibodies to red cell progenitors in the bone marrow were transferred transplacentally from mother to foetus, giving rise to severe affection of these infants. To the best of our knowledge this has not been reported previously in PRCA.