Emergency portable cardiopulmonary bypass for abrupt left main occlusion during coronary angioplasty. Excellent long-term survival.

A 53-year-old man had total occlusion of the left main coronary artery with subsequent cardiac arrest during attempted angioplasty of the circumflex coronary artery. Conventional resuscitation was unsuccessful. However, emergent portable cardiopulmonary bypass support in the catheterization laboratory contributed to excellent long-term survival. Portable cardiopulmonary bypass support is a valuable resuscitative tool readily available in the catheterization laboratory setting.

[The normal values of gamma-glutamyltransferase are falsely defined up to now: on the diagnosis of hypertension, obesity and diabetes with reference to "normal" consumption of alcohol]. / GGT-Normbereich bisher falsch definiert: zur Diagnostik von Bluthochdruck, Adipositas und Diabetes infolge "normalen" Alkoholkonsums.

In a large sample of 1379 adult patients and, in addition, in a smaller group of 223 other patients in whom a glucose tolerance test with measurement of serum insulin was carried out, an increase of blood pressure, pulse rate, relative body weight and serum insulin was found which correlated significantly with that range of gamma glutamyltransferase (GGT) values which erroneously so far is considered to be normal. The really normal range of the GGT is not up to 28 (measured at 25 degrees C), but only up to 10 U/l. Persons with GGT 9-12 U/l have a significantly higher blood pressure than persons with GGT up to 8 U/l. The relationship between blood pressure and GGT is the same in males and females although the females show a higher GGT for the same amount of alcohol consumed; in both, males and females, the steepest increase is just in the low GGT range between 9 and 25 U/l. The nature of this ethanol-effect is toxic, not caloric. Daily alcohol in "normal" ("social") amounts causes hyperinsulinemia (and thus increased sodium reabsorption in the Kidney) as well as increased catecholamine excretion. "Normal" alcohol consumption leading to hepatic steatosis as the "normal" condition of the population, has more health hazards than so for assumed. A GGT higher than 10 U/l (measured at 25 degrees C), is besides hyperinsulinemia the most sensitive test for pathologic changes of the metabolism and the cardiovascular parameters due to hepatic steatosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol, smoking and body build: obesity as a result of the toxic effect of 'social' alcohol consumption.

Previous work showed that obesity in the average human male is not due to increased caloric intake. To test the hypothesis that 'social' ethanol consumption causes obesity by a hepatotoxic mechanism, the relationships between alcohol intake, cigarette smoking, serum gamma-glutamyl transpeptidase (GGT) and body build were investigated in 816 adult patients, 491 males and 325 females. A large part of the Broca index variance could be explained by hepatic damage as reflected by the GGT level. The higher the GGT, the more overweight were the subjects. Hyperinsulinemia may be the pathogenetic link; insulin is the strongest known blocker of lipolysis. Almost the total variation of obesity with GGT, however, occurred in the range of GGT up to 25 U/l, which is usually, but nevertheless erroneously, considered to be the normal range. This effect was independent of sex and age. Normal GGT is below 10 U/l, which is found on average in females aged less than 20 years. Females tolerate less alcohol than males. Although GGT is as high in females as in males around age 30, males drink about three times as much ethanol. For the same GGT the Broca index is significantly higher in females than in males. GGT generally increases with age; maximum GGT is reached in females in the age group 21-40 years (due to the change in drinking habits around 1968), declining thereafter; in males at age 50. Obesity per se is not correlated with a high GGT. In the females there are hormonal factors influencing obesity. Although in the females GGT decreases on average after age 40, obesity increases (due to the decrease in estrogens). After age 50 ethanol tolerance in males decreases: they reduce their alcohol consumption, and yet the GGT remains high. -Cigarette smoking is a factor which independently influences obesity. Although people who smoke tend also to drink more alcohol, smokers are significantly leaner than nonsmokers. On average males smoke about twice as heavily as females; this contributes to the fact that on average males are leaner than females despite their higher alcohol consumption. Due to lower consumption the influence of ethanol and smoking on body build is smaller in females than in males.

Guillain-Barré syndrome and serum activities of gamma-glutamyltransferase and glutamic-pyruvic transaminase.

Objective laboratory indicators of alcohol consumption (mean corpuscular volume and serum glutamic-pyruvic transaminase (GPT), glutamyltransferase (gamma-GT), and glutamic-oxaloacetic transaminase (GOT] were measured in 18 patients with Guillain-Barré syndrome (GBS) and 710 control patients. All of the indicators examined were more frequently found to be pathological in GBS patients, reaching significance for gamma-GT and GPT. Some explanations for this result are discussed. It is concluded that alcohol consumption may be a risk factor for GBS.

Postoperative pericarditis following thymectomy for myasthenia gravis. A prospective study.

Eight consecutive patients who underwent thymectomy for the treatment of myasthenia gravis were evaluated prospectively for the development of postoperative pericarditis. In four of the eight patients (50 percent) pericarditis developed within 48 hours after thymectomy. All four had a three-component pericardial friction rub, two of the four patients had a new postoperative pericardial effusion by echocardiography, and in two typical ECG diffuse concave ST segment elevation and evolutionary ST and T wave changes developed. In the four patients with postoperative pericarditis, a malignant thymoma adherent to the pericardium was found in two, while two patients had a normal thymus histology with no adherence to the pericardium. Thus, postoperative pericarditis was found in both of the patients with a thymoma and in two of six patients without a thymoma. This study demonstrates that a high incidence of pericarditis occurs following thymectomy for the treatment of myasthenia gravis.

Repolarization variant vs acute pericarditis. A prospective electrocardiographic and echocardiographic evaluation.

Patients with ECG nonischemic ST segment elevation were prospectively studied to determine the accuracy of the initial ECG diagnoses. Evaluations were made of 131 consecutive patients by serial clinical, ECG, and echocardiography to establish a diagnosis. Eighty-six (66 percent) had an initial ECG interpretation of repolarization variant. Only three of the 86 (3 percent) subsequently met clinical criteria for acute pericarditis. Analysis of the mean frontal ST segment vector and PR segment depression revealed no significant differences between the 119 patients with final clinical diagnosis of repolarization variant and the 12 with clinical acute pericarditis. The diagnostic reliability of the initial ECG alone as a means of confirming acute pericarditis is low (9/45, 20 percent) but in the detection of repolarization variant is extremely high (83/86, 97 percent).

Tuberculous arthritis of 33 years' duration with destruction of the wrist joint.

We have described an unusual case of tuberculous arthritis with a 33-year history of symptomatic disease and destruction of the left wrist joint. This case emphasizes the chronicity and destructive potential of untreated tuberculous arthritis.