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A cohort of 50 patients under 70 years of age who had suffered their first myocardial infarction (MI) entered an exercise-based rehabilitation programme. An extensive personal interview concerning psychosocial factors, including social network and social support, as well as an assessment of an array of clinical and laboratory variables was made before the patients were discharged from the hospital. A follow-up 6 months later of the 40 patients that completed the programme showed that material social support and social anchorage at baseline predicted improvement in physical working capacity, independently from age, gender and important clinical variables. The authors conclude that psychosocial factors could be predictors of equal importance as many of the standard risk factors and clinical assessments in the rehabilitation of a majority of post-MI patients. It is suggested that training programmes should provide opportunities for involvement of the patients' social network, in order to benefit from optimal social support during the rehabilitation process.

Cardiac and neurological functions were evaluated at the time of operation in 81 randomly selected elderly patients who had sustained a fracture of the neck of the femur. Although only one-fifth of the patients had clinical signs of senile dementia or cerebrovascular disease on admission to hospital, more than half had seriously abnormal EEGs including 12 of the 15 patients who died within six months. ECGs before operation showed that patients with signs of arrhythmia or previous myocardial infarction had a much lower survival rate than those with normal or other pathological ECG signs. Nerve conduction velocity findings proved inconclusive when correlated with survival or return home. Routine EEG and ECG examinations are of value in detecting underlying dysfunctions which may not be observable clinically on admission but are important prognostic indicators for survival or return home, and may be implicated as causative factors of fracture in the elderly.

There is a multitude of method for assessing the efficiency of the arterial circulation in the legs. Most of these methods can give conclusive information about the patency of the main arteries in the leg; the level of an arterial obstruction can also be estimated. However, none of these methods provides a direct estimate of the functional importance of arterial lesions of light to moderate severity. The present report describes preliminary findings of the distribution of intravenously injected 201Thallium, a potassium analogue, in the legs during exercise provoking symptoms of ischemia. From this pilot study the general impression is that the thallium uptake pattern corresponds well with the clinical, physiologic, and angiographic picture.

Myocardial scintigraphy with cesium-131 and thallium-201 was performed in 191 patients. Previous myocardial infarctions localized to the anterior and lateral wall of the left ventricle were correctly diagnosed with both radionuclides. Inferior and posterior infarctions were only detected when thallium was used. In patients with non-informative ECG changes like bundle branch block, non-specific ST-T changes or with atypical symptoms, myocardial imaging made an essential contribution to the establishment of a correct diagnosis. The potential value of myocardial imaging in patients with valvular heart disease and in cardiomyopathy is described.

Radioactive methods have successfully been used to elucidate the cardiovascular effects of nitroglycerin for decades. Xenon-clearance and the single probe technique were originally used to measure changes in myocardial flow caused by sublingual nitroglycerin. Later, similar studies were performed using the Anger camera permitting observations on regional myocardial flow. Microsphere techniques contributed to a better understanding of myocardial distribution of capillary flow. Modern methods in nuclear cardiology such as myocardial scintigraphy and gated blood pool scanning have shown their usefulness in demonstrating the cardiovascular effect of nitroglycerin on cardiac performance. The potential use of these non-invasive methods to study nitroglycerin effects is discussed.

The left ventricular ejection fraction (EF) obtained by first pass radionuclide angiocardiography was compared with that determined by contrast angiocardiography in 49 patients. In 35 of the patients a comparison with the EF obtained by M-mode echocardiography was also made. The EF echo was determined in two ways, from the standard cube formula and the regression equation suggested by Teichholz for left ventricular volume calculations. The latter formula gave an average EF closer to the average EF obtained by isotope technique and cineangiography and was therefore used in the comparison study. Measurements of EF by isotope technique and echocardiography correlated well (r = 0.78). The correlation between these two noninvasive methods for EF determination and their cineangiographic counterpart was almost identical (r = 0.72--0.74).

1 The effect of isoprenaline on pentagastrin-induced gastric secretion was studied in conscious rats with Heidenhain pouches. The influence of isoprenaline on pentagastrin-induced release and formation of gastric mucosal histamine was also examined.2 Isoprenaline strongly inhibited pentagastrin-induced acid secretion, an inhibition which could not be overcome by increasing the dose of pentagastrin.3 Propranolol blocked the inhibitory effect of isoprenaline on pentagastrin-induced acid secretion.4 Isoprenaline enhanced pepsin secretion induced by pentagastrin, an effect which was blocked by propranolol.5 Isoprenaline reduced the increase in formation and release of gastric mucosal histamine following pentagastrin infusion, an inhibitory influence which was almost completely blocked by propranolol.6 The inhibition by isoprenaline of pentagastrin-induced acid secretion is tentatively related to alterations in gastric mucosal histamine occurring simultaneously.

1 The effect of isoprenaline on gastric secretion evoked by various means has been studied in conscious rats provided with Pavlov and Heidenhain pouches. 2 Interdigestive acid secretion in the Pavlov pouch was reduced by isoprenaline, whereas pepsin secretion was unaltered. 3 Central vagal stimulation effected by 2-deoxy-D-glucose injection evoked a gastric secretory response that was substantially reduced by isoprenaline. 4 2-Deoxy-D-glucose increased the mobilization of gastric mucosal histamine, an effect that was prevented by isoprenaline. 5 Isoprenaline infusion alone induced a slight increase in histamine mobilization and also a considerable elevation of immunoreactive serum gastrin concentration. 6 The secretory response to food in the Pavlov pouch was almost abolished by isoprenaline. 7 Although the acid response to histamine in the Heidenhain pouch was susceptible to isoprenaline inhibition, that to methacholine was not. 8 Pepsin secretion in the Heidenhain pouch preparation stimulated by histamine or methacholine seemed to be enhanced by isoprenaline.

In three patients admitted to hospital after ingestion of an overdose of chloral hydrate, the ECG showed supreventricular and ventricular tachyarrhythmias. The possible mechanism for the arrhythmias may be an enhanced automaticity of supraventricular and ventricular pacemaker cells caused by metabolites of chloral hydrate. The ventricular arrhythmia responded to i.v. treatment with lignocaine in one patient, and to phenytoin in another in whom lignocaine failed to restore a normal sinus rhythm.