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Left partial ventriculectomy has been proposed for treatment of heart failure. We investigated the effects of isolated left partial ventriculectomy and left partial ventriculectomy associated with mitral annuloplasty on refractory heart failure due to idiopathic dilated cardiomyopathy.

A group of 533 patients had cardiac valves replaced with homologous dura mater valves. The dura mater was preserved in a solution of 98 per cent glycerol and antibiotics for a period of 12 days before use. The leaflets were mounted in a stainless steel ring covered by Dacron velour. Two hundred forty-five patients had mitral valve replacement; 205 patients, aortic valve replacement; 17 patients, tricuspid valve replacement; and 2 patients, pulmonary valve replacement. Sixty-four patients were subjected to multivalvular replacements. The patients were followed for a period of 1 to 40 months after surgery with satisfactory clinical and hemodynamic results. Because 2 patients developed endocarditis produced by fungii, fungicidal drugs were added to the preservative solution. No bacterial endocarditis has been observed. No pressure gradient through the valve has been noted at rest. Anticoagulant drugs have not been used in the postoperative period.

Multiple mechanisms have been proposed to explain the hyperventilation and the limited exercise capacity in congestive heart failure (CHF) including increased intrapulmonary pressures, total pulmonary resistance, and airway abnormalities. We investigated the hypothesis that inhalation of nitric oxide could influence the maximum exercise capacity and excessive ventilatory response to exercise in CHF. Fifteen patients in CHF (mean age 48 +/- 12 years) underwent a control and a nitric oxide inhalation progressive treadmill exercise test with 30 ppm. We determined the maximum oxygen consumptiom (peak VO "2 ), CO "2 production (VCO "2 ), minute pulmonary ventilation (VE), respiratory rate, tidal volume (VT), ventilatory equivalent for oxygen (VE/VO "2 ), ventilatory equivalent for carbon dioxide (VE/VCO "2 ), estimated physiologic dead space/tidal volume ratio (VD/VT), VE/VCO "2 slope, heart rate, systemic arterial pressure, VE/exercise time slope, and VT/exercise time slope during every incremental exercise. Mean maximum exercise values of heart rate, systolic systemic arterial pressure, diastolic systemic arterial pressure, VD/VT, respiratory rate, peak VO "2 , VO "2 /heart rate, VE/CO "2 , and maximum exercise time were unchanged by inhalation of nitric oxide. There was a strong trend toward reduction of VE/VO "2 from 53 +/- 15 to 47 +/- 12 ( p = 0.051) and in maximum VE from 58 +/- 21 to 48 +/- 17 L x min ^-^1 ( p = 0.059). Maximum VT decreased from 1639 +/- 556 to 1406 +/- 479 ml ( p = 0.04). The VE/VCO "2 slope was reduced from 43 +/- 12 to 35 +/- 8 ( p = 0.018). Two patients had signs of pulmonary congestion during peak exercise or the recovery period with inhalation of nitric oxide. The VE/exercise time slope and VT/exercise time slope during incremental exercise were reduced by inhalation of nitric oxide, demonstrating a statistically significant minor increase in VE and VT. Inhalation of nitric oxide attenuated the excessive increase in VT response to exercise in CHF. The l -arginine-nitric oxide pathway may be involved in mechanisms contributing to hyperventilation during exercise in CHF. (Am Heart J 1997;134:737-44.)

Objective To study the effects of oestrogen replacement treatment on fibrinolytic potential in postmenopausal women. Design Randomised, double blind, placebo controlled trial of oral 17β-oestradiol. Setting Subjects were evaluated in the outpatient setting. Patients Nineteen postmenopausal women with mild dyslipidaemia, aged 44 to 69 years (mean (SD) 55.7 (6.7)). Main outcome measures Fibrinolytic activity (fibrin plate assay) and tissue plasminogen activator (t-PA) antigen were measured at baseline and after three, six, and nine weeks of each treatment. Results After nine weeks of 2 mg oestradiol treatment, there was a significant increase in fibrinolytic potential compared with placebo, as indicated by an increase in fibrinolytic activity (mean (SEM), 80 (9) v 54 (5) mm ² of lysis in the fibrin plate, 2 mg v placebo, p = 0.002) and a decrease in t-PA antigen (5.8 (0.9) v 8.4 (1.2) ng/ml, 2 mg v placebo, p < 0.001). There was a similar trend with the 1 mg dose but the changes were less noticeable. ConclusionsHormone replacement treatment with 17β-oestradiol for nine weeks significantly increased fibrinolytic potential in postmenopausal women with mild dyslipidaemia. This suggests that the cardioprotective effect of oestrogen may be mediated, in part, by an increase in fibrinolytic potential.

An epidemic which occurred on the maternity and newborn service of a moderate-sized hospital is reported. It is the first such reported outbreak to involve the organism Group A, type 33, β-hemolytic streptococcus. The manner in which the epidemic was recognized and the steps taken to control it are described. The importance of specific typing to relate a diversity of infections is stressed. Recommendations are made relative to the prevention, early recognition, and control of future epidemics.