Gerald I. Shugoll

Medial calcinosis of Mönckeberg: A review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries

Massive medial calcific deposits (Mönckebergs calcinosis) are described in the peripheral and visceral arteries, and similar but small-sized deposits in the coronary arteries of a 41 year old woman with diabetes mellitus. Although observed by roentgenogram fairly commonly during life in the muscular arteries of the legs in middle-aged men, medial calcinosis infrequently involves the visceral arteries and has never, to our knowledge, been documented in the coronary arteries. Although it may be associated with intimal atherosclerosis, medial calcinosis, per se, does not obstruct the lumens of the arteries and, therefore, does not lead to symptoms or signs of limb or organ ischemia. The cause of medial calcinosis remains a mystery, but it appears to affect people with diabetes more frequently than those without.

Plasma membrane extensions in intercalated discs of human myocardium and their relationship to partial dissociations of the discs

Abstract Examination of myocardium from 14 patients with idiopathic hypertrophic subaortic stenosis and from 31 patients with non-obstructive cardiomyopathies of various types revealed the consistent presence of plasma membrane processes in intercalated discs. These processes extended for variable distances into the cytoplasm of adjacent cells, contained small nexuses and small knob-like endings, and sometimes terminated in the vicinity of longitudinally oriented T tubules. In three patients (one with polymyositis and congestive cardiomyopathy, one with polymyositis, congestive cardiomyopathy and chronic alcoholism, and one with congestive cardiomyopathy of unknown cause) some of the intercalated discs showed areas of dissociation which involved the undifferentiated regions and myofibrillar insertion sites. Vesicles of various sizes filled many of these areas of dissociation and appeared to be derived from swelling of the plasma membrane processes of intercalated discs.

Electrocardiographic changes in acute pancreatitis resembling acute myocardial infarction

Abstract A patient with acute pancreatitis of moderate severity showing transient ECG changes indistinguishable from those of acute myocardial infarction is being described. The patient had neither shock nor electrolyte imbalance. Recovery was uneventful. The major ECG abnormalities returned to normal within 3 days. Selective coronary arteriogram was normal. Local electrolyte derangement with membrane potential alterations inducing transient electrical silence is the most likely explanation.

The relationship between the timing of atrial systole and the useful work of the left ventricle in man

Abstract Beat-to-beat variations of as much as 100 per cent in the external left ventricular stroke work have been found in 3 patients with acquired, chronic, complete heart block studied during idioventricular pacing. These changes in work output reflect the presence or absence of a preceding atrial contraction, its placement in time, and the cardiac rate.

Percutaneous myocardial and pericardial biopsy with the Menghini needle

Abstract A simple, safe method of obtaining myocardial or pericardial tissue for analysis by light or electron microscopy or for culture has obvious application. The Menghini needle has been demonstrated to be a safe and effective instrument for the aspiration biopsy of liver and kidney. Therefore, application of aspiration biopsy with a 17 gauge Menghini needle to the heart by means of the left ventricular apical percutaneous approach has been evaluated in humans in 27 myocardial and 8 pericardial biopsies. Adequate tissue was obtained in all except one pericardial and two myocardial biopsy attempts. Of the eight pericardial biopsies, the diagnosis of tuberculous pericarditis was made in two cases and carcinomatous invasion of the pericardium was made in another two cases. Three cases showed nonspecific pericarditis. Of the 27 myocardial biopsies, 6 were examined by light microscopy and 21 were examined by electron microscopy. Light microscopy revealed no specific findings. However, electron microscopy showed moderate to severe intracellular abnormalities, the significance of which remains to be determined. Biopsy procedure takes 5 minutes or less under local anesthesia following mild premedication. Pneumothorax occurred in two patients and transient mild pleuritic chest pain occurred in four patients. Both complications were well tolerated. The technique seems effective and safe. Its utility and application remain to be determined.