Lawrence Scherr

Left ventricular function and rapid release of creatine kinase MB in acute myocardial infarction. Evidence for spontaneous reperfusion.

Intracoronary thrombolysis during acute myocardial infarction in human beings is associated with rapid release of creatine kinase and improvement of the cardiac ejection fraction. To examine the phenomenon of spontaneous coronary-artery recanalization, we studied the release of creatine kinase MB and sequential radionuclide ventriculograms in 52 patients with transmural myocardial infarction. Patients were divided into two groups according to whether the release of creatine kinase MB (time from base-line to peak serum level) was rapid (n = 24) or slow (n = 28). Patients with slow release had no significant change in global or regional ejection fraction from the time of admission to discharge. However, global ejection fraction in patients with rapid release improved from 0.38 +/- 0.09 (mean +/- S.D.) to 0.48 +/- 0.08 (P less than 0.001). The regional ejection fraction of Q-wave regions also improved, from 0.33 +/- 0.11 to 0.43 +/- 0.13 (P less than 0.001). A negative correlation (r = -0.52, P less than 0.001) existed between time to peak enzyme level and degree of improvement in ejection fraction. With increasing left ventricular damage, patients with rapid release had greater increments in creatine kinase MB than comparable patients with slow release (P = 0.03), suggesting enzyme washout. These data are consistent with the idea that spontaneous reperfusion, leading to altered enzyme release and improvement in ventricular function, is not uncommon after acute myocardial infarction.

The management of resistant fluid-retention states with intravenous L-arginine monohydrochloride in combination with mercurial diuretics

Abstract The daily intravenous administration of a large dose of l -arginine monohydrochloride is a safe and effective method of producing hyperchloremic acidosis and restoring responsiveness to mercurial diuretics in patients with refractory retention of fluid due to hepatic cirrhosis or congestive heart failure. Results obtained with 5 patients thus treated, and the advantages of this agent in certain clinical situations, are discussed.

Graduate Medical Education: A Vital Renewal for Internal Medicine

Excerpt In this issue, the Federated Council for Internal Medicine (FCIM) states its position on methods to enhance excellence in internal medicine through graduate training programs and the method...

An Unusual Clinical SignMydriasis Associated with Hyperkalemia and Metabolic Acidosis

Excerpt Muscle paresis or paralysis is infrequently associated with hyperkalemia (1-3). This relationship was noted in the case presented here and was particularly interesting because of associated...