Louis A. Soloff

Reactivation of Rheumatic Fever Following Mitral Commissurotomy

A febrile syndrome following mitral commissurotomy is described. This syndrome consists of the episodic recurrence of a combination of events first occurring after a variable latent phase following mitral commissurotomy and is uniformly characterized by precordial pain and fever, is commonly featured by the precipitation or intensification of pre-existing heart failure, is variably accompanied by migratory joint pains, arrhythmias, hemoptysis or psychosis and sometimes terminates in death. The syndrome was found to occur in 43 (24.0 per cent) of 179 consecutive individuals subjected to mitral commissurotomy. Because we have never encountered such a syndrome following any other type of nonrheumatic cardiac or pulmonary surgery and for other reasons we are compelled to regard it as a reactivation of rheumatic fever.

Acute pulmonary embolism

Abstract Pulmonary embolism is the commonest lethal pulmonary disease in the United States and is a contributing cause to the deaths of many additional patients. Yet its clinical recognition remains difficult and often impossible. This is so because the lung has no pain fibers, and has a large vascular reserve, and because clinical manifestations, when present, are variable, complex, and not infrequently completely obscured by the underlying disorder. It is unlikely that additional clinical observations will significantly increase accuracy of diagnosis. Increased accuracy of diagnosis will depend upon the development of new screening tests and the fullest use of those presently available. These latter are the triad of increased serum lactic dehydrogenase and bilirubin with a normal serum glutamic oxalacetic transaminase, frequently repeated electrocardiograms and roentgenograms of the chest, lung scanning, and (hopefully) ultrasound. There would appear to be no reason to use screening tests in the vast majority of instances of pulmonary embolism which are clinically silent and free of clinical precursors, and yet these emboli may be forerunners of an additional pulmonary embolism for which treatment is still not satisfactory. Hence the best hope for reducing the morbidity and mortality from pulmonary emboli lies not in treatment but in prevention.

Pericarditis and Perimyocarditis Associated with Active Mycoplasma pneumoniae Infection

In 13 patients an association existed from 1970-73 between Mycoplasma pneumoniae infection and acute pericarditis (in eight) or perimyocarditis (in five). In 12 patients the association was moderately probable, with a fourfold rise in complement-fixing antibody titers between acute and convalescent phase sera being noted. In the last patient, a lesser-order association was found using only convalsecent phase serum. The presence of influenza, herpes simplex, Coxsackie B, or adenovirus was excluded by serologic testing. Acute illness was variable, with four patients developing heart failure. Long-term evaluation (mean, 47 months) found eight patients asymptomatic and three symptomatic. Two patients died. Residual effects of the Mycoplasma infection seemed at least partially responsible in one compromised patient and in one who died. Mycoplasma infection should be considered in the presence of acute cardiovascular decompensation, especially when preceded by upper respiratory infection, and added to the possible causes of idiopathic cardiomyopathy.

Measurement of the initial rate of serum cholesterol esterification

Abstract A method for the measurement of initial rate of serum cholesterol esterification is described. The technique is a modified version of the assay described originally by Stokke and Norum (7). Improvements include the depression of background values as well as an increase in the overall efficiency of the procedure. The study of healthy male human subjects revealed that the initial rate of cholesterol esterification increases linearly with the individuals serum free cholesterol content.

Anomalous coronary arteries arising from the pulmonary artery

Abstract 1. 1. A case in which the left coronary artery arose from the pulmonary artery is described. 2. 2. The literature of anomalous coronary arteries arising from the pulmonary artery is reviewed.

Serum cholesterol esterification in species resistant and susceptible to atherosclerosis

Abstract Initial rates of cholesterol esterification were measured in rat, rabbit, pig, dog, guinea pig and human serum. The data indicate a tendency for the rate of esterification to increase with serum free cholesterol levels in all species. The fractional rate of esterification ( % cholesterol esterified/min) for the species in decreasing order are rat, guinea pig, rabbit, dog, pig and man.

The supernormal phase of ventricular excitation in man. Its bearing on the genesis of ventricular premature systoles, and a note on atrioventricular conduction

Abstract Artificially produced ventricular premature beats apparently due to a supernormal phase of ventricular excitation in man is demonstrated. This phase occurs within 0.04 second of the beginning of the descent of the T wave. Subthreshold stimuli can produce parasystole with constant coupling and may explain some hitherto obscure A-V arrhythmias.

Incidence of Significant Coronary Artery Disease in Rheumatic Valvular Heart Disease

Abstract Thirteen percent of 77 patients who died after surgical treatment to correct valvular dysfunction were found at necropsy to have clinically significant coronary artery disease. This disorder occurred at all ages but was more common after age 40 years. It was commoner in aortic valvular disease either alone (17.7 percent) or combined with mitral valvular disease (21.1 percent) than in isolated mitral valvular disease (8.6 percent). This difference might be due to the older age at death of the patients who had aortic lesions. Because clinically significant coronary artery disease complicating valvular heart disease is difficult to recognize on clinical grounds and because it might adversely affect prognosis, coronary cinearteriography and left ventricular angiography are suggested in the overall evaluation of patients for valvular heart surgery. Such studies should be made particularly in those above age 40 years and in those with X-ray evidence of aortic calcification and with atherosclerosis detected during retrograde catheterization of the femoral artery.

Sotalol: A new, safe beta adrenergic receptor blocking agent∗

Abstract Sotalol [MJ 1999-dl-4(2-isopropylamino-1-hydroxylethyl) methanesulphonanilide] is a highly selective beta adrenergic receptor blocking agent devoid of major toxic effects in the isolated and intact myocardium of experimental animals. This study was performed to determine whether Sotalol acts as a beta adrenergic receptor blocking agent when given intravenously to man, the dose at which it blocks the beta adrenergic stimulating effect of an intravenous infusion of isoproterenol, the duration and constancy of its action and whether toxic effects would appear when the drug had been used in doses two to three times larger than the effective beta adrenergic blocking dose in man. Three healthy volunteers were utilized in an acute study to determine the beta adrenergic receptor blocking dose and 5 healthy volunteers were utilized in a chronic study to determine the constancy of action and possible toxic effects. Sotalol, in doses of 0.06 to 0.08 mg./kg., produced effective blockade of the isoproterenolinduced stimulation of the beta adrenergic receptors. These effects remained constant for five days, the duration of the chronic study. The drug, in doses two to three times larger than that required to inhibit the chronotropic action of isoproterenol, was well tolerated and produced no untoward or toxic effects in either the acute or chronic study. Sotalol, in doses sufficient to block the isoproterenol-induced beta adrenergic receptor stimulation, did not reduce cardiac output or cardiac work below control values. If it can be verified that oxygen consumption is reduced, then cardiac efficiency would be increased by Sotalol. Sotalol would thus be safe to use in those clinical states in which beta adrenergic blockade is indicated but cardiac depressant drugs are contraindicated.

Studies on Enzymatic and Molecular Properties of Lecithin: Cholesterol Acyltransferase

I. Cholesterol esterification in human serum was measured in healthy male and female subjects using a modified version (2) of the Stokke & Norum assay technique (1). Strong positive correlation was observed between the rate of cholesterol esterification and serum free cholesterol esterification (rp = 93, p < 0.001 for males: rp = 81, p < 0.001 for females), suggesting that the fractional rate of esterification is a more useful parameter for comparative studies than the rate of esterification.II. Purification and characterization of LCAT. Highly purified LCAT preparations were obtained by using the combined techniques of density gradient centrifugation, DEAE cellulose chromatography, and affinity chromatography. A stable 4000-fold purified preparation was obtained as the result of this procedure, yielding 2 bands on acrylamide gel electrophoresis in the presence or absence of sodium dodecyl sulfate (SDS). Molecular weight determinations on calibrated gel columns give a value of 95, 000 in the absence and a...