Sidney Alexander

DECREASED PREMATURE VENTRICULAR CONTRACTIONS THROUGH USE OF THE RELAXATION RESPONSE IN PATIENTS WITH STABLE ISCHÆMIC HEART-DISEASE

To determine whether decreased sympathetic-nervous-system activity achieved by the relaxation response could decrease premature ventricular contractions (P.V.C.s), eleven ambulatory patients with proven, stable ischaemic heart-disease and P.V.C.s were investigated. The patients, who were taking no medication for the P.V.C.s, were trained to elicit regularly the relaxation response through a non-cultic psychological technique. The frequency of the P.V.C.s was measured by computer analysis of Holter monitor tapes for 2 complete days before learning the technique, which was learned in approximately 5 minutes after the second day. Patients were instructed to evoke the response for 20 minutes twice daily thereafter. After 4 weeks, a reduced frequency of P.V.C.s was documented in eight of the eleven patients. This effect was especially striking during the sleeping hours and less so during the entire monitoring session. The relaxation response is a simple, no cost, non-pharmacological mechanism without side-effects which seemed to decrease the frequency of P.C.V.s in most patients with ischaemic heart-disease.

Fatal ventricular fibrillation during carotid sinus stimulation

Abstract The third case of ventricular fibrillation (the first with autopsy) occurring during carotid sinus stimulation is reported. Although this patient received only moderate amounts of digoxin, had no obvious electrolyte derangement, and received carotid sinus stimulation for only a few seconds, a fatal outcome occurred. The heart was normal at necropsy. Although carotid sinus stimulation is an invaluable and usually a safe tool in the treatment and diagnosis of cardiac arrhythmias, it is suggested that caution be used in applying this maneuver to the critically ill patient who has received even modest amounts of cardiac glycosides.

Effects of simvastatin and probucol in hypercholesterolemia (simvastatin multicenter study group II)

This 12-week, randomized, double-blind, multicenter study compared the efficacy, tolerability and safety of simvastatin (a potent HMG-CoA reductase inhibitor) and probucol. Two doses of simvastatin, 20 or 40 mg once daily, were compared to probucol, 500 mg twice daily. Both simvastatin doses were significantly more effective than probucol in improving the plasma lipid profile. Mean reduction in low density lipoprotein (LDL) cholesterol was 34% with 20-mg simvastatin and 40% with the 40-mg dosage, compared to a mean reduction of 8% with probucol. Simvastatin significantly decreased total cholesterol, triglycerides and apolipo-protein B, and increased high density lipoprotein (HDL) cholesterol and apolipoprotein A-I. Probucol caused some reduction in LDL cholesterol but significantly decreased HDL cholesterol. Both simvastatin and probucol were well tolerated and no serious drug-related events occurred. Simvastatin appears to be a well-tolerated and effective new agent used once-a-day as an adjunct to diet in the management of patients with hypercholesterolemia.

The Accelerator as a Generator of Steady Growth

Introduction: The theory of the accelerator to date, 174. — How steady growth is generated, 176. — Influence of the investment period, 180. — Influence of the income period, 181. — A more general case, 182. — Qualifications, 186. — Price as a stabilizer, 188. — Appendix, 193.