Managing public demand for badger rehabilitation in an area of England with endemic tuberculosis.

Badgers are a popular and protected species in England, despite their association with tuberculosis (Mycobacterium bovis infection) in cattle. Casualty badgers are commonly presented to veterinarians and wildlife rescue centres following injury, as a result of disease, or as orphans. Strict policies are adopted for their rehabilitation and release, with respect to the prevention of spread of tuberculosis, these policies differ between adult badgers and badger cubs.

Body surface potential mapping to monitor the effects of thrombolytic therapy following acute myocardial infarction.

The authors demonstrate the value of body surface potential mapping (BSPM) and a limited lead system in monitoring complete ECG evolution following myocardial infarction (MI) and the effects of thrombolytic therapy. They produced ST-segment isopotential maps, which indicate the site and extent of myocardial injury. Pathological Q wave maps were also produced, which intimate the extent of myocardial necrosis.

Laser recanalisation of coronary arteries by metal-capped optical fibres: early clinical experience in patients with stable angina pectoris.

The delivery of laser energy to the coronary circulation by bare optical fibres may cause perforation of the vessel. Experimental studies have shown that this complication can be avoided if the optical fibre is fitted with a metal cap to prevent the potentially dangerous forward projection of the laser beam. This study was performed to assess the feasibility and short term effects of percutaneous coronary laser recanalisation with these modified fibres.

Assessment of the effect of coronary artery bypass grafting on left ventricular performance by Doppler measurement of the aortic blood velocity during exercise.

The effect of coronary artery bypass grafting (CABG) on left ventricular (LV) function is studied noninvasively in 30 male patients with a mean age o 55.4 years using the continuous-wave Doppler technique of transcutaneous aortovelography (TAV). With a transducer applied in the suprasternal notch the main-stream aortic blood velocity recordings were obtained before and at maximum-tolerated supine exercise both prior to, and six weeks after, CABG.

Non-invasive assessment of left ventricular function in coronary artery disease by Doppler stress testing.

Left ventricular (LV) function in 62 patients presenting with chest pain typical of angina was studied non-invasively at rest and at maximum-tolerated supine exercise using the continuous-wave Doppler technique of transcutaneous aorto-velography (TAV). The signals were analysed to derive peak velocity (Vp), systolic velocity integral [an index of stroke volume or stroke distance (Sd)], and minute distance (Md; index of cardiac output = Sd X heart rate). Comparison was made with results obtained from 66 normal volunteers.

Preregistration rotation including general practice at St Mary's Hospital Medical School.

A rotation for the preregistration year which included medicine, surgery, and general practice started at St Mary's Hospital Medical School in August 1981. Initially approved by London University for an experimental period of three years, in 1984 it became an established rotation subject to normal review. Special arrangements were made for clinical work, supervision, prescribing, teaching, and other aspects of the general practice component.

The value of exercise-induced U-wave inversion on ECG chest wall mapping in the identification of individual coronary arterial lesions.

Exercise-induced U-wave inversion on chest wall mapping was compared with coronary arteriographic findings in 160 consecutive patients who presented with chest pain suggestive of ischaemic heart disease. ECG recordings were made from 16 points on the chest wall before, during and after exercise. None of the 27 patients with normal coronary arteriograms developed U-wave inversion during or after exercise (specificity = 100%).

Electrocardiographic chest wall mapping in the diagnosis of coronary artery disease.

Chest wall mapping of ST segment changes, inverted U waves, and Q waves using 16 electrocardiographic electrodes was performed at rest and during and after bicycle ergometry in 150 patients presenting with chest pain suggestive of angina. All patients underwent coronary angiography. The presence or absence of appreciable coronary artery disease (greater than or equal to 50% stenosis) was detected with a sensitivity of 98% and a specificity of 88%.

Initial assessment of meptazinol in the treatment of the pain of myocardial infarction/unstable angina.

Meptazinol, a new analgesic agent, was used to treat chest pain in patients admitted to a coronary care unit with suspected myocardial infarction or unstable angina. A pilot study showed that meptazinol was effective in relieving pain in 15 out of 22 subjects. There were no adverse haemodynamic effects nor respiratory depression.

Angina pectoris: effects of lidoflazine on exercise tolerance and chest pain.

In a double-blind study involving 24 patients, treatment with lidoflazine in comparison with placebo was associated with a significant improvement in exercise tolerance; the median increase in work performed was 62 percent. This increase was significant at the 6th week of assessment. Ten patients were followed up for a further 2 years.

Myocardial infarction - a rare complication in Henoch-Schönlein purpura.

A 29-year-old man with previous Henoch-Schönlein disease presented with multiple systemic emboli and a myocardial infarction. Subsequent investigation by angiography showed normal coronary arteries. This appears to be the first reported case of Henoch-Schönlein disease and myocardial infarction probably due to coronary vasculitis.

Audit of an inner city coronary unit.

The performance of the St Mary's Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates.

Effect of nifedipine on exercise tolerance in angina pectoris.

Nifedipine is a new antianginal drug, the calcium-antagonistic inhibitory action on excitation-contraction coupling apparently being so pronounced that, in therapeutic dosage, all other pharmacological properties are negligible. Its effect on exercise tolerance in angina was assessed by an exercise study involving 14 patients: single-stage exercise tests were chosen and the advantages of this are given. Our results suggest that the onset of action occurs after about 20 minutes, reaches a peak of activity at approximately one-half to two hours, and some effect may still be present at three hours.

A biochemical and clinical comparison of two commercially available creatine kinase iso-enzyme MB assay kits suitable for use in the routine medical laboratory.

Two methods for the measurement of plasma creatine kinase MB (CK-MB) activity were compared for analytical performance, cost, practicality, and diagnostic correlation with clinical and electrocardiographic findings in patients admitted to the coronary care unit of a district general hospital. The methods were column chromatography and immunoinhibition. Both methods were found acceptable, and the method to be adopted would depend on the staff arrangements and resources available in the laboratory.

Blood viscosity, red-cell flexibility, haematocrit, and plasma-fibrinogen in patients with angina.

Whole-blood viscosity, haematocrit and plasma-fibrinogen concentration were measured in 22 patients with angina and 22 controls. All four variables were significantly higher in patients with angina. When the viscosity was corrected to a standard haematocrit (45%), however, there was no significant difference in the mean viscosity of the two groups, indicating that the higher viscosity in patients with angina is the result of the higher haematocrit.

Oral disopyramide for the prevention of arrhythmias in patients with acute myocardial infarction admitted to open wards.

Patients with acute myocardial infarction admitted to open wards of three hospitals were given either oral disopyramide (100 mg four times daily) or matching placebo, prophylactically, for seven days. The drug was associated with a significant reduction in mortality (p = 0-0025) and in incidence of extension of infarction (p = 0-01), ventricular fibrillation (p = 0-05), and ventricular tachycardia (p = 0-01). Disopyramide was not associated with any particular complication or side-effect.