Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial.

Background: Severe cardiac glycoside cardiotoxicity after ingestion of yellow oleander seeds is an important problem in rural areas of Sri Lanka. Currently, patients must be transferred to the capital for temporary cardiac pacing. We did a randomised controlled trial to investigate whether anti-digoxin Fab could reverse serious oleander-induced arrhythmias.

Management of acute myocardial infarction in general medical wards in Sri Lanka.

The study was designed to evaluate the management of acute myocardial infarction in the general medical wards of the National Hospital of Sri Lanka. All patients with acute myocardial infarction admitted from September 1996 to August 1997, were evaluated with regard to the time delay in admission and drug treatment. The facilities for monitoring and resuscitation were also assessed.

Time delay to thrombolytic therapy--a Sri Lankan perspective.

Reducing the time delay in initiating thrombolytic therapy in acute myocardial infarction is critical in maximising the functional and survival benefit. We analysed 120 consecutive admissions for thrombolytic therapy to the Coronary Care Unit. The total delay was divided into prehospital, in-hospital and Coronary Care Unit stages, and the median delays were found to be 130, 70, and 15 minutes, respectively.

Recent aspects of alcoholism in Sri Lanka--an increasing health hazard.

Eighty-five patients (81 males and 4 females) with significant alcoholic histories were studied. Alcohol misuse was directly or indirectly responsible for about 5-10% of hospital admissions in Sri Lanka. Prevalence of alcoholism in patients below 40 years (43% of cases) or with a strong family history (56% of cases) were demographic features simulating trends in developed nations.

Sensitivity of electrocardiographic criteria for left ventricular hypertrophy according to type of cardiac disease.

The sensitivity of 30 electrocardiographic criteria for left ventricular (LV) hypertrophy, isolated or combined, was examined to determine the relation to the underlying disease. Patients with coronary artery disease (CAD), systemic hypertension, valvular heart disease and cardiomyopathy were evaluated. A cardiac partition technique was used to define ventricular hypertrophy.

The reliability of the routine chest roentgenogram for determination of heart size based on specific ventricular chamber evaluation at postmortem.

Routine posteroanterior and lateral chest radiographs in 268 patients were analyzed to determine heart size--normal, cardiomegaly, or specific chamber enlargement--using specified radiographic criteria for enlargement. The accuracy of this determination was compared with a specific ventricular mass derived from a postmortem cardiac chamber partition technique. The data indicate that in the majority of cases (greater than 70%) a normal-sized heart or cardiomegaly can be correctly determined from the chest x-ray either by the subjective criteria of chamber enlargement or by measurement of the transverse diameter.

Reevaluation of electrocardiographic criteria for left, right and combined cardiac ventricular hypertrophy.

Cardiac chamber weight was determined at necropsy in 323 men to develop correlative studies of electrocardiographic criteria for ventricular hypertrophy. Thirty recommended criteria for left ventricular (LV) hypertrophy, 10 for right ventricular (RV) hypertrophy, and combinations of both criteria for combined hypertrophy were evaluated. Four methods for electrocardiographic diagnosis of LV hypertrophy were derived: (1) a modification of the Romhilt-Estes point system; (2) the presence of any 1 of 3 criteria: (a) S V1 + R V5 or V6 greater than 35 mm, (b) left atrial abnormality, or (c) intrinsicoid deflection in lead V5 or V6 greater than or equal to 0.

Descriptive characteristics of the electrocardiogram from autopsied men free of cardiopulmonary disease--a basis for evaluating criteria for ventricular hypertrophy.

Most measurements establishing standard values for the normal electrocardiogram have been derived from a healthy population, whereas many electrocardiographic interpretations are necessary in hospitalized or seriously ill patients. Therefore, the characteristics of the electrocardiogram were described from 48 autopsied men known to be free of cardiopulmonary disease by clinical assessment and by a special cardiac examination using postmortem coronary angiography and a chamber partition technique. Highest values, mean and standard deviation, and the upper 97.

Quantitation of fibrosis of the heart in chronic obstructive pulmonary disease with and without cor pulmonale.

This study examined the hearts of 55 patients dying of chronic obstructive pulmonary disease, with and without cor pulmonale, quantitated histologically the degree of myocardial fibrosis in the left and right ventricle, and determined the relationship to associated disease states. Comparison has been made to a control group of 17 patients free of cardiopulmonary disease. Patients with associated and advanced ischemic heart disease, as proved by marked atherosclerosis and myocardial infarction, have significantly increased myocardial fibrosis throughout all layers of the left ventricular wall in comparison to control patients or patients with chronic obstructive pulmonary disease free of associated cardiac disease.

Left atrial abnormality as an electrocardiographic criterion for the diagnosis of left ventricular hypertrophy in the presence of right bundle branch block.

Left atrial (LA) abnormality determined from precordial lead V1 was assessed by 2 observers as a criterion of left ventricular (LV) hypertrophy in the presence of right bundle branch block (BBB) in 23 patients. The presence of LV hypertrophy was confirmed from a postmortem cardiac partition technique and defined at 2 levels of confidence: probable and definite hypertrophy. Observers reliably differentiated between the hypertrophied and normal-sized ventricle in the presence of right BBB by using LA abnormality as an electrocardiographic criterion.

Ventricular arrhythmia before and after aorto-coronary bypass surgery.

The influence of aorto-coronary bypass surgery (ACBS) on ventricular arrhythmia was examined in 57 patients. Six-hour Holter monitoring was done on the day prior to and 3 mth after ACBS. None of the patients were on any antiarrhythmic drugs during these recordings.

Transient emboligenic aortoarteritis. Noteworthy new entity in young stroke patients.

The clinical and postmorten anatomical data in a group of ten patients with occlusive cerebrovascular disease in the 15- to 40-year group were studied. The occlusion of the peripheral supply artery in the brain in all cases was found to be due to thromboemboli generated from focal thrombotic lesions situated proximally in the aorta and elastic arterial trunks arising from it. These central thrombotic lesions were caused by a transient form of focal aortoarteritis that primarily affects medial elastic tissue underlying the thrombi.

Observations on the treatment of dissection of the aorta.

The results are presented of treatment in twenty-three patients with dissection of the thoracic aorta, in four of whom it was acute (less than 14 days' duration), and in nineteen chronic (more than 14 days' duration). Sixteen patients had Type I and II dissection (involving the ascending aorta) and five Type III (descending aorta at or distal to the origin of the left subclavian artery); in two, dissection complicated coarctation of the aorta in the usual site. Thirteen patients had aortic regurgitation.