Comparison of Effects of Oral Melatonin with Oral Alprazolam used as a Premedicant in Adult Patients Undergoing Various Surgical Procedures under General Anesthesia: A Prospective Randomized Placebo-Controlled Study.

Background And Aims: Preoperative anxiety is a major concern in patients undergoing any surgical procedure. Various drugs have been used to alleviate it. This study aims to compare the effects of oral melatonin versus oral alprazolam on preoperative anxiety, sedation, orientation, and cognitive function.

Pemphigus vegetans: An unusual presentation.

Pemphigus vegetans is a rare variant of pemphigus vulgaris that is characterized by vegetating lesions primarily in the flexures. We report a 45-year-old male patient with an unusual presentation of the disease. A careful analysis of the clinical and laboratory findings enabled us to reach a diagnosis and successfully treat the patient.

Primary mesenteric fibromatosis.

Primary mesenteric fibromatosis is a rare condition. We report a 46-year-old man with this condition.

Significance of exercise-induced ST-segment deviation in right-sided chest leads in the diagnosis of right ventricular ischemia.

Seventy-three patients were subjected to bicycle ergometry and exercise-induced ST-segment changes in right-sided chest leads were correlated with changes in conventional leads. ST-segment elevation in right-sided chest leads was found to be more frequent than ST-segment depression. ST-segment elevation in right-sided chest leads was commonly reciprocal to ST-segment depression in leads V3 to V7, indicating that this change is usually secondary to left ventricular subendocardial ischemia, rather than to right ventricular ischemia.

Transvenous pacing in the presence of acute right ventricular infarction.

Ventricular tachycardia and ventricular fibrillation are very frequent during transvenous pacing in the presence of acute right ventricular infarction. An acceptable pacing threshold is not usually achieved. A relatively high pacing threshold should, therefore, be accepted in these cases with minimum catheter manipulation.

Gross tricuspid incompetence due to isolated tricuspid valve prolapse.

We report a case of isolated prolapse of the tricuspid valve producing gross incompetence as documented by Doppler examination. This case shows that hemodynamically significant tricuspid regurgitation can occur from isolated prolapse of valvar leaflets.

Human equivalent doses of platelet inhibitors and experimental atherosclerosis.

The effects of aspirin, dipyridamole and sulfinpyrazone on the development of atherosclerotic lesions in the aorta were studied in cholesterol-fed rabbits. Aspirin and sulfinpyrazone prevented the development of atherosclerosis, whereas dipyridamole-treated animals developed advanced atherosclerotic lesions. As all the three drugs inhibit platelet function, some non-platelet effects are probably responsible for the differences in results.

Early detection of myocardial ischemia in hypertensive patients using exercise esophageal electrocardiography.

Effects of submaximal exercise were studied on the unipolar esophageal electrocardiogram recorded at ventricular level in 15 patients with essential hypertension who complained of chest discomfort on effort but had negative exercise stress tests using standard leads and lead CM5. Six patients developed horizontal or downsloping depression of the ST segment in the esophageal lead. The ischemic response might result from subcritical coronary stenosis in face of the increased myocardial oxygen demand of hypertrophied myocardium.

Acute right ventricular infarction without infero-posterior left ventricular infarction.

Two cases of acute right ventricular infarction associated with acute extensive anterior myocardial infarction in the absence of inferior and/or posterior left ventricular infarction are presented. Such a combination is likely to occur from acute occlusion of the left anterior descending artery in the face of severe narrowing of the infundibular (conus) artery rather than from acute occlusion of the right coronary artery.

Rheumatic tricuspid stenosis without involvement of the mitral valve.

We describe a case of rheumatic tricuspid stenosis without involvement of the mitral valve. Rheumatic disease of the tricuspid valve is very rare in the absence of concomitant mitral valvar disease. We suggest that the closing pressure at the valve is not the only factor governing localization of the rheumatic process.

Electrocardiographic correlates of hyperglycemia in acute myocardial infarction.

Clinical, biochemical and electrocardiographic parameters were studied in 10 patients with uncomplicated acute myocardial infarction with hyperglycemia (but normal glycosylated hemoglobin), and 15 age- and sex-matched patients with uncomplicated acute myocardial infarction without hyperglycemia. The magnitude of hyperglycemia correlated with the site and extent of the infarct, the magnitude of ST-segment elevation and the levels of 17-ketosteroids in the urine.

Renal effects of calcium channel blockers in vivo.

Daily output of urine was measured in three groups of five rabbits each, before and during seven days of oral therapy with nifedipine, verapamil and diltiazem. All the drugs caused significant (P less than 0.001) increases in mean daily output.

Effect of esophageal erosion on esophageal electrocardiogram.

We recorded an esophageal electrocardiogram in a rabbit before and after producing esophageal erosion. The erosion caused an increase in P wave and R wave height and inversion of the T wave. Esophageal erosion can thus cause false positive repolarization changes in the esophageal electrocardiogram.

The resting surface electrocardiogram as a predictor of future hypertension.

Resting supine and post-provocation (dynamic exercise, isometric exercise and cold pressor) levels of blood pressure were measured in 80 normotensive offspring of normotensive parents (control) and 55 normotensive offspring of parents with essential hypertension. The surface electrocardiogram (including conventional twelve leads, posterior chest leads, right-sided chest leads and bipolar precordial leads) was also recorded in all subjects. Twenty-eight offspring of parents with essential hypertension had their resting and/or post-provocation blood pressure above the upper limit of standard deviation in age- and sex-matched control group.

Bradycardia-dependent aberrancy in type I second-degree atrioventricular block.

We present an example of bradycardia-dependent aberrancy in the left posterior fascicle in the presence of type I second-degree atrioventricular block occurring in the setting of acute inferior myocardial infarction. The need for prophylactic pacing of such cases is stressed.