Angiology

We tested the correlation between impedance plethysmography (IPG) and venography (VG) in evaluating patients with suspected venous thrombosis of the lower extremity. Three hundred and eight limbs in 205 such patients were evaluated by both IPG and VG. With the results of the venograms as standards, 169 limbs (55%) were classified as "normal" and 139 limbs (45%) as "abnormal." Acute deep venous thrombosis (DVT) was present in 65 limbs, 47 of which had DVT of the major veins, popliteal and above. The correlated IPG was positive in 43 limbs, with a sensitivity of 91%, a specificity of 89%, and P < 0.001.

The prevalence of thoracic outlet compression of the subclavian or axillary artery was determined in both upper extremities of 130 normal individuals. Photoplethysmographic (PPG) recordings were made simultaneously in each index finger during performance of Adson, costoclavicular, and hyperabduc tion maneuvers. Significant arterial obstruction resulted from one or more of these maneuvers in 78 subjects (60%) and was bilateral in 43 individuals (33%). Thoracic outlet arterial compression is common in normal persons and thus has little diagnostic value in symptomatic patients.

Endocarditis restricted to the base of the mitral valve and an adjacent calcified anulus is rare. This report describes a hitherto unre corded complication: massive intramural hemorrhage of the left atrium.

We describe the case of a young woman with systemic lupus erythematosus (SLE) who suffered an acute myocardial infarction (MI). The patient was treated by corticoste roids in addition to the usual management for acute MI. The role of arteritis in produc ing the infarction is also discussed.

Two cases of ventricular fibrillation occurring during a physician-directed exercise program are described. Both were successfully resuscitated. No single clinical parameter can predict which patient is at increased risk for exercise-in duced ventricular fibrillation. We conclude that all cardiac patients who wish to exercise should do so only with physician supervision.