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The efficacy of oral enoximone, a new positive inotropic and vasodilator agent; was assessed in 12 patients with chronic congestive heart failure (New York Heart Association [NYHA] class II or III) in a double-blind randomized crossover comparison with placebo. Duration of each treatment was 6 weeks and the dose of enoximone was 150 mg tid. Efficacy was assessed by exercise tolerance, symptoms, radionuclide angiography for ejection fraction at rest and during exercise, and Holter monitoring. Two patients were withdrawn before completion of the study, one with pulmonary edema after 1 week on placebo and the other for noncompliance with enoximone therapy. Symptomlimited exercise capacity improved with enoximone by 30% and 43% (p < .01) compared with baseline after 2 and 6 weeks treatment, respectively. Ejection fraction improved at rest (p < .02) with enoximone but not with placebo. No change was found during exercise. Heart rate and blood pressure remained unaltered. During treatment with enoximone symptoms of exertional dyspnea and fatigue were improved and NYHA class decreased by at least one class for every patient. Holter monitoring revealed an overall increase (NS) in ectopic activity during enoximone therapy. There were no serious adverse effects and laboratory values did not change significantly. The addition of enoximone to the existing therapy of patients with moderately severe congestive heart failure provided clear and sustained subjective and objective benefit when compared with placebo.

In 1919 Stoland and Kinney (1) published a brief statement concerning the relation of external temperature to the toxicity of administered thyroid. They found that rats kept at 32°C. and receiving 0.2 gin. of desiccated thyroid daily, lived an average of 7.3 days; others at 25°C. lived an average of 22 days, while a third group kept at 180C. lived more than 32 days. A survey of the literature reveals no other reports specifically concerned with this question, although the more general problem of the relation of the environmental temperature to the structure and activity of the thyroid has been the subject of several investigations (2-9).The present work is partly the outgrowth of the observation by one of us (10) that rats are much more resistant to thyroid and thyroxine in cool than in warm weather. It is improbable that this simple and obvious relationship has not been frequently observed by experimental workers, and certainly in clinical practice; yet it is remarkable that even in the more authoritative and comprehensive discussions of the physiology, pharmacology and therapeutics of the thyroid hormone, little or no mention is made of the importance of environmental temperature in relation to its tolerance and toxicity. For this reason the present report seems to be justified. MethodsThe rats used in this work were from a pure inbred Wistar strain reared in the laboratory under very favorable conditions. Special attention was given to the

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