We report a 52-year-old man who presented with cardiac tamponade a few years after accidental breakage of an acupuncture needle that had not been removed. Thoracotomy showed a hemopericardium with penetration of the pulmonary artery by the very fine needle which was barely detected on the chest roentgenogram. This lesion was not suspected on the basis of roentgenography, two-dimensional echocardiography, or computed tomography, but was detected by the presence of other thick needles in the neck, chest and abdomen. This case showed a possible threat of ‘stealthy’ and migrating foreign bodies, such as very ñne acupuncture needles.

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The effects of enalapril on exercise capacity and neurohumoral factors during exercise were evaluted in 10 patients with heart failure. Echocardiograms and exercise testing with expired gas analysis were performed before and after enalapril. Blood samples were obtained before and after exercise. Both ejection fraction and percent fractional shortening increased with enalapril (p < 0.05). The anaerobic threshold and peak Vo₂ did not change with enalapril. Epinephrine and norepinephrine levels at peak exercise decreased with enalapril (p < 0.1). Plasma renin both at rest and at peak exercise increased with enalapril (p < 0.1). Angiotensin II was lower after enalapril both at rest and at peak exercise (p < 0.1 and p < 0.05, respectively). Aldosterone was lower after enalapril both at rest and at peak exercise (p < 0.05). Atrial natriuretic peptide (ANP) was lower after enalapril both at rest and at peak exercise. There was no significant correlations between peak VO₂ and changes in neurohumoral factors before and after enalapril during exercise. In conclusion, neurohumoral changes with enalapril occurred during exercise even if exercise capacity did not improve. Moreover, the improvement of cardiac function at rest and neurohumoral factors with enalapril did not lead to a change of exercise capacity