1 The effects of atenolol (50 mg and 100 mg) and oxprenolol (80 mg) on respiratory function were studied in ten patients with angina pectoris or hypertension complicated by chronic airways obstruction. 2 In patients with “fixed” airways obstruction, neither atenolol nor exprenolol significantly affected airways resistance. 3 In patients with “labile” airways obstruction, atenolol did not produce a significant increase in airways obstruction, whereas oxprenolol did. 4 Following isoprenaline challenge (1500 microgram by inhalation), atenolol permitted full bronchodilatation, whereas oxprenolol almost completely blocked the action of isoprenaline. 5 Partial agonist activity appears to be of less clinical importance than cardioselectivity.

Summary: The cardiovascular system in Paget's disease of bone and the response to therapy withcalcitonin and diphosphonate. J. W. Henley, R. S. Croxson and H. K. Ibbertson, Aust. N.Z. J. Med., 1979, 9, pp. 390–397. The cardiovascular status of 39 patients with Paget's disease of bone was studied before and after treatment with porcine calcitonin or diphosphonate (disodium etidronate). Cardiovascular abnormalities were detected in 32 patients. Systemic hypertension was present in four, ischaemic heart disease in five, cardiac enlargement in ten and evidence of valvular and/or arterial calcification in 14. Before treatment the cardiac index was elevated in 27 of 39 patients (69%) and there was a significant direct correlation with the serum alkaline phosphatase (r = 0·68, P < 0·001), urine total hydroxyproline (r = 0·51, P<0·001) and percentage skeletal involvement (r = 0·51, P<0·001). After 24 weeks' treatment with either diphosphonate or calcitonin, there was a fall in cardiac index in 17 of 18 patients; the mean reduction being 12·7% for the calcitonin group and 27% for the diphosphonate treated patients. There was a rise in mean arterial pressure and peripheral resistance in both groups (P< 0·025) and a fall in cardiothoracic ratio (P<0·005) but no change in heart rate. In 17 patients studied 24 weeks after the end of therapy, similar, though less marked changes were observed. The cardiac index was lower than the pretreatment value in all eight diphosphonate treated patients but cardiac index and biochemical indices were higher than basal levels in three of nine patients who had received calcitonin. This study confirms a high incidence of cardiovascular complications and an increased cardiac output in most patients with moderate or severe Paget's disease of bone. There was a significant correlation between these abnormalities, the biochemical indices of disease activity and the radiological evidence of skeletal disease. Treatment with either diphosphonate or calcitonin caused partial or complete biochemical remission and a reduction in cardiac index in most patients studied.

Experience of I2 patients with atrial myxoma over a period of Io years is reviewed. Eleven patients had a left atrial tumour and one a right atrial tumour.Successful surgical removal was carried out in 9 (8 left, and I right). Three patients died before operation, the diagnosis having been made in life in 2 of them.Seven patients with left atrial myxoma have been followed for 5 to Io years after operation. Two died after 4 and 6 years, respectively, from probable neoplasia of the lungs without evidence of a recurrence of the myxoma.All the remaining 5 patients are well and without any evidence of recurrence, apparently having been cured of the condition.Angiocardiography and cardiac catheterization in 4 patients revealed relief of left atrial and pulmonary arterial hypertension. There was no evidence of a space-occupying lesion in the left atrium.The importance of early diagnosis and surgical treatment is stressed, and the advisability of removing part of the atrial septum surrounding the tumour is commented upon. The value of echocardiography in establishing the diagnosis, and thus avoiding the necessity for angiography, is discussed. It is concluded that though recurrence, which has been reported in 2 cases, is rare, regular follow-up is advisable.Atrial myxoma is the commonest primary cardiac tumour (Leach, I947). The features of left atrial obstruction, systemic embolism, and systemic illness are now well known and the profile of the disorder was reviewed by Greenwood (I968).In i962, we (Goodwin et al.) reported our initial experience in the diagnosis and management of 4 patients with left atrial myxoma, 3 of whom came to successful surgical treatment.We now review the fate of I2 patients with atrial myxoma over a period of ii years, with emphasis on the long-term results of surgical treatment. PatientsThree patients died before operation. In the first the diagnosis was not made until necropsy, the significance of the association of severe pulmonary hypertension, signs suggesting mitral valve disease, haemolytic anaemia, and fever not having been appreciated (McGregor and Cullen, I959).The second patient who was reported in I962Received 30 December I971.(Goodwin et al.) was diagnosed, but died before operation. The third patient was admitted in extremis as a result of left atrial obstruction, and died after diagnostic investigation.Of the remaining 9 patients, 8 had a left and one a right, atrial myxoma. The tumour was successfully removed in all. The patient with the right atrial myxoma (Case 6) was a girl of I7 years, diagnosed and referred for operation by Dr. Ian Gray of Coventry. The clinical and angiographic features were characteristic (Barlow, Fuller, and Denny, x962) and the postoperative course has been uneventful. There are now no abnormal signs, and angiography is normal.

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