The finding of abnormal levels of sex hormones in men with coronary artery disease has led to the hypothesis that alterations in sex hormones may represent an important risk factor for myocardial infarction. In this study, the sex hormone profile of 28 young men (aged less than 40 years) with myocardial infarction was compared with 28 age- and weight-matched normal men. Although the mean total serum estradiol levels and the free estradiol index of the patients and controls were similar, the mean serum total testosterone level and the free testosterone index were significantly lowered in the patients with myocardial infarction (p less than 0.01). The ratio of serum estradiol to testosterone was significantly increased in the patients (p = 0.0005) and correlated with serum cholesterol, triglycerides, and plasma glucose. A significant inverse correlation was also demonstrated between total testosterone and serum cholesterol and triglycerides. Hence, the results of this study support the hypothesis that low plasma testosterone and an increased estradiol-to-testosterone ratio may be important risk factors for myocardial infarction.

The efficacy of balloon dilatation of the mitral valve by a bifoil (2 x 19 mm) or trefoil (3 x 15 mm) catheter (single catheter technique) was assessed in 53 patients (mean age 28) with mitral stenosis, most of whom were women. The procedure was unsuccessful in three patients. After balloon dilatation the left atrial pressure decreased from 22 mm Hg to 13 mm Hg and the mitral valve gradient from 12 mm Hg to 4 mm Hg. The mitral valve area increased from 0.7 cm2 to 2.1 cm2. Exercise time on the standard Bruce protocol increased from 3.9 minutes to 7.2 minutes. In 22 (44%) patients mitral regurgitation developed or the grade of regurgitation increased. Left to right shunts with pulmonary to systemic flow ratios greater than 1:5 were detected in four patients. Transient cerebrovascular episodes developed in two patients. One patient died after emergency valve replacement for severe mitral regurgitation. Balloon dilatation of the mitral valve by the single catheter technique with the bifoil or trefoil catheters is an effective treatment for patients with mitral stenosis. Mild mitral regurgitation is a frequent complication of the procedure.

Summary:Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients.The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 + 0.10 vs 6.18 + 0.09 mmol/l) and women (6.75 ± 0.30 vs 6.44 + 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P< 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there was a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance.These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.

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Case report A 23 year old man presented with a two week history of dyspnoea on exertion and generalised swelling of the body. He had been treated at another hospital for a sore throat two weeks before. There was no family history of anaemia.He was feverish, pale, and had slight ankle oedema. The pulse rate was 72 beats per minute and it was regular and bounding in character. The blood pressure was 130/60 mm Hg. The jugular venous pressure was elevated to 5 cm and there was hepatomegaly (3 cm). At the heart apex there was a soft, short, systolic murmur, and at the left sternal border there was a harsh, low pitched, early distolic murmur that increased on inspiration. There were no splinter haemorrhages, clubbing of the fingernails, splenomegaly, or petechial haemorrhages. The chest Initial investigations showed: haemoglobin 71 g/l, white cell count 1017 x 109/l, and platelet count 219 x 109/l. There was a reticulocytosis of 8 9% and the smear showed many fragmented red blood cells, spherocytes and schistocytes consistent with fragmentation haemolysis. Because of the red cell structure, the diagnosis was changed to aortic incompetence with haemolytic anaemia and the patient was investigated accordingly. The serum concentration of fibrin degradation product was < 12 pg/I, the urine stain did not show haemosiderin, and the serum bilirubin concentration was 8 pmol/l. The direct antiglobulin test, antinuclear factor, and serum complement were normal. There was a slight increase in erythrocyte osmotic fragility in 0-5%o saline.Repeated blood cultures during the first week showed no growth. The proportion of reticulocytes increased to 14% and the erythrocyte sedimentation rate to 95 mm/hour. Echocardiography performed one week after admission showed normal mitral and aortic valves, and large vegetations were detected on the pulmonary valve, the leaflets of which were thin and mobile (fig 1). Treatment was started with intravenous penicillin 5 megaunits six hourly and gentamicin 80 mg eight hourly. In the following week the patient's condition improved, the proportion of reticulocytes fell to 2-4% and the erythrocyte sedimentation rate to 55 mm/h. His haemoglobin concentration subsequently rose to 115 g/l. Repeat echocardiography showed vegetations still attached to the pulmonary valve. Three weeks later, while he was being treated with antibiotics, the patient became febrile and complained of right sided chest 527 on 7 June 2019 by guest. Protected by copyright.