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The total analysis of 204 cases of myocardial rupture which occurred in the Los Angeles County Hospital was reported. Myocardial rupture rarely occurs under the age of 50 years. Although the incidence of myocardial infarction invariably is reported to be higher among men than women our material indicates that cardiac rupture is somewhat more likely to develop in women [110 women (53.9 per cent), ninety-four men (46.1 per cent)]. Myocardial rupture is relatively rare in Negro patients. In our material reasonably good correlation was obtained between electrocardiographic indication of acute myocardial infarction and necropsy incidence of myocardial necrosis. As was anticipated, myocardial rupture occurred at or immediately adjacent to the site of necrosis. Ordinarily, myocardial ruptures occur in the left ventricle. In our series the most frequent site of rupture was in the anterior wall, especially at the junction of the anterior wall and the septum. Average survival time for twenty-one patients admitted to the hospital within 6 hours of the clinical onset of myocardial infarction was 9 days, whereas average survival time for twentyone patients hospitalized 7 hours or longer after the myocardial infarction was only 2.6 days. The longer survival time for patients hospitalized within the first 6 hours may be due to greater restriction of their activity in the immediate postinfarction period. Death usually is immediate in ventricular rupture, whereas in the interventricular septal rupture most of the patients survive a few days. In the final 8 years and 3 months of our survey, the incidence of rupture following myocardial infarction has undergone a sharp decrease at the Los Angeles County Hospital. This decrease is presumably due to better management of the acute episode of myocardial infarction and more particularly to the use of vasopressor drugs and anticoagulants. Anticoagulants did not increase the incidence of the rupture but cardiac tamponade is relatively frequent in patients with myocardial rupture maintained on anticoagulants. The physician must be alert for signs of tamponade (i.e., pulsating neck veins, increase in cardiac dullness) because tamponade can be managed surgically. Except for the reduced incidence of myocardial rupture in the period of survey, the findings are in agreement with earlier reports from the same hospital.

Pivalylbenzhydrazine was administered to forty patients over a period ranging from one to ten months in maintenance doses of 50 to 300 mg. per day. The majority required 100 to 200 mg. daily for therapeutic effect. Excellent results were obtained in nineteen (47.5 per cent), good or fair results in fourteen (35 per cent), and no effects in four (10 per cent). This is similar to the results obtained with isocarboxazid, though the latter appeared to be a better analeptic agent. No serious side effects or toxicities have been noted clinically or in the laboratory, particularly as related to orthostatic hypotension or hepatitis, neither of which was observed. A study of the effects of monoamine oxidase inhibitors on trace metals in humans is now being made. Preliminary results indicate elevation of serum manganese, copper and aluminum, but no effect on zinc, lead and iron. We have found pivalylbenzhydrazine to be an effective and apparently safe agent in the treatment of angina pectoris.