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Serum cardiac enzyme levels (CK, LDH, SGOT) were estimated and the ECG recorded for 4 days following admission of 288 patients (Group I) to a stroke intensive care unit. Sixty-four of these patients, subsequently found not to have strokes, served as controls. Mean serum levels of all 3 cardiac enzymes were elevated in 8% of the 224 patients with stroke. The mean serum enzyme levels in patients with transient ischemic attacks (TIA) did not differ from controls. In a second group of 230 patients with stroke (Group II) serum CK levels were measured and the isoenzyems were fractionated to determine the tissue source of the enzymes. One hundred and one patients had raised total CK values and 25 of these (11%) had raised CK-MB (heart) iso-enzyme, the remainder having CK-MM (skeletal muscle) fraction. No serum CK-BB (brain) iso-enzyme was detected in any patient. Patients with positive serum levels of CK-MB has more evidence of acute myocardial ischemia on ECG (p less than 0.05), and more cardiac arrhythmias (p less than 0.001) than those with normal CK levels. Scattered areas of myocytolysis were found in the myocardium at autopsy in one patient. The acute rise in serum cardiac enzymes which we have recorded in the initial stages of stroke suggest that acute myocardial involvement is a commoner complication than is generally recognized. Also, since the CK-MB rises were modest and progressive, it is more likely that this acute myocardial dysfunction is a consequence, rather than a cause, of the acute cerebrovascular lesion.

The effect of 3 hours of ambulatory activity on the mental function of 12 elderly persons with postural hypotension was examined. There was little difference between the mean combined mental status and set test scores when the subjects were supine (42.3) and when they were erect after 3 hours of ambulatory activity (42.2). A control group of persons of similar age and health who did not have hypotension also exhibited little difference in mean scores (49.9 v. 51.5 respectively). The mean scores of the two groups of subjects did not differ significantly. After 6 months the mean scores of the two groups were 40.9 and 44.7 respectively. It appears that elderly individuals with postural hypotension do not exhibit any appreciable deterioration in mental function with ambulation or after a 6-month period.

We report a child with asymptomatic latent exoerythrocytic Plasmodium vivax malaria whose initial presentation was only hepatomegaly and elevated serum lipids. Histology of the liver showed severe fatty metamorphosis. Liver size and the severe fatty metamorphosis decreased markedly with the return of serum lipids to normal after successful treatment of P. vivax. Although this association has been reported in monkeys infected with P. knowlesi, this is the first report of such an association in humans.

Between 1978 and 1982 at least eight physicians at our institution were exposed to infectious secretions while performing mouth-to-tube resuscitation. A questionnaire revealed that 74% of responding pediatric physicians accidentally ingested secretions in 1982. The risk of cross-contamination between newborn patients and resuscitating physicians with the oral methods of oropharyngeal and endotracheal suctioning is considerable.

In a matched pair study, one member of a pair may not be obtained. For example, an experiment may not be completed. It is sometimes suggested to include the unpaired observations by using a general linear model program. In this note we show that no information is lost by omitting these unpaired observations in the usual paired t test.