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Dissection of the ascending aorta is a rare complication of aortocoronary bypass surgery. A 63-year-old man who had received a double graft was found to have dissection of the ascending aorta, which was shown angiographically four months after operation. Since the patient was asymptomatic, operation was postponed. He has been followed up regularly and two years later his condition is still satisfactory. [ABSTRACT FROM PUBLISHER]

Health care services and regional development, a medicometric approach. If regional development is defined in terms of job creation and increased quality of life, health services can be seen as an investment contributing to employment and local structural changes. Spendings to increase health services, especially in peripherical regions, increase the level of economic development. Through case studies in Switzerland we open four perspectives for the future and propose a global view of health care systems in a regional context.

We report a case of a fifty year old woman with Graves' disease with positive AntiTPO antibodies and positive AntiTSH receptor antibodies, who was hospitalized with a right cardiac failure. A pulmonary hypertension was discovered on echocardiography. After adequate antithyroid therapy, the right cardiac failure regressed rapidly and pulmonary pressure normalised. An autoimmune process has often been proposed to explain the association between pulmonary hypertension and hyperthyroidism. We report the arguments supporting this autoimmune etiopathogenesis. We also discuss an other hypothesis based on a direct effect of thyroid hormones on the pulmonary circulation and the effects of high cardiac output associated with hyperthyroidism.

Background: The purpose of this study was to investigate the effect of sexual activity on cycle ergometer stress test parameters, on plasmatic testosterone levels and on concentration capacity in high-level male athletes., Methods: Experimental design. Analysis of two days of testing accomplished in a laboratory setting, comparing a day with to a day without sexual activity (control day). Participants. Fifteen high-level male athletes, consisting of 8 team players, 5 endurance athletes and 2 weight-lifters, participated in the study. Measures. Each subject completed the following on each test day: two maximal graded stress tests on a cycle ergometer and a one-hour exercise stress test coupled to an arithmetic mental concentration test. Blood samples of testosterone were obtained and cardiac activity of each athlete was monitored with a 24-hour ECG tape recording over the two test days., Results: Significantly higher differences were achieved for post-effort heart rate (HR) values at 5 minutes (p<0.01) and at 10 minutes (p<0.01) during the recovery phase of the morning stress test 2 hours after sexual activity. These differences disappeared during the recovery phase of the afternoon stress test performed approximately 10 hours after sexual intercourse took place., Conclusions: Our findings show that sexual activity had no detrimental influence on the maximal workload achieved and on the athletes' mental concentration. However, the higher posteffort HR values after the maximal stress test on the morning of sexual intercourse suggest that the recovery capacity of an athlete could be affected if he had sexual intercourse approximately 2 hours before a competition event.

It is the goal of regional medicometrics, a new discipline devoted to analysis of cost and benefit of the health care chain, to change the image of the latter to an indispensable economic and social investment for developed societies. Using some swiss data this article shows that while health care is costly it also contributes to society as a whole. This analysis permits us to propose a counsel of experts for management of the future health resources without sacrifices to pressure-groups and actual economic conditions. To reform the health system means to guess whether our choice will not neglect one of the participants of the system.

On 24-hour ambulatory ECG, 17 patients with mitral valve prolapse displayed more frequent and serious arrhythmias than a control group of 17. Neither resting ECG, treadmill ECG, nor other external recordings were capable of predicting which of the patients were prone to development of arrhythmias.

Digitalis still remains a source of astonishment to electrophysiologists as well as clinicians. The presently known effects on the neurovegetative system and the action potential are described, and some clinical problems which may lead to ineffective digitalization or digitalis intoxication are stressed. Clinical and ECG manifestations and some therapeutic aspects are pointed out.

17 medicine undergraduates sitting their final examinations underwent continous ECG recording during a period of 3 h. Their usual heart rate was 71 +/- 9 per minute, accelerating to 149 +/- 13, most often at the moment of entering the examination room. This reaction was usual in all candidates despite their knowledge that the failure rate at the exams is always very low; all of this group likewise passed. Two subjects exhibited marked alterations in the terminal phase compatible with myocardial ischemia. In 6 cases severe sinus rhythm variations evidenced an unstable balance of the vagal and adrenergic stimulations. No other arrhythmias, augmentation in the number of premature beats or atrio-ventricular blockade were observed. Analysis of the results shows that the heart response to psychic aggression differs from that to physical effort.