Platelet-release reaction in myocardial infarction.

A study was made of the platelet-release reaction in heparinised platelet-rich plasma taken from 26 patients, of whom 22 had sustained a definite and four a possible myocardial infarction, and from 54 age-matched controls. No significant differences in reaction were observed between the two groups. Signficant differences were seen, however, between eight patients who died within a year after infarction and the controls (P less than 0.01) and the remaining 18 patients who survived (P = 0.02). These differences were abolished when sodium citrate was included in the experimental procedure. Poor prognosis was thus related to an increased platelet-release reaction after infarction.     

Depression after myocardial infarction.

The Minnesota Multiphasic Personality Inventory was completed by 101 patients 16 to 18 months after a proved myocardial infarction. The data suggested a bimodal distribution of patients. One class of patients had a relatively "normal" personality score apart from a tendency to hypomania. The second class had severe depression, with associated hysteria, hypochondriasis and psychasthenia. The severely depressed patients were older, with a greater tendency to hypertension and angina, and a tendency to smaller gains in aerobic power despite an equal intensity of endurance training. The distinction between "normal" and "depressed" postinfarction patients seems of some clinical importance, for the two classes of patients require opposite supportive techniques--restraint and encouragement, respectively.     

Pituitary-thyroid axis, thyroid volume and leptin in healthy adults.

OBJECTIVE: Patients with thyroid diseases usually have disturbances relating to body weight and thermogenesis. On the other hand, leptin is involved in the regulation of body weight, food intake and thermogenesis. Some studies have investigated the relationship between leptin and dysthyroid states, but the complex interactions between leptin and pituitary-thyroid axis have led to controversial results. DESIGN: The aims of this cross-sectional study were to investigate the relationship among basal TSH, ultrasonographic thyroid volume and leptin in a group of 268 healthy adults randomly selected from our city, L'Hospitalet de Llobregat, Barcelona, an area free of iodine deficiency. In this euthyroid group, we determined basal TSH, thyroid autoantibodies, leptin concentrations, and thyroid volume by ultrasonography, body anthropometry, and body composition. RESULTS: All subjects were free of goitre and were negative for anti-thyroid antibodies. Basal TSH concentrations were 1.49 +/- 0.8 mU/l in males and 1.67 +/- 0.83 mU/l in females (p = 0.6). Anti-thyroid antibodies were negative in all cases; leptin concentrations were 6.1 +/- 4 ng/ml in males and 16.8 +/- 11.7 ng/ml in females (p = 0.0001). Thyroid volume was 9.8 +/- 4.6 ml in males and 6.5 +/- 2 ml in females (p = 0.001). There were significant correlations among leptin concentrations and anthropometric and body composition variables in both sexes, without correlation with TSH concentrations. There was no significant correlation between anthropometric and body composition variables and thyroid volume in males but there was a correlation in females. In females, there was a positive correlation between leptin and thyroid volume (r = 0.181, p = 0.038). In males, there was a negative correlation between TSH concentrations and thyroid volume (r = - 0.271, p = 0.002). CONCLUSIONS: We did not find any correlation between leptin levels and pituitary-thyroid axis in this control population. The correlation between leptin and thyroid volume in females is probably a consequence that leptin and thyroid volume are regulated in parallel by variables relating to anthropometry and body composition.     

Sexual activity after myocardial infarction.

Questionnaires on sexual activity were completed by 161 patients attending an exercise-centred rehabilitation program an average of some 3 years after a myocardial infarction. In almost half the group, sexual activity was unchanged or increased compared with the period before the infarction. In the remainder it was reduced; this group included 29 men who had adopted a more passive sexual role and 26 who were now having angina or ventricular premature beats during intercourse. Although the patients with diminished activity could not be distinguished by means of formal personality test, questionnaires completed by their wives suggested that they were less willing to assume responsibility, had increased difficulty in adjusting to life at home and at work and were more neurotic and depressed than those with normal or increased activity. Furthermore, those with decreased sexual activity had a poorer response to training in terms of attendance, final average jogging distance and gains in physiologic status. Since the frequency of angina and ventricular premature beats was less during intercourse than during standard laboratory exercise, it was concluded that normal sexual relations carry no special risk for the average postcoronary patient; indeed, by enhancing self-esteem and encouraging effective participation in an exercise programm, acceptance of normal sexual activity may improve the prognosis.     

Psychological rehabilitation after myocardial infarction.

The value of psychological counselling in rehabilitating patients after myocardial infarction was assessed. A total of 143 men who had recently had a myocardial infarction were randomly allocated to either a group receiving intensive rehabilitation or a control group, their outcome being examined after six months. Patients with neurotic, introverted personalities had a poor outcome in the control group but a satisfactory outcome when rehabilitated. Neurotic personalities responded to help, and rehabilitative measures did not increase neurosis. In addition all patients with a negative attitude towards their illness and future had a poor outcome but those with a positive attitude did well. Selection by simple methods of patients who would benefit from psychological rehabilitation seems desirable.