Is adverse pregnancy outcome predictable after blunt abdominal trauma?

OBJECTIVE: The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal trauma and (2) factors that may predict preterm birth and adverse peripartum outcomes. STUDY DESIGN: All women who had noncatastrophic abdominal trauma and came to the labor and delivery suite July 1994-August 1997 were prospectively evaluated and admitted for continuous uterine and fetal monitoring. A complete blood cell count, coagulation profile, and Kleihauer-Betke stain were performed. Ultrasonographic examination was performed to rule out hematoma. Tocolytic agents were administrated in cases with persistent contractions. Pregnancy outcomes and risk factors were compared between those with preterm birth before 37 weeks' gestation and those who were delivered after 37 weeks' gestation. RESULTS: Delivery information was available for 85 women with blunt abdominal trauma from motor vehicle accident (28), falls (27), and direct assault (30, which included 17 cases of domestic abuse). Four women, 3 of whom were exposed to domestic abuse, were hospitalized twice. Thirteen patients had preterm birth and 72 patients were delivered at term. In all cases the results of Kleihauer-Betke stains, maternal vital signs, blood cell count, coagulation profile, and placental ultrasonographic examinations were normal. The differences between the 2 groups with respect to gestational age at the time of trauma, length of hospital stay, subjective reports of abdominal pain, objective findings of abdominal tenderness, patterns of uterine contractions, interval between trauma and delivery, and Apgar scores were not statistically significant. However, the preterm birth group received magnesium sulfate tocolysis more frequently (31% vs 7%) and had a significantly greater rate of peripartum complications, such as rupture of membranes and abruptio placentae, than the group of patients who delivered at term (46.2% vs 12.5%, P <.05). Women with domestic abuse had increased uterine contractions at the time of abdominal trauma (52.9% vs 19.1%, P =.01) but did not require increased use of tocolysis. Women with domestic abuse had more peripartum complications (41.8% vs 11.8%, P <.01). CONCLUSIONS: Women with noncatastrophic blunt abdominal trauma in pregnancy tend to have favorable neonatal outcomes. Findings or reports of abdominal tenderness and uterine contractions are not predictive of preterm birth. Preterm birth was associated with increased peripartum complications. However, domestic abuse was associated with repeated trauma in the index pregnancy and increased peripartum complications.     

Changes in bone mineral density in patients with Paget''s disease treated with risedronate

Our purpose was to evaluate the impact of intravenous and oral tocolysis on prolongation of gestation for women with preterm uterine contractions and/or labor. Candidates for evaluation and treatment including women with contractions between 24 and 35 weeks. Two hundred women (group I) without cervical changes met the protocol criteria and 175 women (group II) who presented with or developed cervical changes were treated by protocol. A representative sample of both groups received oral terbutaline maintenance therapy until 37 weeks' gestation. Primary outcome variables included the length of gestation obtained following initial treatment and the preterm birth rate. Women in group II were twice as likely to deliver before 35 weeks, 23% versus 9.5%, respectively, and to have a delivery before 37 weeks' gestation, 45% versus 22%, respectively, (p < 0.05). There was no significant difference in days gained in utero for women on oral terbutaline for either group. Women in group II on oral therapy were more likely to be readmitted and retreated with parenteral tocolysis. In conclusion, oral maintenance tocolysis has no significant impact on further prolongation of pregnancy after intravenous tocolysis.     

Mucosal melanomas of the head and neck

PURPOSE: To determine the effect of epidural analgesia on biochemical markers of stress, plasma oxytocin concentrations and frequency of uterine contractions during the first stage of labour. METHODS: Nine nulliparous women, in spontaneous labour, with a singleton fetus and cervical dilatation < or = 5 cm were enrolled. Epidural bupivacaine 0.25% (range 10-14 ml) was administered and bilateral sensory blockade to ice (T8-L4) achieved. Blood samples were collected before the epidermal block and every 10 min for one hour after the block was achieved for the measurement of plasma beta-endorphin, cortical, glucose, lactate and oxytocin concentrations. No exogenous oxytocin was given. Intensity of pain was assessed at the time of the blood sampling using a 10 cm visual analogue scale (VAS). The frequency of uterine contractions was recorded for 60 min before and after the epidural block. RESULTS: There was a decrease in plasma beta-endorphin and cortisol concentrations after epidural block (P < 0.01). There were no changes in plasma glucose and lactate concentrations. The mean VAS for pain decreased 10 min after epidural block was achieved and remained < 2 throughout the study period (P < 0.001). Mean plasma oxytocin concentrations did not change. The frequency of uterine contractions before and after the epidural block was similar. CONCLUSIONS: The metabolic stress response to the pain of labour was attenuated by epidural analgesia. In contrast, plasma oxytocin concentration and frequency of uterine contractions were unaffected by the attenuation of metabolic stress response.     

Ability of naloxone to enhance the colonoscopic appearance of normal colon vasculature and colon vascular ectasias

OBJECTIVE: To compare the safety and efficacy of high-dose intravenous (IV) nitroglycerin with those of IV magnesium sulfate for acute tocolysis of preterm labor. METHODS: Thirty-one women with preterm labor before 35 weeks' gestation were assigned randomly to IV magnesium sulfate or IV nitroglycerin for tocolysis. Preterm labor was defined as the occurrence of at least two contractions in 10 minutes, with cervical change or ruptured membranes. Acute tocolysis was defined as tocolysis for up to 48 hours. Magnesium sulfate was administered as a 4-g bolus, then at a rate of 2-4 g/h. Nitroglycerin was administered as a 100-microg bolus, then at a rate of 1- to 10-microg/kg/min. The primary outcome measure was achievement of at least 12 hours of successful tocolysis. RESULTS: Thirty patients were available for analysis. There were no significant differences in gestational age, cervical dilation, or incidence of ruptured membranes between groups at the initiation of tocolysis. Successful tocolysis was achieved in six of 16 patients receiving nitroglycerin, compared with 11 of 14 receiving magnesium sulfate (37.5 versus 78.6%, P = .033). Tocolytic failures (nitroglycerin versus magnesium sulfate) were due to persistent contractions with cervical change or rupture of previously intact membranes (five of 16 versus two of 14), persistent hypotension (four of 16 versus none of 14), and other severe side effects (one of 16 versus one of 14). Maternal hemodynamic alterations were more pronounced in patients who received nitroglycerin, and 25% of patients assigned to nitroglycerin treatment had hypotension requiring discontinuation of therapy. CONCLUSION: Tocolytic failures were more common with nitroglycerin than with magnesium sulfate. The hemodynamic alterations noted in patients receiving nitroglycerin, including a 25% incidence of persistent hypotension, might limit the usefulness of IV nitroglycerin for the acute tocolysis of preterm labor.     

Acceleration of small intestine contrast study by ceruletide

The effect of ceruletide on the small bowel transit time of barium sulfate suspension was studied in 165 patients. The control group consisted of 115 cases. An intramuscular injection of 500--750 ng/kg body weight ceruletide was given in 106 cases (group A), 20 ng/kg ceruletide was intravenously injected in 35 patients (group B), and 40 ng/kg was intravenously injected in 24 cases (group C). The mean transit time in group A was 62 +/- 41 min (mean +/- SD), and 126 +/- 62 min in the corresponding control group of 83 cases. (P less than 0.001). The mean transit time in group B was 65 +/- 50 min, and 69 +/- 56 min in group C, whereas in the corresponding control group of 32 cases the mean transit time was 137 +/- 79 min (P less than 0.01). A normal radiographic pattern was found in 75%, and slightly increased segmental contractions in 21%. Overtonicity and pronounced segmental contractions were seen in 4%. The recommended standardized small bowel study using ceruletide reduces the examination time by roughly one-half and produces simultaneous and uniform opacification of the jejunum and ileum.     

Effects of sulphonylureas on the volume-sensitive anion channel in rat pancreatic beta-cells

OBJECTIVE: This study's aim was to determine whether maintenance therapy with terbutaline administered by pump prolongs gestation in women after treatment with intravenous magnesium sulfate tocolysis for suspected preterm labor. STUDY DESIGN: Consenting women with a singleton gestation and intact membranes who had uterine contractions and >1 cm cervical dilation, 80% effacement, or progressive cervical change and whose contractions were successfully arrested with intravenous magnesium were randomly assigned to receive either terbutaline or normal saline solution placebo by subcutaneous infusion pump. Pump therapy was administered with a standardized protocol. Pump therapy was discontinued and parenteral magnesium was resumed if recurrent preterm labor developed while women were on the therapeutic regimen at <34 weeks' gestation and no contraindication for tocolysis existed. If recurrent labor was arrested, pump therapy was restarted according to the original treatment group. A sample size of 48 women was required to detect a 2-week intergroup difference in mean time to delivery. Analyses were based on intent to treat. RESULTS: Fifty-two women received terbutaline (n = 24) or placebo (n = 28). At random assignment the groups were similar with respect to age, race, parity, previous preterm delivery, gestational age, and cervical examination. Overall there was a 1-day difference in mean time to delivery between the groups (terbutaline 29 +/- 22 days and placebo 28 +/- 23 days, P = .78). There were no differences in the rates of preterm delivery at <34 and <37 weeks' gestation. Neonatal outcomes were similar. CONCLUSIONS: Maintenance terbutaline therapy administered by pump does not prolong gestation in women successfully treated for suspected preterm labor.     

Effects of intravenous meperidine and meperidine with promethazine on uterine activity and fetal heart rate during labor

A prospective study of the effects of the i.v. injection of 75 mg meperidine, alone or combined with 25 mg promethazine, was conducted by continuous and direct monitoring of the fetus and of intrauterine pressure. The study was carried out in 16 primiparas and 24 multiparas in active spontaneous labor with cervical dilatation of 3 to 4 cm. Administration of meperidine and of meperidine with promethazine was associated with an increase in uterine activity of 31 to 45% (Montevideo units), respectively. The most marked effects were on the amplitude of the uterine contractions. There was no significant change in uterine tone. A tetanic response was recorded in two patients who vomited after the administration of meperidine with promethazine and was followed by slowing of the fetal heart rate. In no other cases were there significant changes in fetal heart rate. Except for the latter two patients, no adverse effect of meperidine or of meperidine with promethazine on the fetal heart rate was noted. The condition of the newborns at birth was excellent in all but three cases, in two of which maternal amniotic infection and high fever were present.     

Effect of ethanol on postprandial duodenojejunal motility in humans

The effect of ethanol on postprandial small bowel motility was investigated in eight healthy volunteers using perfusion of nutrient solutions (17% proteins, 59% carbohydrates, 24% lipids) into the descending duodenum (5 ml/min for 120 min). An ethanol-containing solution (4% w/v, 4.06 kcal/min, 1190 mosmol/kg) was compared with the corresponding ethanol-free solution (2.64 kcal/min, 160 mosmol/kg) and another ethanol-free hyperosmolar solution adapted in caloric load and osmolality (4.06 kcal/min, 1160 mosmol/kg). Motility was recorded with a data logger and six pressure transducers at 3-cm intervals around the duodenojejunal flexure. Clustered contractions (27 +/- 4/hr) migrating aborally through the whole recording segment were the predominant motor pattern with ethanol compared with the ethanol-free (10 +/- 2/hr; P < 0.01) and the ethanol-free hyperosmolar solution (6 +/- 3/hr; P < 0.001). Other motility parameters with ethanol were not different from the ethanol-free solution, whereas the ethanol-free hyperosmolar solution showed a much less intense motor response. We conclude that ethanol does modify human postprandial duodenojejunal motility by inducing propagative motor patterns.     

Contraction specific changes in passive torque in human skeletal muscle

The present investigation examined passive torque and electromyographic response in human skeletal muscle during passive static stretch within 60 s after maximal repetitive eccentric and concentric contractions. Passive torque (Nm) offered by the hamstring muscle group was measured during passive knee extension in a modified dynamometer in 10 subjects. The distal thigh was elevated to 0.52 rad from horizontal and the backrest was positioned at 1.57 rad. The lever arm moved the leg passively at 0.09 rad s-1 from a starting position of 1.48 rad below horizontal to the final position where it remained stationary for 90 s. Gross electrical activity of the human hamstring muscle group was recorded simultaneously. The effect of concentric or eccentric contraction was tested on separate days. Two stretch manoeuvres with a 45 min hiatus were administered on a control and experimental side. The experimental side performed 40 maximal effort repetitive concentric or eccentric hamstring muscle contractions at 1.05 rad s-1 prior to the second stretch. Passive torque during the 90 s stretch declined 30-35% on the experimental and control side in all stretches, P < 0.001, without a significant effect of prior contraction mode. Passive peak and final torques were lower on the experimental side, P < 0.01 after concentric contractions. Passive peak and final torques remained unchanged after eccentric contractions on the experimental side. The low level EMG response of the hamstring muscle during the stretch was unchanged after maximal repetitive concentric or eccentric contractions. These data demonstrate acute contraction specific alteration in passive torque in human skeletal muscle, which cannot be accounted for by EMG activity. Furthermore, the lack of difference on the control side implies that one 90 s stretch has no effect on passive torque of the muscle 45 min later.     

Embryo transfer--can we learn anything new from the observation of junctional zone contractions?

To assess whether embryo transfer can alter junctional zone contractility, we studied the effect of easy and difficult mock transfers in 14 oocyte donors during in-vitro fertilization (IVF) cycles. An Echovist bolus (30 microl) was used to represent embryos and transfer medium. An 'easy' transfer was judged to be an atraumatic insertion of the catheter without touching the uterine fundus. A 'difficult' embryo transfer was mimicked by deliberately touching the uterine fundus twice with the soft end of the cannula. Transvaginal scan images were recorded, digitized and converted into five times normal speed to allow us to evaluate junctional zone contractility. Easy mock embryo transfers did not change endometrial mechanical activity. Echovist remained in the upper part of the uterine cavity and was not dispersed after 45 min. A difficult procedure generated strong random waves in the fundal area and waves from fundus to cervix which relocated the Echovist in six out of seven cases. We observed movements of the transfer bolus from the upper part of the uterus towards the cervix (four cases) and into Fallopian tubes (two patients). Our study confirms that the mechanical activity of the uterus is capable of relocating intrauterine embryos and that this activity depends on physical stimulation. Junctional zone contractions can be implicated in cases of IVF/embryo transfer failure or ectopic gestation.     

Mental symptoms in Parkinson''s disease during chronic treatment with levodopa

The influence of epidural block with bupivacaine (Marcaine-adrenalin) on fetal heart rate, uterine activity, and the frequency and intensity of contractions was studied in twenty-five nulliparae at term. Uterine activity was found to decrease during the first 30 minutes following epidural block. In the time interval 30 to 40 minutes after epidural block uterine activity increased again and attained the same level as during the last 10 minutes before analgesia. The frequency of uterine contractions did not decrease after the block. The lower levels of uterine contractility were due only to a lower amplitude of the contractions. The regularizing effect of epidural analgesia on incoordinate uterine action was noted. The recording of fetal heart rate in the time interval studied revealed no pathological findings. Mode of delivery, mean labour duration and Apgar scores after epidural block were comparable with earlier studies of a larger patient population. This study suggest that epidural analgesia does not induce any important changes in fetal heart rate but temporarily decreases uterine activity.     

Prostaglandin-F-levels in human plasma during late pregnancy and labour (author's transl)

The concentrations of prostaglandin F-equivalents were measured in peripheral plasma during labour at a cervical dilatation of 5 cm and at complete dilatation. After purification, extraction and chromatography the PGF-equivalents were measured radioimmunologically. The intraassay variation was 1.5%, the interassay variation 3.5%. The specificity for PGF was 96-98%. Logit/log transformation of the standardcurve yielded a sensitivity of the assay of 120 pg. At cervical dilatation of 5 cm PGF-equivalents varied between 1300 and 3200 pg/ml plasma. At complete dilatation values changed between 1200 and 5400 pg/ml. These fluctuations correlate timedepending to the uterine contractions recorded and may be interpreted as a result of uterine PGF-release.     

Effect of the calcium antagonist amlodipine on non-vascular smooth muscle exemplified by the uterus

The effect of amlodipine, a recently developed calciumantagonist on 21 uterine strips was investigated. Uterine activity, expressed by the area under the curve was depressed from 504 (51 to 1056) mm2 to 0 (0 to 130) 10 min after the application of amlodipine. After 20 and 60 min, the values were 0 (0 to 1310) and 0 (0 to 317) (median, 10th and 90th percentile). The decrease of uterine activity was highly significant (p < 0.0001). In summary, amlodipine exhibits a prompt and excellent relaxation on the spontaneous contractions of uterine strips.     

Paraneoplastic optic neuropathy and autoantibody production in small-cell carcinoma of the lung

There are no published data of manometric studies of pyloric motor function in patients with infantile hypertropic pyloric stenosis (IHPS). The present study attempted to examine the characteristics of motor abnormality of the pylorus in five children with IHPS. Using a transducer-built-in manometric catheter cannulated through the pylorus under fluoroscopy, the pressure in the pyloric canal was recorded continuously over 3 h during fasting. Clusters of high-amplitude spastic contractions of over 300 mmHg were recorded at intervals. The frequency was 1-3/min (mean 1.7 cpm) and the duration was 7-15 s. These periodic spastic contractions were suppressed temporarily for 20-30 min after intravenous injection of 0.01 mg/kg atropine. After pyloromyotomy, these spastic contractions decreased remarkably in amplitude, but there were no changes in frequency. It is concluded that the underlying motor abnormality observed in hypertrophied pyloric muscle is clusters of high-amplitude contractions, although more precise measurements of basal pyloric pressure are needed to explore the pathophysiology of IHPS in detail. The effect of pyloromyotomy may be related to the decrease in high-amplitude contractions.     

Less blood damage in the impeller centrifugal pump: a comparative study with the roller pump in open heart surgery

A centrifugal pump with an impeller (Nikkiso Centrifugal Pump, Model HPM15; Nikkiso Co. Ltd.) was applied to cardiopulmonary bypass (CPB) in 14 patients who underwent elective coronary artery bypass grafting. Serum hemoglobin level, platelet count, and serum beta-thromboglobulin (beta TG) level were measured during CPB. The results were compared with those obtained in a comparative roller pump (RP) group (n = 10). There was no difference in the time on CPB between the NP (109 min) and RP (121 min) groups. The serum beta TG level (ng/ml) was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB). The plasma-free hemoglobin level also was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB, 120 min after the initiation of CPB, immediately after the termination of CPB, 3 h after termination of CPB; p < 0.01). There was no significant difference in platelet depletion. The HPM15 pump showed excellent hemodynamic performance with less blood trauma compared with the roller pump in its clinical application to open heart surgery.     

The effect of labor on olfactory exposure learning within the first postnatal hour.

Thirty-one neonates delivered by cesarean section were exposed to an odor for 30 min shortly after birth. Fifteen births had uterine labor contractions before delivery; 16 were without contractions. All babies were later tested (median age = 80 hr) for their responses to the familiar exposure odor and a novel odor presented on either side of the face. Overall, the babies spent more time turned toward the exposure odor than toward the novel scent. Babies in the labor condition, but not those born without labor, displayed a significant preference for the exposure odor. Norepinephrine (NE) levels were higher in babies who oriented preferentially toward the exposure odor. Brief exposure immediately after birth is sufficient for the development of olfactory learning. Heightened learning by neonates from births with contractions may reflect locus coeruleus and NE activation. Olfactory learning may therefore be particularly efficient shortly after birth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PGF2 and the induction of the trial of labor. The prognostic value of uterine contractions

BACKGROUND: Uterine contractions during the first hour following intracervical application of dinoprostone would show the myometrial sensitivity to prostaglandins E2 (PGE2) and could be a good practical marker of the real prospects of success of an attempt to induce labor according to the above mentioned modalities. The verification of such an hypothesis is the principal aim of this work. METHODS: The study was carried out on a group of 90 cardiotocograms recorded soon after a sample of pregnant women at term underwent labor induction by intracervical application of a gel containing 0.5 mg of PGE2 (dinoprostone). Special attention was paid to some characteristics of the cardiotocograms obtained during the first hour following administration of the gel: regularity of uterine contractions, total number of contractions, number of contractions having an intensity equal or superior to 50 mmHg, mean number of contractions during a period of 10 minutes, mean number of "effective" contractions during a period of 10 minutes, presence or absence of "excessive uterine activity" (tachysystole and/or hypersystole). RESULTS: Some cardiotocographic patterns were associated with a higher percentage of successful inductions, but the observed differences, not statistically significant, do not seem to be clinically interesting. CONCLUSIONS: However, it's not possible to exclude that a longer period of uterine contractions monitoring, perhaps lasting 2 hours instead of only 60 minutes, could lead to more useful information for the management choices.     

Morphine inhibits nocturnal oxytocin secretion and uterine contractions in the pregnant baboon

Morphine is a potent inhibitor of nocturnal uterine contractions (UCs) in the pregnant baboon, and these contractions are known to be induced by oxytocin (OT). The purpose of this study was to determine the mode of action of morphine in inhibiting nocturnal UCs by examining the effect of morphine on OT secretion, OT clearance, and uterine responsiveness to OT. A tethered pregnant baboon model during the last third of gestation was used for these experiments. In study 1, the effects of morphine or control saline on OT release and on spontaneous nocturnal UCs were examined. Study 2 determined the effects of morphine or control saline on the pharmacokinetics of OT after a bolus injection of OT. To exclude/include direct opiate effects on UCs, study 3 examined the responsiveness of the uterus to exogenous OT after morphine or control saline administration. Plasma OT levels were analyzed by RIA after extraction. UCs were assessed by frequency, amplitude, duration, and area under the curve. During nocturnal UCs, morphine, but not saline, administration resulted in the precipitous suppression of integrated OT levels (p < 0.05) to 42% of pretreatment values at 0-15 min postinjection and 17% at 30-45 min. Simultaneously, UCs were significantly suppressed (p < 0.05) by 75% at the 30- to 45-min interval. By 1 h, 5 of 7 animals showed no UCs. In study 2, morphine consistently increased the metabolic clearance rate (MCR) of OT in all trials (p < 0.05), although the magnitude of this effect was small (median 9%). Finally, study 3 demonstrated that myometrial responsiveness to the challenge of exogenous OT was not depressed by opiate administration (p > 0.05). To summarize, the decrease in nocturnal UCs after morphine is primarily due to an inhibition of OT release, and perhaps, but to a much lesser extent, an increase in OT MCR. There was no evidence of a direct tocolytic effect of morphine on the uterus. In conclusion, opioids such as morphine are potent inhibitors of nocturnal UCs and act by suppressing OT release in the pregnant baboon.     

Response of human uterine arteries to local anesthetics

The in vitro effects of local anesthetics and norepinephrine upon strips of early gestation and term pregnancy uterine arteries were studied in eight cases. In another case, the effect upon uterine veins was studied with a standard organ bath used to record isometric contractions. Histologic preparations were made to verify the type of vessel studied. An artery obtained from an eight-week gestation did not respond to either lidocaine or mepivacaine. All other arterial specimens (radial and helicoidal strips) responded with slow, rising, strong contractions to diluted concentrations of both of these substances. Likewise they responded with rapid contractions when exposed to norepinephrine. Alpha blockers were unable to prevent the contractions triggered by the local anesthetics. The vein specimens did not respond to local anesthetics but contracted when stimulated by norepinephrine. Based on these observations and after brief review of some hypotheses advanced to explain post-paracervical anesthesia fetal bradycardia, it is postulated that this bradycardia is probably due to uterine artery spasm, causing decreased intervillous space blood flow and fetal hypoxia.     

Polyclonal/monoclonal ratio in kidney and bone marrow transplanted patients treated with cyclosporine

OBJECTIVE: To examine the hypothesis that suppression of frequent premature ventricular contractions may be associated with improvement in left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. DESIGN: We conducted a retrospective case study and statistical analysis of the effect of cardiac medical therapy on outcome. MATERIAL AND METHODS: The study population consisted of 14 patients with more than 20,000 premature ventricular contractions in 24 hours recorded by Holter monitoring and associated left ventricular dysfunction (ejection fraction, 40% or less). Clinical characteristics, number of premature ventricular contractions per hour on 24-hour ambulatory Holter monitoring, and ejection fraction based on transthoracic echocardiography were compared before and after cardiac therapeutic intervention. RESULTS: Of the 14 patients, 10 had presumed idiopathic dilated cardiomyopathy, and 4 had ischemic heart disease. Of the overall study group, seven had received additional cardiac medical therapy after the index evaluation, including four patients who had amiodarone therapy. A significant reduction (75% or more from baseline) in premature ventricular contractions after medical therapeutic intervention was observed in five patients at the first follow-up examination. The mean interval to the first follow-up examination was 6 +/- 3 months. Of the five patients, four had significant improvement in clinical functional status and the ejection fraction. The mean ejection fraction of these five patients increased from 27 +/- 10% at baseline to 49 +/- 17% after medical therapy (P = 0.04). CONCLUSION: The suppression of frequent premature ventricular contractions may be associated with improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy.