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Lamm discusses several symptoms that one should always take seriously. Sudden mild to severe abdominal pain without diarrhea could signal appendicitis

Instead of taking people who may have had heart attacks to the nearest hospital, as is now advised, the researchers said it may be better to send them farther, to a hospital where a trained team can perform angioplasty to open clogged coronary arteries

Costs of angioplasty and clot-dissolving drugs vary among hospitals and regions. The drugs cost about $2,200; an angioplasty, $2,000 to $4,000. But up to two-thirds of patients who receive the drug also then need angioplasty because their arteries are still clogged. All nine hospitals in Boston and the Boston Emergency Medical Services have started a program to monitor the quality of angioplasty performed in the seven hospitals offering it, Dr. [Christopher P. Cannon] said. The researchers want assurance that all seven hospitals that perform angioplasty can do so around-the-clock daily so that all patients will get angioplasty and not T.P.A. He said he expected that in six months patients with ST elevation heart attacks would be taken only to hospitals that did angioplasty. He cautioned that the approach might not be feasible everywhere. After six months, 6.2 percent in the angioplasty group died, compared with 7.1 percent in the drug therapy group. An additional heart attack occurred in 5.3 percent of the angioplasty patients, compared with 10.6 percent in the T.P.A. group. Stroke rates were 2.2 percent for the angioplasty group and 4 percent for the T.P.A. group. Length of stay was also shorter in the angioplasty group, 4.5 days compared with 6

Heart researchers, responding to new findings that a procedure to open clogged arteries is superior to clot-dissolving drugs for heart attacks, are urging the United States to change its system for emergency care of heart attacks

Heart researchers, responding to new findings that a procedure to open clogged arteries is superior to clot-dissolving drugs for heart attacks, are urging the United States to change its system for emergency care of heart attacks. Costs of angioplasty and clot-dissolving drugs vary among hospitals and regions. The drugs cost about $2,200; an angioplasty, $2,000 to $4,000. But up to two-thirds of patients who receive the drug also then need angioplasty because their arteries are still clogged. The researchers want assurance that all seven hospitals that perform angioplasties do so around-the-clock every day so that all patients will get angioplasties and not TPA. [Christopher Cannon] said he expected that in six months, patients with ST elevation heart attacks will be taken only to the hospitals that perform angioplasty. But he cautioned that the approach might not be feasible everywhere

Smallpox vaccine has traditionally been made by placing a strain of vaccinia, a cousin of the smallpox virus, on the cut skin of a calf, which is killed a week later. Then scientists remove hair and the microbes that normally live on the skin to prepare the vaccine. The newly disclosed cache of up to 90 million doses will be donated by the drug company Aventis Pasteur. Some batches date from 1958, when companies since acquired by Aventis Pasteur made the vaccine the traditional way. The cache could swell the supply to about 167 million doses. Rumors have circulated since at least the mid-1990's about the existence of frozen stores of tens of millions of doses of smallpox vaccine. Aventis Pasteur officials said they told the Department of Health and Human Services about its stockpile years ago and had discussed plans to destroy it. But because destroying the cache was not a high priority, the vaccine was saved. Tommy G. Thompson, the department secretary, said Aventis Pasteur officials first approached him office in October after the anthrax attack

The cardiac sarcoplasmic reticulum calcium-ATPase (SERCA2a), Na(+)/Ca(2+) exchanger (NCX1), and ryanodine receptor (RyR2) are proteins involved in the regulation of myocyte calcium. We tested whether exercise training (ET) alters those proteins during development of chronic heart failure (CHF). Ten dogs were chronically instrumented to permit hemodynamic measurements. Five dogs underwent 4 wk of cardiac pacing (210 beats/min for 3 wk and 240 beats/min for the 4th wk), whereas five dogs underwent the same pacing regimen plus daily ET (5.1 +/- 0.3 km/h, 2 h/day). Paced animals developed CHF characterized by hemodynamic abnormalities and reduced ejection fraction. ET preserved resting hemodynamics and ejection fraction. Left ventricular samples were obtained from all dogs and another five normal dogs for mRNA (Northern analysis, band intensities normalized to glyceraldehyde-3-phosphate dehydrogenase) and protein level (Western analysis, band intensities normalized to tubulin) measurements. In failing hearts, SERCA2a was decreased by 33% (P < 0.05) and 65% (P < 0.05) in mRNA and protein level, respectively, compared with normal hearts; there was only an 8.6% reduction in mRNA and a 32% reduction in protein in exercised animals (P < 0.05 from CHF). mRNA expression of NCX1 increased by 44% in paced-only dogs compared with normal (P < 0.05) but only by 22% in trained dogs (P < 0.05 vs. CHF); protein level of NCX1 was elevated in paced-only dogs (71%, P < 0.05) but partially normalized by ET (33%, P < 0.05 from CHF). RyR2 was not altered in any of the dogs. In conclusion, long-term ET may ameliorate cardiac deterioration during development of CHF, in part via normalization of myocardial calcium-handling proteins