Diagnosis of myocardial infarction-induced ventricular aneurysm in the presence of complete left bundle branch block

An analysis of the 4,196 files of our Cardiology Clinic cohort showed 128 patients with a complete left bundle branch block (LBBB) in their electrocardiograms (ECGs). Of these patients, 27 had suffered a myocardial infarction in the past and had been found to have a ventricular aneurysm (VA), documented by > or = 1 of several noninvasive and invasive diagnostic methods. Five of these 27 patients had stable ST-segment elevation in > or = 1 of left precordial ECG leads, with predominantly positive QRS complexes (an ECG criterion for the diagnosis of VA in the presence of LBBB, which we have recently described). The sensitivity of this ECG criterion for the diagnosis of VA was 18.5%, and the specificity was 100%. The frequency of distribution of VA in the septal, and even more, apical myocardial regions was higher in the patients with a positive ECG diagnosis of VA, than in the patients with a negative one (P = .049, and P = .009, correspondingly). The number of myocardial territories involved with a VA was not different in the 2 subgroups (P =.325). Pathophysiologically, this ECG alteration diagnostic of VA represents a superimposition of the primary ST-segment elevation due to the VA, on the expected secondary ST-segment depression due to the LBBB, and represents a summation effect.     

Evaluation of live attenuated measles vaccines prepared in human diploid cells for reimmunization

Two live attenuated measles vaccines developed in baby calf kidney cells, a similar vaccine produced in chick embryo chorioallantoic cells and five vaccines prepared from human diploid cells (HDC) have been studied by subcutaneous injection in groups of susceptible and immune children in three field trials. The results indicated that the vaccine developed in chick embryo cells which caused mild clinical reactions, had induced a lower seroprotection rate in susceptible children and only a low rise in hemagglutination-inhibition (HI) antibody titre in previously immunized children. The serological responses induced by vaccines developed in HDC or in calf kidney cells were satisfactory in both susceptible and immune children. The superiority of HDC grown measles vaccine for revaccination is discussed.     

Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique

This study investigate the effect of stapes surgery on bone conduction (BC) improvement in otosclerotic patients with mixed hearing loss and also compare the effect of three different types of surgery (complete stapedectomy, partial stapedectomy and microfenestration stapedotomy) on this improvement. We retrospectively reviewed surgical database of 84 otosclerotic patients with mixed hearing loss. Sixty-two patients (75%) had significant improvement in BC after surgery (P = 0.03). In 85% of patients with follow-up time longer than 1 year, this improvement had remained. Improvement in BC after surgery was better in partial stapedectomy group (82.6%) and complete stapedectomy group (80.8%) in comparison with microfenestration stapedotomy group (63%) (P = 0.052).     

Comparative study of two cefazolin prophylactic protocols in oncologic surgery of the larynx: A randomized trial

Objective

Patients who need major head and neck surgery like laryngectomy are at risk of postoperative wound infection. Although the role of antibiotics in prophylaxis of clean contaminated head and neck surgery has been well documented, controversy exists in the optimal antibiotic regimen.

Methods

In two tertiary referral hospitals (Imam Khomeini and Amir Alam hospital), 90 patients undergoing laryngectomy were prospectively randomized into two groups receiving cefazolin perioperative prophylaxis either for 2 days or for 5 days from June 2004 to March 2006. Then patients were blindly examined for the development of wound infection.

Results

No wound infection was detected in either group. Two (4.4%) mucocutaneous fistula occurred in the 2-day group, and 3 (6.7%) in the 5-day group. There was no statistically significant difference in the infection rate between two groups.

Conclusion

We conclude that a 2-day perioperative cefazolin prophylaxis is equally effective as longer therapies. The increased morbidity and cost of the latter are in favor of the 2-day prophylactic regimen.     

知识管理与医院核心竞争力的形成

基于知识和技能的核心竞争力理论与知识管理有着十分密切的联系。本文介绍了医院核心竞争力的知识特性,知识经济条件下医院知识管理的职能,知识管理实施的步骤以及知识管理对医院核心竞争力的作用,为知识经济条件下医院利用知识管理促进核心竞争力的形成提供指导。