The clinical course of patients with suspected pulmonary embolism and a negative pulmonary arteriogram

Selective pulmonary arteriography, with superselective magnification views of the lung bases or other areas where abnormalities are shown on perfusion lung scans, performed within 24-48 hours after the onset of symptoms, can effectively rule out clinically significant pulmonary thromboembolism. One hundred and eighty consecutive patients (minimum follow up, six months) with suspected pulmonary embolism and negative pulmonary arteriograms were studied. Not one of the 167 untreated patients died as a result of thromboembolic disease during the acute illness (20 died from unrelated causes), and none of the 147 patients who survived suffered "recurrent embolism" during follow up.     

Effect of a ''centralized intensive education system'' for clean intermittent self-catheterization in patients with voiding dysfunction who start catheterization for the first time

BACKGROUND: This study evaluated the effects of a 'centralized intensive education system' (CIES) in terms of acquiring a proper clean intermittent self-catheterization (CISC) technique by patients with voiding dysfunction. METHODS: Between March 2002 and March 2003, we prospectively and consecutively enrolled 132 hospitalized patients who learnt and started CISC for the first time due to voiding dysfunction. Patients were enrolled either of two groups (the CIES group vs the 'individualized ward education system'[IWES] group) at the time of the urologic consultation for voiding dysfunction. Out of 132 patients who enrolled in the study, 112 (45 males and 67 females, mean age 57.3 with a range of 18-81) were included in the primary analyses. The questionnaire was applied immediately before discharge. RESULTS: There were similar patient demographics and clinical parameters for the CIES (n = 62) and the IWES groups (n = 50). Of 10 items including the methodology of CISC, six items discriminated significantly in favor of the CIES (P < 0.05). The patient satisfaction with CISC education was significantly different for the two groups in terms of response to the questionnaire. The CIES group was found to be more satisfied with the education received than the IWES group (P < 0.05). Moreover, the number of trials to gain confidence to perform CISC in CIES group was significantly fewer than that of IWES group (P < 0.001). CONCLUSION: Our results demonstrate that CIES might be a superior training program for the patients with voiding dysfunction to acquire a proper CISC technique to the conventional IWES.     

Propofol for induction and maintenance of anaesthesia at Caesarean section A comparison with thiopentone/enflurane

A propofol infusion regimen and a standard general anaesthetic were compared in 40 Chinese women undergoing elective Caesarean section. Twenty patients received propofol 2 mg/kg for induction of anaesthesia followed by propofol 6 mg/kg/hour, while 20 patients received thiopentone 4 mg/kg with enflurane 1% for maintenance of anaesthesia. All patients were given atracurium and their lungs ventilated with nitrous oxide 50% in oxygen until delivery of the neonate. The hypertensive response after intubation was of shorter duration in the propofol group compared with the thiopentone group. Induction to delivery times ranged from 5 to 14 minutes and neonates from both groups had similar and satisfactory Apgar scores. Neurologic and Adaptive Capacity Scores and umbilical cord blood gas analysis. However, a prolonged propofol infusion time before delivery may cause lower Neurologic and Adaptive Capacity Scores. There were no differences in maternal recovery times or psychomotor performance.     

Catheter Ablation of Ventricular Tachycardia in Patients with Right Ventricular Dysplasia: Identification of Target Sites by Entrainment Mapping Techniques

Objective: To identify target sites for radiofrequency ablation of ventricular tachycardia (VT) by entrainment mapping techniques in patients with arrhythmogenic right ventricular dysplasia. Methods: Entrainment mapping and radiofrequency ablation of eight VTs was performed in seven patients. Radiofrequency ablation was applied at 31 reentry circuits sites that were classified based on findings during entrainment. Results: By entrainment criteria the 31 sites were classified as: exit sites (n = 12), proximal sites (n = 6), and outer loop sites (n = 13). Radiofrequency current application terminated VT at 7 of 31 sites: 2 of 12 exit sites (17%), 4 of 6 proximal sites (67%), and 1 of 13 outer loop sites (8%). Conclusion: Radiofrequency ablation terminated VTs most often at sites proximal to the exit as opposed to outer loop sites and exit sites (P = 0.05). The critical isthmus for ablation of VT in right ventricular dysplasia often may be distant to the exit.     

EFFECT OF DOBUTAMINE ON OXYGEN SUPPLY AND UPTAKE IN HEALTHY VOLUNTEERS

We have measured the changes in Vo₂ and the Vo₂; D_o2 relationshipduringinfusion of dobutamine in healthy volunteers. Nine healthy,adult, non-obese, male physicians were infused with an incrementalinfusion of dobutamine starting at 2.5 µg kg^–1 min^–1increasing to 5.0 and then 7.5 y.g kg^–1 min^–1 for15 min each. Vo ₂ and cardiac index were measured every fiveminutes. Vo₂/(VO₂ m^–2) increased from a baseline of 128(SEM 6.1) ml min^–1 m^–2 to 159 (8.0)ml min¹ m^–2(P< 0.05) at 7.5 fig kg^–1 min^–1. The correspondingchanges for Do₂l (Do₂m^–2) were from 643 (35) ml min^–1m^–2 to 1240 (142) ml min^–1 m^–2 (P<0.05).The coefficient of correlation for pairs of Vo₂ and DO₂ values,at baseline and each dobutamine infusion in individual subjects,range from 0.89 to 0.99 (mean 0.95, SD 0.03). Dobutamine haspotent calorigenic effects; demonstration of a positive correlationbetween Vo₂ and Do₂ after infusion of dobutamine does not necessarilyimply an underlying tissue oxygen debt.     

PERIPHERAL CIRCULATORY RESPONSE TO PHOTOTHERAPY IN NEWBORN INFANTS

Calf blood flow (CBF), calf skin temperature, incubator wall and ambient temperature, and respiratory rate, were measured in 8 newborn infants 10 to 127 hours of age, who were treated by phototherapy because of jaundice. During phototherapy (within 30 min) the CBF increased to a range of 30 to 80% above the control values of 8.8 ± 0.9 ml/min/100 g. The CBF is correlated directly with the leg skin temperature (γ= 0.724 and 0.588 at 15 and 30 min after phototherapy respectively). The increase in CBF was associated with a fall in incubator ambient temperature, the latter is a result of the use of servo control unit in monitoring incubator temperature by epigastric skin temperature. The increase in CBF is probably evidence of peripheral vasodilatation to facilitate evaporative heat loss. An increase in respiratory rate was also observed during phototherapy. The observed increase in heat loss (and water loss) from vasodilatation and increased respiratory rate serve as a basis for the increase in insensible water loss as previously reported.