Minoxidil therapy in chronic congestive heart failure: Acute plus long-term hemodynamic and clinical study

The hemodynamic response to minoxidil, an orally active, potent vasodilator, was evaluated in 11 patients with severe chronic congestive heart fallure (CHF). The hemodynamic response was determined following single doses of 10, 15, 20, 25, and 30 mg of minoxidil. The hemodynamic response was characterized by marked increases in cardiac index (+63%) and stroke volume index (+52%) and by decrease in systemic vascular resistance (?38%). There was also a slight decrease in pulmonary capillary wedge pressure from an average of 24 ± 8 to 21 ± 7 mm hg. Although the average mean arterial pressure remained unchanged, one patient developed significant hypotension. Chronic minoxidil therapy (eight patients) was associated with fluid retention and weight gain. In four patients in whom fluid retention could be minimized with larger doses of diuretics, a sustained clinical and hemodynamic improvement was observed. These findings suggest that minoxidil has the potential to improve cardiac function and may be useful in chronic vasodilator therapy of CHF, provided fluid retention can be controlled.     

Low sweat electrolytes in a patient with cystic fibrosis

A patient with the clinical syndrome of cystic fibrosis characterized by chronic pulmonary disease, infection with mucoid Pseudomonas aeruginosa, sinusitis, nasal polyposis, abnormal pancreatic bicarbonate response to secretin stimulation, but normal levels of trypsin and chymotrypsin in the duodenal drainage, and a sibling with autopsy-documented cystic fibrosis, is described. Sweat chloride ranged from 20 to 44 meq/liter and sweat sodium from 36 to 55 meq/liter. Immunoglobulin deficiency, α₁-antitrypsin deficiency, tuberculosis and abnormalities of ciliary ultrastructure were excluded. Review of sweat electrolytes in 213 patients with cystic fibrosis revealed that patients with normal pancreatic enzyme release have significantly lower sweat sodium and chloride concentrations (p <0.0005) than do patients with pancreatic insufficiency.Chronic pulmonary disease, pancreatic insufficiency and elevated levels of sweat electrolytes comprise the classic diagnostic triad for cystic fibrosis. The expression of these features may be variable, but the sweat test remains the cardinal laboratory confirmation of the diagnosis. Over 98 percent of patients with cystic fibrosis have sweat chloride values greater than 60 meq/liter, 1 to 2 percent between 50 and 60 meq/liter, and only about one in 1,000, like our patient, less than 50 meq/liter. Patients with cystic fibrosis with borderline sweat chloride values frequently have chronic pulmonary disease but intact pancreatic enzyme release. In such patients, family history, ancillary clinical features and systematic exclusion of other syndromes assume special diagnostic importance.     

Coronary arterial disease in systemic lupus erythematosus: Quantification of degrees of narrowing in 22 necropsy patients (21 women) aged 16 to 37 years

The degrees of cross-sectional area luminal narrowing by atherosclerotic plaques of each 5 mm long segment of each of the four major (right, left main, left anterior descending and left circumflex) epicardial coronary arteries in 22 necropsy patients (age 16 to 37 years, 21 women) with systemic lupus erythematosus (SLE) was determined, and the findings were compared to those in 13 control subjects. Of 623 coronary segments (5 mm long) in the patients with SLE, 80 (13 percent) were narrowed 76 to 100 percent (controls = 0 of 431 segments); 125 (20 percent), 51 to 75 percent (controls = 6 percent); 273 (44 percent), 26 to 50 percent (controls = 63 percent) and 145 (23 percent), 0 to 25 percent (controls = 31 percent). Of the 22 patients with SLE, 10 had one or more of the four major coronary arteries narrowed 76 to 100 percent in cross-sectional area, and 12 patients had lesser degrees of narrowing similar to that in the 13 control subjects. The 10 patients with SLE and severe coronary narrowing compared to the 12 patients with SLE and no severe (> 75 percent) coronary narrowing had significantly higher (1) mean values of total serum cholesterol (382 versus 290 mg/dl), (2) mean systolic/diastolic systemic arterial pressures (175/119 versus 151/93 mm Hg), (3) frequencies of mitral valvular disease (seven of 10 patients versus none of 12 patients) and (4) frequencies of pericardial adhesions (seven of 10 patients versus three of 12 patients).     

Daily changes in concentration of pancreatic and serum insulin and of blood glucose during 5 days of treatment of rats with growth hormone,ACTH, cortisol,dexamethasone, and tolbutamide alone and in combinations

Rats with or without 0.5% tolbutamide in the diet were injected over a 5-day period with growth hormone, ACTH, cortisol, dexamethasone, or various mixtures of these diabetogenic hormones and the daily alterations in blood glucose (BG), serum (SI), and pancreatic insulin (PI) concentrations followed as well as glucosuria. GH (5 mg/day) increased the insulin concentration in the pancreas and serum without affecting blood glucose. ACTH (80 IU/day) decreased PI and increased SI with only a slight increase in BG. Cortisol and dexamethasone decreased PI and increased SI and BG. The severalfold increase in SI with glucocorticoids always preceded the increase in BG by 12–24 hr. Mixtures of GH with the glucocorticoids increased and quickened the rise in BG and SI and the falls in PI, but the rise in SI always preceded the rise in BG by several hours. During multiple hormonal treatment, PI decreased in magnitude usually for 3–4 days but by the fifth day tended to revert toward normal, showing adaptation. In contrast, BG and SI tended to remain elevated and glucosuria persisted. These data suggest that in spite of the high concentrations of diabetogenic agents used compensatory changes were made by the rat with intact pancreas over a period of 5 or more days. This hormonally induced condition of elevated SI and BG but normal PI is characteristic of insulin resistance. Tolbutamide by itself decreased PI without a rise in SI (except for a temporary increase at 4–8 hr after the first injection) and with only a minor decrease in BG. Most of the changes due to the hormones were accentuated in rats with 0.5% tolbutamide in the diet, suggesting that tolbutamide is diabetogenic because it decreases PI.     

Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart

Certain clinical and necropsy findings are described in 16 young (aged 15 to 33 years) patients who received greater than 3,500 rads to the heart five to 144 months before death. All 16 had some radiation-induced damage to the heart: 15 had thickened pericardia (five of whom had evidence of cardiac tamponade); eight had increased interstitial myocardial fibrosis, particularly in the right ventricle; 12 had fibrous thickening of the mural endocardium and 13 of the valvular endocardium. Except for valvular thickening, the changes were more frequent in the right side of the heart than in the left, presumably because of higher radiation doses to the anterior surface of the heart. In six of the 16 study patients and in one of 10 control subjects, one or more major epicardial coronary arteries were narrowed from 76 to 100 percent in cross-sectional area by atherosclerotic plaque; one patient had a healed myocardial infarct at necropsy and one died suddenly. In 10 patients and in the 10 control subjects, the four major epicardial coronary arteries were examined quantitatively: 6 percent of the 469 five millimeter segments of coronary artery from the patients were narrowed from 76 to 100 percent (controls = 0.2 percent, p = 0.06) and 22 percent were narrowed from 51 to 75 percent (controls = 12 percent). The proximal portion of the arteries in the patients had significantly more narrowing than the distal portions. The arterial plaques in the patients were largely composed of fibrous tissue; the media were frequently replaced by fibrous tissue, and the adventitia were often densely thickened by fibrous tissue. In five patients, there was focal thickening (with or without luminal narrowing) of the intramural coronary arteries. Thus, radiation to the heart may produce a wide spectrum of functional and anatomic changes but particularly damage to the pericardia and the underlying epicardial coronary arteries.     

肠梗阻 112 例外科治疗体 会简

目的：探讨肠梗阻的外科治疗时机与方法。方法：回顾性分析行手术治疗的112例肠梗阻患者临床资料。结果：在112例肠梗阻中,粘连性肠梗阻57例,肠道肿瘤性肠梗阻36例,嵌顿疝性肠梗阻9例,肠套叠6例,肠扭转2例,结肠粪便堵塞2例。外科治疗后108例治愈,3例好转,1例死亡。结论：肠粘连和肠道肿瘤引起的肠梗阻最为常见,应根据患者的具体病因、病情,选择恰当的手术时机和合理的手术治疗方法。     

岗位胜任力管理模式对护理人员工作满意度的影响

目的探讨岗位胜任力管理模式对护理人员工作满意度影响,为合理配置手术室人力资源提供参考。方法分别采用护士工作满意度量表、自我设计调查问卷,评价岗位胜任力培训前的护理人员工作满意度和岗位胜任能力;按护理人员职称类别及工作年限,分层次对324名护士进行岗位胜任力培训,采用自我设计调查问卷评价岗位胜任力;对不符合岗位胜任能力要求的人员进行分工调整,采用护士工作满意度量表评价调整后的护士满意度状况,比较采用岗位胜任力管理模式前后护士工作满意度变化。结果岗位能力培训后21人（占6.48%）无法胜任现岗位工作;岗位胜任力管理模式实施后护理人员在工作总体满意度、个人及专业发展机会、被认可与表扬、成就感、排班安排与工作条件、管理与医院政策、家庭与工作间的平衡等均高于实施前,差异有统计学意义（P＜0.05）。结论应积极提倡岗位胜任能力管理模式,提高护理人员工作满意度。     

多种形式中心供应室工作模式的探讨

作者简述了目前中小型供应室的发展困境,并提出了以共享医疗资源、提高工作质量为目的的三种代消毒模式:辅助大型医疗机构完善自身消毒供应中心已承担周边小型医疗机构的代消毒工作,建立区域性的中心供应室、引入社会专业代消毒机构。     

标准化流程在外来器械质量控制中的管理

目的通过探讨标准化流程管理,提高对手术外来器械的处理流程的质量控制,达到高效、安全的保障环节质量和控制。方法规范化的接收、清洗、包装、灭菌效果监测过程,各环节制定标准化的工作流程,并严格地贯彻落实,实行全程标准化管理。结果实施手术外来器械的标准化流程管理,提高了工作效率,确保了手术室外来器械的质量,外来器械供应合格率达100.0%,并无感染病例发生,有效控制医院感染。结论通过外来器械标准化流程管理,提高了的供应质量,保障了患者的医疗安全。     

Successful interventions to reduce first-case tardiness in Dutch university medical centers: Results of a nationwide operating room benchmark study

Background

First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact.

Methods

Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions.

Results

Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning “intensive care unit bed release” policy, and a shift in responsibilities regarding transport of patients to the OR.

Conclusions

Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.