Chrome congestive heart failure: Non-invasive measurement of cardiac output by a carbon dioxide rebreathing method at rest and during exercise

Cardiac output was measured in 11 patients undergoing routinecardiac catheterization using a carbon dioxide rebreathing techniqueand compared with cardiac output measured by direct Fick andthermodilution. The carbon dioxide rebreathing technique gaveconsistently lower values for cardiac output than the othertwo methods (mean difference –0·73, 95% CI –0·95to–0·511. min^–1 with the direct Fick and–0·72. 95% CI –1·19 to –0·261.min^–1 with thermodilution). The direct Fick and thermodilutionmethods gave similar results (mean dtfference –0·08,95% CI –0·32 to 0·16a. min^–1). Cardiacoutput was also measured in 10 healthy subjects at rest andduring two steady-state levels of exercise using the carbondioxide rebreathing technique. Measurements were made in triplicateon 3 separate days. The technique gave reproducible resultsbetween replicates at rest (coefficient of variation 91%) andbecame more reproducible on exercise (coefficients of variation56% and 54% respectively at each exercise level). There wasa good correlation between cardiac output and oxygen consumption(r=0·98 The carbon dioxide rebreathing technique is afeasible non-invasive way of measuring cardiac output. It tendsto underestimate cardiac output at rest but is reproducibleand becomes more so on exercise which is where it should beof most value.     

Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates.

Sixty-three women participated in a study in Calgary, Alberta to assess the rate of arm recovery and factors affecting it up to one year after axillary node dissection for breast cancer. Outcomes included objective measures of swelling, mobility, and strength, and subjective assessments of pain (at rest and with movement) and stiffness. Approximately 42% of women had residual impairment of at least one type one year after surgery, the most common problems being pain (16%) and reduced grip strength (16%). Except for lymphedema, measurements one year after surgery showed little change from measurements at 6 months, suggesting that the shorter follow-up may be appropriate for assessing the long term effects of axillary dissection. Lymphedema was the only sequela which increased over time. The results provide parameter estimates for designing studies to evaluate the role of physiotherapy after axillary dissection.     

Bilocular atrial malignant mesenchymoma causing mitral and localized pulmonary vein flow obstruction: diagnosis by transoesophageal echocardiography.

Cardiac malignant mesenchymoma is an extremely rare malignancy with poor prognosis. We report a patient presenting with a history and clinical findings typical of mitral stenosis. Transthoracic echocardiography showed a mass on the thickened posterior mitral leaflet. Transoesophageal echocardiography revealed two tumoural masses: one on the atrial side of the posterior mitral leaflet causing mitral obstruction, the other arising in the region of the right lower pulmonary vein orifice and obstructing inflow through this vein.     

间置空肠贲门再造术在抗返流性食管炎上的应用

作者对１５例贲门癌患者行根治术同时，采用食管残胃间插入带蒂空肠并附加贲门再造术，通过ＳＰＥＣＴ胃食管返流指数测定、食管下端ｐＨ检测及返流症状评定方法，并与单纯食管胃套叠吻合术进行随机对比分析，证明该术式具有单向住屏障作用，能有效地预防返流性食管炎的发生。     

不同层次护生对临床教学质量的评价

目的分析不同层次护生对临床教学质量评价的差异,以便采取有针对性的教学方法.方法护生在每个科室实习结束后,采用自行设计的临床教学评价表对每名护生进行问卷调查,然后分别从中专、大专、本科护生填写的调查表中各随机抽取30%进行分析.结果对病房教学氛围和护士长教学管理的评价,本科与中专、大专护生间比较,差异有显著性意义(均P<0.05),中专与大专护生间无差异(P>0.05);对带教老师的评价,本科与中专、大专与中专护生间均差异有显著性意义(P<0.01,P<0.05),本科与大专间无差异(P>0.05).结论不同层次护生对临床教学质量评价的侧重点不同,本科生对病房教学氛围及护士长教学管理的要求较高,大专生次之.在临床教学中应根据护生的学历层次,采取有针对性的教学方法,以便不断提高临床教学质量.     

肠内营养在慢性阻塞性肺病机械通气治疗与护理中的作用

目的　探讨肠内营养对慢性阻塞性肺病 (COPD)机械通气治疗与护理中的作用。方法　行机械通气的2 8例患者随机分为 2组 ,治疗组 14例给予安素营养 4周 ,对照组 14例给予一定量糖、脂肪、氨基酸等常规输液 ,上述两组病人每周常规测定血清蛋白 (ALB)、IgA、IgG、IgM、FEV1、PaO2 、PaCO2 及一次脱机成功率。结果　治疗 2周末实验组ALB、IgA、IgG、IgM均显著高于对照组 (P <0 0 5 ) ;治疗 4周末治疗组所有指标均显著高于对照组 (P <0 0 5 )。结论　肠内营养是COPD机械通气患者的一项重要治疗措施 ,良好细致的护理是保证其成功实施的关键     

睫状体缝合复位术的临床观察及护理

目的:探讨适合睫状体缝合复位术病人的护理方法。方法:对34例(34只眼)因外伤致睫状体分离和脱离导致低眼压,随后行睫状体缝合复位术的病人进行观察和护理。结果:32只眼术后1周至6个月眼压恢复正常,其中5只眼术后2～5个月内分别进行第二次手术或氩离子激光光凝而痊愈。视力改善者21例,无变化者13例。结论:睫状体缝合复位术是治疗外伤性睫状体分离和脱离的有效方法。术前行超声生物显微镜(UBM)检查、术后密切观察眼压变化并给予正确处理、做好心理护理和出院指导是确保手术成功的重要措施。     

Geriatric care on a ward without nurses

The Multiphasic Environmental Assessment Procedure (MEAP; Moos and Lemke, 1984) was used to assess three long-stay settings within a geriatric hospital, one of which is a non-nursing unit committed to the philosophy of residents viewing the setting as their own home. Findings suggest positive outcomes for residents on the nonnursing unit, and support the view that types of care fostering independence and personal responsibility of elderly residents in their setting may be associated with increased mental functioning and activity. The lack of trained nursing staff had no detrimental effect on any measure of resident life, and some specific caring practices on the unit may be interpreted as having a positive outcome for residents.     

超声心动图诊断原发性心脏肿瘤

目的：探讨原发性心脏肿瘤超声心动图(ECG)特征。方法：利用ECG检查42例心脏肿瘤。其中粘液瘤38例，恶性肉瘤2例，均经手术病理证实。横纹肌瘤2例，经随访证实。结果：ECG对38例粘液瘤，2例横纹肌瘤全部做出正确诊断。2例恶性肿瘤提示相应部位占位病变。粘液瘤多发生在左房，有明确的瘤蒂，肿瘤回声稀疏，活动度大。恶性肿瘤回声较强、无蒂，活动度小。横纹肌瘤多发生在室壁心肌内，呈结节状，与正常心肌间有明确的界限。结论：ECG对原发心脏肿瘤的诊断具有重要意义，可初步区分良、恶性肿瘤。     

心脏创伤35例报告

本文报告心脏创伤３５例。年龄最小７岁，最大６８岁，其中包括心脏刺伤患者１０例，心肌挫伤患者２５例，死亡５例。作者强调快速确定诊断，紧急剖胸心包切开减压和心脏修补止血是心脏刺伤救治成功的关键。同时，对心肌挫伤的临床表现、早期诊断和及时处理等问题进行了讨论。