Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 +/- 0.73 min) than in the VVI mode (mean 7.81 +/- 0.62 min) (P less than 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 +/- 16.22 points) compared to the VVI mode (mean 156.27 +/- 21.22 points) (P less than 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).
Abstract-Hypertensive crises require immediate therapy, usually by parenteral drug administration.Sublingual nifedipine has been shown to be highly effective. However, the blood pressure fall following nifedipine is frequently associated with side effects.The use of sublingual captopril has recently been indicated in hyper tensive crisis, assuming that by this route, there would be a faster absorption and thus a more rapid effect on blood pressure than with the oral route. To verify this hypothesis, we have compared the hypotensive effects of sublingual nifedipine and sublingual captopril in 52 patients with hypertensive emergencies:25-mg captopril and 1 0-mg nifedipine were administered sublingually to 28 and 24 patients, respec tively. Blood pressures and heart rates were continuously measured up to 240 min postdose.A significant (P<0.001) hypotensive effect of both sublingual captopril and nifedipine therapy occured at 5 min and persisted for 240 min. Heart rates increased with nifedipine, but decreased with captopril.
SUMMARYA patient was found to have a mobile catheter fragment in the right atrium incidentally during echocardiography. On further investigation, it was learned that the catheter had been inserted 9 years earlier during surgery and had probably been broken during removal. The patient did not experience any symptoms during this period. The catheter was removed percutaneously without any complications using a system similar to the loopsnare catheter. (Jpn Heart J 34: 117-119, 1993.) Key Words: Percutaneous extraction Catheter fragment ANY patients receive intravascular catheters, and infrequently, complications due to their use are seen in clinical practice. Catheter breakage is one of the complications seen, and may be associated with serious consequences in 71% of these patients.4)Since the removal of the catheter usually requires major surgery, there have been attempts to remove intravascular catheters by alternative methods. The first case of nonsurgical removal of an intravascular catheter was described in 1984, and since then, several different techniques have emerged and have been utilized safely.1),6) CASE REPORT A 52-year-old man underwent subtotal gastrectomy, gastrojejunostomy and partial omentectomy for gastric lymphoma in 1982. He received chemotherapy and radiotherapy after the operation. An intravascular catheter was placed durFrom the
Although lipoprotein (a) [Lp(a)] has been shown to interfere with thrombolysis in vitro, its effects on thrombolytic therapy in patients with acute myocardial infarction (MI) are not clear. The authors evaluated 32 male patients ages thirty-five to seventy-five (mean fifty-two +/- ten) with the diagnosis of acute MI who underwent thrombolytic therapy with 1,500,000 units of intravenous streptokinase. All patients underwent coronary angiography within seven days of the infarction from which the thrombolysis in myocardial infarction (TIMI) flow grades of the infarct-related artery, coronary scores, and ejection fraction were determined. Anterior MI was found in 19 patients (59.4%), inferior MI in 12 (37.5%), and posterolateral MI in 1 patient (3.1%). They found that 6 patients (18.8%) had TIMI flow 0 to 1, and 26 patients (81.2%) had TIMI flow grade 2 or 3. The Lp(a) levels ranged from 0.1 to 60 mg/dL with a mean of 8.6 +/- 17 mg/dL. Eight (25%) of the patients had Lp(a) levels above 30 mg/dL. The TIMI flow rates were not found to be lower in patients with high Lp(a) levels (P > 0.05), and there was no significant correlation between the TIMI flow rates and the Lp(a) levels (r = 0.28). There was a good correlation between coronary scores and Lp(a) levels (r = 0.87). They conclude that although there is a good correlation between the extent of coronary atherosclerosis and Lp(a) levels, Lp(a) is not a strong predictor of the outcome of thrombolytic therapy.
Prazosin and digoxin are frequently coadministered in clinical practice. To determine the effects of oral prazosin treatment on steady-state digoxin levels, 20 patients receiving a constant maintenance dose of digoxin, who had normal renal and liver functions and were not receiving any other treatment, were given 5 mg of prazosin for 3 days. Plasma digoxin levels were measured before, on days 1 and 3 of prazosin treatment, and after prazosin had been discontinued. It was found that prazosin significantly increased plasma digoxin levels. On discontinuation of prazosin digoxin levels returned to their previous values.
Fifteen patients with constrictive pericarditis were prospectively evaluated with echocardiography and Doppler recordings during respiratory monitoring. Eleven who agreed to surgery also underwent right heart catheterization and a repeat echocardiography with Doppler 10 days after pericardiectomy. Preoperatively, there was a significant inspiratory decrease in the mitral E wave (P < 0.05) and increase in the tricuspid E wave velocities (P < 0.05), which both normalized after pericardiectomy. The mitral deceleration times increased from 110 +/- 40 to 149 +/- 46 msec (P < 0.05) postoperatively. The preoperative hepatic vein velocities showed an accentuated systolic flow pattern. The systolic to diastolic ratio of the hepatic vein velocities was higher in patients who improved with surgery (1.42 +/- 0.31 vs 0.65 +/- 0.13) (P < 0.05). Postoperatively the diastolic flow became more pronounced. There was a 100% expiratory diastolic flow reversal in eight patients preoperatively, which normalized after pericardiectomy. Clinically these patients improved significantly postoperatively. Left atrial size, ejection fraction, and mitral and tricuspid filling velocities during respiratory monitoring could not predict surgical outcome. Pericardiectomy improved Doppler filling dynamics in all patients although this was not parallel to clinical improvement.
Amaç: Bu çalışmanın amacı, akut pulmoner emboli (APE) ve kronik tromboembolik pulmoner hipertansiyon (KTPHT) olgularının cerrahi ile belirgin olarak düzeldiklerini öngören kanıta dayalı veriler temelinde cerrahi sonrası seyir ile ilgili belirsizliği azaltmak ve bu olgularda cerrahi tedavi seçeneklerini dikkate alan doktorları cesaretlendirmektir. Ça lış ma pla nı: Bu gözlemsel ve geriye dönük gerçekleştirilen çalışmaya Şubat 2009 ile Ekim 2010 tarihleri arasında, APE ve KTPHT tanısı ile ameliyat edilen yedi olgu (3 erkek, 4 kadın; ort yaş 43.8±18.5 yıl; dağılım 25-73 yıl) dahil edildi. Hastaların ameliyat öncesi ve sonrası ortalama pulmoner arter basıncı (mPAP), New York Heart Association (NYHA) fonksiyonel sınıfı, yoğun bakım ünitesi (YBÜ) ve hastanede kalış süresi, demografik, klinik ve ameliyat özellikleri kaydedildi. Olgu sayısının yetersizliğinden dolayı istatistiksel analizler, parametrik olmayan testler ile yapıldı. Grupların karşılaştırılmasında Wilcoxon testi kullanıldı. Bul gu lar: Cerrahi sonrasında bütün hastalarda mPAP'da 20 mmHg (dağılım 5-53) düşüş sağlandı ve altıncı olgu hariç tüm olguların mPAP'ları, 30 mmHg'nın altına çekildi. Ameliyat öncesi ve sonrası mPAP'ları, sırasıyla 43 mmHg (dağılım 33-68) ve 23 mmHg (dağı-lım 15-37) idi. Bu durumda cerrahi sonrasında anlamlı bir düşüş elde edildi (z=-2.36; p=0.018). Buna ilaveten, cerrahi sonrasında hastanın NYHA sınıfındaki iyileşmesi 1 (dağılım 1-3) birimdi. Hastaların ameliyat öncesi ve sonrası NYHA sınıfları sırasıyla III (II-III) ve II (I-II) idi. Ameliyat sonrası NYHA sınıfındaki düşüş ile birlikte cerrahinin iyileştirme üzerine etkisi anlamlıydı (z=-2.26; p= 0.024). Yoğun bakım ünitesi ve hastanede ortalama kalış süreleri, sırasıyla üç (dağılım 2-14) ve 9.5 (dağılım 5-27) gündü. So nuç: Çalışma bulgularımıza göre, ayrıntılı bir ameliyat öncesi değerlendirme ve uygun hasta seçimi ile hekimler, cerrahi seçe-neğin kararında çekimser olmamalı ve hastaların yaşam kalitesini artırmak için çaba harcamalıdır.Anah tar söz cük ler: Akut pulmoner emboli; kronik tromboembolik pulmoner hipertansiyon; fonksiyonel kapasite; ortalama pulmoner arter basıncı; pulmoner tromboendarterektomi.Background:This study aims to reduce the uncertainity related to the prognosis after surgery of the acute pulmonary embolism (APE) and chronic thromboembolic pulmonary hypertension (CTPHT) patients, and to encourage physicians to consider surgical treatment options based on the evidence-based data which suggests that surgery offers the best chance for improvement in these patients. Methods: Between February 2009 and October 2010, seven cases (3 males, 4 females; mean age 43.8±18.5 years; range 25 to 73 years) who were operated on due to APE and CTPHT were included in this observational and retrospective study. The preand postoperative mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and length of stay in the intensive care unit (ICU) and hospital along with the demographic, clinical and operational characteristics of the patients were r...
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