Angiology
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Case Reports
Doppler echocardiographic detection of traumatic ventricular septal defect--a case report.
A case of traumatic ventricular septal defect diagnosed by Doppler echocardiography is described. The characteristic pulsed Doppler findings of a left-to-right shunt were recorded and the two-dimensional echocardiographic images of septal interruption were shown. Combined Doppler and two-dimensional echocardiography enhances the ability to detect the presence of a ventricular septal defect. Doppler echocardiography appears to be a useful noninvasive imaging modality in the evaluation of patients with cardiac trauma.
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Comparative Study
The influence of sympathetic nerves on transcutaneous oxygen tension in normal and ischemic lower extremities.
The authors evaluated the relationship between sympathetic nerve activity and transcutaneous oxygen tension (TcpO2) in normal and ischemic lower extremities. Dorsal foot TcpO2 was measured by using oxygen-sensing electrodes with surface temperatures of 42 degrees C and 45 degrees C; in theory, changes in sympathetic activity should affect vasomotor tone and TcpO2 in skin beneath an electrode at 42 degrees C (submaximal vasodilation), but not at 45 degrees C (maximal vasodilation). The vasodilation index (TcpO2 at 42 degrees C/TcpO2 at 45 degrees C) was created as an index of vasomotor tone (vasodilation index increases as tone decreases). ⋯ Among ischemic limbs (n = 34) vasodilation index was highly variable (range: 0-0.77); in general, vasodilation index fell as the ischemia worsened. In a subset of patients with ischemic limbs, the vasodilation index increased after the limb was wrapped in a warm dressing (average vasodilation index = 0.25 without dressing, 0.37 with dressing). The authors conclude: TcpO2 can be used to assess the degree of vasomotor tone (and sympathetic activity) in skin; tone generally increases as ischemia worsens; and local warmth can improve cutaneous circulation in ischemic limbs.
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User "friendly" computers are becoming available for increased usage in the medical arena. The Surgical Intensive Care Unit (SICU) has a large number of items to identify, quantify, manage, and record frequently, often on a continuing basis. At the Palo Alto Veterans Hospital, a program has been developed (A. ⋯ Fewer laboratory studies such as blood gas determinations are required. Trending of information is critical in making appropriate plans of care. Twenty patients with a variety of surgical problems have been evaluated by utilizing a bedside computer.
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Clinical Trial
Efficacy and safety of oral tocainide in refractory ventricular arrhythmia: a preliminary report on an open label study.
The preliminary data on efficacy and safety of oral tocainide in refractory ventricular dysrhythmia in 8 patients is described. Two patients died; one within 15 days and the other after 1750 days of continuous tocainide therapy. ⋯ Four out of 8 patients received tocainide in presence of left ventricular dysfunction and 2 out of 4 such patients died suddenly. Minor central nervous system side effects were seen in 2 patients and dermatologic adverse reaction was seen in one patient only.
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A patient is reported who presented with fatal hypothermia. The electrocardiographic changes of a sinus bradycardia, prolonged QT interval and Osborn waves were documented and correlated with body temperature. The possible genesis of these electrocardiographic changes is reviewed in this article.