European heart journal
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European heart journal · Dec 1989
Acute renal failure after cardiovascular surgery. Current concepts in pathophysiology, prevention and treatment.
Acute renal failure (ARF) is a serious complication of cardiovascular surgery and has a high mortality rate, especially with oliguria. It is usually caused by ischaemic injury of the kidney, resulting from inadequate perfusion. ⋯ Once renal failure is established close control of hydration, solutes and potentially toxic metabolites is necessary. Early renal replacement therapy with proper nutritional support appears to improve survival.
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European heart journal · Aug 1989
Randomized Controlled Trial Clinical TrialA randomized prospective study on anxiety reduction by preparatory disclosure with and without video film show about a planned heart catheterization.
Unfortunately, giving preparatory information to the patient is generally regarded as legally mandatory for obtaining his written consent to an invasive procedure. Disclosure, however, could be used to reduce his anxiety as well; we hypothesized that showing a preparatory video film might be helpful in this respect. Patients who were admitted for elective coronary angiography were eligible for the study. 65 were randomized to two groups: both groups received the same leaflet and personal interview with the doctor, but only one group (Group 2) additionally watched a 14 min preparatory video. ⋯ The two groups did not differ with respect to initial anxiety levels and other important parameters. Group 1 patients, who did not watch the video had no significant reduction in anxiety score; group 2 patients showed a significant benefit. We conclude that disclosure with the additional aid of a video film may be an easy, yet effective way to reduce patients' anxiety.
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European heart journal · Aug 1989
ReviewPharmacology of positive inotropic phosphodiesterase III inhibitors.
Cardiac phosphodiesterase III (PDE) inhibitors derived from pyridinone, imidazolone, pyridazinone and related structures form a new class of positive inotropic vasodilator agents (e.g. milrinone) that are beneficial in the treatment of acute and chronic heart failure. These agents inhibit the intracellular hydrolysis of cyclic AMP, thereby promoting cyclic AMP-catalysed phosphorylation of sarcolemmal calcium channels and activating the calcium pump. Drugs such as milrinone have a wider therapeutic index than the cardiac glycosides. ⋯ The effectiveness of these new agents is, however, dependent upon some degree of basal adenylate cyclase activity. Individual PDE inhibitors differ in terms of both chronotropic and extracardiac properties. The reasons for this are not yet fully understood.
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This study is concerned with the value of basic CPR (manual ventilation and closed chest cardiac massage) initiated within 5 min in delaying brain damage after cardiac arrest in adult patients at ambient temperature. In 88 cases of cardiac arrest, basic CPR was initiated within 5 min of collapse by trained ambulance personnel. Basic CPR was continued during transport to the hospital in ambulances not equipped with defibrillators. ⋯ All 11 patients eventually discharged from the hospital without apparent brain damage arrived at the hospital within 10 min of cardiac arrest. A significant number of patients arriving later could be resuscitated acutely but later died unconscious or were discharged with severe brain damage. We conclude that basic CPR, including bystander CPR initiated within 5 min of cardiac arrest is likely to be of long-term value only if definitive advanced life support can be provided within 10 min after the patient's collapse.
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European heart journal · May 1989
Thoracic epidural anaesthesia in patients with unstable angina pectoris.
The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated with nitroglycerin infusion for greater than 24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest greater than 2 days after infarction. 4.4 +/- 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments (Th1-7) for 98 +/- 9 min. ⋯ Treatment with thoracic epidural anaesthesia lasted for 6.0 +/- 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 +/- 0.3 the first day to 0.9 +/- 0.3 the fourth day (P less than 0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died.(ABSTRACT TRUNCATED AT 250 WORDS)