Cleveland Clinic journal of medicine
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The various antihypertensive agents reduce blood pressure by different mechanisms. Alpha-1 receptor blockers reduce vascular resistance and maintain cardiac output. Chronic treatment with beta blockers without intrinsic sympathomimetic activity produces a fall in blood pressure which is associated with a fall in cardiac index and heart rate. ⋯ They should not be used in patients with bronchial asthma, reduced peripheral blood flow, or heart failure. Labetalol reduces blood pressure in a somewhat larger fraction of patients than the pure alpha- or beta-blocking agents. It is hoped that its long-term results will include regression of cardiovascular damage, improved quality of life, and increased life expectancy.
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Complex partial seizures originating in the temporal lobe are one of the most common types of seizures in patients with epilepsy. They are frequently intractable to medical treatment and are increasingly considered for surgical therapy. ⋯ Much research is being undertaken to better understand this disorder and to develop more effective approaches to diagnosis and treatment. Experimental work in animals has contributed to the understanding of epileptogenesis, the interictal state, and the homeostatic mechanisms that limit seizure activity.
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Comparative Study
Transesophageal echocardiography in the critical care unit.
Transthoracic echocardiography may be of limited value for patients in intensive care units because of suboptimal patient positioning, surgical wounds, and mechanical ventilation. By contrast, transesophageal echocardiography provides a new window for cardiac imaging, even in critically ill patients. We report our indications based on findings comparing transesophageal and transthoracic echocardiography in 112 studies in intensive care units. ⋯ Transesophageal echocardiography was superior to the transthoracic approach in patients with significant (higher than 2+) mitral regurgitation, with improved detection in 10 (9%) cases (p less than 0.05). Transesophageal echocardiography also provided additional information in the evaluation of vegetations, diseases of the aorta, visualization of the left ventricle, intracardiac masses, intracardiac thrombi, and congenital heart disease. Transesophageal echocardiography provides a useful diagnostic tool for evaluation of critically ill patients.