Annals of clinical research
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Clinically significant differences between various beta-adrenoceptor blocking drugs exist. Patients with ischaemic heart disease and exertional angina pectoris benefit from all types of beta-blockers. Drugs with intrinsic sympathomimetic action (ISA) given intravenously may be safer in some patients with acute myocardial infarction than those drugs without ISA. ⋯ Non-selective beta-blockers may be advantageous in hypokalaemic arrhythmias. Beta 1-blockers may be preferred for patients with bronchoconstriction, diabetes, peripheral vascular disease and, theoretically to some extent in theory also in patients with hypertension. The extent and nature of side effects may also influence the selection of the most suitable beta-blocker in cardiovascular therapy.
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A prospective study of postoperative infectious complications after open-heart surgery was carried out in 885 patients. A total 200 postoperative infections occurred in 173 patients, an overall incidence was 19.5%. The mortality rate was 0.8%. ⋯ Although E. coli was the causative agent in 37% of postoperative urinary tract infections the incidence of infection by the classical hospital-acquired organisms (klebsiella and pseudomonas) was also high (32%). Postoperative infections caused an average prolongation of hospital stay of 8 days. The increase was shortest for urinary tract infections (5 days) and longest in patients with postoperative mediastinitis (28 days).
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Non-suppression of the hypothalamic-pituitary-adrenocortical activity on the dexamethasone suppression test was found in 27/115 patients who were referred to consulting psychiatrists in the Psychiatric Outpatient Clinic of Turku University Central Hospital and in the Rehabilitation Research Centre because of unspecific chronic pain complaints. Depressive symptoms in the patients were identified by the Research Diagnostic Criteria for definite or probable endogenous and non-endogenous depressive disorders. The cortisol levels after dexamethasone suppression were significantly higher in endogenous than in non-endogenous patients and it uncovered masked depression in some complex patients. However, nonsuppression in the dexamethasone suppression test was not specifically associated with the pain-prone disorder, which was further characterized by the factor models of the Hamilton Depression Scale.