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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The accuracy of primary diagnosis made by general practitioners and paediatric house officers was assessed from a nationwide series of 130 Finnish children with bacterial meningitis. Meningitis was diagnosed at the first medical examination in 76 (58%) of the cases (32/70, 46% at physician's office versus 44/60 (73%) in hospital emergency rooms; p less than 0.005). In 44 cases (34%), there was a time lapse (mean, 1.7 days) between the first examination and the diagnosis of bacterial meningitis. ⋯ The overall mortality rate was 5/130 (4%) and the frequency of neurological sequelae was 28/130 (22%). The existence of potentially avoidable diagnostic delay in childhood bacterial meningitis was confirmed. Means of avoiding such potentially disastrous delay were discussed briefly.