摘要:

&NA;Thirty consecutive patients with angiographically demonstrated coronary artery disease randomly received anesthesia either with morphine, diazepam, nitrous oxide in oxygen, and pancuronium (group 1—16 patients), or with ketamine, nitrous oxide in oxygen, and pancuronium (group 2—14 patients). The incidence of intraoperative complications was the same in both groups: hypertension occurred in nine patients of group 1 and six in group 2; ventricular arrhythmias, two in group 1 and one in group 2; death, one in each group. Incidence of postoperative complications was also similar. Although theincidenceof hemodynamic changes was similar, thedegreeof maximal change in systolic blood pressure differed between groups. The mean maximal increase in systolic BP was significantly greater in group 2 (33% of control) than group 1 (16%). The maximal decrease in systolic BP was significantly greater in group 1 (18% of control) than group 2, and the duration of hypotension was significantly greater in group 1 (9.1 minutes) than group 2 (no hypotension). Peak changes in heart rate/systolic blood pressure product (RPP) increased significantly from control in both groups (group 1, 34% and group 2, 71%). Although the percent change in group 2 is twice that in group 1 at peak hypertension, the RPP values were not significantly different. The incidence and degree of hypertension in both groups were unrelated to preoperative ventricular function. We conclude that the morphine anesthetic technic was superior to the ketamine technic in this study, but that neither anesthetic regimen adequately controls the autonomic nervous system in patients with ischemic heart disease.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

&NA;Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smooth‐working obstetrician‐internist‐neonatologist team. Bad prognostic signs include pyelonephritis, ketoacidosis, toxemia, and poor prenatal care. Timing of delivery is no longer arbitrary at 36 or 37 weeks, but is based upon signs of fetal lung maturation and estimates of fetal risk. Abnormalities in the infant, including congenital abnormalities, biochemical abnormalities, respiratory distress syndrome, and large body weight must be managed in a well‐equipped newborn intensive care unit under the care of experienced neonatologists. Strict attention to these principles has resulted in viable infants in the last 36 pregnant diabetic patients delivered at Vanderbilt University Hospital. Therefore, close medical supervision, use of modern obstetric technics, and the availability of a well‐equipped and staffed neonatal intensive care unit can result in a good outcome in this group of patients. Finally, the decision for pregnancy must be carefully considered by the diabetic patient, her husband, and her physician long before pregnancy occurs.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

&NA;Twelve hypertensive patients had measurements of body weight, blood pressure, plasma renin activity, and plasma volume during periods of normal sodium intake and acute sodium depletion. After receiving propranolol orally for four to 14 weeks, repeat measurements were obtained under identical conditions of sodium intake. During normal sodium intake, propranolol therapy was associated with a decrease in plasma renin activity, a variable tendency to an increase in body weight and plasma volume, and a decrease in mean arterial pressure of 5 mm Hg (NS). During sodium restriction, blood pressure was decreased significantly from that observed during normal sodium intake and propranolol added a further significant decrease of 8 mm Hg (P< .01). Blood pressure reductions obtained with sodium depletion and acute diuretic therapy were approximately the same with or without propranolol. The increase in plasma renin activity expected with sodium depletion and diuretic therapy was not blunted by propranolol.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

&NA;A survey was made of hematologic values obtained with the Coulter Counter, Model S, at American Medical Laboratories, Inc. Blood specimens from 6,887 outpatient men, women, and children were analyzed according to age and sex. Patients being seen by nephrologists, hematologists, and oncologists were excluded from the study. The mean values for white blood cell counts, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration correlated well with values frequently quoted as normal. However, the mean values for hemoglobin, hematocrit, and red blood cell counts were slightly lower than the commonly accepted normal mean values. This may be a result of newer and more accurate methods of hematologic analysis.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

&NA;Medical indications for abortion rest on estimating the risk of an abnormal outcome of pregnancy. Recent advances have greatly increased our ability to predict the outcome for both mother and child. Given the safety of aminocentesis and the many disorders now diagnosable prenatally, genetic counseling has evolved from a level of only making a statement of chance to that of knowing the karyotype and genotype of the fetus. Fetal indications for abortion include risk of abnormality from either genetic or environmental factors. Maternal indications include physical or mental disorders which may jeopardize the patient's health. The physician and the geneticist must recognize the pregnancy at risk and fully inform the couple early enough to permit investigation, diagnosis, and decision on termination.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID