For more than two decades cardiologists and cardiac surgeons have estimated the physiologic significance of coronary lesions by measuring percent stenosis of the obstructive vascular segment from ...coronary angiograms. Such measurements, when performed without computer-based analysis, are associated with substantial variability between observers, as well as within a single observer. In addition, recent intraoperative measurements of coronary reserve in individual obstructed vessels of patients with multivessel coronary disease performed with a suction Doppler probe indicate that, in the intermediate range (10% to 90% diameter stenosis), percent stenosis measurements of coronary lesions by angiography correlates poorly with coronary reserve. These studies suggest that the physiologic significance of coronary obstructions cannot be accurately assessed by visual interpretation of coronary angiograms. More sophisticated and accurate approaches are needed for assessing the physiologic significance of coronary obstructions preoperatively.
Census reports and information in burial records of Manti, Utah from 1849 to July 1977 are examined in order to (1) document mortality trends and differentials by age, sex, cause-of-death, and ...seasonality as Manti passed from a frontier settlement to a rural agricultural community; and (2) ascertain whether the shifts in the cause-of-death structure follow those patterns outlined by Omran (1971, 1974, 1977) in his theory of the epidemiologic transition. Findings parallel patterns suggested by Omran. Major factors accounting for mortality reductions are (1) elimination of the population's dependence upon a contaminated water supply, and (2) adoption of medical advances as they became available.
To establish long-term efficacy and the relation between drug plasma concentration and antiarrhythmic response, 12 patients with encainide-responsive frequent complex ventricular ectopic activity ...underwent 1 year of therapy with encainide. Twenty-four hour ambulatory electrocardiograms were obtained at baseline and every 2 months. Drug withdrawal with concomitant plasma sampling and electrocardiographic monitoring was performed at 6 and 12 months. Average group premature ventricular contraction (PVC) suppression during the year was 97 to 99%, with nearly total suppression of pairs and salvos. The most common adverse effects were transient visual disturbances and dizziness or lightheadedness. During a dose interval (6 to 12 hours) the concentration of encainide metabolites exceeded that of encainide by several-fold. The median time of arrhythmia return after drug withdrawal was 12 to 14 hours. At the time of arrhythmia return encainide was generally no longer detectable but the average concentration of O-demethylencainide and 3 methoxy-O-demethylencainide was 72 +/- 49 and 172 +/- 74 ng/ml, respectively. It is concluded that encainide therapy is extremely effective for continuous long-term suppression of complex ventricular arrhythmias and its metabolites contribute significantly to its antiarrhythmic action during chronic oral therapy.
Encainide is a potent Class I antiarrhythmic drug that prolongs conduction in the His-Purkinje system. It produces only minimal hemodynamic changes in the normal or depressed left ventricle. Studies ...to date demonstrate excellent effectiveness against ventricular arrhythmia, and in comparative studies with quinidine, encainide was superior in reducing the frequency and complexity of ventricular premature beats in patients late after myocardial infarction.
Encainide, a new antiarrhythmic drug, was given intravenously (0.9 mg/kg) to 18 patients over 15 minutes to evaluate the hemodynamic effects. Hemodynamics and drug plasma concentrations were measured ...during and 30 minutes postdrug infusions. Encainide infusion was associated with a decrease in cardiac index from 2.6 +/- 0.7 to 2.4 +/- 0.7 L/min/m2 (p less than .05), a significant decrease in stroke work index and left ventricular end-diastolic pressure, and with a rise in systemic vascular resistance. There was no change in systemic or pulmonary arterial pressure, left ventricular dp/dt, or pulmonary vascular resistance. The patients were studied 30 to 60 minutes after cardiac angiography. Comparison of hemodynamic values obtained preangiography with those obtained postangiography (before, during, and after drug infusion) strongly suggests that many of the observed effects were due to radiographic contrast media (initial osmotic volume loading and subsequent diuresis). We conclude that if encainide has any significant hemodynamic effects after intravenous use, it is a modest decrease in cardiac output, possibly as a result of decreased left ventricular filling pressure.
This paper describes psychiatric consultations in a chronic care and rehabilitation hospital. It reports that although 60% of consultation requests were for depression, only 8.6% of patients seen ...received a diagnosis of Affective Disorder. Many patients seen, 51.4%, did not receive a formal psychiatric diagnosis and were found not present problems in adapting to chronic disabling illnesses. These problems included difficulties with convalescent and rehabilitative tasks, manifested by pathological behaviours such as persistent denial and pseudoindependence, as well as characteristic reactions to specific catastrophic illnesses. It is important to recognize that in this population psychotropic medication should be used judiciously, and interpersonal and milieu approaches should be emphasized. It is also important for the psychiatric consultant to maintain an optimistic, therapeutic attitude in what often seem to be rather foreboding consultation settings.
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