[Patients in complex situation in internal medicine intermediate care unit : An example of interprofessionality].

Taking care of patients in complex situation is a challenge as well in outpatient clinics as in hospital settings. Patient complexity varies over time and according to the place of treatment, requiring multiple actors, and usual guidelines are rarely applicable. As multiple organ systems are involved and the need for a "tailored" approach, these patients are often hospitalized in general internal medicine wards.

Diaphragm function after interscalene brachial plexus block: a double-blind, randomized comparison of 0.25% and 0.125% bupivacaine.

Background: Interscalene brachial plexus block (ISBPB) provides excellent analgesia after rotator cuff surgery but is associated with diaphragm dysfunction. In this study, ISBPB with 20 mL of 0.125% or 0.

High intraoperative inspired oxygen does not increase postoperative supplemental oxygen requirements.

Background: Although a high fraction of inspired oxygen (FIO2) could reduce surgical site infection, there is concern it could increase postoperative pulmonary complications, including hypoxemia. Intraoperative positive end-expiratory pressure can improve postoperative pulmonary function. A practical measure of postoperative pulmonary function and the degree of hypoxemia is supplemental oxygen requirement.

Diagnostic accuracy of exercise electrocardiogram in patients with left anterior hemi-block.

Background: Left anterior hemiblock (LAHB) is the most frequent conduction abnormality, but its impact on the diagnostic accuracy of the exercise ECG has not been studied. The aim of our study was to determine the diagnostic accuracy of ST depression for predicting ischaemia in the presence of LAHB.

Patients: Consecutive patients with known or suspected coronary heart disease undergoing exercise ECG and 99mTc-sestamibi single photon emission computed tomography (SPECT) were included in the analysis.

Does subjective burden of early breast cancer and its treatment affect immune measures during adjuvant therapy?

Psychosocial factors have been described as affecting cellular immune measures in healthy subjects. In patients with early breast cancer we explored bi-directional psycho-immune effects to determine whether subjective burden has an impact on immune measures, and vice versa. Patients (n = 239) operated for early breast cancer and randomized into International Breast Cancer Study Group (IBCSG) adjuvant clinical trials were assessed immediately before the beginning of adjuvant treatment (baseline) and 3 and 6 months thereafter, at the beginning of the corresponding treatment cycle.

QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism.

Aims: To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome.

Methods And Results: ECG's from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism.

[Ventricular arrhythmias: diagnosis and drug therapy].

After a brief classification of antiarrhythmic drugs and their mode of action, ventricular dysrhythmias are defined and characterized with respect to underlying causes. A short chapter is dedicated to the treatment of acute ventricular tachycardia, a longer one to the prophylaxis of ventricular dysrhythmias, based on our knowledge in the "post CAST Study era' (CAST = Cardiac Arrhythmia Suppression Trial). A special interest is dedicated to patients commonly encountered in daily practise: patients with coronary artery disease, patients with chronic heart failure, and patients without underlying heart disease.

["Arrhythmica" or: history, extent and practical consequences of pro-arrhythmia effects].

It has been known for many years that antiarrhythmic drugs may have a potential proarrhythmic effect. But it was not until two very important prospective studies were published, of Velebit et al. (1982) and in particular the CAST study (1989), that the extent and potentially deleterious consequences of the proarrhythmic effect were realized.

Stress-induced polymorphous ventricular tachyarrhythmias in two brothers: unusual pattern of inheritance in the long QT syndrome.

Two brothers, 10 and 9 years old, are reported who were treated for years with antiepileptic drugs until the cardiac origin of their syncopal attacks was discovered. Our findings are consistent with the diagnosis of long QT syndrome, although no other family members are affected and only intermittent and mostly borderline QT prolongation could be found. Diagnostic difficulties and genetic implications are discussed.

[Dangerous arrhythmias].

The usual frequent tachyarrhythmias well known to the specialists in internal medicine, such as ventricular tachycardia and ventricular fibrillation, are not discussed in this publication; nor are the bradycardias connected with the sick sinus syndrome or with atrioventricular block of higher degrees (with one exception). In the first section a stratification of the risk after myocardial infarction is presented including the therapeutic implications. Severely reduced left ventricular function is of most negative prognostic value.

Isolated left posterior fascicular block: a reliable marker for inferior myocardial infarction and associated severe coronary artery disease.

The electrocardiographic (ECG) pattern of isolated left posterior fascicular block (LPFB) is a rare condition. It seems that true LPFB is often not recognized, whereas in cases of simple QRS axis of +60 degrees to +100 degrees in the frontal plane, the diagnosis of LPFB is made erroneously. Both facts rely on controversial and partially misleading opinions in the literature.

Prevalence of the Rhesus-negative phenotype in Caucasian patients with small-cell lung cancer (SCLC).

We report that the Rhesus (Rh)-negative phenotype is more prevalent in patients with small-cell lung cancer (SCLC) than in the normal Caucasian population (SCLC: 25% Rh-negative vs. 15% expected, p less than 0.0001).

[Complementary information from Doppler echocardiography in the electrocardiogram in the basic assessment of chronic coronary heart disease, especially following a myocardial infarct. Observations from an ambulatory cardiology clinic].

In chronic ischemic heart disease, Doppler echocardiography (DE) at rest permits semiquantitative evaluation of scarring and remodelling processes, global ventricular function and, frequently, regional wall motion state. Late complications are detected, namely infarct expansion, true and false ventricular aneurysm, mitral insufficiency, thrombus formation, and associated valvular and aortic diseases are discovered. We studied 100 patients with known chronic coronary artery disease referred for noninvasive evaluation, including electrocardiogram (ECG) and DE.

[Myocardial infarct without classical Q-waves in the ECG].

In this article the ECG pattern of myocardial infarction not associated with the commonly seen pathologic Q waves (greater than 0.03 s) or QS waves is discussed. In a short introduction the differential diagnosis of pathologic Q or QS waves is recalled.

Serial chest thumps for the treatment of ventricular tachycardia in patients with coronary artery disease.

Based on excellent results of successive single chest thumping (CT) and serial chest thumping (SCT) for the interruption of ventricular tachycardia (VT) in experimental animals with subacute myocardial infarction, the SCT method was applied for the treatment of VT in patients with coronary artery disease (CAD). SCT was successful in terminating 13 of 19 episodes of VT (68%) in 8 of 14 patients (57%). Conversion of VT was immediate in 9 episodes in 6 patients and latent in 4 episodes in 2 patients.

Pregnancy and delivery in a patient with Uhl anomaly.

We followed throughout pregnancy and delivery a 26-year-old woman suffering from a severe form of Uhl anomaly (congenital arrhythmogenic right ventricular dysplasia with severe enlargement and hypokinesis of the right ventricle, tricuspid valve insufficiency, and mild pulmonary valve insufficiency). Despite severely impaired cardiac function, the patient tolerated pregnancy surprisingly well. At 37.

[Transitory subclavian steal induced by abnormal position of the arm and producing dangerous myocardial ischemia after mammary artery bypass].

Literature reports only eleven cases of subclavian steal syndrome after CABPG through a left internal mammary artery (LIMA). In 2 asymptomatic patients the diagnosis was established at routine control angiography. In all cases some degree of stenosis of the subclavian artery (SCA) proximally to the emergence of the LIMA was demonstrated and quickly corrected by means of a left carotido-subclavian bypass graft.

Myocardial infarction during a football game: empiric estimation of the contribution of skeletal muscle damage to the serum creatine kinase activity.

A 40-year-old untrained participant of a competitive football game experienced chest pain after 20 minutes of playing time. An acute anterior myocardial infarction was diagnosed by electrocardiographic criteria and the creatine kinase rose to its maximum of 3900 U/l (normal range less than 125 U/l) by 24 h with a CK-MB fraction of 6.1%.

Conversion of induced ventricular tachycardia by single and serial chest thumps: a study in domestic pigs 1 week after experimental myocardial infarction.

A single chest thump (CT) is widely accepted in the emergency treatment of ventricular asystole, whereas there exists controversy about this method for the interruption of ventricular tachycardia (VT). Hitherto, delivering serial chest thumps (SCTs) has been described only once for the treatment of VT. A systematic analysis for interruption of VT by CT or SCTs (or both) is lacking.

[ECG and cardiac changes in acute brain injury].

Two case reports and a review of the literature on ECG changes and myocardial damage (subendocardial hemorrhages and focal myocytolysis) in patients with acute brain lesions are presented. The implications and problems associated with these changes are discussed, particularly in relation to the evaluation of potential cardiac transplant donors.

Electrocardiographic detection of left ventricular hypertrophy in the presence of left anterior fascicular block.

The hitherto available electrocardiographic indexes for the detection of left ventricular hypertrophy in the presence of left anterior fascicular block do not provide a reliable diagnosis. Consequently, a new index based on the behavior of the QRS complex in left anterior fascicular block in the frontal and horizontal plane was constructed and its value assessed by echocardiographic measurements. The new index SIII + (R + S) maximal precordial greater than or equal to 30 mm was applied to the electrocardiograms of 50 patients without myocardial infarction and without right bundle branch block, showing a specificity of 87%, a sensitivity of 96%, a positive predictive value of 89% and a negative predictive value of 95%.

[ECG diagnosis of left ventricular hypertrophy associated with a left anterior fascicular block].

The hitherto available ECG indices for the detection of left ventricular hypertrophy in the presence of left anterior fascicular block do not provide a reliable diagnosis. We have therefore constructed a new ECG index, based on vectorcardiographic considerations, and assessed its value by echocardiographic measurements. The new ECG index SIII + (R + S)max precordial greater than or equal to 30 mm, applied to the ECGs of 50 patients without myocardial infarction and without right bundle branch block, showed a specificity of 87.