Exercise tolerance as evidence of quality of life in CAD patients after coronary artery bypass by comparison with medical treatment.

The effects of coronary artery bypass (CAB) by comparison with medical treatment were evaluated on exercise tolerance in 68 patients with stable angina on effort, who underwent coronary and left ventricular cineangiography. Stress tests were performed by bicycle ergometer before medical and surgical treatment, and 6 and 12 months thereafter. Thirty-five patients (31 males and 4 females; 7 with one 70% stenosed vessel, 12 with two, 16 with three) underwent CAB; 33 (30 males and 3 females; 9 with one 70% stenosed vessel, 11 with two, 13 with three), having refused CAB, only underwent medical treatment. Both groups were given long-acting oral nitrates, none received digitalis and/or propranolol; antiarrhythmic drugs were only administered in 5% of medical and 4% of surgical patients. Both groups at 6 and 12 months follow-up showed a significant improvement in exercise tolerance. Surgical patients showed a significant increase in exercise tolerance with lower angina incidence (from the preoperative 100% to 26% and 22%, respectively), higher work load (P < .001), and a significant reduction of S-T segment depression (P < .001). Medical treatment induced an increase of exercise tolerance; angina on effort decreased (from 100% to 74% and 72%, respectively) with higher work load, and a significant reduction of S T depression (in both cases P < .001). Comparing the data of the two groups, we observed that surgical patients showed higher exercise tolerance (P < .01), lower S-T depression (P < .001) and angina incidence. Our results suggest that surgical treatment is able to improve exercise tolerance more remarkably than medical treatment.

Computer-assisted concurrent antibiotic review in a community hospital.

A computer-assisted program that monitors the appropriateness of antibiotic prescribing by matching microbiology reports and patient drug profiles is described. An antibiotic review committee in conjunction with the quality assurance department developed the computer-assisted antibiotic review program. An antibiotic order sheet was incorporated into the physicians' order form. Automatic stop dates were assigned according to the reason the antibiotic was ordered, e.g., surgical prophylaxis or documented infection. Numerous reports are generated from the data gathered from the physicians' order form. A drug/microbiology report is used to match patients' antibiotic drug profiles with their microbiology culture and sensitivity results. This report identifies all patients who have been receiving antibiotics for 72 hours or longer with sensitivities on file and mismatched sensitivity results. All mismatches that are considered important are investigated. Any actions taken are reported to the antibiotic review committee for peer review. The computer-assisted program has helped this hospital screen large populations of inpatients receiving antibiotics. The concurrent review of the drug/microbiology report has made it possible to detect within 24 hours, patients who are receiving antibiotics inappropriately. A computer can be used to perform daily concurrent antibiotic use review as a by-product of order entry by both the pharmacy and laboratory.

[Effects of nifedipine in the treatment of effort stable angina: a double blind study (author's transl)]. / Effetti della nifedipina nel trattamento dell'angina stabile da sforzo. Studio a doppio cieco.

The effectiveness of chronic treatment with nifedipine in patients (pts) with a history of stable angina on effort has been evaluated in a double-blind study in 15 subjects of both sexes, aged 45 to 65 years. All pts underwent diagnostic cardiac catheterization and selective coronary angiography, which showed stenosis of one or two main coronary vessels between 50 and 70%. The pts, after 2 weeks of observation, underwent erect bicycle exercise test with increasing workloads. After 4 weeks of treatment with nifedipine or placebo the stress test was repeated. Nifedipine treatment reduced the weekly number of anginal attacks as well as the weekly number of nitroglycerin tablets consumed by the pts, increased maximum workload tolerated and reduced the S-T segment depression for the same workload, meanwhile heart rate and blood pressure did not change significantly either at rest or during exercise. The result of this study indicate that nifedipine is useful in the treatment of pts with stable angina on effort.

Bugs, drugs, and computers.

The paper describes the development, implementation, and review of a daily reporting system using data from two modules of a hospital information system: drug sensitivity reports from Microbiology, and patient drug profiles from Pharmacy. The system reviews each patient receiving antibiotics and compares that information with the patient's microbiology findings, looking for and flagging "no cultures," "negative cultures," and "mismatches," i.e., the patient is receiving an antibiotic to which the organism is resistant. Reports are produced daily and reviewed by the hospital's Infection Control nurse, who, in turn, notifies the attending physician when appropriate.

[The vectorcardiogram pattern of the athlete's heart (author's transl)]. / Il vettorcardiogramma nel cuore d'atleta.

In order to assess the vectorcardiographic pattern of the athlete's heart, we evaluated the vectorcardiograms of 17 professional footballers; the signs of ventricular hypertrophy were particularly studied. 9 athletes had left ventricular hypertrophy, 3 showed VCgraphic signs of combined ventricular hypertrophy and 5 had normal vectorcardiograms. In all athletes with left ventricular hypertrophy the initial forces had normal spatial orientation (I A left ventricular hypertrophy). Likely, the combined right ventricular hypertrophy explains these VCgraphic patterns. The QRS loop did not show abnormal morphology, only the high magnitude of the spatial maximum QRS vectors was significant for diagnosis of left ventricular hypertrophy. The increase of the cardiac volumes induced by training might explain the high magnitude of the QRS loop.

[Effect of age on heart rate and systolic time intervals in children, adolescents and young adults (author's transl)]. / Effetti dell'eta' sulla frequenza cardiaca e gli intervalli di tempo sistolici in bambini, adolescenti e giovani adulti.

Study was performed to assess if the increase of age can affect heart rate (HR) and systolic time intervals (STI) in a population of children, adolescents and young adults. We made polygraphic recordings in 66 normal subjects (5-25 years old) and regression equations were obtained for STI and age, HR and age and STI and HR. We found a significant relationship of HR and STI with age. Equally STI were correlated with HR. PEP/LVET ratio was unaffected by age or HR. We considered moreover mean values of HR and STI in four age-groups (5-10, 11-15, 16-20, 21-25). Data comparison showed higher LVET and lower HR in elder subjects. These had moreover higher PEP versus younger groups. The Authors believe that the relationship of HR, STI and age, undemonstrated by several other studies, can be found if we consider a large of age. Because other authors studied a little range of age, our demonstration of no statistically significant different values of HR and STI between 5-10 and 11-15 groups, authorize us to consider that the effect of age is highly significative on HR and STI among children, adolescents and young adults.