RESUMO
Fe-Al alloys in the aluminium range of 55-65â at.% exhibit a lamellar microstructure of B2-ordered FeAl and triclinic FeAl2, which is caused by a eutectoid decomposition of the high-temperature Fe5Al8 phase, the so-called ∊ phase. The orientation relationship of FeAl and FeAl2 has previously been studied by Bastin et al. [J. Cryst. Growth (1978 â¸), 43, 745] and Hirata et al. [Philos. Mag. Lett. (2008 â¸), 88, 491]. Since both results are based on different crystallographic data regarding FeAl2, the data are re-evaluated with respect to a recent re-determination of the FeAl2 phase provided by Chumak et al. [Acta Cryst. (2010 â¸), C66, i87]. It is found that both orientation relationships match subsequent to a rotation operation of 180° about a ã112ã crystallographic axis of FeAl or by applying the inversion symmetry of the FeAl2 crystal structure as suggested by the Chumak data set. Experimental evidence for the validity of the previously determined orientation relationships was found in as-cast fully lamellar material (random texture) as well as directionally solidified material (â¼ã110ãFeAl || solidification direction) by means of orientation imaging microscopy and global texture measurements. In addition, a preferential interface between FeAl and FeAl2 was identified by means of trace analyses using cross sectioning with a focused ion beam. On the basis of these habit planes the orientation relationship between the two phases can be described by ([Formula: see text]01)FeAl || (114)[Formula: see text] and [111]FeAl || [1[Formula: see text]0][Formula: see text]. There is no evidence for twinning within FeAl lamellae or alternating orientations of FeAl lamellae. Based on the determined orientation and interface data, an atomistic model of the structure relationship of Fe5Al8, FeAl and FeAl2 in the vicinity of the eutectoid decomposition is derived. This model is analysed with respect to the strain which has to be accommodated at the interface of FeAl and FeAl2.
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BACKGROUND: In clinical practice, monitoring of the efficacy of resuscitation can be challenging. The prediction of cerebral and overall outcome in particular is an unmet medical need. Microdialysis is a minimally invasive technique for the continuous determination of metabolic parameters in vivo. Using this technique, we set out to establish a model allowing for concomitant determination of cerebral and peripheral metabolism in a cardiac arrest setting in rodents. METHODS: Microdialysis settings were optimized in vitro and then used in male Sprague-Dawley rats. Probes were implanted into the CA1 region of the right hippocampus and the right femoral vein. With a time interval of 8 min, glucose, lactate, pyruvate, and glutamate levels were determined during baseline conditions, untreated ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation (CPR), reperfusion, and death. RESULTS: In 16 rodents, restoration of spontaneous circulation was achieved in seven animals. Characteristic metabolic changes were evident during cardiac arrest and reperfusion with both probes. Ischemic patterns in peripheral compartments were delayed and more variable compared to the changes in cerebral metabolism highlighting the importance of cerebral metabolic monitoring. Microdialysis allowed distinguishing between survivors and non-survivors 8 min after termination of CPR. Cerebral glutamate showed a trend toward higher levels in non-survivors during CPR. CONCLUSIONS: We established a new rodent model for research in hypoxic ischemic encephalopathy. This setting allows to investigate the impact of resuscitation methods on cerebral and peripheral metabolism simultaneously. The present model may be used to evaluate different resuscitation strategies in order to optimize brain survival in future studies.
Assuntos
Região CA1 Hipocampal/metabolismo , Reanimação Cardiopulmonar/métodos , Veia Femoral/metabolismo , Parada Cardíaca/metabolismo , Microdiálise/métodos , Reperfusão/métodos , Animais , Modelos Animais de Doenças , Masculino , Monitorização Neurofisiológica/métodos , Ratos , Ratos Sprague-DawleyRESUMO
We report on high-resolution differential conductance experiments on nanoscale superconductor-ferromagnet tunnel junctions with ultrathin oxide tunnel barriers. We observe subgap conductance features that are symmetric with respect to bias and shift according to the Zeeman energy with an applied magnetic field. These features can be explained by resonant transport via Andreev bound states induced by spin-active scattering at the interface. From the energy and Zeeman shift of the bound states, both the magnitude and sign of the spin-dependent interfacial phase shifts between spin-up and spin-down electrons can be determined. These results contribute to the microscopic insight into the triplet proximity effect at spin-active interfaces.
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We investigated psychophysiological responses to fear and anger inductions during real-life and imagination. Female participants (N = 158) were assigned to a fear-treatment, fear-control, anger-treatment, or anger-control group. Context (real-life, imagination) was varied in two sessions of fixed order. Eleven self-report and 29 somatovisceral variables were registered. Results showed that (a) except during anger imagination, control groups were emotionless; (b) in control groups, contexts prompted diverging somatovisceral responses, but similar emotion self-reports; except during fear imagination, the emotion inductions (c) were successful and (d) produced specific emotion reports; (e) during real-life, somatovisceral fear and anger responses exhibited a marked cardiovascular defense reflex; (f) in addition, real-life fear showed an adrenaline-like specific response pattern, whereas real-life anger showed specific forehead temperature and EMG extensor increases, accompanied by an elevated DBP during imagination. A Component Model of Somatovisceral Response Organization is proposed.
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Ira/fisiologia , Emoções/fisiologia , Medo/fisiologia , Adolescente , Adulto , Meio Ambiente , Feminino , Humanos , Imaginação/fisiologia , Pessoa de Meia-IdadeRESUMO
Inspiratory muscle training may have beneficial effects in certain patients with chronic obstructive pulmonary disease (COPD). Because of the lack of a home training device, normocapnic hyperpnea has rarely been used as a training mode for patients with COPD, and is generally considered unsuitable to large-scale application. To study the effects of hyperpnea training, we randomized 30 patients with COPD and ventilatory limitation to respiratory muscle training (RMT; n = 15) with a new portable device or to breathing exercises with an incentive spirometer (controls; n = 15). Both groups trained twice daily for 15 min for 5 d per week for 8 wk. Training-induced changes were significantly greater in the RMT than in the control group for the following variables: respiratory muscle endurance measured through sustained ventilation (+825 +/- 170 s [mean +/- SEM] versus -27 +/- 61 s, p < 0.001), inspiratory muscle endurance measured through incremental inspiratory threshold loading (+58 +/- 10 g versus +21.7 +/- 9.5 g, p = 0.016), maximal expiratory pressure (+20 +/- 7 cm H(2)O versus -6 +/- 6 cm H(2)O, p = 0.009), 6-min walking distance (+58 +/- 11 m versus +11 +/- 11 m, p = 0.002), V O(2peak) (+2.5 +/- 0.6 ml/kg/min versus -0.3 +/- 0.9 ml/kg/min, p = 0.015), and the SF-12 physical component score (+9.9 +/- 2.7 versus +1.8 +/- 2.4, p = 0.03). Changes in dyspnea, maximal inspiratory pressure, treadmill endurance, and the SF-12 mental component score did not differ significantly between the RMT and control groups. In conclusion, home-based respiratory muscle endurance training with the new device used in this study is feasible and has beneficial effects in subjects with COPD and ventilatory limitation.
Assuntos
Tolerância ao Exercício , Pneumopatias Obstrutivas/terapia , Qualidade de Vida , Músculos Respiratórios/fisiopatologia , Terapia Respiratória/instrumentação , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios , Dispneia/etiologia , Feminino , Humanos , Pneumopatias Obstrutivas/complicações , Pneumopatias Obstrutivas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , EspirometriaRESUMO
The robot automation of sampling and the subsequent treatment and storage of aliquots during mammalian cell cultivations was investigated. The complete setup, the development and testing of the sampling device, the robot arm, and the cell imaging system are described. The developed sampling device is directly coupled to a pilot bioreactor. It allows the computerized sterile filling of cell broth into 50 mL sample tubes. After each sampling the whole tubing system is steam sterilized. For further off-line treatment a robot takes the sample to the different devices. This robot is equipped with a camera and a force/torque sensor. A color-based object recognition guides the arm in a complex surrounding with different illumination situations, enabling the robot to load the sampling device with tubes and take the sample to further devices. For necessary pipetting and refilling we developed a computerized device. Cells are automatically stained and counted using an imaging system. The cell number and viability is automatically saved in a process control system together with the on-line parameters. During several cultivations in 20 and 100 L scale these main components of the automation strategy were successfully tested.
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Robótica/instrumentação , Animais , Células CHO , Cricetinae , Humanos , Projetos Piloto , Células Tumorais CultivadasRESUMO
STUDY OBJECTIVES: To test the incendiary characteristics of various silicone endobronchial stents under the impact of the Nd-YAG laser. DESIGN: In vitro study in the laser laboratory of a university-affiliated city hospital. SETTING: The experiments were performed in a reaction chamber under controlled oxygen concentrations. The radiolucent and radiopaque Dumon silicone stent (Novatech; Aubagne, France) and the tracheal part of the Dynamic stent (Ruesch AG; Kernen, Germany) were tested. The Dumon stents were either clean, covered with a thin layer of blood, or mounted on fresh pig tracheal wall. The laser was aimed on them perpendicularly from distances of 1.0 cm and 0.5 cm. INTERVENTIONS: Minimal oxygen concentration to allow ignition and impact time for power outputs (POs) between 10 W and 80 W were determined. MEASUREMENTS AND RESULTS: The lowest oxygen concentration that allowed ignition of some stents was 40%. The clean radiolucent stent could not be ignited with up to 100% ambient oxygen concentration. Radiopacity, presence of blood, tracheal wall, and metal, as well as higher PO and shorter distance of the laser probe decreased impact time to ignition. The radiopaque blood-covered stent was most easily ignited. For this stent, at a PO of 40 W, impact time to ignition was 1.5 +/- 0.2 s, and at 30 W was 2.6 +/- 0.3 s. CONCLUSIONS: At ambient oxygen concentrations > or = 40%, silicone stents can catch fire. Depending on the condition of the stent, the distance of the laser probe, and PO, ignition can occur after short impact times. To prevent stent ignition, oxygen concentration should be kept < 40%. When unusual circumstances require working with higher oxygen concentrations, pulse duration needs to be limited or stent removal might be considered before firing the laser.
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Brônquios , Análise de Falha de Equipamento , Incêndios , Terapia a Laser/instrumentação , Elastômeros de Silicone , Stents , Animais , Humanos , Recém-Nascido , Oxigênio , Fatores de Risco , SuínosRESUMO
Drugs are well known causes of eosinophilic lung disease. In many patients, symptoms increase slowly, pulmonary infiltrates and eosinophilia progress over weeks, and resolve upon withdrawal of the offending agent. Rarely, the disease presents like acute eosinophilic pneumonia with acute onset of symptoms and rapidly progressing infiltrates which may be associated with respiratory failure. This report describe a case of venlafaxine-induced acute eosinophilic pneumonia causing respiratory insufficiency that rapidly resolved upon institution of corticosteroid treatment. This 5-hydroxytryptamine and noradrenaline reuptake inhibitor was previously not known to cause lung or peripheral blood eosinophilia. Considering the increasing use of this class of medication physicians have to be aware of this life-threatening and fully reversible complication.
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Antidepressivos de Segunda Geração/efeitos adversos , Cicloexanóis/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Eosinofilia Pulmonar/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Doença Aguda , Adulto , Antidepressivos de Segunda Geração/uso terapêutico , Biópsia , Cicloexanóis/uso terapêutico , Humanos , Pulmão/patologia , Masculino , Prednisona/administração & dosagem , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/tratamento farmacológico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/tratamento farmacológico , Tomografia Computadorizada por Raios X , Cloridrato de VenlafaxinaRESUMO
The mechanism of the enzymatic degradation of poly([R]-3-hydroxybutyrate) (PHB) was investigated by using well-defined model substrates, including both linear and cyclic [R]-3-hydroxybutyrate (3HB) and [R]-3-hydroxyvalerate (3HV) oligomers, with two different PHB depolymerases. The linear and cyclic oligomers containing from 2 to 10 repeating units were hydrolyzed in solutions of the depolymerase isolated from Aspergillus fumigatus and Alcaligenes faecalis, and the rates of hydrolysis and types of products formed were characterized. Both of the depolymerases catalyzed the hydrolysis of the cyclic oligomers (macrolides) which contained more than three 3HB and 3HV repeating units. The degradation reactions of the linear and cyclic 3HB oligomers with the A. fumigatus depolymerase gave similar ratios of monomer-to-dimer products, but PHB itself formed mostly monomer on hydrolysis, indicating that the enzymatic hydrolysis reactions occurred by different mechanisms for these different types of substrates. The results of this study conclusively show that at least the endo mode of polymer hydrolysis occurs with the two enzymes studied, while the A. fumigatus depolymerase was found to utilize both endo and exo modes of hydrolysis to efficiently degrade PHB and 3HB oligomers.
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Ácido 3-Hidroxibutírico/química , Hidrolases de Éster Carboxílico/química , Alcaligenes/enzimologia , Aspergillus fumigatus/enzimologia , Escherichia coli/enzimologia , Hidrólise , Cinética , Macrolídeos/química , Modelos Químicos , Polímeros/químicaRESUMO
A 46-year-old white female was admitted for decompensated cor pulmonale (CP). It had not interfered with her daily activities and she had not experienced shortness of breath, fatigue or muscle weakness prior to the onset of right heart failure. A thorough investigation revealed severe generalized muscle weakness with restrictive chest bellows disease and secondary CP (mean pressure in the pulmonary artery 60 mm Hg). After having refused respiratory support the patient died a few days after admission. The muscle biopsy was consistent with adult-onset acid-maltase deficiency. This is a rare case of metabolic myopathy presenting as decompensated CP without previous symptoms of muscle weakness. This condition can easily be treated with nocturnal ventilatory support, improving the quality and length of life.
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Glucana 1,4-alfa-Glucosidase/deficiência , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Insuficiência Cardíaca/etiologia , Doença Cardiopulmonar/etiologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Doença de Depósito de Glicogênio Tipo II/complicações , Doença de Depósito de Glicogênio Tipo II/patologia , Humanos , Pessoa de Meia-Idade , alfa-GlucosidasesRESUMO
STUDY OBJECTIVE: To compare the effect of high-frequency oral airway oscillation, high-frequency chest wall oscillation, and conventional chest physical therapy (CPT) on weight of expectorated sputum, pulmonary function, and oxygen saturation in outpatients with stable cystic fibrosis (CF). DESIGN: Prospective randomized trial. SETTING: Pediatric pulmonary division of a tertiary care center. PATIENTS: Fourteen outpatients with stable CF recruited from the CF center. INTERVENTIONS: Two modes of oral airway oscillation (1: frequency 8 Hz; inspiratory to expiratory [I:E] ratio 9:1; 2: frequency 14 Hz; I:E ratio 8:1), two modes of chest wall oscillation (1: frequency 3 Hz; I:E ratio 4:1; 2: frequency 16 Hz; I:E ratio 1:1, alternating with frequency 1.5 Hz, I:E ratio 6:1), and CPT (clapping, vibration, postural drainage, and encouraged coughing) were applied during the first 20 min of 4 consecutive hours. MEASUREMENTS AND RESULTS: Sputum was collected on an hourly basis for a total of 6 consecutive hours. During the first and the last hour, patients collected sputum without having any treatment and underwent pulmonary function tests (PFTs). Oxygen saturation was measured at 30-min intervals during hours 1 to 6. For the first 20 min of the second to the fifth hour, patients received one of the treatments. To assess the effect of the intervention, the weight of expectorated sputum during hours 2 to 6 was averaged and expressed as percentage of the weight expectorated during the first hour (baseline). For the five treatment modalities, mean sputum dry and wet weights ranged between 122% and 185% of baseline. There was no statistically significant difference among the treatment modalities. As measured by sputum wet weight, all oscillatory devices tended to be less effective than CPT (p=0.15). As measured by dry weight, oral airway oscillation at 8 Hz with an I:E ratio of 9:1 and CPT tended to be more effective than the other treatment modalities (p=0.57). None of the treatment modalities had an effect on PFTs and oxygen saturation and all were well tolerated. CONCLUSION: In outpatients with stable CF, high-frequency oscillation applied via the airway opening or via the chest wall and CPT have comparable augmenting effects on expectorated sputum weight without changing PFTs or oxygen saturation. In contrast to CPT, high-frequency oral airway and chest wall oscillations are self-administered, thereby containing health-care expenses.
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Fibrose Cística/terapia , Ventilação de Alta Frequência , Terapia Respiratória , Adolescente , Adulto , Criança , Drenagem Postural , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
The effect of gender and training on repeatability of cardiopulmonary exercise performance has not been well defined. Therefore, we performed two bicycle exercise tests 1 wk apart in each of two groups: In 19 normal subjects (age 24 to 64 yr, 10 females), with a mean maximal oxygen uptake (VO2max) of 42 mL.kg-1.min-1, who had been in an ongoing training program including bicycle exercise, and in 19 untrained volunteers (23 to 54 yr, 11 females) with a mean VO2max of 36 mL.kg-1.min-1 (P < 0.05). Mean differences in physiologic variables measured during tests 1 and 2 were calculated. Repeatability coefficients were defined as 2 SD in percent of the means. In untrained subjects mean (+/- SD) maximal heart rate decreased by 4 +/- 5 beats.min-1 from the first to the second test (P < 0.05). VO2max and maximal work rate (Wmax) remained unchanged. No significant changes in these or other variables occurred in trained subjects. Repeatability coefficients for VO2max were 8 and 13% in trained and untrained subjects, respectively (P = NS). For Wmax the repeatability coefficient in untrained (11%) exceeded that in trained subjects (4%, P < 0.05). Repeatability coefficients did not differ among males and females. Our study provides normal values for repeatability of various parameters assessed during exercise testing and demonstrates that interpretation of performance during repeated tests has to account for training of the subjects.
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Exercício Físico/fisiologia , Resistência Física/fisiologia , Adolescente , Adulto , Débito Cardíaco , Metabolismo Energético , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Masculino , Consumo de Oxigênio , Fatores SexuaisRESUMO
Previous experiments indicated that MIF-A3, a peptidoglycolipid extracted from Mycobacterium avium serovar 2 (Mycobacterium paratuberculosis 18), inhibits the killing of Candida albicans by activated bovine peripheral blood-derived macrophages and murine thioglycollate-elicited peritoneal macrophages in vitro. Subsequent in vitro data from our laboratory indicated that this reduction in killing may be related to the ability of MIF-A3 to scavenge reactive oxygen species (ROS). In this study we examined this hypothesis directly by determining if MIF-A3 reduced exogenous H2O2-induced candidacidal activity. When Candida albicans was incubated with H2O2 (4 mM) alone, colony-forming units/ml x 10(4) (CFU/ml) were 0.4 +/- 0.1 (mean +/- SE, n = 4) as compared to 11.3 +/- 2.0 CFU/ml in control (untreated) cultures (p < .05). The addition of catalase at concentrations > or = 6.8 U/ml, completely blocked the fungicidal effect of H2O2. However, reducing the amount of catalase from 6.8 U/ml to 3.4 U/ml resulted in a loss of scavenging activity, which was associated with a 50% increase in H2O2-mediated killing. Substituting MIF-A3 (400 micrograms/ml) for catalase, also reduced H2O2-induced fungicidal activity. In the absence of MIF-A3, H2O2 reduced Candida albicans to less than 10(3) CFU/ml. However, in the presence of MIF-A3 the CFU/ml of Candida albicans increased 7.5-fold. Based on concentration-response curves of H2O2 inhibition vs. increasing amounts of catalase we determined that the relative inhibitory capacity of the MIF-A3 (400 micrograms/ml) was approximately 1.0 U/ml "catalase equivalents." These findings provide direct evidence that MIF-A3 can scavenge H2O2, and reduce H2O2-induced killing of Candida albicans.
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Sequestradores de Radicais Livres , Glicolipídeos/farmacologia , Glicopeptídeos/farmacologia , Mycobacterium avium/química , Espécies Reativas de Oxigênio/metabolismo , Animais , Candida albicans/efeitos dos fármacos , Catalase/farmacologia , Bovinos , Peróxido de Hidrogênio/farmacologia , Macrófagos/imunologia , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/imunologia , Camundongos , Oxirredução , Tioglicolatos/farmacologiaRESUMO
A total of 160 patients underwent emergency room thoracotomy (ERT) from January 1988 to June 1995. There were 142 male and 18 female patients with ages ranging from 15 months to 72 years old with a mean age of 31 years. Blunt trauma was the mechanism of injury in 11 patients; none of them survived, and they were excluded from further analysis. A total of 149 patients sustained penetrating trauma, 111 patients gunshot wounds, and 38 patients stab wounds. A total of four patients survived to discharge for an overall survival rate of 2.7 per cent. All four were victims of a stab wound and were neurologically intact at the time of discharge. Special interest was placed in classifying patients according to their physiologic status both at the scene and on arrival to the emergency department. Class I, patients with no signs of life; Class II, Agonal--patients in electromechanical dissociation/pulseless electrical activity with no palpable pulse or blood pressure; Class III, Profound Shock--patients with blood pressure less than 60 mm Hg; and Class IV, Mild Shock--patients with blood pressure between 60 and 90 mm Hg. 122 patients (89%) fitted the criteria for Scene Classes I and II. None of these patients improved or responded to prehospital resuscitation to be moved up to Emergency Department Classes III or IV, and all of them died. Of the four survivors, three were in Scene Class III and one was in Scene Class IV. This study confirms a previous report that, overall, ERT has a very low survival rate. ERT should be abandoned in patients sustaining blunt trauma, and should probably be limited to patients sustaining penetrating chest injuries who fall into the physiologic Classes III or IV at the scene.
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Traumatismos Torácicos/cirurgia , Toracotomia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Emergências , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Traumatismos Torácicos/mortalidade , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/mortalidade , Ferimentos Perfurantes/cirurgiaRESUMO
To determine whether intragastric pressure (IGP) and central venous pressure (CVP) would reliably predict successful primary closure of congenital abdominal wall defects (omphalocele/gastroschisis) in newborn infants, we developed the following prospective intraoperative management protocol. Following a temporary trial of fascial closure, infants who had an IGP less than 20 mm Hg or an increase in CVP of less than 4 mm Hg were primarily closed. If IGP was greater than 20 mm Hg or if CVP increased by more than 4 mm Hg, the temporary closure of the abdomen was reopened and a prosthetic silo was placed. Ten infants who were less than 24 hours old and averaged 2.7 kg (range, 1.4 to 4.2 kg) and 37-weeks gestation (range, 32 to 41 weeks) were studied. Eight infants met criteria for primary closure. Their IGP averaged 14 +/- 4 mm Hg (+/- SD) (range, 8 to 19 mm Hg), and their increase in CVP averaged 1 +/- 2 mm Hg (range, -2 to 3 mm Hg). In the two infants who required staged repair, IGP averaged 25 +/- 1 mm Hg (+/- SD) (range, 24 to 25 mm Hg), and the increase in CVP averaged 7 +/- 1 mm Hg (range, 6 to 8 mm Hg). All patients were anesthetized with fentanyl (12.5 micrograms/kg) and paralyzed with metocurine (0.3 mg/kg) intraoperatively. There were no postoperative complications in either group of patients related to increased intraabdominal pressure, and all patients were extubated within 48 hours of the initial surgery. We conclude that the intraoperative measurement of changes in IGP and CVP can serve as a guide to the operative management of congenital abdominal wall defects and can reliably predict successful outcome following repair.
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Músculos Abdominais/anormalidades , Pressão Venosa Central , Hérnia Umbilical/cirurgia , Cuidados Intraoperatórios , Músculos Abdominais/fisiopatologia , Músculos Abdominais/cirurgia , Feminino , Hérnia Umbilical/fisiopatologia , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Fluxo Sanguíneo RegionalRESUMO
A reduction of the infarct-related mortality needs measures to diminish the extension of the infarction. A valuable approach is the thrombolysis, which proved useful in the past years. The aim of this study was to investigate the doctor's and the patient's behaviour related to the delay in hospital admission. During one year, the admission of 148 patients with suspected myocardial infarction was prospectively analysed. The median delay was 7.5 hours. 48% of the patients suffered from an acute myocardial infarction, 17% from an unstable angina, and 35% had no underlying heart disease. 38% reached the hospital within 4 hours (39% of the patients with confirmed myocardial infarction). The total delay was mainly due to the patients behaviour (median delay 3 hours) and in a lesser extent to the doctor's behaviour (median delay 1.5 hours). An immediate admission was only in 14% the first medical measure. In 40% an ECG was performed, in 6% a chest X-Ray, and in 11% laboratory investigations were undertaken. These results confirm the fact that people, especially the patients with known coronary artery disease should be better informed about the nature and the course of the illness and the efficient behaviour in case of onset of complications. The doctor's delay can be shortened by omission of useless diagnostic investigations.
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Hospitalização , Infarto do Miocárdio/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Educação de Pacientes como Assunto , Estudos Prospectivos , Fatores de Tempo , Transporte de PacientesRESUMO
This is a follow up study of 110 patients referred to the hospital because of mono-arthritis of unknown etiology. Patients with mechanical synovitis and infectious arthritis have been excluded from this study initially. From a total of 110 patients (100%) a diagnosis could be made in 49 patients (44.6%), namely in 24 (21.8%) by the initial very thorough work up or by the repeated examinations during the follow up period in 25 patients (22.8%). In 61 patients (55.4%) the cause of the disease remained unknown despite extensive investigations and follow up controls for many years. Of these 61 cases three (2.7%) developed polyarthritis and six (5.5%) oligoarthritis still of unknown origin. The rest, namely 52 (47.2%) remained mono-arthritis and are called mono-arthritis of unknown origin ("Arthritis unbekannter Ursache"). 67% of these 52 patients with mono-arthritis of unknown origin went into complete remission after one year and 80% after two years. 13 patients (11.8%) of the 110 developed rheumatoid arthritis within one month up to three years. Arthroscopy was important in making some diagnosis initially. Twelve patients had relief of symptoms after arthroscopy, ten of the group with mono-arthritis of unknown origin. 19 patients claimed that the initiating factor was a trauma to the joint.