RESUMO
Extensive clinical experience indicates that cardioversion is the most effective method now available for terminating cardiac tachyarrhythmias. This procedure is not accompanied by depression of myocardial contractility, conductivity, or excitability, a common sequel to the use of antiarrhythmic drugs. Furthermore, the incidence of complications with cardioversion is low. These features of effectiveness, safety, and simplicity permit cardioversion to be used by the noncardiologist physician, who may be less experienced than a cardiologist in recognizing arrrhythmias. Cardioversion has not reduced the need for antiarrhythmic agents; on the contrary, more such drugs are required to maintain normal sinus rhythm. The problem at present is not the terminating a tachyarrhythmia but in preventing its recurrence.
Assuntos
Arritmias Cardíacas/terapia , Cardioversão Elétrica , Antagonistas Adrenérgicos beta/administração & dosagem , Fatores Etários , Idoso , Arritmias Cardíacas/diagnóstico , Fibrilação Atrial/terapia , Flutter Atrial/terapia , Comportamento de Escolha , Digitalis , Cardioversão Elétrica/efeitos adversos , Eletricidade , Emergências , Próteses Valvulares Cardíacas , Humanos , Marca-Passo Artificial , Plantas Medicinais , Plantas Tóxicas , Quinidina/administração & dosagem , Taquicardia/terapia , Fibrilação Ventricular/terapiaAssuntos
Meios de Contraste/farmacologia , Doença das Coronárias/fisiopatologia , Teste de Esforço , Ventrículos do Coração/fisiopatologia , Angiografia , Pressão Sanguínea , Cateterismo Cardíaco , Cardiomegalia/complicações , Cineangiografia , Angiografia Coronária , Doença das Coronárias/complicações , Eletrocardiografia , Glucose/farmacologia , Ventrículos do Coração/efeitos dos fármacos , Hemodinâmica , Humanos , Soluções Hipertônicas , Infarto do Miocárdio/complicações , Esforço Físico , DescansoAssuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/terapia , Imunossupressores/uso terapêutico , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Terapia de Imunossupressão/métodos , Lactente , Masculino , Pessoa de Meia-Idade , Transplante/métodos , Estados UnidosAssuntos
Soro Antilinfocitário/economia , Rejeição de Enxerto/tratamento farmacológico , Imunossupressores/economia , Transplante de Rim , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Soro Antilinfocitário/uso terapêutico , População Negra , Cateteres de Demora , Nefropatias Diabéticas/cirurgia , Método Duplo-Cego , Hospitalização , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Diálise Peritoneal , Doadores de TecidosAssuntos
Condicionamento Ácido do Dente , Resinas Compostas , Colagem Dentária , Condicionamento Ácido do Dente/métodos , Materiais Biocompatíveis , Fenômenos Químicos , Físico-Química , Resinas Compostas/farmacologia , Colagem Dentária/métodos , Forramento da Cavidade Dentária , Restauração Dentária Permanente/métodos , Propriedades de SuperfícieAssuntos
Colagem Dentária , Esmalte Dentário , Porcelana Dentária , Coroas , Estética Dentária , Feminino , HumanosRESUMO
This is a report of a multicenter open study of the use of tocainide, a new lidocaine-like antiarrhythmic with a high oral bioavailability, in the treatment of life-threatening ventricular arrhythmias refractory to other therapy. The majority of patients have received 1,200 to 2,400 mg daily in divided doses and have been treated for over 6 months and some for longer than 3 years. Overall, 61% of the patients responded successfully to tocainide therapy. In the 252 patients with documented, severe, symptomatic arrhythmias, 71% responded, and the majority (87%) showed a total abolition of symptomatic events. Gastrointestinal and central nervous system events were the most common adverse experiences, and 11% had to discontinue therapy; however, the remaining 89% tolerated tocainide satisfactorily.
Assuntos
Anilidas/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Adolescente , Adulto , Idoso , Anilidas/efeitos adversos , Criança , Relação Dose-Resposta a Droga , Avaliação de Medicamentos , Cardioversão Elétrica , Eletrocardiografia , Emergências , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , TocainideRESUMO
Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.
Assuntos
Canal Anal/cirurgia , Incontinência Fecal/cirurgia , Prolapso Retal/cirurgia , Telas Cirúrgicas , Adolescente , Adulto , Idoso , Comportamento do Consumidor , Feminino , Seguimentos , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação , Elastômeros de SiliconeRESUMO
This is a report of the safety evaluation of tocainide in the first 369 patients entered into the American Tocainide Emergency Use Program. This humanitarian protocol has made tocainide available for emergency use in the treatment of life-threatening, intractable ventricular arrhythmias in patients who were unresponsive to or unable to take the approved antiarrhythmic drugs. TAhe most frequent adverse experiences reported were neurologic and gastrointestinal in nature and included dizziness, lightheadedness, tremors, nausea, vomiting, and anorexia. Adverse experiences resulted in the discontinuation of tocainide in 16% of these patients and were transient and reversible with no conclusive evidence of permanent organ injury. Adverse experiences having special relevance to the safety assessment of new antiarrhythmic agents are discussed, including congestive heart failure, arrhythmias and conduction disturbances, convulsions, lupus erythematosus-like illness, and deaths while on therapy. No significant abnormal trends were observed in routine hematologic and biochemical laboratory screening tests or in ophthalmologic or chest x-ray examinations. An evaluation of the effects of chronic tocainide administration of ECG intervals showed no significant change in P-R or QRS intervals but demonstrated a statistically significant decrease in Q-T duration. It is concluded that in patients with life-threatening ventricular arrhythmias, tocainide is a safe agent with a favorable risk-benefit ratio.
Assuntos
Anilidas/uso terapêutico , Emergências , Anilidas/efeitos adversos , Antiarrítmicos/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Cardiomiopatias/mortalidade , Doença das Coronárias/mortalidade , Avaliação de Medicamentos , Sistema de Condução Cardíaco/fisiopatologia , Insuficiência Cardíaca/induzido quimicamente , Humanos , Lúpus Eritematoso Sistêmico/induzido quimicamente , Convulsões/induzido quimicamente , Síndrome , TocainideRESUMO
Postextrasystolic potentiation (PESP) and 1-epinephrine infusion have previously been shown by the ventriculographic technique to augment left ventricular wall motion in patients with coronary artery disease. The present study relates the magnitude of this augmentation to short-term prognosis in 56 patients with coronary artery disease and a factor already identified with reduced life expectancy, i.e., an abnormal ejection fraction (EF less than .50). Forty-two patients received PESP and 14 1-epinephrine infusion. Based on severity of symptoms and technical suitability, 37 were treated surgically and 19 medically. Mean follwo-up times were 11.7 and 14.3 months, respectively. The mean increase in EF induced by PESP or 1-epinephrine infusion was significantly greater in patients who subsequently had good results from either surgical or medical therapy than in those who died or had progressive cardiac deterioration. In addition, those patients with an increase in EF of .10 or greater had a statistically greater chance of doing well than patients with less augmentation. Evaluation of change in ejection fraction after inotropic stimulation in patients with depressed ejection fractions is helpful in identifying those patients with greatest contractile reserve and hence better short-term prognosis with eigher medical or surgical therapy. Because of its ease of performance and greater enhancement of contractility, PESP is preferred to 1-epinephrine infusion as the inotropic stimulus of choice.