A group of 19 patients with acute respiratory failure (ARF) of diverse etiology received as a part of their treatment positive and expiratory pressure (PEEP). All of them were evaluated clinically and with several respiratory parameters. The response to treatment, complications and mortality rates are analyzed. The addition of PEEP in the management of this patients was accompanied by a significant increase of the PAO2 (p < 0.001) and a simultaneous decrease in the following parameters: FiO2/PaO2 index, Alveolo-arterial oxygen gradient (A-aDO2) and the pulmonary shunt (Qs/Qt). No hemodynamic deterioration was observed. None of the clinical parameters such as: blood pressure, heart rate and diuresis was significantly modified; neither a significant change in the arterious-venous oxygen gradient (a-vDO2) was detected. Pneumothorax as a complication of the use of PEEP was present in the 10.4% of the patients. The course of the ARF was toward the improvement in most of them at the end of the evolution. The high mortality rate in this study was considered to be secondary to uncontrollable sepsis and also to the presence of multiple organ failure. In none of the cases the poor outcome was secondary to refractory acute hypoxemia. PEEP which is one of the varieties of continuous positive pressure ventilation (CPPV) represents one of the most importants therapeutic advances in the last decade in the management of patients with acute respiratory failure.

Acute Disease↗

PubMedDate not supplied

[Electrocardiographic study of acute infarctions of the right ventricle].

To search for electrocardiographic clues of infarction of the right ventricle, we recorded the right-thoracic unipolar leads from V3R to V6R and the following abdominal leads: MD, ME and MI, in a group of 40 normals (control group) and in a group of 40 patients with their first acute transmural myocardial infarction (25 posterior-inferior, 15 anterior wall). We described the predominant ECG morphologies in the control waves (more than 0.04 sec. duration) could be registered in the right anterior thoracic wall in healthy subjects. Based on the findings from our control group and those reported from other investigators, we concluded that to suspect right ventricular involvement in the above mentioned leads, it is required to find necrosis and subepicardial injury waves in at least two of those leads. The most frequently affected leads were V4R and MD. This electrocardiographic "positive" pattern to suspect involvement of the right ventricle was found in 32% of the posterior-inferior left ventricular infarctions. In none of the left ventricular anterior wall infarctions we observed right-sided involvement. The clinical-electrocardiographic correlation was statistically significant. Due to the hemodynamic and therapeutic consequences when right ventricular involvement is suspected, it is convenient to record, in every patient with posterior-inferior myocardial infarction, the special leads described above, more so since the ECG is a simple fast, low cost invaluable auxilliary in the evaluation of the extension of necrosis in the right ventricle.

Acute Disease↗

PubMedDate not supplied

[Early discharge after acute uncomplicated infarction].

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Arrhythmias, Cardiac↗

PubMedDate not supplied

[Lethal colchicine intoxication (author's transl)].

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Adolescent↗

PubMedDate not supplied

Pneumothorax. A complication of fine needle aspiration of breast tumors.

Of 1,666 patients who underwent fine needle aspiration for breast lumps, 4 developed pneumothorax as a complication. The incidence of this complication in our patients is 1:417. The clinical manifestations were immediate chest pain, shoulder pain and, occasionally, dyspnea that developed later. Observation is sufficient treatment in most patients, and rarely is drainage of the pneumothorax required.

Aged↗

PubMedDate not supplied

[Sexual activity in the convalescent from acute myocardial infarct. Bibliographic review].

There is little information in the medical literature about the renewal of sexual activity in patients who have suffered an MI. The knowledge which the internist and the cardiologist have are normally insufficient. The equivalents in energetic cost of a sexual relation of a middle aged adult, are similar to those of: a) a simple Master test of two stairs, b) walking rapidly the length of a street, c) climbing two flights of stairs. d) a test with ergometer to 100 watts or 600 kg-m-m, e) to walk the endles band at 3.5 miles/hour, f) to carry out activities equivalent to 6 cal/min. The average of the maximum cardiac frequency which is reached during coitus is from 115 to 120, equivalent to approximately 4-5 mets., during 20-36 seconds. In the post and preorgasmic period (1 min, before and after) the energetic cost is close to 4 mts. It should be emphasized that there should not exist an exact limit after which the patient who has had an MI is permitted to have sexual relations. The sexual activity should be advised if the patient has satisfactorily passed any of the equivalent tests mentioned above. The cardiologist should know these facts and not wait until the patient asks about them; he should have the initiative to openly discuss them with the patient and his partner from the period interhospitalary convalescence of the MI.

Adult↗