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The magnitude of the bradycardia induced by face immersion in patients convalescing from myocardial infarction.

Twenty patients who had suffered myocardial infarction within the previous 3 to 13 days performed face immersion with breath-holding. The maximum reduction in heart rate was 17 +/- 9 beats-min--1 (mean +/- SD). When compared with 24 patients without evidence ischaemic heart disease, they behaved more like younger patients (22 +/- 6) than patients in the same age range (7 +/- 6). A greater vagal response for age after infarction may reflect persistent hypersensitivity of a reflex designed to protect the myocardium during cardiogenic shock.

Aged↗

Glomerular filtration rate and tubular involvement during acute disease and convalescence in patients with nephropathia epidemica.

Glomerular filtration rate (GFR) and tubular involvement were studied in 74 patients with serologically verified nephropathia epidemica (NE). Increased levels of serum creatinine and serum beta 2-microglobulin were documented in 96% and 99% of the patients, respectively. The mean of the lowest estimated GFR was 26 ml/min. Proximal tubular reabsorptive capacity was assessed by urinary loss of beta 2-microglobulin and cell damage by urinary activity of N-acetyl-beta-D-glucosaminidase. Both of these parameters were elevated in most of the patients during the acute phase of the disease. Increased serum levels of Tamm-Horsfall-specific IgG and/or IgA occurred in 72 of 74 patients. No patient required dialysis and there was no mortality. Six months after discharge only three patients had a GFR less than 80 ml/min as estimated by [51Cr]EDTA clearance; two of these had underlying chronic diseases and one had suffered clinically severe NE. Desmopressin tests showed decreased urine osmolarity in three patients 8 months after discharge. These three had chronic diseases, which may have contributed to the impaired tubular function. Thus, there was a markedly decreased GFR and a tubular dysfunction in the acute phase of NE. Most patients recovered within a few months and none showed evidence of chronically impaired renal function due to NE.

Acetylglucosaminidase↗

Multimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery.

We sought in this prospective study to use a multimodal approach to reduce stress and improve recovery in patients undergoing major surgery. During an initial study period, 30 patients were randomly allocated to receive general anesthesia (GA; Group 1) or a combination of GA and intraoperative thoracic epidural analgesia (TEA; Group 2) when undergoing radical cystectomy. Parenteral nutrition was provided for 5 days after surgery. During the second period, 15 patients were treated with a multimodal approach (Group 3) consisting of intraoperative GA and TEA, postoperative patient-controlled TEA, early oral nutrition, and enforced mobilization. Data for plasma and urine catecholamines, plasma cortisol, the nitrogen balance, the postoperative inflammatory nutrition index, pain relief, fatigue, sleep, overnight recovery, recovery of bowel function, and mobilization were recorded up to the fifth postoperative day. Plasma concentrations of catecholamines and cortisol were comparable in all patients, but those in Group 3 had lower levels of urinary catecholamine excretion. Protein intake was more effective with parenteral nutrition. Nitrogen balances were less negative, and the postoperative inflammatory nutrition index score increased significantly in the traditional groups but not in Group 3. Multimodally treated patients reported less fatigue and better overnight recovery. Along with improved pain relief, recovery of bowel function, and ambulation, there were no differences in the postoperative complication rates among the three groups. The multimodal approach reduced stress and improved metabolism and recovery after radical cystectomy.

Adult↗

Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction.

In order to evaluate occurrence and cause of a number of diffuse cerebral symptoms (DCS), such as impaired memory, inability to concentrate, emotional instability, irritability, etc., 44 survivors of cerebral infarction (CI) and 40 survivors of myocardial infarction (MI) were seen 6-26 months after onset for psychometric testing and an interview about DCS. Although surprisingly common in both groups, DCS were significantly more frequent in CI patients than in MI patients. 1/2 of the former and 1/3 of the latter complained of 5 or more symptoms. In contrast, a significant difference in test performance was demonstrated in only 1 of 4 tests. There was no significant correlation between the number of DCS and test performance. In both groups, DCS occurrence was independent of age, whereas in the MI group, but not in the CI group, test performance was inversely related to age. In the CI group, DCS occurrence was not significantly related to size or site of the infarction. The results indicate that an organic brain damage cannot be the sole cause of DCS, and it is suggested that some of the symptoms are manifestations of a stress response syndrome provoked by insufficient coping with the consequences of the disease.

Adult↗

PCR Diagnosis of Malaria at Convalescent Stage Post-Treatment.

Malaria is one of the important febrile diseases that travelers contract after visiting tropical or subtropical countries. In Japan approximately 120 cases of imported malaria are reported annually, with additional cases remaining unreported. Because there are few hospitals where malaria-conscious doctors are readily available, some travelers are likely to resort to self-treatment before going to a clinic. We sometimes encounter such self-treated patients with negative blood smear for malaria parasites. It would be very informative if we could determine whether these self-treated patients had actually contracted malaria, using a more sensitive method than conventional microscopy.

Journal Article↗

Quantitative vaginal microflora in women convalescent from toxic shock syndrome and in healthy controls.

We performed sequential and quantitative vaginal cultures obtained from 8 women within 4 days to 3 years (average, 15.8 months) after their recovery from classic menstrual toxic shock syndrome (TSS) and from 11 healthy women who served as age-matched controls. Apart from tampon use, which was significantly less frequent in TSS women after their acute illness, no demographic differences were observed in the two groups. Significantly lower total aerobic and anaerobic bacterial counts were found in TSS women than in healthy controls (P less than 0.05, Mann-Whitney test). These differences were most profound during the menstrual (aerobes) and premenstrual (aerobes and anaerobes) sample times, whereas no difference in bacterial counts was observed in the mid-cycle samples. Although the less frequent usage of tampons among TSS women after their acute illness might explain the lower aerobic counts in menstrual specimens, this is unlikely to explain the significantly lower aerobic and anaerobic counts observed in premenstrual samples when tampons were not used in either group. It is possible that these differences in the quantitative vaginal microflora were a direct result of recent TSS in these women. Alternatively, disruption of the normal indigenous microflora could have predisposed these women to acute TSS by alteration of the resistance of vaginal colonization to pathogenic microorganisms.

Contraceptive Agents, Female↗