[Can predictability of coronary angiographic findings be improved by additional measurement of pulmonary wedge pressure during exercise? (author's transl)]

The correlation between the three ischemia indicators angina pectoris (AP), ST-segment depression (ST) and excessive pulmonary wedge pressure rise (PCP) during exercise, and the coronary angiographic findings, were analysed in 293 patients without previous transmural myocardial infarction. This patient material consisted of 253 men and 40 women between the age of 20 and 65 years, the mean age being 48. The exercise tests were performed on a bicycle ergometer in supine position and in relatively steady state conditions. Pulmonary wedge pressure was measured by means of a Swan-Ganz floating catheter. The essential findings were: 1. If all three ischemia indicators were positive, the incidence of a positive angiographic finding i.e. a greater than or equal to 50% stenoses in at least one main coronary artery was 96.3%. 2. If only the two classic ischemia indicators were evaluated and positive, the incidence of a positive angiographic finding was only 86.1% (24). This difference is mainly due to false positive results of AP and ST in women. 3. If all three ischemia indicators were negative, the incidence of a negative angiographic finding was 89.2%. 4. If only the two classic ischemia indicators were evaluated and negative the incidence of a negative angiographic finding was as high (87,6% [24]). This lack of difference is due to the fact that patients with a previous intramural infarcion can be free not only of AP and ST but also of PCP during exercise. 5. The combination of AP and PCP, or ST and PCP, is equally reliable in predicting coronary morphology as the classic combination of AP and ST. It follows that PCP measurement is recommended, if one of the classic ischemia indicators cannot be properly evaluated.

Nursing students' experience in critical care: implications for staff development

The gap between preservice preparation of nurses for critical-care work and employers' expectations is a crucial factor in providing safe care in special-care units. In this study of senior nursing students from 32 Midwestern schools of nursing, it was found that about 75 per cent of the students had had some experience in critical care, with a mean of 46 hours of experience. Most students observed, did selected procedures, or helped a staff nurse. Only 3 per cent planned and carried out care for more than one patient at a time. Fifty-eight per cent considered themselves unprepared to work in areas of critical care and needed more practice and theoretical instruction. There was wide variation in adequacy of instruction in frequently-used assessment and management techniques.

Cardiac tamponade and acute renal failure following Salmonella agona pericarditis

A 19-year-old female presented with cardiac tamponade complicated by acute renal failure. Salmonella agona was cultured from pericardial aspirate after repeated pericardiocentesis in several sites. Treatment with ampicillin and intermittent haemodialysis led to complete recovery.

Hemodynamics at rest and during exercise in 222 patients with coronary heart disease before and after aorto-coronary bypass surgery

In 222 patients with coronary heart disease hemodynamics at rest and during exercise were measured before and after aortocoronary bypass surgery. A total of 552 grafts were constructed, i.e. an average of 2.47 grafts per patient. Only 10.8% of the patients had a 1-vessel-disease, 59.2% had a 3-vessel-disease. 10.8% of the patients were provided with one graft, 49.7% got 3 or 4 grafts. In 92.8% of the patients the r. desc. ant. was significantly stenosed, and in 94.2% this vessel has been provided with a graft. Preoperatively only 7 patients had no angina pectoris during exercise (bicycle ergometer in supine position, each load lasting 6 min), postoperatively 154 patients have been completely free of angina pectoris. The preoperative angina pectoris-free exercise tolerance was 27.4 +/- 27.4 W (means +/- SD), postoperatively it was 76.5 +/- 33.8 W. The largest increase of exercise tolerance was observed in patients with a 3-vessel-disease (208%). Preoperatively only 10.1% had normal values of pulmonary wedge pressure and cardiac output at rest and during exercise, postooperatively 51.5%. The postoperative normalization of hemodynamics depends on the number of vessels involved (1-vessel-disease 86%, 3-vessel-disease 39.8% normalization) and on the status of the left ventricle (without a previous transmural myocardial infarction 68.4%; with a previous myocardial infarction 41.0%). The effects of revascularization on myocardial ischemia can be evaluated by measurements of pulmonary wedge pressure and cardiac output at rest and during exercise.

A survey of general practitioners' referrals to a psychiatric out-patient service

In recent years reports have shown that in psychiatric practice in this country short treatments with relatively brief interviews and much reliance on drugs are the rule (Carstairs and Bruhn, 1962; Sargant and Slater, 1964). That this is also true of general practice has been demonstrated (Cooper, 1965; Shepherd et al., 1966).