Aqua-Reslin droplet analysis

Aerosol droplets were collected, counted, and sorted using a laser system, the Army Insecticide Measuring System, Teflon-coated slides, and magnesium oxide-coated slides. All droplets, for each method and replication, were generated by a London Aire 1820 or a Leco Model 1600. These data indicate that the Army Insecticide Measuring System or Teflon-coated slides are so closely similar to the laser that they could effectively be used in the field without an overwhelming loss in precision.

Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study

We conducted a multicenter, double-blind, placebo-controlled randomized trial of aspirin treatment (324 mg in buffered solution daily) for 12 weeks in 1266 men with unstable angina (625 taking aspirin and 641 placebo). The principal end points were death and acute myocardial infarction diagnosed by the presence of creatine kinase MB or pathologic Q-wave changes on electrocardiograms. The incidence of death or acute myocardial infarction was 51 per cent lower in the aspirin group than in the placebo group: 31 patients (5.0 per cent) as compared with 65 (10.1 per cent); P = 0.0005. Nonfatal acute myocardial infarction was 51 per cent lower in the aspirin group: 21 patients (3.4 per cent) as compared with 44 (6.9 per cent); P = 0.005. The reduction in mortality in the aspirin group was also 51 per cent--10 patients (1.6 per cent) as compared with 21 (3.3 per cent)--although it was not statistically significant; P = 0.054. There was no difference in gastrointestinal symptoms or evidence of blood loss between the treatment and control groups. Our data show that aspirin has a protective effect against acute myocardial infarction in men with unstable angina, and they suggest a similar effect on mortality.

Pharmacist management of anticoagulant therapy in ambulant patients

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.

Multiple conduction defects with markedly prolonged ventricular depolarization in cardiomyopathy

Electrophysiologic investigation of a diffuse and bizarre conduction abnormality in a patient with cardiomyopathy revealed profound slowing of the impulse in the right ventricular outflow region. The resultant 220 msec QRS duration is the longest reported in right bundle branch block.

Subepicardial infarction, myocardial impression, and ventricular penetration by sutureless electrode and leads

Postmortem examination two weeks following implantation of a demand pacemaker with sutureless electrodes demonstrated that (1) the loops of intrapericardial electrode leads indented the myocardium and produced a circumscribed area of subepicardial necrosis, and (2) one of the electrode coils protruded into the right ventricular cavity. The use of extrapericardial electrode leads and left ventricular implantation sites should avoid these problems.