Management of hypertension.
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Biomedical subjects
Publications and source records attributed to J C Ghose.
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With the aim of reducing myocardial infarction size, isosorbide dinitrate (ISDN) was tried in 27 patients of acute myocardial infarction (AMI). There was 11% reduction of infarction size, in the ISDN treated group, in comparison to that of non treated group, though the result was not statistically significant. But, many of the in-hospital complications were significantly less in the treated group. After a critical analysis of the result it was concluded that a statistically insignificant result, as regard reduction of infarction size in AMI, cannot always exclude the utility of a drug therapy in AMI.
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Breakage of a pacer lead due to the pacemaker-twiddler's syndrome (PTS) occurred in 4 of 62 survivors following epicardial-intramural pacer lead implantation with the pulse generator placed in each case in a subcostal left upper quadrant subcutaneous pocket. The abdominal pulse generator pocket appears to invite spontaneously occurring PTS, more so in a pregnant woman. The important predisposing factor to the development of PTS is an excessively spacious pulse generator pocket containing a pool of fluid. Addition of a few simple modifications to the technique of cardiac pacing would prevent the complication; these include implantation of the pulse generator in a plane deeper to the pectoral muscles, suspending the pulse generator from the clavicle and application of vacuum-suction drainage to the generator pocket in the initial phase of wound healing. In the presence of an optimally fitting pulse generator pocket, PTS should be rare with subclavicular subpectoral pulse generator implantation without active patient participation. The syndrome may not be as rare a cause of pacer lead malfunction as may appear from the relative paucity of reports in the literature.
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Systolic time intervals (STI) were measured from simultaneously recorded phonocardiograms, carotid pulse tracings, and electrocardiograms in 11 patients with constrictive pericarditis and in 10 patients with cardiomyopathy to assess the value of STI in the differential diagnosis of the two conditions. The predicted ejection fraction was calculated from the STI. The results were compared and found significantly different in the two groups of patients. The ratio PEP/LVET and the ejection fraction were found to have greater discriminatory values and separated the two groups clearly. Measurement of STI, a simple, noninvasive bedside technique, appears to be useful in distinguishing between constrictive pericarditis and cardiomyopathy.
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