Biomedical subjects
Publications and source records attributed to M M Beahrs.
Should thrombolytic therapy be used in all patients who have acute myocardial infarction? Is one agent more effective than another? How safe is thrombolytic therapy? In this article, the authors discuss thrombolytic agents currently available, examine the results of ongoing studies, and reflect on future developments in thrombolytic management of myocardial infarction.
The acute fibrinous pericarditis that complicates acute myocardial infarction is usually of no functional significance. Uncommonly, hemorrhagic effusion may compound this process. In the case reported here, the pericardial aspect of acute lateral myocardial infarction dominated the clinical picture, thus posing a diagnostic problem. This phase of the disease stimulates us to place it on record.
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This study reviews the outcome in 36 consecutive patients who survived partial septal myectomy for hypertrophic obstructive cardiomyopathy operated on between 1960 and 1972. All patients were followed up until death or until June 1981 (mean 13.4 years). Of the 26 survivors, 17 had been more than mildly symptomatic preoperatively, but only 1 remained so postoperatively. The operation was effective in relieving the obstruction (peak systolic pressure gradient reduced from 79 to 8 mm Hg [p less than 0.001]), and mitral regurgitation was relieved. No survivor's symptoms worsened, but 10 died late--4 suddenly, 5 from congestive heart failure, and 1 from a malignancy. The 10-year survival rate was 77%. No correlation with outcome was found with respect to age, surgical approach, preoperative functional class, pressure gradient, left ventricular end-diastolic pressure, or presence of atrial fibrillation, but atrial fibrillation occurring late postoperatively (12 patients) was associated with an increased frequency of late death (7 of 10 late deaths) or continuing New York Heart Association functional class III status. Early or late postoperative complete heart block occurred in 1 patient each. Thus, these results suggest a favorable effect of operation and support continued surgical intervention for appropriate patients.
The possibility of urinary tract injury should always be considered in the course of anterior resection or combined abdominoperineal resection of the lower colon and rectum. Controlled studies of ureteral and other injuries and fistulas cannot be made; but fortunately, unanticipated damage to the lower urinary tract does not occur often. The surgeon operating in the pelvis should be aware of the problems rarely encountered and should be capable of their management. If a urologic surgeon is available, consultation often is desirable. Prompt intraoperative recognition is most important so remedial procedures can be carried out immediately. Delay in recognition and treatment jeopardizes the patient's course and the function of the urinary tract. Postoperative urinary tract infections should be diagnosed early so prompt treatment can be instituted.