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PubMed · 8707645

Mixed blessings: an essay.

E P Siddell
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Abstract

It has been 12 years since Robert and Peggy Stinson chronicled the brief life of their prematurely born son in The Long Dying of Baby Andrew. Their story examined the ethical dilemmas involved in providing neonatal intensive care to marginally viable infants. Although much has changed in neonatal intensive care in 12 years time, issues regarding treatment of marginal infants remain unresolved. Further, neonatal intensive care has provided society a window through which to observe the growing fetus, with potentially profound implication for women's reproductive decision-making. The unintended and unanticipated consequences of neonatal intensive care are examined according to Roger's change model, as described in his book Diffusion of Innovations.

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DeathEthics, NursingHumansInfant, NewbornInfant, PrematureIntensive Care, NeonatalNeonatal NursingParentsJournal Article

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E P Siddell. Mixed blessings: an essay.. https://doi.org/10.3109/01460869509080965

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Increased risk of cardiac death in primary hyperparathyroidism: what is a role of electrical instability?

BACKGROUND: Increased risk of death in patients with primary hyperparathyroidism (PHPT) is referred to cardiovascular complications induced by hypercalcemia. At the moment the role of bioelectrical risk and of enhanced sympathetic activity, not related to cardiovascular complications, is unknown in PHPT patients. METHODS: The study was designed to evaluate the QT parameters and sympathovagal balance in 28 PHPT uncomplicated patients compared to 29 healthy subjects (HS). Nine of 28 patients were restudied after parathyroidectomy. Standard ECG, short and 24-h ECG monitoring were performed to calculate QT parameters and Heart Rate Variability (HRV). RESULTS: QTc interval resulted shorter in PHPT patients than in HS and QTc dispersion resulted higher in PHPT patients than HS. The physiological adaptation of QT length to R-R interval was lacking in PHPT patients. Enhanced sympathetic tone was found in PTHP patients than controls. These data were confirmed after parathyroidectomy. CONCLUSION: Our findings revealed an increased risk to develop life-threatening arrhythmias in PHPT patients due to bioelectrical instability induced by hypercalcemia. Parathyroidectomy doesn't seem to reverse this abnormality.

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