Acute and long-term hemodynamic response to low-dose enoximone in refractory heart failure.

Enoximone possesses both positive inotropic and vasodilatory properties. In heart failure, doses varying between 3 mg/kg and 6 mg/kg produce a beneficial acute hemodynamic response but have been associated with significant side effects. Little is known about the long-term hemodynamic efficacy of this agent. To assess whether a lower dose of enoximone could produce both acute and long-term hemodynamic benefits and be better tolerated, 15 patients with refractory heart failure were given enoximone 100 mg every 8 hours (mean dose, 1.7 mg/kg). The cardiac index, pulmonary capillary wedge pressure, pulmonary artery pressure, right atrial pressure, systemic vascular resistance, pulmonary vascular resistance, and stroke volume index all improved significantly during the first 24 hours. The systemic blood pressure and heart rate did not alter appreciably during this period. Five of six patients remaining on therapy at 6 months had a follow-up hemodynamic study. Sustained improvement was seen in the cardiac index, pulmonary capillary wedge pressure, and pulmonary artery pressure when compared to baseline (all p less than 0.05). A satisfactory trend, which did not reach statistical significance, was noted in the right atrial pressure (p = 0.09) and stroke volume index (p = 0.06). Diarrhea occurred in one patient. These findings indicate that enoximone has a beneficial acute and long-term hemodynamic effect at a low dose that is clinically well tolerated.

A cluster of adolescent suicide attempts: is suicide contagious?

Adolescent self-destructive behavior has increased during recent decades. Suicide now ranks third as a cause of death among older teenagers. Although recent studies have highlighted multiple risk factors for this behavior, little attention has been paid to the role of contagion as a possible cause for suicide attempts. Within a 6-month period, a small suburban community experienced two adolescent deaths from suicide followed by five attempts and an admission for suicidal ideation, within 7 weeks subsequent to the second fatality. The six patients were among a group of students from the same high school who not only related to each other during the school day but who also visited each other at the time of hospitalization for suicidal behavior. The possible role of suicidal behavior precipitating other self-destructive attempts within a peer group is explored. The development of strategies for dealing with issues of depression and suicide within a high-school environment may be needed.