Factors in decision making following genetic counseling for pre-natal diagnosis of de novo chromosomal rearrangements.

A retrospective survey of genetic counselors was conducted in order to identify practice patterns and factors that influence a patient's decision making when a de novo translocation is diagnosed pre-natally. Different variables that influence patients' decisions about pregnancy management were assessed and compared. Specifically, the type of rearrangement and/or knowledge of the breakpoints, risks provided for abnormal outcome, anxiety, fetal ultrasound findings and personal reasons for parental decisions were evaluated. Our findings suggest that patient anxiety level significantly predicts pregnancy management decisions. This information may be of benefit in identifying potential areas of education for genetic counselors as well as other health care providers.

Comparison of methohexital and propofol for electroconvulsive therapy: effects on hemodynamic responses and seizure duration.

Electroconvulsive therapy can produce severe disturbances in the cardiovascular system, most commonly a transient period of hypertension. This study was designed to determine whether propofol, in comparison with methohexital, would attenuate this hypertensive response. Fifteen patients were studied during courses of six ECT administrations, each patient receiving propofol or methohexital on different occasions. Arterial pressure, heart rate, and cardiac rhythm were recorded. The induction doses were 1.08 +/- 0.03 mg.kg-1 of methohexital, and 1.60 +/- 0.04 mg.kg-1 of propofol. Systolic pressure, diastolic pressure, and heart rate were consistently lower following propofol than methohexital (P less than 0.005). The mean maximum increase over baseline systolic pressure was 2.1 +/- 2.9 mmHg with propofol, and 26.7 +/- 4.5 mmHg with methohexital (P less than 0.001). Cardiac rhythm abnormalities were infrequent, and their incidence did not differ significantly between the two induction agents (P greater than 0.3). The duration of seizures, as measured clinically, was reduced with propofol (17.9 +/- 2.5 s) in comparison with methohexital (30.9 +/- 2.8 s) (P less than 0.001). Recovery times were similar for the two agents. Since the role of seizure duration in the therapeutic efficacy of ECT remains controversial, propofol may be a useful induction agent for this procedure.

Haemodynamic and metabolic effects of prophylactic nitroglycerin infusion in the immediate period following coronary artery bypass grafting.

This is a preliminary report of work in progress to assess the effects of prophylactic nitroglycerin infusion in patients undergoing coronary artery vein grafting. So far 14 patients have been studied. They were divided into two groups to receive either nitroglycerin (1 microgram kg-1 min-1) or placebo (5% dextrose). The infusion was commenced on removal of the aortic cross-clamp after completion of the distal anastomoses of the grafts. During cardiopulmonary bypass myocardial protection was provided by cold potassium cardioplegia and systemic hyopthermia. For 2 hours after cessation of cardiopulmonary bypass simultaneous samples of coronary sinus and femoral arterial blood were taken to estimate lactate concentrations and oxygen saturation. No differences were found between the groups. At the same times haemodynamic measurements were made. There was a statistically significant increase in cardiac index in the nitroglycerin group up to 30 minutes post cardiopulmonary bypass. There was also a statistically significant fall in systemic and pulmonary vascular resistances with no differences in systemic or pulmonary arterial pressures. There was no difference in central venous or pulmonary capillary wedge pressures. Patients receiving nitroglycerin seemed more stable cardiovascularly than those receiving placebo. In conclusion nitroglycerin improves cardiac output in the immediate post bypass period following cold potassium cardioplegia.