ABSTRACT
The debate continues. As Materials Management in Health Care went to press, the Occupational Safety and Health Administration was getting an earful about proposed revisions to its respiratory protection standard. The standard sets requirements for respirator use in the workplace and will be a basis for part of OSHA's proposed tuberculosis standard, which should be released later this year. Here are the American Hospital Association's comments on the proposed revisions.
Subject(s)
Occupational Exposure/prevention & control , Respiratory Protective Devices/standards , Tuberculosis/prevention & control , American Hospital Association , Disposable Equipment/standards , Equipment Design , Humans , Masks/standards , United States , United States Occupational Safety and Health AdministrationABSTRACT
Intracoronary streptokinase administration has been an effective procedure for establishing reperfusion of an evolving myocardial infarction by lysing the thrombus that is usually responsible for the infarction. After reperfusion is accomplished, appropriate management of the patient must be planned to provide the best chance for assuring continued vessel patency, and appropriate management of the patient's residual coronary artery disease also must be considered. In selected patients, percutaneous transluminal coronary angioplasty of the residual coronary lesion has been performed successfully immediately following reperfusion with streptokinase. Early coronary artery bypass graft surgery has been performed with good results in other patients. The appropriate management of the patient with acute myocardial infarction is still evolving, and only with additional study and experience will the "best" approach in the management of these patients be defined.
Subject(s)
Myocardial Infarction/therapy , Streptokinase/therapeutic use , Adult , Aged , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/therapeutic use , Drug Therapy, Combination , Female , Heart , Heparin/administration & dosage , Heparin/therapeutic use , Humans , Injections/methods , Injections, Intravenous , Male , Middle Aged , Myocardial Infarction/drug therapy , Nitroglycerin/administration & dosage , Nitroglycerin/therapeutic use , Recurrence , Streptokinase/administration & dosage , Time FactorsABSTRACT
A case of an intracardiac echinococcal cyst is presented. The diagnosis was made by two-dimensional echocardiography, which clearly identified a large multiseptated cystic structure in the right ventricular outflow tract. The findings were verified at surgery. It is suggested that two-dimensional echocardiography may be the procedure of choice in the diagnosis of cardiac echinococcal disease.
Subject(s)
Echinococcosis/diagnosis , Echocardiography , Heart Diseases/diagnosis , Adult , Cardiac Catheterization , Echinococcosis/surgery , Heart Diseases/surgery , Humans , MaleABSTRACT
Limited (heart rate to less than or equal to 120 beats/min) standardized treadmill stress testing was done before hospital discharge in 40 survivors of uncomplicated acute myocardial infarction. Each patient had subsequent coronary arteriography. Twenty-one had inferior, 10, anterior, and nine, nontransmural infarctions; in 30 patients this was their first infarction. A positive electrocardiographic response or angina, or both, occurred in 15 patients and correctly detected most patients with multivessel disease (sensitivity 67%, predictive value 87%) and patients at risk for coronary events: 35% of positive responders admitted for angina in the first month after discharge versus 4% of patients with a negative test (p less than 0.05). During a 7-month follow-up period, 73% of patients with a positive test result developed angina versus 16% of those with negative test results (p less than 0.001). Thus, predischarge post-myocardial infarction limited stress testing correctly identifies the high-risk subset of patients with multivessel coronary disease and thereby allows intelligent selection of patients for early coronary arteriography.
