RESUMO
The ever-increasing importance of the P & T Committee is well illustrated in this exclusive interview with members of a committee from a leading academic, private-practice, health-science center--Rush-Presbyterian-St. Luke's Medical Center. The participants detail the progress achieved in P & T Committee policy making, particularly in recent years. Unprecedented change in the healthcare environment has demanded a more aggressive P & T Committee, and theirs has responded appropriately. Because the medical staff at Rush constitute a unique blend of academicians and private practitioners, the mechanics of their decision making tends to be consensus-related, while the implementation of those decisions is education-oriented. Other P & T Committees can learn from their political and professional strategies in the management of drug therapy.
Assuntos
Tratamento Farmacológico/normas , Formulários de Hospitais como Assunto/normas , Comitê de Farmácia e Terapêutica , Formulação de Políticas , Chicago , Uso de Medicamentos , Hospitais com mais de 500 LeitosRESUMO
A clostridial mycotic aneurysm of the right coronary artery was diagnosed by the use of multiple imaging modalities including gated magnetic resonance imaging. Percutaneous drainage was performed as a palliative measure in hope of avoiding repeat sternotomy.
Assuntos
Aneurisma Infectado/diagnóstico , Doença das Coronárias/diagnóstico , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/etiologia , Infecções por Clostridium/complicações , Clostridium perfringens , Doença das Coronárias/diagnóstico por imagem , Humanos , MasculinoRESUMO
Pulmonary hypertension is a rare association of portal hypertension, although its etiology is unclear. We report the development of severe "primary" pulmonary hypertension after an end-to-side portacaval shunt in a woman with postnecrotic cirrhosis.
Assuntos
Hipertensão Portal/complicações , Hipertensão Pulmonar/etiologia , Derivação Portocava Cirúrgica , Cateterismo Cardíaco , Feminino , Humanos , Hipertensão Portal/cirurgia , Hipertensão Pulmonar/patologia , Cirrose Hepática/cirurgia , Pulmão/patologia , Pessoa de Meia-IdadeRESUMO
The effects of coronary bypass grafting on ventricular tachycardia induced by treadmill stress testing (TST) were analyzed in nine patients by repeating the test an average of 5 months after operation. Preoperatively, eight patients experienced pain and all had ischemic ST-segment depression during exercise. Six patients had a single episode and two patients had multiple episodes of ventricular tachycardia; in one patient ventricular tachycardia degenerated into ventricular flutter necessitating direct-current cardioversion. Postoperatively, time of exercise and double product were significantly higher during TST. Electrocardiographic ischemic changes were present in only two patients and ventricular tachycardia was not observed. All patients are alive and average of 24 months after the operation, and eight of them are asymptomatic. In conclusion, among patients with coronary artery disease who have exercise-induced ventricular arrhythmias, myocardial revascularization is associated with improvement of exercise capacity and suppression of arrhythmias.
Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Teste de Esforço , Taquicardia/diagnóstico , Adulto , Idoso , Arritmias Cardíacas/diagnóstico , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Forty-seven patients (0.08%) from a total of 5,730 consecutive patients undergoing treadmill stress tests developed one or more episodes of ventricular tachycardia. Forty patients had heart disease, coronary artery disease being the leading cause. Rest ECG was normal in 12 patients and showed long QTc (greater than 440 msec) in 16 patients. Ventricular tachycardia was brief and self-terminating, requiring D/C cardioversion in only one patient. "Exertional hypotension" preceded ventricular tachycardia in 16 of 34 patients. There was poor correlation (r = 0.16) between the rate of ventricular tachycardia (VT) and the underlying heart rate. Only four episodes of VT were initiated by R on T premature ventricular beats. In summary, exercise-induced ventricular tachycardia 1) is a rare complication of treadmill stress test and occurs in patients with heart disease; 2) is frequently preceded by "exertional hypotension," and 3) is not related to the R on T phenomenon. The high incidence of prolonged QT may indicate a role for the automatic nervous system in its pathogenesis.
Assuntos
Teste de Esforço/efeitos adversos , Taquicardia/etiologia , Adulto , Idoso , Angiografia Coronária , Doença das Coronárias/diagnóstico , Doença das Coronárias/diagnóstico por imagem , Eletrocardiografia , Feminino , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia/diagnóstico , Taquicardia/diagnóstico por imagemRESUMO
Thirty-four patients had noninvasive myocardial perfusion imaging at rest using 134mCs. The results were compared with the results of coronary cineangiography and left ventriculography. All 21 patients who had abnormal left ventriculograms had corresponding myocardial imaging defects. This group included 14 patients with electrocardiographic evidence of either an old inferior, anteroseptal, anterior, or anterolateral myocardial infarction. Thirteen patients had normal left ventriculograms: this group included 6 patients with 75% or greater obstruction of one or more coronary arteries and 7 patients with normal or insignificantly diseased vessels. Only 2 of these patients had abnormal myocardial images: both had severe obstruction of the proximal left anterior descending artery without collateral filling of this vessel. In the resting patient who has 134mCs myocardial imaging, we concluded that we primarily are visualizing varying degrees of scarred myocardium rather than reversibly ischemic myocardium.
