Annals of internal medicine
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We have analyzed the safety of doing pulmonary angiography in 67 consecutive patients with moderate-to-severe primary pulmonary hypertension or hypertension secondary to chronic thromboembolic occlusions of the pulmonary arteries. The average (+/- SD) pulmonary arterial systolic and diastolic pressures were 74 +/- 19 and 34 +/- 10 mm Hg, respectively. Fourteen patients had a right ventricular end-diastolic pressure of 20 mm Hg or more. ⋯ Thrombotic occlusions of the pulmonary arteries were identified in 52 patients and confirmed in all 42 of those who had a thromboendarterectomy. At autopsy, 3 of the 15 patients who had normal angiograms were found not to have had thrombotic occlusions. We conclude that pulmonary angiography can be done safely despite the presence of severe pulmonary hypertension and right ventricular failure, and that the procedure leads to the identification of chronic, major-vessel thromboembolic pulmonary hypertension that may be alleviated by thromboendarterectomy.
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Comparative Study
Complications of intrahospital transport in critically ill patients.
To determine the frequency of hemodynamic and respiratory complications during movement within the hospital, we conducted a prospective study involving 36 critically ill, ventilator-dependent patients who needed procedures done outside the intensive care unit. During the first 20 transports, patients received ventilation through a manual resuscitation bag. Arterial blood gas measurements showed frequent changes from baseline with alterations in PCO2 (greater than 10 torr) or pH (greater than 0.05) occurring on 14 occasions. ⋯ Although 6 patients showed changes in arterial blood gas values, mean changes in PCO2 and pH were significantly less than in the group that received manual ventilatory support. (p less than 0.01). Hemodynamic complications of hypotension and cardiac arrhythmia showed a significant correlation with disturbances in arterial blood gases (p less than 0.05). Although limited by the lack of a control period, this study shows that the transport of critically ill patients may result in severe hemodynamic complications; it also suggests that these complications might be prevented by more careful monitoring of ventilation.
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Randomized Controlled Trial Clinical Trial
Computerized display of past test results. Effect on outpatient testing.
To determine the effect of displaying previous results of diagnostic tests on the ordering of selected outpatient tests. ⋯ Presenting physicians with previous test results reduced the ordering of those tests. The actual effect may have been greater than 13%, because there were reductions in study tests ordered for both intervention and control patients during the intervention period when compared with the pre-intervention period, and both tended to rise after the intervention, or display, was turned off.
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Case Reports
The Neurobehavioral Cognitive Status Examination: a brief but quantitative approach to cognitive assessment.
The Neurobehavioral Cognitive Status Examination (NCSE), a screening examination that assesses cognition in a brief but quantitative fashion, uses independent tests to evaluate functioning within five major cognitive ability areas: language, constructions, memory, calculations, and reasoning. The examination separately assesses level of consciousness, orientation, and attention. ⋯ Standardization data are provided for 119 healthy adults (age range, 20 to 92 years) and for 30 patients receiving neurosurgical care for brain lesions (range, 25 to 88 years). Cognitive profiles for several common neuropsychiatric conditions illustrate the usefulness of this examination in clinical practice.