Beta-blockers, nitrates, aspirin and thrombolytic drugs have each separately been shown to reduce mortality in acute myocardial infarction, but the effect of these treatments combined during routine coronary care has not been assessed. The coronary care unit at Ostra Hospital services a stable community of 250,000 inhabitants. Since 1984 all patients have been entered into a computerized database. In addition, information on age, sex, discharge diagnosis and hospital outcome is also available for patients admitted between 1979 and 1983. In 1984, routine treatment with intravenous beta-blockers was introduced, to be followed in 1986 by intravenous nitroglycerin and in 1988 by aspirin in all patients without contraindications. Since 1988, intravenous thrombolytic treatment has been also given routinely to all patients with ST-elevation and chest pain < 6 h. Despite a similar number of patients and an increasing median age, the in-hospital mortality has declined from 18.5% in 1979 to 11.8% in 1990 (P < 0.01). It is concluded that mortality from acute myocardial infarction has declined by almost 40% since 1979. This reduction cannot be explained by a single major therapeutic intervention but may be attributed to the combined use of multi-lead monitoring, early use of beta-blockers, nitroglycerin, aspirin and thrombolytic agents.
Somatosensory evoked electroencephalogram (EEG) responses (SER) were recordedin 19 fetal lambs with gestational ages varying from 66 to 140 days. The ewes were anesthetized with chloralose and the fetuses were exteriorized with intact umbilical circulation. Periods of hypoxia at different p H levels were induced by ventilating the ewe with gas mixtures including 8-15yG oxygen, either alone or combined with a 10yo COr mixture, or with an intravenous infusion of bicarbonate to the fetus.
SUMMARY
Evoked electroencephalographic responses are useful for the study of cerebral maturation in full‐term and pre‐term newborn infants. In an attempt to achieve wider clinical application, 57 newborn infants with differing degrees of perinatal asphyxia were examined. Altogether 154 examinations were performed. In all of them photostimulation was used, and in 72 investigations somatosensory evoked responses were also recorded. The following results were obtained:
Visual evoked responses were affected in 85 per cent of the cases. Somatosensory evoked responses were affected less often—in 65 per cent of the newborn babies examined. The incidence and degree of deviations were related to the degree of asphyxia.
The most characteristic features of the evoked responses in asphyxiated infants were abnormal response patterns, increase of latency and poor photic driving.
On the basis of all alterations observed, a scoring system was developed which enabled quantitative evaluation. The evoked response risk‐score correlated well with the degree of asphyxia.
Repeated observations were important: a permanently high risk‐score at repeated investigations was a serious prognostic sign.
RÉSUMÉ
Applications cliniques des potentiels EEG évoqués chez les nouveaux‐nés. I: Asphyxie périnatale
Les réponses électroencéphalographiques évoquées sont utiles pour l'étude de la maturation cérébrale chez les nourrissons, nés à terme et avant terme. Dans une tentative pour faire appel à des applications cliniques plus larges, 57 nourrissons nouveaux‐nés présentant des degrés divers d'asphyxie périnatale ont été examinés. Au total, 154 examens ont été faits. La photo‐stimulation a été utilisée dans tous les cas et 72 recherches de potentiel évoqué somato‐sensoriel ont étéégalement enregistrées.
Les résultats suivants ont été obtenus:
Les réponses évoquées visuelles étaient altérées dans 85 pour cent des cas; les réponses évoquées somato‐sensorielles moins souvent (65 pour cent des nouveaux‐nés examinés). La survenue et le degré d'altération étaient reliés au degré d'asphyxie.
Les aspects les plus caractéristiques des potentiels évoqués chez les enfants asphyxiés étaient des formes de réponses anormales, un accroissement de latence et un entrainement photique pauvre.
A partir de toutes les altérations observées, un système de notation a été construit, permettant une évaluation quantitative. La note de risque de potentiel évoquéétait bien reliée au degré d'asphyxie.
Les observations répétées sont importantes. Une note permanente de haut risque des potentiels évoqués à des examens répétés s'est montrée un signe de pronostic grave.
ZUSAMMENFASSUNG
Die klinische Bedeutung evozierter Entladungen im EEG bei Neugeborenen. I: perinatale Asphyxie
Evozierte Entladungen im eeg sind zur Beurteilung der Hirnreife bei reifen Neugeborenen und bei Frühgeborenen von Bedeutung. Mit dem Ziel, die klinische Anwendung zu erweitern, wurden 57 Neugeborene mit unterschicdlichem Schweregrad der Asphyxie untersucht. Insgesamt wurden 154 Untersuchungen ...
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