Enoximone in chronic stable angina: a double-blind placebo-controlled cross-over trial

Enoximone, a phosphodiesterase inhibitor (PDEI), has both positive inotropic and vasodilatory properties. We examined the effect of a single oral dose of enoximone as compared with placebo on myocardial ischaemia and global left ventricular (LV) function using both exercise ECG and Doppler measurements of aortic blood flow, respectively. Twenty patients (16 men, 4 women) with a mean age of 59 years and stable angina were studied. Total exercise duration was significantly longer after enoximone as compared with placebo treatment, with a mean difference of 22.8 s (p = 0.003). Times (mean +/- SD) to onset of angina and development of significant ST-segment decrease were similar after placebo (454 +/- 101 and 352 +/- 155 s, respectively) or enoximone (500 +/- 155 and 413 +/- 192 s, respectively), although both showed trends in favour of enoximone. As compared with placebo, significantly higher heart rate (HR) was measured for enoximone both at rest (75 +/- 18 vs. 90 +/- 22 beats/min, p < 0.01) and on recovery from exercise (81 +/- 18 vs. 89 +/- 19 beats/min, p < 0.05). Enoximone had no significant effect on systolic or diastolic blood pressure (SBP, DBP) or rate-pressure product (RPP) generated at rest or during exercise. Changes in both acceleration and velocity of aortic blood flow during exercise were similar after administration of enoximone or placebo. We showed that a single oral dose of enoximone is well tolerated in patients with ischaemic heart disease, improving both exercise capacity and favourably influencing ST-segment changes with no increase in adverse events or significant haemodynamic disturbances.     

Operative site bacteriology as an indicator of postoperative infectious complications in elective colorectal surgery

Toward the completion of elective colorectal operations, 75 patients had qualitative aerobic and anaerobic cultures of specimens obtained from peritoneal irrigation fluid, anastomoses sites, and abdominal wound irrigation fluid to determine if a correlation exists between intraoperative flora and postoperative infectious complications. Patients enrolled in this prospective study received a mechanical bowel prep and a 12-18 hour course of perioperative intravenous antibiotics. Comparisons were made between the 60 (80%) patients who had no postoperative infections and the 15 (20%) who developed postoperative infectious complications (9 wound infections, 6 intraabdominal infections). There were significantly more low anterior resections in patients who developed postoperative infection compared to those who had no postoperative infection (26% vs 2%), while there were more colocolostomies in the group with no infections (38% vs 7%). Streptococcus spp., Bacteroides fragilis group, and Escherichia coli were the most commonly isolated organisms from each of the three sites sampled. Isolation of > or = 3 organisms from incisional wound cultures (P = 0.017) and < or = 4 organisms from peritoneal irrigation (P = 0.009) or anastomotic culture (P = 0.004) correlated with development of postoperative infectious complications. Thus, patients with infectious complications had significantly more isolates than those without infectious complications, and were more likely to have had a low anterior resection. These data suggest that future clinical studies should reexamine the duration of perioperative antimicrobials based on early laboratory reports of qualitative and quantitative operative site bacteriology.     

Evaluation of fear and analysis of personality structure of women at risk for premature and after term labor

Psychological studies were performed in 57 pregnant women at risk for premature labour and 36 at risk for after term labour. The level of fear was evaluated using the Spielberger STAI questionnaire. The structure of fear and restlessness was studied using the R.B. Cattell's five factor Self-estimation Sheet. The analysis of personality structure was performed on the basis of results of the MMPI-WISKAD test. In the patients in both studied groups, groups an increased level of situational and persistent fear was found. Women at risk for premature labour are characterized by higher level of fear of neurotic character resulting from disharmonious personality. In women delivered after term the fear is of reactive character. Women at risk for after term labour are characterized by a higher degree of personality integration and more effective ability to control fear. Women at risk for premature labour are characterized by disharmonious personality and simultaneously they use more primitive protective mechanisms. Women delivered after term are characterized by higher degree of personality integration and more effective ability to control fear.