Impulsive Source of the 2017 MW=7.3 Ezgeleh, Iran, Earthquake

On 12 November 2017, a M W=7.3 earthquake struck near the Iranian town of Ezgeleh, at the Iran-Iraq border. This event was located within the Zagros fold and thrust belt which delimits the continental collision between the Arabian and Eurasian Plates. Despite a high seismic risk, the seismogenic behavior of the complex network of active faults is not well documented in this area due to the long recurrence interval of large earthquakes. In this study, we jointly invert interferometric synthetic aperture radar and near-field strong motions to infer a kinematic slip model of the rupture. The incorporation of these near-field observations enables a fine resolution of the kinematic rupture process. It reveals an impulsive seismic source with a strong southward rupture directivity, consistent with significant damage south of the epicenter. We also show that the slip direction does not match plate convergence, implying that some of the accumulated strain must be partitioned onto other faults.

Isolated facial diplegia: a diagnostic dilemma

A 43-year-old man presented to his GP with a right facial palsy of 1 day's duration. He was prescribed a 5-day course of oral prednisolone for a diagnosis of Bell's palsy. Two weeks later he presented to the emergency department with a left facial palsy. He had a 2-month history of back pain, generalized myalgia and paraesthesia. There was no history suggestive of any other neurological deficit. There was no history of fever or weight loss. However, he had travelled to the Scottish Highlands 3 months previously and had noticed an itchy red rash over his buttock (approximately 3 cm in size) 4 weeks after his holidays. The rash was diagnosed as cellulitis and he was prescribed a 5-day course of oral flucloxacillin. The patient, however, did not recall having sustained a tick bite or having a characteristic migrating rash.

Examination revealed a bilateral lower motor neurone facial palsy. Detailed examination of the central and peripheral nervous system was otherwise normal. No vesicles were found in either external auditory canal. Tuning fork tests were normal. The initial investigations undertaken in the emergency unit are listed in Table 1.

Repeat serology 8 weeks later was positive for Borrelia burgdorferi immunoglobulin G (IgG) antibody by both enzyme-linked immunosorbant assay (ELISA) and immunoblot assay. The initial CSF sample was not subsequently examined for B. burgdorferi antibody as the sample had been discarded. A repeat lumbar puncture was not considered appropriate.

This patient's right-sided facial weakness showed spontaneous improvement over 4 weeks from the initial presentation by which time his left-sided weakness had improved.

Based on the history of travel to a tick-infested area, together with the neurological and serological findings, a diagnosis of early Lyme neuroborreliosis was made. Although antibiotic treatment does not hasten resolution of 7th cranial nerve palsy associated with B. burgdorferi infection, doxycycline was prescribed to prevent further sequelae.

The Food Marketing Institute and the National Council of Chain Restaurants: animal welfare and the retail food industry in the United States of America

In order to achieve real change, there must be a motivating force and all the stakeholders need to be involved. This is the premise of the animal welfare programme developed for the food retail, wholesale and chain restaurant industries in the United States of America (USA) by the Food Marketing Institute (FMI) and the National Council of Chain Restaurants (NCCR). This paper outlines a collaborative process that retailers and producers in the USA are using to enhance the care and welfare of animals in commercial food production. Although the efforts of the FMI and the NCCR are still underway, the process provides one example of how different parts of the food production system can work together to achieve positive change.

Confocal microscopy of Thygeson's superficial punctate keratopathy

PURPOSE

To describe the changes seen with the confocal microscope in Thygeson's superficial punctate keratopathy (TSPK).

METHODS

Confocal microscopy was performed on six patients with TSPK presenting to Manchester Royal Eye Hospital from October 1999 to June 2001. Both eyes were examined including the normal fellow eyes of two patients with unilateral TSPK. Images were compared with age-matched controls.

RESULTS

Irregular nerve fibers, masked by considerable haze, were seen in the subepithelial nerve plexus immediately above Bowman's membrane in TSPK. Generalized haze was also present in the anterior stroma along with areas of high reflectivity, microdots, and reflective bodies. Keratocytes had highly reflective nuclei and cell bodies of irregular size, orientation, and shape. The changes were related to the duration of TSPK, were not seen in normal fellow eyes, and were also present in areas without lesions.

CONCLUSION

Confocal imaging of TSPK demonstrated considerable abnormalities in the subepithelial nerve plexus, Bowman's membrane, and the anterior stroma that were related to disease duration. Similar changes have been reported in a variety of corneal diseases and following laser corneal surgery. Recent evidence has supported interactions between the epithelium and Bowman's membrane and the anterior stroma in corneal disease and after laser corneal surgery. We speculate that such interactions may have a role in TSPK.

A population study of the normal cornea using an in vivo, slit-scanning confocal microscope

PURPOSE

To document qualitative and quantitative changes in the normal, healthy human cornea with age using the confocal microscope.

METHODS

The central corneas of 120 subjects (mean age, 41 years; range, 11 to 80 years) were examined using an in vivo slit-scanning real-time confocal microscope. Images of the corneal stroma and endothelium from both eyes of each subject were semiautomatically analyzed in an observer-masked, randomized manner.

RESULTS

Anterior keratocyte density, posterior keratocyte density, and endothelial cell density were shown to be unaffected by the sex of the subject with p values of 0.46, 0.55, 0.50, respectively (multivariate analysis of variance). No statistically significant difference was detected between right and left eyes for all corneal layers examined. The anterior keratocyte density, posterior keratocyte density, and endothelial cell density decreased at a rate of 0.48, 0.22, and 0.33% per year, respectively. A positive correlation was found between the coefficient of cell variation and age.

CONCLUSIONS

This data constitutes essential normative data that can be used as a control in further research into abnormal corneal conditions.

Troponin T as a first-line test: the Royal Liverpool and Broadgreen University Hospital experience

Many hospital laboratories are unable to offer a cardiac troponin service because of the cost of providing this assay in addition to existing cardiac enzyme profiles: we circumvented this problem by withdrawing the conventional cardiac enzyme service and substituting cardiac troponin T. By ensuring that only one specimen for cTnT is analysed per episode of chest pain. substantial financial savings have been achieved.

Serotype distribution of Salmonella isolates from food animals after slaughter differs from that of isolates found in humans

If raw meat and poultry are the primary point of entry for Salmonella species into human populations, a correlation might be expected between the serotype distribution of Salmonella species isolated from animals at the time of slaughter and that of isolates found in humans. For 1990-1996, sufficient national data were available to permit such a comparison. A mathematical model was developed to predict serotype distributions of Salmonella isolates among humans on the basis of animal data. There was a significant mismatch between the serotype distributions among humans predicted by the model and those actually observed. This mismatch raises questions about the validity of the "standard" assumptions about Salmonella transmission on which the model was based-namely, that raw animal products are the primary source for human salmonellosis, that the risk of transmission to humans is equal for all food product categories, and that all Salmonella serotypes have an equal ability to cause human illness.

Confocal microscopy of the normal human cornea

The slit-scanning confocal microscope is a new clinical paradigm that allows the living human cornea to be viewed at a magnification of 680 x and a lateral resolution of 1 mum. As such, it allows corneal morphology to be inspected at a cellular level. The corneas of both eyes of 119 subjects who were evenly distributed in age from 10-80 years were examined using a Tomey ConfoScan P4 in-vivo slit-scanning real-time confocal microscope (Erlangen, Germany). Good quality representative images of the various corneal layers were selected for detailed qualitative analysis and are displayed here. A grid of corneal layer versus age was constructed from these images; this tool can be used as a normative confocal microscopy reference against which suspected corneal abnormalities can be assessed.

The role of microbiological testing in systems for assuring the safety of beef

The use of microbiological testing in systems for assuring the safety of beef was considered at a meeting arranged by the International Livestock Educational Foundation as part of the International Livestock Congress, TX, USA, during February, 2000. The 11 invited participants from industry and government research organizations concurred in concluding that microbiological testing is necessary for the implementation and maintenance of effective Hazard Analysis Critical Control Point (HACCP) systems, which are the only means of assuring the microbiological safety of beef; that microbiological testing for HACCP purposes must involve the enumeration of indicator organisms rather than the detection of pathogens; that the efficacy of process control should be assessed against performance criteria and food safety objectives that refer to the numbers of indicator organisms in product; that sampling procedures should allow indicator organisms to be enumerated at very low numbers; and that food safety objectives and microbiological criteria are better related to variables, rather than attributes sampling plans.

Factors associated with self-concept in children with asthma

PURPOSE

To investigate the relationship of demographic asthma, family, and child factors with self-concept in children with asthma.

METHODS

Data were collected twice approximately 4 years apart from both the affected children and their mothers (N = 134) via interviews and self-report questionnaire.

FINDINGS

Children who demonstrated more negative attitudes toward their illness, had less satisfaction with family relationships, and used more negative coping behaviors had the poorest self-concepts. Over time, the greatest improvement in self-concept occurred in children whose attitudes and satisfaction with family relationships improved and whose use of negative coping behaviors decreased.

CONCLUSIONS

Results suggest that some children with asthma, especially girls with severe asthma, appear to be at risk for poor self-concept.

Unfractionated heparin, time for a change?

BACKGROUND

In Ireland physician transfer to utilisation of Low Molecular Weight Heparin for Venous Thromboembolism has been slow, despite evidence of efficacy and concern about the level of anticoagulation achieved with Unfractionated Heparin.

OBJECTIVE

To examine the effectiveness of Unfractionated Heparin administration in a teaching hospital in Ireland. Primary outcomes measured were time to therapeutic APTT and length of hospital stay.

METHODS

We identified 50 consecutive eligible patients treated with continuous intravenous unfractionated heparin for Venous Thromboembolism from the period August 1994 to December 1996 at Beaumont Hospital, Dublin, Ireland. Data analysed included length of hospital stay, costing data and anticoagulation parameters (time to therapeutic APTT, percentage of time within therapeutic range, number of diagnostic tests, heparin dosages).

RESULTS

A significant number of patients (22%) never achieved therapeutic APTT levels. Of those who did achieve therapeutic APTT levels at some time during their therapy, therapeutic range APTT was maintained only 28% of the time on heparin. 57% of the time results were below therapeutic while 15% of the time results were above therapeutic. Also 26% of the patients were discharged with INR results outside the therapeutic range despite an average length of stay of 13.3 days (over twice the ideal of 6 days). Ineffective anticoagulation influenced hospital length of stay in 60% of cases in our evaluation. Average cost of treatment with Unfractionated Heparin was 5897.86 Pounds versus the projected cost of Low Molecular Weight Heparin at 2562.78 Pounds for 6 days of in-patient therapy or 60.78 Pounds for outpatient therapy (excluding physician visit costs).

CONCLUSIONS

Unfractionated Heparin therapy as reviewed in our study is sub-optimal with inadequate anti coagulation and prolonged hospitalisation. Low Molecular Weight heparin, with comparable therapeutic effect documented elsewhere, overall may cost less.

Pancreatic enzyme supplementation in cystic fibrosis patients before and after fibrosing colonopathy

BACKGROUND

In 1994 we cared for nine cystic fibrosis patients with fibrosing colonopathy. To evaluate the relationship between fibrosing colonopathy and supplemental pancreatic enzymes we reviewed our dosing of enzymes prior to fibrosing colonopathy development and then evaluated the subsequent effect of drastically reducing pancreatic enzyme dose.

METHODS

We retrospectively reviewed pancreatic enzyme dosing for 267 cystic fibrosis patients with pancreatic insufficiency. The supplemental enzyme history of nine patients with fibrosing colonopathy was contrasted with the history of 258 nonaffected patients. The pancreatic enzyme doses of 75 patients taking at least 6,000 U lipase/kg/meal were systematically reduced to approximately 2,000 lipase units/kg/meal. We evaluated the effect of this dose reduction on change in height and weight z scores one year after achievement of stable enzyme dose.

RESULTS

In the year prior to diagnosis patients with fibrosing colonopathy took a significantly larger pancreatic enzyme dose, whether assessed by highest dose or cumulative dose, than did nonaffected patients. Similar results were observed after controlling for sex and age. All 75 patients on at least 6,000 U lipase/kg/meal were able to tolerate a significant reduction in dose while achieving clinically acceptable nutrient absorption, with no change over one year in height and weight z scores.

CONCLUSIONS

Our data demonstrate a strong relationship between very high doses of pancreatic enzyme supplementation and formation of fibrosing colonopathy. These very high doses do not appear to be needed for adequate nutrient absorption and growth.

A new route of transmission for Escherichia coli: infection from dry fermented salami

OBJECTIVES

This study evaluated the production of dry fermented salami associated with an outbreak of Escherichia coli O157.H7 infection in Washington State and California.

METHODS

Facility inspections, review of plant monitoring data, food handler interviews, and microbiological testing of salami products were conducted.

RESULTS

Production methods complied with federal requirements and industry-developed good manufacturing practices. No evidence suggested that postprocessing contamination occurred. Calculations suggested that the infectious dose was smaller than 50 E. coli O157:H7 bacteria.

CONCLUSIONS

Dry fermented salami can serve as a vehicle of transmission for O157:H7 strains. Our investigation and prior laboratory studies suggest that E. coli O157:H7 can survive currently accepted processing methods.

Umbilical vein to artery ratio in fetuses with single umbilical artery

In fetuses with single umbilical artery (SUA) the entire blood flow to the placenta is transported through only one umbilical artery, resulting in a compensatory increase of the arterial diameter. In order to establish whether umbilical vessel size could be used as an additional ultrasonographic criterion for prenatal diagnosis of SUA, we measured umbilical vein and umbilical artery diameters in 55 fetuses with SUA and in 55 with a normal three-vessel cord matched for gestational age. In all but one fetus with SUA, the diameter of the umbilical artery was greater than 50% of that of the umbilical vein, resulting in an umbilical vein to umbilical artery ratio of < or = 2. In contrast, none of the fetuses with a three-vessel cord had a ratio of < or = 2. Increasing diameter of the umbilical artery with no modification of the diameter of the vein is a characteristic prenatal ultrasonographic feature of SUA, making this observation a useful technique for the detection of this vascular anomaly in utero.

Emerging foodborne pathogens: Escherichia coli O157:H7 as a model of entry of a new pathogen into the food supply of the developed world

There would appear to be little argument that the large outbreaks of E. coli O157:H7 which have occurred since the early 1980s represent a distinct, new phenomenon. The number of reported cases have increased dramatically, starting from zero in 1981; however, it is also clear that this increase in reported cases is in part an artifact of improved surveillance and reporting. Available data suggest that E. coli O157:H7 infections were present prior to 1982, although numbers appear to have been small. At a molecular level, the organism shows evidence of clonal origin, but there is not the striking clonality, with virtually identical pulsed-field gel electrophoresis and ribotyping patterns, which has been seen in situations such as the emergence of Vibrio cholerae O139 Bengal in the Indian subcontinent in 1992 or the introduction of V. cholerae O1 into naïve populations in South America in 1991 (127-129). Findings are more consistent with the image of an organism which arose from a common ancestor, but which has had time to become distributed geographically and to show some evidence of genetic divergence. While this is an "emerging" infection, at least in terms of its distribution and public recognition, it is unlikely that it will be possible to identify the "first" O157:H7 case or to track the clonal spread of the organism through cattle or human populations.

Fetal cholecystomegaly: a prenatal marker of aneuploidy

The fetal gall bladder can now be easily identified during the second and third trimesters using high-resolution ultrasonography. In this report we present eight fetuses with an enlarged gall bladder detected on prenatal ultrasonography at a mean gestational age of 24.6 weeks (range 19-31 weeks). Additional ultrasonographic findings were present in four cases: fetal anomalies and intrauterine growth retardation in three and polyhydramnios in one. Of those cases associated with fetal anomalies, one women underwent amniocentesis at 21 weeks revealing trisomy 18. The other two declined prenatal karyotyping; neonatal karyotyping revealed trisomy 13 in one and trisomy 18 in the other. Although an enlarged fetal gall bladder can be a normal variant in the second and third trimesters, the prenatal detection of cholecystomegaly should prompt a search for associated anomalies and other markers of aneuploidy. If found, prenatal karyotyping should be considered.

Fetal intraluminal gastric masses after second trimester amniocentesis

Eight instances of homogeneous, well-defined echoes within the fetal stomach were identified on routine second trimester detailed scan over a 7 month period, a prevalence of 1 in 287 or 0.35%. This finding was significantly more frequent in women who had cytogenetic amniocentesis than in those who had not had the procedure (4 in 266 [1.5%] versus 4 in 2031 [0.2%], respectively; P < 0.01). Indirect signs of intra-amniotic bleeding, such as particles in the amniotic fluid, chorioamniotic separation, or hyperechogenic bowel, were present in four cases. The association between echogenic material within the fetal stomach and cytogenetic material within the fetal stomach and cytogenetic amniocentesis is discussed.

Fetal hyperechogenic bowel following intra-amniotic bleeding

OBJECTIVE

To test the hypothesis that increased echogenicity of the fetal bowel at second-trimester scans results from intra-amniotic bleeding.

METHODS

We studied 726 patients undergoing second-trimester amniocentesis for advanced maternal age. Three groups were identified according to the color of the amniotic fluid (AF) obtained: clear fluid, blood-stained fluid, and dark brown fluid. Two to 4 weeks after the amniocentesis, all patients had a targeted ultrasound examination for the detection of fetal structural anomalies and markers of chromosomal abnormalities, which included a survey of the fetal bowel. The incidence of hyperechogenic bowel in each group was compared by Fisher exact test. P < .05 was considered significant.

RESULTS

In 694 cases, the AF was clear (95%), in 20 blood-stained (3%), and in 12 dark brown (2%). Hyperechogenic bowel was detected in 14 fetuses with clear fluid (2%), in two with blood-stained fluid (10%), and in three with dark brown fluid (25%). Fetuses with proven intra-amniotic bleeding (ie, dark brown or blood-stained AF at amniocentesis) had a significantly higher incidence of hyperechogenic bowel compared to those with clear AF (five of 32 [15.6%] and 14 of 694 [2.0%], respectively; P < .001, 95% confidence interval for the difference in proportions 6.3-17.6%).

CONCLUSIONS

Our study demonstrates that intra-amniotic bleeding is associated with an increased incidence of fetal hyperechogenic bowel at second-trimester ultrasound scans. This sonographic phenomenon may be due to the presence of blood in the fetal bowel caused by fetal swallowing of bloody AF.

Service needs of children with disabilities and their families

A survey of 1527 families receiving the Child Disability Allowance was undertaken. There were substantial unmet needs for home help services, respite care and equipment. Satisfaction with services, particularly therapy, and respite care facilities was less than optimal. Many families also lacked knowledge about resources available to them. Improvement in the quality and availability of services is essential as is dissemination of information about available facilities.

Secretion of intravenously administered antibiotics in gastric juice: implications for management of Helicobacter pylori

AIMS

To study whether differences in eradication rates of antibiotics may be explained by differences in secretion of antibiotics in gastric juice.

METHODS

A single intravenous dose of either ampicillin 500 mg, erythromycin 500 mg, or metronidazole 500 mg was administered to four healthy Helicobacter pylori negative volunteers on different days. Antibiotic concentrations were measured in gastric juice before and every 10 minutes after administration of the drug for two hours and after one hour in serum.

RESULTS

No ampicillin was detected in gastric juice. Erythromycin concentrations in gastric juice showed considerable individual variation and reached maximum concentrations of 2.2-4.8 mcg/ml between 30 and 80 minutes after dosing. Metronidazole concentrations in gastric juice showed much less individual variation and maximum concentrations of 5-6 mcg/ml were reached within 30 minutes and remained high during the study period.

CONCLUSION

Metronidazole and erythromycin are secreted across the gastric mucosa, but ampicillin is not.

14C-urea breath test for the detection of Helicobacter pylori

The high urease activity of Helicobacter pylori can be used to detect this bacterium by noninvasive breath tests. We have developed a 14C-urea breath test which uses 5 microCi 14C with 50 mg nonradioactive urea. Breath samples are collected at baseline and every 30 min for 2 h. Our study compared the outcome of the breath test to the results of histology and culture of endoscopically obtained gastric biopsies in 84 patients. The breath test discriminated well between the 50 positive patients and the 34 patients negative for Helicobacter pylori: the calculated sensitivity was 100%, specificity 88%, positive predictive value 93%, and negative predictive value 100%. Treatment with bismuth subsalicylate and/or ampicillin resulted in lower counts of exhaled 14CO2 which correlated with histological improvement in gastritis. The 14C-urea breath test is a better "gold standard" for the detection of Helicobacter pylori than histology and/or culture.

Legionella: an infrequent cause of adult community acquired pneumonia in Dublin

The commonest infectious agents identified in community acquired pneumonia (CAP) amongst 50 patients admitted to a Dublin hospital were Streptococcus pneumoniae and Haemophilis influenzae. Legionella pneumophila pneumonia occurred in only one patient who acquired infection abroad. A serological screen of blood bank donors and renal transplant recipients failed to detect antibody to Legionella pneumophila supporting the clinical findings of a low prevalence of infection in this community. It is concluded that initial antibiotic therapy for patients with CAP need not routinely include cover for Legionella.

Optimization of a medium for the rapid urease test for detection of Campylobacter pylori in gastric antral biopsies

We developed a buffered azide-free urea medium which is sensitive, specific, and nontoxic for rapid detection of Campylobacter pylori in gastric biopsies. Detection of urease produced by the organism provides the basis for the test. The substrate is urea in monobasic sodium phosphate buffer, and phenol red provides indication of the pH change that results from urease activity. A rapid change from yellow to red occurs in the presence of C. pylori, even at low concentrations of the organism. A slower color change occurs with higher concentrations of other urease producers, such as Yersinia enterocolitica and Proteus mirabilis. Experience with 51 patients with our medium showed excellent results in detection of C. pylori in gastric mucosal biopsies. In clinical research and practice, a rapid bedside test will be helpful for rapid diagnosis of C. pylori-positive patients.

Clinical application of Doppler ultrasonography in the thoracic outlet syndrome

Difficulties in diagnosing the thoracic outlet syndrome prompted a pilot study of noninvasive Doppler ultrasonography in 160 thoracic outlets of healthy volunteers. Encouraged by the results we applied the technique to the clinical evaluation of flow disturbances during various provocative maneuvers. Ninety-four thoracic outlets were examined; of these, 32 were operated upon. Severe flow occlusion which was detected by Doppler ultrasonography reproduced symptoms of which the patients had originally complained. All patients were relieved of their symptoms, and only five had minor flow disturbances after resection of the first rib and scalenotomy. Resection of cervical ribs was carried out in seven of nine patients with this anomaly. Doppler ultrasonography was found to be a most valuable diagnostic modality and its wider application in this field is recommended.

Long-term prognosis of mitral-valve prolapse

We examined the natural history of mitral-valve prolapse in 53 patients who had had a midsystolic click or late systolic murmur (or both) documented phonocardiographically a mean of 13.7 years earlier. Thirty-eight patients were alive without serious complications, and seven had died of unrelated causes. In two patients prolapse was implicated in the cause of death. Other complications were ventricular fibrillation in one patient and bacterial endocarditis in three. Progressive mitral regurgitation developed in five patients, requiring valve replacement in two. These complications occurred in a total of eight patients (15 per cent), and were significantly (P = 0.15) associated with a late systolic murmur rather than an isolated midsystolic click. Thus it appears that the diagnosis of mitral-valve prolapse should not be regarded as ominous; however, patients in whom this diagnosis is associated with a late systolic murmur should be followed carefully.

Comparative hemodynamic responses to chlorpromazine, nitroprusside, nitroglycerin, and trimethaphan immediately after open-heart operations

The hemodynamic effects of intravenous chlorpormazine, nitroprusside, nitroglycerin, and trimethaphan camsylate were studied in 51 patients with high mean arterial pressures immediately after open-heart operations. Chlorpromazine was given by bolus intravenous injection to 24 patients (average dose 10.3 mg); nitroprusside (17 patients), nitroglycerin (8 patients), and trimethaphan (12 patients) were administered by constant intravenous infusion at average doses of 77 mug/min, 59 mug/min, and .097 mg/min, respectively. Measured or derived variables included right atrial pressure, pulmonary artery pressure, left atrial pressure, systemic arterial pressure, heart rate (HR), cardiac index (CI), stroke index (SI), stroke work index (SWI), and systemic vascular resistance index (SVRI). All four vasodilators significantly reduced systemic and intracardiac pressures and SWI (P less than 0.01). Associated changes in left ventricular pumping performance, however, differed importantly between groups. Chlorpromazine caused a significant rise (+19%) in HR with preservation of SI; thus, CI rose significantly (P less than 0.01). Only nitroprusside, however, resulted in enhancement of SI (P less than 0.05) at the lowered left atrial pressure; CI increased by 19% (P less than 0.01), HR rose minimally (6.5%), and calculated SVRI diminished 33% (P less than 0.01). Both nitroglycerin and trimethaphan caused decreases in SI and CI. These results indicate that in general, among the vasodilators studied, nitroprusside is associated with the most favorable hemodynamic responses in early postoperative cardiac surgical patients.