Mechanism of supraventricular tachycardia and pharmacological effects on it. Electrophysiologic study in 30 patients with documented SVT, 16 of whom had preexcitation, and in 24 control subjects were reported. The mechanism of SVT were found to be various and to include reentry confined to the AV node, SA node or the atrium, reentry through accessory pathway and ectopic atrial automaticity. It was noted that some of SVT might use concealed accessory pathway in VA direction while the some of SVT in WPW syndrome might not utilize accessory pathways. Electrophysiological properties in cases with SVT did not differ from those observed in controls. There were no differences in the mode of electrophysiological action of drugs between XVT and control groups. Both propranolol and procaine amide slightly depressed AV conduction. However, the action of the drugs on echo zone were not the same. The basic mechanisms of the action of the drugs in SVT were discussed.


Purification of host DNA synthesis-suppressing factor (DSF) produced by infection with measles virus. Host DNA synthesis-suppressing factor (DSF) produced into culture fluid of cloned HeLa cells (HeLa C-9) infected with a small plaque variant of Toyoshima strain of measles virus was purified by precipitation with ammonium sulfate, chromatography on CM-cellulose and DEAE-cellulose, and gel-filtration on Sephadex G-100 and G-200. The specific activity of the finally purified DSF was 302 units/mg of protein representing approximately 300-fold purification. The molecular weight of DSF was estimated to be about 55 000. By isoelectric focusing, two kinds of DSF having isoelectric points of 4.24 and 5.24 were detectable. The purified DSF was able to suppress host DNA synthesis of HeLa cells, continuous human lymphoid cells (NC-37), mouse L cells and Meth-A cells derived from an ascitic tumor of the mouse. The activity of the purified DSF was inactivated by heating at 56 C for 30 min or by treatment with trypsin.


Isolation of a small rod with lytic activity against Vibrio parahaemolyticus from fresh sea water. A small rod, capable of formine crater-like plaques on lawns of Vibrio parahaemolyticus, was isolated from a marine environment. The isolate was a gram-negative straight rod with round ends and was small in size, equal to that of halophilic Bdellovibrio strain 5501. The isolate appeared to have close taxonomic relationships to Cytophaga, since this bacterium moved slowly in a gliding manner on a solid agar surface, hydrolyzed agar and starch, contained yellow pigment and was halophilic. The isolate was able to grow not only under host-dependent but also under host-independent conditions when low nutrient media were used for cultivation, and its bacteriolytic mode was different from that of Bdellovibrio, an endoparasite. The isolate was halophilic and required Mg++ and Ca++ in addition to 3% saline for growth. The isolate showed a broad host rnage when tested for plaque-forming activity on gram-negative bacteria but not on the gram-positive bacteria tested so far.


Binding of tobacco mosaic virus to membrane material isolated from tobacco leaves. Binding of tobacco mosaic virus (TMV) to disrupted tobacco leaf membrane was studied. Membrane isolated from tobacco leaves was treated successively with (NH4)2SO4, Li-diiodosalicylate and then pronase. TMV-binding substance was thus isolated in a soluble form. From enzymatic digestion experiments, it was suggested that the binding substance was composed of lipid and carbohydrate.


Lymphocyte responsiveness to phytohemagglutinin (PHA) and serum inhibitory effect in patients with gastric cancer. The in vitro lymphocyte response to PHA was determined in patients with gastric cancer in various stages prior to the surgical treatment. The lymphocyte responsiveness in the presence of homologous pooled AB serum in patients of stages II, III and IV were markedly reduced as compared with that in healthy controls (stages II, III; p less than 0.05, stage IV; p less than 0.01). Inhibition of normal lymphocyte responsiveness to PHA by serum from patients in stages III and IV were statistically significant only in the advanced stage. It was concluded that the suppression of the immune response in the early stage of gastric cancer was mainly due to the impairment of lymphocyte itself, which advanced with the progress of the stage and was modified by the serum inhibitory effect in advanced stages. In patients with advanced cancer, the higher was the lymphocyte responsiveness to PHA and PWM prior to the initial treatment, the more effective was the immunotherapy. This shows that the indication of the immunotherapy in patients with advanced cancer could be initiated. Furthermore, the correlation between the lymphocyte responsiveness to PHA and the clinical results of immunotherapy was discussed.


Carcinomas of the stomach in the young adults. The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.


Evaluation of hepatic reserve for surgical treatment in portal hypertension. Based on a hepatic hemodynamic study, estimated by hepatic catheterization technique in 233 patients of portal hypertension, a classification of hepatic reserve is proposed. Surgical treatments for preventing esophageal variceal bleeding which does not decrease portal pressure may safely be applied to the patients whose effective hepatic blood flow of over 300 ml/min/M2, intrahepatic shunting rate below 40 per cent, IGC disappearance rate of over 0.04 min-1, or BSP 30 minute retention rate of below 35 per cent.


Percutaneous transtracheal ventilation.

Percutaneous transtracheal ventilation. The technique of percutaneous transtracheal ventilation (intermittent  jets of oxygen under high pressure, 50 pounds per square inch [psi]) has been used for resuscitation during anesthesia and prior to tracheostomy, and has been established as an important adjunct to life-support techniques. The technical aspects are described together with experimental evidence that intermittent jet ventilation is necessary to eliminate carbon dioxide. The complications occurring with a series of 80 patients are reported along with experimental work in ventilation of dogs with compressed air sources, including truck tires. Emergency physicians should be familiar with this technique and equipment for its use should be readily available in the emergency department. The potential role of transtracheal ventilation in the mobile intensive care unit at accident sites has been explored and appears promising. Conventional airway support techniques should be applied prior to resorting to transtracheal ventilation.


Hydrocarbon ingestion in children: a six-year retrospective study. The results of a six-year retrospective study of 116 children admitted with the diagnosis of hydrocarbon ingestion showed that the major toxicity of hydrocarbons was to the respiratory tract, with 79 patients (68%) developing pneumonia. There was a significantly higher initial white blood cell count in children who developed pneumonia (15,900/cu mm vs 12,000/cu mm, p less than .001). All hydrocarbon products studied had a similar incidence of complicatons, except turpentine products, which had a significantly lower incidence of pneumonia (p less than .005). There was no correlation between amount ingested and development of complicatons. Initial treatment, which consisted of induced vomiting, gastric lavage, administration of oil or saline cathartics, was not associated with fewer complications. Oil administration correlated with higher incidence of pneumonia (p less than .025). The present study recomends only supportive treatment following hydrocarbon ingestion in children.


Caffeine intoxication: a case of paroxysmal atrial tachycardia. Caffeinism is a syndrome resulting from the excessive ingestion of caffeine and characterized primarily by cardiovascular and central nervous system manifestations. A variety of tachyarrhythmias and extrasystoles are believed to reflect the toxic, cardiotonic effects of caffeine. A case of paroxysmal atrial tachycardia (PAT) related to caffeine abuse is PAT. The importance of considering this and other less frequent conditions as potential causes for this arrhythmia is stressed.


Jarisch-Herxheimer reaction. Case report. The Jarisch-Herxheimer reaction is a response to the treatment of syphilis. The most common findings are fever, malaise, headache, and exacerbation of cutaneous lesions. The reaction is thought to be due to the effects of treponema breakdown products, and it should not be confused with an allergic reaction to the antibiotic employed. Thus, further therapy must not be withheld. Treatment is symptomatic.


A conceptual framework for emergency care planning. The experience of functional program planning, in addition to facilitating the planning process for a new emergency unit, has had additional benefits. It has given the staff a common conceptual framework for analyzing patient care as provided and for identifying areas where improvements can be made. Also, a new approach has been developed for communicating with other departments and with hospital administration about day-to-day operating problems which may be useful for addressing other resource allocating and operating room time schedules. By developing a planning framework, it is possible to integrate the expertise of various services, while retaining an integrated overall orientation within which the efficacy of different proposals can be judged. This approach is critically important in helping to avoid the adverse effects of fragmented planning.


The emergency joint: arthrocentesis and synovial fluid analysis. Arthrocentesis and the subsequent evaluation of synovial fluid is often the definitive diagnostic procedure for the patient presenting with a joint effusion or intrasynovial hemorrhage. The difficulty of performing arthrocentesis varies with the joint in question, but those joints most frequently involved are easily entered. The indications and contraindications for this procedure are discussed. Effusion-producing pathologic processes often yield fluids of a characteristic nature permitting their classifications into categories of noninflammatory (Group I), inflammatory (Group II), septic (Group III), and hemorrhagic. This categorization of the effusion may permit specific diagnosis or the narrowing of the differential diagnosis. Criteria are established on the basis of joint fluid features to differentiate septic arthritis, which requires inpatient treatment, from those entities for which the patient may reasonably be treated as an outpatient.


Algorithm-directed triage in an emergency department. At Brooke Army Medical Center the Emergency Services Section has developed an algorith,-directed triage system to be used by "screeners" who may be basic medical corpsmen but sometimes have had no previous medical experience. After 25 hours of classroom and 120 hours of on-the-job training, the screeners use the algorithms to triage patients into one of three treatment areas in the emergency section or to clinics outside the emergency section during the day and evening. The screeners may consult with a triage physician if the algorithm-directed disposition appears inappropriate, Triage dispositions of 78,822 patient visits during the calendar year 1975 are presented.


Effectiveness of nurse triage in the emergency department of an urban county hospital. The effectiveness of patient triage by a specially trained registered nurse in the emergency department of an urban county hospital, San Francisco General Hospital, was evaluated over a three-month period. Ambulatory patients thought to have nonemergent illnesses were directed to the Walk-In Service for physician evaluation and treatment; the remainder were seen in the Emergency Service. In three months, 11,329 patients registered for care, and 4,150 (37%) were referred to the Walk-In Service. Of the 77 admitted patients, six were thought to require treatment within a few hours, 67 within hours to days, and four were considered elective admissions. There were no deaths. Error in triage was about equally divided between mistaken diagnosis and underestimated severity of illnes. The overall accuracy of triage was 98%.


Rape evidence kit: simplified procedures for the emergency department. The crime of rape requires medical evaluation and therapy concomitant with the collection of legal evidence for potential prosecution. A practical, inexpensive evidence kit has been disigned that meets the needs of the local health department, police department, hospital emergency centers, and district attorney personnel. Costs of assembly and specimen analysis are assumed by the police department. Chain of custody is assured through tamper-proof bags, appropriate reporting forms and police involvement in specimen pick-up. Victims participate in chain of custody by sharing in collection and authorization. The requirement for physician appearance in court is thus lessened. Standardization of examination and reporting prompts all community hospitals to share in examinations, preventing over loading of a single, busy facility. Six months' experience had borne out the anticipated simplification of collection, standardization of reporting, and reduction of physician involvement in legal procedures.


Laryngotracheal trauma: recognition and management. In 23 patients with laryngotracheal trauma at the Louisville General Hospital during a ten-year period, 19 survived. One death was directly atributable to the airway injury. The most common postinjury complication was hoarsensess attributable to direct injury to the cords or recurrent nerve paralysis. One patient had further operation for subglottic stenosis. In general, blunt injuries were more severe than penetrating injuries. Subcutaneous emphysema, aphonia or dyshonia, hemoptysis, signs of injuries, a sucking wound, are presumptive findings of laryngotracheal injury. Appropriate endoscopy and radiographic studies should confirm the diagnosis. Control of the airway is achieved by emergency tracheostomy or intubation followed by tracheostomy. Prompt operative intervention and primary repair follow.


The crush injury: a high risk wound.

The crush injury: a high risk wound. A standardized experimental impact injury model was developed to produce soft tissue trauma that simulated impact injuries to soft tissue overlying the cranium. An aluminum impact instrument was constructed so as to deliver a measured amount of energy to a finite area of soft tissue over a fixed foundation. Impact injury resulted in readily demonstrable changes in the morphology of the tissue and its blood flow. As measured by the distribution of fluorescein dye, the blood flow to the impact site was considerably less than that to unwounded tissue. The magnitude of this reduction in blood flow to the site of injury was proportional to the level of energy absorbed by the tissue. The injury to skin resulting from the impact was restricted primarily to the subcutaneous tissue and panniculus carnosus. Loss of adipose tissue and necrosis of skeletal muscle fibers in these layers were associated with the development of a dense inflammatory infiltrate. The structural damage to the tissue and its reduced perfusion were correlated with the tissue's increased susceptibility to infection by bacteria delivered either by direct infection or as a result of a bacteremia. The magnitude of this damage to the host's defenses is, again, directly related to the amount of energy absorbed per unit area of soft tissue. Antibiotics did suppress the growth of bacteria in these experimental soft tissue impact wounds, even when treatment was delayed eight hours. While the therapeutic efficacy of antibiotics was readily apparent in soft tissue impact wounds, the degree to which they could suppress bacteria in these wounds was less than that encountered in the treated control wounds not subjected to impact.


Provider performance in the recognition and treatment of telemetered electrocardiogram patterns. A test of electrocardiogram diagnostic skills in the form of a ten-slide presentation of six-second rhythm strips was administered to 25 emergency department nurses, 23 intensive care unit (ICU) nurses, 34 cardiac technicians (CRT, EMT) and 37 physicians. The ICU nurses had the best performance overall. Physicians had difficulty with mechanical problems, viz, loose leads, flat line and inverted leads. ICU nurses had less difficulty identifying and treating flat line than did emergency department nurses. The study's limitations were that the sample was self-selected and that the providers might respond differently to a real life situation.


A unique academic approach to critical care-emergency medicine training. The four-year program for training physicians in critical care-emergency medicine at Sacramento Medical Center, University of California, Davis School of Medicine is described. Its purpose is to train the physician in resuscitation, emergency care for life-threatening conditions, and intensive care, so that the graduate can staff community hospital emergency departments and intensive care units, be director of an emergency department or intensive care unit, or pursue an academic career in emergency medicine.


Abscess formation as a complication of parenteral methylphenidate abuse. Case reports of five patients suffering from either skin abscesses or cellulitis following parenteral methylphenidate abuse are presented. Four patients had similar lesions consisting of abscesses or cellulitis which demonstrated typical signs and symptoms of an infective process and were treated with local symptomatic therapy, incision and drainage if indicated, and systemic antibiotics. The fifth patient suffered from a circular, necrotic, nonpurulent ulcer on the dorsum of the right foot which produced no local or systemic toxic effects. Attempts to culture a responsible organism yielded Streptococcus viridans, an organism which is normal flora of the skin and, although opportunistic, is generally considered nonpathogenic. These cases further substantiate the belief that local vasospasm, chemical irritation, or both, produced by the methylphenidate solution may primarily cause a necrotic ulcer susceptibble to secondary bacterial infection.


Xylocaine viscous as an aid in the differential diagnosis of chest pain. Sixty patients with chest pain, chest and epigastric pain, or predominantly epigastric pain, not explained by electrocardiographic (EKG) changes or pulmonary findings, were given 20 cc of Xylocaine Viscous orally. Thirty-seven out of 60 experienced complete or almost complete relief within 10 to 15 minutes. Of this group, none were found to have suffered a myocardial infarction. Of the 23 patients who did not experience pain relief, six had a myocardial infarction and seven were diagnosed as having cardiac angina. Determination of serum lidocaine levels after oral ingestion of 20 cc of Xylocaine Viscous in patients with normal gastric function demonstrated a maximum level of 0.55 mu/ml--a serum level unlikely to result in adverse side effects.


Can the well trained EMT-paramedic maintain skills and knowledge? Reliable criteria exist to assess emergency medical technician (EMT)-paramedic team and individual competence. In addition to written and oral examiniation, reliable individual manipulative skill data, and on-scene observation of emergency care by responsible physicians, EMT-paramedic team competence may be assessed by using tracer conditions that reflect patient outcome converted to a standard base population per unit time. Using standard definitions of "resuscitation" and "save," and the pulseless, nonbreathing patient as tracer, 75 (31%) of 241 patients were resuscitated and 34 (14%) were saved. Team manipulative skill competence may also be determined by an appropriate tracer.


The portable Doppler: practical applications in EMS care. The practical application of a new, commercially available, portable Doppler ultrasound device to the operation of a busy city-county emergency department and ambulance service was investigated. An initial evaluation using healthy volunteers confirmed accuracy and reproducibility of the Doppler blood pressure readings comparable to that of auscultatory and palpatory measurement. In selected patients, the Doppler readings correlated well with readings from patients who had intra-arterial lines. When used in several low flow states, such as testing adequacy of cardiopulmonary resuscitation (CPR) and verification of electromechanical dissociation, the Doppler aided the clinical evaluation and treatment in many cases where traditional methods were useless. The Doppler was also helpful in the evaluation of local arterial injury but this unit was not found sensitive enough for venous disease. Finally, the Doppler enhanced the obtaining of vital signs in the noisy environment of our ambulances.


Prehospital use of the military anti-shock trouser (MAST). Complications of prehospital use of the military anti-shock trouser (MAST) in treating hypotensive and hypovolemic patients have been few and minor. Undesirable consequences--compromised respiratory excursion or autonomic disturbances such as emesis, urination or defecation--were rare. Forty-seven (88.7%) of 53 patients with conditions classed as potentially lethal or severe survived. Close communications between prehospital and emergency department personnel can assure accurate transmission of circumstances of MAST application and result in optimal responses and improved inhospital patient care. Both "false positives" (supposed initial hypotension or hypovolemia) and "false negatives" (seeming stability in the face of major anatomic derangements) require a carefully structured operational sequence. Further evaluation of the device, particularly in cardiovascular/cardiopulmonary cases, is in progress.


Resuscitation--opening the airway. A comparative study of techniques for opening an airway obstructed by the tongue. The effectiveness of three techniques for opening an airway obstructed by the tongue was studied and compared. The research involved patients who were anesthetized for elective surgery. The first group of patients, not breathing on their own, were ventilated by mouth-to-mouth breathing. The second group was unconscious, making spontaneous respiratory effort, but had total airway obstruction produced by the tongue from relaxation of the lower jaw. The three techniques--neck lift, chin lift, and jaw thrust--were performed on all patients in both groups. The adequacy of ventilation was compared subjectively and by measuring air flow with a Wright Respirometer. Results indicate that the chin lift technique provides the most consistently adequate airway.


Spontaneous bladder rupture: rare cause of peritonitis. Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal.


Hypothermia--a sign of hypoglycemia.

Hypothermia--a sign of hypoglycemia. Hypothermia may occur in association with hypoglycemia, and indeed may be the only sign. Two cases are presented. In one, the patient presented with hypoglycemic encephalopathy. In the insulin dependent diabetic, the condition is life-threatening. Subnormal temperature is a clue to hypoglycemia in the alcoholic. The mechanism of hypothermia has been extensively studied, but remains unclear.


An emergency intravenous route for the pediatric patient. In pediatric patients, percutaneous venipuncture is preferable to cutdown, especially in inexperienced hands. The best route for maintenance fluid administration is a  No. 19, No. 21 or No. 23 scalp vein needle or No. 18 or No. 20 plastic cannula placed in a superficial hand or foot vein. An incision 1 cm proximal to the medial malleolus of the tibia over the great saphenous vein is the classic pediatric cutdown. Other alternatives are brachial vein, saphenous vein distal to the medial aspect of the knee and, in extreme emergencies, the external jugular vein or cephalic vein in the arm. The cutdown technique with facilitating suggestions and possible dangers is described.


Emergency medical technician-paramedic training. With a nationally standardized emergency medical technician-paramedic training program soon to be adopted, certain factors in the planning of training programs should be emphasized. (1) The facilities should provide an opportunity for the paramedics to gain clinical experience in intensive care units and emergency departments. Teaching must be appropriate to the students' educational background. (2) The course content should include advanced life-support. (3) Full-time and part-time programs must be developed, possibly using a modular format. (4) The operating procedure should conform to local medical and legal practice. (5) Mechanisms for evaluation and recertification must be developed. (6) Continuing education, as important or more important than the original training, should be included in program planning.


Clinical use of the "G-suit".

Clinical use of the "G-suit". The "G-suit," a device for combating hypovolemic shock with external pneumatic counterpressure, represents an application of an old idea to a relatively common medical problem. Its simplicity of use and quick therapeutic effect buys time for the patient with hypovolemic shock, whether the suit is applied in the prehospital or emergency department setting.


On-the-scene emergency care by the primary physician. One year's experience with on-the-scene emergency responses by a rural family physician equipped for advanced life-support is analyzed. Three (6.7%) out of 45 consecutive emergency responses were lifesaving, specifically because the physician was there. No definite reduction in morbidity was documented. Accurate assessment of emergencies when reported and at the scene of spontaneous events was enhanced by the physician's familiarity with  the patient and/or the reporter. Economic considerations, useful equipment, and special problems encountered in on-the-scene emergency care are discussed. The primary physician is a reasonable candidate to provide on-the-scene emergency care, especially in communities where advanced life-support is otherwise inadequate. His properly equipped vehicle deserves emergency vehicle status. Simultaneous summoning of the physician along with other emergency personnel by a central dispatching agency would be ideal in these communities.


Airway obstructed by foreign material: the Heimlich maneuver. To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. Both the low chest and midchest thrusts produced significantly better results than did the abdominal thrust. There were no side effects attributable to the thrusts. The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.


Psychiatric training for emergency medicine residents on a multidisciplinary team. The Cincinnati General Hospital Emergency Department has a training program for emergency medicine residents on a multidisciplinary emergency psychiatry team. This essential training should occur in the emergency department setting rather than in psychiatric inpatient units of state hospital settings. There are advantages and disadvantages to this arrangement. Nonmedical members of the emergency psychiatry team train and support emergency medicine residents in a multidisciplinary approach to treatment. Some observations are made about how the emergency medicine residents deal with emotionally disturbed patients. Finally, 80% of emergency medicine residents responded to questionnaire on their reactions to the multidisciplinary emergency psychiatry team.


Nerve blocks of the foot.

Nerve blocks of the foot. Emergency treatment of foot injuries can be made less painful by regional block anesthesia. There is limited medical literature on these techniques and many physicians, while familiar with regional anesthesia of the upper extremity, are not experienced with nerve blocks in the lower extremity. Infiltration anesthesia of the plantar structures of the foot and toes can be very painful and may inhibit healing. Regional anesthesia avoids both of these problems and can prove effective and useful. This paper discusses the techniques and possible complications of nerve block anesthesia of the foot.


Upper airway obstruction.

Upper airway obstruction. A large number of diseases may present  with respiratory distress. In adults, upper airway obstruction (UAO) is relatively rare. Consequently, UAO may initially be overlooked in the differential diagnosis of the dyspneic patient. Because it may progress rapidly, delays or errors in diagnosis can be critical. During an eight-month period in one emergency department, seven adult patients with potentially life-threatening diseases of the upper airway were seen. To reacquaint physicians with the syndrome of mechanical obstruction of large airways, several illustrative cases are presented and the syndrome is discussed.


[Evolution of pulmonary hypertension in the late period following correction of congenital heart defects]. The presented analysis is based on the data of haemodynamics studies in 62 congenital heart disease patients prior to and following surgery within 1 to 13 years (mean -- 5 years). Patent arterial duct ligation was performed in 34 cases, ventricular septal defect was closed in 28. Twenty of the patients had moderate, 42 -- high pulmonary hypertension (IIIa stage in 37 cases, IIIb stage -- in 5). Late postoperative haemodynamic studies have shown that Stage II patients demonstrated its normalization, the pulmonary artery pressure remaining above the normal level only in few cases in whom it had been 50 mm Hg and higher. In IIIa stage patients no normalization of haemodynamics is usually achieved, and in 9.1% of the cases an evolution of the total pulmonary resistance was noted. However, a distinct improvement of the haemodynamic parameters in the majority of such cases proves the efficacy of their urgical management. The persistence of high pulmonary hypertension or its progressive course in IIIb stage patients, caused by the spreading of the sclerotic process in the pulmonary vessles, indicates the inefficacy of surgery in this group of patients.


[Diagnosis of thrombosis of the left atrium in rheumatic heart defects, using the main components methods]. A new method of diagnosis of left atrial thrombosis was developed for rheumatic heart disease patients. The mathematic method of the main components was used that permits to detect the thrombosis of the left atrium in 94.3% of the cases. Fourteen most frequently encountered symptoms of this complication were singled out, the probability of the occurrence of these symptoms was calculated for the patients with rheumatic heart diseases and atrial fibrillation with and without thrombosis. A computer was employed to develop the method, while no computer is needed for the diagnosis itself. Symptoms from the list must be identified in the given patient, the digital values of the main components found in the table be summed up with that of the free member, with due regard of the sign, and the presence of the thrombus be determined on the basis of the presented chart.


[Interpretation of a bundle of His electrogram (using the spike potentials of the sinus node and atrial conduction tracts in the analysis)]. Spike potentials of the sinus node and of the atrial conductivity pathways were recorded by way of heart microcatheterization via the subclavian vein in 40 canine experiments and in 307 patients, using the obtained data for a more precise interpretation of the bundle of His electrogramme taken in the course of these examinations. The importance of the density of the spikes for their successful recording was studied, and it was found that the onset of the atrial A--wave preceeded that of the P-wave by 10-30 ms on ECG tracings recorded from the body surface. The atrial A--complex recorded with the aid of an intracardiac unipolar electrode from the right atrium was found to consist of a slow depolarization wave of the atria and of three spike potentials (A1, A2 and A3). The A2 spike coinsides with the peak of the P-wave in the II lead and reflects the moment of the impulse's arrival at the atrioventricular node along the Bachman and Wenkebach's tract, while the A3 spike coinsides with the termination of the P-wave in the II lead being dependent on the depolarization of the Torel's tract. The P--A interval should be measured between the sinus spike and the A2 spike, while the A--H interval--between the A2 spike and the H-potential.


[Coagulation of arterial and venous blood in acute myocardial infarct]. The conducted study has demonstrated that aged patients with large focal and transmural myocardial infarctions had coagulation changes throughout the acute period of the disease that manifested themselves predominantly in the arterial bed and displayed clear phase-wise fluctuations. The coagulability of peripheral venous blood failed to give a distinct picture of the true state of blood coagulation.


[Interrelationship of lipid metabolic disorders and hemostasis in arteriosclerosis]. Proceeding from the obtained data, the authors conclude that two factors are of paramount importance in the pathogenesis of atherosclerosis: 1) lipid infiltration, 2) fibrin and platelets deposits on the vascular wall. It seems hardly proper to oppose the lipid-infiltrationab of pathogenesis of atherosclerosis to the thrombogenic one, since they do not necessarily exclude one another. Moreover, they seem to present two aspects of a single process: on the one hand, lipids increase platelet adhesion and aggregation on the vascular wall; on the other hand, platelets during aggregation help the penetration of beta-lipoproteins into the arterial wall by increasing the permeability of the endothelium and by adsorbing cholesterol-rich beta-lipoproteins on their own surface. A vicious circle occurs that must underly one of the mechanisms of the atherosclerosis development.


[Method of using Sokolow's and Lyon's electrocardiographic signs for the diagnosis of chronic cor pulmonale]. A method introduced by the authors for the diagnosis of chronic cor pulmonale based on the evaluation of Sokolov's and Lion's electrocardiographic criteria is described. The results presented were checked by comparing the pathoanatomic data of 124 patients dying of chronic pulmonary lesions, as well as the analysis data of ECG recorded in 92 normal individuals with a vertical or semi-vertical electric position of the heart. The advantages of the suggested method over that of Widimski are indicated.


[Diagnosis of pulmonary hypertension with the aid of electrokymography]. Electrokymography was carried out in 198 patients with cor pulmonale and mitral defect with clinical signs of elevated blood pressure in the pulmonary circulation. The electrokymographic signs of pulmonary hypertension were developed, as well as those for the evaluation of the functional state of the myocardium of both ventricles. In making the diagnosis of elevated--pressure in the pulmonary artery system of special importance is the analysis of the electrokymogrammes of the pulmonary artery, right atrium and right ventricle, and the determination of the pulse wave speed along the pulmonary vessels. The study of the electrokymogrammes and their comparison with the clinical pattern permitted to classify all the electrokymographic criteria of pulmonary hypertension into true and relative ones, requiring verification. A differentiated analysis of the systolic and diastolic phases of the left and right ventricles was conducted. All the phases of the cardiac cycle were calculated with due regard of the contractions rate. The phase analysis permitted to assess separately the functional state of the myocardium of both halves of the heart. Electrokymography helped to reveal pulmonary hypertension that could be often diagnosed with its aid at an early stage. It permitted to diagnos an initial reduction of the contractile finction of the right ventricle.


[Significance of external respiratory indices in the diagnosis of pulmonary hypertension]. The results of the presented study include the parameters of pulmonary ventilation, respiratory volumes, pulmonary diffusion, oxygen saturation of arterial blood in patients with mitral stenosis, aortic valve insufficiency, and primary forms of pulmonary hypertension, as well as the dynamics of several parameters of pulmonary respiration in a group of patients following an alleviation of their circulatory insufficiency. Some pecularities of the changes in the studied parameters were demonstrated with reference to the peculiarities of the haemodynamic shifts in the pulmonary circulation, to the nature of pulmonary hypertension in particular, as well as the correlation between the severity of the functional disorders in the pulmonary respiration system and the severity of circulatory insufficiency. Some pathogenetic mechanisms of the changes of certain pulmonary respiration parameters were analysed in the mentioned pathological conditions. The importance of a compound dynamic study of the pulmonary respiration state is emphasized for an objective assessment of the degree and peculiarities of the functional disorders developing in these conditions, and for an evaluation of the efficacy of the conducted treatment.


[Echocardiographic signs of pulmonary hypertension]. The results of examination of patients with primary and secondary pulmonary hypertension by means of the echocardiographic method are presented in the article. Basing on the analysis of their own data and foreign literature the authors have set out the most informative indices of pulmonary hypertension on the echogram of the vulve of the pulmonary artery and the right ventricle. It has been noted that in the left hypertension the form of the echocardiogram of the left cusp of the pulmonary valve is depressed, the amplitude of the precardiac wave "a" increased, and the amplitude and rate of the cusp opening decreased. The anterior-posterior size of the right ventricle is significantly increased and a parodoxal movement of the interventricular septum appears with a relative insufficiency of the tricupsid valve.


[Changes in the electro- and vectorcardiograms in primary vascular pulmonary hypertension]. A progressive elevation of the blood pressure in the pulmonary circulation in patients with primary vascular pulmonary hypertension results in isolated hypertrophy of the right-ventricle. According to electro- and vectorcardiographic data of the McFee--Parungao system, a significant predominance of the right vetricular potentials is noted, distinct reorientattion observed in those sections of the vectors that may reflect the process of hypertrophy and dilatation of the outflow tracts of the right ventricle.


[Phonocardiogram characteristics in different forms of pulmonary hypertension]. To study the peculiarities of phonocardiogrammes in pulmonary hypertension of different genesis a comparison was conducted between the phonocardiographic data and those of heart catheterization and zonotomography. The study was conducted in 49 normal individuals and 177 patients with various lesions accompanied by an elevated pressure in the pulmonary vessels. It was found that no phonocardiographic peculiarities inherent in pulmonary hypertension are typical for any of the examined entities. The common features of pulmonary hypertension are: 1) growing amplitude of the pulmonary component of the II sound, increasing parallel to the degree of hypertension (with the exception of patients with chronic non-specific pulmonary lesions in whom the pulmonary component of the II sound does not grow, in absolute figures); 2) reduction of the coefficient II/IIIP of the II sound components, also developing parallel to the growth of hypertension; 3) detection of the ejection sound on the phonocardiogramme, as well as of a systolic murmur of the ejection and of a diastolic murmur; 4) increasing indices of the IV sound recordings in primary vascular hypertension. Not infrequently the amplitude of the Isound is also increased in cases of pulmonary hypertension, although its direct relationship with pulmonary hypertension is hardly possible.


[Primary pulmonary hypertension and the difficulties of clinical diagnosis]. An analysis of 38 patients is presented of whom 23 had primary pulmonary hypertension proper, 6--congenital heart diseases, and in 6 pulmonary hypertension was combined with chronic recurrent thrombophlebitis and thromboembolic episodes in the pulmonary artery system, and in 3--with sclerodermia. The greatest difficulties arise when primary pulmonary hypertension has to be clinically differentiated from some congenital heart diseases (septal defects and patent Botalli duct). The discreapances of clinical and anatomic diagnoses of primary pulmonary hypertension happen most often in cases of the above mentioned congenital heart diseases. Catheterization of the cardiac cavities is an important tool in the diagnosis of primary pulmonary hypertension that permits to differentiate it from congenital heart diseases.


[Clinical and instrumental characteristics of primary high altitude arterial pulmonary hypertension]. The clinical pattern of primary high altitude pulmonary arterial hypertension observed in permanent residents of mountain regions is described. The diagnostic value of some non-invasive instrumental methods in primary high altitude pulmonary artery hypertension is analysed: electro- and vectorcardiography, rheopulmonography, and indirect pulmonary artery pressure determination. It is suggested to distinguish the labile, stable and decompensated forms of the disease on the basis of its clinical and functional peculiarities. The criterion for the initial two forms consists in the persistence of the pulmonary artery pressure elevation, while the latter form is established when the high altitude cor pulmonale gets decompensated. Functional vasoconstriction of the pulmonary resistive vessels was shown to play an important role in the genesis of the disease: the administration of 0.5 mg of nitroglycerine and a 5-minute oxygen inhalation caused a positive dynamics in the indices of the pulmonary rheogramme and a reduction of the pulmonary artery pressure, which did not reach the level of the plane inhabitants, though.


[Pneumooxyhemographic method for the comprehensive study of circulation and respiration]. Over 3000 pneumoxyhaemogrammes were recorded in 1840 persons. Periods, types and criteria of pathology were differentiated in the structure of the pneumoxyhaemogramme. The method permits to reveal early forms of cardiovascular pathology. It is applicable for the examination of both normals and patients for early diagnosis of cardiovascular pathology, for the control of the therapeutic effect, and for a dynamic observation in the course of a dispensary screening.


[Pulmonary circulation in ischemic heart diseases under bicycle ergometer load and acute strophanthin test conditions (based on data from catheterization of the right heart and pulmonary artery)]. On the basis of monitoring the systolic, diastolic and mean pulmonary artery pressur at rest, during ergometric exercises and under identical conditions following premedicatio with cardiac glycosides (48 measurements in 12 patients with ischaemic heart disease) the authors concluded on the importance of studying this parameter for the diagnosis of initial stage cardiac insufficiency, and on its high informativeness for deciding the indications for initiating therapy with cardiac glycosides.


[Changes in the hemodynamic indices of the pulmonary circulation and in the functional state of the right ventricular myocardium in stage II hypertension under certain types of hypotensive therapy]. The author observed 76 patients with Stage II essential hypertension undergoing combined therapy with Rauwolfia serpentaria, Isobarine and Hypothiazid, 37 patients treated with Dopegit, and 44--with Obsidan. The examined patients demonstrated pulmonary arterial hypertension or a tendency towards its development, an increasing lung-ear time interval, and a reduced functional capacity of the right ventricular myocardium. A direct correlation was established between the level of blood pressure in the general circulation and the pressure in the pulmonary artery and the degree of blood flow deceleration in the lung-ear interval. Combined therapy results in a reduction of the elevated blood pressure not only in the general, but also in the pulmonary circulation.


[Pulmonary hemodynamics in the immediate and late periods after mitral commissurotomy in children, based on rheopulmonographic data]. On the basis of the analysis of rheopulmonograms the condition of the pulmonary blood flow was studied in 35 children with mitral stenosis prior to operation and on the 20--30th day and 6 months after the operation. There was revealed partial normalization of the pulmonary blood flow in patients with "pure" stenosis and insufficient effectiveness of commissurotomy in persons with concomitant mitral valve insufficiency.


[Intracardiac hemodynamics after pulmonary artery valvuloplasty]. Studies of intracardiac haemodynamics were conducted in 30 patients subjected to valvuloplasty of the pulmonary artery valve. The method of continuous (for several days) right ventricle and pulmonary artery catheterization was employed. The isometric hyperfunction of the right ventricle was found to persist following the elimination of pulmonary valve stenosis. Myocardial insufficiency then develops that requires intensive cardiac therapy.


[Clinical diagnosis and prognosis of the course of congenital heart defects with pulmonary stenosis]. An analysis of 433 observations is presented (164 cases of isolated pulmonary stenosis, 132 cases of its combination with atrial septal defect, and 137--with ventricular septal defect), the patients being 1 year 1 month to 36 years old, and the form of their heart disease being verified during surgery on a "dry" heart. The mentioned diseases were classified into 3 groups according to the tactical importance of the pulmonary stenosis. Haemodynamic studies in patients with pulmonary stenosis and an intact ventricular septum have demonstrated that with age right-ventricular hypertension progresses the faster the greater the pulmonary artery valve is stenosed. A combination of a valvular stenosis with a large ventricular communication is accompanied by a levelling of the pressure in both ventricles, its absolute figures being somewhat higher in patients over 16 years of age.


[Accidents and lethality in ocular surgery (author's transl)]. The mortality and morbidity rates in eye surgery are low as compared to other surgical specialities. The lethality rate is not, however, as low as one might suppose if one follows the fate of patients which require postoperative transfer into other (non ophthalmologic) clinics. The morbidity rate differs markedly, depending on whether a local or general anesthetic is used. Following local anesthetics, the incidence of pulmonary emboli was 2.4 times greater, and thrombophlebitis twice as common as with general anesthetics, whereas cardiac complications occurred more frequently with general anesthetics. Pre- and postoperative measures are presented which have proven useful in the reduction and prevention of such mishaps.


[Trepanation with scleral flap (Elliot-Fronimopoulos) in acute narrow-angle glaucoma (author's transl)]. 120 eyes with acute closed angle glaucoma were operated by goniotrepanation (Elliot-Fronimopoulos). The follow-up controls showed excellent results. Especially the quick restoration of the anterior chamber and the increase in its depth must be emphasized. There are very rare complications and the resulting eye pressure is normal.


[Exposure of the ciliary body. A new operative method for treatment of irreversible angle closure glaucoma and aphakiaglaucoma (author's transl)]. In various forms of glaucoma with an unfavorable prognosis an operation developed by us in the Eye Clinic of the University of Graz since 1972, ciliary body exposure, has been performed. Up till now 68 such operations have been performed. In 63.2% of cases we had a good result. Technique, indications, post-operative care an complications are discussed.


[Silicon sponge: ultrastructural examinations in chronic infection (author's transl)]. Ultrastructural examinations of a silastic sponge implant (which was removed with the clinical diagnosis rejection against the silicon material) revealed massive infiltration of so called apothogenic bacteria and macrophages. The results of this examination support the idea that in most of the cases with symptoms of inflammation, there is not a rejection against the sponge material itself but acute or chronic bacterial infection. In the bradytrophic area of the sponge socalled apathogenic bacteria may grow and lead to considerable reactions, because antibodies are decreased.


[Running time of ultrasound in the distal portion of the optic nerve (author's transl)]. In 160 cross sectional ultrasonograms of normal optic nerves the double running time of ultrasound in 4.5-5 musec. The standard deviation is up to 1 musec. The conditions of measurement and the typical ultrasonographic patterns are discussed. These results are of value in the differential diagnostic of bilateral optic nerve lesions. Increased running time of ultrasound could be found in papilloedema due to neuritis, raised intracranial and intraorbital pressure, and in trauma and tumor. It can be decreased in optic atrophy.


[The behaviour of plastic catheters within the anterior segment of rabbit's eyes (author's transl)]. The location and tolerance of plastic tubes (2 polyvinyl and 7 silicone respectively) within the anterior segment of the eyes of nine rabbits were observed for periods of 3 to 9 months. In 3 animals the tube was held in place with a single (scleral) suture: the catheter was ultimately totally displaced into the anterior chamber. In the remaining 6 cases a second (corneal) suture was applied. As a result only a limited migration of the silicone catheters was observed. The suprascleral as well as the intracameral portions of the tubes were well tolerated. Even the catheters that had migrated completely into the anterior chamber did not cause any inflammatory reaction.


[Choroid neurilemmoma. Considerations for clinical differential diagnostics]. A report is given on an extremely rare case of neurilemmoma of the choroid and observations are made on the difficult differential diagnosis of malignant melanoma. Clinical diagnosis and treatment apart from enucleation, was impossible. The recognition of the nature of this tumor could be made only on histological examination.


[Results of a glaucoma mass screening program (author's transl)]. During a so called "glaucoma-week" the intraocular pressure of 4661 persons was measured and the statistics obtained were evaluated according to the spss-program. The mean value of the intraocular pressure was 17.18 mm Hg, the standard deviation +/-3.78 mm Hg. The frequencies of various pressure values were in accordance with a Gaussian distribution up to 21 mm Hg. For higher applanation scores a deviation from the Gaussian line became obvious, increasing in intensity with age. Therefore a subpopulation is postulated consisting of persons with diabetes, arteriosclerosis or family history of glaucoma.


[Ektoprosthesis with a synchronically movable eyelid (author's transl)]. An ektoprosthesis with a synchronically movable, electronically controlled eyelid has been developed. A suitable trigger-signal is derived from the movement of the natural contralateral eyelid. The miniaturized electronic processing unit is intergrated into the spectracle frame. The artificial eyelid is moved by an electromagnet situated in the orbital cavity.


[Experiences in the therapy of acute glaucoma with Miopos-eye ointment "stark" (POS) in the surgery (author's transl)]. The author demonstrates 5 cases of acute glaucoma. In one of them (case 4). the i.o. pressure of 60 mm Hg appl. was normalized only by the above mentioned ointment combination of Pilocarpin/Physostigmin; the remaining patients received in addition intravenous injections of 500 mg Acetazol-Nitrium, but it seemed retrospectively that the latter was not necessary.


[Late complications with anterior chamber lenses (author's transl)]. 6 intraocular lenses (type Dannheim) which had given good optical results after implantation had to be removed after 7-19 years because of keratopathy, iritis, and secondary glaucoma. The most important finding was an advanced arrosion of the supporting supramide loops. This often caused breaking of the loops and was a major factor for late complications.


[Complete or peripheral iridectomy in acute glaucoma? (author's transl)]. The re-examinations of 28 complete sector and 27 peripheral iridectomies, performed because of acute glaucoma, showed an equally good regulation of IOP from both methods, even in longstanding cases (stadium III of Leydhecker) and when an operation during an attack is necessary. The postoperative reduction in vision mainly caused by cataract, was seen more frequently after sector iridectomy. In acute glaucoma the peripheral iridectomy as the less extensive and less severe procedure is to be preferred to the sector iridectomy with the exception, that an optical iridectomy is indicated.


[Assessment of eye damage in private accident insurance (author's transl)]. Following a fundamental sentence of the German Supreme Court eye damage affecting both eyes - actual or preexisting - has to be judged under the aspect of coordinating function. So the usual practice of isolated judgement of each eye can only be performed in unilateral damage associated with complete function of the other eye.


[A short observation on the cause of myopia (author's transl)]. The increased excretion of acid mucopolysaccharides in the urine of patients with advanced myopia is indeed relevant for understanding the chemical processes in the sclera during this period, but it does not say anything concerning the genesis of myopia as such. This is due more to an infiltrative malformation of the eyeball and the optic nerve. The behaviour of the connective tissue can also be due to infiltration, or contrariwise induced from parenchyma at the appropriate time. Hence therapeutic possibilities can hardly be deduced from the chemistry of the sclera. Abnormally small corneas in people with high myopia point to a genetic connection between such eyes and "true" microphthalmos with orbital cyst.


The etiology of transmissible murine colonic hyperplasia. The etiology of a transmissable colonic mucosal hyperplasia of mice was investigated. Hyperplasia was produced in mice inoculated with unfiltered colonic suspension from affected mice, but infectivity was lost after passage through a 0.45 mum filter. The etiologic agent was subsequently identified as a variant of Citrobacter freundii. The organism induced colonic mucosal hyperplasia when inoculated into germfree mice, and it was recovered in pure culture from the affected animals.


Vaginal septa in mice: incidence, inheritance, and effect on reproductive, performance. Dorso-ventral vaginal septa were observed in 38% of the recently weaned BALB/cJ female mice in the production colony at The Jackson Laboratory. The frequency of septa in two other BALB/c substrains and eight different inbred strains ranged from 0 to 8%. The vaginal anomaly was similar regardless of genetic background although individual variations were observed. The remainder of the reproductive tract was normal. Microscopically, the septum consisted of a fibrous partition covered by normal epithelium. Genetic analysis was undertaken by outcrossing septate BALB/cJ females to C57BL/6J, DBA/2J, or BALB/cBy males. Examination of female F1 and F2 progeny indicated more than one recessive gene was involved and genetic background influenced expression of these genes. Reproductive performance of septate and nonseptate BALB/cJ females was compared using several criteria. Fewer septate females were fertile, but the fecundity of fertile septate females was not affected.


Effect of repeated halothane anesthesias on Syrian hamster lung lipids. Sixteen adult Syrian hamsters were exposed 33 times over a 19-day period to enough halothane to induce a deep surgical plane of anesthesia. The exposures caused no significant change in the total amount of lipid in the exposed lungs; however, the percentage of neutral lipid due to cholesterol increased from 29 +/- 5% to 43 +/- 7% while the percentage of free fatty acid decreased from 33 +/- 3% to 22 +/- 5%. Among the phosphoglycerides, there was a slight shift toward more phosphatidyl choline and less phosphatidyl serine, phosphatidyl glycerol, and phosphatidyl ethanolamine.


Hemoglobins of the opossum (Didelphis marsupialis). II. Polymorphism; electrophoretic and chromatographic observations. Eighty-five adult opossums (Didelphis marsupialis) were examined for variation of hemaglobin by means of electrophoresis and column chromatography. A single hemoglobin was found in 83 animals while two hemoglobins were observed in two animals. The results of the chromatography studies suggested that the polymorphism was due to primary sequence differences in the alpha chain. Attempts to confirm this result by hybridization with human or canine hemoglobins were unsuccessful. The polymorphism was found not to be due to size differences and further investigation into its genetic basis was suggested.


Semen volume and sperm concentration in the ferret (Mustela putorius). Semen was obtained from 40 of 62 attempted electro-ejaculations of nine anesthetized male ferrets. The ejaculations were performed using a bi-polar rectal electrode and an electrical stimulus of about 4 V and 0.35 mA applied for approximately 4 seconds and repeated at 10-second intervals. The mean number of stimuli required to obtain an ejaculation was 12.3. The spermatozoa concentration per mm3 ranged from 0.07 x 10(6) to 1.98 x 10(6) with a mean of 0.62 x 10(6). The mean number of spermatozoa per ejaculate was 16.35 x 10(6) and the mean volume of semen per ejaculate was 0.026 ml.


Changes in anticoagulation in dogs assayed by three methods. As a preliminary to a membrane oxygenator study, a study was made of clotting indices in dogs and their intercorrelation and relationship to human data. The most useful criterion for monitoring coagulation in experimental extracorporeal systems was sought. Linear regression and correlation analysis indicated that activated partial thromboplastin time (APTT) predicted whole blood clotting time with a correlation of 0.77 (p less than 0.01). Changes in the APTT with time after heparinization were similar to those previously reported in man, making the animal model an acceptable one for use in developing extracorporeal systems such as the membrane oxygenator. When blood activated recalcification time (BART), APTT, and whole blood clotting time (WBCT) assays were compared on the basis of applicability to studies of extracorporeal support, the APTT and the BART assays proved superior to the WBCT assay due to their reduced variability and increased speed of determination. The variability of the BART assay was the lowest, and its sensitivity was the same as the APTT assay. The principal drawback to the BART assay was not experienced in this study; that is, its dependence on adequate platelet levels which are unpredictable in extracorporeal systems.


Comparison of hemagglutination inhibition pregnancy tests in the chimpanzee and the orangutan. A hemagglutination inhibition pregnancy test (Subhuman Primate Pregnancy Test), based on antiserum to the beta-subunit of ovine luteinizing hormone was evaluated for use in the chimpanzee and orangutan. The test was shown to give earlier indication of pregnancy in both species that two sensitive tests currently available for use in man (the Pregnosticon Accusphere Test and the UCG-Test). A comparison of sensitivity to chimpanzee chorionic gonadotropin was performed. The Subhuman Primate Pregnancy Test was 10 and 15 times as sensitive as the UCG-Test and the Pregnostican Accusphere Test respectively.


A device for the cutaneous exteriorization of chronic intravascular catheters. A device has been designed which permits the cutaneous exteriorization of chronically implanted intravascular catheters. From one to three catheters may be exteriorized for withdrawing blood samples or for connecting to a pressure transducer. The device is uniquely suited for studying animals in a conscious and unrestrained state such as during exercise.


Exteriorized carotid-jugular shunt for hemodialysis of the goat. A surgical technique was developed for the establishment of a permanent exteriorized artificial shunt between a carotid artery and a jugular vein of a goat. The shunt allowed continuous hemodialysis with an artificial kidney for hours or a prosthetic unit for days and intermittent experimental use of the animal for months.


[Perspectives of intrauterine contraception]. The author describes the current research in intrauterine contraception. It is directed in two ways: to improve the design of inert devices and to construct an optimal bioactive IUD. The design of the inert IUD should be adapted as much as possible to anatomical and functional conditions of the uterus. In developing new bioactive devices it is ained at finding the optimal dosage of metals and hormones as well as the new material acting as carriers of bioactive substances. With new constructions and the determination of the optimale dosage of antifertile and antifibrinolitic substances it is hoped to reduce three main insufficiences of intrauterine contraception: bleeding, expulsion and pregnancy.


[Surgical interventions in the digestive tract during gynecological and obstetric operations]. At the University Hospital Department of Gynecology and Obstetrics in Novi Sad, from 1945 to 1975, there were 17,362 major gynecological (laparotomies and vaginal) operations and cesarean sections. During these operations 0.11% of patients (19 women) had accidental injuries of the digestive organs (small or large intestines, or the mesenterium). All these injuries were treated during one and the same surgical act (sutures or resections of the small or large intestines). In 39 (0.22%) women, owing to a wrong preoperative diagnosis, laparotomy revealed inflammatory changes or tumours of the digestive tract which required primary surgical treatment: resection of the small or large intestines or the treatment of the perforated or gangrenous appendix, etc. Among the operations performed there were also 944 appendectomies and 65 hernitomies (in the course of gynecological operations or, less frequently, as separate interventions), 13 intestinal injuries during legal and illegal abortions, as well as 9 other surgical interventions (splenectomies, surgical treatment of the ileus, etc). In a total of 1079 pelvic operations also operations of the digestive tract were jointly made, which makes 6.46% of all major gynecological operations and cesarean sections. Obviously, it is not rare that the gynecologist-obstetrician faces situations requiring surgical interventions in the abdominal organs along with those in the genital tract. This raises the question of how much the gynecologist-obstetrician should be qualified also for abdominal surgery and urology, which is particularly important from the point of view of postgraduate education of gynecologists-obstetricians. In this country there are still certain dilemmas concerning this question.


[Intrauterine growth and its variations in different populations]. Intrauterine growth of newborns in the population of Novi Sad shows markedly low values in the median and the tenth and ninetieth percentiles between the 35th and the 37th gestation week. These data suggest a higher pathology of gravidity in the third trimester and inadequate antenatal care. After the 38th gestation week the intrauterine growth curve shows an extremely positive trend. In the tenth percentile the curve for male newborns exceeds the value of the tenth percentile for newborns in Prague, Pécs, Denver, and Aberdeen.


[Incidence of aplasia of the umbilical artery in fetuses with intrauterine retardation]. The author analysed the occurrence of the aplasia of the umbilical artery in 320 umbilical cords of fetuses with intrauterine retardation and in 225 umbilical cords of normal fetuses and a normal course of pregnancy used as controls. Aplasia of the umbilical artery in umbilical cords of fetuses with intrauterine retardation was found in 5.93% and in the control group in 0.44% of cases (P less than 0.05). Fetuses with intrauterine retardation and aplasia of the umbilical artery showed a velamentous insertion of the umbilical cord in 31.57% of cases, an approximate duration of pregnancy of 36 weeks and 5 days, and the mean birth weight of 2250 +/- 2 S.D. 420 g. Out of 19 fetuses with intrauterine retardation and aplasia of the umbilical artery, 6 had congenital anomalies which in 50% of cases could not be detected by external examination. Perinatal mortality of fetuses with intrauterine retardation and aplasia of the umbilical artery proved to amount to 368.43% and of fetuses in the control group to 8.88% (P less than 0.05).


[C-reactive protein in inflammatory processes of the female genital organs]. C-reactive protein (CRP) was investigated in 202 women: in 20 women with acute non-specific inflammation and the presence of different bacteria (Streptococcus pyocyaneus, Enterococcus, Escherichia colli, Proteus), in 12 women with confirmed genital tuberculosis, in 66 women with the chronic inflammation of genital organs, and in 104 women with normal genital findings. In all patients with acute inflammations CRP was positive. It was highly positive in those with elevated temperature and sedimentation values. CRP was also positive in the group of women with genital tuberculosis. A quantitative analysis mainly gave low CRP values in these women. The CRP values correlated with the Middelbrook-Dubos reaction titer. In women with chronic inflamations and those with a normal genital finding CRP proved negative. In women with CRP was positive even when the antistreptolysin caused by streptococci but also for those caused by other agents. It is concluded that C-reactive protein is a useful indicator of the activity of different inflammatory processes and that it may be affected by different drugs.


[Induction of ovulation by antiestrogens]. The mode of action of antioestrogens is in blocking oestrogen receptors in the target cell cytoplasm. For this reason they can be used only in cases where basal oestrogen activity is present. We treated two groups of patients with antioestrogens. In the first group (30 patients) with oligomenarrhoe and an ovulatory sterility we had 15 pregnancies. In the second group of  26 patients with amenorrhoe and sterility we had 4 of pregnancies and 12 menstruations. In this very small group a child with enterocoele was born to a 38-years old patient. All other patients' children were normal. Out of 19 pregnancies 4 were completed by early abortion.


[Cancer of the stomach, pregnancy and labor]. The authors describe a case of gastric carcinoma coupled with pregnancy, the only such case they encountered in 80,064 deliveries over a period of 30 years. The pregnancy was complicated by pronounced anemia and general weakness. By administering roborants, antianemic therapy, and blood transfusion to improve the patient's general condition, the pregnancy was completed by the birth of a clinically healthy at-term live child, weighing 3150 g. The patient lived only 6 months after delivery.


[Single oral administration of Fasigyn in the treatment of genitourinary trichomoniasis]. In 35 women and 30 men with Trichomoniasis one day therapy with Fasigyn was applied. 8-th day after treatment Trichomonas vaginalis was found in only three women and two men, but they were also curred by the repeated treatment. Side effects were not observed. Authors opinion is that this kind of therapy is specially acceptable in women with metrorhagia and those in preoperative care.


[Unusual form of dystocia - constriction ring]. A rare form of distocia, the constriction ring, is presented. The etiology of this kind of distocia is vague and the diagnosis complicated, almost invariably made only during the cesarean section itself. The increased basal tonus or uterine musculature, always present in this kind of distocia, would indicate the administration of tocolytics but there is too little experience at hand so far.


[Cervical pregnancy].

[Cervical pregnancy]. Cervical pregnancy is still a diagnostic and therapeutic problem. What is important in its treatment is to preserve women's fertility but very often more radical surgical interventions cannot be avoided. Two cases of cervical pregnancy are presented. In one case only the cervix was amputated, so that the women's fertility was preserved. In the other patient the uterus had to be removed because, after attempts to apply more conservative surgical treatment, intense bleeding was threatening the woman's life.


[Functional conditions of the respiratory system and work site pollution. III. Relationships between "risk indicators" and "respiratory risk" in a chemical industry (author's transl)]. The results are reported of a retrospective study carried out by the authors on 717 workers of a chemical industry whose exposure was diversified and quantified through a work environment survey. A comparison between "risk indicators" and both objective (respiratory function changes) and subjective (chronic bronchopneumopathy symptoms) "risks" showed a significant probability of the causal role played by work environment pollution in respect of the repiratory changes found by the authors.


[Lead poisoning hazard in pewter manufacturing industry and in art bronze foundries (author's transl)]. Two manufacturing processes are reported by the authors, which proved to be sources of lead poisoning hazard, due to the presently employed row materials. The results of a survey performed in 50 pewter manufacturing workers, as well as in 16 workmen involved in artistic bronze melting, are also reported. The inspection of the manufacturing processes made it possible to find out the poison sources in both the above mentioned types of industry.


[Liver dye metabolism and constitutional indocyanine green retention syndrome in Japan (author's transl)]. Some recent studies from Japan on liver dye metabolism are presented. Special attention has been given to 17 cases of constitutional indocyamine green retention syndrome. This syndrome consists of marked ICG-retention and normal BSP excretion. Other liver function tests such as enzymes or serum fractions are normal. In liver biopsy specimens there are no significant abnormal findings. The cause of the syndrome is still unknown but disturbance of passage through the membrane is considered. So far, this syndrome has only been noted in Japan.


[The present state of cholelithiasis research in Japan (author's transl)]. Research on cholelithiasis in Japan deals with such different aspects as development and composition of gallstones, geographical distribution of the disease, intrahepatic formation of gallstones, diagnostic and surgical procedures. This paper presents results on these current research topics.


[Diagnostic procedures in congenital dilatation of the bile ducts (author's transl)]. A report is given of 29 cases with congenital dilatation of the bile ducts, and the value of different diagnostic procedures is discussed. Histology in combinations with clinical symptoms allows the diagnosis in cases with microhamartoma or with congenital fibrosis of the liver. Sonography is the most important procedure in the diagnosis of cysts of the liver (solitary cysts or polycystic conditions); it may be complemented by peritoneoscopy if diagnosis cannot be established with certainty by echogramm. If segmental dilatation of intrahepatic bile ducts (Caroli's disease) is suspected, intravenous cholangiography ought to be the first diagnostic step. A more reliable diagnostic procedure is endoscopic retrograde cholangiography (ERC) in theses cases; if ERC does not help, percutaneous transjugular cholangiography may be indicated. In establishing the diagnosis of cysts of the choledochus and of intra- plus extrahepatic dilatations of the bile duct systems sonography ought to be used in the first place; the method of choice in these latter conditions however is the ERC.


[Torsion of the gallbladder (author's transl)]. The torsion of the gallbladder is a rare disease. A case of torsion of the gallbladder is reported who came to surgery under the diagnosis of acute appendicitis in an elder person. Factors facilitating torsion of the gallbladder are discussed. The only form of therapy is immediate cholecystectomy.


[Alkaloids of the Annonaceae: composition of the bark of the trunk and roots of Enantia pilosa]. The alkaloidal content of stem- and root-bark of Enantia pilosa Exell (Annonaceae) was studied and compared to that of other Enantia spp. Six aporphine alkaloids were isolated; two alkaloids, oliverine and oliveridine, were found in major amounts; two oxoaporphines, liriodenine and lanuginosine, were present; two other alkaloids, N-oxyoliverine and N-oxyoliveridine, were isolated for the first time. Quaternary alkaloids from stem-bark are presently under investigation.


The alkaloids of Strychnos dolichothyrsa. In the stem bark of Strychnos dolichothyrsa Gilg ex Onochie et Hepper (Loganiaceae) the following alkaloids were found: bisnor-dihydrotoxiferine, bisnor-C-curarine, bisnor-dihydrotoxiferine N-oxide and bisnor-dihydrotoxiferine di-N-oxide. Tentatively, two alkaloids were identified as bisnor-C-alkaloid D and 18-deoxy Wieland-Gumlich aldehyde. Bisnor-dihydrotoxiferine seems to give dichlorometho compounds and N-oxides easily, analogous with strychnine and brucine.


Antineoplastic agents. 42. The butterfly, Prioneris thestylis. Isoguanine (2) was found to be an antineoplastic constituent of Prioneris thestylis Dbldy. wings. Three other purine components of the butterfly wings were identified as hypoxanthine (3), uric acid (4) and xanthine (5). Isolation of urocanic acid (6) from the same wing material represented the first detection of this interesting histidine derivative in an arthropod.


An exploratory multi-level attempt to investigate intrapersonal and interpersonal patterns of 20 Athenian families. The present study is an attempt to explore patterns of family relationships in the context of milieu specific value and role assumptions and to capture the trends in relation to social change. Information collected includes intrapsychic as well as interpersonal material elicited by a combination of tools administered individually and conjointly. The revealed patterns -- extreme emphasis on the future achievement of the child as a shared family goal, the mother's central role which was shown to inhibit constructive processes, the distant marital relationship, and scapegoating of the child because of denied marital difficulties -- are shown to create conflict and tension in all members and render cooperation and decision-making difficult. It is attempted to interpret the above-mentioned patterns in the light of traditional value and role assumptions. The analysis seems to indicate that the adherence to the dysfunctional patterns appears to serve the function of preserving stability of the family in a period of transition.


The relationship between marital status and mental illness. The relationship between marital status and mental illness was investigated in a relatively new psychiatric hospital in the Mid-Western State of Nigeria. The results showed a different pattern from what has been reported from other studies. In this study, it was found that single persons had the largest number of referrals, followed closely by married persons. The widowed and divorced had a relatively small number of referrals. There were more male than female patients and there were also sex and age variations in the type of mental disorders. The explanation for this could be related to the social structure of the population, and the legal and social definitions of the concepts of marriage and divorce. It was not possible, because of lack of relevant population data, to compare the hospital rates with those in the population at large. Future work along this line and for over a longer period is suggested.


A quest for purpose in psychic research. Metapsychiatry is a term born of necessity to designate the important but hitherto unclassified interface between psychiatry and mysticism. By "mysticism" the author means phenomena experienced by the senses but not explainable by the intellect. Examples of such phenomena are dreams, ESP, faith healing and so forth. The author believes that such phenomena were endowed by nature as life preserving functions. Thus, precognition is a sort of psychic radar, warning an individual of impending danger; dreams are a safety valve for potentially psycholytic repressions; and faith is an important element in the healing process. Such phenomena are probably a primitive acquisition, latent in all of us. They should not be treated merely as divine manifestations requiring no further explanations. Scientists must seek rational answers, and physicians should seriously consider using gifted, reputable psychics as paramedical aides.


Anthropological perspectives on population growth. Rapid population growth affects many different system levels simultaneously: the individual, the family, the community, the nation-state and the world. What may appear to be an optimal population level for one system, given certain value premises, may not be optimal for another. Anthropologists can contribute to an understanding of rapid growth by generating an appreciation for the complexity of the phenomenon, and by providing representation for a range of cultural viewpoints. This may help to reduce the risk we now run of committing all of mankind to a singular path which may prove to be an evolutionary dead end.


School psychological emergency interventions proposal for guidelines based on recent Israeli experience. The Yom Kippur War and its stressful aftermath created a number of special psychological effects in Israeli schools. During that period mental health and counseling services were available and made use of in the educational system. Extensive experiences permit an attempt to delineate guidelines for future school psychological emergency interventions. These guidelines rest on the supposition that the planning and delivery of professional emergency interventions resemble those governing routine mental health services in a number of crucial aspects. Firstly, the need for an educated anticipation of problems, their kinds, their ecology and other characteristics. Schematically, three categories of emergency reactions could be expected in schools: shock and grief, and other acute disturbances; fear and its psychological concomitants; confusion, perplexity, and their attitudinal accompaniments. It is noted that the stressful event can also generate positive effects. Secondly, the necessity for a preliminary, on the spot, assessment of psychological affliction in any specific emergency case. Such examination should be done against the background of the total emergency situation (locally and country-wide), as well as the chronic characteristics of the particular school or system. Third, the requirement for deliberate planning of the intervention program. In this phase, judgements have to be made about the recipients of the aid, the methods of help and the levels at which professional services will be extended. Fourth, the consideration of important clinical and community psychological principles during the execution of the program.


Short-term intervention: a model of emergency services for times of crisis. This paper approaches 'crisis' in system terms. The analysis is applied broadly to organization and community systems, as well as to personality and small-group systems. Based primarily on current developments in Israel, it is written from the viewpoint of a community social worker. Using public health theory, the author develops a model of three distinct types of social service systems: Restorative (traditional), Curative (crisis-intervention in the literature of therapy), and Preventive. He goes on to elaborate both the general characteristics of these service systems and the particular emergency-oriented contribution each can make in times of community-wide crisis.


Cultural perspectives on the range of human behavior. Traditional societies provide a homogeneous world view for everyone, encouraging people to work towards specific objectives. Lack of flexibility in the culturally defined ways of reaching these objectives creates considerable distress for individuals. In rapidly changing urban settings, unlimited modalities create the anxieties which in turn lead people to search for security in unsuitable patterns of belief and behavior. Others tolerate uncertainty better if the culture assisted them in developing skills for becoming involved in short term immediate objectives without having to mortgage the present for a vague future. In our own society recent reorientation towards a traditional type fatalism and a de-emphasis on the Puritan work ethic reflects a marked value shift which may stultify many, much as it fosters increased individualization among others.


Alcoholism as a political problem in Chile. Chile has a very serious alcohol problem. 20% of the population over 15 years of age are problem drinkers, - 15% are excessive drinkers, and 5% are alcoholics. Excessive drinking, particularly inebriety, is considered to be the core of the alcohol problem. During Allende's government, there was an increasing concern for the national patterns of drinking. Workers began to become conscious that drinking seriously limited social and political participation. And patterns of alcohol abuse among men predict stimulated conservative attitudes in women. This paper discusses the concept of alcoholism as a disease, considering that alcohol addiction is a part of a wider problem, alcohol culture, which, in the context of the situation in Chile in 1972, had to be seen ideologically as opposed to the revolutionary process.


Space, territory and psychiatry.

Space, territory and psychiatry. Space and territory have been the hidden dimensions of human and other animal life. Beginning with studies reported in animals, and incorporating the few formal studies and several informal observations of man, this paper explains the importance of mastering the unwritten rules of space and territory which differ with individual cultures in relation to the behavioral aberrations possibly resulting from the disrupted territoriality of modern urban life.


A medical model vs. a normative approach: the place of values in community psychiatry. Based on a series of consultations with the staff in a mental hospital, which followed staff-patient meetings, the point of view taken derives from Scheff's 'social system' model, according to which psychiatric symptoms are considered as labelled violations of social norms, and mental illness is considered as a social role. It was found that in a somewhat cyclical succession, patient deviance was followed by the staff's spontaneous moral indignation. But thanks to the intervention of a medical idelogy, this was channelled and transformed into an impersonal, value free, non-judgemental reaction. It seems that as a first step towards humanizing their relationships with patients, the staff must be prepared to engage in a clarification and definition of their moral convictions. A major therapeutic goal should be to help de-moralized people, called mental patients, to acquire a new sense of morality and self-responsibility.


Perinatal implications of the respiratory distress syndrome. Major advances in the prevention and treatment of the respiratory distress syndrome (RDS) have occurred. Since 1970 there has been a fall in the mortality rate but not in the incidence. Persistence of the disorder could be partly accounted for by the increasing practice of elective delivery in normal pregnancies. In 1974 and 1975, 28 (25%) of babies with RDS were delivered this way and six died. The major problem appeared to be mistaken gestational age.


Post-infarction cardiac rupture.

Post-infarction cardiac rupture. Three allied conditions are described in this paper: (i) haemopericardium with cardiac rupture (5 cases); (ii) haemopericardium without rupture (2 cases); (iii) pseudoaneurysm (1 case). In the first 2 of these, the significant features were clinical deterioration with shock 3 or more days after infarction, recurrent cardiac pain, cardiac tamponade, and immediate or later ineffectiveness of counterpulsation. An additional feature in the second group was the development of haemopericardium after heparin therapy. In the third group, infarction followed by left ventricular failure and progressive cardiac enlargement was the significant feature. An apical systolic murmur was not present, as a false sac had not been formed. Ante-mortem diagnosis depends upon an appreciation of these features. Without it successful surgery is impossible. There were 4 survivors in this group of 8 patients.


Diverticular disease of the colon and megacolon. Incidence in a psychiatric centre compared with a teaching hospital. A five-year survey of hospital admissions at a modern mental hospital reveals a rarity in the incidence of diverticular disease of the colon and its complications and a greatly increased frequency of idiopathic megacolon and its complications compared with patients admitted to a general hospital.


Smoking in nurses.

Smoking in nurses. An anonymous questionnaire requesting information on smoking habits was administered to 220 randomly chosen trainee and registered nurses (159 females and 61 males). There was no significant difference between the proportion of male nurses (55-7%) and the proportion of males (45-0%) in the Australian sample who smoked. However, the 52-2% of female nurses smoking was significantly greater than the 29-0% reported for the Australian female population. There was some indication that the increased smoking in female nurses reflected a response to stress. Further analysis showed that nursing personnel were giving up smoking at the same rate as the general Australian sample.


A functional assessment of total knee replacement in the arthritic patient. The aims of knee replacement are to provide freedom from pain and a return to a resonable level of function. A survey was undertaken to determine the functional advantages of knee replacement and problems that may still be encountered by the patient. The results of the survey highlighted certain advantages and problem areas. It also pointed out the seemingly greater functional value of the knee replacement in those patients who had no problems in other joints.


Angiomatous osteolysis of the skull vault. A case is reported of angiomatous osteolysis of the calvarium. This condition normally affects long bones and there is only one previous report in literature of massive osteolysis of the skull. The clinical, radiological and pathological implications of this condition are considered.


The medical undergraduate programme at McMaster University: learning epidemiology and biostatistics in an integrated curriculum. The medical undergraduate programme at McMaster University is a three-year integrated course in which major emphasis is placed upon self-directed, problem-based learning. Group tutorials are the major meeting place for students, and there are very few formal lectures. In this paper we describe the curriculum in broad outline and the way in which epidemiology and biostatistics have been incorporated into it in the past seven years.


White sponges and surgical wound illumination. A study has been made of the effect of glare in the surgeon's field of vision from reflected light associated with white surgical sponges. Reflected light increases by as much as 226% with the use of white sponges. Standardized measurements indicate that this glare reduces visual acuity, darkens colour interpretation and fatigues the surgeon. A suggested solution is to slightly darken the colour of surgical sponges.


Residual disability after industrial hand injuries. A review of 218 patients. The case records of 218 patients with residual hand disability were reviewed. Sixty-six per cent had significant stiffness of the digital joints (metacarpophalangeal and proximal interphalangeal); 25% had amputation of part or whole of the digit; 33% of these had troublesome neuromata; 7% had residual numbness; 25% had more than one operation on their injured hand. The average age of the patients was 44 years. The average time off work was 10 weeks. The average experience in the job before injury was six years.


Reducing hospital readmission rates among schizophrenics. Most schizophrenics become in-patients in State mental hospitals, and most improve on neuroleptic medication and are rapidly discharged. The majority require long-term medication; the single most important factor in maintaining remission. This paper describes a mirror-image study using patients as their own controls, and demonstrates the highly significant differences in hospitalization before and after the administration of a depot phenothiazine. It highlights the need for vigorous and determined out-patient follow-up. It is suggested that the costs of an adequately staffed clinic are still small when compared with the costs of hospitalization. Subgroups of poor drug-responders, sex differences, variations in side effects and frequency of administration of the depot drug require further evaluation.


Urinary sodium, potassium and creatinine excretion in hypertensive and normotensive Australians. Studies were made in urine obtained from people attending for routine measurement of blood pressure in a screening programme. Subjects with diastolic blood pressure between 95 and 109 mm Hg excreted significantly more sodium than the group with diastolic blood pressure below 90 mm Hg. Urine volumes, potassium excretion and creatinine excretion did not differ significantly between the groups.


Antibody to parietal cells in patients with duodenal ulcer, and relationship to pernicious anaemia. Of 160 patients with pernicious anaemia, none had current duodenal ulceration, whereas in a random population of similar age and sex distribution some 5% would be expected to have a duodenal ulcer. Parietal-cell antibody was detected in serum from 8 of 169 men (4-7%) and from 2 to 31 women (6-4%) with duodenal ulceration. None of the 200 duodenal ulcer patients had antibody to intrinsic factor. The prevalence of these antibodies in duodenal ulcer patients was not significantly different from that in control subjects of similar age and sex distribution. The decreased prevalance of duodenal ulcer in pernicious anaemia patients implies that pernicious anaemia must be less prevalent in duodenal ulcer patients than in a random population; but it appears that this cannot be attributed to an absence of gastric autoimmunity in patients with duodenal ulcer. To resolve this disrepancy, we suggest that pernicious anaemia is determined not only by autoimmune reactions, but also by independent genetic and environmental factors which influence the state of the gastric mucosa.


Human pulmonary dirofilariasis associated with pleural effusion. Tuberculosis, untreated pneumonia and other chest infections were excluded as possible causes of histological features observed in patient who had been discovered in a chest X-ray survey. Pleural effusion was eventually attributed to a dirofilarial granuloma found in a small pulmonary artery.


The Medical Register of South Australia for 1976. An analysis of the Register of Medical Practitioners and specialists of South Australia for 1976 shows that South Australia has a more favourable doctor-population ratio than other parts of Australia, although some specialities and rural areas are undersupplied. With the planned increase in the output of doctors, the State may soon be saturated and some adjustments may have to be made in the numbers of students accepted and/or the distribution of graduates.


A case of manslaughter by heat-stroke.

A case of manslaughter by heat-stroke. In the course of his treatment by a herbalist who had undertaken to cure his disability, a mildly spastic retarded four-year-old child was immersed in a heap of fermenting horse manure for 40 minutes. He was unconscious when removed and died two days later despite intensive care in a children's hospital. When medical aid was sought a false history was given and the true nature of the child's illness, heat stroke, was not determined until after death. The herbalist was subsequently convicted of manslaughter.


The Brisbane floods, January 1974: their impact on health. In the 12 months following the Brisbane flood of 1974, 234 flooded families (695 persons) and 163 non-flooded families (507 persons) were interviewed to ascertain changes in health status. We found that the number of visits to general practitioners, hospitals and specialists were all significantly increased for flooded persons in the year following the flood. Persistent psychological symptoms, which included irritability, nervous tension and depressed mood, predominated in those seeking medical care, and the consumption of sleeping tablets and psychotropic drugs rose. Increased psychological symptoms were significantly more common in female than in male flood victims and significantly more common in both sexes than increased physical complaints. There was no increase in mortality after the flood. The incidence of psychiatric symptoms was directly related to dissatisfaction with help received.


Freshwater drowning and near-drowning accidents involving children: a five-year total population study. A large total population study of childhood fresh water immersion accidents is reported. The study was undertaken in the City of Brisbane over the five-year period 1971 to 1975 inclusive, and 111 fresh water immersion accidents involving children were studied and analysed. The childhood fresh water immersion accident rate, including drowning and near-drownings, of 10-43 per year per 100,000 at risk (fatality rate of 5-17) is the highest reported. If an unsupervised child gets into difficulties in fresh water and loses consciousness he has a 50% chance of dying. The immersion accident rate has doubled over the last six years. Age-specific immersion accident rates have been calculated, and have revealed that, in the toddler group (12 months to 23 months), the fresh water immersion accident rate is 50-01 per 100,000 (fatality rate of 22-55). Rates for drowning and near-drowning accidents after a fresh water immersion, by site, age and outcome (survival versus fatality), are also presented for the first time. Swimming pools produce 6-20 immersion accidents per year per 100,000 children at risk, and the domestic family bath tub produces 1-78. Possible factors explaining the high incidence are discussed, and comparisons of drowning rates from other centres are made.


Attitude change: be reasonable, do it my way. Governing most of medical practice are our attitudes towards people, policies, and procedures. This article considers attitude components and models of attitude change. Some consequences are discussed as a conceptual survival kit for hospital staff, in the hope that as we become more aware of how we form attitudes, we will be less inhibitory to healthy change.


The plasma scalpel.

The plasma scalpel. The plasma scalpel simultaneously cuts tissue and cauterizes blood vessels measuring 3 mm in diameter with a small, hot (3000 C) gas jet. In animal studies, the amount of hemorrhage has been shown to be less with the plasma scalpel than with steel or electrosurgical scalpels, and incisions have healed without complications. Amount of damaged tissue is limited. Human trials are under way, and the device shows promise as a clinical tool.


ECG telephone transmission for monitoring pacemakers and cardiac arrhythmias. A network of ECG telephone transmission has been established which uses simple and inexpensive equipment, and which is aimed particularly at arrhythmia monitoring. Hospitals in areas remote from major medical centers are able to transmit to the Toronto General Hospital for expert advice. 400 patients in their homes may transmit to any of these hospitals for monitoring of pacemaker function or intermittent cardiac arrhythmia. Any patients in the Toronto General Hospital not admitted for a cardiac problem may be monitored via telephone by the expert nurses in the coronary care unit if a cardiac arrhythmia should arise. Equipment for the system has been carefully designed to minimize cost and to make it simple to use, particularly for the old or infirm patients in their homes. Transmissions between hospitals meet American Heart Association specifications for ECG recording. Transmissions of arrhythmias from patients' homes are carried out with a reduced low-frequency response. Expert cardiologists find both transmissions acceptable for their particular purpose. Standards should be set for simple, economic transmission systems as well as for those meeting the most stringent criteria.