[The acute visual hallucinosis in infancy. Clinical, neurophysiological and psychodevelopmental aspects and differential typology (author's transl)]. By introducing the definition "hallucinosis" (Wernicke) it has become possible to confine the psychoses of organic origin more closely. Therefore, this term should also be used in pediatry and pedopsychiatry in order to designate cases with corresponding clinical aspects. Thus, accordance to the phenomenological characteristics of such syndromes as described in this paper, it is justified to emphasize that the acute hallucinosis in children is a special type of disease as compared to other psychoses caused by exogenic influences in this age group. The 10 case reports deal with visual hallucinoses which turned out to be characteristically different compared to those in adults. Hallucinating children at the age of 3 to 9 years predominantly visualized animals and legendary beings. Contrary to findings in adults, scenic and systematized visions were scarcely noticed, which psychodevelopmentally may be attributed to the fact that creative power in children is still little pronounced. Etiologically intoxications and infectious diseases were the cause for the visual hallucinations of the 10 children described. In the development of visual hallucinations somatic and psychic factors are significant. They have been discussed on the basis of today's knowledge. As today, however, there exists no satisfactory theory concerning the conditions favoring the development of hallucinations. To explain the somatogenesis of visual hallucinations three theories have been outlined, based on the present neurophysiological findings. It has been worked out that especially in children emotion plays an essential role in the origin of hallucinations. In infancy and early school age, while rational control of reality is still suppressed to a great extent, domination of emotional life goes along with lack of differentiation. At the same time the difference between imagination and perception is still little precise; therefore, phenomena, impressing as hallucinations in the adult, occur with greater facility in children.


[Transient global amnesia - a paroxysmal amnestic syndrome (author's transl)]. The Syndrome of Transient Global Amnesia is clinically characterized by a disorder of the ability to form memory engrams, appearing suddenly and lasting for several hours. Since the first papers on this syndrome by Bender (1956) and Fisher and Adams (1964) approximately one hundred cases of transient global amnesia have been described. Symptomatology, course, somatic findings and differential diagnosis are discussed with consideration of the literatur and three own observations. Regarding the etiology most authors discuss a transitory localized ischemia in the circulatory area of the vertebral-basilar artery system. Relapsing episodes occur less frequently than single episodes. In connection with this disorder characterized by the paroxysmal occurence and the episodic course, possible ways of genesis of amnesic syndromes are discussed. Theoretically three types of amnestic syndromes of organic origin may be differentiated: (1) amnesia in the frame of "function psychosis", i.e. of global mental deterioration caused by various diffuse brain function disorders; (2) amnesia caused by a combination of diffuse (function psychosis) and local brain function disorder; (3) purely local type of amnesia without function psychosis. In the combined type of amnesia a dissociation between the severity of memory disorders and relatively mild function psychosis is to be found. The importance of psychopathometric investigations, i.e. of quantitative determination of other mental dysfunctions besides memory disorder, for the interpretation of an amnesic syndrome is emphasized. Unfortunately these have not been possible in the cases described in this paper.


Antibacterial activity of combinations of cefazolin and semisynthetic penicillins. The antibacterial activity of cephalosporin (CS) and semisynthetic penicillins was studied using CS-resistant strains of Escherichia freundii and Proteus morganii. A synergistic growth inhibitory action toward these microorganisms was demonstrated by a qualitative method and confirmed by a quantitative determination.


Nursing's contribution to social psychiatry: a holistic approach to personhood. The expanded role of the nurse in social psychiatry involves building upon the conventional role of the nurse to include a focus on health promotion and prevention as well as on the detection and treatment of illness. Nursing is strategically located and uniquely prepared to take on such a challenge. Nursing has long recognized the holistic nature of families and communities. Nursing assumes that families have rights and responsibilities which include participation in the solution to problems which they helped to create. Nursing has been sensitive to the interrelationship between social expectation and dysfunctional behaviour. In the expanded role, nurses have accepted the mandate to transform society, to act as social change agents, as family advocates, as champions of minorities and as facilitators of mental health, i.e., the promotion and maintenance of mental health as well as disease detection and restoration of health. With a focus on mental health teaching, mental health promotion and prevention, nursing has the potential for providing an essential, holistic, now missing, link in the delivery of mental health services.


Pneumothorax as a function of gestational age: Clinical and experimental studies. Infants with respiratory distress syndrome are especially prone to pneumothorax and pneumomediastinum as a complication of their disease. In a retrospective clinical analysis of a consecutively delivered population of infants with RDS the data suggested that the less premature infant with RDS was apparently more at risk to develop pulmonary rupture. This clinical observation was confirmed in postmortem studies in premature rabbits. The most immature group of lungs were relatively resistant to pulmonary rupture, owing to high surface forces. Toward term, surface forces were decreased as were lung tissue elastic forces, which predisposed to rupture at lower pressures.


Treatment of aspiration pneumonia and primary lung abscess. Penicillin G vs clindamycin. Aspiration pneumonitis and lung abscess generally involve anaerobic bacteria, which normally colonize the upper respiratory passages. The therapeutic response of these infections to parenteral penicillin G (49 patients) and parenteral clindamycin (35 patients) was compared to determine relative efficacy. No difference was discerned between these two agents in terms of time required for defervescence, roentgenographic clearing, and ultimate outcome. Seven patients with infections including Bacteroides fragilis were treated with penicillin G, and all responded well. These data indicate that penicillin G is the preferred agent for pulmonary infections involving anaerobic bacteria. Clindamycin is a suitable alternative for patients in whom penicillin G is contraindicated.


The effect of the teachers smoking behavior on their involvement in smoking education in the schools. The smoking behavior and attitudes of public school teachers were studied to determine if the teachers' smoking behavior is related to their attitudes and behavior regarding students' smoking practice and smoking education in schools. The Northampton, Massachusetts, School System was studied, where 162 of the 194 teachers randomly selected from various schools in the district completed the close-ended questionnaires administered and collected by the researcher. The study yielded a return rate of 83 percent. The results of the study showed that the general climate in school is one conducive to the establishment of a comprehensive smoking education program. It also indicates that the teachers' attitudes and behavior towards smoking education were closely related to their smoking  behavior. The ex-smokers were the most active group in attempting to initiate student smoking behavior change, while the smoking teachers were  the least active in this respect. Furthermore, pre-service and in-service teacher training programs in relation to smoking education were shown to be extremely sparse and ineffective in the past. This study suggests the need to strengthen pre-service and in-service teacher training programs in smoking education and to make smoking cessation programs available to those teacher who want to stop smoking.


[Position of cyticholine in pneumologic therapy]. The position of cyticholine in lung lipid metabolism and hence in pneumological therapy (the subject of a personal hypothesis) is discussed. A summary is given of personal experimental work and papers read at the 1974 Padua meeting (11th December) held by the Societas Europae Physiologiae Clinicae Respiratoriae. It is shown that cyticholine may: 1) prevent the onset of acute neonatal respiratory distress; 2) improve chronic pneumogenous respiratory insufficiency; 3) prevent postoperative hypoventilation; 4) improve ventilation mechanics in hyperelastic lung syndromes; 5) increase the gas permeability of the air-blood barrier; 6) counterbalance the loss of surfactants caused by endobronchial aspiration in patients with tracheal tubes.


Educational preparation for nursing--1974. Each year a report of some of the most recent statistics on nursing education appears in the September issue of Nursing Outlook. The data presented are derived from The National League for Nursing's annual survey of state-approved schools of nursing in the 56 jurisdictions of the United States. The programs surveyed include those which prepare for beginning practice in nursing (baccalaureate, associate degrees, diploma, and practical nursing); those graduate programs that lead to masters and doctoral degrees in nursing; and those baccalaureate programs that conduct nursing programs for registered nurses only. Data on the status of state-approved basic schools (new schools, closed schools, and changes in existing schools) are obtained in September of each year from the state boards of nursing. In October, questionnaires are mailed to each school of nursing, as well as to those nursing programs that do not require state board approval (masters and doctoral programs, and baccalaureate programs for registered nurses). Information is also obtained from irregularly conducted surveys of all four-year colleges and universities in the United States that do not have state-approved basic nursing baccalaureate programs. The data obtained include admissions and graduations for the preceeding academic year, admissions for the current fall term, and enrollments as of October 15. Other information, such as data on men and minority students, is collected every three years. In recent years, enrollment figures for students who were admitted with advanced placement status have also been collected. With few exceptions, the schools have been most cooperative in providing the data, making it possible for us to obtain a 100 percent response rate for both registered nurse and practical nurse programs.


Applying the nursing process to patient care in the operating room. Using the nursing process in operating room nursing helps to assure personalized, continuous, and integrated care for the surgical patient. The steps in the nursing process clearly demonstrate the role and functions of the O.R. nurse as a professional member of the surgical team and as a component of the health care system. By this means the patient is assured of protection and quality care.


A master nurse clinician for intraoperative care. The intraoperative period has long been the missing link in the chain of continuity of care for the surgical patient. An intraoperative clinical nurse specialist who is able to work with patients, families, and health care team members preoperatively, intraoperatively, and postoperatively can effectively bridge the gap in care. Nursing care given to patients in the O.R. should be no different qualitatively from nursing care given sedated and/or unconscious patients in other nursing units. The C.N.S. in the O.R. can help make such care a reality through giving care to patients and families as a role model, directing care as an expert through written care plans or physical presence, doing formal and informal teaching of patients, families, and staff, and through research. Operationalizing the role of the C.N.S. for surgical patients during the intraoperative period requires the specialist to move out of the O.R. to assess patients and families preoperatively and to evaluate the postoperative results of care. Implementation of the specialist role in the O.R. clinical nursing setting is accompanied by the same frustrations and problems met by master clinicians in other nursing specialty areas.


The new graduate in the operating room.

The new graduate in the operating room. New graduate nurses today come to their first positions in nursing with varying knowledge bases and minimal clinical nursing skills. Gone are the days when new graduates begin functioning fully in a budgeted position on day one of employment. Mastery of psychomotor, cognitive, and affective skills necessary for nursing practice must be acquired through experience in the work situation. The more complex the clinical setting, the more stressful is the period of learning. The O.R. can be a highly stressful place. The need for anticipation, planning and organization to provide efficient care with meticulous attention to detail is coupled with the need to perform smoothly numerous technical skills. Safe, humanistic care cannot be implemented unless the nurse is also able to assess each patient's individual biopsychosocial status, and identify his unique nursing care needs. In order to learn to cope with this level of complexity, the neophyte nurse must be provided with a planned, supportive experiential learning situation that also provides the time necessary to achieve a beginning level of mastery. The program in Basic O.R. Nursing described here was one attempt to provide such an experience for new graduates.


Controlling operating room-related infection in cancer patients. This paper outlines the program for controlling surgical infections in one cancer research hospital dealing with a unique group of patients. Control must -begin before the patient comes to the surgical suite and must continue when the patient returns to the nursing unit. These patients are often elderly, debilitated, and receiving anti-cancer chemotherapy, and they undergo lengthy massive resections often requiring several procedures. Some of the guidelines that we have evolved over a long period may be helpful in stimulating others to establish, implement, or improve similar programs in their own units. It is obvious that any such programs will have to be tailored to meet the demands and personnel of each institution. The important thing is that each surgical department must work toward the goal of keeping postoperative mosocomial infection at the lowest possible rate.


Play therapy: preparing the young child for surgery. A child is not a miniature adult. His thought processes are pre-conceptual, pre-logical, and characterized by many fantasies. The child needs concrete information about his impending surgery: (1) what will happen; (2) what is expected of him; (3) that he is not to blame for his illness or injury, and (4) where the organ to be removed or repaired is located and that no other body parts will be harmed. Play therapy is an effective method for providing tangible information about the surgical experience and simultaneously decreasing the child's fantasies and fears about the surgery.


A program in continuing education for primary health care. Influential recommendations have been made that preparation for expanded roles in primary health care be part of basic nursing education. Much of the learning required for the roles is already included in many, if not all, baccalaureate programs. Implementation of these recommendations implies that short "add-on" courses such as the one described here should be considered interim measures to upgrade skills and knowledge of present graduate nurses, both diploma and baccalaureate. For such measures, continuing education should be available in a variety of courses which could meet in a flexible manner the varying needs and objectives of diverse service settings. As the expectations of consumers and service settings change, and as roles and functions evolve, variations and modifications in course offerings can then continue. It would be expected that, with clearer perception of the role to be ascribed to nursing in primary health care, such course offerings could be based soundly on data derived from systematic study of the effect of nursing. It is anticipated that the experience and findings of this project may have a contribution to make to the development of future courses. The project showed encouraging results from a working collaboration of a variety of health care personnel in both instruction and evaluation, and demonstrated that such courses can involve a variety of students from a variety of relevant practice settings. It is also felt that the evaluation approaches and tools evolved hold promise, with further refinement, of contributing to the development of evaluative procedures.


The independent nurse practitioner. Alive and well and living in rural Saskatchewan. At this point, it is impossible to express analysis of the data collected in concrete terms as the project will not be finalized until October, 1976. It is possible, however, to make some personal observations. Each nurse practitioner has been truly independent in carrying out her role in the community, influenced to a degree by the communities' felt need and the attitudes of other health professionals. All began practice with a heavy emphasis on diagnosis and cure rather than comprehensive care. As time evolves and the nurses feel more confident in their new role, some are continuing a cure orientation, and others are beinning to find that they have a unique dimension to add to health care services. Those who were professional "nurses" in the true sense of the word before the project began have not stopped being nurses, but have only become more competent professionals by recognizing and responding to the health needs of today.


The community clinical nurse specialist. A two-year perspective. I have described my role as a clinical nurse specialist in an official agency over the past two years. The circumstances of my setting and position, my personal feelings of commitment and accountability, have all influenced the direction of my position. In relation to my nursing practice, I have concentrated on areas that have appeared to me as high-risk. I believe that there is a very definite role in the community for nurses who have the expertise to deliver health care of a high quality with more independence than usually exists in a nursing role. Before a clinical nurse specialist can function in an official agency, however, there are limitations that must be resolved.


The role of the nurse working with employment upgrading programs. Working in a project where there are general objectives but no fixed program to reach them can be both a challenge and a frustration. But this work is never dull. The key points in the success of such a program are defined behavioral objectives for each student, an imaginative, flexible, and versatile nurse, and an administrative structure which is prepared to be flexible enough to say, "Do our thing your way."


The terminal hepatic microcirculation in the rat. The hepatic microcirculation was observed microscopically in the transilluminated liver of the rat. The portal and hepatic venous microvessels were classified into four orders according to their branching hierarchy, and the hepatic sinusoids into branching, direct and interconnecting types according to their topographic arrangements. The diameters of the various orders of microvessels and types of sinusoids were measured by serial photomicrography, and the velocity of the erythrocytes in these various microvessels and sinusoids by the dual-slit photometric technique. The microvascular volume flows were calculated from these data. In both portal and hepatic venous systems, the erythrocyte velocity and the volume flow significantly decreased in successive orders of the microvessels in apparent relation to the cross-sectional areas. The diameters of the three types of sinusoids did not significantly differ, but the velocity of the erythrocytes in the direct sinusoid was significantly faster than that in the branching sinusoid while that in the inter-connecting sinusoid fluctuated widely.


Changes in the metabolism of the shivering hind leg of the young ox during several days of continuous cold exposure. The effect of 4 days of continuous exposure to a cold environment on blood flow in, and oxygen and energy substrate uptake by the shivering hind leg has been studied in young steers. The animals shivered throughout the period of cold exposure and total oxygen consumption (total VO2) remained 40-50% greater than VO2 during thermoneutrality. Leg blood flow (leg Q) and oxygen uptake (leg VO2) increased two- and four-fold respectively on the first day of cold. Both had declined significantly by the final day, leg Q to a level 37% greater than, and leg VO2 to about double, pre-cold levels. The change in the relationships of leg Q and leg VO2 to total VO2 was examined by linear regression analysis, which suggested that the changing contribution of leg VO2 to total VO2 was entirely due to changes in leg Q, rather than in the arteriovenous difference in blood oxyhaemoglobin saturation across the leg. The net uptakes by the leg of free fatty acids (FFA), acetate, glucose and lactate all increased on the first day of cold. Both glucose and acetate uptakes were greater on day 4 than on day 1 in the cold, in spite of the lower leg VO2, but net uptakes of FFA and lactate were considerably lower. The decrease in net uptake of FFA is attributed mainly to an increase in the rate of lipolysis and release of FFA from fat depots in the leg, because of the associated progressive increase in the release of glycerol and oleic acid from the leg. The molar ratios of net carbohydrate substrate, acetate and FFA uptakes to leg VO2 are compared. The results suggest that tissues other than the leg muscles become increasingly important as sites of heat production, and that there are changes in the utilization of glucose, acetate and FFA by shivering muscle, during prolonged cold exposure.


The effects of vagotomy on ventilation and blood gas composition in dog, sheep and rabbit. The influence of vagotomy on resting arterial blood gases (PaCO2 and PaO2) and on the ventilatory responses to hypercapnia and hypoxia was studied in three different species of anaesthetized animals. After bilateral cervical vagotomy resting PaCO2 generally declined. In the dog, where this was studied more fully, resting PaCO2 declined significantly (8-13 +/- 0-67 mm Hg) over several hours, but PaO2 changes were not significant. After vagotomy tidal volume (VT), but not frequency (f), increased with increasing chemical drive. It is concluded that the increase in frequency in response to increased CO2 or decreased O2 is dependent on the vagal mechanisms. Minute volume, fractional inspiratory CO2 (VE, FICO2) and minute volume, fractional inspiratory O2 (VE, FIO2) relationships have been determined. Although vagotomy may not decrease the response of minute volume of ventilation in the lower part of VE, FICO2 curves (mild hypercapnia), it flattened the upper parts of the curves in sheep and rabbits, and to a lesser extent in dogs; it seemed that there was little species difference in this respect. Ventilatory responses to graded hypoxia were close to or slightly higher than pre-vagotomy values throughout the VE, FIO2 curves in all animals.


Renal regulation of phosphate excretion in the pig. Young pigs of about 25 kg in weight were given supplements of Na2HPO4 either in their food or by intravenous infusion and the effects on urinary phosphate excretion were studied. The results obtained showed that the amount of inorganic phosphate excreted in the urine increased with increase in the amount of phosphate filtered at the glomerulus. A threshold value for phosphate excretion in these pigs occurred at a plasma concentration of 2-03 mmol/l. while over a wide range of filtered phosphate load (0-21-1-14 mmol/min) phosphate was reabsorbed at a mean maximum rate of 0-19 mmol/min. Parathyroidectomy did not alter the relationship between phosphate excretion and filtered phosphate load which suggests that in the pig adjustment of renal phosphate excretion in relation to filtered load is not dependent upon parathormone.


Mast cells and gastric secretion in the rat. Gastric secretion of acid was measured in adult rats deprived of solid food for 48 hr. In control animals, values were obtained for the residual content of acid in the stomach, indicative of the rate of basal secretion, and for the quantities of acid secreted in 30 min following injections of histamine, pentagastrin, insulin and compound 48/80. The same measurements were made in groups of rats treated for 5 days with compound 48/80 (a regime which depleted the whole body of mast cells) and for 3 days with dexamethasone (which selectively depleted the gastric mucosa of mast cells). The content of residual acid was depressed to one third of the control value in the 48/80-treated rats, but the additional secretion due to histamine, pentagastrin or insulin was unaffected. A secretory response to a single injection of compound 48/80 could not be obtained in rats depleted of mast cells. In the dexamethasone-treated rats, the residual level of acid was increased to 1-5 times the control value, but the magnitudes of the responses to secretogogues were unchanged. It is concluded that basal secretion of acid into the stomach of the rat is stimulated by histamine derived from mast cells throughout the body, those of the gastric mucosa having no special significance in this respect. Mast cells are not involved in the mediation of the secretagogue actions of exogenous histamine, pentagastrin and insulin, but the present results do not preclude the participation of histamine from sources other than mast cells in the process of gastric secretion.


Secretory responses to sympathetic stimulation of the cat's salivary glands in a state of resting secretion. The secretory effect of sympathetic stimulation on the cat's submaxillary gland was augmented greatly when studied against a background of slow secretion evoked by parasympathetic stimulation at a low frequency and imitating the slow resting secretion normally present in the waking state. The sympathetic secretory threshold was markedly lowered, and even at low frequencies sympathetic stimulation caused a large, well-maintained response. After an alpha-adrenoceptor blocking drug sympathetic stimulation alone lost its secretory effect, but during resting secretion part of the accelerating effect was found to remain; this effect was elicited via beta-adrenoceptors. A marked secretory effect of sympathetic stimulation was also obtained during resting secretion in the parotid gland, where the sympathetic secretory effect is normally very small.


Indications and techniques for ambulatory electrocardiogram monitoring. The development of the ability to record a patient's ECG during a full 24-hour day of normal activities has resulted in improved arrhythmia detection and potential for treatment. Improved methods of ECG data processing, using computer techniques, now allows quantitation of PVC frequency and improved correlation of the arrhythmia with events occurring during the period of recording. Knowledge of the natural occurrence and variability of ambulatory arrhythmias permits appropriate choice and timing of antiarrhythmic therapy.


The role of ambulatory real-time monitoring in ischemic heart disease. Pending the long-term solution of the problem of coronary atherosclerosis, and considering the unlikelihood of a universally effective, nontoxic, anti-arrhythmic regimen, it seems likely that ambulatory real-time monitoring is a promising avenue of approach for attacking the largest share of IHD mortality, namely the 2/3 who currently die before any medical attention.


The role of ambulatory monitoring in postinfarction patients. Ventricular premature contractions noted at the time of hospital discharge following myocardial infarction identify a population of patients at risk for late, sudden cardiac death. Patients with PVC's who are at exceptionally high risk can be identified by means of certain clinical and arrhythmic characteristics. Late ambulatory monitoring is the most effective single technique for identifying such individuals and for monitoring their response to anti-arrhythmic medication.


Energy metabolism in shock.

Energy metabolism in shock. Shock produces a state of low-energy production secondary to lack of oxygen. Only 1/5 of the energy produced under aerobic conditions can be produced in shock and less so if shock continues and loss of nucleotide bases and substrate occurs. Carbohydrates and their intermediate compounds are responsible for the energy produced during shock. As cellular derangements and loss of energy supplying compounds are becoming better understood, their contributions to a condition of irreversible shock are receiving more consideration. Studies utilizing energy substrates, prevention of nucleotide loss, and supplying high-energy compounds have been done and show promise as a therapeutic modality.


Dyspnea in the patient with cardiopulmonary disease. Dyspnea in the patient with cardiopulmonary disease has been defined and discussed, emphasizing those conditions which increase the work of breathing: increased elastic resistance; increased airway obstruction; and deformities of the chest wall, lung, and pleura. Methods of assessing the cardiopulmonary status of the patient as it relates to each condition were presented. Determining and understanding such clinical signs as patterns of breathing, cough and secretions, râles, rhonchi, wheezes, diminished or augmented breath sounds, poor or unequal expansion of the rib cage, and dullness or hyperresonance on percusion is extremely important for the nurse in order to accurately and comprehensively make a nursing assessment. Such an assessment can provide the information necessary to plan more effectively for the care of the patient with cardiopulmonary disease.


Arrhythmias in the coronary-care unit. I. Physiologic bases of ectopic beats. Ectopic beats appearing in the wake of an acute myocardial infarction are best explained with a fundamental knowledge of myocardial cellular electrophysiology. When the physician or nurse has knowledge of the electrical events of intracellular recordings then normal as well as abnormal states of automaticity and conductivity are better understood.


Some aspects of the nursing care for patients on hemodialysis. Currently the majority of patients receiving hemodialysis for chronic renal failure are treated as outpatients in hemodialysis units of large hospitals. In most of these units it is the nurses that handle the entire dialysis procedure with little if any direct supervision from physicians. The nurses are also the ones on the health team that have the most contact with the patients. Thus the nurse must have a thorough knowledge of the pathophysiology of renal failure, of the mechanics and technical aspects of the dialyzer, of the expected outcomes and complications of hemodialysis and, particularly, the needs of the hemodialysis patient. The nurses that choose to work with chronic hemodialysis patients can enjoy much satisfaction in assisting in maintaining both a productive life and a long-term relationship with chronic renal failure patients. The nurse makes the difference.


The ailing A-V junction.

The ailing A-V junction. The "ailing A-V junction" includes a spectrum of arrhythmias and conduction defects owing to abnormalities in impulse formation (junctional rhythms), impulse conduction (A-V dissociation), and impulse storage (ventricular pre-excitation). A schema is presented for the identification of these dysrhythmias based upon modern electrophysiologic concepts. Hopefully, precise electrophysiologic diagnosis will yield a rational approach to therapy.


Pacemaker bigeminy: pseudomalfunction.

Pacemaker bigeminy: pseudomalfunction. The first reported unique case of atrial synchronized pacemaker-induced bigeminy is described and related literature is briefly discussed. The arrhythmia reported in this case can be erroneously misinterpreted as a malfunctioning pacemaker unless the physician is fully familiar with the specific nature of the atrial synchronized pacemaker. By recognizing this type of pacemaker bigeminy as an arrhythmia simply related to a normally functioning pacemaker, unnecessary surgery can be avoided.


Vasodilator therapy in acute myocardial infarction. In the context of these studies, the evidence indicates that cardiac performance can improve significantly during vasodilator therapy in acute MI complicated by pump failure. Although the clinical course in uncomplicated patients is good, even without active therapeutic interventions, prognosis in patients with pump failure treated by standard methods (digitalis and diutetics) is discouraging. Hospital mortality approaches "40 per cent in patients with moderately depressed cardiac function and may reach as high as 100 per cent in patients with severe pump failure and/or cardiogenic shock." The evidence presented suggests that early and cautious vasodilator therapy may significantly alter this poor prognosis by its beneficial effects on both LV function and the determinants of myocardial oxygen consumption.


Near-drowning.

Near-drowning. It can be seen that the physiologic changes occurring in near-drowning are complex. The pulmonary changes including edema, shunting, and alterations in surfactant properties cause disturbances in oxygenation and acid-base balance which can have severe consequences for the near-drowning victim if immediate and intelligent treatment is not directed toward their correction. Although blood volume, serum electrolyte, and hematologic changes are generally not severe, they must still be considered. The secondary effects, which make up the clinical situation met with in patients eventually admitted to the hospital, may result in disaster in those who appear to have recovered from the acute episode unless careful vigilance is maintained. The possession of a sound knowledge base related to these aspects is essential in the treatment and care of near-drowning victims.


Arrhythmias in the coronary-care unit. III. Physiologic bases of paroxysmal tachycardia-dependent A-V block. This vignette illustrates the application of electrophysiological principles to the clinical problems of acute trifascicular A-V block occurring during an acute MI. Paroxysmal trifascicular A-V block that occurs transiently during an acute MI can be explained electrophysiologically as being due to tachycardia-dependent or bradycardia-dependent A-V block or both. Tachycardia-dependent A-V block also referred to as phase 3 A-V block is a term used when a premature beat occurring during repolarization of the preceeding beat causes conduction failure. Bradycardia-dependent A-V block or phase 4 block is used to explain the slowing of conduction or block after a longer diastolic interval. Physicians and nurses can improve their care of the critically ill cardiac patient through a better understanding of pathophysiology.


[Changes of antimicrobial susceptibility of anaerobic bacteria from clinical specimens (author's transl)]. The susceptibility to several commonly used antimicrobial agents was examined on approximately 900 isolates of various anaerobes from clinical specimens between October 1965 to May 1975, and the changes of susceptibility were investigated. Antimicrobial agents tested were penicillin G (PC-G), ampicillin (AB-PC), cephaloridine (CER), erythromycin (EM), josamycin (JM), lincomycin (LCM), clindamycin (CLDM), chloramphenicol (CP) and tetracycline (TC). And thiamphenicol (TP) and doxycycline (DOTC) were also used against recently isolated organisms. Minimal inhibitory concentrations (MIC) were determined with agar plate dilution method. The activity of PC-G, AB-PC and CER against almost all strains of anaerobes was good at 12.5 mug/ml or less, but a marked increase of resistant strains of Bacteroides was recognized. EM, JM and LCM had similar activity against anaerobes, and were effective to most strains of anaerobes except for Veillonella, Bacteroides and Fusobacterium. CLDM was highly active against almost all strains of anaerobes, and more active than the two macrolides and LCM. But recently, significant increase in resistant strains was observed among Bacteroides. CP had good activity against all strains of anaerobes, and the increase of resistant strains was not recognized. TP had a similar good activity as CP. While, activity of TC against all anaerobes was poor at the level of 25 mug/ml or more. DOTC was more active than TC against all strains tested.


The physiological effects of inhaling exhaled cigarette smoke in relation to attitude of the nonsmoker. Fifty-six nonsmoking college students were exposed, in a closed environment, for a period of 20 minutes to the exhaled cigarette smoke of two smokers. After intervals of 5, 10, 15 and 20 minutes of being exposed to the exhaled smoke, heart rates and systolic and diastolic blood pressures were monitored. Differences between times on systolic pressure was the only statistically significant finding. The subjects were then divided into two distinct attitude groups: (1) those who objected ("disliked") to being in the presence of cigarette smoke, and (2) those who did not mind ("indifferent") being in the presence of cigarette smoke. Variances attributable to between groups was statistically significantly different for heart rate. The "dislike" group had the higher rate in comparison to the "indifferent" group. Between times was statistically different for both groups for systolic pressure. Between group systolic pressures were not significantly different. As expected, there was no significant finding concerning diastolic changes.