Effect of increases in afterload before and after coronary occlusion in awake dogs.

Ventricular function curves relating stroke work and left ventricular end-diastolic pressure were generated in awake dogs during increases in preload produced by infusion of fluid and during increases in afterload produced by administration of phenylephrine. The ventricular function curves produced by preloading were steeply upsloping whereas those produced by afterloading were essentially horizontal. Coronary occlusion produced downward displacement of these horizontal curves, but no change in slope. This increases in afterload did not help to demonstrate the functional impairment produced by coronary occlusion.     

Systemic absorption of noxythiolin from the pleural cavity in man and in the rabbit.

Systemic side-effects during irrigation of body cavities with the antiseptic noxythiolin (Noxyflex) have not previously been reported. In two patients undergoing intrapleural lavage with 1% noxythiolin, anorexia and nausea with or without vomiting were observed which suggested systemic absorption. This was confirmed by chemical assays of serum from these patients. The process of absorption was studied in rabbits by injection of noxythiolin into the pleural or peritoneal cavity. Serum levels reached a peak at one to two hours indicating rapid entry into the bloodstream, declined slowly over seven hours, and reached zero before 24 hours. Although side-effects resulted from systemic absorption of noxythiolin during irrigation of the pleural cavity, they were mild and did not contra-indicate the use of noxythiolin as an irrigant. Awareness of the mechanism of side-effects of noxythiolin provides a rational basis for management of symptoms through reduction of the volume or frequency of irrigation.     

Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy

AIM:To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol(4-L SF-PEG)vs 2-L polyethylene glycol solution with ascorbic acid(2-L PEG+Asc)in patients undergoing afternoon colonoscopy.METHODS:206 patients(mean age 56.7 years,61%male)undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG(n=104)or 2-L PEG+Asc solution(n=102).Colonoscopies were performed by two blinded endoscopists.Bowel preparation was graded using the Ottawa scale.Each participant completed a satisfaction and side effect survey.RESULTS:There was no difference in patient demographics amongst groups.4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG+Asc,4.2 vs4.9(P=0.0186);left colon:1.33 vs 1.57 respectively(P=0.0224),right colon:1.38 vs 1.63 respectively(P=0.0097).No difference in Ottawa scores was found for the mid colon or amount of fluid.Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating:23.1%vs 11.5%(P=0.0235).Overall polyp detection,adenomatous polyp and advanced adenoma detection rates were similar between the two groups.CONCLUSION:Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG+Asc bowel preparation for afternoon colonoscopy.Thus,future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use4-L SF-PEG as the standard comparator.     

Bone marrow transplantation for refractory acute leukemia in 34 patients with identical twins

Thirty-four patients aged 4-67 yr (median 17) with acute lymphocytic leukemia (ALL) (18 patients) or acute nonlymphocytic leukemia (ANL) (16 patients) who failed to enter complete remission (CR) or relapsed on conventional chemotherapy were treated with cyclophosphamide (CY), 60 mg/kg/day for 2 days, 1000 rad total body irradiation, and a marrow transplant from a genotypically identical normal twin. Sixteen of the patients received additional chemotherapy within the week before CY. After the transplant, 23 patients received immunotherapy consisting of killed autologous leukemic cells and/or normal twin peripheral blood lymphocytes, 16 as part of a prospectively randomized study. One moribund patient died before engraftment. Nine patients (6 ALL, 3 ANL) continued to have detectable leukemic cells. Twenty-four patients (70%) achieved CR. One of them died of viral hepatitis at 1 mo and another of viral interstitial pneumonitis at 4 mo in CR. Fourteen patients (7 ALL, 7 ANL) relapsed 2-16 mo (median 4) after transplantation. However, 8 patients (24%) (3 ALL, 5 ANL) remain in CR without any maintenance chemotherapy at 29-103 mo (median 80) after the transplant. The end results were not signficantly influenced by the type of leukemia, the immediated pre-CY chemotherapy, or the immunotherapy. The results show that this approach, even when applied to endstage patients with acute leukemia in relapse, causes tolerable morbidity, rare nonleukemic deaths, and frequent remissions, some of which represent cures.     

China’s great wall,Israel’s Bar Lev Line,and passive infectious disease surveillance

Emerging infectious diseases are some of modern society’s greatest threats. Like some great construction efforts designed to protect mankind, current public health measures against these emerging pathogens have not always been successful. This paper highlights the importance of embracing new interdisciplinary approaches towards emerging pathogen threats. One such approach, termed One Health, is quickly being embraced by professional organizations and public health institutions across the world as a way forward. This paper briefly discusses the above problems and preliminary steps taken by Chinese academic institutions to embrace the One Health approach.     

Hospital costs and return to work after coronary bypass surgery

A study to assess the cost and some of the benefits of coronary bypass surgery was carried out at the Alfred Hospital, Melbourne. The minimum cost to the hospital of a typical coronary bypass graft procedure in 1980 was estimated to be $4700. The benefit of the procedure in terms of symptomatic relief and return to work was assessed by means of questionnaires. In the working-age group (55 years and under) of 591 patients, assessed from two to nine years after surgery, 68% of patients were working. In a group of 100 patients, aged 55 years and under, and interviewed from one to two years after surgery, 56 patients were working before surgery, but only 16 of these at full capacity. After surgery, 78 patients were working; 64 of these at full capacity. The cost of a coronary bypass graft operation is considerable, but this is offset in the majority of patients in the working-age group by a return to gainful employment.     

Extracorporeal adsorption of endotoxin.

In a porcine endotoxin shock model using a continuous intravenous endotoxin infusion of 250 ng/kg body weight per hour, the cardiorespiratory and hematologic parameters were studied while applying a new on-line polymyxin B immobilized adsorption system. This preliminary report shows that the new adsorbent can remove endotoxin selectively from the circulation and confers a good amount of protection from endotoxin-induced cardiopulmonary decompensation as well as hematologic alterations. Survival time could be extended from 216 min to 313 min. Whereas cardiac output and mean arterial pressure declined critically after 3 h in the controls, the treated group remained stable for another 3 h. These data show that endotoxin adsorption by polymyxin B coupled covalently to acrylic spheres as an adjunctive on-line measure in the septic syndrome seems feasible.