Placement of Umbilical Artery Catheters High vs. Low

Placement of umbilical artery catheters was retrospectively reviewed in 181 newborns to evaluate random placement of catheter tip in the "high" position between T₇ and T₉ in the thoracic aorta of 127 infants and in the "low" position below 4 in the abdominal aorta of 54 infants. Group differences in gestational age, asphyxia, hypotension, respiratory disease, duration of catheterization, or infusate type were not significant. Cyanosis or blanching in the low extremities occurred in 67% of the "low" group and 21% of the "high" group ( P < .001). Hematuria occurred in 39% of the "low" group and 21% of the "high" group ( P < .05). High placement appears to have fewer complications. Prompt intervention by neonatal nurse practitioners can help reverse complications that occur during umbilical artery catheterizations.     

Community care of the mentally ill: Implementation of the Saskatchewan Plan

There has been partial implementation of the Saskatchewan Plan to replace the large centralized public mental hospital with small regional centers stressing community care. Intensive treatment of new patients together with intensive rehabilitation of old patients has greatly reduced the accumulation of chronic patients in the Saskatchewan Hospital, Weyburn. As a result there has been a significant fall in the population of the hospital from 1,478 in January 1963 to 443 at the end of 1966. Follow-up studies indicate that patients are doing well in community care and that there are no undue strains on community tolerance. This experience challenges justification of the continued existence of large isolated mental hospitals.Dr. Lafave, a psychiatrist, formerly superintendent of Saskatchewan Hospital, Weyburn, Saskatchewan, CanadaDr. Grunberg, formerly Director of the Psychiatric Services Branch, Saskatchewan Department of Public Health, Regina, SaskatchewanWe are deeply indebted to Dr. R. C. Hunt for his help with the preparation of this paper. Part of the material was originally presented under the title Halving the Population of a Large Psychiatric Hospital Within Two Years at the APA Meeting in Atlantic City in May 1966.     

Uropharmacology: IX. direct-acting smooth muscle stimulants and depressants

Agents which exert their effect on the lower urinary tract by stimulating or depressing the activity of smooth muscle directly are discussed. Many of these drugs also exert other actions on the urinary tract mediated via the autonomic nervous system.