Method of single-lung transplantation in the absence of a left atrial cuff.

A method used clinically for anastomosing the pulmonary veins to the left atrium, in the absence of a left atrial cuff, during single-lung transplantation by reconstructing the atrium with pericardium is described. Postoperative ventilation/perfusion scans show normal pulmonary blood flow.     

Nonoperative management of adult blunt hepatic trauma in a municipal trauma center.

While nonoperative management of blunt hepatic trauma has become the standard of care in children, its use in the adult population is not as well accepted. The purpose of this study was for the authors to review their experience with operative and nonoperative management of adults with blunt hepatic trauma at an urban trauma center. During the past 7 years, 56 adults were found on abdominopelvic computerized tomography or at exploratory laparotomy to have sustained blunt hepatic trauma. Nonoperative management was considered in patients who were hemodynamically stable; had no signs of peritoneal irritation; and had no other intra-abdominal injuries that might require surgical repair. Of the 56 patients, 20 were admitted to the surgical intensive care unit for careful observation. One patient required the administration of blood products and a second underwent laparotomy within 12 hours of presentation for progressive abdominal pain. This patient had a 4-cm liver laceration easily controlled with electrocautery. This review supports the judicious application of nonoperative management in the hemodynamically stable adult with blunt hepatic trauma who is without signs of significant peritoneal irritation or other intra-abdominal injuries that would require surgical repair.     

Improved compliance with quality assurance markers during trauma room resuscitation using trauma nurse specialists.

Trauma nurse specialists (TNS) have been shown to reduce the burden on house staff and to facilitate patient care on trauma wards. In the authors' facility, this expertise has been extended to the emergency department where TNS contribute to an improved standard of care by (1) nursing assessment and injury recognition and (2) continuity of care. As specially trained individuals, TNS expand upon the role of the emergency department staff nurse. The TNS could be shown to improve compliance with trauma resuscitation room protocol and quality assurance markers of direct patient management at a statistically significant level.     

Evaluation and Treatment of Children with Primary Immune Deficiency in the Emergency Department

The potential for morbidity and mortality in patients who have PID with febrile and nonfebrile illness is extremely high. Familiarity with the clinical manifestations of PID and collaboration with a pediatric immunologist are prerequisites for optimal short-term care of these complex patients. Conservative management with empiric broad-spectrum antimicrobials, early and aggressive surgical debridement of abscesses, and admission at a tertiary pediatric care center are often indicated.     

Everyday memory following traumatic brain injury

Residual memory deficits may represent a problem to the everyday functioning of a large number of people, including those who have sustained traumatic brain injury (TBI). The present exploratory study sought to investigate the interrelationships between subjective memory reports, performance on traditional memory tests, and performance on tests of prospective memory. These interrelationships were contrasted between a group of 24 adults who had sustained TBI and a group of 24 matched control subjects. Prospective memory was hypothesized to be indicative of everyday memory functioning. The results provided preliminary evidence that prospective memory tests are sensitive to TBIrelated neurological impairment and, in comparison to traditional tests, may be better indicators of functional memory capacity. This pattern was particularly true for control subjects, possibly because TBI subjects had difficulties in evaluating their memory functioning.     

Positive and negative symptoms covary during clozapine treatment in schizophrenia

Although negative symptoms were traditionally considered to be unresponsive to neuroleptic medication, recent studies have demonstrated that negative symptoms do improve during neuroleptic treatment and that such improvement tends to occur concurrently with improvement in positive symptoms. Clozapine is an atypical neuroleptic that is effective in a significant proportion of otherwise neuroleptic-nonresponsive schizophrenic patients; in contrast to conventional neuroleptics, clozapine is also purported to possess unique efficacy in the amelioration of negative symptoms. How clozapine-associated reduction in negative symptoms relates to change in positive symptoms is not clear. To study the relationship between change in positive and negative symptoms during clozapine treatment, we monitored symptomatology in 40 DSM-III-R schizophrenic patients before and about 8 weeks after a trial of clozapine. Both positive and negative symptoms improved significantly. There was a significant correlation (r = .63,p <.01) between change in positive symptoms and change in negative symptoms; as with conventional neuroleptics, negative symptoms improved concomitantly with positive symptoms during clozapine treatment. Clozapine's apparent greater efficacy on negative symptoms may be related to its greater efficacy on positive symptoms in otherwise neuroleptic-refractory patients and its lesser propensity to cause extrapyramidal side-effects.     

Convulsive Therapy in the Treatment of Mania: McLean Hospital 1973-1986

The authors completed a retrospective chart review of the records of all patients identified with diagnoses of mania and schizoaffective disorder, manic type, who underwent electroconvulsive therapy between the years 1973 and 1986 at McLean Hospital. Ten of 18 manic patients (56%) and 3 of 9 schizoaffective patients (33%) experienced meaningful clinical benefit. The authors report the correlation of treatment and patient factors with outcome and review the literature on the convulsive therapy of mania.     

Lipopolysaccharide induces DNA-synthesis in a sub-population of hemocytes from the swimming crab, Liocarcinus depurator.

The swimming crab, Liocarinus depurator, contains a small proportion of circulating blood cells which enter S-phase in vitro, as revealed by BrdU assay. These cells are enriched within the semigranular cell band produced by density gradient centrifugation on Percoll and their proportion is significantly higher in blood samples taken from crabs injected 3h previously with lipopolysaccharide (LPS). The occurrence of these cells does not persist as blood samples taken 12h post-injection show similar numbers of these cells to those from saline-treated and untreated controls. However, their appearance appears to be dose related; hemolymph from animals given 15 microg LPS per animal contains greater numbers than that from animals given LPS doses of 0.15 or 0.015 microg per animal. Estimation of the probable number of these cells per ml of the hemolymph, taking into account cell viability and changes in the size of the semigranular cell pool, indicates that they are very rare, comprising merely ca 0.06% of the total cell count. Notwithstanding, this still represents a baseline population in the region of 1.25 x 10(4) ml-1. More importantly, their number rises, approximately 11-fold to ca 14 x 10(4) ml-1 of hemolymph by 3h of injection of LPS. These results show that certain hemocytes from a brachyuran crab can synthesise DNA in vitro, and offers evidence that these cells constitute a rare but distinct sub-population of hemocytes that co-migrate with the semigranular cells during density gradient centrifugation. Since the cells received the stimulus to enter S-phase in vivo, the response must represent one of the mechanisms used by decapods to restore the hemocyte number in the circulation after non-self challenge.     

Chromatic sensitivity and spatial organization of cat visual cortical cells: cone-rod interaction

1. Colour sensitivity and spatial organization were determined for the dominant-eye receptive fields of thirty-eight simple or complex cells in cat primary visual vortex. Receptive fields were all from the cortical area associated with central vision. Each cell was investigated with threshold or suprathreshold monochromatic stimuli, under scotopic, low and high mesopic adaptation.2. The Purkinje shift, well defined for all units, was consistent with dual input from each of only two receptor mechanisms, viz. 556 nm cones and 500 nm rods. With change of adaptation level there was a systematic change in the peak sensitivity of spectral response curves to suprathreshold monochromatic stimuli, equated for quantum flux but of different wave-length. Equally with change of adaptation, the relative shift in threshold between wave-lengths selective for cone or rod activation was in close agreement with the change predicted from the Dartnall nomogram curves for visual pigments 556 and 507 respectively.3. For ganglion cells with concentric fields rod input derives from a spatially larger area than cone input. Rod field centre and rod field surround are substantially larger than the corresponding centre and surround for cones (Andrews & Hammond, 1970b). For cortical cells a conclusive comparable change could only be demonstrated for one simple unit. Its receptive field consisted of a horizontal excitatory stripe with asymmetric inhibitory flanks. When light-adapted the weaker, upper flank was functionally undetectable, indicative of purely rod input to this sideband, and the preference for upward movement was enhanced.4. No difference in receptive field configuration, or in spatial extent of input mediated by cones or by rods, was detected for any other unit. The discrepancy between retinal and cortical findings is discussed. It is inferred that cortical fields are compounded essentially by convergent input from geniculate cell field-centres.     

Traumatic Memories: Empirical Foundations, Forensic and Clinical Implications

This article reviews empirical research on memories for negative personal experiences among adults. It examines basic concepts (including neural underpinnings), theoretical models of the affect-memory relationship, and data from three sources: victims or witnesses to crimes and atrocities, "flashbulb memories" for traumatic events, and laboratory simulations of shocking experiences. Evidence suggests that memories for traumatic experiences contain more central than peripheral detail, are reasonably accurate and well-retained for very long periods, but are not completely indelible. Assertions of eyewitness memory's vulnerability to change through suggestion have overstated the evidence. Forensic and clinical implications are discussed and a plea issued for more study of the memory phenomena that characterize posttraumatic stress disorder (PTSD) and are the focus of trauma survivors' treatment.