Neuroleptic malignant syndrome in the intensive therapy unit

A case of the neuroleptic malignant syndrome occurred in a 40-year-old male after administration of chlorpromazine while on an Intensive Therapy Unit. Treatment with dantrolene sodium was successful, and a muscle biopsy was examined in the recovery phase of the illness. The importance of this condition and the difficulties in establishing a diagnosis at an early stage in patients on an Intensive Therapy Unit are discussed, along with implications for treatment.     

Continuous observations of the arterial oxygen saturation at rest and during exercise in congenital heart disease

Continuous observations, made with the Millikan compensated circuit oximeter, of the arterial oxygen saturation of nineteen normal subjects and of twenty patients with cyanotic and noncyanotic types of congenital cardiac defects are presented.When normal individuals were given pure oxygen to breathe, their arterial oxygen saturation increased, on the averag,, 2.7 percentage points (to reach 100 per cent saturation) in 1.3 minutes. In fifteen patients with a cyanotic type of congenital cardiac defect, breathing pure oxygen produced an average increase in oximeter saturation reading of 6.2 percentage points attained in an average period of 3.0 minutes.Normal subjects showed practically no change in their arterial oxygen saturation when they changed from the supine to the erect position or when they walked on a treadmill for five minutes at 1.7 miles per hour. Patients with a cyanotic type of congenital cardiac defect showed an average decrease in oximeter saturation reading of 2.4 percentage points when they stood up and 10.9 percentage points when they exercised on the treadmill.It is suggested that the compensated circuit oximeter is of considerable value in studying patients with congenital cardiac defects for two reasons: (1) Its use in conjunction with Van Slyke analyses of arterial blood makes possible a more accurate estimation of the resting arterial oxygen saturation of such patients. (2) Measurements of the arterial oxygen saturation can be made continuously during the performance of various cardiovascular and respiratory function tests, thus greatly facilitating an objective interpretation of the results obtained. Such tests serve as a valuable adjunct in the judging of the efficacy of corrective surgical procedures in these patients.     

Developmental Toxicity of L-Selenomethionine in Macaca fascicularis

Forty pregnant long-tailed macaques were dosed via nasogastricintubation with 0, 25, 150, or 300 µg/kg of L-selenomethionine(Se) daily during organogenesis [Gestational Day (GD) 20–50].Clinical examination of the dams, maternal body weights, sonographicevaluations, clinical chemistry screens, and measures of serumprogesterone and urinary estrone conjugates were used as indicatorsof maternal and fetal status in all animals. The pregnanciesof two to three dams from each dose group were followed untilterm ({small tilde}GD 165); the remainder (N = 7/dose group)were scheduled for hysterotomy on GD 100 ± 2. A standardteratologic evaluation was performed including visceral andskeletal examinations. Fetal liver, kidney, skin, and smooth,cardiac, and skeletal muscles were examined by light microscopy;heart muscle was also evaluated by transmission electron microscopy.Neonates delivered at term remained with the dams and were removedperiodically for morphometric, neurologic, behavorial, and ophthalmologicassessments on Days 1, 8, 15, 22, and 30 of age. Dose-dependentmaternal toxicity as evidenced by anorexia, vomiting, and asignificant reduction in body weight increased with increasingduration of Se exposure. One growth-retarded fetus was recoveredon GD 131 from a compromised dam exposed to 25 /ig/kg-day; oneearly embryonic death (GD 35) and two fetal deaths [GD 68 (followedby maternal death) and GD 123] occurred among animals dosedwith 300 µg/kg-day. Pregnancy loss among treated animalswas not significantly different from concurrent or historicalcontrols. No statistically significant treatment-related effectswere observed at necropsy on GD 100 ± 2. One infant exposedto 150 Mg/kg-day prenatally exhibited a unilateral corticalcataract, which may have been a spontaneous occurrence. Thelimited developmental effects observed and reported teratogenesisin nonmammalian species suggest that comparative pharmacokineticstudies are required before the full public health significanceof elevated Se is understood.     

The danger of freely rocking cradles

Objective: To assist the Adelaide State Coroner with his inquest into the death of two infants in South Australia, and to assist the Department of Public and Consumer Affairs develop Australian Standards for rocking cradles.
Methodology: A sample of each brand of new cradle commercially available in South Australia was examined. Videotapes were made of 11 healthy infants in rocking cradles to examine how they moved and how they reacted in different positions.
Results: Many cradles had insecure locking pins. Infants in a cradle tilted at 10 or greater, face down with the side of the face against the bars, and an arm trapped between the body and bars or through the bars, were unable to obtain a clear airway unless a dummy was in the mouth.
Conclusions: Infants should never be left unattended in freely rocking cradles. Australian Standards should recommend locking pins be bolted into place and that cradles cannot tilt to greater than 5.