First Aid Treatment of Electric Shock

The mode of death was determined in the 82 electrocutions as being either asphyxial or cardiac in type. Using the information obtained from the electrocutions, the functional response in the 7,724 electrical accidents was determined. From this, the relative success of the first aid treatments was decided.

External cardiac massage with mouth-to-mouth artificial respiration was a failure even when applied to the cases with ventricular fibrillation. Only four cases of recovery from ventricular fibrillation following electric shock are known. Mouth-to-mouth artificial respiration compared very unfavorably with the older manual methods.

It is recommended that the first aid treatment of electric shock be reevaluated. The recommended treatment should consist of two blows on the chest followed by a manual method of artificial respiration. In electric shock, external cardiac massage with mouth-to-mouth artificial respiration should not be recommended for use by first aid personnel.     

Ambulatory bio-feedback for stress incontinence exercise regimes: a novel development of the perineometer

Stress incontinence is a debilitating condition affecting a large proportion of the female population. Pelvic floor exercising with the aid of bio-feedback is well established as an effective treatment regime. However, current monitoring devices are restrictive in the way they may be employed in community-based therapy. A prototype unit is described, which is both compact and accurate and suitable for ambulatory monitoring of vaginal pressure. This device is suitable for self-help domiciliary regimes and may also be used as an accurate yardstick to judge individual response to therapy. Conceptual changes in health-care provision are leading to greater emphasis on community-centred care for non-acute conditions such as stress incontinence. Development of more appropriate scientific and technological support is likely to have a fundamental role in the success of such schemes.     

Monitoring EEG frequency and amplitude during cardiac surgery

Changes in the electroencephalograms of patients undergoing cardiac surgery with cardiopulmonary bypass were studied. An analysis technique with a simple display of amplitude and frequency within the traditional bands was used. During the course of an operation, there can be dramatic changes in frequency contribution with little or no change in overall EEG amplitude. Evaluation of the results shows that this technique clearly draws attention to periods of EEG change, and examples are given.     

Effects of daily high-intensity exercise on myocardial perfusion in angina pectoris

Forty male patients with chronic stable angina pectoris and no prior myocardial infarction were studied by planar thallium scintigraphy with use of circumferential profile analysis. Ischemic defects were assessed by measuring degrees of circumference involved and area of defect. Data were collected for 3 vascular regions in each of 3 views (anterior, 45 ° and 65 ° left anterior oblique projection). Patients were then randomized to exercise and control groups, the former training for a period of 1 year using the Canadian Airforce plan for physical fitness. After 1 year, both groups were restudied. Exercise training produced a 34% reduction in degrees of ischemia overall (p < 0.02), the most significant change being seen on the anterior view (72 ° ± 59 ° before vs 30 ° ± 35 ° after training). Regional analysis showed markedly improved perfusion anterolaterally and apically on the anterior view and anteroseptally on the 65 ° left anterior oblique view. These improvements support the hypothesis that exercise training improves myocardial perfusion by enhanced collateral function.     

The effects of deliberate hypotension and foot down tilt on the incidence of deep vein thrombosis during plastic surgical operations: a pilot survey

The incidence of postoperative deep vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.     

The long‐term outcome of treated high‐risk nonmuscle‐invasive bladder cancer

BACKGROUND:

The treatment of high‐risk nonmuscle‐invasive bladder cancer (NMIBC) is difficult given its unpredictable natural history and patient comorbidities. Because current case series are mostly limited in size, the authors report the outcomes from a large, single‐center series.

METHODS:

The authors reviewed all patients with primary, high‐risk NMIBC at their institution from 1994 to 2010. Outcomes were matched with clinicopathologic data. Patients who had muscle invasion within 6 months or had insufficient follow‐up (<6 months) were excluded. Correlations were analyzed using multivariable Cox regression and log‐rank analysis (2‐sided; P < .05).

RESULTS:

In total, 712 patients (median age, 73.7 years) were included. Progression to muscle invasion occurred in 110 patients (15.8%; 95% confidence interval [CI], 13%‐18.3%) at a median of 17.2 months (interquartile range, 8.9‐35.8 months), including 26.5% (95% CI, 22.2%‐31.3%) of the 366 patients who had >5 years follow‐up. Progression was associated with age (hazard ratio [HR], 1.04; P = .007), dysplastic urothelium (HR, 1.6; P = .003), urothelial cell carcinoma variants (HR, 3.2; P = .001), and recurrence (HR, 18.3; P < .001). Disease‐specific mortality occurred in 134 patients (18.8%; 95% CI, 16.1%‐21.9%) at a median of 28 months (interquartile range, 15‐45 months), including 28.7% (95% CI, 24.5%‐33.3%) of those who had 5 years of follow‐up. Disease‐specific mortality was associated with age (HR, 1.1; P < .001), stage (HR, 1.7; P = .003), dysplasia (HR, 1.3; P = .05), and progression (HR, 5.2; P < .001). Neither progression nor disease‐specific mortality were associated with the receipt of bacillus Calmette‐Guerin (P > .6).

CONCLUSIONS:

Within a program of conservative treatment, progression of high‐risk NMIBC was associated with a poor prognosis. Surveillance and bacillus Calmette‐Guerin were ineffective in altering the natural history of this disease. The authors concluded that the time has come to rethink the paradigm of management of this disease. Cancer 2012. © 2012 American Cancer Society.     

Steady-state visual evoked cortical potentials from stimulation of visual field quadrants

The effects of check size and stimulus size were investigated to optimize the steady-state visual evoked cortical potentials from pattern-reversal stimulation of the visual field quadrants. Check sizes of 15, 30, 60, 90, 120 and 180 were investigated at a pattern reversal rate of 11.6 per second for field sizes varying from 2° × 2° to 24° × 24°. The visual evoked cortical potentials were recorded from mid occipital, right occipital and left occipital positions. In the inferonasal quadrant, the largest amplitudes were obtained with 30 and 60 check sizes; however, for these check sizes, the visual evoked cortical potential yielded limited additional information for field sizes greater than 4° × 4° and 6° × 6°, respectively. When a field size of 12° × 12° was investigated, a 90 check size was optimal. The results indicated hat, with the above recording positions and check sizes of 15 to 120, there is an optimal number of pattern elements, 40 to 100, for stimulation of the inferonasal quadrant. This should be taken into account when a check size is selected to investigate a field quadrant of a particular size. Digital signal processing techniques were applied to analyze the visual evoked cortical potential, and the system shows promise for objective examination of the visual field.