Search

Background.Electronic surveillance systems (ESSs) that utilize existing information in databases are more efficient than conventional infection surveillance methods.Objective.To develop an ESS for monitoring bloodstream infections (BSIs) and assess whether data obtained from the ESS were in agreement with data obtained by traditional manual medical-record review.Methods.An ESS was developed by linking data from regional laboratory and hospital administrative databases. Definitions for excluding BSI episodes representing contamination and duplicate episodes were developed and applied. Infections were classified as nosocomial infections, healthcare-associated community-onset infections, or community-acquired infections. For a random sample of episodes, data in the ESS were compared with data obtained by independent medical chart review.Results.From the records of the 306 patients whose infections were selected for comparative review, the ESS identified 323 episodes of BSI, of which 107 (33%) were classified as healthcare-associated community-onset infections, 108 (33%) were classified as community-acquired infections, 107 (33%) were classified as nosocomial infections, and 1 (0.3%) could not be classified. In comparison, 310 episodes were identified by use of medical chart review, of which 116 (37%) were classified as healthcare-associated community-onset infections, 95 (31%) as community-acquired infections, and 99 (32%) as nosocomial infections. For 302 episodes of BSI, there was concordance between the findings of the ESS and those of traditional manual chart review. Of the additional 21 discordant episodes that were identified by use of the ESS, 17 (81%) were classified as representing isolation of skin contaminants, by use of chart review. Of the additional 8 discordant episodes further identified by use of chart review, most were classified as repeat or polymicrobial episodes of disease. There was an overall 85% agreement between the findings of the ESS and those of chart review (K = 0.78; standard error, K = 0.04) for classification according to location of acquisition.Conclusion.Our novel ESS allows episodes of BSI to be identified and classified with a high degree of accuracy. This system requires validation in other cohorts and settings.

Background: Venlafaxine is a structurally novel antidepressant that is believed to potentiate monoamine activity in the central nervous system. In preclinical studies, venlafaxine was shown to inhibit the neuronal uptake of serotonin and norepinephrine and, to a lesser degree, dopamine reuptake, but was without effect on monoamine oxidase (MAO) activity. Clinical trial results from similar to3000 patients suggest that venlafaxine is a safe and effective antidepressant with the potential to invoke an early onset of clinical activity. Objective: The purpose of this 8-week, open-label, uncontrolled, multi-center, Phase IV study was to examine the extent of remission and symptom relief in outpatients and inpatients with major depressive disorder treated with venlafaxine. Methods: This study was conducted at 12 centers across Belgium and Luxembourg. Consecutive, severely depressed inpatients and moderately depressed outpatients aged 18 to 70 years were eligible. Patients were administered open-label venlafaxine for 8 weeks. Dosing was initiated at venlafaxine 75 mg/d (37.5 mg BID), with dose adjustments made throughout the study, to a maximum daily dose of 375 mg for inpatients and 225 mg for outpatients. Results were measured using the Hamilton Depression (HAM-D) scale, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impression (CGI) scale. Results: A total of 149 consecutive patients (84 females, 65 males; mean age, 46.5 years; 88 outpatients, 61 inpatients) were enrolled; the intent-to-treat (ITT) population comprised 144 patients (84 outpatients, 60 inpatients); 111 patients (64 outpatients, 47 inpatients) completed the study. At the week 8 visit, 71.3% of patients (77/108) were considered to be responders according to the HAM-D scale; 73.8% (79/107) according to the MADRS; and 78.7% (85/108) according to the CGI scale. A sustained response was achieved in 33.3% of the ITT population (48/144), and at week 8, 50.8% of outpatients (32/63) and 37.8% of inpatients (17/45) were in remission according to the HAM-D scale. Venlafaxine was well tolerated at all doses, with the most frequently experienced adverse events (AEs) being nausea, sweating, and headache. Fewer inpatients than outpatients reported greater than or equal to 1 AE (57.4% [35/61] and 73.9% [65/88], respectively), despite receiving a higher maximum daily dose of venlafaxine. Conclusion: The results of this study indicate that venlafaxine was a tolerable and effective antidepressant in both outpatients and inpatients, with a significant proportion of patients achieving remission.

Much attention is being focused on the availability and use of non-fuel minerals in the United States. Because of the rapid increase in demand since 1978, titanium has been one of the much-publicized metals in this group. Sponge producers are now expanding sponge manufacturing plants to meet this greater demand, and it now appears that there could be a surplus of sponge in 1981. A delay in airplane purchases caused by severe operating losses of the airlines could have a significant effect on mill product shipments in 1981. However, there is no reason to believe that titanium has reached maturity as a structural aerospace or industrial metal. While it is unreasonable to anticipate that demand will continue to grow at the same rate experienced between 1978 and 1980, new greenfield capacity will nevertheless be required in the early 1980s. Two basic issues must be resolved before such ventures become reality: 1) choice of process; and 2) method for financing, either public or private. Both will be the subject of study and debate in 1981.

The authors describe the probable role that psychologists will play in the training of primary health care providers for the delivery of mental health services. This concept is based upon the expectation that the primary care practitioners will soon be assuming an expanded role requiring the incorporation of more specialist knowledge during his professional training period and that the psychologist will likely be the facilitator for this process in the mental health area of training.

The Remotely Piloted Vehicle, or RPV, is here as a viable element in the arsenal of aerospace power. The astute student of air power, the United States Air Force planner, and we in the research and development community are well aware of the current and potential applications of the RPV in fulfilling aerospace missions.

Details of a new concept in the design of the hydraulic system for medium-lift navigation locks are presented. The new design, the multi-port system, combines the lower costs of construction with a lock filling time of approximately 10 min and without the manifestation of objectional disturbances in the lock chamber during operation. The system features three rows of closely spaced 8-in. diameter ports, with slightly bell-mount ends connecting the culverts to longitudinal concrete trenches that extend along each lock wall. The ports are prefabricated from standard pipe components, adding to the cost savings in construction. The trenches are 3-ft wide and 6-ft deeper than the excavated lock floor.

Each phase of the supersonic-compressor program conducted at the NACA Lewis Laboratory is reviewed with a discussion of the objectives and results of the various experiments and associated analyses. Particular emphasis is placed on the state of development at the time the work was done, the advancement resulting due to this program, and the association of the several phases of the research program. The assembling of all the reference material of this program serves as a background for further work in the area of supersonic compressors or related fields. Included in this paper are a few comments on the results of the supersonic-compressor research program and a mention of possible future applications.

1. Renal shock with oliguria or anuria after unilateral kidney operation has not been produced in seventeen rabbits. 2. For a period of 2 hours after unilateral nephrectomy the one kidney carries on a proportionate part of the work of the previous two kidneys, and there is no evidence of functional compensation. 3. There is a general correlation between open glomeruli and urine output.

E PIDERMOID tumors involving the spinal cord are quite rare. 4,'~,8,~',11,1:* The opinion of the majority of authors is that these tumors arise from displaced normallydeveloping somatic cells. Recently, Van Gilder and Schwartz TM reported a method of producing epidermoid and dermoid tumors in the albino rat by direct skin implantation along the neuraxis; this evidence supports the concepts of a congenital origin or subsequent development after repeated lumbar puncture. The vast majority of intraspinal epidermoid tumors are intradural and extramedullary. They are commonly associated with a dermal sinus and occur usually in the lumbosacral segments. In 1962, Manno, et al.fl in a review of all reported cases, found only five tumors that they classified as being intramedullary. However, a critical review of these cases 4-3,~~ revealed that these were confined to the conus medullaris and extended down the dural sac; hence, they were not truly intramedullary. Gross 6 reported a case in which the tumor initially appeared intradurally and upon reoperation years later was found within the substance of the cord. King, 7 in 1957, reported a case quite similar to the ones we are about to describe and stated that he was unable to locate a similar case in the literature. In none of these series has a long-term follow-up been reported giving the results of operative management of a recurrent tumor or the effect of radiotherapy upon such a lesion. We are able to provide these data in the following cases.

It has been postulated that alterations in the intravascular distribution of blood affect antidiuretic hormone (ADH) secretion in man. The studies reported here were designed to alter blood distribution by thermal and by positional change to test this thesis.HUMAN BLOOD ADH LEVELS HAVE BEEN SHOWN TO VARY WITH POSITION: a mean value of 0.4 +/- 0.6 (SD) muU/ml was obtained while the subject was supine, a value of 1.4 +/- 0.7 muU/ml while sitting, and 3.1 +/- 1.5 muU/ml while standing. In 79 control subjects, sitting comfortably for 30 min in a normal environment, a blood ADH level of 1.65 +/- 0.63 muU/ml was found. It is suggested that subjects assume this position during experiments in which blood is drawn for measurement of ADH levels.In eight seated subjects the ADH level rose from 1.6 +/- 0.4 to 5.2 +/- 0.8 muU/ml after a 2 hr exposure at 50 degrees C and fell to 1.0 +/- 0.26 muU/ml within 15 min at 26 degrees C.Six subjects with a mean ADH level of 2.2 +/- 0.58 muU/ml sat quietly in the cold (13 degrees C) for 1 hr, and the ADH level fell to 1.2 +/- 0.36 muU/ml. After 15 min at 26 degrees C, the level rose to 3.1 +/- 0.78 muU/ml. The serum sodium and osmolal concentrations remained constant during all studies.Water, sodium, and total solute excretion decreased during exposure to the heat, whereas the urine to plasma (U/P) osmolal ratio increased. During cold exposure, water, sodium, and total solute excretion increased, and there was a decrease in the U/P osmolal ratio.These data are interpreted as indicating that changes in activity of intrathoracic stretch receptors, in response to redistribution of blood, alter ADH secretion independently of changes in serum osmolality. The rapidity of change of blood ADH concentration indicates a great sensitivity and a prime functional role for the "volume receptors" in the regulation of ADH secretion.

Arachnoiditis occurring after myelography is well recognized and the mechanism is understood. Three cases of arachnoiditis caused by oily myelographic contrast media are presented. This complication of myelography may occur even if recognized precautions are observed. The general problem of encystment of dye with a chronic inflammatory process, fibrosis and granuloma formation is described.

Techniques were developed with the electric dynamometers to: (1) measure vehicle driveline and tire losses on the emission rolls; and (2) establish the windage and friction settings required to match the dynamometer load to the actual road load or other desired load conditions. Vehicle driveline and tire losses were measured on 33 similar front wheel drive vehicles equipped with the same tire size. The total losses averaged 6.2 HP at 50 MPH and ranged from 4.8 to 8.4 with a standard deviation of .75 HP. With the standard dynamometer load used for the FTP test with that vehicle, the plus or minus .75 HP represents a 11% change in load and about a 5% effect on fuel economy. The difference between the maximum and minimum driveline and tire losses measured would result in a 27% change in load and an approximate 11% change in fuel economy. Tires accounted for the largest percentage of the total losses while the brake systems caused the greatest variations. Measurement of the vehicle losses and the ability to match the dynamometer to a desired load would allow testing all vehicles in a given program at the same load conditions. This would eliminate the effect of variations in losses when comparing the merits of various development designs and calibrations.

Research was continued on the polyoptic sealing of hydrogen thyratron tubes. Life tests were continued. All tubes required to have been made on the automatic exhaust machine have either completed life test or are being tested. The present results show no essential difference in survival rates between the 2 types of seals. No further work on variations in sealing techniques was done but consideration is given to an extension of the high temperature bake process investigation. Initial work was begun in determining the proper techniques for polyoptic sealing on trolley exhaust.

ELECTROMYOGRAPHY, long used in physiologic research, has recently emerged as a clinical diagnostic method with a high degree of accuracy and widespread clinical application. With the recent advances in electronics it is now possible to produce commercially a sensitive instrument which utilizes a needle electrode placed directly into a denervated muscle and which records characteristic action potentials by means of a cathode ray oscilloscope. Such an instrument1has been used in this study to determine the exact location of lesions causing compression of spinal nerve roots. This localization depends on the accurate detection of the action potentials of denervation fibrillation, whereas heretofore electromyographic localization of a lesion of a single nerve root has depended on the detection of fasciculation by the use of percutaneous electrodes, a much less accurate method (page 96). Visible fibrillation of a denervated muscle was first described by Schiff in 1851, when he sectioned the

The Sachs-Georgi reaction depends on the visible flocculation of a cholesterinized alcoholic extract of beef heart on its incubation with specific serums or spinal fluid. Drs. Sachs and Georgi 1 in their original paper claimed a reliability equal to, or even greater than, the Wassermann reaction in distinguishing syphilitic from nonsyphilitic serums, but in a later paper they 2 somewhat modified this view. Several other investigators, Georgi, 3 Plant, 4 Nathan, 5 Levinson and Petersen, 6 Logan, 7 with slight modifications of the original technic, report results favoring the accuracy of the reaction as an additional method for the serodiagnosis of syphilis. In reviewing the literature, it is noted that most of the results with the Sachs-Georgi reaction are recorded on serums. As a reliable estimate of the value of the reaction can only be judged after the findings of several laboratory workers are collected, the present series of comparisons

Interest in the relation of renal function and arterial hypertension, recognized since the time of Bright, has been greatly stimulated by the experimental work of Goldblatt and his associates,1who were able to produce permanent hypertension in animals by partial constriction of the main renal arteries. The experiments of Goldblatt and his co-workers have been successfully repeated in different ways by many authors, as cited by Goldblatt,2and the importance of normal renal circulation for the maintenance of normal blood pressure in animals appears to be an established fact. Page and his associates3and Munoz and Braun-Menendez and their associates,4reviving the original work of Tigerstedt and Bergman,5have offered further evidence of the importance of the renal circulation in hypertension by demonstrating the production in the kidney of a pressor substance, which they have called angiotonin, or hypertensin. The amount of angiotonin produced is increased when

The use of the electromyograph (EMG) in clinical diagnosis is now firmly established. Its application in human neurological disorders was described in 1938 by Denny-Brown and Pennybacker.1It has been, however, only in the past 12 years that the specific value of the instrument has gained widespread recognition.* This field of clinical electromyography has been covered in excellent fashion by Marinacci in his monograph published in 1955. All workers have noted that the EMG is a laboratory instrument which supplements, but obviously cannot replace, accurate clinical examinations. The technical accuracy of electromyography depends on two primary factors: a trained electromyographer and an instrument of high fidelity. This instrument should consist of a cathode ray oscilloscope, a sensitive sound amplifier, and methods for permanently recording the electromyogram obtained (tape recording and synchronized cameras). A fine monopolar needle electrode inserted directly into skeletal muscle is used to pick up normal or

The evaluation of any surgical procedure in the treatment of a systemic disease can be reached only after an adequate period of carefully controlled and unbiased trial. This trial demands that certain fundamental conditions be strictly adhered to: 1. The surgical procedure must be utilized in a large number of cases and must remain identical in all cases. 2. The selection of cases must be based on constant criteria, fully investigated in each case before operation. 3. Postoperative results must be judged by the same criteria in an identical manner and on as many occasions as possible. 4. All cases in which operation is performed must be included in the results. 5. The trial must extend over a sufficiently long period of time to eliminate mere temporary effect of the operative, procedure. It is our purpose in this paper to present evidence that the surgical treatment of hypertension has fulfilled

Intensive search through the literature on tumors of the spinal cord reveals a surprisingly incomplete knowledge of the various pathologic types of intramedullary lesions in relation to surgical treatment and postoperative course. It is the purpose of this paper to present as complete an analysis as possible of 68 consecutive cases of intramedullary lesions of the spinal cord in which operation was performed at the University Hospital between 1925 and 1943. In 35 of these cases the lesion was a tumor verified by pathologic diagnosis; in 4 cases tissue for histopathologic study was not obtained, and in 5 cases a hemangiomatous tumor, presenting both extramedullary and intramedullary characteristics, was observed. In 4 cases the clinical diagnosis of intramedullary lesion was without confirmation by operation, and in 20 cases syringomyelia was present. We have been able to make follow-up observations to date, until death or for periods longer than one year

In a previous paper1we presented the results of 350 consecutive cases of hypertension in which treatment was by bilateral supradiaphragmatic splanchnicectomy and lower dorsal sympathetic ganglionectomy. Our purpose in the present paper is to compare the results of this operation with those of an analogous series in which treatment was by medical means alone. The first 76 consecutive cases of our main series were chosen for this study because the postoperative period of from five to seven years seemed adequate to evaluate the results fully and because this time period lends itself to comparative study. A careful review of the literature concerning the results of therapy and the mortality rate in hypertension reveals an unexpected degree of confusion. This confusion results chiefly from inadequate classification of the cases before and after therapy and an inadequate period of observation after the therapy. The fundamental question in the mind of

In a previous paper1we reported the results of the determination of effective renal blood flow, glomerular filtration rate and tubular excretory mass by the diodrast and inulin clearance methods in 20 patients with arterial hypertension. It was concluded that arterial hypertension is associated with renal ischemia and that the reduction of blood supply to the kidney shows a definite correlation with the severity of the disease, as indicated by the changes, in the eyegrounds, the degree of thickening of the systemic arterioles, the renal function and the elevation of systolic and diastolic blood pressures. While this previous paper was in press, the results of similar studies were published by other investigators2who also concluded that the rate of renal blood flow is decreased in most cases of hypertension. The purpose of this paper is to report the results of the determination of effective renal blood flow, glomerular

To the Editor:— May we first express our appreciation to Dr. Weiss for the keen interest he has shown in our paper and for his penetrating criticisms, indicating a thorough knowledge of the therapeutics of hypertension. The question is not at all a matter of "surgical versus medical treatment of hypertension" but rather of determining the point in the progress of the disease when surgical treatment should be called on to replace accepted medical treatment which has failed. In confirmation of this point of view may we agree with the author that we do not see "the kinds of patients who comprise most of the cases seen in private practice" but instead are asked to treat those patients who have not gained relief after a thorough trial of medical treatment. The term "versus" arises only when persistent medical therapy has proved inadequate for too long and has allowed irreversible damage

ELECTROMYOGRAPHIC 1 investigations of the myotonias reveal a dramatic and pathognomonic picture. Thus, in patients with myotonia congenita (Thomsen's disease), dystrophia myotonica (myotonia atrophica), and myotonia acquisita (Talma's disease) 2 we have found identical abnormal action potentials generated in the skeletal musculature. These abnormal action potentials are elicited from a myotonic muscle immediately when the needle electrode is inserted into such a muscle. Large bursts of spontaneous, involuntary motor-unit voltages are seen in the cathode-ray oscilloscope, accompanied by a high-pitched, pulsating sound. Both the abnormal wave forms and the sounds reach a peak immediately and then gradually recede to an isoelectric level and silence. The slightest motion of the needle electrode in the hyperirritable muscle reproduces this characteristic response, which is seen and heard only in a myotonic muscle. Voluntary motion of the muscle produces normal, simple motor-unit contraction voltages, which persist, however, for a considerable period after motor relaxation

Chronic constipation as an exciting factor is a frequent complaint of patients with epileptiform seizures. It is noted by clinicians that attacks may be controlled or decreased in frequency by careful catharsis. 1 Whether constipation is an exciting cause of the attacks in patients with epilepsy is not known as an established fact. Numerous cases have been reported in which patients have been entirely relieved of their seizures following surgical procedure, i. e., colostomy, 2 the operation being indicated by the findings of chronic colonic stasis, or by daily rectal injections. It therefore seemed desirable to study the amount of colonic stasis found in a series of epileptic patients entering the University Hospital for treatment. These were, so far as any gastro-intestinal symptoms were concerned, entirely unselected. The findings were distinctly surprising, and cast doubt on the rationality of indiscriminate gastro-intestinal operations in these cases. In most of the modern textbooks, when