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Left main coronary angioplasty is associated with high risk because of interruption of blood flow to much of the left ventricle during balloon inflation. An "autoperfusion" balloon angioplasty catheter that allows blood to flow passively distal to an inflated balloon was tested in dogs and compared with inflations with standard balloon catheters. During 3 min occlusions of the left main coronary artery with the autoperfusion catheter, regional myocardial blood flow was preserved at 0.60 +/- 0.14 ml/min/g, compared with 0.07 +/- 0.03 ml/min/g during inflation with standard balloon catheters (P less than 0.01). Similarly, at the end of 3 min of inflation, left ventricular systolic pressure and dP/dt were maintained with autoperfusion catheter inflation, but they were severely depressed after standard angioplasty balloon inflation. All seven dogs survived autoperfusion balloon inflation, whereas five of seven developed sustained ventricular tachycardia and/or ventricular fibrillation during or after standard balloon inflation. Thus, distal blood flow, hemodynamics, and survival were preserved during autoperfusion balloon inflation in the left main coronary artery.

Inotropic and vasodilator therapy for congestive heart failure improve left ventricular systolic performance by different mechanisms. However, the nature and extent to which diastolic filling is altered have not been well described. Acute severe left ventricular dysfunction was induced in 21 dogs by severe left ventricular global ischemia produced by left main coronary artery microsphere embolization until left ventricular end-diastolic pressure was greater than or equal to 18 mm Hg. Dobutamine was infused in seven dogs until the peak positive first derivative of left ventricular pressure (dP/dt) increased by greater than or equal to 33%. Nitroprusside was infused in seven dogs until left ventricular end-diastolic pressure was less than 15 mm Hg. Seven dogs were observed for 1 h after the induction of acute severe left ventricular dysfunction and served as the control group. In all groups of dogs, severe left ventricular dysfunction resulted in left ventricular dilation, reduction in area ejection fraction, elevation of left ventricular end-diastolic pressure and an early redistribution of diastolic filling (increased 1/3 and 1/2 filling fractions) despite a markedly abnormal time constant of relaxation. No changes were noted in any variable after 1 h of observation in the seven control dogs. Nitroprusside reduced left ventricular size and filling pressure, increased cardiac output, improved relaxation and redistributed diastolic filling to later in diastole as characterized by a reduced 1/3 filling fraction (19.4 +/- 7.4% versus 51.4 +/- 10%, p less than 0.001). The pressure-area curve was shifted downward and leftward.(ABSTRACT TRUNCATED AT 250 WORDS)

Sixty three 24 hour oesophageal pH studies were performed in children with known or suspected gastro-oesophageal reflux and their progress was followed for at least a year. Forty two studies were of children who were well at follow up who were not receiving medical treatment for gastro-oesophageal reflux, and had not required antireflux surgery. Twenty one studies were from children who were still on treatment for gastro-oesophageal reflux or had undergone antireflux surgery. The results were analysed using non-parametric statistics to assess the value of pH recordings in predicting which children were likely to have continuing problems. Sleep reflux (minutes/hour) and acid clearing time were the most highly significant variables (p less than 0.0005 and p less than 0.0001 respectively). The results suggest that either sleep gastro-oesophageal reflux of more than 6.4 minutes/hour or an acid clearing time of seven minutes or more are good predictors of the clinical outcome (specificity 88.1%, sensitivity 81.0%). Three of the five children with false positive results were under 10 months of age. Positive results in this age group should therefore be interpreted with caution.

School medical records of 1000 children born in 1981 were studied retrospectively. They showed that once known medical problems and those screened for by the school nurse (hearing, vision, growth) were excluded, only 17 problems requiring treatment were discovered: speech (n = 10), development (n = 3), undescended testes (n = 3), and phimosis (n = 1). This indicates that routine screening by a nurse, backed up by selective medical examination by the school doctor, is efficient and effective.

This article describes the epidemiology of acquired immunodeficiency syndrome (AIDS) in women in the United States. Comparisons of female and male transmission categories are made and emphasis is placed on the heterosexual transmission and undetermined risk categories for women. Since its onset in 1981, AIDS has affected males predominantly and female AIDS cases have not received as much attention. AIDS education efforts have not targeted women as much as men, despite women's vulnerability to infection, especially through heterosexual transmission. AIDS tends to generate many issues that concern women's sexuality--contraception, pregnancy and abortion among them. Some of the special problems that women with AIDS face are discussed. Women's role as caregiver for persons with AIDS also is examined. Attention is directed to the ways in which AIDS is associated with the traditional female role.

Acodazole (NSC 305884) was examined in a Phase I trial evaluating a 1-h infusion repeated every 21 days in 37 patients with advanced carcinomas. Cardiac toxicity was dose-limiting at 1370 mg/m2, manifested as multiple premature ventricular contractions, QTc interval prolongation, and decreasing heart rate. Other toxicities included mild to moderate nausea and vomiting and local reaction near the i.v. injection site requiring the use of central venous catheters. Antineoplastic activity was not observed. Acodazole levels assayed by high-performance liquid chromatography disclosed a peak plasma level of 19 +/- 4 (SEM) micrograms/ml for 1370 mg/m2. Acodazole plasma levels decreased in a triphasic manner over a 100-fold range. The volume of distribution at steady state was 238 +/- 18 liter/m2 suggesting extensive tissue binding. The total body clearance was 13.6 +/- 0.9 liter/h/m2; the percentage of urinary excretion was 29 +/- 2% for 48 h. To evaluate cardiac toxicity, acodazole was administered to five dogs at 2262 mg/m2 (1-h infusion) which provided plasma concentrations similar to those achieved at 1370 mg/m2 in humans. Consistent findings in dogs were drug-related prolongation of QTc intervals, and reduction in heart rate, left ventricular dP/dt, and mean blood pressures. Clinical development of acodazole requires studies to further elucidate and alleviate this cardiac toxicity.

The most important finding to emerge from this review of experimental and clinical studies is that the earlier therapy is begun after the onset of symptoms of acute MI, the greater the potential for reduction of infarct size and possibly mortality. It is difficult to define a precise time after which therapy would not have an effect, since the clinical trials for each drug group vary significantly in respect to time of therapy initiation. In experimental studies, major salvage of ischemic myocardium occurs when the drug is given within two hours of coronary artery occlusion. If drug therapy is begun four to six hours postocclusion, then only minor or no reductions in infarct size will occur. The ability of any drug or intervention to reduce infarct size in humans would be optimized if therapy were begun less than four hours of onset of symptoms. With the realization of the wavefront phenomenon and the potential salvage of myocardium at risk with reperfusion, the introduction of reperfusion in the clinical setting with thrombolytic agents or other procedures becomes highly desirable. Clot-selective thrombolytic agents, such as tissue plasminogen activator, diminish the adverse effects and high costs of intracoronary thrombolytic therapy or PTCA. Consequently, it is probable that the initial procedure of choice would be the use of clot-selective thrombolytic therapy. Thrombolytic therapy only lyses thrombi and does not affect the underlying causes of the coronary artery occlusion. Therefore, therapy to reduce the chances of reinfarction and death must also be initiated. Percutaneous transluminal coronary angioplasty, in selected patients, should reduce the reocclusion rate. Beta-adrenoceptor blocking agents appear to be an excellent therapy for reducing mortality when administered chronically; these agents reduce myocardial oxygen consumption and reverse the imbalance between oxygen supply and oxygen demand caused by activation of the sympathetic nervous system and actions of catecholamines. Since thrombus formation has occurred at least once in patients who survive an MI, it is probable that the conditions for thrombus formation still exist. Therefore, institution of antiplatelet aggregating drugs, such as aspirin, would seem to be an appropriate prophylactic regimen. Beta blockers and possibly nitroglycerin have desirable effects when thrombolysis is unavailable. The efficacy of calcium-channel blocking agents on reduction of infarct size appears to be limited, although in the setting of stable and unstable angina postinfarction, these agents can play an important role.(ABSTRACT TRUNCATED AT 400 WORDS)

Numerous studies have shown that early coronary reperfusion is feasible in the setting of evolving acute myocardial infarction in man. While early reperfusion reduces myocardial infarct size, there are potentially deleterious consequences of reperfusion. The concept of "reperfusion injury", oxygen-free radical damage, no reflow phenomenon, and stunned myocardium are discussed.

The effects of several beta-adrenoceptor blocking agents, [+), (-) and (+/-)-oxprenolol, p-oxprenolol, practolol, propranolol and timolol) were investigated on the ventricular arrhythmias occurring within the first 30 min of acutely ligating the main left coronary artery in anaesthetized rats. The degree of cardiac and vascular beta-adrenoceptor blockade was also assessed. All the compounds exhibited antiarrhythmic activity under these conditions. The degree of cardiac beta-adrenoceptor blockade required for this protection was less for the cardioselective agents, p-oxprenolol and practolol, than for the non-selective beta-adrenoceptor blocking agents. A comparison of the two isomers of oxprenolol demonstrated that the (-)-isomer markedly suppressed ischaemic arrhythmias (ventricular ectopic beats, incidence and duration of ventricular tachycardia and duration of ventricular fibrillation) more effectively than the (+)-isomer. Compounds possessing intrinsic sympathomimetic activity (ISA) caused less marked haemodynamic changes (in equivalent beta-blocking doses) than those that did not possess this ancillary property. The membrane stabilizing activity of oxprenolol and p-oxprenolol did not appear to contribute to the antiarrhythmic activity of these agents; however, the membrane stabilizing activity of propranolol may contribute to its effectiveness. In all the drugs studied, the main pharmacological property required to suppress early postischaemic arrhythmias is blockade of cardiac beta-adrenoceptors.

Reocclusion after successful coronary reperfusion occurs in 15 to 35% of patients receiving thrombolytic therapy for acute myocardial infarction. The present study was designed to simulate the clinical situation of reocclusion and determine whether verapamil might be effective in reducing myocardial necrosis and preserving high energy phosphates in this setting. Pentobarbital-anesthetized, open chest dogs underwent occlusion of the left anterior descending coronary artery for 2 hours followed by 1 hour of reperfusion and a further 4 hours of coronary artery occlusion. Treatment with verapamil (intravenous bolus dose of 0.2 mg/kg body weight followed by infusion of 0.56 +/- 0.14 mg/kg per h) was begun 1 hour after occlusion and infusion was continued for the remainder of the experiment. The dose of verapamil was adjusted to lower mean arterial pressure to approximately 90 mm Hg. The area at risk was determined by intraatrial injection of monastral blue dye and the area of necrosis was assessed by triphenyltetrazolium chloride staining. In vivo myocardial needle biopsy for determination of adenosine triphosphate and creatine phosphate was performed at the end of the experiment. The area of the left ventricle at risk was similar in both groups (control [n = 8], 20.2 +/- 1.6% versus verapamil-treated [n = 9], 23.1 +/- 2.9%; p = NS). The area of necrosis expressed as a percent of the area at risk was reduced in the verapamil-treated group compared with the control group (43.3 +/- 5.0% versus 63.1 +/- 6.8%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The design of a new radiotelemetry capsule (26 mm long X 7.6 mm diameter), with an in vivo life of 1 month is described in the context of previous work in this field. In vitro evaluation of the capsule indicates an accuracy and performance comparable with a conventional pH meter. Several clinical applications are described, including measurements of gastrointestinal pH in humans and the measurement of extracellular pH in laboratory animals.

A new autoperfusion balloon angioplasty catheter with sideholes proximal and distal to the balloon--facilitating distal blood flow during inflation--was compared with standard angioplasty catheters in a prospective, randomized study with blinded data analysis. Hemodynamic and electrocardiographic markers of ischemia after 1 minute of standard or autoperfusion catheter inflations were compared with ischemia after control inflation with standard balloons. In the patient group randomized to standard balloon inflation only, ST-segment elevation after control inflation with a standard balloon catheter was 0.37 +/- 0.04 mV; ST-segment elevation after final balloon inflation with a standard catheter was unchanged at 0.35 +/- 0.04 mV (difference not significant). In the group randomized to the autoperfusion catheter, control inflation with a standard catheter resulted in 0.48 +/- 0.1 mV ST elevation; final inflation with the autoperfusion catheter demonstrated 0.16 +/- 0.09 mV ST elevation (p less than 0.005). Autoperfusion catheter inflation was continued for 2 minutes without change in electrocardiographic findings: ST segments remained at 0.08 +/- 0.03 mV, unchanged from 0.07 +/- 0.03 mV before angioplasty (difference not significant). Thus, while coronary angioplasty performed with standard catheters resulted in marked ST-segment elevation, in patients undergoing angioplasty with the autoperfusion catheter, ischemia was generally not seen, despite sustained balloon inflation for 2 minutes.

One hundred and twenty-three total colonoscopies were performed on 115 children with ages ranging from 3 months to 16 years. The major indications were suspected inflammatory bowel disease and unexplained rectal bleeding. Ninety-seven per cent of all procedures were carried out with sedation only. Adult colonoscopes were used in most of the patients but in babies and small children paediatric instruments were preferable. Total colonoscopy was possible in all patients with a patent colon. The terminal ileum was examined in 63 patients. Endoscopic snare polypectomy was successfully carried out in 8 children and multiple haemangiomas were electrocoagulated in one. Total colonoscopy in this paediatric series proved to be at least as easy, rapid, well-tolerated, and safe as in adults. In selected patients as single colonoscopy can give an accurate diagnosis with biopsy proof and sometimes the opportunity for definitive treatment.

Although impaired growth hormone secretion in response to pharmacological stimuli occurs in some growth retarded children with Crohn's disease, its relationship to past and future th is uncertain. We have therefore determined the growth hormone and gonadotrophin response to the physiological stimulus of sleep by continuous venous sampling in five severely gonadotrophin profiles, the mean plasma hormone concentrations during the first five hours of sleep were determined. In three of the five patients, five hour mean growth hormone levels were reduced (3.8, 5.0, and 8.5 mU/l) compared with levels reported previously in normal short children (10-43 mU/l), although the pulsatile pattern of growth hormone secretion was preserved in all. Nocturnal growth hormone secretion was unrelated to the growth velocities of these children during both pre- and post-treatment assessment periods but a significant correlation was found between growth hormone concentration and a disease activity score (r = 0.79, P less than 0.05), suggesting that growth hormone release by the pituitary was influenced by the severity of the disease. Nocturnal growth hormone secretion was also correlated with gonadotrophin secretion (luteinising hormones, r = 0.99, and follicle stimulating hormone, r = 0.96; p less than 0.01) indicating more extensive hypothalamic-pituitary disturbance. These findings suggest that hypothalamic-pituitary function is depressed in growth retarded children with Crohn's disease, but that abnormalities of growth hormone secretion are unlikely to be directly involved in the growth retardation seen in this condition.

Five children presenting with chronic and intermittent rectal bleeding were diagnosed as having colorectal polyps by fibreoptic colonoscopy performed under sedation. Three of the children had had barium-enema films reported on as normal. Eight polyps were seen, of which six were proximal to the sigmoid colon. All were removed endoscopically (one by proctoscopy, one by snare-intussusception) without complication. Colonoscopic polypectomy is a safe and efficient procedure in children, and colonoscopy may be regarded as first-line management in those with rectal bleeding.

A new test for the detection of antibodies to gliadin in the sera of children who are gluten sensitive is described. This test is based on the observation that wheat protein binds selectively to connective tissue fibres in cryostat sections of mammalian tissues. Sera containing antibodies to gliadin give a reticulin pattern of staining on section pretreated with wheat gliadin if tested by indirect immunofluorescence. Antibodies to gliadin were detected in this manner in sera fom all of 32 children with coeliac disease, in 16 of whom a provisional diagnosis had been given and in 16 an established diagnosis confirmed by gluten challenge. The incidence of reticulin antibodies detected on untreated sections (in the absence of gliadin) was only 28%. Gliadin antibodies were also present in sera from 15% of 152 children with gastroenterological disorders other than coeliac disease, but most of these non-positive results for coeliac disease were in patients with transient gluten in tolerance, cows' milk-sensitive enteropathy, or Crohn's disease. This new test, although not specific for coeliac disease, promises to be of value as an indicator of gluten sensitivity, and when negative excludes a diagnosis of coeliac disease. It may also be useful in monitoring diet, and in determining when rebiopsy after gluten challenge in appropriate.

A new balloon angioplasty catheter with multiple proximal and distal side holes has previously been shown to allow significant protection from ischemia during a 3 min balloon inflation in a coronary artery. Because of the potential benefits of very long periods of inflation, 21 anesthetized thoracotomized dogs were randomized to left circumflex coronary artery occlusion with either a standard or an autoperfusion balloon catheter for 90 min. Nine dogs sustained ventricular fibrillation before completing the study, eight after standard balloon inflation and one after autoperfusion balloon inflation (p = 0.04). ST segment elevation was 0.45 +/- 0.13 mV after 15 min of standard balloon inflation versus -0.03 +/- 0.03 mV after autoperfusion balloon inflation (p less than 0.001). Regional myocardial blood flow was 0.02 +/- 0.01 ml/min per g after 30 min of standard balloon inflation compared with 0.78 +/- 0.23 ml/min per g in the group subjected to autoperfusion balloon inflation (p = 0.01). The area of necrosis/area at risk in the standard catheter group was 40.4 +/- 19.3% versus 1.2 +/- 1.2% for the autoperfusion catheter group (p = 0.01). Thus, the autoperfusion catheter preserves blood flow and limits myocardial ischemia and necrosis despite 90 min of balloon inflation.

A newly designed balloon coronary angioplasty catheter that allows passive antegrade blood flow during balloon inflation (autoperfusion catheter) was compared with a standard balloon coronary angioplasty catheter. In a randomized sequence, inflations were performed for 3 min in the left circumflex coronary artery of 12 dogs with the standard catheter followed by the autoperfusion catheter or vice versa. During inflation with the standard catheter, the ST segment of standard limb lead II increased from -0.02 +/- 0.03 mV to 0.39 +/- 0.08 mV (p less than .001), whereas during inflation with the autoperfusion catheter the ST segment did not change (-0.03 +/- 0.03 vs -0.01 +/- 0.04 mV; p = NS). Regional myocardial blood flow measured by the radioactive microsphere technique in the posterior subepicardium and subendocardium was 0.12 +/- 0.03 and 0.08 +/- 0.03 ml/min/g, respectively, with the standard catheter as compared with 0.57 +/- 0.08 and 0.61 +/- 0.14 ml/min/g with the autoperfusion catheter (both p less than .01 compared with the standard catheter). Thus, unlike the standard catheter, the autoperfusion catheter allows for inflations up to 3 min in duration without producing deleterious changes in the ST segment or severe reductions in regional myocardial blood flow.

Technetium-99m t-butylisonitrile ([99mTc]TBI) is a promising new radiotracer for myocardial imaging. Its myocardial uptake is sufficiently high in humans to permit planar, tomographic, and gated images of excellent technical quality. We studied the behavior of [99mTc]TBI in the dog at rest and under conditions of hyperemia and reperfusion in order to determine the relationship between [99mTc]TBI myocardial concentration and blood flow. After permanent occlusion of the left anterior descending artery, the correlation between the relative myocardial concentration of [99mTc]TBI and regional myocardial blood flow (RMBF) measured with radiolabeled microspheres was excellent. In a dog model of transient hyperemia, the concentration of [99mTc]TBI was directly related to blood flow but underestimated the degree of hyperemia. Technetium-99m TBI redistributed into transiently ischemic myocardium. The myocardial concentrations of [99mTc]TBI and thallium-201(201TI) in transiently ischemic myocardium were similar at 10 and 30 min following reperfusion and were significantly higher than blood flow prior to reperfusion. When [99mTc]TBI was injected into the left anterior descending artery, the washout was slow, falling to 78% of initial activity at 120 min after injection. In conclusion, [99mTc]TBI reflects regional myocardial blood flow accurately in ischemic and normal resting myocardium and underestimates blood flow at high flows. The rate of myocardial redistribution after reperfusion is similar for [99mTc]TBI and 201TI.

The serum levels of five acute phase proteins (APP) were measured in 18 children with Crohn's Disease (CD) or ulcerative colitis (UC) and in two control groups. The levels of C-reactive protein, alpha 1-acid glycoprotein, alpha 1-antitrypsin, C9, and Factor B were significantly raised in patients with CD and UC with good separation from controls, but they were not entirely reliable used as screening tests unless used in combination. The levels of APP were monitored for periods varying from 18 to 28 months in each patient and found to reflect the disease activity in both CD and UC. On seven occasions the APP levels did not match the clinically assessed disease activity, but when the serum levels were related to outcome of the disease, C-reactive protein was found to be elevated--whether or not there were symptoms of the disease--in all patients who later had a relapse, while normal values were found in those who had a long remission. These results suggest that the estimation of Creative protein is of prognostic value and that its measurement is particularly useful in children with mild symptoms in whom disease activity and prognosis are difficult to assess.

Recent information has suggested that early diastolic filling may be influenced by the left ventricular filling pressure, especially in the failing left ventricle. Acute severe left ventricular dysfunction was induced in 14 dogs by severe left ventricular global ischemia produced by left main coronary artery microsphere embolization until the left ventricular end-diastolic pressure was greater than or equal to 20 mm Hg. To assess the importance of left ventricular filling pressure on left ventricular diastolic filling, nitroglycerin was infused and titrated to reduce left ventricular end-diastolic pressure to less than 15 mm Hg in seven dogs, whereas the remaining seven dogs were observed for 1 h after acute severe left ventricular dysfunction. In both groups of dogs, severe left ventricular dysfunction resulted in left ventricular dilation and elevation of end-diastolic pressure, reduction in area ejection fraction (echocardiographically determined) and an early redistribution of diastolic filling (increased filling fractions at one-third and one-half diastole) despite prolongation of the time constant of left ventricular pressure decline. Pressure-area plots shifted upward and rightward with severe left ventricular dysfunction and were unchanged at 1 h as were all other variables. Nitroglycerin infusion reduced left ventricular size and filling pressure, redistributed diastolic filling to later in diastole as characterized by reduced filling fraction at one-third diastole (left ventricular dysfunction 48.8 +/- 9.7%, nitroglycerin 17.9 +/- 7.9%, p less than 0.001) and shifted downward left ventricular pressure-area plots. Nitroglycerin also improved the time constant of relaxation (left ventricular dysfunction 83 +/- 15 ms, nitroglycerin 52 +/- 15 ms, p less than 0.001) and lengthened the diastolic filling period.(ABSTRACT TRUNCATED AT 250 WORDS)

A private practice, free standing work evaluation center was established in November 1982 to serve a large metropolitan area in northern California. Originally conceived to evaluate and treat persons with traumatic hand and/or upper extremity injuries, the practice has now expanded to include services for industrially injured workers, persons with personal injury claims who have sustained a broad range of physical and/or emotional disabilities, as well as individuals receiving State rehabilitation services. The role of the occupational therapist within this vocationally oriented unit is varied and has proven highly beneficial for individuals with various kinds of disabilities. While occupational therapists have moved in and out of this area of practice over the years, they now seem to be re-establishing themselves as viable and significant parts of work-related programming. Their unique skills and broad expertise enhance overall care of impaired workers and 'bridge the gap' between medical and vocational services. This paper presents a brief description of programming in a work unit and concludes with recommendations for others interested in this area of practice.

The serum concentrations of 24 trace elements were measured by neutron activation analysis in 32 patients on long-term lithium treatment and 32 age- and sex-matched healthy controls. Whole blood and hair samples were also taken from a number of these subjects. Compared to controls, patients on lithium were found to have a lower serum vanadium, a lower serum cobalt, and an elevated serum aluminium level. These findings are discussed.

The usefulness of serial study of C reactive protein in the early detection of neonatal septicaemia was evaluated in a neonatal unit using a commercially available latex agglutination slide test as a rapid screening method and electroimmunoassay as a reference method for C reactive protein determination. A positive latex test was obtained in 11 infants with verified septicaemia (positive blood culture), two infants with clinically evident infection but without bacteriological confirmation, one infant with recurrent chest infection due to Pseudomonas aeruginosa, and one infant who showed signs of birth asphyxia with meconium aspiration, but was not infected. Positive latex test results correlated with raised concentrations of C reactive protein, measured by immunoassay. In some instances, however, concentrations of C reactive protein in excess of 12 mg/100 ml gave weaker agglutination results in the slide test, which could be interpreted as negative results. In a sequential study of the infected infants, 6.3% of the values recorded on a slide test were false negatives. In contrast, false positive values were observed on a slide test in 1.9% of 27 non-infected infants. The higher percentage of false negative values may be due to the presence of excess antigen in the sera of some infected children. It is suggested that the latex test should be carried out on suitable dilutions of serum. Although the slide test may reliably indicate infection at an early stage in neonates, the C reactive protein response is non-specific, as seen in a non-infected infant who showed signs of birth asphyxia with meconium aspiration. Provided the non-specific nature of the C reactive protein response is recognised, the latex test may be a useful serum measurement for early diagnosis of neonatal septicaemia of the newborn. The test has the advantage of being performed easily, quickly, and cheaply.

The diagnosis of Crohn's disease in childhood has been facilitated by the use of fibreoptic endoscopy with biopsies, complemented by double-contrast radiology. Clinical suspicion leads initially to several relevant blood tests. These are followed by endoscopy and multiple colonic biopsies or barium follow-through studies depending on whether large-bowel or small-bowel disease is suspected. The present approach to diagnosis is based on corroborative investigative techniques-endoscopy, radiology, and histology, The availability of paediatric colonoscopes of small diameter should make it possible for paediatricians to perform limited examinations, but when more extensive endoscopy is indicated the child should be referred to special centres.

1. The effect of the haemorrheological agent pentoxifylline was investigated in a canine model of acute myocardial infarction, induced by occlusion of the left anterior descending coronary for 6 h. Thirty minutes post-occlusion the dogs were randomized to receive either distilled water or pentoxifylline (0.3 mg kg-1 min-1 for 1 h followed by 0.15 mg kg-1 min-1 for 4.5 h) intravenously. 2. At 6 h post-occlusion the in vivo area at risk was determined with monastral blue dye and the area of necrosis was determined with triphenyltetrazolium chloride. The area at risk was 16.5 +/- 1.3% in the control group (n = 10) and 17.2 +/- 1.8% in the pentoxifylline treated group (n = 10; NS). The area of necrosis was 12.3 +/- 1.9% in the control group and 11.9 +/- 2.2% in the pentoxifylline treated group (NS). The area of necrosis expressed as a percentage of the area at risk was 69.3 +/- 7.7% in the control group and 63.6 +/- 7.4% in the pentoxifylline treated group (NS). 3. Pentoxifylline had no significant effects on heart rate, systolic or diastolic blood pressure. Regional myocardial blood flow, measured by the radioactive microsphere technique, was not significantly different between the groups. 4. Thus, pentoxifylline does not reduce infarct size in this model of acute myocardial infarction and does not enhance coronary collateral blood flow.

The medical record practitioner must maintain proficiency in all areas related to coding and indexing of disease and operation information. This article presents evidence that there is confusion concerning the basic terminology used to designate such information. It appears that many practitioners have lost sight of the purpose in making the distinctions "primary" and "principal".

The Enhanced Productivity Program is based on an organizational audit of a dietary department by a foodservice consultant. The objective of the program was to enhance department productivity by increasing personnel efficiency through work simplification and work organization principles while maintaining quality standards. The Enhanced Productivity Program comprises 13 subsystems that interact to affect overall productivity of the department. The program was structured by a task-oriented program schedule that identified tasks to be carried out in each subsystem. A system diagram detailed time frames and milestones guiding each task to completion. A comprehensive work plan was developed for each task. Time and motion studies carried out before and after implementation of program changes demonstrate a savings of 9.27 labor hours per day. Trayline speed increased from 1.7 trays to 3 trays per minute. Improved personnel efficiency allowed an 11% growth in meal volume in 6 months, thus improving departmental productivity.

We examined the effects of prolonged oral administration of oxprenolol (twice daily for 6 weeks) to male Sprague-Dawley rats. At two times (1 or 16-18 h) after the last oral dose, the rats were anaesthetised and subjected to acute coronary artery ligation, and the severity of the resulting arrhythmias was assessed. Ischaemic damage was measured histochemically (using frozen section analysis by toluidine blue dye in nitrobluetetrazolium ) and by myocardial enzyme release. Cardiac muscle (atria and papillary muscle) was also removed and the transmembrane action potentials recorded using conventional microelectrode techniques. When coronary artery ligation was performed 1 h after the last oral dose (at which time there was evidence of substantial myocardial beta 1-adrenoceptor blockade), there was significant reduction in the severity of early arrhythmias, but no evidence that the severity of ischaemic damage was reduced or that the intracellular cardiac action potentials were modified. No protection was observed when coronary artery ligation was carried out 16 h after the last oral dose of oxprenolol. These results support our previous studies with acutely administered beta-adrenoceptor blocking drugs that myocardial beta-adrenoceptor blockade is the main factor involved in the protection afforded by such drugs against early ischaemic arrhythmias and that other possible effects, such as membrane stabilisation and action potential prolongation, are relatively unimportant in this model.

Patients with congestive heart failure and elevated left ventricular filling pressures demonstrate an abnormal pattern of diastolic filling that is characterized by a redistribution of diastolic filling to early diastole with reduced reliance on late diastolic filling. The diastolic filling pattern superficially resembles that which is seen with constrictive pericarditis. To examine potential mechanisms for these clinical findings, a model of ischemic left ventricular dysfunction was produced in seven dogs by repeated coronary microsphere embolization, producing a dilated left ventricle with reduced systolic function. Measurements of left ventricular systolic and end-diastolic pressures, rate of rise of left ventricular pressure (dP/dt) and echocardiographic end-diastolic and end-systolic areas were obtained at baseline, during intermediate embolization (moderate left ventricular systolic dysfunction, dilation and mild increases in left ventricular end-diastolic pressure), postembolization (further embolization resulting in severe left ventricular systolic dysfunction, dilation and marked increases in left ventricular end-diastolic pressure), after thoracotomy and after pericardiectomy. The filling fraction at 1/3 and 1/2 of diastole and the time constant of left ventricular pressure decline were also determined. Repetitive coronary microembolization caused progressive left ventricular dilation and decreasing systolic function, which did not change after opening the chest or pericardium. The filling fraction at 1/3 and 1/2 of diastole declined with intermediate embolization (12.0 +/- 5.6% and 23.1 +/- 10.8%, respectively) as compared with baseline values (29.0 +/- 11.9%, 42.9 +/- 15.6%, p less than 0.05). After embolization, there was an increase in the 1/3 and the 1/2 filling fraction (47.5 +/- 8.9%, 72.0 +/- 6.0%, respectively, p less than 0.01) as compared with baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)

Serial C reactive protein concentrations were assayed by electroimmunoassay in 41 infants. Values in most of the non-infected infants were below 0.3 mg/dl, the lower limit of detection of C reactive protein by electroimmunoassay. Eleven of 12 infants with proved sepsis (positive blood cultures) had significantly raised concentrations and one infant with recurrent pseudomonas chest infection had a raised C reactive protein concentration. High C reactive protein concentrations were also found in infants with suspected infection. Successful treatment was followed by a decrease in the C reactive protein concentration. Total white blood cell count was not as appropriate as C reactive protein determination in the early identification of bacterial infection in the newborn.

The effect of the positive inotropic agent amrinone on anatomic infarct size induced by coronary artery occlusion and reperfusion in dogs is unknown, although previous studies have shown that amrinone increases indices of myocardial ischemia during very brief coronary artery occlusions. Thus, this study was performed to determine if amrinone changes anatomic infarct size and improves hemodynamics induced by 3 h of coronary occlusion and 3 h of reperfusion in anesthetized, open-chest dogs. Amrinone (1-mg/kg bolus followed by 6 mg/kg/h) or an equivalent volume of saline was administered intravenously for 3 h beginning 30 min postocclusion. The area at risk was 19.7 +/- 2.6% in the control group (n = 9) and 20.2 +/- 1.8% in the amrinone-treated group (n = 9; p = NS). The amount of the area at risk that developed infarction was 60.6 +/- 6.1% in the control group and 54.6 +/- 5.6% in the amrinone-treated group (p = NS). Pretreatment left ventricular end-diastolic pressure increased from 11.4 +/- 1.8 to 20.1 +/- 3.0 mm Hg (p less than 0.05) in the control group and from 10.8 +/- 1.3 to 17.3 +/- 1.3 mm Hg (p less than 0.05) in the amrinone-treated group following coronary artery occlusion. During coronary occlusion, amrinone administration significantly increased left ventricular maximum +dP/dt [+483 +/- 85 vs. -11 +/- 53 mm Hg/s (p less than 0.01) in amrinone vs. control group, respectively] and heart rate (+27 +/- 6 vs. -4 +/- 2 beats/min; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)