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Two hundred fifty-five determinations of the protamine sulfate test, the staphylococcal clumping test, and the tanned red blood cell hemagglutination inhibition immunoassay were performed on 30 patients undergoing cardiovascular surgery. The level of serum fibrin-fibrinogen degradation products rose in all patients and reached the highest levels between the fifth and ninth postoperative day. After the first postoperative day, a fibrin-fibrinogen degradation product increase of greater than 10μg/ml within 24 to 48 hours was associated with clinically recognized thrombotic complications in only two out of five patients. Isolated levels of serum fibrin-fibrinogen degradation products as high as 67μg/ml could not be correlated with clinically evident thrombotic disease or serious complications of surgery. Increased excretion of urinary fibrin-fibrinogen degradation products was associated with, but not predictive of, acute ischemic renal failure.

We studied plasma renin activity (PRA) in eight children before and after surgical correction of aortic coarctation. These eight children underwent a combination of low-sodium diet and diuresis before surgery, and PRA was measured shortly thereafter. Thirty-two to 51 months after successful surgical correction, PRA was measured again. The mean PRA was 21.4 +/- 1.3 ng/ml/hour (+/- SD) preoperatively and 5.5 +/- 1.5 ng/ml/hour postoperatively. These findings provide further evidence of the significance of increased renin-angiotensin activity in patients with aortic coarctation.

Mechanical complications that cause heart failure after acute myocardial infarction may be corrected early by surgery. The development of effective cardiac assistance by intra-aortic balloon pumping (IABP) has proved invaluable in resuscitating patients in over-whelming cardiac failure, maintaining them during diagnostic evaluation, and affording long-term (up to two weeks) postoperative support. Four of five patients with acutely expanding ventricular aneurysms, two of six patients with acute mitral regurgitation, and one of two patients with acute ventricular septal defects are living and well. Ten of these 13 patients required IABP. Seven of the group, which was totally refractory to medical therapy, are long-term survivors as a result of this combined supportive, diagnostic, and surgical approach. Usually the heart can be repaired successfully. Patients are lost primarily from the ravages, prior to surgery, of over-whelming cardiac failure on other organs.

Whole-body arterial and venous dilating properties of nitroprusside and nitroglycerin were compared with each other in 20 adult patients during cardiopulmonary bypass for coronary artery bypass or valvular heart surgery and were compared with simultaneous forearm vascular measurements. Nitroprusside was found to be a more effective whole-body arterial vasodilator and nitroglycerin a better whole-body venous vasodilator when each drug was infused at rates of 1.5 and 2.0 microgram/kg/min. No difference in whole-body vasodilation between the two drugs was found at 1.0 microgram/kg/min. Forearm plethysmography did not distinguish between the two drugs at any dose level.

• A grass inflorescence (flowering head) aspirated by a child is difficult to diagnose, and frequently cannot be retrieved by bronchoscopy. Of four pediatric patients with aspirated grass inflorescences, two had severe hemoptysis and the other two were septic at the time of diagnosis. Their chronic debilitation and bronchiectasis necessitated an eventual pulmonary resection, with full recovery in all four patients. (Arch Surg115:979-983, 1980)

Iatrogenic injury to the thoracic duct followed percutaneous cannulation of the left internal jugular vein. The case was managed successfully by supraclavicular ligation of the thoracic duct. We feel cannulation of the right internal jugular vein is preferable to cannulation of the left internal jugular vein.

If middle-class parents are to act in accord with their values, they must take explicit account of subjective and emotional factors, including the possible effects of punishment. They give considerable evidence that they so do. For example, when asked if there are any ways in which they would prefer to act differently toward the child, they are likely to cite the desirability of fuller understanding. When the child does poorly in school, they often try to be supportive, while working-class parents are likely to respond negatively. Of course, parents can rationalize. It is easy to believe that behavior which is at the moment infuriating ought to be punished. One gains the impression, however, that although middle-class parents may punish when angry, they try to restrain themselves-as they apparently do when they believe their children's actions to be wild play.12 The working-class orientation, on the other hand, excludes or minimizes considerations of subjective intent, and places few restraints on the impulse to punish the child when his behavior is out of bounds. Instead, it provides a positive rationale for punishing the child in precisely those circumstances when one might most like to do so.

THIS report deals with the treatment of pulmonary embolism by the application of the partially occlusive Mortez 1 clip to the inferior vena cava in 62 patients over a five-year period. The effectiveness of the clip in controlling recurrent pulmonary emboli was evaluated. The patency of the inferior vena cava has been determined in 31 of 43 patients surviving six months or more, and the degree of venous insufficiency has been examined. The Moretz clip is but one of many nonligation techniques described which offer the theoretical advantage of inferior vena caval patency while protecting the patient against a fatal pulmonary embolus. 1 There have been many reports dealing with the various methods of achieving this using a filter, 2 plication with suture, 3 or staples, 4 or with a clip, with 5 or without compartmentalization. 1 It seemed apparent that more information was needed to evaluate the long-term caval