With a greater demand for cost consciousness in the health-care delivery system, it is time to review what we expect to accomplish with intensive coronary care. This paper reviews the literature on the subject, attempts to determine the nature and function of the "system," and tries to provide reasons for maintaining its existence or eliminating it altogether. The approach in this paper is objective, but not financially so. Funding to save lives is largely a matter of society's priorities, returning to the old question about how much a life is worth. Costs and priorities are so variable from place to place, this paper limits its coverage to "technical" aspects of the system.

Adult↗

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Occupational biohazards affecting clinical engineers & BMETs. Part I: Preliminary survey of perceived hazards.

The authors developed this preliminary survey in order to collect current information to answer three questions: 1) Is there reason to be concerned about the occupational health and safety of BMETs; 2) Is a larger study needed; and 3) Is continuing education about certain classes of hazards desirable? Of the 136 BMETs completing the questionnaire, 18.4% reported illnesses or disabilities believed to be job related. More than 90% of the respondents indicated a need for additional training on biological hazards in the workplaces of BMETs; likewise, 86% desired additional training on hazards related to chemicals, fire, and explosion.

Attitude of Health Personnel↗

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Research training of surgical residents as studied from the Resident's Forum.

Participants in the Resident's Forum were surveyed to gain an appreciation of their impression of their research training. The vast majority believed that adequate resources and supervision had been available for their research. The resident generally was the principal investigator, the primary writer of the grant to fund the study, and developed the experimental design. Supervision was usually by a diplomate who took an active role in the project. Projects were funded by several different sources for widely varying amounts. The most common duration of the studies was more than 4 months, and most residents conducted at least one other study during their residency. Ninety per cent stated that the study and its presentation at the Resident's Forum increased their enthusiasm for research, in contrast to the less than one half who, at the start of their residency, were planning on doing research during their career.

Education, Graduate↗

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Urodynamic alterations after prostatectomy in dogs without clinical prostatic disease.

Prostatectomy in dogs with clinical prostatic disease has been associated with a high incidence of urinary incontinence. In this study, urodynamic alterations after prostatectomy in 10 dogs without clinical prostatic disease were evaluated. Measurements of residual urine volume, simultaneous urethral pressure profilometry and electromyography, and carbon dioxide cystometry were made before and 14 and 20 weeks after prostatectomy. Voiding was observed daily for 20 weeks after prostatectomy. All dogs remained continent for 20 weeks after prostatectomy, and only minor urodynamic abnormalities were noted. Castration had no effect on urodynamic changes associated with prostatectomy. Prostatectomy produced minimal functional changes in dogs without clinical prostatic disease.

Animals↗

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Metoclopramide reversal of decreased gastrointestinal myoelectric and contractile activity in a model of canine postoperative ileus.

Postoperative ileus is characterized by decreased gastrointestinal myoelectric activity and motility. Metoclopramide was used to treat experimentally induced postoperative ileus in six dogs. Contractile activity was monitored by extraluminal strain gages on the pyloric antrum and proximal segment of the duodenum, and myoelectric activity was measured by recording bipolar electromyograms (EMGs) at the pyloric antrum, pyloric canal, proximal segment of the duodenum, proximal and distal parts of the jejunum, and ileum. Measurements were obtained from animals without ileus (baseline) and those with ileus that were either untreated or treated with metoclopramide. Adynamic ileus was induced by rubbing a 50 cm segment of jejunum with a dry sponge for 5 minutes and exposing the bowel to the air for 30 minutes. Treated dogs received metoclopramide (0.4 mg/kg 4 times daily [QID] intravenously [IV]), whereas untreated dogs received a saline placebo, starting 1 hour after celiotomy closure. Recordings were made for 26 hours after induction of ileus. The phases of the migrating myoelectric complex (MMC) were identified and motility index values were determined. During ileus, the MMC phase II duration was increased at the duodenum and phase III duration was decreased at the antrum, pylorus, duodenum, and proximal segment of the jejunum (p less than 0.05). Motility index values were decreased at the antrum and duodenum during ileus (p less than 0.05). Treatment with metoclopramide reversed the MMC phase III inhibition at the antrum and pylorus, and partially reversed the inhibition at the duodenum and jejunum (p less than 0.05). Motility index values were restored to preoperative baseline values with metoclopramide treatment (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

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Cardiovascular function and serum catecholamine concentrations after anesthesia and surgery in the dog.

Peripheral vasoconstriction and plasma catecholamine concentrations were studied in 37 dogs after cervical disc fenestration and salivary gland excision, laparotomy for intestinal anastomoses and cystotomy, or laparotomy for repair of diaphragmatic rupture, gastrotomy, and pyloromyotomy. Meperidine (4.4 mg/kg) was administered before extubation of 12 dogs undergoing laparotomy. Heart rate, respiratory frequency, indirect blood pressure, rectal temperature, toe web temperature, and plasma concentrations of epinephrine and norepinephrine were determined before induction of anesthesia, after intubation, after extubation, at sternal recumbency, and at standing. All dogs were hypothermic during surgery. After surgery, peripheral hypothermia (large rectal-toe web temperature gradients) increased from a mean of 4.6 degrees C after intubation to a mean of 10.4 degrees C when the dogs initially stood. Heart and respiratory rates and blood pressures during recovery were similar to those before anesthesia. Mean plasma catecholamine concentrations were neither significantly higher during recovery than before surgery nor were they increased in any surgical group, including the dogs not treated with meperidine. After anesthesia, 15% of the epinephrine and 12% of the norepinephrine samples were more than two standard deviations above the mean of the preanesthetic concentrations of all dogs. The ratio of all dogs with an epinephrine concentration more than two standard deviations above the mean of baseline epinephrine concentrations was greater at sternal recumbency than before anesthesia and the ratio of dogs with an increased epinephrine concentration at sternal recumbency was greater in the laparotomy dogs (9 of 24) than in the cervical surgery dogs (0 of 12).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

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Intracapsular subtotal prostatectomy in normal dogs: use of an ultrasonic surgical aspirator.

In an attempt to reduce postoperative incontinence associated with excisional prostatectomy and the recurrence of prostatic disease after less radical surgeries, a new technique for subtotal prostatectomy was developed using an ultrasonic surgical aspirator. During laparotomy, a longitudinal incision was made in the ventral surface of each lobe of the prostate gland. Biopsies for histology and culture were taken. Through the ventral incisions, the ultrasonic surgical aspirator was used to resect approximately 85% of the glandular tissue from inside the capsule. The ultrasonic surgical aspirator allowed resection of the glandular tissue without damaging the vessels, nerves, and connective tissue stroma. The ventral portion of the capsule was excised. The dorsal portions of the capsule were apposed on the ventral midline by suturing their ventral margins to form a periurethral cuff. As preclinical research, seven intact male dogs were evaluated by physical examination, complete blood cell count, serum urea nitrogen, urinalyses, and urethral pressure profile (UPP) with urethral electromyograms (EMGs). The dogs underwent subtotal prostatectomy and castration. All dogs were continent after surgery. UPPs and EMGs at 1 and 2 months after surgery were no different than before surgery. This contrasts to our previous studies in which excisional prostatectomy reduced maximal urethral closure pressure (MUCP) in dogs without prostatic disease. The use of the ultrasonic surgical aspirator for intracapsular subtotal prostatectomy facilitated removal of glandular tissue with decreased hemorrhage and provided preservation of the prostatic urethra, nerves, and vessels involved in maintaining urinary continence.

Animals↗