Punishment of self-injurious behavior in natural settings using contingent aromatic ammonia.
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Biomedical subjects
Publications and source records attributed to J W Cook.
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We present the clinical and epidemiological features of Mycobacterium fortuitum epidemics involving 19 patients who underwent open-heart surgery. The source of the infection could not be identified. However, bone wax and homografts utilized at that time have been suspected. The infected patients responded poorly to antibiotic management and their courses in most cases were influenced beneficially by total sternectomy and transplantation of the omentum into the mediastinum. The emergence of M. fortuitum may represent an aggressive bacterial strain resistant to presently used broad-spectrum antibiotic drugs.
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The technique presented in this paper is based on the authors' previous observations in which they found that artificial decrease of blood flow to a portion of the heart muscle leads to an immediate and proportional drop in the regional myocardial temperature. It appeared to the authors as a logical next step to apply the thermographic camera to a monitor and to record such changes in the human patient during coronary surgery and to use the data to draw conclusions applicable to regional blood supply and to blood flow through surgically inserted vein grafts. They found that, on the normothermic heart, there were well-identifiable "cold" patches corresponding with areas of impaired coronary circulation. By infusion of blood to the ischemic myocardium through individual release of the bypass grafts, the thermogram responded by immediate appearance of "warm" spots corresponding with the areas supplied by the grafts. Even more dramatic demonstration of graft patency and outline of the area supplied by the graft could be performed by injecting cold saline solution into the grafted saphenous veins. In the author's experience this most interesting new method proved to be a useful tool in coronary surgery both as an adjunct in delineating ischemic areas and in proving the patency and efficiency of the grafts inserted.
The authors present their experiences with the Roche-5000 Computer-Based Intensive Care System in the management of 100 consecutive patients who have undergone open heart or major vascular surgery. The system performs the following junctions: (1) numerical and graphic display, out-of-limits alarms, storage and printout of 12 biological and surgical parameters, including chest drainage and urine output, by on-line direct monitoring; (2) display, storage, and printout of all additional laboratory and clinical data by manual input; (3) automatic demand-regulated transfusion and infusion program; (4) a program of medical logic, which includes situation analysis based on the above, two way dialogue with the computer, treatment recommendations to the physician, selective nursing and laboratory orders, acid-base analysis, and instructions for respirator setting. It was found that the computer-monitored patients recovered faster and smoother, with fewer fluctuations in the measured parameters and fewer postoperative complications than did those treated by conventional methods. One additional important effect of the system was that the nurse, relieved of the mechanical tasks of measuring, charting, and recording, was left with a greater amount of time for the care of the patient's personal needs. It seems ironic that such a technical advancement in electronics not only made the recovery faster and safer but also created a more humanistic approach in patient care, through better application of basic nursing techniques.
A method to prevent and treat sternum separation following open-heart surgery is presented. The procedure consists of passing parasternal continuous sutures placed alternatingly in front and behind the costal cartilages and then including them in the usual parasternal sutures.
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The influence of ouabain and alpha angelica lactone on (45)calcium accumulation in cardiac microsomes was studied. Calcium binding (accumulation in the absence of excess oxalate or phosphate) was augmented by both ouabain and alpha angelica lactone in the presence of adenosine triphosphate (ATP) but unaffected in its absence. Calcium turnover (defined as the change in (45)Ca(++) bound to the microsomes after the specific activity is changed) was studied to determine if the augmented bound pool was freely exchangeable at equilibrium. Ouabain and alpha angelica lactone augmented calcium turnover in both the presence and absence of ATP. Calcium-stimulated ATPase was increased by both agents.It is proposed that these two unsaturated lactones, with known cardiotonic activity, may exert their effects by providing an increased contraction-dependent calcium pool to be released upon systolic depolarization.