The course of patients with suspected myocardial infarction. The identification of low-risk patients for early transfer from intensive care.

The hospital course of all patients admitted to a medical intensive-care unit (ICU) with suspected myocardial infarction was reviewed to test the feasibility of identifying patients suitable for earlier transfer from the ICU. Three hundred sixty patients admitted after presentation with uncomplicated chest pain could be stratified into three risk groups within 24 hours of admission to the ICU. One hundred sixty-eight patients (47 per cent), who were without major complications, elevation of total serum creatine phosphokinase, or electrocardiographic evidence of transmural infarction during the first day, could be designated "low-risk" patients.

Medical intensive care: indications, interventions, and outcomes.

To evaluate current practices regarding intensive-care units (ICU's), we collected data on 2693 consecutive admissions to a medical ICU during a two-year period and studied indications for admission, specific interventions, costs, and outcomes. The need for noninvasive monitoring rather than immediate major interventions prompted 77 per cent of the admissions. Only 10 per cent of monitored patients had subsequent indications for major interventions.

Unexplained in-hospital fever following cardiac surgery. Natural history, relationship to postpericardiotomy syndrome, and a prospective study of therapy with indomethacin versus placebo.

In Part I of this study, the in-hospital course of 219 patients who had undergone a cardiac operation is analyzed. Fever (greater than or equal to 37.8 degrees C, rectal) was present after postoperative day 6 in 159 patients (73%) and was of unexplained cause in 118.

Geriatric profile of Thomas Jefferson (1743-1826).

This geriatric profile specifically reflects the impressive achievements of Thomas Jefferson during the years of his retirement (ages 66-83) following a distinguished political career culminating in the Presidency. President Monroe sought his advice even after the age of 80, and Jefferson's reasoning was instrumental in the formulation of the Monroe Doctrine. Education was a foremost priority in retirement.

The meaning of cherished personal possessions for the elderly.

An interview survey was conducted with ninety-four elderly persons, sixty-two in community senior service centers and thirty-two in a nursing home, to find out whether aged persons do identify certain possessions as cherished above all others and to see what meaning these possessions had for their later years. It was found that 81 per cent of the sample could quite readily identify a most cherished object. Different kinds of possessions tended to have different meanings and referents in the lives of the subjects.

Design and evaluation of head unit for wheelchair control by quadriplegic patients.

A control unit was designed to allow persons who have lost hand and arm function to control the speed, steering, reversal and on-off switching of an electric wheelchair by means of backward movement and rotation of the head. When possible, shoulder movement was used to control both reversal and on-off switching. Clinical evaluation in 10 patients with quadriplegia and 2 with severe neuromuscular disease showed that the unit neither interfered with nor restrained the patients' residual body movements, permitted use of natural head movements for smooth and fast control of the wheelchair, and was well accepted by and integrated into the life of the patients.

Clinical conference: De subitaneis mortibus. XIII. Multifocal Purkinije cell tumors of the heart.

Multifocal Purkinje cell tumors were found in the heart of a nine-month-old black female infant who died with arrhythmias which had become progressively more frequent and severe until they were completely intractable. The Purkinje cell tumors were composed of exactly the same type of cells found in the left bundle branch and the right bundle branch, and they were also located in the expected region of the His bundle. In none of these locations were these Purkinje cells forming normal longitudinally oriented Purkinje fibers, however, and no such fibers were found anywhere in this heart.

A Canadian electric-arm prosthesis for children.

The thalidomide tragedy in Canada initiated new efforts to produce functional prosthetic appliances for very young amputees. In 1962, the Rehabilitation Institute of Montreal began to fit 36 babies with adapted conventional and gas-operated devices.Practical experience with the Soviet prosthesis proved the feasibility of myoelectric control, and indicated the possibility of using skin electrodes over an active muscle for control purposes in children.

Medical and psychosocial aspects of the habilitation of thalidomide children.

The habilitation of 34 thalidomide children, begun in 1963 at the Rehabilitation Institute of Montreal, involved the contribution of many medical and paramedical disciplines. These individual contributions are described.Habilitation of congenitally deformed children must be initiated at an early age.