Severe iron poisoning treated with enteral and intravenous deferoxamine.

An 18-month-old boy ingested approximately 18 g FeSO4, equivalent to 336 mg/kg elemental Fe. He rapidly developed severe gastroenteric symptoms, obtundation, and transient hypotension. The serum iron level two hours after ingestion was 6,798 micrograms/dL.

Contrasting ischemic contraction patterns by zone and layer in canine myocardium.

The effect of graded coronary occlusion on myocardial shortening in different zones of the left ventricle is not clear. Therefore, in 15 dogs ultrasonic crystals were used to evaluate the effect of graded coronary occlusion on subendocardial and subepicardial contraction in both the left anterior descending coronary artery (LAD) and left circumflex coronary artery (Circ) distributions. Subepicardial shortening was evaluated along both the long and short axes.

A new device and method for rapid emergency pacing: clinical use in 10 patients.

A new multipurpose transthoracic pacing device is described that will simultaneously enable transthoracic electrode insertion, intracardiac drug infection, and blood sample removal for blood gas determination, all via a single myocardial needle insertion. The device proved efficacious and safe in trials in an animal model. In clinical use in 10 emergency room patients with brady-asystolic cardiac arrest, pacing was achieved in all 10 with one short-term survivor.

Tracking: an answer to psychiatry's recruitment problem?

Part of psychiatry's recruitment problem stems from large-scale defections among students who were planning careers in psychiatry when they entered medical school. The authors present data indicating that University of Maryland freshmen who preferred psychiatry were more than four times as likely to enter psychiatric residency training if they participated in the Combined Accelerated Program in Psychiatry, a continuous 4-year medical school track, than if they pursued the regular undergraduate psychiatry program. The authors believe that an enthusiastic psychiatric faculty intimately involved with students over an extended period of time was the crucial factor neutralizing antipsychiatric socialization experiences in medical school.

Comparative effects of nitroglycerin and nifedipine on myocardial blood flow and contraction during flow-limiting coronary stenosis in the dog.

Both nifedipine and nitroglycerin are used to treat angina pectoris. The comparative effects of these agents on myocardial blood flow and contraction in the setting of flow-limiting coronary stenosis are poorly understood. Thus 24 open chest dogs underwent carotid to left anterior descending coronary arterial perfusion with coronary flow probe and perfusion pressure monitoring.

Spatial distribution of [14C]-lidocaine and blood flow in transmural and lateral border zones of ischemic canine myocardium.

The purpose of this study was to determine the spatial distribution of lidocaine relative to blood flow in ischemic, normal and border zone canine myocardium. Ischemic zone tissue was distinguished from normal zone tissue by a special microsphere technique in adjacent sections 4 to 5 mm wide from the center to the lateral border of the ischemic region in 14 open chest dogs. Gamma-labeled microspheres were separated by a special technique from carbon-14 ([14C])-lidocaine in the same tissue sample.

The successful management of chronic constipation in infants and children.

During a 3 yr period, 77 patients with functional constipation and 34 patients with constipation related to organic lesions of the anorectal area were managed with a strict regimen employing the long-term use of daily enemas. Seventy-four percent of the patients with functional constipation had excellent results and the rest had good results. In children with associated anorectal anomalies, 52% had excellent results, 35% had good results and only 13% had a poor result.

Psychiatric manpower and public mental health: Maryland's experience.

From July of 1976 through December 1981, 67 psychiatrists who graduated primarily from American medical schools and who had completed university residency training programs were recruited into Maryland's state mental health system. As of 1981, 43 of these psychiatrists still worked in inpatient facilities; they represented 33 per cent of all state hospital psychiatrists in Maryland. The Maryland Mental Hygiene Administration and the University of Maryland have used two general strategies to develop psychiatric manpower and improve employment conditions.

The effects of nifedipine on myocardial blood flow and contraction during ischemia in the dog.

Nifedipine has been proposed as an agent to preserve viability and function of ischemic myocardium. We studied 23 open-chest dogs that underwent carotid-to-left anterior coronary artery perfusion with flow probe and perfusion pressure monitoring. Segment length was measured with ultrasonic crystals in the ischemic and nonischemic endocardium.

Variable effect of nifedipine on myocardial blood flow at three grades of coronary occlusion in the dog.

The effect of nifedipine on myocardial blood flow at various grades of coronary stenosis is unknown, Thus 22 open-chest dogs underwent carotid to left anterior descending perfusion with flow and perfusion pressure monitoring. Grades of coronary occlusion were defined by minimum diastolic perfusion pressure. six dogs (group 1) underwent moderate occlusion to 50 to 55 mm Hg diastolic perfusion pressure; (group 2), severe occlusion to 40 mm Hg perfusion pressure; and six (group 3), more severe occlusion at 25 mm Hg.

The relationship between myocardial blood flow and contraction by myocardial layer in the canine left ventricle during ischemia.

We investigated the relationship between regional myocardial blood flow (MBF) and segmental shortening in 17 open-chest dogs. The left anterior descending coronary artery was cannulated and perfused from the left carotid while measuring perfusion pressure. Graded occlusion was produced by a screw clamp.

Improved hemodialysis access in children.

Vascular access for chronic hemodialysis in children is difficult because of problems that include obtaining vessels of sufficient size, the limited life-span of external shunts, and the multiple painful punctures associated with internal fistulae. Twenty-five expanded polytetraflouroethylene (PTFE) grafts of 6-mm diameter were inserted for dialysis access over a 2-yr period in 23 children. Grafts were placed either in the upper arm or thigh.

Corticosteroid therapy in hemorrhagic and septic shock in puppies.

The efficacy of corticosteroid therapy in the treatment of shock remains controversial. In order to evaluate this question, the following controlled experimental study was undertaken. There were 44 puppies (2-6 kg) used to examine the effects of methylprednisolone (30 mg/kg) in both hemorrhagic and live Escherichia coli septic shock.

Fluid resuscitation in live Escherichia coli shock in puppies.

The infusion of live E. coli in the puppy produces a severe and usually lethal model of pediatric septic shock with characteristic reduction in cardiac output and blood pressure. Hemodynamic abnormalities are partially reversed with fluid resuscitation alone, and large volumes, supplemented with albumin well within tolerated fluid loads, produce the most pronounced corrections of these derrangements.

An evaluation of the modified endorectal procedure for Hirschsprung's disease.

During the past 4 yr, 60 patients with Hirschsprung's disease have been treated at our institution. Twenty-eight patients within this group have undergone a modified endorectal pull-through procedure. There are 18 males and 10 females in the series.

The influence of left ventricular late diastolic filling on the A wave of the left ventricular pressure trace.

To study the influence of left ventricular (LV) late diastolic filling on the A wave of the LV pressure, simultaneously recorded echocardiographic LV dimensions and high-fidelity LV pressure measurements were taken in 24 patients. Group 1 comprised eight patients without LV hypertrophy (LVH) and LV end-diastolic pressure (LVEDP) less than or equal to 13 mm Hg. Group 2 comprised 16 patients with LVH secondary to aortic stenosis, idiopathic hypertrophic subaortic stenosis, or hypertension and increased LVEDP.

The importance of different calorie sources in the intravenous nutrition of infants and children.

The intravenous infusion of amino acid and carbohydrate solutions is a well-established technique for nutritional support of the pediatric surgical patient. By using peripheral veins for total parenteral nutrition (TPN), weight gain can be achieved and the complications of central venous catheters avoided. Over a 2-year period, 45 patients from 1 day to 16 years of age received peripheral TPN in which fat provided a major portion of the daily calories.

Crohn's disease in children and adolescents: is inadequate weight gain a valid indication for surgery?

Seventy children and adolescents hospitalized for Crohn's disease at the University of Michigan Medical Center between 1966 and 1976 are reviewed. Thirty-three of these children were managed medically and 37 underwent a total of 60 operative procedures. There were 33 bowel resections, 7 appendectomies, 4 abscess drainages, 3 bowel bypasses, and 13 miscellaneous operative procedures.