[The psychological effects of intensive care (author's transl)]

After some twelve years experience as a Consultant Anaesthesist in Intensive Therapy Units the author suffered a catastrophic illness which required a period of artificial ventilation in the I.T.U. in which he worked. He found that much of what he and others had written about the psychological effects on the patient of intensive therapy was mistaken. The main psychological problems were anxiety, disorientation and exhaustion and communication difficulties. The methods used by the author to achieve recall of these distressing events and suggestions as to how such problems may be alleviated are discussed.

Familial hypertrophic cariomyopathy and lentiginosis

Members of three generations of a family studied, manifest profuse lentiginosis and hypertrophic cardiomyopathy. The autosomal dominant inheritance of this syndrome is established. Lentiginosis should alert the physician to possible underlying heart disease.

Foetal respiratory movements, electrocortical and cardiovascular responses to hypoxaemia and hypercapnia in sheep

1. Foetal breathing movements, electrocortical activity, arterial pressure and heart rate were recorded continuously in chronically catheterized sheep, 97-145 days pregnant.2. With increasing gestational age there was a fall in heart rate of 0.67 beats/day and a rise in arterial pressure of 0.46 mmHg/day.3. Hypoxaemia in the foetus was induced by allowing the ewe to breathe low oxygen mixtures, 9% O(2) with 3% CO(2) in N(2). In the younger foetuses there was an initial rise in heart rate whereas in the older foetuses there was a fall. After the end of hypoxia there was a persistent tachycardia in both groups. In the older foetuses there was a rise of arterial pressure.4. Two vagotomized older foetuses showed cardiovascular responses similar to those of the younger foetuses.5. Foetal breathing movements were abolished by hypoxaemia in twenty-two of twenty-five experiments. In the three exceptional experiments there was a small rise in P(a, CO2).6. The proportion of time occupied by low voltage electrocortical activity in the foetus was reduced by hypoxaemia.7. Hypercapnia was induced by giving the ewe 4-6% CO(2) with 18% O(2) in N(2) to breathe. After an initial slight fall the foetal heart rate increased and there was a small rise in foetal arterial pressure.8. The proportion of time occupied by low voltage electrocortical activity and breathing movements was increased by hypercapnia.9. Maternal hyperoxia, induced by giving 50% O(2) in N(2), did not significantly increase foetal breathing movements unless the ewe was in labour. In labour the foetuses had lower P(a, O2) values initially and a reduced incidence of foetal breathing, both of which were increased by maternal hyperoxia.

Lipid absorption and deposition in rainbow trout (Salmo gairdnerii)

Rainbow trout, fed or starved for 5 weeks, were force-fed 23 μCi 1-14C-palmitic acid and sacrificed at [Formula: see text], 1, 2, 4, 8, and 14 h after feeding. Analysis of the blood suggested that trout possess an intestinal absorption mechanism for lipid that is very different from that found in other animals. The fish, incapable of delivering triglyceride to its circulation in the usual way, receives most of its absorbed lipid as free fatty acids, probably via the portal system. It was also found that light muscle more easily yielded its triglyceride stores, in agreement with its role as the major lipid depot in trout. Nonetheless, dark muscle was metabolically more active in deposition of muscle lipids. Dark muscle appeared to function more as an organ than a kinetically responsible contractile body.

Modern management of acute myocardial infarction

Coronary care units have led to a reduction in the mortality of patients with acute myocardial infarction (Goble et al., 1966; Killip and Kimball, 1967; MacMillan et al., 1967). Continuous electrocardiographic monitoring in patients with acute myocardial infarction has shown that cardiac arrhythmias are extremely common (Julian et al., 1964). The prompt and effective control of minor cardiac arrhythmias by appropriate anti-arrhythmic therapy, prevents the development of major cardiac arrhythmias and this is the chief benefit of the coronary care unit. To a lesser extent the successful resuscitation of patients with cardiac arrest contributes to the reduction in mortality.

External method for detection of fetal breathing in utero

An ultrasonic technique for detecting fetal breathing in utero has been developed using chronic fetal lamb preparations, and has been used successfully in pregnant women.