Distinguishing elation, gladness, and joy

On the basis of a structural analysis of the emotions, descriptive items were created that were postulated to discriminate between elation, gladness, and joy. The items described the situation of each emotion, the different ways in which the body was transformed, the propensity to behave in particular ways, and the different manner in which the emotions functioned to improve the person's life. In the first study, the items were given to subjects who had been asked to recall an instance of elation, gladness, or joy. Ss noted the extent to which each of the items pertained to their particular experience. Analyses of the data establish clear distinctions between elation and gladness and suggest that there may also be a distinct structure for joy. In the second study, the situations for elation and gladness were experimentally created, and objective measures of bodily transformation and behavioral propensity were taken while subjects were in the different emotional states. The results confirmed the structural differences suggested by the retrospective accounts.

Testing some attribution€motion relations in the People's Republic of China

We conducted a questionnaire study to test the generality of attribution-emotion relations to individuals in the People's Republic of China. Replications of prior findings of studies conducted with American subjects were reported: (a) High effort and success enhanced interpersonal evaluations when ability, effort, and outcome information were provided; (b) affective communications of pity, anger, and guilt were respectively used to infer low ability, lack of effort, and teacher as causes of failure; (c) effort and ability levels were inferred from the presence or absence of anger reactions; and (d) controllable causes of a broken social contract were expected to result in anger from others. Chinese and American respondents also indicated what situations would arouse the affects of anger, guilt, pity, pride, and shame. We found no evidence for the characterization of Chinese as (a) emphasizing effort over ability as a cause of achievement outcomes or (b) de-emphasizing the importance of personal achievement and stressing group goals and accomplishments.

An attributional analysis of reactions to stigmas

In two experiments, we examined the perceived controllability and stability of the causes of 10 stigmas. Guided by attribution theory, we also ascertained the affective reactions of pity and anger, helping judgments, and the efficacy of five intervention techniques. In the first study we found that physically based stigmas were perceived as onset-uncontrollable, and elicited pity, no anger, and judgments to help. On the other hand, mental-behavioral stigmas were perceived as onset-controllable, and elicited little pity, much anger, and judgments to neglect. In addition, physically based stigmas were perceived as stable, or irreversible, whereas mental-behavioral stigmas were generally considered unstable, or reversible. The perceived efficacy of disparate interventions was guided in part by beliefs about stigma stability. In the second study we manipulated perceptions of causal controllability. Attributional shifts resulted in changes in affective responses and behavioral judgments. However, attributional alteration was not equally possible for all the stigmas.

Intravenous labetalol for the control of hypertension following repair of coarctation of the aorta

Paradoxical hypertension is a relatively common complication of surgical repair of coarctation of the aorta. An early phase of systolic hypertension has been ascribed to elevated levels of norepinephrine. Activation of the renin-angiotensin system from sympathetic stimulation has been implicated in a later phase of systolic and diastolic hypertension that can result in mesenteric arteritis. The use of a rapidly acting, titratable intravenous alpha- and beta-adrenergic blocker, such as labetalol hydrochloride, addresses both of these neurohormonal mechanisms. In the intravenous form, it would appear to be an excellent choice for the management of early postoperative hypertension and it can be converted to the oral form in cases of persistent hypertension. We report for the first time the use of labetalol in two young patients for the control of paradoxical hypertension following coarctation repair.

Cefamandole pharmacokinetics during standard and pulsatile cardiopulmonary bypass

The pharmacokinetics of cefamandole during standard or pulsatile cardiopulmonary bypass were studied in 13 adult cardiac surgery patients. All patients received 20 mg/kg of cefamandole intravenously at midnight before surgery, 6 AM on the morning of surgery and just prior to the initiation of cardiopulmonary bypass (CPB) surgery. Serum, skeletal muscle, and fat samples were taken at the beginning of CPB and at 30-minute intervals thereafter and assayed for cefamandole concentration. The average elimination rate constant and elimination half-life for cefamandole in patients undergoing standard CPB were 0.73 +/- 0.09 hour-1 and 0.94 +/- 0.11 hour, respectively. In contrast patients undergoing pulsatile CPB had significantly slower elimination rate constants (0.50 +/- 0.1 hour-1 and 1.4 +/- 0.28 hours, respectively; P less than or equal to .05). Area under the curve (AUC) values for cefamandole in fat and muscle tissue were higher in patients undergoing pulsatile CPB, but the differences were not statistically significant. Prolonged elimination from the serum, skeletal muscle, and adipose tissue, as compared with normal subjects, is seen with both pulsatile and standard CPB but is greater for the pulsatile method. Intraoperative dosing of cefamandole is required to maintain adequate serum and tissue levels for operations lasting longer than 4 or 6 hours in which standard or pulsatile CPB, respectively, are used.

Attribution theory and attributional therapy: some theoretical observations and suggestions

Two shortcomings of attributional therapy and therapy-related research are pointed out. First, crucial comparisons between attributional inductions are not being made, so that the variables mediating change remain uncertain and, secondly, the full theory is not being used, thereby greatly limiting the possible change programmes.

Methemoglobinemia from intravenous nitroglycerin: a word of caution

The dose of intravenously administered nitroglycerin (IV NTG) used to control ischemic chest pain usually is limited by hypotension from decreased preload. Herein we describe 2 patients who tolerated IV NTG without hemodynamic compromise but in whom severe impairment of blood oxygen content developed from methemoglobinemia noted during coronary bypass surgery. Methemoglobinemia must be suspected if chocolate-brown blood is encountered despite a normal arterial oxygen tension and calculated oxygen saturation. Before a methemoglobin level is available, the extent of hypoxemia can be determined by an oximetric oxygen saturation and therapy begun with intravenous administration of methylene blue. These case reports focus attention on the potential deleterious effects of undetected hypoxemia from methemoglobinemia in patients being stabilized with high-dose IV NTG for urgent cardiac surgery.

An attributional analysis of excuse giving: studies of a naive theory of emotion

We conducted four studies that pertained to excuses given for a broken social contract. In an initial field investigation, participants recalled occasions in which they had given true and false reasons for not fulfilling a social obligation. Communicated reasons tended to be external to the person, uncontrollable, and unintentional (e.g., "My car broke down"), whereas withheld reasons tended to be internal, controllable, and either intentional (e.g., "I did not want to go") or unintentional (e.g., "I forgot"). The external uncontrollable excuses were anticipated to lessen the anger of the wronged party. In a subsequent simulation study, excuses based on the categories detected in Experiment 1 were manipulated and related to anger ratings. The same pattern of results was displayed, with intent and negligence provoking the highest anger ratings. The final two studies involved laboratory manipulation of a communicated reason for coming late to an experiment. In Experiment 3, a confederate conveyed either an internal controllable, an external uncontrollable, or no reason for making a subject wait, whereas in Experiment 4, subjects were detained and created their own good, bad, any, or no excuse for being tardy, which was communicated to a second, waiting subject. A consistent pattern of good excuse/external uncontrollable reason and bad excuse/internal controllable reason was displayed; offering no excuse resulted in the same judgments as giving a poor excuse. Relative to the external uncontrollable reasons, internal controllable excuses for being late augmented aversive emotional reactions, increased negative personality ratings, and resulted in a desire for no further social contact.(ABSTRACT TRUNCATED AT 250 WORDS)

An attributional analysis of excuse giving: Studies of a naive theory of emotion

We conducted four studies that pertained to excuses given for a broken social contract. In an initial field investigation, participants recalled occasions in which they had given true and false reasons for not fulfilling a social obligation. Communicated reasons tended to be external to the person, uncontrollable, and unintentional (e.g., "My car broke down"), whereas withheld reasons tended to be internal, controllable, and either intentional (e.g., "I did not want to go") or unintentional (e.g., "I forgot"). The external uncontrollable excuses were anticipated to lessen the anger of the wronged party. In a subsequent simulation study, excuses based on the categories detected in Experiment 1 were manipulated and related to anger ratings. The same pattern of results was displayed, with intent and negligence provoking the highest anger ratings. The final two studies involved laboratory manipulation of a communicated reason for coming late to an experiment. In Experiment 3, a confederate conveyed either an internal controllable, an external uncontrollable, or no reason for making a subject wait, whereas in Experiment 4, subjects were detained and created their own good, bad, any, or no excuse for being tardy, which was communicated to a second, waiting subject. A consistent pattern of good excuse/external uncontrollable reason and bad excuse/internal controllable reason was displayed; offering no excuse resulted in the same judgments as giving a poor excuse. Relative to the external uncontrollable reasons, internal controllable excuses for being late augmented aversive emotional reactions, increased negative personality ratings, and resulted in a desire for no further social contact.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of pindolol and hydrochlorothiazide on blood pressure, and plasma renin and plasma lipid levels

After three weeks' administration of placebo, three groups of eight patients with moderate hypertension were randomly assigned to single daily dose, double-blind treatment with either pindolol 15 mg, hydrochlorothiazide 50 mg, or a combination of both for eight weeks. All determinations were made 24 hours after ingestion of a dose. Reductions in supine, sitting, and standing systolic and diastolic blood pressure were greater in patients receiving hydrochlorothiazide than in those administered pindolol; however, the greatest reductions were registered in individuals receiving combination therapy. Mean basal plasma renin activity rose significantly from 0.45 +/- 0.44 to 1.42 +/- 1.31 ng/mL/hr and from 0.67 +/- 0.46 to 1.27 +/- 0.83 ng/mL/hr in patients receiving hydrochlorothiazide and combination therapy, respectively, but there was no change in those administered pindolol. Hydrochlorothiazide and combination therapy increased mean total cholesterol levels from 247 +/- 25 to 263 +/- 37 mg/dL and 198 +/- 36 to 211 +/- 33 mg/dL, respectively, at eight weeks, and both increased mean triglyceride concentrations at two weeks. Pindolol did not show any tendency to alter lipid levels. Pindolol should be given twice daily. At 15 mg daily, it has little or no effect on basal plasma renin activity or plasma lipid levels.

Digoxin prophylaxis following coronary artery bypass surgery

The effect of the postoperative administration of digoxin to patients undergoing coronary artery bypass surgery on the incidence of supraventricular arrhythmias was studied. Patients were randomly assigned to a control group (n = 51) or digoxin group (n = 47) on a prospective basis. Patient characteristics were similar in both groups, and no patients were receiving digoxin therapy preoperatively or other antiarrhythmic medications. All patients had normal systolic ejection fractions, renal function, and hepatic function. Eight patients (16%) in the control group developed postoperative arrhythmias while seven patients (15%) in the digoxin group developed supraventricular arrhythmias. This difference was not significant. Two patients in the digoxin group developed digoxin-induced arrhythmias, and two other patients experienced digoxin-related nausea and vomiting, which were resolved with discontinuation of the drug. The postoperative administration of digoxin to patients undergoing coronary artery bypass surgery had no effect on the incidence of supraventricular arrhythmias. The prophylactic use of digoxin therapy in this patient population is not recommended unless there is a history of arrhythmias responsive to digoxin therapy.

Esophageal tear following forceful removal of an impacted oral-gastric lavage tube

We report an unusual complication of oral-gastric lavage in a drug overdose patient. During the lavage procedure, the oral-gastric tube became impacted in the esophagus. Forceful removal of the tube resulted in an esophageal tear. The patient did well with conservative management and was discharged with no long-term sequelae.

Hemodynamic effects of verapamil in the beta-blocked dog

The use of the calcium channel-blocking agent, verapamil, in beta-blocked patients has been the subject of intense investigation, particularly because both verapamil and the beta-blockers can produce negative inotropic effects. We studied the hemodynamic effects of verapamil in beta-blocked dogs to establish specific measurements that could be used clinically for early identification of combined negative inotropism. Seven anesthetized, mongrel dogs were beta-blocked with propranolol, and then given 2.5-, 5.0-, and 10.0-mg iv boluses of verapamil. The 2.5- and 5.0-mg boluses represent clinical doses, whereas the 10.0-mg bolus is a large pharmacologic dose. Hemodynamic measurements showed that verapamil was well tolerated at clinical doses; increases in stroke volume compensated for decreases in mean arterial pressure. At high doses of verapamil this response was not observed and left ventricular stroke work decreased. Cardiac and stroke indices were not useful indicators of combined drug toxicity in this dog model.

Warfarin dosage following prosthetic valve replacement: effect of smoking history

Warfarin currently is the most widely used agent in the prevention of thrombosis and embolism after prosthetic cardiac valve replacement. Since smoking has been shown to increase the requirement for medications undergoing hepatic metabolism, this study was designed to determine if a correlation exists between smoking history and warfarin daily maintenance dose (DMD) in patients undergoing cardiac valve replacement. Of 200 charts retrospectively reviewed at the New England Medical Center, 174 satisfied the criteria for inclusion in the study (normal hepatic, renal, and hematologic function, and absence of complicating medications). The study population included aortic, mitral, and combined valve replacement. Study groups consisted of 117 nonsmokers (Group A), 23 light smokers (Group B), and 34 heavy smokers (Group C). Thirty-three percent of patients required a low DMD of warfarin (less than or equal to 2.5 mg), 43 percent required a moderate DMD (greater than 2.5-7.5 mg), and 24 percent required a high DMD (greater than 7.5 mg). Each of the subgroups followed a similar pattern. In Group A, there were 31 percent low, 44 percent moderate, and 25 percent high-dose requiring patients. In Group B, there were 48 percent low, 39 percent moderate, and 13 percent high-dose requiring patients and in Group C there were 29.5 percent low, 41 percent moderate, and 29.5 percent high-dose requiring patients. Chi-square analysis did not demonstrate any statistically significant difference between smokers and nonsmokers in regard to daily maintenance warfarin dose (p = 0.5). The study population followed a normal pattern of distribution in regard to warfarin dosage. On the basis of these data we conclude that smoking history does not affect warfarin dose requirement.

Antibiotic prophylaxis in high-risk biliary operations: multicenter trial of single preoperative ceftriaxone versus multidose cefazolin

A prospective, double-blind trial of a single preoperative dose of ceftriaxone, a new long-acting cephalosporin, versus one preoperative and three postoperative doses of cefazolin was carried out in 81 patients at high risk of infection after biliary surgery. Indications for antibiotic prophylaxis included recent or ongoing cholecystitis (52 patients), common duct stones (14 patients), common duct obstruction (3 patients), and age greater than 70 years (22 patients). Intraoperative bile cultures were positive in 7 of 41 patients (17.1 percent) given ceftriaxone and 12 of 40 patients (30 percent) given cefazolin, but there were no wound infections in either group. Neither regimen was associated with significant antibiotic resistance. Side effects, such as proteinuria and elevated liver transaminases and alkaline phosphatase levels, were transient and not definitely related to the antibiotics. We conclude that a single preoperative dose of ceftriaxone is as effective as multiple perioperative doses of cefazolin in the prophylaxis of infection associated with biliary tract surgery.

Selective thromboxane inhibition: a new approach to antiplatelet therapy

Antiplatelet drugs as exemplified by aspirin are used frequently to prevent stroke. Aspirin inhibits the formation of both the potent platelet aggregator, thromboxane A2 and the potent anti-aggregator, prostacyclin. Another approach to the inhibition of platelet aggregation might involve selective suppression of thromboxane formation. We report our experience in swine with UK-38,485, a drug which selectively inhibits thromboxane formation. The rationale and potential uses of UK-38,485 in the in vivo prevention of platelet aggregation and for the therapy of cerebrovascular disease are discussed.