Factors influencing one's ability to adapt to chronic illness

The disease course in chronic illness may be subtle and accompanied by irreversible changes that have to be managed. Once the immediacy of the illness has been dealt with, the patient may face a future full of uncertainties related to illness recurrence, further disease progression, and perhaps even death. Thus the long-term implications of chronic illness necessitate multiple accommodations on the part of the patient, the family, and society. To aid in one's ability to deal with a chronic illness such factors as care, technology, family relationships, developmental level, cultural values and beliefs, communication, and economics need to be considered. An understanding of how each of these factors affects chronic illness can facilitate the appropriate development and initiation of options for adaptation to the illness.

The dexamethasone suppression test as a predictor of antidepressant response

There is some evidence to suggest that dexamethasone suppression test (DST) results obtained prior to treatment for depression might aid in selecting the proper type of antidepressant medication. Forty endogenously depressed outpatients were evaluated with the DST and 12 (30%) were identified as nonsuppressors. All patients were then treated with desipramine (150-350 mg/day). Plasma concentrations of desipramine were monitored to assure that therapeutic levels were achieved. At 5 weeks of treatment, patients were characterized as treatment responders or nonresponders on the basis of change in Hamilton Depression Scale scores.

Nocturnal sleep apnoea: method of diagnosis

A patient with sleep apnoea syndrome is presented. The value of a rapid CO2 analyser and an oesophageal pressure recorder in the diagnosis is described.

DALE--a system for developing computer-aided biomedical experiments

The implementation of new computer-aided biomedical experiments usually requires a high level of computing expertise and a significant amount of time. Acquiring this knowledge and devoting the necessary time may result in the inefficient use of a researcher's own particular skills. A number of software aids for laboratory experimentation have been developed, but it is considered that none adequately satisfies the user's requirements. DALE (direct access to laboratory equipment) has been designed as a user-oriented software system, and consists of a menu-based interactive subsystem, with which experiments are defined, and a table-driven interpreter to execute the experiment. Little computing knowledge or development time is required to implement new experiments, and experience has indicated that DALE is a useful tool for biomedical experimentation.

An analysis of the performance of a variable venturi-type oxygen mask

The theoretical performance of the Hudson Multivent mask is considered. A method is described of determining the flow-weighted mean inspired oxygen concentration produced by the mask. Using this method, it was found that the inspired oxygen concentration was predictable only at the 24% setting using the recommended flow rates, but that increasing the supplied-oxygen flow rates above the recommended levels resulted in the return of predictable function. At settings above 30% predictable function was found to be unlikely, whatever the supplied oxygen flow rate. Recommendations are made regarding the use of this device.

Multiple sequential femoral tibial grafting for severe ischemia

For the past decade a common procedure used to salvage severely ischemic limbs has been autogenous vein bypass grafting to the distal popliteal artery or, if the popliteal trifurcation is occluded, to one of the tibial-peroneal branches. Reported limb salvage rate and long-term graft function varies considerably but in most series is low. To increase graft flow and to decrease resistance in femoral-poplitical-tibial grafts and thereby to perfuse the ischemic foot more effectively, we have employed multiple sequential anastomoses of a single vein graft to distal branches--a technique similar to that used occasionally in aortocoronary bypass grafting. The autogenous vein graft alone, or in combination with bovine heterograft, has been used in six patients with gangrenous toes or far advanced ischemia and in one patient with severe claudication. Multiple anastomoses below the knee were carried out in each patient. Anastomosis has been to a blind popliteal segment, then to a tibial or peroneal in four patients, to both tibials in another two patients, and to both tibials and the peroneal in one patient. Flow rates measured on the operating table clearly demonstrated a significant increase in flow through the graft with each additional anastomosis. There has been a greater response to surgery with return of pulses, warmth of the foot, and rapid healing as compared with previous patients having single femoral-tibial anastomoses. One failure occurred acutely from a technical problem early in the series; one failed at 3 months in a patient with pancreatic cancer and another patient died 2 weeks after operation of a myocardial infarct.

Ventilatory abnormalities in hospital admissions

The incidence of unrecognised ventilatory impairment was investigated in a group of 531 routine hospital admissions who had been considered to be free of significant respiratory disease. Using spirometric tests of FEV 1, FVC and FEV 1/FVC percent before and after sympathomimetic bronchodilator, it was found that 42 percent of these patients had abnormal ventilatory tests, and 47 percent were considered to have obstructive lung disease. Routine use of screening respiratory function tests would be useful in the assessment and management of general medical and surgical hospital admissions.

Priorities in management of trauma victims

Good results of the emergency management of trauma victims depend on recognition of serious injuries and rapid, effective treatment as well as anticipation and prevention of complications. The most spectacular injury is not always the most urgent and life-threatening. Based on priorities of management, care is recommended to improve mortality and morbidity statistics. Suggestions for effective treatment of rapidly lethal lesions and preparations for transporting seriously injured patients are also outlined.