JAMA

doi: 10.1001/jama.1969.03160100001001pmid: N/A

doi: 10.1001/jama.1969.03160100003002pmid: N/A

Unilateral Lung Lavage Clears Obstruction Unilateral pulmonary lavage has been found to be safe and therapeutically useful in some patients with obstructive airway disease, report three North Carolina physicians. Fifteen clinical trials have been performed on seven patients, two with asthma and five with chronic bronchitis, said Jose Ramirez-R., MD, chief, pulmonary disease service, Veterans Administration Hospital, Durham, NC. Improvement in respiratory function has been noted in four patients observed for 12 to 16 weeks, he told the American Thoracic Society meeting in Miami Beach. Repeated lavage of one lung while ventilating the other with oxygen is an effective way to debridebronchoalveoli. The safety of the technique has been shown in treating alveolar proteinosis, but safety has not been established in patients with diffuse obstructive airway disease. The lungs' ventilatory functions are separated with a double-lumen bronchospirometric catheter. Oxygen is then administered to one lung while the other, partially

doi: 10.1001/jama.1969.03160100014003pmid: N/A

A high incidence of anemia has been found among Biafran refugee children arriving at the Ivory Coast. A previous Medical News article (JAMAMedical News207:2366 [March 31] 1969) erroneously referred to many instances of leukemia. Only one child with leukemia has been discovered thus far, according to Fred D. Rose, MD, Philadelphia.

Hall, Michael C.; Elmore, Stanley M.; Bright, Robert W.; Pierce, James C.; Hume, David M.

doi: 10.1001/jama.1969.03160100015004pmid: N/A

Between August 1962 and May 1968, 140 renal transplantations were performed. Of the patients in this series, prior to transplantation, three were found with severe epiphysiolyses of the femoral heads, one with stress fractures of the femoral necks, and three with avascular necrosis of the femoral heads. It is suggested that these deformities should be stabilized as in other children. After transplantation, avascular necrosis of a femoral head or condyle developed in six patients. The cause is unknown but is believed related to the use of prednisone. Three infections of bone or joint have occurred.

Simon, Harvey B.; Daggett, William M.; DeSanctis, Roman W.

doi: 10.1001/jama.1969.03160100020005pmid: N/A

Two elderly women had hemothorax as a complication of anticoagulant therapy for pulmonary infarction. To our knowledge, this complication has not previously been reported. Both patients were treated with heparin sodium and warfarin sodium following pulmonary infarction. Excess anticoagulant effect developed in both, and both had significant intrapleural hemorrhage, which was fatal in one case. Clinical differentiation between simple pulmonary emboli and emboli with infarction is difficult but important.

Petit, Donald W.

doi: 10.1001/jama.1969.03160100025006pmid: N/A

A state medical association can have a strong role in continuing medical education if it represents the physician, bears the responsibility and privilege for continuing education of its members, and recognizes today's needs and inadequacies in this field. It can act as a catalyst between its members and medical educators; it can coordinate educational activities of other organizations and can provide leadership in developing evaluation programs; it can serve in accreditation activities; it can help in motivating the physician to participate in continuing medical education; it can strengthen the relationship between medical schools, medical societies, and hospitals; it can provide a statewide forum for exchange of ideas and problems in continuing medical education. I suggest that the American Medical Association provide an annual national forum for all state medical associations to accomplish the same goals together.

Gode, Alexander

doi: 10.1001/jama.1969.03160100028007pmid: N/A

Fisch, Charles; Oehler, Robert C.; Miller, Jerry R.; Redish, Charles H.

doi: 10.1001/jama.1969.03160100029008pmid: N/A

Electrocardiograms were recorded continuously during 103 consecutive oral surgical procedures in 65 apparently healthy individuals anesthetized with intravenously administered methohexital (Brevital) sodium followed by inhalation of halothane-nitrous-oxide-oxygen mixture. Cardiac arrhythmias were recorded in 44 (42.7%) of the 103 procedures, with more than one arrhythmia recorded in each of 16 patients. The incidence of the arrhythmias rose sharply with beginning of the surgery and declined equally abruptly with its termination, suggesting reflex stimulation and simultaneous "sensitization" by the anesthetic, most likely halothane. Because of the potentially serious nature of many of the arrhythmias encountered, we suggest that this form of anesthetic not be used routinely for oral surgery in an outpatient setting unless the equipment and personnel for prompt resuscitation are available.

Jelliffe, Roger W.; Hill, Dennis; Tatter, Dorothy; Lewis, Edward

doi: 10.1001/jama.1969.03160100033009pmid: N/A

Weakness, vomiting, severe hypokalemia, and cardiac arrhythmias developed in an obese 19-year-old boy on a weight-reduction regimen of thyroid preparations, digitalis, amphetamines, and diuretics. The patient died despite attempts to replace potassium, cardioversion, and cardiac massage. Protein-bound iodine and serum uric acid levels were elevated. Autopsy revealed no other cause of death. Results of postmortem chemical studies revealed digitalis in the myocardium and amphetamine in the liver. Death is believed to have been due to the combined effect of weight-control medications causing myocardial irritability, cardiac arrhythmias, and hypokalemia. Obesity alone is not a valid indication for large doses of thyroid preparations, for digitalis, or for prolonged fluid depletion by long-term diuretic administration.

Breen, Francis A.; Tullis, James L.

doi: 10.1001/jama.1969.03160100038010pmid: N/A

Chromatographic DEAE-adsorbed prothrombin complex (Hemoplex) was administered to 14 patients with disorders involving depression in the levels of factors II, VII, IX, and X. These included patients with Christmas disease, liver disease, and hypoprothrombinemia induced by bishydroxycoumarin (Dicumarol). In every instance, prompt hemostasis was achieved as evidenced by cessation of hemorrhage and correction of procoagulant deficits. A frequently seen immediate improvement in hemostasis was attributed to the presence of activated surface factor. Limited usage of tricalcium phosphate adsorbed prothrombin complex failed to show significant improvement in subsequent levels of circulating factor IX.