Louis Gdalman, pioneer in hospital pharmacy poison information services.

The role played by hospital pharmacist Louis Gdalman in the development of poisoning information services in the Chicago area is described. In the 1930s, decades before the creation of the Chicago Poisoning Control Program, Louis Gdalman had already established a poison information service at St. Luke's Hospital in Chicago. Pharmacists provided poison information to the physicians and nurses working in the emergency room. By the early 1950s, Gdalman had established an extensive library of information on the management of acute and chronic poisoning and had developed a standard form for the collection of data from poison information calls. He personally provided a 24-hour poison information service and often took calls at home. In 1953, the American Academy of Pediatrics initiated the Chicago Area Poisoning Control Program and established treatment and referral centers at 11 hospitals, including St. Luke's Hospital. Louis Gdalman was the only pharmacist involved in this city-wide program. By 1962, the Master Poison Control Center was established at St. Luke's Hospital, which had merged with Presbyterian Hospital in 1956. Today, this center, known as the Chicago and Northeastern Illinois Regional Poison Control Center, is located at the Rush-Presbyterian-St. Luke's Medical Center in Chicago. Louis Gdalman, a hospital pharmacist, pioneered the area of poison information and established what was perhaps the first hospital-based comprehensive poison control center.

Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective.

We prospectively studied the safety of replacing intravenous delivery systems, including those used in total parenteral nutrition, at 72- compared with 48-hour intervals in 487 patients. Although the prevalence of contamination of intravenous fluid was higher in administration sets replaced at 72-hour intervals (10/664, 1.5%) than in sets replaced every 48 hours (6/710, 0.8%), the difference is not statistically significant. Contamination in both groups was almost exclusively with small numbers of coagulase-negative staphylococci (range, 1 to 27 colony-forming units/mL); no contaminated infusion was associated with clinical signs of sepsis or concordant bacteremia. Contaminants were recovered less frequently from peripheral venous infusions (0.6%) than from infusions used for central venous access or hemodynamic monitoring (1.5%) or total parenteral nutrition (3.6%); infusions in an intensive care unit were more frequently contaminated (2.5%) than infusions on medical and surgical wards (0.9%). These data indicate that extrinsic contamination of intravenous fluid is a rare cause of endemic nosocomial septicemia, and for most infusions it is unnecessary to routinely replace delivery systems more frequently than every 72 hours.

[Paroxysmal tachycardic atrial fibrillation: termination by surgically induced A-V block (author's transl)]. / Paroxysmales tachykardes Vorhofflimmern. Therapie durch einen chirurgisch induzierten AV-Block

In a 58-year-old patient frequent attacks of tachycardic atrial fibrillation had given rise to signs of abnormal cardiac function. All drug treatment had failed, as had several attempts at electric countershock and rapid atrial and ventricular stimulation. For this reason a surgical A-V block at the level of the His bundle was induced under cardio-pulmonary bypass and a ventricular pacemaker inserted. One year postoperatively the pacemaker functions without complication, and the patient is without symptoms. The ECG shows no sign of spontaneous A-V conduction. This is thought to be the first report of surgically induced A-V block for the control of atrial fibrillation.

[Clinical and haemodynamic results with intra-aortic counterpulsation (author's transl)]. / Klinische und hämodynamische Ergebnisse mit der intra-aortalen Gegenpulsation

The AVCO balloon pump (model 7) was used on 13 patients with cardiogenic shock and for circulatory support after open-heart surgery. Twelve patients survived, but one patient died of a cerebral embolism which had occurred before the use of the balloon pump. Mean systemic arterial pressure, mean pulmonary artery pressure, pulmonary wedge pressure and heart rate were measured in all patients, while cardiac index and arterio-venous oxygen difference were measured in seven. Average duration of counterpulsation was four days. Vasopressor treatment was reduced or discontinued in all patients, urinary output increased markedly and the clinical state improved. Although systolic pressure did not change significantly, MAP increased significantly by 25 mm Hg (P less than 0.005), with a mean diastolic pressure increase to 104 mm Hg. The pulmonary artery pressure, the pulmonary wedge pressure and the mean pulse rate all decreased significantly by 25 mm Hg, 16 mm Hg and 24 beats/min, respectively. A fall in arterio-venous oxygen difference of 2.6 ml/100 ml (P less than 0.025) was associated with a significant increase in cardiac index by 0.62 l/min-m2 (P less than 0.025). It is concluded from these results that intra-aortic balloon counter-pulsation may be an effective means of providing circulatory support in cardiogenic shock and after open-heart surgery.