Actinotignum schaalii infection: Challenges in diagnosis and treatment.

Actinotignum schaalii affects elderly people and is associated with individuals with urological-related predispositions, but can be found in a variety of locations, such as cutaneous, intraabdominal, genitourinary and surgical infections. Disseminated infections occur less frequently and are by and large related to urinary tract colonisation. This pathogen is often neglected due to growth requirements, especially in urinary tract infections. We present 107 Actinotignum schaalii isolated from genitourinary samples (80.4%), from skin and soft tissue infections (13.1%), from bone and deep tissue infection (4.7%) and from blood cultures (1.9%). The automated system Alfred 60/AST was paramount for the isolation of 77.6% of the UTI. All the isolates tested were susceptible to penicillin, ampicillin, linezolid, vancomycin, teicoplanin, rifampicin and tetracycline. In conclusion, we present a large series of Actinotignum schaalii infections. This pathogen is hard to isolate, and is resistant to commonly used empirical antimicrobials.

Prognosis in epilepsy: initiating long-term drug therapy.

INTRODUCTION: Prognosis in epilepsy refers to the probability of either achieving seizure remission (SR), whether spontaneously or using antiepileptic drugs (AED), or failing to achieve control of epileptic seizures (ES) despite appropriate treatment. Use of AED is recommended after a second unprovoked ES. For a first episode, the decision of whether or not to start drug treatment depends on the risk of recurrence and the advantages or disadvantages of the antiepileptic drug. The main goal of treatment is achieving absence of ES without adverse effects (AE). AED is selected according to epilepsy type and the demographic and clinical characteristics of the patient. DEVELOPMENT: A PubMed search located articles and recommendations by the most relevant scientific societies and clinical practice guidelines concerning epilepsy prognosis and treatment. Evidence and recommendations are classified according to the prognostic criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Most newly diagnosed epileptic patients achieve good control over their ES. The majority of the AEDs available at present provide effective control over all types of ES, and choice therefore depends on the patient's individual characteristics. Treatment should be initiated as monotherapy at the lowest effective dose, which in half of all patients provides ES control and is well tolerated. In cases in which the first AED is not effective, alternative therapy should be started, and monotherapy should be employed before combination therapy where possible. The probability of achieving good control over ES decreases with each successive treatment failure.

Recursos estructurales de los Servicios de Medicina Intensiva en España / Intensive Care Services resources in Spain

Objetivos: Identificar los recursos existentes con relación a la atención de pacientes críticos en España, ubicados en unidades asistenciales dependientes de Servicios de Medicina Intensiva (SMI), o de otros servicios/especialidades, analizando su distribución según las características de los hospitales, y por comunidades autónomas. Diseño: Estudio prospectivo, observacional. Ámbito: Hospitales españoles. Participantes: Jefes de SMI. Variables de interés principales: Número de unidades y camas de pacientes críticos y dependencia funcional. Resultados: El número total de registros obtenidos con al menos un SMI fueron 237, con un total de camas hospitalarias de 100.198. Predominaron los hospitales de nivel III (43,5%) y nivel II (35%). El 73% de los hospitales fueron de gestión pública y el 55,3%, no universitarios. El número total de camas de críticos de adultos identificadas fue de 4.738 (10,3/100.000 habitantes). Los SMI registrados disponen de 258 UCI, con 3.363 camas, predominando las UCI polivalentes (81%), y de 43 Unidades de Cuidados Intermedios. El número de pacientes atendidos en los SMI durante el año 2008 fue de 174.904, con un porcentaje de ocupación del 79,5%. Se identificaron 228 unidades asistenciales que atienden pacientes críticos dependientes de otros servicios con 2.233 camas, 772 pediátricas o neonatales. Excluyendo estas últimas, hay un predominio marcado de unidades posquirúrgicas, seguido de unidades coronarias y de cirugía cardiaca. Conclusiones: El 71% de las camas disponibles en las unidades de críticos en España, que atienden a pacientes adultos graves, son dependientes de los SMI y, en su mayoría, son polivalentes

Objectives: To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. Design: Prospective observational study. Setting: Spanish hospitals. Participants: Heads of the Services of ICM. Main outcome variables: Number of units and beds for critically ill patients and functional dependence. Results: The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5% A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. Conclusions: Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent

[Intensive care services resources in Spain]. / Recursos estructurales de los Servicios de Medicina Intensiva en España.

OBJECTIVES: To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. DESIGN: Prospective observational study. SETTING: Spanish hospitals. PARTICIPANTS: Heads of the Services of ICM. MAIN OUTCOME VARIABLES: Number of units and beds for critically ill patients and functional dependence. RESULTS: The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5% A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. CONCLUSIONS: Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent.

The future of intensive care medicine / El futuro de la medicina intensiva

Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved (AU)

La formación en medicina intensiva, ya sea como especialidad primaria o a partir de una troncalidad común para después convertirse en supra-especialidad, debería incluir competencias clave que garanticen un cuidado estándar y homogéneo del paciente crítico, así como proveer al sistema sanitario del número de especialistas en medicina intensiva (intensivistas) de forma ajustada y anticipada al ritmo de crecimiento de la necesidad asistencial. La organización de los cuidados intensivos desde la visión de las distintas especialidades o en unidades centralizadas y jerarquizadas, es heterogénea y está en constante evolución. No obstante el acceso y tratamiento precoz del enfermo crítico por parte de un intensivista, debería estar siempre garantizado, no únicamente en los servicios de medicina intensiva, sino en todos los departamentos de un hospital, actuando el intensivista como elemento central en la comunicación y coordinación entre los diferentes servicios y especialistas, a fin de lograr la más alta calidad y eficacia en la asistencia. La investigación clínica en medicina intensiva está sustentada por la excelencia de conocimiento de sus profesionales, pero son necesarias estructuras de apoyo: la integración de la investigación e innovación en la rutina diaria y un incremento de la investigación traslacional, a fin de identificar áreas que muestren elementos potenciales de avance en el aspecto clínico y la aplicación de los principios de la investigación básica y fisiológica en el entorno de la medicina intensiva. Las tecnologías de la comunicación y la información ofrecen un marco idóneo para compartir y poner en común el conocimiento y apoyar (..) (AU)

The future of intensive care medicine.

Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved.

Situación actual de la realización de fibrobroncoscopias en los Servicios de Medicina Intensiva / Current status of fibreoptic bronchoscopy in intensive care medicine

La fibrobroncoscopia (FBC) flexible en el campo de la Medicina Intensiva ha supuesto la introducción de una técnica de gran ayuda para el manejo de pacientes críticamente enfermos. Su seguridad y utilidad, en manos de un profesional adecuadamente entrenado y con las debidas precauciones, ha derivado en un uso cada vez más extendido, incluso en pacientes críticos inestables ventilados mecánicamente y con requerimientos elevados de oxígeno. La Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), mediante el Grupo de Trabajo de Insuficiencia Respiratoria Aguda (GT-IRA) y Enfermedades Infecciosas (GTEI), tiene como objetivo promover el conocimiento y los estándares de calidad de la práctica de la FBC en todos los especialistas de Medicina Intensiva. La SEMICYUC se ha propuesto como objetivo, a través de un comité de expertos, acreditar la formación aportando para ello un currículum, así como las unidades con capacidad para formar en las distintas técnicas y niveles. El proceso de acreditación busca estimular las buenas prácticas de aprendizaje y de calidad en la formación. Tanto el especialista en Medicina Intensiva como otros especialistas médicos y los pacientes se beneficiarán del nivel de compromiso y de control que la acreditación conlleva y del aprendizaje y el entrenamiento que involucra este proceso (AU)

Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), through its Acute Respiratory Failure (GT-IRA) and Infectious Diseases (GT-EI) Work Groups, aims to promote knowledge and standards of quality in the use of FB among all specialists in Intensive Care Medicine. Through an expert committee, the SEMICYUC has established the objective of accrediting such training, with the preparation of a curriculum and definition of those Units qualified for providing training in the different techniques and levels. The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails (AU)

[Current status of fibreoptic bronchoscopy in intensive care medicine]. / Situación actual de la realización de fibrobroncoscopias en los servicios de medicina intensiva.

Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), through its Acute Respiratory Failure (GT-IRA) and Infectious Diseases (GT-EI) Work Groups, aims to promote knowledge and standards of quality in the use of FB among all specialists in Intensive Care Medicine. Through an expert committee, the SEMICYUC has established the objective of accrediting such training, with the preparation of a curriculum and definition of those Units qualified for providing training in the different techniques and levels. The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails.

Real time and in situ determination of lead in road sediments using a man-portable laser-induced breakdown spectroscopy analyzer.

In situ, real time levels of lead in road sediments have been measured using a man-portable laser-induced breakdown spectroscopy analyzer. The instrument consists of a backpack and a probe housing a Q-switched Nd:YAG laser head delivering 50 mJ per pulse at 1064 nm. Plasma emission was collected and transmitted via fiber optic to a compact cross Czerny-Turner spectrometer equipped with a linear CCD array allocated in the backpack together with a personal computer. The limit of detection (LOD) for lead and the precision measured in the laboratory were 190 microg g(-1) (calculated by the 3 sigma method) and 9% R.S.D. (relative standard deviation), respectively. During the field campaign, averaged Pb concentration in the sediments were ranging from 480 microg g(-1) to 660 microg g(-1) depending on the inspected area, i.e. the entrance, the central part and the exit of the tunnel. These results were compared with those obtained with flame-atomic absorption spectrometry (flame-AAS). The relative error, expressed as [100(LIBS result-flame AAS result)/(LIBS result)], was approximately 14%.

Man-portable laser-induced breakdown spectroscopy system for in situ characterization of karstic formations.

This paper reports the development and field testing of a man-portable instrument based on laser-induced breakdown spectrometry (LIBS) for inspection and analysis of speleothems. The 50 mJ of a Q-switched Nd:YAG laser operating at 1064 nm was used to generate a plasma on the sample. Plasma emission was then guided using a fiber-optic cable to a 1/10 m spectrometer equipped with a charge-coupled device (CCD) array detector. Plasma light was automatically processed in order to obtain surface and in-depth information from the speleothems. A field campaign in the interior of Nerja Cave (a large karstic formation in the South of Spain) has been carried out, aimed at evaluating the analytical performance of the instrument when operating in an unfriendly environment. Identification analysis of the speleothems' alteration layers and depth profiles of Sr and Ca is carried out and reported.

In situ analytical assessment and chemical imaging of historical buildings using a man-portable laser system.

In this work, the capability of laser-induced breakdown spectrometry for the in situ analytical assessment and chemical mapping of the façade of the cathedral of Malaga (Spain) has been demonstrated. The task required the use of a portable laser analyzer that allowed real-time spectral acquisitions in the field. A man-portable laser, based on a Q-switched Nd:YAG laser operating at its fundamental wavelength, has been utilized to generate a LIBS plasma of the sample surface. A chemical characterization of the different materials employed in the construction of this building has been performed. The purpose of this study was to use LIBS spectrochemical analysis to qualitatively discriminate between sandstone, limestone, marble, and cement mortar, which are the main components used in this class of historical monument. The field analysis was performed in two zones: the northern façade and the "girola"; the total areas of analysis of the two regions were 250 m(2) and 650 m(2), respectively. Chemical images of Si/Ca and Ca/Mg ratios from both parts of the building were generated. During the measurement campaign, a protocol of analysis was chosen so as to achieve an accurate description of the building materials with respectable spatial resolutions.

Factores asociados al uso de la reperfusión en pacientes con infarto agudo de miocardio y elevación del segmento ST en España: Proyecto de Registro del Infarto Agudo de Miocardio en Hospitales (PRIAMHO II) / Factors associated with the use of reperfusion therapy in patients with acute myocardial infarction and st segment elevation in spain: the register of acute myocardial infarction in hospitals project (priamho ii)

Objetivo. Un porcentaje cercano al 30 por ciento de los pacientes con síndrome coronario agudo, elevación del segmento ST en el electrocardiograma (ECG) y menos de 12 h de evolución, no recibe tratamiento de reperfusión. En este estudio, se investigan los factores asociados a ese comportamiento y su influencia en la evolución hasta un año. Material y método. El registro PRIAMHO II fue diseñado como un estudio de cohorte, con seguimiento a un año, de pacientes ingresados por infarto agudo de miocardio (IAM) en un período de 6 meses, en el año 2000, en las unidades de cuidados intensivos cardiológicos (UCIC) de 58 hospitales españoles seleccionados de manera aleatoria. Se analizaron las características demográficas y clínicas, la evolución y la mortalidad, a los 28 días y al año, de los pacientes tratados con y sin reperfusión. Resultados. Se incluyeron 6.221 pacientes entre el 15 de mayo y el 15 de diciembre de 2000, ingresados en 58 hospitales. De ellos, 3.735 cumplían las indicaciones para reperfusión primaria, pero sólo se realizó en 2.675 (71,6 por ciento). En el 89,3 por ciento de los casos se hizo fibrinólisis y en el resto intervención percutánea. El análisis univariante mostró que las variables asociadas a no recibir tratamiento de reperfusión son: la edad avanzada, el sexo femenino, los antecedentes de diabetes mellitus, de hipertensión arterial o de infarto de miocardio, el retraso en la llegada al hospital, el no poder precisar la localización del IAM por el ECG y la clase IV en la clasificación de Killip. La mortalidad fue superior en los pacientes no reperfundidos, tanto la mortalidad hospitalaria (17,4 frente a 10,3 por ciento), como al año (23,8 frente a 12,9 por ciento). En el 1,2 por ciento de los pacientes que recibieron fibrinolíticos apareció un accidente cerebrovascular. Conclusiones. Los resultados muestran que sólo un 72 por ciento de los pacientes con IAM y ST elevado o bloqueo completo de la rama izquierda del haz de His (BCRIHH) que acuden al hospital con menos de 12 h de evolución, reciben tratamiento de reperfusión. De ellos, un 11 por ciento lo reciben mediante intervencionismo percutáneo. Los pacientes que no son tratados con métodos de reperfusión tienen un perfil de riesgo peor, y la mortalidad es superior a corto y, especialmente, a largo plazo (AU)

[Chloroquine-induced myopathy and neuropathy: progressive tetraparesis with areflexia that simulates a polyradiculoneuropathy. Two case reports]. / Miopatía y neuropatía inducida por cloroquina: tetraparesia progresiva con arreflexia que simula una polirradiculoneuropatía. A propósito de dos casos.

INTRODUCTION: Chloroquine is a drug that is widely used in rheumatology and occasionally prescribed in dermatology. From a neurotoxicological point of view, chloroquine can have effects on the peripheral nerves, muscles, neuromuscular junctions and the central nervous system. In this study we analyse the clinical, neurophysiological and anatomopathological findings in two patients with chloroquine induced neuromyopathy, which took the form of a polyradiculoneuropathy. CASE REPORTS: Case 1: a 75 year old female with rheumatoid arthritis treated with daily doses of 250 mg of chloroquine for four years. The patient visited because of several months history of predominantly proximal progressive tetraparesis with areflexia. Analytical tests and lumbar puncture were normal. Electromyogram (EMG): proximal myopathic and distal neuropathic patterns. Muscular biopsy: vacuolar myopathy with accumulations of phagolysosomes, lipids, lipofuscin, myelinic curvilinear bodies. Case 2: a 74 year old female with arthropathy treated with daily doses of 250 mg of chloroquine for nine months. The patient presented a progressive proximal paraparesis with generalised areflexia. Analytical tests and lumbar puncture were normal. EMG: mixed sensory motor polyneuropathy, myogenic pattern with high frequency discharges in the iliac psoas and a neurogenic pattern in the distal muscles. Muscular biopsy: vacuolar myopathy suggesting a myopathy due to chloroquine. After stopping treatment with this drug the patients progressed favourably. CONCLUSION: Chloroquine can induce a clinical pattern that suggests a polyradiculoneuropathy. It is important to establish a history of having taken this drug. If this is indeed the case, then an electromyographic study of the most proximal muscles should be performed in order to detect a myogenic pattern and the same exploration should be applied to the distal muscles to reveal a neurogenic pattern. The final diagnosis will be established by muscular biopsy.

[Neuroleptic malignant syndrome, multiorgan failure and peripheral polyneuropathy]. / Síndrome neuroléptico maligno, fallo multiorgánico y polineuropatía periférica.

The Malignant Neuroleptic Syndrome (MNS) is characterised by the acute appearance of hyperthermia, muscular rigidity, loss of motor control, and alterations in the level of consciousness, which could prove fatal if not rapidly diagnosed and treated. It is held to be a serious idiosyncratic reaction which appears in patients being treated with neuroleptics, independently of the dosage and the length of time the drug has been prescribed. Relapses do not usually occur when the drug is re-prescribed, once the acute phase has been passed, which suggests the existence of predisposing factors. There are frequent complications (acute respiration difficulties, acute kidney failure, disseminated intravascular coagulation and multiorganic failure) which condition the prognosis. The treatment consists of the suppression of the neuroleptic, rehydration, and specific drugs (bromocryptine, sodium dantroline). We have analysed two new cases which reacted badly, one of them with a multiorganic failure and the other, who had a good initial therapeutical response but who went on to develop a peripheral neuropathy, an infrequent complication in international medical casebooks.

Physical and mechanical properties of elastomers in orthodontic positioners.

Elastomers for conventional Kesling-type tooth positioners are relatively inelastic and are primarily indicated as finishing devices. However, new materials, first described in the Japanese literature, with claims of a greater range of tooth movement warrant a comparison with conventional materials. Physical and mechanical property testing of positioner elastomers has not been reported in the orthodontic literature. This investigation compared properties of a high temperature vulcanizing (HTV) Japanese silicone (Orthocon) to three traditional polyurethane and vinyl-based polymers and five experimental silicone elastomers. Fourier transform infrared spectroscopy established the definitive chemical composition of the urethane and vinyl materials obtained from a commercial positioner laboratory. Tear strength, tensile strength, tensile stress at selected elongations, and ultimate elongation of all materials were evaluated at 37 degrees C in an aqueous environment. Hardness and water sorption values also were determined and an in vitro force measurement apparatus was fabricated to determine force levels exerted by positioner materials at low displacements. Orthocon was statistically different (Duncan's multiple range test, p less than 0.05) from the traditional commercial urethane and vinyl materials. Orthocon had lower tear strength than the traditional materials. It also demonstrated lower stress values below 100% elongation. The parameters of tensile stress at 50% elongation and ultimate elongation were statistically identical for Orthocon and one experimental silicone material.

The neurologic effects of thiopental therapy after cardiac arrest.

We studied the effect of thiopental loading during resuscitation of 53 patients following cardiopulmonary arrest and compared the outcome with that found in 54 patients treated conventionally in the 30 previous months. Thiopental therapy (10 mg/kg i.v.) was begun within 30 min of the arrest once hemodynamic stability had been established. Thiopental infusion (20 mg/kg over 6 h) was followed by phenobarbital sodium (125 mg every 12 h), tolerance to the initial dose having been assessed. The in-hospital mortality rate for both groups was similar. In patients with ischemic heart disease, the mortality rate within the first 6 h was significantly higher in the thiopental group (p less than 0.05), although for the remaining patients there were more survivors among the thiopental treated patients (p less than 0.05). Excluding the patients who died within the first 6 h, 61% of the patients in the thiopental group survived cardiac arrest with normal cerebral performance, whereas only 37% in the standard treatment group showed normal functional outcome (p less than 0.03). These results suggest a favorable neurologic effect of thiopental loading during resuscitation of patients without ischemic heart disease. In patients with ischemic heart disease, an initial hemodynamic deterioration may contribute to minimising the beneficial effect of barbiturate therapy.

CT evaluation of patients during treatment of advanced non-small cell lung carcinoma.

Twenty-one patients with Stage III non-small cell bronchogenic carcinoma were studied by chest radiograph and computed tomography (CT) before and after chemotherapy. In three patients (14%), the prechemotherapy CT showed measurable disease not seen on chest radiograph. Postchemotherapy CT scans showed additional measurable disease not seen on chest x-ray films in nine of 56 (16%) follow-up exams. This represented additional disease in seven of the 21 patients (33%). The CT findings resulted in a significant change in therapy in six of the 21 patients (29%).