Septicemia secondary to impacted infected pacemaker wire. Successful treatment by removal with cardiopulmonary bypass.

Infection of an intravenous pacemaker electrode developed in a 78-year-old man after multiple replacements and revisions of the pulse generator and the pacemaker lead. Spread of the infective process to the endocardium was followed by septicemia with Serratia marcescens and Staphyloccus epidermids. Failure of medical treatment and external traction on the pacemaker electrode led to thoracotomy and removal of the pacemaker electrode wires with the use of extracorporeal circulation. The tip of one of the pacemaker electrodes was found imbedded in the wall of the right ventricle and attached to the base of the tricuspid valve. Cultures from the endocardium removed with the electrode rendered the same organisms as cultured preoperatively. There has been no recurrence after 2 years following the removal of the infected electrodes. Although the problem described herein is not frequently found, radical treatment becomes necessary whenever infection and septicemia develop.

Pulmonary dirofilariasis in man. A case report and review of the literature.

Pulmonary dirofilariasis in man is becoming a well-recongnized entity. Its pathogenesis and histopathologenical picture have been well characterized but the preoperative diagnosis still remains a challenge. The roentgenographic picture, usually described as a "coin lesion," is nonspecific and easily mistaken for other inflammatory and neoplastic nodules. Forty-seven clinical instances of pulmonary dirofilariais have been reported in the literature, with most of them in the last two decades. Considering the entire clinical picture, a strong suspicion can be based on serological studies, thus improving the possibilities of a correct preoperative diagnosis.

Relationship of cell type and lymph node metastasis to survival after resection of bronchial carcinoma.

In the completed adjuvant chemotherapy lung trials conducted by the Veterans Administration Surgical Group, the cell type was recorded in 2,341 of 2,349 curative resections; extent of lymph node involvement was known in all cases. Nodes were normal in 1,231 patients. Five- and ten-year survival computed by the life-table method was 33.7% and 20.4%, respectively. These rates were significantly greater than the 16.2% and 8.8% recorded in 1,118 patients whose nodes showed metastases. Among patients whose cell type was known, five-year survival in 484 with hilar node involvement was 17.4% and was not significantly different from 20.1% in 364 patients in whom only lobar nodes were involved. The survival was 8.9% in 268 patients with cancer in the mediastinal nodes; this was significantly worse than either of the aforementioned groups. A five-year survival of 26.8% in 1,482 patients with squamous cell carcinoma was greater than the 24.3% in 359 with adenocarcinoma and 22.4% in 500 with undifferentiated cell types, but the differences were not significant. Variations between these groups remained nonsignificant when nodes were normal and were of only borderline significance, at the 5% level, when they showed metastasis. When a curative resection has been accomplished, cell-type as classified in this study has little bearing on long-term survival, whereas the presence of node metastasis as well as its location is of the utmost importance.

A test of Magill's closed-to-open continuum for skill development.

Magill's arrangement of Gentile's 2 x 2 matrix of skills classification into a closed-to-open-skill learning continuum was investigated. 63 volunteer university students were assigned to three experimental groups who performed different learning sequences on the Bachman Ladder for four practice sessions, climbing the unsupported Bachman Ladder (Task 4) in the final scored session. Following practice sessions, a five-trial, scored, Task 4 "retention" session was performed. Analysis of variance of retention trials indicated no difference between the practice groups regardless of practice sequence. Comparison of five selected trials from the Task 4 practice session and the five Task 4 retention performances, using a 4 x 2 analysis of variance with repeated measures, indicated significant group and time effects but no interaction. While Magill's arrangement of related activities into closed-to-open-skill learning continuums is supported, the specific arrangement of the lead-up skills does not appear critical. The question of task specificity for any learning continuum is raised, and further issues for research are proposed.