Two roads to coma: the Scottish hypothesis

Clinical experience seems to indicate two separate types of entry to coma. Some patients follow a pathway characterized by confusion, hallucinations, mumbling delirium, myoclonic jerks, and seizures. The author has called this sequence of symptoms the high road to coma and hypothesized that its basic underlying pathophysiology involves increased neuronal firing rates. Other patients develop somnolence, lethargy, obtundation, and unresponsiveness without seizures or muscle twitches. This low road to coma involves either anatomical compression of the midbrain reticular formation or a metabolic or toxic disorder characterized by membrane stabilization and decreased neuronal excitability.     

The effects of self-induced mood states on behavior and physiological arousal

The effects of reading emotionally loaded statements on behavioral tasks and physiological measures were investigated. Statements were constructed to arouse elation, depression, or neutrality. Ss were both pre- and posttested on Writing Speed, Reaction Time, Decision Time, and Spontaneous Verbalizations. Base rates were obtained for heart rate and galvanic skin response. Elation Ss significantly outperformed both Neutral and Depression Ss on the Reaction Time task. Scores for Neutral Ss fell between those of Elation and Depression Ss on three of the four behavioral measures. No significant differneces were found on the physiological measures.     

Cardiovascular and neuromuscular effects of dimethyl sulfoxide in anesthetized rabbits

In rabbits anesthetized with pentobarbital, the carotid arterial blood pressure and bilateral contractions of the gastrocnemius muscles due to electrical stimulation of the sciatic nerves were recorded. Intravenous administration of up to 1 ml of dimethyl sulfoxide/kg caused profound hypotension and eventually failure of neuromuscular transmission. Caution must be used in considering dimethyl sulfoxide as a solvent for drug administration.     

Influence of environment on passive immunity in calves

Passive immunity in neonatal calves is influenced by environment. Placing newly born Holstein calves (108 head) in three different housing environments (shade, cooled shade, hutch) during hot weather produced differences in body temperature, serum cortocosteroids, immunoglobulin IgG1 concentrations, and mortality. Experimental design permitted examination of effects due to treatments, time, differences in colostrum, and climatic environment in an analysis of variance. Calves exposed to the hotter, less desirable environment responded by having a higher mortality, higher serum corticosteroid concentration, and lower serum immunoglobulin IgG1 at 2 and 10 days after birth. All of these were correlated. Calves that died had serum immunoglobulin IgG1 falling below the mean for all experimental calves.     

A computerized obstetric medical record

Duke University has utilized computerized obstetric medical records since 1971. System evolution is described. Deficiencies in the current system appear to evolve from the computer/human interface rather than from basic system design. Critical elements in system success are physician acceptance of the appearance of data collection sheets and printed notes and continual rapid response in programing modification to allow for physician individuality and changes in medical practice. The limiting factor in the potential usefulness of such a system is the rate of incomplete data collection. It is suggested that if the physician were to enter data directly into the computer through a terminal, data collection would be more accurate and complete.     

Empyema due to Streptococcus mutans

Empyema due to Streptococcus mutans occurred following dental manipulation in two patients with periodontal disease. Isolation of this dental pathogen from pleural fluid localized the site of origin of the empyemas to the oropharynx and precluded the need to search for a remote intra-abdominal source of these pleuropulmonary infections. Although there is controversy regarding the susceptibility of S mutans to penicillin, the isolates from our patients were markedly sensitive to the drug, and both patients were cured with penicillin therapy and surgical drainage.