California medicine
-
The newer penicillins give high promise of overcoming some of the few disadvantages of penicillin-G. THEY FALL INTO THREE GROUPS: The alpha-phenoxy-penicillins; the penicillinase resistant penicillins; and the penicillins with enhanced activity against gram-negative bacteria. The newer alpha-phenoxy-penicillins offer little over alpha-phenoxy methyl penicillin (penicillin-V). ⋯ It is most useful as prolonged therapy following methicillin, in the treatment of mixed hemolytic streptococcal-penicillin-G resistant staphylococcal infections, and as primary therapy for moderately severe penicillin-G resistant staphylococcal infections. The third group is still mostly in the experimental stage, but some strains of Proteus, E. coli, Salmonella and Shigella are highly vulnerable to their action. Toxic and allergic reactions to the newer penicillins, and crossed allergic reactions with penicillin-G, present unsolved problems.
-
External cardiac compression and external defibrillation were successful in resuscitating 27 consecutive dogs after the production of ventricular fibrillation. Twelve patients survived following circulatory arrest treated with closed chest cardiac compression and, when indicated, defibrillation. Five additional patients were successfully resuscitated but died in the hospital. In fifteen cases, resuscitation was not successful.
-
The malignant potential of burn scars has been recognized since Marjolin's classical description of cancer arising in several types of post-traumatic scars. With improved burn therapy since the last war, there has been a higher survival rate of severe burns with proportionate increase in cancer associated with burn scars. This will create increasing problems of permanent disability and compensation. ⋯ Once it has developed the treatment is the same as for other malignancies which are not associated with burns. Wide surgical excision with block dissection of the regional lymph nodes when they are involved is the treatment of choice. The prognosis of burn scar cancer is poor, once the process has extended because of early and distant metastasis.
-
In this age of specialization it is often difficult for the patient to determine who "his doctor" is. In the circumstances of anesthesia and surgery, the professional services of both physicians, the anesthetist and the surgeon, are highly integrated and the lines of responsibility must be clearly established. In the particularly close associations between anesthetist, surgeon and patient there is an urgent need for the application of scientific method in order to facilitate communication, improve the approach to the solution of problems, and enhance the welfare of the patient.