California medicine
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Whiplash injury may extend far beyond the neck, and may involve even the soft tissues of the pelvis. For permanent recovery, all the injuries must be evaluated and treated together. When impact from the rear snaps the head back and then forward, posterior subluxations in the cervical spine cause anterior-posterior narrowing of the intervertebral foramina, which may result in injury to the cervical nerve roots. ⋯ Detailed neurologic, roentgen and electromyographic studies may be necessary for proper evaluation of injuries. Seemingly psychosomatic pain or disability is likely to have some physical basis in whiplash injuries. In 33 patients with whiplash injury, some recently injured and some chronically disabled with persistent symptoms, good results were observed following hydromassage, hot packs, joint mobilization exercises and, in a few, cervical or pelvic traction.
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California medicine · Apr 1958
Resuscitation of newborn premature infants; a clinical study of the use of positive pressure respiration.
The Goddard-Bennett-Lovelace hand resuscitator was used for initiating respiration in 87 newborn infants with respiratory difficulties, during a five-month period at the Los Angeles County General Hospital. On alternate days, when the respirator was not used, 126 comparable infants received resuscitation by mouth-to-tracheal pressure and other means. Neither term infants nor previable infants benefited by use of the hand resuscitator, but premature infants weighing more than 1,000 gm. had a definite advantage, with a mortality of only 13 per cent for those treated with the resuscitator against 34 per cent among the controls. Neither roentgen nor postmortem studies of the lungs disclosed any consistent effect of any resuscitative measure employed.
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The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint. Observation of a group of 36 patients with myasthenia gravis, and another group of 30 cases involving the differential diagnosis of myasthenia gravis, led to a conclusion that a physician should apply criteria carefully before arriving at a diagnosis of myasthenia gravis and instituting drug therapy, since nonmyasthenics may frequently respond with subjective improvement temporarily following administration of cholinergic drugs. Myasthenia gravis may be a more common disorder than was suspected in the past.
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California medicine · Dec 1957
Aspiration of gastric contents under anesthesia; a review and clinical study.
Aspiration of vomitus is one of the leading causes of anesthetic deaths. These deaths can be prevented only by proper evaluation of the patient preoperatively and assuming that any patient dealt with in emergency has a full stomach until proven otherwise. Preliminary observations on the incidence of "silent regurgitation and aspiration" in a series of patients anesthetized for elective operation indicated that by obtaining a smooth induction and preventing any respiratory obstruction during anesthesia, regurgitation and aspiration can be minimized.
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A method for continuous measurement of surgical blood loss has been devised and has been used clinically in some 400 cases. The method combines volumetric measure of the suction loss and gravimetric measure of the sponge loss. The volumetric device automatically deducts the volume of rinse water used and thus measures the amount of blood collected in a metering cylinder. ⋯ Use of the instrument, which is under the supervision of the anesthesiologist, adds about two minutes per hour to the time normally required for counting the sponges; and about three minutes per hour is required for tending the volumetric instrument. In clinical use, knowing constantly the amount of blood loss permits the starting of transfusion before serious deficit develops, and then maintaining the patient's blood volume at a predetermined optimum level. In some 400 cases the continuous measurement of the blood loss served as a reliable guide for carrying out the loss-replacement plan within close limits of accuracy.