CARDIAC ARREST—Successful Resuscitation in the Hospital Outside the Operating Rooms

It is believed that if physicians generally can bring themselves to carry out the drastic action necessary, the benefits of cardiac massage for patients with reflex inhibition of heartbeat can be extended to most cases of this kind occurring anywhere in a hospital, even though there is not time to summon a surgeon or anesthesiologist.This concept requires that attending physicians be prepared to recognize and treat cardiac arrest in salvageable patients. To carry out massage of the heart, a short incision must be made beneath the left breast to permit grasping the heart and starting it again. Mouth-to-mouth breathing until a mask and oxygen arrive is a necessary part of the procedure.Whether to attempt massage must be a decision entirely up to the physician on his appraisal of the circumstances; but the procedure is probably not advisable outside a hospital.     

A FLORA FROM THE CHESTER SERIES (UPPER MISSISSIPPIAN) OF SOUTHERN ILLINOIS

New localities in southern Illinois have yielded a flora consisting of 9 taxa. The plant remains occur in sandstones of the Chester Series and consist of casts, molds, and flattened impressions. The most important elements in the flora are: Archaeocalamites radiatus, Lepidodendron volkmannianum, Stigmaria ficoides, Rhynchogonium fayettevillense, and an unnamed Trigonocarpus. Stems probably referable to Lepidodendron veltheimii and Dictyoxylon also occur, as do numerous casts of the Knorria and Bergeria types. The range of features found in specimens of Lepidodendron volkmannianum allows some revision to be made of several species previously described by White in the Wedington Sandstone flora of northwest Arkansas, with which the present flora is closely comparable. The difficulties in making precise correlations with Upper Mississippian floras in other parts of the world are discussed. The necessity for critical re-examination of existing described collections and of undertaking more extensive field-work in the Mississippian of N. America is emphasized.     

CIRRHOSIS OF THE LIVER—Clinical Course in 2,377 Patients at San Francisco General Hospital

The records of 2,377 patients with Laennec''s cirrhosis were reviewed for the period 1947-1957. The chief presenting symptom was ascites in 46 per cent, bleeding in 23 per cent, coma in 18 per cent, jaundice in 9 per cent, and both jaundice and ascites in 4 per cent. Nearly half of the patients died during the period under study—one-third from hepatic failure, one-third from gastrointestinal bleeding, and one-third from other causes, most of which were related to alcoholism.Massive gastrointestinal bleeding occurred in 21 per cent of the patients at some time in their clinical course, and in the 10 per cent of these in whom ulcer was demonstrated, one-fifth died as a result of the hemorrhage. Of those presumed to be bleeding from esophageal varices, 64 per cent died at the first hemorrhage and 10 per cent at subsequent hemorrhages; 85 per cent of all those who bled from varices were dead at the end of one year, and 91 per cent were dead at the end of three years.The survival curve of a group of patients who bled once and were good operative risks but had received no operative treatment was compared to the survival curve for entire group who survived the first hemorrhage. The three-year survival in the good risk group was 47 per cent; for the group as a whole it was 30 per cent. The difference in mortality rate was primarily due to an increased number of deaths from hepatic failure in the combined group, whereas 60 per cent of the good risk group died of recurrent gastrointestinal hemorrhage.As 86 per cent of those who were to die of gastrointestinal bleeding did so at the first hemorrhage, it was concluded that any decided improvement in the salvage rate achievable by operation must come from some means of diagnostic forecast of the likelihood of bleeding, with resort to prophylactic operation in such cases.     

Cerebrovascular Occlusive Disease—Experience with Panarteriography in 300 Consecutive Cases

Three hundred patients with cerebrovascular occlusive disease have had cerebral angiographic examination at the Veterans Administration Hospital, San Francisco, in the last five years. The present technique consists of preliminary visualization of the aortic arch and the major extracranial branches, followed by selective study of the subclavian and carotid arteries as necessary for evaluation of the intracranial circulation.Nine major complications occurred (an over-all incidence of 3 per cent). Two patients died after angiography and seven had major neurologic deficits persisting for more than 24 hours. Three of these patients had permanent damage, but four recovered completely.One-third of the patients had extracranial disease and one-third had intracranial disease. No significant lesion was found in the remainder. In the 212 patients with lesions, multiple lesions were common, the average number being three. Six patients had brain tumors and five had aneurysms.The mechanism of the stroke could be ascertained readily in most of the patients, but the extent of the disease and the resulting symptoms varied considerably. Several patients with occlusion of most of the cerebral vessels had minimal symptoms, while others had catastrophic symptoms but only minimal findings at arteriography.