Interaction between bunk management and monensin concentration on finishing performance, feeding behavior, and ruminal metabolism during an acidosis challenge with feedlot cattle.

Two commercial feedlot experiments and a metabolism study were conducted to evaluate the effects of monensin concentrations and bunk management strategies on performance, feed intake, and ruminal metabolism. In the feedlot experiments, 1,793 and 1,615 steers were used in Exp. 1 and 2, respectively, in 18 pens for each experiment (six pens/treatment). Three treatments were evaluated: 1) ad libitum bunk management with 28.6 mg/kg monensin and clean bunk management strategies with either 2) 28.6 or 3) 36.3 mg/kg monensin. In both experiments, 54 to 59% of the clean bunk pens were clean at targeted clean time, or 2200, compared with 24 to 28% of the ad libitum pens. However, only 13% of the pens were clean by 2000 in Exp. 1 (summer), whereas 44% of the pens in Exp. 2 (winter) were clean by 2000. In Exp. 1, bunk management and monensin concentration did not affect carcass-adjusted performance. In Exp. 2, steers fed ad libitum had greater DMI (P < 0.01) and carcass-adjusted ADG (P < 0.01) but feed efficiency (P > 0.13) similar to that of clean bunk-fed steers. Monensin concentration had no effect on carcass-adjusted performance (P > 0.20) in either experiment. A metabolism experiment was conducted with eight fistulated steers in a replicated 4 x 4 Latin square acidosis challenge experiment. An acidosis challenge was imposed by feeding 125% of the previous day's DMI, 4 h later than normal. Treatments consisted of monensin concentrations (mg/kg) of 0, 36.7, 48.9, or 36.7 until challenged and switched to 48.9 on the challenge day and 4 d following. Each replicate of the Latin square was managed with separate bunk management strategies (clean bunk or ad libitum). Feeding any concentration of monensin increased number of meals and decreased DMI rate (%/h) (P < 0.12) for the 4 d following the acidosis challenge. Meal size, pH change, and pH variance were lower (P < 0.10) for steers fed monensin with clean bunk management. However, no monensin effect was observed for steers fed ad libitum. Bunk management strategy has the potential to decrease DMI and ADG when steers managed on a clean bunk program are restricted relative to traditional, ad libitum bunk programs. Monensin helps control intake patterns for individuals, but increasing concentration above currently approved levels in this study seemed to have little effect.

Medtronic Mosaic porcine bioprosthesis: midterm investigational trial results.

BACKGROUND: The midterm clinical and hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis was evaluated in a regulatory trial. METHODS: In nine Canadian centers, 802 bioprostheses (560 aortic and 242 mitral) were implanted between September 1994 and April 1999 in patients with a mean age of 70 years. RESULTS: Survival for aortic valve replacement at 4 years was 84.4%+/-3.1%. Freedom from valve-related or unexplained death was 95.6%+/-1.9%; structural valve deterioration, 100.0%; reoperation, 96.2%+/-1.7%; major thromboembolism, 96.1%+/-1.8%; and major antithrombotic-related hemorrhage, 96.4%+/-1.7%. Echocardiographic derived mean systolic gradient was 13.4 mm Hg at 4 years with an indexed effective orifice area of 0.7 to 0.8 cm2/m2. A significant decrease in left ventricular mass was shown over time in all valve sizes. Survival for mitral valve replacement at 4 years was 79.2%+/-6.8%. Freedom from valve-related or unexplained death was 96.5%+/-3.4%; structural valve deterioration, 100%; reoperation, 97.0%+/-3.2%; major thromboembolism, 95.7%+/-3.8%; and major antithrombotic-related hemorrhage, 95.0%+/-4.2%. Echocardiographically measured averaged mean diastolic gradient was 4.5 mm Hg. CONCLUSIONS: The Medtronic Mosaic bioprosthesis is safe and effective in both the aortic and mitral positions. The valve has low gradients in both positions and excellent left ventricular mass regression in the patients with aortic valve replacement.

Bacterial flora of liver abscesses in feedlot cattle fed tylosin or no tylosin.

Bacterial flora of liver abscesses from cattle fed tylosin or no tylosin and susceptibilities of the predominant bacterial isolates to tylosin and other antimicrobial compounds were determined. Abscessed livers were collected at slaughter from cattle originating from feedlots that had fed tylosin (n = 36) or no tylosin (n = 41) for at least 2 yr, and segments of livers with one or two intact abscesses were transported to the laboratory. Abscesses were cultured for anaerobic and facultative bacteria. Fusobacterium necrophorum, either as single culture or mixed with other bacteria, was isolated from all abscesses. The incidence of subsp. necrophorum, as part of the mixed infection, was lower (P < .05) in the tylosin group than in the no-tylosin group (33 vs 61%). However, the incidence of Actinomyces pyogenes was higher (P < .01) in the tylosin group than in the no-tylosin group (53 vs 10%). Totals of 119 F. necrophorum and 21 A. pyogenes isolates were used for determinations of susceptibilities to bacitracin, oxytetracycline, chlortetracycline, lasalocid, monensin, tylosin, tilmicosin, and virginiamycin. The minimum inhibitory concentrations (MIC) of antibiotics were determined with a broth microdilution method. The mean MIC of tylosin for F. necrophorum and A. pyogenes were not different between isolates from tylosin and no-tylosin groups. We concluded that continuous feeding of tylosin did not induce resistance in F. necrophorum or A. pyogenes. Also, the higher incidence of mixed infection of F. necrophorum and A. pyogenes in liver abscesses of tylosin-fed cattle suggests a potential synergistic interaction between the two organisms in causing liver abscesses.

Effects of imposed feed intake variation on acidosis and performance of finishing steers.

Four metabolism and two finishing trials were conducted to determine the effects of imposed feed intake variation on acidosis and performance of finishing steers. In Metabolism Trial 1, four ruminally fistulated steers were limit-fed and subjected to either a constant amount of feed per day (C) or low intake variation of .7 kg/d (LV). No treatment differences were found for intake or measures of acidosis. Metabolism Trial 2 was conducted similarly to Metabolism Trial 1 with treatments of C and high intake variation of 1.4 kg/d (HV). Treatment HV increased (P < .05) acidosis, as indicated by the area of ruminal pH below 5.6. In Metabolism Trial 3, four steers were fed at ad libitum levels of intake and subjected to three levels of intake variation: ad libitum intake with no imposed intake variation (AL), LV of .7 kg/d, and HV of 1.4 kg/d. No treatment differences were found. In Metabolism Trial 4, six ruminally fistulated steers were fed at ad libitum levels and subjected to three levels of intake variation: AL, LV of .9 kg/d, and HV of 1.8 kg/d. Average ruminal pH increased (P < .05) and area of ruminal pH below 5.6 decreased (P < .05) as level of intake variation was increased. In Finishing Trial 1, 75 steers were assigned to eight pens and two treatments: AL or HV of 1.8 kg/d. Dry matter intake increased (P < .05) from AL to HV. Daily gain and gain/feed were not affected by treatment. In Finishing Trial 2, 94 steers were assigned to 12 pens and two treatments: AL or HV of 1.8 kg/d. No treatment differences were noted in DMI, daily gain, or gain/ feed. Therefore, results of these trials indicate that intake variation of up to 1.8 kg/d does not increase acidosis or decrease performance of finishing steers fed at ad libitum levels of intake.

Medtronic mosaic porcine bioprosthesis satisfactory early clinical performance.

BACKGROUND: The Medtronic (Minneapolis, MN) Mosaic porcine bioprosthesis is an investigational prosthesis which incorporates zero-pressure fixation, aortic root predilation, low profile stent, and alpha oleic acid antimineralization treatment. METHODS: From September 1994 to August 1996, 289 patients (mean age 70 years, range, 28 to 88 years) had 227 (78.5%) aortic valve replacements and 62 (21.5%) mitral valve replacements. Concomitant procedures were performed in 61.2% (139) of aortic valve replacements and 54.8% (34) of mitral valve replacements. Of the aortic valve replacement group 70 (30.8%) were in the 61 to 70 age group and 134 (59.0%) were 71 years or older. Of the mitral valve replacements, 23 (37.1%) were 61 to 70 years and 30 (48.4%) 71 years or older. RESULTS: The early mortality, overall, was 4.2% (12 of 289); for aortic valve replacement it was 4.0% (9) and for mitral valve replacement it was 4.8% (3). The late mortality for aortic valve replacement was 2.6% per patient-year (3 events, 1.3% of total) and for mitral valve replacement it was 3.3% per patient-year (one event, 1.6% of total). The reoperative rate for aortic valve replacement was 3.0% per patient-year (4), while there were no mitral valve replacement reoperations. The freedom from major thromboembolism was 97.3%+/-1.6% for aortic valve replacement and 94.7%+/-3.0% for mitral valve replacement at 1 to 1.5 years. The freedom from reoperation was 96.7%+/-1.7% for aortic valve replacement; there was no reoperation for mitral valve replacement. There were no cases of structural valve deterioration. In the aortic position the mean systolic gradient was low, approximately 11 mm Hg, across all sizes (range 8 to 12 mm Hg at 3 months and 10 to 13 mm Hg at 12 months). In the mitral position the mean diastolic gradient was approximately 5 mm Hg (range, 2 to 6 mm Hg) for all sizes 25 to 31 mm at the early and 1 year follow-up echocardiographic assessment. CONCLUSIONS: The early clinical performance and in vivo hemodynamics are encouraging.

Tertiary cancer services in Britain: benchmarking study of activity and facilities at 12 specialist centres.

OBJECTIVE: To collate information on current activity and facilities in British hospitals to assist the planning of future cancer services. DESIGN: 12 hospitals delivering specialist cancer services provided information on the size of population served, activity levels related to non-surgical oncology for 1994-5, and facilities available. Inconsistencies in the recording of data were resolved through meetings of all participants. SETTING: Five single specialty NHS trusts and seven specialist cancer facilities within multispecialty trusts, serving a combined population of 24.3 million. MAIN OUTCOME MEASURES: Activity levels and facilities per million population served. RESULTS: The facilities available per million population served varied widely between centres. In contrast, the range in the number of new referrals per million population (seen either at the centre or in peripheral clinics) was relatively small. Considerable variations were observed in the number of attendances per patient and amount of radiotherapy and chemotherapy delivered. Overall it was estimated that 40-45% of all new cases of cancer are currently being referred to non-surgical oncologists. For the seven hospitals which could provide data on trends in activity, the average increase in chemotherapy day case episodes between 1992-3 and 1994-5 was 83%. CONCLUSIONS: The results of this study provide a benchmark both for purchasers and providers of cancer care. The increase in the use of chemotherapy points to an urgent need for a unified system for monitoring both activity and outcomes of treatment.

Effect of monensin and monensin and tylosin combination on feed intake variation of feedlot steers.

A trial involving four commercial feedlots and an individual feeding trial evaluated the effect of monensin and monensin/tylosin on intake variation and deaths from digestive disorders. Four commercial feedlots in Texas and Colorado fed 2,904 yearling crossbred steers (340 kg) high-grain diets containing approximately 82% grain, 8% silage and alfalfa hay, 4% fat, and 6% supplement (DM basis). Steers were allotted randomly to one of three monensin/tylosin levels: 1) no monensin or tylosin (control); 2) 22 mg/kg of monensin and 11 mg/kg of tylosin; or 3) 33 mg/kg of monensin and 11 mg/kg of tylosin. Monensin/tylosin reduced DMI (P < .05) and improved ADG (P < .05) and feed efficiency (P < .01). Intake variation associated with dry matter offered per pen was not different among treatments. In the individual feeding trial, feeding 27 mg/kg of monensin reduced (P < .10) DMI variation during grain adaptation and during d 57 to 70 and d 97 to 110 compared with the control (no monensin) diet. The magnitude of intake variance was 5 to 10 times greater with individually fed steers than with steers fed in the commercial feedlot pens. When the DMI of the individually fed steers were averaged and treated as a pen of steers, DMI variance was reduced drastically and was not different between treatments. We interpret these data to indicate that monensin and monensin/tylosin reduce feed intake variation among individual steers within a pen of steers. Pen means mask individual animal variation to the point that it is difficult to detect treatment differences.

Cardiopulmonary bypass resuscitation for accidental hypothermia.

Many victims of accidental hypothermia have been successfully resuscitated with cardiopulmonary bypass, but questions remain regarding treatment indications and efficacy. To assess the role of cardiopulmonary bypass in resuscitation from hypothermia, a collective literature review was performed. Data on 68 hypothermic patients resuscitated with cardiopulmonary bypass were analyzed. Impairment from alcohol, drug abuse, or mental illness was the most common predisposing factor for accidental hypothermia. Mean initial core temperature was 21 degrees C. Sixty-one patients (90%) were in cardiac arrest. Femoral-femoral bypass was used in 72% of patients. Overall survival was 60%. Eighty percent of survivors returned to their previous level of function. Sixty-seven percent of nonsurvivors died because of inability to establish a cardiac rhythm or wean from bypass. Patient age, type of cardiopulmonary bypass (femoral-femoral or atrial-aortic), and initial core temperature were not significant prognostic indicators. There were no survivors among the 6 patients with a core temperature less than 15 degrees C. Patients in cardiac arrest had a higher mortality than patients who were not (p = 0.02). Climbing and avalanche victims had a higher mortality than other hypothermic patients (p = 0.003). The possibility of publication bias must be considered before firm conclusions can be drawn from this collective literature review. Controlled studies comparing the efficacy of cardiopulmonary bypass and alternative warming techniques have not been done. Nevertheless, cardiopulmonary bypass has several advantages over other warming methods for profoundly hypothermic patients. Tissue perfusion and oxygenation are maintained while rapid warming occurs. Cardiopulmonary bypass resuscitation is recommended for hypothermic patients in arrest and for patients with core temperatures lower than 25 degrees C, irrespective of rhythm. Patients in stable condition with temperatures between 25 degrees and 28 degrees C can be treated with cardiopulmonary bypass or conventional warming methods.

Pneumothorax complicating cardiac surgery.

Pneumothorax is an infrequent complication of cardiac surgery. In order to evaluate potential causative or associated factors and to formulate guidelines for prevention and management of this complication, we undertook a retrospective nine-year analysis of our adult cardiac surgical procedures. Twenty-one of 1463 patients suffered a postoperative pneumothorax for an overall incidence of 1.4%. Life threatening pneumothoraces occurred in four patients. Seven of 21 had chronic obstructive pulmonary disease. Eighteen required chest tube insertion. Four patients, including three with chronic obstructive pulmonary disease, required further interventions. These included additional chest tube insertion in three, high constant chest tube suction in three, tetracycline pleurodesis in three, and thoracotomy in one patient. Pneumothoraces following cardiac surgery are often preventable, may be associated with prolonged morbidity, and are potentially life threatening. Conservative management with chest tube drainage is usually successful. Patients with chronic obstructive lung disease are more likely to suffer prolonged morbidity and require thoracotomy.

Fistulas between the aorta and tracheobronchial tree.

Aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. With appropriate surgical intervention, survival rates greater than 70% can be achieved. A review of the literature and an illustrative case report are presented. A total of 63 fistulas in 62 patients have been described. The case we present is unusual in the use of serratus anterior muscle for repair of the fistula. Eighty-seven percent of the cases documented in the literature were associated with an aneurysm of the thoracic aorta. Eighty-six percent of the fistulas were between the descending aorta and left bronchopulmonary tree. More than 95% of patients experienced at least a single episode of hemoptysis, and massive hemoptysis occurred in more than half of the reported cases. A correct preoperative diagnosis was made in only 54% of cases. Plain chest radiographs definitively demonstrated an aneurysm in only 16%. The computed tomographic scan was the most rewarding test, identifying an aneurysm in 11 of 12 patients and the fistula in 50% of them. Surgical repair resulted in a 76% survival rate.

Effects of grain type, roughage level and monensin level on finishing cattle performance.

Interactions among grain type (grain sorghum, corn or wheat), roughage level and monensin level were studied in four feedlot trials using pen-fed crossbred yearling cattle. In Trial 1, cattle fed high-moisture corn (HMC) were more efficient (.1537 vs .1406 for gain/feed; P less than .01) than cattle fed dry-rolled grain sorghum (DRGS). As level (0, 3, 6, 9%) of dietary roughage was increased, feed efficiency (gain/feed) decreased (.1566, .1461, .1479, .1382; linear, P less than .01). In Trial 2, a grain type (DRGS; dry-rolled corn, DRC; dry-rolled wheat, DRW) x roughage level interaction was observed for daily gain and feed efficiency. Feed efficiency (gain/feed) was decreased when roughage was added to diets containing DRC (.1608 vs .1750) or DRGS (.1674 vs .1465), but not to the diet containing DRW (.1664 vs .1607). In trial 3, a grain type x roughage level x monensin level interaction (P less than .08) was observed for feed efficiency. The addition of 27.5 mg of monensin per kilogram of the 0% roughage-DRC diet tended to improve feed efficiency (.1633 vs .1531), but the addition of monensin to the 7.5% roughage-DRC diet tended to depress feed efficiency (.1476 vs .1575). The addition of either roughage (.1493 vs .1420) or monensin (.1500 vs .1413) to the DRW diet improved feed efficiency. In Trial 4, cattle fed a combination of 75% DRW and 25% DRC were more efficient (.1618 vs .1591; P less than .06) than cattle fed DRC. As level of roughage (0, 3.75, 7.5%) increased, feed efficiency decreased linearly (.1645, .1599, .1569; P less than .0001). Monensin had no effect on feed efficiency. The value of feeding roughage and monensin was variable both across grain types and within similar grain types.

The effect of a monensin ruminal delivery device on performance of cattle grazing pasture.

A total of 28 trials utilizing 2,262 steers and heifers were conducted to evaluate a sustained monensin2 ruminal delivery device (RDD) on the daily gain of grazing cattle. Five series of trials, with four to eight trials per series within a grazing season, were conducted to evaluate the daily gain response under different environmental conditions and locations. Pastures grazed included both summer (cool- and warm-season grasses and native range) and winter (rye, ryegrass and wheat) growing pastures. The experimental design for all trials in each of five series was a randomized complete block with initial weight or breed as the blocking factor. The treatments compared in series I, III, IV and V (20 trials) were a control and a single RDD, whereas in series II (eight trials), a 2 x 2 factorial was utilized that compared RDD and estradiol 17-beta controlled release implants. In the five series of trials, the monensin RDD increased daily gain .04 (P = .002), .03 (P = .07), .09 (P = .01), .05 (P = .10) and .08 kg (P = .04) compared with the controls. Use of the RDD provided an effective method of achieving consistent monensin delivery and weight gain improvement without requiring the extra labor needed to administer monensin via hand-feeding or self-feeding supplements, blocks or loose mineral.

Severity of liver abscesses and efficiency of feed utilization of feedlot cattle.

Relationships of gain, intake, feed efficiency and severity of liver abscesses were evaluated in 12 experiments involving 566 head of individually fed cattle. Concentrate level in the diets ranged from 64 to 95%. In all experiments, livers were scored as unabscessed (0), one or two small abscesses (A-), two to four small active abscesses (A) or one or more large, active abscesses (A+). Based on homogeneity of variances, nine of the experiments were divided into two groups. In one group (four experiments) the incidence of liver abscesses was 32.1% and no significant (P greater than .25) effects of liver abscess severity score on feedlot performance variables were found. In the second group (five experiments), the incidence of liver abscesses was 77.7%. In the second group, liver abscess severity score affected final live weight (P less than .10), hot carcass weight (P less than .0001), dry matter intake (P less than .10), daily gain based on live weight recorded 24 h prior to slaughter (P less than .10), daily gain based on live weight estimated from hot carcass weight with a 62% dressing percentage (P less than .0001), feed efficiency using final live weight estimated from hot carcass weight (P less than .0001) and dressing percentage (P less than .01). In all cases, performance means for cattle with A+ liver scores were the only ones that differed significantly from those of non-abscessed cattle.

Responsibilities of university investigators when conducting trials on investigational new animal drugs.

Before the start of an Investigational New Animal Drug clinical investigation, the trial protocol is written and signed by both investigator and monitor. Responsibilities of the investigator are discussed with the monitor, and a Statement of Investigator form is complied by the investigator. The monitor will provide the investigator with copies of all regulatory notifications that are submitted to the Center for Veterinary Medicine (CVM). Investigator's responsibilities include maintaining accurate records, reporting periodically to the monitor and(or) sponsor, making records available to the sponsor and carrying out the clinical investigation according to the protocol. The Food and Drug Administration by regulation has the responsibility to determine that trials are conducted in compliance with federal guidelines. The investigator should document all meetings, actions and significant events of the clinical investigation to demonstrate that federal regulations and protocol were followed. The experimental drug should be accurately monitored and dispensed during the trial and properly disposed of at the end of the study. Only the animals authorized by CVM should receive the experimental drug. During the clinical investigation, the disposition of all experimental animals should be known and at the end of the study all animals should be disposed of according to the protocol.

Factors affecting retention of estradiol-17 beta silicone rubber implants in ears of steers.

A series of trials were conducted to identify the factors causing loss of estradiol-17 beta (E2-beta) silicone rubber implants from the ears of cattle and to evaluate methods of reducing this loss. Surface application of cattle feces to the ears before implanting resulted in an increase in loss of implants compared with the loss from dry, clean ears (30.6 vs 8.6%; P less than .05). Washing ears with a povidone-iodine antiseptic solution before implanting or treating implant sites with an antibiotic after implanting reduced (P less than .05) implant loss when ears were coated with the fecal slurry. Coating silicone rubber implants with .5 to 2 mg of oxytetracycline hydrochloride (OTC) reduced (P less than .0001) implant loss from 39.8 to 13.8% when ears were coated with fecal slurry. When silicone rubber implants with a 1.5-mg coating of OTC were implanted in cattle before submerging in a dipping vat, implant loss was reduced from 6.2 to 2.7%. In studies designed to evaluate mechanical factors affecting implant loss, implants that were placed in the middle of the ear in tight skin moved .79 cm toward the insertion site during a 14-d period after administration compared with 2.82 cm when placed in the base of the ear. When placed in the middle of the ear in tight skin, only 2 of 399 (.5%) implants were lost from steers submerged in a dipping vat immediately following implantation compared with 42 of 394 (10.7%) when placed in the base of the ear (P less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Does pulsatile flow influence the incidence of postoperative hypertension?

Twenty patients undergoing primary elective aorta--coronary artery bypass were divided into two equal groups, both receiving identical premedication, anesthetic, and pump primes. The control patients received hypothermic nonpulsatile flow and the study patients received hypothermic pulsatile flow. Hypertension, defined as a pressure of 160/100 mm Hg or higher, was observed in 80% of the control patients and 20% of the patients receiving pulsatile flow (p less than 0.05). Serial renin measurements demonstrated maximum values in the intensive care unit and coincided with the onset of postoperative hypertension in the control patients. Those patients who had received pulsatile flow did not demonstrate notable renin stimulation. Catecholamines were markedly elevated during bypass and in the intensive care unit, but there was no significant difference between the two groups. Peripheral vascular resistance was not significantly lower with pulsatile flow, except in the first study performed in the intensive care unit. We conclude that catecholamines and the renin-angiotensin system contribute to the production of postoperative hypertension and that pulsatile flow diminishes renin stimulation. Pulsatile flow results in a decreased incidence of postoperative hypertension.

Inline blood gas analysis by gas chromatography in patients during and after coronary artery surgery.

A system was evaluated of measuring Pao2 and Pao2 by an inline sensor in the brachial artery and gas chromatography. Eight patients having coronary artery vein grafts were studied during anaesthesia, operation, perfusion and for 24 hours afterward. Compared to conventional blood gas analysis by polarography (electrodes), the chromatographic method gave readings for Pao2 which were not significantly different during normothermia. During hypothermic perfusion, the chromatographic system read significantly higher than the bench electrode, due at least in part to a difference in temperature correction. For Pao2 the correlation between the two methods was close and differences were clinically insignificant. The Sentorr blood-gas analyser provides a sensitive, accurate indicator of changes in oxygenation, ventilation and circulation during anaesthesia and in the intensive care unit.

The effect of a mechanical venous pump on the circulation of the feet in the presence of arterial obstruction.

A boot of single layer, flexible vinyl sheeting and a pneumatic cuff encircling its top at the ankle, each independently inflatable, constitute a mechanical venous pump. Inflation of the cuff to the desired boot pressure is followed immediately by inflation of the boot from a reservoir with higher available pressure than that in the cuff. When the boot pressure reaches cuff pressure, the excess air escapes from the boot under the cuff. A low venous pressure at the foot could be maintained by compressing the foot for 2 seconds every 15 seconds with a pressure which is 10 millimeters of mercury above initial venous pressure. In seated patients with arterial obstruction whose supine ankle blood pressure was 60 milimeters of mercury or less, the rate of blood flow in the skin of the forefoot was increased by 104.1 +/- 43.7 per cent S.E.M., p less than 0.05, during venous pumping. In these patients, a change in posture alone from supine to sitting increased the rate of blood flow by 81.7 +/- 19.47 per cent, p less than 0.002. The combined effect of the erect posture and venous pumping was an increase of 185.7 +/- 49.63 per cent, p less than 0.01. Rest pain was relieved by the combined effect.

The surgical management of bacterial endocarditis: a review.

A total of 239 surgically treated patients with primary endocarditis were reviewed both from the literature and from our own experience. The age range was 10 to 74 years with a male to female ratio of 3:1. A wide variety of organisms was found. However, as a group, gram positive organisms predominate. The onset of congestive failure was the major indication for surgery. The aortic valve was predominantly involved with the mitral valve running a distant second. The hospital mortality rate was 20% and the late mortality rate was 6.7% with an overall mortality of 26.7%. The prognosis in infective endocarditis when congestive failure develops, even in the presence of antibiotic therapy, is poor (79-89% mortality). In view of this poor prognosis, an aggressive attitude with regard to early surgical intervention can greatly improve the outcome of valvular endocarditis.