Diagnosis and successful treatment of subacute erysipelas in a captive dolphin.

Ersipelas, a common disease of swine, is caused by Erysipelothrix rhusiopathiae. The organism was isolated in a blood culture taken from an infected captive dolphin. The dolphin showed typical subacute symptoms of square- and diamond-shaped skin lesions as seen in swine. It was surmised, in retrospect, that the disease was secondary to a primary pneumonia. The symptoms, clinical pathology and other special examinations, treatment and response are discussed.

Trace element concentrations in commonly used intravenous fluids.

The concentrations of several essential trace elements in various intravenous fluids commonly used in South Africa were measured. With the exception of 4% human serum albumin and fresh freeze-dried plasma (FDP), intravenous fluids contained minimal amounts of essential trace elements. Although FDP contained significant quantities of zinc, copper, iron and chromium, the common practice of giving patients on total parenteral nutrition 1-2 units per week will not fulfil the recommended daily requirements. Additional trace element supplements should therefore be given intravenously to these patients.

Hypoxaemia and leucopaenia after fractures.

Blood gas analysis an various haematological measurements were studied prospectively in forty patients suffering from lower limb fractures. Hypoxaemia (arterial PO2 of less than 70 mmHg at sea level) was common with a mean value for all patients of 76 mmHg, despite O2 therapy, when indicated. None of the haematological findings was significant except that every patient with a white blood cell count of less than 7000 per mm3 was also hypoxaemic. Not all patients with hypoxaemia had a relative leucopaenia. A white blood count of less than 7000 per mm3 in the first 72 h following trauma may therefore be considered as an indication for oxygen therapy.

Effects of anticoagulants on acid-base and blood gas estimations.

The use of excessive amounts of heparin to anticoagulate blood samples for pH and blood gas analysis leads to erroneously low PCO2 results, whereas pH and PO2 are relatively unaffected. Derived base deficit values accordingly will be high. Dilution is seldom less than 6% but may exceed 40%, particularly when sampling fron neonates. Sodium citrate and Heller-Paul oxalate solutions were found to be suitable alternatives to heparin, whereas EDTA was not.

The respiratory depressive effects of intravenous buprenorphine in patients in an intensive care unit.

Buprenorphine hydrochloride, a new, potent, long-acting synthetic opiate analgesic, with partial agonist-antagonist activity, was administered intravenously to two groups of patients in an intensive care unit. Arterial blood was drawn for blood gas analysis before (control) and at regular intervals after drug administration, to determine the effects of intravenous buprenorphine on respiration in critically ill patients, each acting as his or her own control. Intravenous buprenorphine 0,4 mg (group I -- 10 patients) caused a significant reduction in mean respiration rate and an increase in mean PaCO2, but did not alter heart rate, PaO2 or base excess values. Intravenous buprenorphine 0,2 mg (group II -- 10 patients) was associated with a less significant reduction in the rate of breathing and elevation of PaCO2. Both 0,4 mg and 0,2 mg buprenorphine produced effective relief of pain, sedation, and reduction in restlessness, and allayed anxiety. Our results suggest that intravenous buprenorphine 0,2 mg can be safely recommended for the prolonged relief of postoperative pain in adults.

Acute confusional states and depression treated with maprotiline mesylate. Report of 4 patients successfully treated in an intensive care unit.

Four patients admitted to hospital with multiple injuries developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly endogenous in origin. Within 24--48 hours of intravenous administration of maprotiline mesylate (Ludiomil, Ciba), a tetracyclic antidepressant drug, considerable improvement was noted in all 4 patients, with regard to both the depressive state and the clouding of consciousness. The importance of recognizing psychiatric disorders in severely ill patients in an intensive therapy environment is stressed.

First aid for shark attack victims.

A first-aid kit designed for the treatment of shark attack victims is presented. Emphasis is placed on the control of massive haemorrhage, the restoration of plasma volume and the transfer of the patient to hospital after initial shoch has been treated on the beach.

Bronchodilators and physiotherapy during long term mechanical ventilation of the lungs.

The effects of physiotherapy and hexaprenaline sulphate administration were studied on 10 patients requiring mechanical ventilation. No significant changes in arterial oxygen tensions were noted, but alveolar pressure fell significantly after treatment, indicating improvement in pulmonary compliance.

Psychiatric problems in intensive care. Five patients with acute confusional states and depression.

Five case histories are presented of patients with multiple trauma or severe infection, who developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly primarily endogenous in origin. Following intravenous Clomipramine administration, considerable improvement was noted in all five patients, regarding both the depressive state and the clouding of consciousness. The importance of recognising psychiatric disorder in severly ill patients in an intensive therapy environment is stressed.

Total parenteral nutrition. A review.

Surgery, trauma, severe sepsis and burns are the most demanding physical stresses that a patient is likely to suffer, yet until recently, the nutrition of these patients was usually completely ignored. The concept of adequate feeding by the intravenous route is now well accepted and the authors present a review of many of the appropriate preparations which are available in South Africa, as well as a description of several regimens that have been successful in total parenteral nutrition (TPN).

Chest physiotherapy during mechanical ventilation.

The effects of three different physiotherapy techniques on arterial oxygen tensions and A-aO2 gradients were evaluated in 17 patients subjected to mechanical ventilation. No significant changes were detected and the clinical significance of these findings, which contrast with those of other investigators, is discussed.

A simple clinical method of quantitating the effects of chest physiotherapy in mechanically ventilated patients.

A simple clinical method, allowing quantitive assessment of the effects of chest physiotherapy on patients subjected to I.P.P.V., is presented. The method involves measuring of the "alveolar" pressure using the end-expiratory retard mechanism available on the Bennet MA 1 (volume cycled) ventilator. Using this simple technique three different methods of physiotherapy were shown to significantly lower alveolar pressure, indicating an increase in pulmonary compliance. The inhalation of acetyl cysteine however, appeared to render treatment less effective in this regard.