John H. Kennedy

Postinfarction Ventricular Septal Defect

A series of four patients who died following rupture of the ventricular septum due to myocardial infarction has been reported. One of these died of hemorrhage due to a defective clotting mechanism 8 hours after successful surgical repair.The 13 cases of surgical repair of postinfarction ventricular septal defect reported by other authors are reviewed.The time interval is important and preferably 3 to 6 months should elapse following myocardial infarction before surgery is undertaken.Surgery should be considered in every patient diagnosed as having an acute septal rupture following myocardial infarction who fails to respond to vigorous medical treatment.

Long term use of neuroleptics by schizophrenic patients

1. Use of antipsychotic medications by schizophrenic patients. 2. Side effects of typical neuroleptics. 3. Dosage strategies for treating schizophrenia. Evidence that high dosage treatment and rapid neuroleptization concepts should be abandoned. 4. Minimal effective dosage in maintenance treatment. Studies attempting to define this regimen. 5. Blood levels of antipsychotics and their clinical relevance. 6. New research strategies, focusing on a) case definition, b) target symptoms, c) clinically stable patients, d) dosage reduction studies.

Experimental hypothermic closed chest cardiopulmonary bypass

Summary o 1. In a series of 11 experiments in 10 mongrel dogs, closed chest cardiopulmonary bypass was begun 1 to 35 min after all evidences of cardiorespiratory function had ceased following exsanguination. The animals had been previously heparinized and cannulated. 2. Heart function could be restored after 1 hr of perfusion in seven experiments; in three of five animals with no evidence of cardiorespiratory function for 30 min or more, effective cardiac function returned after resuscitation. Surface pH of the heart rose to above 7 units after 1 hr of perfusion, suggesting relative integrity of the myocardial diphosphopyridine-nucleotide-FPN cytochrome oxidase transport system. 3. From this small series of experiments, it would appear that clinical cadaver perfusion may be carried out 30 or more min after death with some expectation of restoring heart (but not brain) function. 4. It remains to be shown that a heart obtained under these circumstances is indeed transplantable and will maintain long term functional integrity.