Extracted from text ... 204 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003
A 56-year-old female smoker presented to hospital with the
sudden onset of chest tightness and dyspnoea, lasting for 4
hours. Clinical and radiological examination revealed dextrocardia
and situs inversus. The admission ECG, performed
with the electrodes in the conventional position, showed features
of dextrocardia (rS complexes and poor QRS amplitude
progression from lead V1 to V6, the tall R wave in lead
aVR, and P wave and QRS axes directed at +120?) and widespread
changes suggestive of myocardial ischaemia/injury
(ST segment elevation of 1-2 mm in aVR, ST segment ..
Summary We have used nitric oxide in the treatment of four children admitted to the paediatric intensive care unit with acute, severe respiratory failure. Administration resulted in an improvement in arterial oxygenation range 1.3–18.4 kPa (9.9–140 mmHg): mean 6.7 kPa (51 mmHg) and a reduction in arterial carbon dioxide tension range 0.6–1.2 kPa (4.5–9 mmHg): mean 0.9 kPa (6.8 mmHg). No adverse effects were encountered following administration for a duration of 3–12 days at a dose of 40–64 parts per million.
Abstract : Substantial changes in Eastern Europe and within the Soviet Union, coupled with coalition warfare in the Middle East, suggest that the role, missions, and force structure of the U.S. Army will change in the near future. The Army's senior leadership faces the challenge of breaking the existing paradigm and recasting a new one in a turbulent international and domestic environment. Strategic processes, primarily the responsibility of senior leaders but part of a leader's work at all levels, provides a conceptual framework in which strategy is formulated and implemented. Formulation brings together environmental forces and internal capability, whereas implementation is an internal phenomenon. Effective strategy implementation depends on the extent to which resultant changes conform to existing knowledge structures used by members of the organization to make sense of and give meaning to their work. Such cognitive paradigms form the culture construct of the organization. An organizational culture perspective of the Army can enable its leaders to more effectively deal with potential resistance to change through conscious efforts to restructure underlying cognitive paradigms.
To the Editor: We read with interest the work of Fu et al. [1] and believe that it contains an important misinterpretation of the data in one of the quoted [2]. In their discussion, Fu et al. refer to fluoroscein stereotactically administered into the lateral ventricle, and the effect of norepinephrine, phenylephrine, and prostaglandin F2 alpha similarly administered into the lateral ventricle, on its uptake into brain parenchyma. The fact that the alpha-agonists enhanced the uptake of fluorescein, whereas PGF2 alpha did not, is cited as supporting their hypothesis of an alpha-adrenoceptor-mediated increase in capillary permeability as an explanation for enhancement of accumulation of clonidine administered epidurally at the lumbar spinal vertebral level. Closer perusal of the original paper reveals that the fluorescein was given IV, not intraventricularly; thus, the extraction effect seen was in the reverse direction to that effect postulated by Fu et al. in the lumbar spinal cord. Furthermore, this effect cannot be a two-way process, as adrenergic-activated change in capillary permeability is possibly related to an increase in pinocytosis, a one-way process, and facilitation of transport in the opposite direction has been ruled out by an in vitro study by the same group of investigators [3]. In addition, Fu et al. postulate that the lumbar spinal cord has some specificity in both the blood-spinal cord and cerebrospinal fluid-spinal cord barrier, and cite the fact that epinephrine prolongs the analgesic effect of intrathecally administered lidocaine at the lumbar and sacral level, but not at the thoracic level [4], as supporting evidence for their two hypotheses. This is, however, a function of the dose of epinephrine, as demonstrated by work that we have recently performed [5], demonstrating that when 0.2, 0.4, and 0.6 mg of epinephrine were added to hyperbaric lidocaine, potentiation of the analgesic effect progressed higher up the thoracic spinal cord with increasing dosage of epinephrine, despite the total volume of injectate and the total dose of lidocaine remaining constant. Thus, although the hypothesis of Fu et al. remains attractive, we do not believe that the data and the discussion presented in their article support their views. Kenjiro Mori, MD, FRCA Hiroko Kato, MD John Stevens, FRCA Koichi Kito, MD Department of Anesthesia; Kyoto University Hospital; Sakyo-ku, Kyoto 606, Japan
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