Coronary risk factors in a rural community which includes Aborigines: lnverell heart disease prevention programme. L. Simons, P. Whish, B. Marr, A. J o n e s , J. S i m o n s , Aust. N.Z. J. Med.. 1981, 11, pp.
386-390.A coronary risk factor screening and referral service was established in Inverell, New South Wales, in July 1978. In non-Aboriginal subjects, there was an increasing prevalence of coronary risk factors with age (hyperlipidaemia, hypertension and obesity), except for cigarette smoking which showed a reverse trend. Allowing for minor differences in sampling, the average /eve1 of plasma chalesterol, blood pressure and cigarette smoking in rural lnverell closely resembled that in Sydney. However, lnverell subjects of both sexes were consistently more overweight at all ages. Aboriginal subjects of both sexes showed an increased prevalence of hypertriglyceridaemia and cigarette smoking compared with non-Aboriginal subjects, whilst hypertension and obesity were also more prevalent in the Aboriginal females. High coronary risk lnverell subjects sustained significant improvements in serum cholesterol, cigarette smoking and body weight levels over one year of follow-up. Community-wide control of hypertension was initially unsatisfactory and this remained so.AUGUST 1% 1 COROSAR'r RISK IS A RURAL C OMMUNITY
Recirculation during dual lumen veno-venous (DLVV) extracorporeal membrane oxygenation (ECMO) is a dynamic event that results in a fraction of the oxygenated blood exiting the arterial lumen and immediately shunting back into the venous lumen. Excessive recirculation will result in suboptimal oxygen delivery to the patient. Ultrasound dilution is a technology that has been shown to rapidly quantify recirculation in veno-venous (VV) ECMO animal models. This manuscript reports the first clinical application of ultrasound dilution in quantifying recirculation during neonatal VV ECMO. A 2.8-kg neonate with congenital diaphragmatic hernia was placed on VV ECMO using a single DLVV cannula inserted into the right atrium through the internal jugular vein. Ultrasound sensors were clamped to the arterial and venous lines near the dual lumen cannula and 3- to 5-mL bolus injections of isotonic saline were used proximal to the circuit heat exchanger to make the recirculation measurements. Recirculation measurements were made after initiation and periodically thereafter. During the 12-day ECMO period, 86 recirculation measurements were performed. The average recirculation was 34.3% (range, 15–57%). Reproducibility of paired measurements was 5.6%. Changes in patient positioning resulted in significant changes in recirculation. Measurements using platelet injections were compared with those made with saline. The two were found to closely correlate (mean difference, .25% ± 2.8%). Ultrasound dilution measurements of recirculation provided rapid monitoring data during a clinical VV ECMO procedure. Application of this technique could provide early data that will assist the clinician in guiding interventions to minimize recirculation.
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