Because of renewed clinical interest in the Q-T interval and because of a need of normal values for an accompanying investigation in rheumatic fever, the Q-T was studied in 517 normal infants and children from birth to 13 years of age. A mean K of 0.404 for Bazett's formula and of 0.378 for Ashman and Hull's formula was obtained. With Bazett's curve approximating the data more closely, a Bazett's scattergram of the normal Q-T at varying heart rates was constructed. Although no difference in K value was noted between the sexes, significant differences were observed in certain age groups.
Information regarding the normal unipolar electrocardiogram in the young ages is very limited. This study furnishes data obtained from 521 normal infants and children from birth to 13 years, using the V chest leads and the aV limb leads. Four age groups were noted in the evolution of the newborn pattern into the adult pattern as mainly reflected by the configuration of the QRS complex in V1. Detailed analyses of the rest of the unipolar electrocardiogram disclosed other distinctive features both in wave patterns and voltages which differ significantly not only from adult findings but also among the various age groups noted.
Recently we have had a patient with carcinoma of the cardia of the stomach which was present in a hiatal hernia. A transthoracic oesophago-gastrectomy was performed in which " artificial hibernation" with hypothermia was used, the technique employed being a modification of that described by Huguenard (1953). Following this procedure multiple pulmonary emboli developed, and in this paper some of the factors which may have predisposed to this complication are discussed. Case HistoryA 76-year-old white man was admitted to On January 6 oesophagoscopy revealed a lesion, situated 37 cm. from the incisural ridge, which on biopsy proved to be an adenocarcinoma of the stomach. In preparation for the removal of this he was given whole-blood transfusions to restore his blood volume and at the same time fluid intake was maintained.Operation A transthoracic oesophago-gastrectomy was performed on January 10 under " artificial hibernation " with hypothermia. The procedure was as follows. The previous night the patient was given "thorazine" (chlorpromazine), 100 mg., pethidine, 50 mg., and atropine, 0.3 mg., intramuscularly. At 7.30 a.m. two infusions were started-one consisting of 1,000 ml. of 5 % glucose in water, and the other of 250 ml. of normal saline solution, the latter being the vehicle for the "lytic cocktail." Anaesthesia was induced with 2.5% thiopentone sodium, 6 ml. intravenously, and maintenance was by 1 litre of oxygen and 2 litres of nitrous oxide. At 7.45 a.m. he was given promethazine, 50 mg. intramuscularly, and the " lytic cocktail," composed of diethazine, 50 mg., pethidine, 10 mg., and chlorpromazine, 25 mg. Hypothermia was induced by covering the entire body with small bags of crushed ice. No shivering occurred. Endotracheal intubation was performed and oxygen given through a closed circuit. Pulmonary ventilation was assisted with intermittent positive pressure of 12 cm. of water.At 8.45 a.m. the " lytic cocktail " was repeated; the icebags were removed when the temperature reached 91.4' F.(33' C.), and surgery stated at 9.30 a.m. During the operation " arfonad,"* 5 mg., was given by intravenous injection. This was followed in ten minutes by a drop in blood pressure to 60/30 mm. Hg, but the systolic pressure gradually returned to 100 mm. within the next hour. Meanwhile the body temperature slowly fell to reach its lowest level of 83.3' F. (28.5' C.), where it remained for two and a half hours. Respiratory acidosis was avoided by the adequate ventilation. There was no change in the electrocardiographic picture during the entire procedure. Electrolytes, determined before, during, and after the operation, remainej within normal limits, and the total operating time was six hours. The estimated blood loss was 600 ml. The patient was rewarmed slowly over a period of seven hours and all vital signs were normal. Post-operative CourseThe immediate post-operative course was uneventful. A Levin tube was placed in the stomach through the anastomosis, and maintenance was by nasal oxygen, intravenous therapy, and ch...
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