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THIS WEEK
October 26, 2000
in the New England Journal of Medicine

 


Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos
Automated external defibrillators were placed in casinos in Nevada and Mississippi, and security guards were trained in their use. The devices were used in 105 patients with cardiac arrest due to ventricular fibrillation. A total of 56 patients (53 percent) survived to hospital discharge. Among the 90 patients whose collapse was witnessed, the survival rate was 74 percent when the interval between collapse and the first shock was three minutes or less and 49 percent when the interval was longer.

Automated External Defibrillators on Aircraft
A U.S. airline equipped its aircraft with automated external defibrillators, and over two years, the devices were applied to 200 patients by flight attendants trained in their use. Thirteen of the 14 patients who had ventricular fibrillation had successful defibrillation with the first shock (defibrillation was withheld in 1 patient at the family's request), and 40 percent survived to hospital discharge.

Postoperative Adjuvant Therapy for Stage II or IIIa Non­Small-Cell Lung Cancer
In a multicenter trial, 242 patients with non­small-cell cancer were randomly assigned to receive postoperative radiotherapy alone and 246 to receive radiotherapy combined with cisplatin and etoposide. In all patients, the tumor was completely resected but metastases were present in draining lymph nodes. The median survival in the two groups was virtually identical: 39 months in the radiotherapy group and 38 months in the combined-treatment group.

Effects of Intrathecal Morphine on the Ventilatory Response to Hypoxia
graphMorphine administered intrathecally has a potent analgesic action, but it also depresses respiration. To determine whether this depression is a central or peripheral effect, the respiratory responses to intrathecal morphine (0.3 mg) and intravenous morphine (0.14 mg per kilogram of body weight) were studied in 30 normal men. The ventilatory response to hypercapnia was reduced only by intrathecal morphine. The ventilatory response to hypoxia was reduced by both intravenous and intrathecal morphine, but the effect of intrathecal morphine lasted much longer.

Transmission of Norwalk Virus during a Football Game

Nausea and diarrhea developed during a football game among many players on the visiting team, and on the next day among players on the home team. An investigation identified the source of infection as lunch eaten only football picture by members of the visiting team (attack rate, 62 percent), and a single strain of Norwalk virus was isolated from stool from members of both teams, indicating person-to-person transmission of the virus during the football game.


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