Injection and aspiration techniques for the primary care physician

Aspiration and injection techniques are useful, relatively safe office procedures. The physician must have a good understanding of the basic technique and pertinent anatomy. The indications, contraindications and specific injection and aspiration techniques are discussed. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Estimation of the effective dose when protective aprons are used in medical procedures: a theoretical evaluation of several methods

The use of the personal dose equivalent Hp(10), as measured by one or more dosimeters, in estimating the effective dose equivalent H(E) and the effective dose E was examined for situations in which a protective apron is worn by the monitored person during medical procedures. The photon energy range considered was between 0.03-1.0 MeV. Several methods recommended in the technical literature for this purpose were assessed and their ability to provide reasonable estimates for H(E) and E were compared. The assessments were theoretical and used Monte Carlo transport methods and an anthropomorphic phantom to calculate H(E), E, and Hp(10). The results showed that all of the recommended methods, using either one or more dosimeters, were applicable to this situation but that most gave good results only within limited photon energy ranges, outside of which they either considerably over-or under-estimated the doses. Some provided good estimates over the entire energy range considered.     

Stratification of cardiac risk in unstable angina: value of troponin measurements

Recent studies have identified patients with unstable angina and increased troponin I or T as a high risk population gaining benefit from adjunctive treatment with glycoprotein IIb/IIIa receptor antagonists and early reperfusion by coronary interventions.     

Epidemiologic,clinical and therapeutic aspects of chronic lymphoid leukemia: apropos of 120 cases

We retrospectively studied 120 cases of chronic lymphocytic leukemia diagnosed between January 1988 and December 1998. The median age of our patients was of 66 years, 75% among them were male. The discovery of the illness was fortuitous in 20% of the cases, the peripheral adenopathy and the splenomegaly were noted respectively in 72 and 48% of the cases. The blood lymphocytosis was on average 51.109/1 with extremes of 5 and 818.109/1. Anemia was noted in 71% of the cases and a thrombopenia in 42%. Fifty patients were classified C stage of BINET and sixty elevated risk according to RAI. The therapeutic attitude was according to patient's age and the CLL stage. Thus, 94 patients received a chemotherapy and a complete or partial response was observed in 58 of the cases. The overall survival at 5 years were 47%. The retained prognostic factors were the stage according to the classifications of BINET and RAI, the thrombopenia and the lymphocytosis blood overhead 100.109/1.     

Congenital auriculo-ventricular block in the adult

In this work we report a consecutive series of ten patients having auriculoventricular block "presumed" congenital which is seen in adulthood between 1990 and 2001 to determine their clinical profile and forecast, and to deduct the therapeutic consequences. Our criteria of inclusion requires the existence of patients with a second or third degree heart block, who are less than 40 years old at the time of diagnosis, which is not totally regressive in the effort test and the atropine injection, and whose congenital origin was strongly suspected because of the notion of slow pulse during their youth and the absence of acquired affect which enables us to explain this disease. The population contains ten patients whose average age in hospitalization is 23 years old with the range of 11 to 39, while the average age of the discovery of the disease was 20 years old with the range of 8 to 34. Our patients were referred to us because of cardiac symptoms such as syncope or an equivalent, effort intolerance, asthenia, thoracic pain (like angina), or palpitations. The clinical exam, the electrocardiogram, and additional exams (holter, effort test, echocardiography, electrophysiological investigation) allowed us to retain six indications for the definitive cardiac stimulation, associating to different degrees the existence of worrying symptoms such as a syncope, a congenital heart disorder, a low heart frequency, the association in a sinus dysfunction. Short-term and long-term evolution is favorable for patients of the stimulated group as well as the non-stimulated group.     

Performance and Arousal as a Function of Incentive, Information Load, and Task Novelty

Pulse and respiration rate, pulse volume, skin conductance level, and muscle tension were recorded from 12 S₈ while they carried out a 40-min test of choice serial reaction in which incentive level, task difficulty (number of choices), and task novelty (or practice) were varied. 1) Little unanimity was observed among the physiological measures in responding to these task variables. Incentive was reflected in pulse rate, respiration rate, and skin conductance level; task difficulty in pulse volume; and novelty in respiration rate and muscle tension. 2) Only when the effects of information load and practice could be held constant was there any sign of an inverted-U relationship between performance and physiological level. 3) Although both choice and incentive had significant effects on performance, the two did not interact.