Direct medical costs attributable to acute myocardial infarction and ischemic stroke in cohorts with atherosclerotic conditions

BACKGROUND: The cost of acute ischemic events in persons with established atherosclerotic conditions is unknown. METHODS: The direct medical costs attributable to secondary acute myocardial infarction (AMI) or ischemic stroke among persons with established atherosclerotic conditions were estimated from 1995-1998 data on 1,143 patients enrolled in US managed care plans. RESULTS: The average 180-day costs attributable to secondary AMI or stroke were estimated as USD 19,056 in the AMI cohort having a private insurance (commercial; n = 344), USD 16,845 in the AMI cohort having government insurance (Medicare, age >/=65 years; n = 200), USD 10,267 for stroke commercial (n = 108), USD 16,280 for stroke Medicare (n = 113), USD 15,224 for peripheral arterial disease commercial (n = 170), and USD 15,182 for peripheral arterial disease Medicare (n = 208). CONCLUSION: These estimates can be used to study the cost-effectiveness of interventions proven to reduce these secondary events.     

Frank Stinchfield Award. Titanium surface with biologic activity against infection

Despite immense improvements, periprosthetic infection continues to compromise the result of otherwise successful joint arthroplasty. There are various limitations in the treatment of periprosthetic infection, the most important of which is the inability to deliver antibiotics to the local tissue without the need for intravenous administration. We have developed a novel route to covalently tether vancomycin to a metal (titanium) surface, which showed effective bactericidal activity because of a vancomycin coupling. The chemistry of tethering does not affect the biological activity of the biofactors that are attached to the metal surface. This technology holds great promise for the manufacturing of "smart" implants that can be self protective against periprosthetic infection, or can be used for the treatment of periprosthetic infections when they occur.     

Ileal endometriosis: radiographic findings in five cases

PURPOSE: To determine the radiographic findings in five patients with ileal endometriosis. MATERIALS AND METHODS: A search of radiology files revealed five patients with surgically proved endometriotic implants in the ileum at enteroclysis (three patients), at small-bowel follow-through (one patient), and at double-contrast barium enema study (one patient). The radiographic findings were reviewed retrospectively. Clinical, surgical, and histopathologic findings were also reviewed. RESULTS: All five patients were nulliparous women (mean age, 34.4 years; age range, 28-41 years). Four patients presented with abdominal and/or pelvic pain, but only one of these four had cyclic pain that coincided with menstruation. Barium studies revealed endometriotic implants in the terminal ileum within 10 cm of the ileocecal valve in four patients and in the mid-ileum in one. The radiographic findings consisted of extrinsic mass effect with variable spiculation and tethering of folds in two patients, annular lesions with spiculated folds and abrupt or tapered borders in two, and a plaque-like lesion in one. In four patients who underwent double-contrast barium enema studies, associated endometriotic implants were found in the rectosigmoid colon. CONCLUSION: Ileal endometriosis usually involves the terminal ileum within 10 cm of the ileocecal valve and manifests as a spectrum of findings on barium studies. Ileal endometriosis should therefore be considered when these findings are present in young, nulliparous women with abdominal or pelvic pain.     

Cardiac operation and end-stage renal disease

From 1972-1979, 22 patients with end-stage renal disease underwent 23 cardiac operations involving the pump oxygenator. Fourteen patients had coronary artery bypasss, 2 had aortic valve replacement, 2 had mitral valve replacement (MVR), 2 had MVR with coronary artery bypass, and 2 had ascending aortic root replacement with a composite graft. One patient underwent successful reoperation for a false aneurysm of the left ventricle after MVR. There were 2 postoperative deaths, for a mortality of 9.1%. The patients undergoing coronary artery bypass had an average of 2.7 grafts and an average Functional Class improvement from New York Heart Association Class III or IV to Class I to II. Eighteen patients required preoperative and postoperative dialysis to control blood volume, potassium, and uremia. Four patients had functioning renal transplants, and 4 patients underwent subsequent successful renal transplantation. We conclude that: (1) patients who have transplants and require dialysis can be successfully managed for cardiac operation in spite of their complex associated medical problems; (2) functional and symptomatic improvement simplifies continued management of the patient needing dialysis; and (3) improvement of a cardiac disability can allow favorable renal transplantation in selected patients.     

Chlorambucil inhibition by dimethyl sulfoxide and thiosulfate: Implications for chlorambucil chemotherapy

Chlorambucil alkylation of pyridine, a model for nucleotides, appears to be first order in chlorambucil, but zero order in pyridine, and is strongly inhibited by dimethylsulfoxide. The same results are seen with chlorambucilyl [³H]prolyl proline; full alkylation activity was regained upon removal of dimethylsulfoxide. Chlorambycilyl [³H]prolyl proline alkylation of tRNA also appears to be first order in alkylator, but somewhat dependent on tRNA concentration, and is also strongly inhibited by dimethylsulfoxide. 10 mM Na₂S₂O₃ completely inhibits alkylation by aqueous 1 mM chlorambucil. Up to 1 M chlorambucil in Me₂SO retains full alkylation activity for at least a year. We suggest that the risk of carcinogenesis inherent in chlorambucil chemotherapy may be avoided by the topical application or injection of 1 M chlorambucil in Me₂SO, in conjunction with oral administration of Na₂S₂O₃.     

Targeting Apoptosis for Optical Imaging of Infection

Purpose  

Infection is ubiquitous and a major cause of morbidity and mortality. The most reliable method for localizing infection requires radiolabeling autologous white blood cells ex vivo. A compound that can be injected directly into a patient and can selectively image infectious foci will eliminate the drawbacks. The resolution of infection is associated with neutrophil apoptosis and necrosis presenting phosphatidylserine (PS) on the neutrophil outer leaflet. Targeting PS with intravenous administration of a PS-specific, near-infrared (NIR) fluorophore will permit localization of infectious foci by optical imaging.     

Ballet Injuries

Only in the last five years has medical care for ballet injuries received more than perfunctory professional interest, although ballet companies in other countries have long had regular medical attention. Most ballet injuries are to the foot, ankle, knee, thigh, hip, spine, and related muscles. Dance masters emphasize that injuries occur because of faulty technique and that any cure is only temporary unless the fault is corrected. Injured dancers are impatient to return to classes or performance because of intense competition and a short career span. Permitting the dancer to do as many of the ballet exercises as possible without further injury will alleviate anxiety and promote cooperation from the dancer.     

Interstitial deletion of the short arm of chromosome 4.

A 17 year old girl investigated for mental retardation and minor anomalies was found to have an interstitial deletion of 4p. Her clinical and cytogenetic findings are compared with previous reported case of interstitial 4p deletion and with terminal 4p--deletions (Wolf-Hirschhorn syndrome).     

Effect of work load and respirator wear on postural stability, heart rate, and perceived exertion

The effects on postural stability (sway) were investigated for different work loads under conditions of wearing a full facepiece respirator and not wearing any respiratory protection device. Fifteen subjects accomplished light (40 W), moderate (85 W), and heavy (125 W) work loads under the two conditions. Measurements of postural sway were made immediately after each load by using a multicomponent, strain gage-type force platform. Changes in each subject's movement pattern of the center of pressure were quantitated and compared to their initial baseline sway tests. Each subject's heart rate and perceived exertion were also recorded during each condition. A statistically significant effect (p = 0.007) caused by work load was observed for total length of sway with or without a respirator. An interaction approaching statistical significance (p = 0.056) between work load and respirator use was found. This indicated that sway increased more quickly and in a more consistently linear fashion with increasing work load under the respirator condition (p = 0.02) compared to the nonrespirator condition. The results from the respirator condition showed linear increases in postural sway length across the entire range of work loads, but sway length in the nonrespirator condition showed an increase only at 125-W work loads. The greater increase in sway during the postural balance test could be attributable to the increasing work load-induced proprioceptive fatigue effect on the nervous system's ability to process signals from proprioception systems incongruent with body sway. The heart rate was significantly higher during respirator wear (an increase in heart rate averaging 5.62 beats/min).(ABSTRACT TRUNCATED AT 250 WORDS)