Intrapericardial bleomycin for the management of cardiac tamponade secondary to malignant pericardial effusion.

A patient with malignant pericardial effusion with cardiac tamponade was treated by the instillation of intrapericardial bleomycin. The tumour deposits elsewhere in the body continued to progress and eventually killed the patient, but drainage and one dose of intrapericardial bleomycin prevented further episodes of pericardial effusion.     

Guided tissue regeneration in the treatment of furcation defects in man

The regenerative potential of the periodontal tissues in degree II and III furcation defects at mandibular molars was assessed in a clinical trial using a surgical treatment technique based on the principles of guided tissue regeneration. The patient sample included 37 subjects who had periodontal lesions in the right and left mandibular molar regions, including advanced periodontal destruction within the radicular area. Following a baseline examination, the furcation-involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of mucoperiosteal flaps and the placement of a teflon membrane to cover the entrance of the furcation area and the adjacent root surfaces as well as a portion of the alveolar bone apical to the crest. The flaps were repositioned and secured with interdental sutures. A procedure identical to the one used at the test teeth was performed at the control tooth regions with the exception of the placement of the teflon membrane. Following surgery, all patients were placed on a plaque control regimen which involved daily rinsing with chlorexidine gluconate and, in addition, professional tooth cleaning once every 2 weeks for 6 months. After 6 months of healing, the test and control sites were re-examined. The findings demonstrated that the treatment of degree II furcation defects at mandibular molars using the principles of guided tissue regeneration in 19 sites out of 21 resulted in the resolution of the furcation defect. Conventional therapy reached the same goal in less than 20% of the cases treated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relative proton density and relaxation times in liver metastases during interferon treatment

Relaxation times and relative proton densities were calculated from magnetic resonance examinations of the liver in eight patients with liver metastases from neuroendocrine tumours. Single, spin-echo sequences with eight different repetition times and a four-echo sequence were used to calculate T1 and T2 in tumour and normal liver, and the proton density tumour-liver quotient, before and during treatment with interferon. Changes over time of these parameters were compared with variations in tumour marker levels and changes in size and number of the metastases. During therapy, six out of eight cases showed a decrease in tumour T1, five responding to therapy and one with stationary disease, while the two patients with progressive disease showed unchanged tumour T1. The proton density quotient also decreased in a corresponding way, indicating a change in water content in tumours responding to interferon therapy. No significant change in liver T1, tumour T2 or liver T2 occurred in any patient. It is thus possible to perform reliable measurements of relaxation parameters over time, which may be valuable in follow-up of tumour treatment.     

The role of the secretary in community mental health: A training model for integrating secretaries into the therapeutic team in community mental health

Within the mental health setting there is seldom any continuing education program for secretaries dealing with the vaguely-defined areas of their job. Their understanding of their function, as well as their comfort with the work, is crucial to the success or failure of the therapeutic program. The Mental Health Training Institute of North Carolina initiated a training program to facilitate the secretary's appreciation and understanding of her role, and her integration into the therapeutic team. This paper is a discussion of that program and its results.At the time this article was written, Dr. Nyman was psychiatric consultant to Onslow County Mental Health Clinic. Mr. Watson, who at the time of the Workshop was employed by the Mental Health Training Institute, is currently employed by the Alcoholism Training Program for North Carolina at East Carolina University in Greenville, North Carolina.The Mental Health Training Institute which conducted this workshop was established in 1969 as a cooperative program of East Carolina University and the North Carolina Department of Mental Health. The general purpose of the institute is to develop and operate continuing education and in-service training programs for mental health and allied professionals employed in Eastern North Carolina. Any correspondence concerning this article should be addressed to Mr. Harry Campbell, Director, Mental Health Training Institute, P.O. Box 2772, East Carolina University, Greenville, North Carolina 27834.     

The value of health insurance: the access motive.

Why do people purchase health insurance? Many economists would answer that it permits purchasers to avoid risk of financial loss. This note suggests that health insurance is also demanded because it represents a mechanism for gaining access to health care that would otherwise be unaffordable. For example, although a US$300,000 procedure is unaffordable to a person with US$50,000 in net worth, access is possible through insurance because the annual premium is only a fraction of the procedure's cost. The value of insurance for coverage of unaffordable care is derived from the value of the medical care that insurance makes accessible.     

Health insurance theory: the case of the missing welfare gain

An important source of value is missing from the conventional welfare analysis of moral hazard, namely, the effect of income transfers (from those who purchase insurance and remain healthy to those who become ill) on purchases of medical care. Income transfers are contained within the price reduction that is associated with standard health insurance. However, in contrast to the income effects contained within an exogenous price decrease, these income transfers act to shift out the demand for medical care. As a result, the consumer’s willingness to pay for medical care increases and the resulting additional consumption is welfare increasing.     

T1, T2, and relative proton density at 0.35 T for spleen, liver, adipose tissue, and vertebral body: normal values

An MRI installation (Magnetom, Siemens, software version B1 of NUMARIS) working at 0.35 T was used to estimate T1, T2, and relative proton density in the spleen, liver, adipose tissue, and vertebral body in 14 healthy volunteers. Two double-echo sequences were applied for all subjects: TR = 500 ms, TE1 = 35 and TE2 = 70 ms; and TR = 1600 ms, TE1 = 35 and TE2 = 70 ms. The images were sampled in regions of interest and appropriate relaxation expressions fitted to the ROI data yielding relaxation parameters and relative proton densities. Relaxation expressions, included in standard software (Siemens), were compared to more elaborate functions, developed in parallel to this study. The latter were found more appropriate, especially for high T1 values, and gave the following mean values for the four tissues (estimated uncertainty of mean in parentheses) T1 (ms) 915(36), 428(5), 261(7), and 501(11); T2 (ms) 79.7(8.8), 51.0(0.2), 59.8(1.0), and 64.7(0.8); and corresponding relative proton density (rho, arbitrary units) 2088(136), 2182(10), 2915(49), and 2136(21). The uncertainty in the values was estimated in the fitting procedure and does not include systematic errors. The relative noise in the ROIs was about 9% and the reproducibility of the ROI mean values about 8%.     

Magnetic resonance imaging of acute myocardial infarction in pigs using Gd-DTPA

Six pigs with coronary artery occlusion were investigated with MR imaging before and subsequently for about 2.5 hours at repeated intervals after the intravenous administration of Gd-DTPA (0.4 mmol/kg). The animals were sacrificed after a total occlusion time of 6 hours and the hearts were excised. The excised hearts were then reexamined in the MR equipment and stained with TTC (triphenyl tetrazolium) in order to define areas of infarction. Four control hearts with 6-hour-old infarctions were only imaged ex vivo without any previous administration of contrast media. In vivo, there was no clear demarcation of infarction with or without Gd-DTPA. Ex vivo, without any contrast media, the infarctions were poorly discriminated with a discretely increased signal intensity relative to normal myocardium in the T2 weighted images. Gd-DTPA was found to accumulate in the infarctions, which caused an elevated signal intensity most pronounced in the T1 weighted images. This considerably improved the delineation of the infarcted area.     

Thromboprophylaxis-in-hip arthroplasty: Dextran with graded compression or preoperative dextran compared in 150 patients

Totally, 150 patients, subjected to total hip arthroplasty, were randomly allocated into three prophylactic groups with either conventional dextran alone or with additional graded compression stockings or with additional preoperative administration of dextran. The overall frequency of deep venous thrombosis (DVT), as studied by radioactive fibrinogen uptake test and ascending phlebography of the operated on thigh was in the conventional dextran group 46 percent, the additional stockinged group 30 percent, and in the additional preoperative dextran group 52 percent. In the stockinged group, there was a lower frequency of DVT in the nonoperated on leg as well as, on an average, about 350 mL less peroperative bleeding as compared with the other two groups. No adverse reaction occurred from dextran administration.

Increased and prolonged postoperative administration of dextran decrease the number of femoral DVTs.