Establishing the feasibility of performance measures for alcohol and other drugs

The Washington Circle (a multiple-disciplinary group of providers, researchers, managed care representatives, and public policy representatives) examined three performance measures for alcohol and other drug (AOD) services. These measures, which were developed and applied to managed care organizations' administrative data for their commercial enrollees, are: (a) identification, the percent of adult enrollees with AOD diagnoses; (b) initiation, the percent of adults with an inpatient AOD admission or with an index outpatient visit for AOD abuse or dependence and any additional AOD services within 14 days of identification; and (c) engagement, the percent of adults diagnosed with AOD disorders that receives two additional AOD services within 30 days of the initiation of care. We conclude that using administrative databases to compare managed care organizations' performance is feasible, meaningful and informative. The article discusses issues in interpreting performance measures in several areas: organizational structure of alcohol and other drug services, information available for measurement, and computational issues.     

A novel technique for parenchymal division during hepatectomy

The major complication in the performance of hepatic rectional surgery is hemorrhage. This report describes a novel technique to achieve hepatic parenchymal division. Preliminary use of the ultrasonic dissector results in the fracture of hepatocytes and leaves bridging arteries, veins, and ducts intact. The use of the Ligasure clamp heat-seals these bridging structures, allowing their bloodless transection with surgical scissors. Six consecutive liver resections were performed in this fashion. The range of blood loss was 425 to 700 mL. This paper describes a simple technique to achieve rapid safe parenchymal division of the liver during hepatectomy resulting in minimal blood loss.     

Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases

As a term, the "petrosal approach" to the petroclival region has a variety of meanings. The authors define a common nomenclature based on historical contributions and add new terminology to describe a technique of hearing preservation that allows for greater exposure of the petroclival region. The degree of temporal bone dissection defines five stages of operation. The authors used the second or "transcrusal" stage, in which the posterior and superior semicircular canals are sacrificed while preserving hearing, in six consecutive cases. Use of a common terminology ensures better understanding among surgeons. In the authors' hands, hearing has been successfully preserved in six patients after partial labyrinthectomy.     

Metastatic melanoma of the tonsil

Metastasis to the tonsils from malignant melanoma is rare. This paper describes one such case in a woman with synchronous breast adenocarcinoma and cutaneous malignant melanoma who had a most unusual clinical course.     

汉族志愿者阿米替林代谢与异喹呱羟化代谢的关系

8名男性健康志愿者po阿米替林100 mg后,以阿米替林及其3种代谢物的血浓度曲线下面积(AUC₀^∞)计算阿米替林的脱甲基化代谢及羟基化代谢能力。结果提示个体间阿米替林及其3种代谢物的AUC差异很大。其中7名志愿者测定异喹呱羟化代谢表型,6例为异喹呱强代谢者,1例为弱代谢者。尿中异喹呱的羟化代谢率与阿米替林的羟基化代谢率、阿米替林和10-羟基阿米替林的AUC₀^∞呈显著相关。阿米替林总血浆清除率与异喹呱羟化代谢率呈弱相关。此结果表明阿米替林和异喹呱的羟化代谢可能由同一酶控制,阿米替林的羟基化代谢和脱甲基化代谢可能为两个独立的代谢途径。     

The effects of topical and oral slow-release nitroglycerin on anterior myocardial infarction size assessed by precordial ST segment mapping

The effect of slow-release nitroglycerin and nitroglycerin ointment in reducing anterior myocardial infarction size was assessed in 18 patients by means of epicardial mapping. The sum of all ST elevations (sigma ST), the number of leads with ST elevations greater than 1 mm (NST), the sum of the ST segment elevations of those leads with ST elevations greater than 1 mm (sigma STmm) and the average ST segment elevations (ST) were evaluated. No statistically significant difference between the two forms of nitroglycerin and placebo was found over a 72-h period. These data suggest that no benefit in terms of reduction in myocardial infarction size, assessed by epicardial mapping, is obtained from therapy with oral slow release nitroglycerin and nitroglycerin ointment.     

Antitumour imidazotetrazines--VIII. Uptake and decomposition of a novel antitumour agent mitozolomide (CCRG 81010; M and B 39565; NSC 353451) in TLX5 mouse lymphoma in vitro

The uptake and incorporation of 8-carbamoyl-3-(2-chloroethyl)(6-14C-imidazo)[5,1-d]-1,2,3,5-tetrazin+ ++-4-(3H)- one (Mitozolomide) into TLX5 mouse lymphoma cells has been studied in vitro. Uptake was rapid, reaching a cell/medium distribution of approximately unity in 1 min at 37 degrees and 10 min at 4 degrees, directly proportional to drug concentration and was unaffected by metabolic inhibitors. These results are consistent with a simple diffusion mechanism. No difference in uptake was observed between drug sensitive and resistant TLX5 lymphoma cells. Cellular radioactivity was found to be progressively accumulated into acid-insoluble material. Acid hydrolysis of this precipitate followed by hplc analysis of the DNA and RNA bases showed that the radioactivity was associated solely with adenine and guanine bases. Mitozolomide was unstable in tissue culture medium and over a 24 hr period about 80% of the drug was converted into 5-aminoimidazole-4-carboxamide (AIC). Non-radioactive AIC suppressed the incorporation of radioactivity into nucleic acids, but had no effects on the initial rate of uptake of mitozolomide into the cell. These results suggest that the radioactivity in nucleic acids arises as a result of salvage of AIC, formed by intracellular decomposition of mitozolomide.     

Apparent coexistent valvular and subvalvular left ventricular outflow tract obstruction.

A patient is presented in whom coexisting bicuspid valvular aortic stenosis and asymmetrical septal hypertrophy were suggested by echocardiography. A focal area of hypertrophy noted at operation was excised. Subsequent histological examination did not reveal evidence to support the echographic and surgical observations. The necessity for careful intraoperative assessment of the degree and nature of subvalvular muscular hypertrophy is stressed. The absence of classic echographic findings in these patients is noted.