Screening for carotid artery disease in the general public

BACKGROUND: Screening for various diseases is now being offered to the public in settings other than their physicians' office, often using expensive and sophisticated technology. Little is known about how patients decide to participate in such programs, whether they understand the implications of a positive or negative test, or if their primary care physician is involved in the decision to screen. METHODS: We surveyed a cohort of patients who participated in a free carotid artery screening using Doppler ultrasound at a tertiary care academic medical center. RESULTS: One hundred twenty-four patients participated and underwent the ultrasound exam. Their mean age was 68.8 (+/-9.8) years and 54% were female. Some 117 patients (94%) completed the survey. Five patients (4%) tested positive for significant carotid artery stenosis. Sixty-two percent (95% CI: 53-71%) of the patients learned about the program through a newspaper advertisement. Eighty-eight percent (95% CI: 82-94%) of the subjects stated that their primary physician had not suggested that they have the test, and 59% (95% CI: 50-68%) did not know that carotid artery surgery is often recommended for patients who test positive. CONCLUSIONS: This study of one group of patients who voluntarily took a screening test for carotid artery stenosis raises some important questions since most subjects did not understand the implications of a positive result, nor did they involve their physicians in their decision to take the test. Further studies are needed to evaluate whether providing patients with more information about the implications of a screening test would change their desire to have the test and about the nature of the informed consent required before such screening is carried out.     

Darstellung und polymerisationsverhalten von einigen neuen vinylverbindungen

4-Vinylbenzophenone anile is prepared from 4-vinylbenzophenone and aniline. In contrast to 4-vinylbenzophenone, it can be polymerized up to high conversions without crosslinking. From IR-spectroscopic analysis of the copolymers prepared radically at 60°C from styrene and 4-vinylbenzophenone anile, the following copolymerization reactivity ratios result: r₁ = 1.88 ± 0.08 (4-vinylbenzophenone anile) and r₂ = 0.36 ± 0.02 (styrene). Vinyl-α.α-diphenylethylene is obtained from methylmagnesium. iodide and 4-vinybenzophenone. Polymerization as well as copolymerization with styrene takes place not only via the vinyl group but also via the vinylidene group ; the rather low-molecular polymers which are formed still contain free vinyl groups. 4-Vinyl-4′-dimethylaminoazobenzene (prepared by diazotation of 4-aminostyrene and subsequent coupling with dimethyl aniline) does not undergo radical polymerization; it does, however, copolymerize with styrene. In this case, the rate of polymerization increases with decreasing content of 4-vinyl-4′-dimethylaminoazobenzene. The copolymerization reactivity ratios of this system can hence only be approximated. 4-Vinyltriaryl carbinols can be prepared in yields of 50 to 70 % from 4-vinyl-phenylmagnesium chloride and aryl ketones. 4-Vinyl-4′-phenyltriphenyl carbinol and 4-vinyl-4′.4″-diphenyltriphenyl carbinol can be polymerized radically in bulk as well as in benzene solution. Insoluble, completely cross-linked polymers are formed in bulk polymerization. In benzene solution at low conversions, soluble polymers are obtained with degrees of polymerization of 300 to 350. Dilatometric measurements show that the polymerization rates of the 4-vinyltriarylcarbinols are substantially greater than that of styrene. The 4-vinyltriarylmethyl chlorides, which are accessible via the corresponding 4-vinyl-triaryl carbinols with acetyl chloride, can be neither homopolymerized nor copolymerized with styrene since the triarylmethyl chloride groups inhibit radical polymerization.     

Open reduction and screw fixation of mallet fractures

Twelve patients with mallet fractures treated by open reduction and internal fixation with small screws were reviewed at an average of 31 months after surgery. The indication for surgery was a fracture involving more than one-third of the distal phalanx articular surface or with subluxation of the distal interphalangeal joint. Loss of reduction occurred in one patient and in another one screw loosened slightly without loss of reduction. There were no nail deformities, infections, or secondary procedures. The mean range of motion was from 6 degrees (range, 0-30 degrees ) (extensor lag) to 70 degrees (range, 60-90 degrees ) flexion. Ten patients had no evidence of degenerative changes, one had minor joint space narrowing and one had significant deformity. Open reduction and screw fixation with small screws can lead to satisfactory outcome in appropriate patients.     

Cine magnetic resonance imaging for evaluation of focal tracheomalacia: innominate artery compression syndrome

BACKGROUND: The contribution of an 'aberrant innominate artery' to respiratory distress syndromes has been a matter of debate nearly since the introduction of this concept. Recent advances in dynamic imaging are proving to be of value in assessing tracheal function in patients with respiratory distress. We therefore evaluated patients with innominate artery compression syndrome using the cine magnetic resonance imaging (CMRI) modality. OBJECTIVES: To apply the CMRI modality to evaluate patients with respiratory distress who exhibited tracheal compression at the level of the innominate artery. METHODS: A cohort of three patients in respiratory distress underwent bronchoscopy, followed by CMRI using a Siemens 1.5T Vision system. RESULTS: These three patients exhibited tracheal compression at the level of the innominate artery in agreement with their findings during bronchoscopy. All three exhibited dynamic tracheal compression that varied with the respiratory cycle. The degree of tracheal compromise was readily appreciated using the dynamic, real-time CMRI modality. Due to the severity of symptoms, the two children underwent innominate arteriopexy with complete resolution of their symptoms. CONCLUSIONS: CMRI provides extremely rapid acquisition of images, as well as integrated information regarding relationships of mediastinal structures. By providing functional imaging of tracheal patency during the respiratory cycle, CMRI may provide additional insight into innominate artery compression syndrome as more patients are evaluated.     

Cost-effective and safe ambulatory long-term immunoprophylaxis with intramuscular instead of intravenous hepatitis B immunoglobulin to prevent reinfection after orthotopic liver transplantation

BACKGROUND: Hepatitis B (HBV)-infected patients receive an anti-HBs immunoprophylaxis [hepatitis B immunoglobulin (HBIG) titre of more than 100 IU/L] in combination with lamivudine to prevent reinfection after orthotopic liver transplantation (OLT). In comparison with intramuscular (i.m.) HBIG, costs for intravenous (i.v.) HBIG are found to be extremely high. We therefore studied patients' outcome (i) after a switch from i.v. to i.m. HBIG and (ii) the outcome after the patients were initially treated with i.m. HBIG after discharge from the hospital. METHODS: (i) Six outpatients were switched from 2000 IU i.v. HBIG (Hepatect) administered every 2 wk to 2000 IU i.m. HBIG (Hepatitis-B-Immunoglobulin Behring) given once a month. (ii) Six other outpatients were directly treated with i.m. HBIG every 4 wk after OLT. All patients also received 100 mg lamivudine/d. RESULTS: Patients switched from i.v. to i.m. HBIG had stable anti-HBs titres (i.v. HBIG: 180 +/- 37 IU/L vs. i.m. HBIG: 173 +/- 23 IU/L). Patients directly treated with i.m. HBIG also had sufficient anti-HBs titres (176 +/- 31 IU/L). Intramuscular application of HBIG was well tolerated by all patients and no side-effects were observed in patients receiving i.m. HBIG. In comparison with the protocol using i.v. HBIG, the costs of i.m. treatment were 60% lower. CONCLUSION: Long-term administration of i.m. HBIG saves up to 60% of the usual costs for i.v. prophylaxis of HBV reinfection in patients after OLT. In combination with lamivudine, long-term i.m. HBIG therapy is as efficient as i.v. HBIG treatment, but its lower costs clearly favour its use in preventing HBV reinfection after OLT.