Radiological evaluation of the ascending aorta following repair of type A dissection

A patient with persistent chronic dissection proximal to an aortic interposition graft for repair of a type A dissection prompted us to review the computed tomographic (CT) findings in 14 other such patients 5–47 months after surgery. No other case of proximal aortic dissection was identified although dilatation of the aortic root proximal to the graft was present in 8 patients (57%). Persistent dissection distal to the graft in 11 patients (79%) was in keeping with that reported by other workers. Chronic dissection proximal to the surgical repair of a dissection seems a rare although important complication     

Polymicrobic bacteriuria: significant association with bacteremia.

Current clinical practice states that a urine culture yielding three or more isolates must be considered a contaminated specimen and discarded. The validity of this practice was tested by reviewing all patients at the West Haven Veterans Administration Hospital with positive blood cultures for 1 year to determine how many were associated with polymicrobic bacteriuria (two or more urine isolates each present at greater than 10(5) colonies/ml). During 1973 there were 18 patients who had bacteremia associated with a urinary tract infection in which the same organism with the identical antibiogram was found in both the blood and the urine of these 18 patients with monomicrobic bacteremia 11(61%) had polymicrobic bacteriuria, with a mean of an additional 1.75 urinary pathogens present in significant quantities. In these patients with polymicrobic bacteriuria, an indwelling bladder catheter was present for a mean period of 4.4 months before the episode of bacteremia. Only 5 of the 11 patients with polymicrobic bacteriuria had temporally associated urinary tract manipulation. Monomicrobic bacteriuria occurred in seven patients (39%). The mean indwelling bladder catheter time was 0.9 days, and urinary tract manipulation near the time of bacteremia occurred in all seven patients. Prospectively, nine other patients with polymicrobic bacteriuria were recultured by one of us to be certain that appropriate collection and transportation methods were used; the presence of polymicrobic bacteriuria was repeatedly demonstrated in 7(78%). This study illustrates the clinical importance of polymicrobic bacteriuria.     

Direct demonstration of transsynaptic degeneration in the human visual system: a comparison of retrograde and anterograde changes

Transneuronal degeneration of retinal ganglion cells was directly demonstrated in a patient who had unilateral removal of the striate cortex forty years prior to necropsy. For comparison, another case is presented showing anterograde transneuronal atrophy forty years after enucleation of one eye.     

Pediatricians' own weight: self-perception, misclassification, and ease of counseling

OBJECTIVES: Pediatricians underdiagnose overweight and feel ineffective at counseling. Given the relationship between physicians' health and health habits and counseling behaviors, we sought to determine the 1) percentage of pediatricians who are overweight; 2) accuracy of pediatricians' own weight status classification; and 3) relationship between weight self-perception and perceived ease of obesity counseling. RESEARCH METHODS AND PROCEDURES: This study was a cross-sectional, mail survey of North Carolina pediatricians that queried about their weight status and ease of counseling. Accuracy of pediatricians' self-classification of weight status was compared with BMIs derived from self-reported height and weight. Using logistic regression, controlling for potential confounding variables, we examined the association between weight perception and ease of counseling. RESULTS: The unadjusted response rate was 62%, and the adjusted response rate was 71% (n = 355). Nearly one-half (49%) of overweight pediatricians did not identify themselves as such. Men had greater adjusted odds of misclassifying overweight than women [odds ratio (OR), 3.61; 95% confidence interval (CI) = 1.81, 7.21]. Self-classified "thin" pediatricians had nearly six times the odds of reporting more counseling difficulty as a result of their weight than "average" weight pediatricians (OR = 5.69; 95% CI = 2.30, 14.1), and self-identified "overweight" pediatricians reported nearly four times as great counseling difficulty as "average" weight physicians (OR = 3.84; 95% CI = 1.11, 13.3), after adjustment for self-reported BMI weight status and other potential confounders. DISCUSSION: The roles that physician weight misclassification and self-perception potentially play in influencing rates of obesity counseling warrant further research.     

Controlling inflammation: a fat chance?

The inflammatory response protects the body against infection and injury but can itself become deregulated with deleterious consequences to the host. It is now clear that several endogenous biochemical pathways activated during defense reactions can counterregulate inflammation. New experimental evidence adds resolvin E1 to this group of endogenous inhibitors and provides further rationale for the beneficial effects of dietary supplementation with fish oils. It also highlights an unexpected twist in the pharmacology of aspirin.     

Lifestyle drugs: pharmacology and the social agenda

The precise definition of 'lifestyle' drugs is a subject of debate. However, they are generally defined as drugs taken to satisfy a non-medical or non-health-related goal. Although the term has been used only recently, the media debate that surrounds these agents, fuelled by the release of medicines such as Viagra (sildenafil), is intense. The increasing availability of drugs that can be used to alter our appearance, our physical and mental capabilities or even our characters is changing the social fabric of our culture and poses a difficult challenge to our healthcare systems. It is also revolutionizing the traditional doctor-patient relationship and raises important issues about the rights to, and limits of, self-diagnosis and self-medication.