Use of low-osmolality contrast media in a price-sensitive environment

Over the past 3 years, three radiographic contrast media that are lower in osmolality than traditional contrast media have become available in the United States. These lower osmolality media have been reported to produce fewer adverse reactions than the higher osmolality media, but they cost 10 to 20 times more than higher osmolality media. To explore hospital and physician decision-making regarding the use of lower osmolality media in the increasingly price-sensitive health-care environment, we surveyed the 40 hospitals in the United States that received the most funding from the National Institutes of Health in 1985. Radiologists in 27 (68%) of the hospitals responded. Of these, 93% believed lower osmolality media improve the quality of patient care. However, nearly half of responding institutions limited the use of lower osmolality media. On average, in 1986 lower osmolality media were used in 9% of procedures in which contrast media were injected intravascularly. The decision to limit use was made primarily by radiologists, rather than hospital administrators, and was based on concerns regarding the high price of lower osmolality media. Twelve respondents had developed guidelines for appropriate use of lower osmolality media, but only 25% of these had developed mechanisms to ensure or increase compliance with those guidelines. Only one respondent (4%) reported that he routinely informs patients of the issues and tradeoffs involved in deciding whether to use lower or higher osmolality media. We conclude that cost is an important factor in physicians' and hospitals' choices of contrast media and that increased attention should be given to defining appropriate procedures to follow when informed consent is obtained for the use of contrast material.     

Treatment of TRIC infection of the eye with rifampicin or chloramphenicol.

An open trial was carried out on 63 patients in London to assess the efficacy of 1% rifampicin eye ointment in comparison with 1% chloramphenicol eye ointment in the treatment of sexually transmitted TRIC infection of the eye. Patients included were selected on the basis of positive cultures for Chlamydia trachomatis. Three weeks' treatment with rifampicin eye ointment used 3 times daily was not sufficient to cure the disease, but a 6 or 7 week course gave 90% clinical and microbiological cure rate. Treatment with chloramphenicol eye ointment 3 times daily for 4 to 6 weeks failed to cure the disease.     

Massive global ozone loss predicted following regional nuclear conflict

We use a chemistry-climate model and new estimates of smoke produced by fires in contemporary cities to calculate the impact on stratospheric ozone of a regional nuclear war between developing nuclear states involving 100 Hiroshima-size bombs exploded in cities in the northern subtropics. We find column ozone losses in excess of 20% globally, 25-45% at midlatitudes, and 50-70% at northern high latitudes persisting for 5 years, with substantial losses continuing for 5 additional years. Column ozone amounts remain near or <220 Dobson units at all latitudes even after three years, constituting an extratropical "ozone hole." The resulting increases in UV radiation could impact the biota significantly, including serious consequences for human health. The primary cause for the dramatic and persistent ozone depletion is heating of the stratosphere by smoke, which strongly absorbs solar radiation. The smoke-laden air rises to the upper stratosphere, where removal mechanisms are slow, so that much of the stratosphere is ultimately heated by the localized smoke injections. Higher stratospheric temperatures accelerate catalytic reaction cycles, particularly those of odd-nitrogen, which destroy ozone. In addition, the strong convection created by rising smoke plumes alters the stratospheric circulation, redistributing ozone and the sources of ozone-depleting gases, including N(2)O and chlorofluorocarbons. The ozone losses predicted here are significantly greater than previous "nuclear winter/UV spring" calculations, which did not adequately represent stratospheric plume rise. Our results point to previously unrecognized mechanisms for stratospheric ozone depletion.     

Long-segment femoropopliteal stenoses: is angioplasty a boon or a bust?

Analysis of 193 femoropopliteal angioplasties demonstrated patency rates in the stenotic group of 75.5% at 6 months and 54.4% at 54 months. The patency rates for the occlusive group were 93.7% at 6 months and 72.9% at 54 months; these rates were significantly better than those in patients with stenoses. A group of 14 patients with long-segment (greater than 7 cm) stenosis had the highest risk of early failure, with a 6-month patency of 23.1%. After removal of the long-segment stenosis group from the results, there were no significant differences between the long-term patencies for stenotic and occlusive lesions. If angioplasty of long stenoses is attempted, a high initial success rate but early failure should be anticipated.