Health care heats up as potential presidential campaign issue

Health care professionals and election analysts agree that health care will be a bigger issue in the 1992 election than it was in 1988. Among the reasons: Some prominent members of Congress are active in health care issues, media coverage of health insurance problems is growing, and several major health care reform bills have been introduced in Congress.     

Ulna neuropathy after elbow injury in children

Six children developed seven cases of ulna neuropathy between 7 days and 6 years after significant elbow injury. None had evidence of acute nerve damage at the time of initial trauma. This complication, which develops soon after injury, has not been well documented. For this reason, the mode of presentation, treatment options, and review of the literature is presented.     

Early bladder outlet obstruction in fetal lambs induces renal dysplasia and the prune-belly syndrome

A model of posterior urethral valves in fetal lambs was developed in order to evaluate the effect of intrauterine urinary obstruction on the developing kidney. Complete urethral obstruction was induced in five fetal lambs at 43 to 45 days of gestation. Two control fetal lambs underwent sham operations. At full term (140 days), two of the five experimental lambs and both control lambs were available for postmortem examination. Results of gross and histological examination of the control lambs were normal. In contrast, the kidneys of the experimental lambs were markedly asymmetrical in size. Histological examination of the kidneys in experimental lambs showed cystic dilatation of the collecting ducts and occasional cystic dilatation of Bowman's spaces, features compatible with obstruction. Also noted were peripheral cortical cysts and primitive tubules lined with cuboidal epithelium and surrounded by fibromuscular collarettes, characteristic of renal dysplasia. One of the infant lambs had many characteristics of the prune-belly syndrome, including a wrinkled, markedly distended abdomen, deficient abdominal wall musculature, flared chest wall, limb deformities, and undescended testes. These results suggest that early in utero urethral obstruction (at the beginning of the second third of gestation) causes renal dysplasia. The results also support the hypothesis that the prune-belly syndrome results from abdominal distention that occurs early in gestation.     

A preliminary statistical model for identifying repeaters of parasuicide

This paper presents a statistical model constructed using logisticregression to identify those at high-risk of repeating parasuicide. Thesubjects in the study are Cork city residents who exhibited parasuicidalbehaviour between 1 January and 30 June 1995. Repetition of the behaviourwithin six months of the index episode distinguishes repeaters fromnon-repeaters. The model was designed so that it could be used bynon-clinicians and hence does not require information relating topsychiatric diagnosis or use of psychiatric services. The proportion ofsubjects correctly classified remained stable across a range of cut-pointprobabilities (mean = 86%, range: 83.9–87.5%). Using acut-point of 0.2, 96% of repeaters and 81% of non-repeaters were correctly classified. Using 0.45 led to the correct identification of81% of repeaters and 90% of non-repeaters. If these highlevels of sensitivity and specificity are maintained in validation tests onfuture cohorts in Cork city then the model could form the basis of anintervention programme designed to prevent the repetition of parasuicide.     

The effect of the number of electrocardiograms analyzed on cardiovascular disease surveillance: the Minnesota Heart Survey (MHS)

One method used to control costs in community cardiovascular disease surveillance is to limit the number of electrocardiograms (ECGs) used to validate acute myocardial infarction (AMI). The Minnesota Heart Survey investigated the impact of decreasing the maximum number of ECGs analyzed on classification of ECG pattern and final AMI diagnosis (definite, probable, none). A 50% sample of all 1980 acute CHD hospital discharge records (ICD-9 code 410 or 411) from 30 of 31 Twin Cities hospitals were abstracted. Comparing results using all available ECGs in the record (maximum of 12) with those obtained using up to 4 ECGs showed little differences in the ECG classification or final AMI diagnosis.     

Mucous cyst of the distal interphalangeal joint: treatment by simple excision or excision and rotation flap

Thirty-five patients who had thirty-seven mucous cysts excised from the distal interphalangeal joints were reviewed not less than one year later. Seven out of 25 which had been treated by simple excision recurred, whereas only one out of twelve treated by excision and skin closure with a rotation flap recurred.     

Anti-estradiol immunoperoxidase labeling of nuclei, not cytoplasm, in paraffin sections, determines estrogen receptor status of breast cancer

We evaluated a commercially available polyclonal antibody to 17 beta-estradiol as the basis for an estrogen receptor (ER) assay of breast carcinoma in formalin-fixed paraffin tissues and then compared it with both the ER-ICA antibody in serial paraffin sections and the biochemical assay of corresponding fresh tissue. Using the estradiol antibody, 49 of 50 cases showed some cytoplasmic staining; 38 cases had nuclear staining. Sensitivity and specificity for different proportions of positive nuclear and cytoplasmic staining were calculated using receiver-operator characteristic curves. The optimum correlation with the biochemical assay was obtained with nuclear staining alone. Greater than 30% nuclear positivity as a cut-off point yielded a sensitivity of 76% and a specificity of 82%. The corresponding ER-ICA values in 38 cases yielded a sensitivity of 93% and a specificity of 56%. The methodology for the ER-ICA assay was more technically demanding in paraffin sections than that of the estradiol antibody and considerably more expensive. This study is the first to show that with nuclear staining only, and not cytoplasmic staining, as the parameter of positivity, the immunocytochemical assay of ER with anti-17 beta-estradiol antibody in routinely processed, formalin-fixed, archival material is an accurate and specific method for the determination of the ER status of breast carcinoma.