Severe supravalvular aortic stenosis: successful surgical correction by extended aortoplasty

Surgical treatment of severe discrete supravalvular aortic stenosis by placement of a patch graft across the narrowed area of aorta at one point has been associated with a substantial incidence of residual stenosis. Successful relief of a severe stenosis was achieved by a modification of a previously reported technique in which the stenotic area is expanded at two points. Use of this technique should be considered in cases of severe discrete supravalvular aortic stenosis.     

Data omitted from psychiatric consultation notes

To assess how often psychiatric consultants omit written data from their consultation notes, the authors reviewed 78 initial consultation notes written by second-year psychiatric residents. Data considered essential for an adequate psychiatric evaluation were typically omitted. Categories that were observed to have the highest frequencies of missing data included family history of psychiatric illness (60.3%), history of substance abuse (44.9%), marital status (37.2%), previous psychotropic drug use (35.9%), previous psychiatric treatment (26.9%), and patient history of psychiatric illness (24.4%). The frequencies of omissions were significantly (p less than .001, except for the last item, p less than .01) higher than those from the consultation notes written by a second cohort of psychiatric residents who used a worksheet that listed data categories. The authors' findings argue for the use of worksheets delineating data categories to ensure that clinicians write adequate consultation notes.     

Inhibition of human non-pancreatic phospholipases A2 by retinoids and flavonoids. Mechanism of action

The interaction of retinoids and flavonoids with phospholipases A2 (PLA2) was studied to assess the mechanism of inhibition. Retinoids, such as retinal, retinol, retinoic acid and retinol acetate, and flavonoids, such as quercetin, rutin, morin and sciadopitysin, inhibit Ca2+-dependent PLA2 activity of human synovial fluid (HSF) in vitro in a dose-dependent fashion; ID20S ranged from 2-8 microM. Retinal inhibited neutral active Ca2+-dependent PLA2S from human platelets, human plasma, human polymorphonuclear leukocytes and Naja mossambica mossambica venom in a dose-dependent manner while quercetin inhibits extracellular PLA2 activities of human plasma, HSF and N. m. mossambica venom in a dose-dependent manner but not PLA2 activity derived from human platelets and polymorphomonuclear leukocytes. Inhibition of PLA2 activity by both flavonoid and retinoids were independent of Ca2+ or Na+. Increasing substrate concentration (9-144 nmols) relieved the inhibition of HSF-PLA2 activity by quercetin indicating probable interaction with the substrate. The inhibition by retinal is independent of substrate concentration suggesting that inhibition by retinal is probably due to direct interaction with the enzyme. both retinal and quercetin quenched the relative fluorescent intensity of N. m. mossambica PLA2 and in a dose-dependent manner in the same concentration range at which they inhibit in vitro PLA2 activity. Retinal and quercetin shift the thermotropic phase transition of distearoylphosphatidylethanolamine (DSPE) liposomes. Both compounds broadened the transition peak, shifted the Tm to lower temperature, and decreased enthalpy significantly. These findings indicate that inhibition of non-pancreatic human PLA2S by retinoids and flavonoids can be mediated by interaction with enzyme and/or substrate.     

Percutaneous extraction of urinary calculi: use of the intercostal approach

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.     

Evaluation of psychosocial problems of the homebound cancer patient: I. Methodology and problem frequencies

Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.