Accuracy in coronary graft flow measurement

A blood flow calibration apparatus is described for use with electromagnetic flow probes. It is an automatic gravity-flow system, which provides a constant level and therefore constant flow at any preset rate. On several occasions, the use of this device has helped to determine whether flow probes require simple adjustment, factory repair, or replacement. Using this system, a systematic error in the manufacturer's "precalibration" averaging +22% (range, 9 to 50%) has been discovered, and appropriate corrections have been made. The accuracy of these corrections has been confirmed by a rapid, in vivo method of calibration, which also is described and which can be carried out during the conduct of aortocoronary bypass operation. It is recommended that all groups measuring coronary graft flow become familiar with their electromagnetic flowmeter and probes by means such as those described, in the interest of accurate flow measurement after bypass operation.     

Eucharistic health care facility transcends professionalism

The members of a Catholic health care facility individually and corporately celebrate Christ's presence in the fullness of eucharistic faith. To be in a Catholic hospital is to have a Gospel experience among Gospel people.     

Effective chemotherapy of acute myelocytic leukemia occurring after alkylating agent or radiation therapy for prior malignancy

Eleven consecutive patients with acute myelocytic leukemia occurring as a second malignancy were treated with high-dose, timed, sequential chemotherapy. Eight of the patients were felt to have "secondary" acute leukemia because they had received an alkylating agent or radiation therapy. The other three patients were considered controls. Despite a median age of 65, four of the eight secondary leukemia patients achieved complete remission with this regimen. One of the three control patients also achieved complete remission. This remission rate and duration are comparable to what was achieved with this treatment of "primary" acute myelocytic leukemia during the same period of time. These results suggest that patients with leukemia occurring after an alkylating agent or radiation therapy are not at especially high risk if treated aggressively.     

Prevention and management of infection in trauma

Examination of the causes of late mortality in multiple trauma patients reveals that as much as 78% of all deaths may be attributed to septic complications, suggesting the value of understanding the prevention and treatment of traumatic sepsis. In penetrating trauma, the protective features of the skin are eliminated, and systemic mechanisms of host defense are compromised. These changes in the host defense mechanism and the risk of infection influence the choice and technical features of wound closure and the use of antibiotics. Early diagnosis is imperative, but difficult.     

Medicare appeals process offers hope for some hospitals

For hospital officials who feel wronged by Medicare's payment system, a recent opportunity to appeal geographic status has stirred new hope for survival. Last September, the Health Care Financing Administration published interim final regulations detailing criteria hospitals have to meet to merit reclassification; hospitals had until Nov. 6, 1990, to file their appears. Now, officials are slogging through nearly 1,000 completed applications. "There has been pent-up demand for some review" of geographic classification, says one official.     

Phase II trial of extended indications for resection is small cell carcinoma of the lung

Surgical resection offers distinct theoretical advantages as the "local" modality in treatment of Stage I and II small cell carcinoma of the lung. We have treated 10 such patients by initial resection since 1975; all survivors but one received adjuvant chemotherapy for the full course thereafter. One patient died of a pulmonary embolus; the other nine remain without evidence of disease from 7 to 69 months after resection. A trial was undertaken of extended indications for resection in selected patients with Stage III-M0 disease. Criteria for patient selection have been developed gradually; these exclude patients for reasons of refusal, physiological inadequacy, disease unsuited to gross total eradication, or lack of adequate initial response to chemotherapy. Of six patients who survived the exclusion criteria and underwent resection, one has had a relapse at 26 months. All others remain without evidence of disease, 5 to 25 months after the start of treatment. We believe that systematic patient selection on the basis of defined criteria will identify a subset of patients having markedly improved chances for disease control. This group may represent as many as half of the patients first presenting with localized or MO disease. Patients excluded as candidates for resection have continued to receive standard nonsurgical combined-modality therapy.     

高效液相色谱法测定绿茶和饮料中的咖啡因

采用反相高效液相色谱法，固定相为十八烷基硅烷键合硅胶，以乙腈-水(20：80)为流动相，检测波长274nm，测定绿茶和饮料中的咖啡因含量。结果线性范围为3．9～3900ng，r=O.9999；绿茶和2种饮料的平均加样回收率分别为100．2％、100．1％和99．8％。该方法准确、简便、快速，适合绿茶和可乐型饮料中咖啡因的测定。     

The incidence of protrusio acetabuli in Marfan's syndrome and its relationship to bone mineral density

Twenty-one patients with Marfan's syndrome participated in a study to assess the incidence of and radiographic measurements significant for protrusio acetabuli. Our data show that the incidence of protrusio acetabuli in Marfan's syndrome is 31%. The most sensitive radiographic parameter to determine protrusio acetabuli is crossing of the acetabular line by the iliopectineal line. The presence of protrusio in Marfan's syndrome was not related to the bone mineral content of the hip and pelvis. Protrusio acetabuli in Marfan syndrome's also did not correlate with clinical symptoms. Based on our results, the presence of protrusio acetabuli alone is not an indication for early surgical intervention.     

Hyperparathyroidism and dialysis vintage

BACKGROUND: Secondary hyperparathyroidism and its effects on bone and viscera are among the most important complications of end-stage renal disease. Despite its ubiquity, little is known about the treated natural history of the disorder. METHODS: We assembled a cohort of 310 patients with endstage renal disease on hemodialysis who were participants in one of four clinical trials of the phosphate binder sevelamer. Baseline parathyroid hormone levels were collected, and the relation between dialysis vintage and other clinical variables with parathyroid hormone were described. RESULTS: There was a direct relation between dialysis vintage and the severity of hyperparathyroidism. Other variables that were significantly associated with PTH on univariate analysis included age, African American race, Kt/V, and the serum concentrations of calcium, phosphate, and bicarbonate. Multivariable linear regression analysis yielded three significant predictors of PTH: calcium, phosphorus, and vintage (5.8% (4.0-7.5%) expected increase in PTH per year of vintage). The model R2 was 0.22. CONCLUSION: Dialysis vintage is a key determinant of the severity of secondary hyperparathyroidism. Vintage and certain laboratory variables should be considered in the evaluation of therapies aimed at modifying the treated natural history of this disorder.