Labor markets and economic inequality in the United States since the end of the 1970s.

By most measures, the United States is the most unequal of the world's advanced capitalist economies, and inequality has increased substantially over the past 30 years. This article documents trends in the inequality of three key economic distributions--hourly earnings, annual incomes, and net wealth--and relates these developments to changes in economic and social policy over the past three decades. The primary cause of high and rising inequality is the systematic erosion of the bargaining power of lower- and middle-income workers relative to their employers, reflected in the erosion of the real value of the minimum wage, the decline in unions, widescale deregulation of industries such as airlines and trucking, the privatization and outsourcing of many state and local government activities, increasing international competition, and periods of restrictive macroeconomic policy.     

Medical complications of spinal cord disease

Spinal cord injury increases the risk of many life-threatening medical problems, including respiratory failure, pulmonary embolism, and renal failure. Respiratory failure results from paralysis of muscles of inspiration (which impairs oxygen transport to alveoli) and of expiration (which impairs cough and predisposes to pneumonia and atelectasis). Respiratory failure in patients with spinal cord injury can be prevented by proper positioning of the patient, training of ventilatory muscles, pulmonary toilet, and aggressive use of antibiotics and bronchodilators. When respiratory failure occurs, it can be managed by administration of oxygen, intubation, and mechanical ventilation, and in instances of paralysis of the diaphragm, by diaphragmatic pacing. The risk of deep vein thrombosis and pulmonary embolism in acute spinal cord disease is increased by the immobilization of the patient and abnormalities in clotting factors. Thrombotic disease in spinal cord disease can be prevented by intermittent calf compression and heparinization. If pulmonary embolism develops, the patient should be started on a regimen of warfarin for at least 3 months. If anticoagulation is contraindicated, a Greenfield filter can be placed. However, concurrent use of quad cough places the patient at increased risk for complications from the Greenfield filter. Chronic pyelonephritis and systemic amyloidosis are the most common causes of renal failure in the patient with spinal cord disease. Renal failure can be prevented by maintaining a low postvoid residual volume, avoidance of indwelling catheters, use of medications that are not nephrotoxic, and rapid treatment of infection. Hemodialysis and peritoneal dialysis can extend the life of the patient with spinal cord disease in whom renal failure develops, and successful use of renal transplantation has recently been reported.     

Gastrointestinal stromal tumor (GIST): morphologic and immunohistochemical study of 10 cases]

To study the histogenesis of spindle and epithelioid cell tumors of gastrointestinal tract we evaluated ten cases of gastrointestinal stromal tumors (GIST) previously classified as leiomyomas (6 cases) and leiomyosarcomas (4 cases). The cases were studied by morphological and immunohistochemistry procedures with search of three markers: muscle specific actin (HHF-35), vimentin and S-100 protein. All tumors showed vimentin positivity. Muscle differentiation was demonstrated in three cases (33.3%), all of them benign. One tumor, in small intestine, displayed S-100 protein positivity. The results showed that the GIST represent a heterogeneous group of tumors, most of which consist of primitive mesenchymal cells.     

Percutaneous renal biopsy: comparison of manual and automated puncture techniques with native and transplanted kidneys

The diagnostic usefulness of the biopsy cylinder and biopsy-inducedcomplications were investigated for 458 percutaneous renal biopsies(315 native, 143 transplant kidneys) on 339 patients (averageage, 44.6±18.5 years) under two different biopsy regimes(regime I, manual biopsy technique with Tru-Cut needle, 14 gauge;regime II, automated biopsy technique using a Biopty instrumentand adapted biopsy needle, 18 gauge). In 435 (95%) of the biopsies, kidney tissue with 9.09 ±5.28 glomeruli was obtained (regime I, 93.5%, 9.5±4.9glomeruli; regime II, 96.5%, 8.7 + 5.6 glomeruli; p>0.05).Neither with native nor with transplant kidneys was there anyevident advantage for a particular regime in terms of the diagnosticusefulness of the cylinder. Bleeding complications (perirenalhaemat-omas, bleeding into the renal pelvis, blood clots inthe urinary bladder) were observed in 69 (15.1%) patients (regimeI, 15.6%; regime II, 14.6% P>0.05). Clinically relevant bleedingcomplications were significantly rarer under regime II (9.1%versus 3.5%; P<0.05). Complications were less frequent withtransplant than with native kidneys (12.6% versus 16.2%). Dopplersonography of the biopsied transplant kidneys revealed arteriovenousfistulae in nine cases (6.3%; regime I, 8.0%; regime II, 5.4%). In general, use of an automated biopsy instrument and a thinnerbiopsy needle reduced the number of significant complicationsfollowing percutaneous renal biopsy, while achieving comparablydiagnostic efficacy.     

Cognitive training adjunctive to pharmacotherapy in schizophrenia and depression: a pilot study on the lateralization hypothesis of schizophrenia and depression and on cognitive therapy as adjunctive to pharmacotherapy

Although controversial, evidence from various experimental sources suggests a dysfunction/overactivity of the hemisphere dominant for speech - usually the left - in schizophrenia and of the other one in depression. Based on these lateralization hypotheses and on the dependency of regional cerebral blood flow on regional neuronal activity, the concept of pharmacopsychotherapy was proposed. The present double-blind pilot study tried to test this concept by cognitive training procedures tentatively relevant to the mechanisms of information processing of the left (analytical) and right (holistic) hemisphere, respectively. It was hypothesized that the outcome of patients putatively trained in mechanisms of the right hemisphere might be superior to that of those trained left in depression and the converse in schizophrenia. This hypothesis could not be verified. Apparent differences in the outcome of depressives were attributable to differences of independent variables (age, seriousness of illness).     

Aneurysm of the arteria lusoria. Clinical and diagnostic aspects. Postoperative results after resection and restoration of arterial continuity

A 55 year old man, hypothyroid from previous thyroidectomy, presented with angina due to tracheal compression by a tumour of the posterior superior mediastinum. The preoperative work-up was negative. An aneurysm of a retrooesophageal subclavian artery was found at exploratory right thoracotomy in January 1977. This was resected and arterial reconstruction with a dacron graft was performed. The long term post operative clinical and angiographic results are satisfactory. The medical literature of this rare condition is reviewed.     

Recurrent posterior instability of the shoulder

Seven cases of recurrent posterior instability of the shoulder were reviewed, three with recurrent subluxation and four with recurrent posterior dislocations. All were treated surgically, one by inverted Putti-Platt, one by glenoplasty and five by posterior bone block procedures. The follow-up goes from three to 17.5 years (mean 8.5 years). Clinical history and physical examination were the most accurate diagnostic methods. There were three excellent, one fair, and one poor results with two failures. The poor result and failure cases are due to technical errors, particularly because of wrong positioning of the graft in posterior bone block procedures. We suggest a bone graft with a projection of at least 15 mm beyond the glenoid rim to obtain a good result with this technique. Osteoarthritis does not seem to develop at long-term in our patients even with a poor result except for those with iatrogenic origin. The functional results are stable over time except for patients with osteoarthritis.     

Clinical significance of cerebrospinal fluid tests for neurosyphilis

From 1978 to 1987, 1,665 cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption (CSF-FTA-ABS) tests were performed as the screening procedure for neurosyphilis. The CSF samples from 48 patients were reactive, and the medical history and results of the CSF-Venereal Disease Research Laboratory test (CSF-VDRL) for syphilis for 38 of these patients were reviewed. Likely active neurosyphilis was diagnosed if the patient had a reactive CSF-FTA-ABS test, recent onset of neurological signs consistent with neurosyphilis, abnormal CSF, and no other recognized cause for the neurological illness. Fifteen patients were so classified. Four had a reactive CSF-VDRL test. The specificity of the CSF-VDRL in diagnosing likely active neurosyphilis was 100%, but the sensitivity was only 27%. The insensitivity of the CSF-VDRL test limits its usefulness as a screening test for neurosyphilis. The CSF-FTA-ABS test appears more sensitive for screening but is less specific than the CSF-VDRL test in distinguishing currently active neurosyphilis from past syphilis. These findings imply that clinical judgment is still essential in establishing the diagnosis of active neurosyphilis.