Selective operative treatment for tetraology of Fallot: rationale and results.

Eighty-one patients with tetralogy of Fallot malformations evaluated between July 1, 1971 and November, 1975 are presented. Fifty-one patients underwent primary intracardiac repair; three died. Twenty-seven patients were corrected after a previous palliative shunt; there was one death. Three additional patients have been palliated and are awaiting repair. While the overall mortality in these patients was less than 5%, the infants undergoing total correction before the age of two years appeared to be at greater risk (25%). There were no deaths in the group of patients undergoing palliative procedures. Based on these data it appears that a safely performed palliative shunt in the symptomatic small infant is a reasonable first step, particularly if the outflow tract of the right ventricle is diffusely hypoplastic.     

Does a residents' continuity clinic provide primary care?

Pediatric residents are required to care for a group of children over a period of time. For many, this "continuity" experience is in a hospital outpatient department that may or may not provide primary care. We applied a measure of primary care to the Primary Care Clinic, the continuity clinic at The Johns Hopkins Hospital, Baltimore, Md, and found that it compared favorably with private pediatric practices in the Baltimore area, providing significantly more "principal care" (93% vs. 84.5% of encounters), and to the Harris Lane Home walk-in clinic, where only 51% of encounters were "principal care". The Primary Care Clinic scored higher on a primary care index, a measure of the extent to which the facility serves as a primary care source for patients, suggesting that hospital-based training can provide residents with an opportunity to provide primary care.     

Transvenous retrieval of central embolized fragments of venous catheters (author's transl)]

The industrial supply with complete venous catheter sets facilitated central venous techniques via various peripheral venous entries. The complication rate by pneumothorax, hemothorax, hemopericardium after perforation of a cardiac cavity and central embolism of catheter fragments are rather rare. Nevertheless the indication for central venous catheterization procedures should be calculated critically in every case because of the hazard of venous thrombosis and embolism or sepsis, which occurs more often. Perforation of a cardiac cavity by venous catheters leads to lethal sequelae in more than 60%. Central embolism of venous catheter fragments without perforation is followed by serious complications in most cases. Therefore the retrieval of the embolized fragment should be attempted by trasvenous technique or by thoracotomy. For the transvenous retrieval a special forceps or the transvenous Dotter retrieval set were very useful in our experience. Centrally embolized catheter fragments were drawn back in three patients after transcutaneous puncture via the femoral vein with two-plane X-ray control.     

Eosinophilic meningitis complicating Hodgkin's disease. A report of a case and review of the literature.

A case of eosinophilic meningitis as a complication of Hodgkin's disease is reported. Intrathecal chemotherapy with methotrexate and whole brain radiation therapy were effective in clearing the cerebrospinal abnormalities, pathologic evidence of meningeal disease, and the clinical manifestations. The differential diagnosis of eosinophilic meningitis and therapy of lymphomatous meningitis are discussed.