Fallopian tube obstruction: selective salpingography and recanalization. Work in progress

Seven infertile women, in whom interstitial fallopian tube obstruction (IFTO) was suspected at hysterosalpingography and who were recommended for surgical evaluation and treatment, were treated with catheterization techniques. Selective salpingography with ostial injection demonstrated tubal patency in two patients; direct intratubal salpingography demonstrated patency in another patient. Four patients with a true IFTO underwent fallopian tube recanalization: in the first two, a small soft-tipped guide wire was used, and in the other two, a guide wire and 3-F catheter were used. The suggested catheterization techniques have the potential to make evaluation and treatment of IFTO more efficient, safer, and less expensive than presently used methods.     

Systems model of physician professionalism in practice

Rationale This article proposes a systems level conceptualization of physician professionalism that is embedded in and results from the characteristics of the organizations in which doctors work such as hospitals, group practices and physician organizations. Aims and objectives The goal of this study was to develop and test the systems model of professionalism. Methods In total, 25 interviews were conducted in Minneapolis and Miami. Job titles of the subjects included hospital presidents, medical directors, chairs of hospital departments, quality and safety directors, chief of quality improvement and practising physicians. The data from the interviews were coded and then sorted by members of the study team into major and minor themes. Results Virtually, all of the subjects were readily able to confirm aspects of the model by providing real‐life examples of factors at the practice, hospital and market levels that they believed strongly influenced the extent to which physicians adhere, or fail to adhere, to the professional norms. Conclusions The systems model of professionalism was consistent with the views and experiences of physicians and administrators in two different geographic regions of the USA. If born out by further research, this model has implications for interventions aimed at improving professionalism as well as for professionalism as a field of study.     

Urokinase versus streptokinase in local thrombolysis

In a retrospective analysis, the efficacy of lysis, the degree of systemic thrombolytic effect, and the rate of complications during local thrombolytic therapy with either streptokinase (SK) or urokinase (UK) were compared in 47 patients. There were 24 infusions of each agent; one patient in the UK group received two infusions. The overall efficacy of lysis was better in the UK-treated group (80% vs. 63%). The UK group had a lower frequency of systemic thrombolytic effect and of bleeding complications. SK antibody titers were measured in all patients who received infusions. Patients with high titers who were treated with SK responded poorly (20% lysis); patients with low titers responded at a rate equal to that of UK-treated patients. Three patients with high titers of SK antibodies did not respond to SK, but subsequent successful lysis did occur with UK. In conclusion, UK is believed to be preferable to SK for local thrombolytic therapy due to increased efficacy of lysis and decreased rate of systemic fibrinolytic effect and bleeding complications.     

Evaluation of RapID onE system for identification of 379 strains in the family Enterobacteriaceae and oxidase-negative, gram-negative nonfermenters.

The ability of the RapID onE system (Innovative Diagnostic Systems, Inc., Norcross, Ga.) to identify 364 strains in the family Enterobacteriaceae and 15 oxidase-negative, gram-negative, nonfermentative rods was evaluated. Kits were inoculated with no. 2 McFarland standard suspensions, and reactions were interpreted after 4 h of incubation at 35 degrees C. Overall, the method correctly identified (to the species level or to the genus level for salmonellas and non-Shigella sonnei Shigella species) 363 strains (95.8%) without additional tests. For four strains (1.0%), additional tests were required to delineate the correct identification from a range of two or more possibilities; these included one Serratia liquefaciens (Serratia marcescens or Serratia liquefaciens), one Serratia rubidaea (Serratia rubidaea or Serratia odorifera), one Salmonella typhi (Leminorella richardii or Salmonella sp.) and one Yersinia enterocolitica (Yersinia frederiksenii, Yersinia intermedia, or Yersinia enterocolitica). Twelve strains (3.2%) were misidentified or yielded codes with no identification; these comprised one Citrobacter amalonaticus (no identification), three Enterobacter hormaechei (not in the RapID onE database; two Enterobacter amnigenus, one Enterobacter sp.), one Serratia liquefaciens (Enterobacter cloacae), one Serratia rubidaea (no identification), four Serratia fonticola (not in RapID onE database; two Enterobacter aerogenes, one Serratia marcescens, one not identified), one Proteus mirabilis (Proteus penneri), and one Proteus vulgaris (Providencia rustigianii). If the seven strains not included in the database had been excluded, correct identification rates would have risen to 97.6% without additional tests and 98.7% with additional tests, with misidentification rates dropping to 1.3%. The RapID onE system is easy to set up and the results are easy to read, and the system provides an accurate, nonautomated commercially available method for the same-day identification of members of the family Enterobacteriaceae and oxidase-negative, gram-negative nonfermenters.     

Growth stimulation of human bone marrow cells in agar culture by vascular cells

Human vascular cells are capable of stimulating granulopoiesis in agar culture of human bone marrow cells. This effect was obtained by including vein fragments in the culture or by using endothelial cells separated from the vein of human umbilical cords as feeder cells. Furthermore, the stimulatory capacity of conditioned medium obtained from cord veins was found to be highly active in comparison to that obtained from peripheral leukocytes. Endothelial cells within the bond marrow cavity are suggested as a local source of factors regulating granulopoiesis in humans in addition to the monocyte.     

Effect of preferred volume setting on speech audibility in different hearing aid circuits

This study compared preferred volume setting for linear peak clipping, compression limiting, and wide dynamic range compression (WDRC) amplification and quantified speech audibility at the preferred volume setting for each amplification type. Ten listeners with mild-to-moderate hearing loss were fitted monaurally with a behind-the-ear hearing aid programmed sequentially with WDRC, compression limiting, and linear peak clipping amplification. Speech was presented in quiet and in noise at a range of input levels. In each condition, the listener adjusted the volume for maximum clarity. Signal levels were measured using a probe microphone system. There was no significant difference in speech audibility between amplification strategies for any speech level regardless of the presence or absence of background noise. These results imply that the improved audibility advantage of WDRC over linear amplification demonstrated in controlled environments may not be maintained in situations where the hearing aid wearer controls the volume.