Improving recovery following cardiac surgery: a randomized clinical trial*

To enhance individual and family health during recovery from heart surgery, this study employed nursing interventions based on self-efficacy and family stress theory during the hospitalization period and for 3 months thereafter. The effectiveness of the interventions were assessed through a randomized trial in which 67 prospective bypass and valve surgery patients, aged 30-77 years, and their spouses, were allocated either the experimental interventions or usual care and followed for 6 months. At 3 months post-surgery, the only statistically significant differences between the experimentals and controls were on perceived self-efficacy for lifting and tolerating emotional distress. At 6 months no significant differences were found on individual or family measures. Analyses revealed that age, gender and preoperative cardiac status significantly affected individual recovery. The study is continuing with a larger sample in order to explicate the recovery process and to better determine whether a low intensity nursing intervention can effect changes in individual and family recovery.     

Biochemical evidence that cytokeratins are present in smooth muscle

Recent immunocytochemical studies have revealed that cytokeratin intermediate filaments, previously thought to be restricted to epithelial tissues, are present in muscle. In view of the implications of these reports for diagnostic pathology it is important to investigate by biochemical means whether these findings represent the presence of true cytokeratin proteins or an unexpected antigenic cross-reaction. In the present study intermediate filament proteins have been extracted from samples of human myometrium and identified by immunoblotting techniques using well characterized monoclonal antibodies, two against cytokeratins and two against desmin. The results show that the proteins of the appropriate molecular weight for cytokeratin were labelled by anti-cytokeratin antibodies and were quite distinct from those recognized by anti-desmin antibodies. This study therefore confirms previous immunocytochemical findings and emphasizes the need for caution when using anti-intermediate filament antibodies for diagnostic purposes.     

An Inbred Epilepsy-Prone Substrain of BALB/c Mice Shows Absence of the Corpus Callosum, an Abnormal Projection to the Basal Forebrain, and Bilateral Projections to the Thalamus

BALB/c mice lack a corpus callosum in about 11% of the population.Two inbred substrains of BALB/c mice, epilepsy-prone (EP) andepilepsy-resistant (ER), have been examined to determine whetherthese substrains differ in regard to corpus callosum morphology.Further, this study addressed the issue of whether misroutedcortical axons form an aberrant pathway instead of the corpuscallosum. Initial studies that examined fresh brain tissue ofadult animals revealed normal corpora callosa in all ER micebut deficient or absent corpora callosa in all EP mice. Subsequently,Dil crystals were placed in the motor cortices of aldehyde-fixedbrains of 2-week-old animals to investigate cortical projectionsin both inbred substrains of mice. Fluorescent microscopy revealedthat all of the ER animals had normal corpora callosa, whereasall EP animals exhibited either reduced corpora callosa (partiallycallosal) or an absence (acallosal) of this structure. Bothacallosal and partially callosal EP mice displayed an extensive,aberrant projection to the basal forebrain as well as bilateralprojections to midline and intralaminar thalamic nuclei. Thefibers projecting to the basal forebrain arose from the cortex,coursed toward the midline before turning ventrally along themidline, and appeared to terminate in the medial septal nucleusand the nucleus of the diagonal band. ER animals lacked thisaberrant cortical projection to the basal forebrain. Electronmicroscopic results obtained from EP mice indicated that labeledaxons in this aberrant pathway formed axosomatic, axodendritic,and axospinous synapses with the neurons in the medial septal/diagonalband complex. The function of the aberrant projection to thebasal forebrain remains unknown but it may provide an abnormalexcitatory input to a region that provides cholinergic and GABAergicinput to the cerebral cortex and hippocampus. The additionalprojections to midline and contralateral intralaminar thalamicnuclei in EP mice may function to intensify the synchronizationof bilateral discharges.     

Who is providing ambulatory care to Medicaid beneficiaries with acquired immunodeficiency syndrome in New York State?

This study examined the number of ambulatory care providers treating individuals with the acquired immunodeficiency syndrome who were Medicaid beneficiaries in New York State in 1988 and examined the distribution of this care across various practice settings. The study population was identified retrospectively in the New York State Medical HIV/AIDS Research Data Base and included a cohort of 5535 individuals with the acquired immunodeficiency syndrome who were enrolled in Medicaid in 1988 for at least 6 months after being diagnosed as having the disease and who had at least one ambulatory care encounter during the year. Ambulatory care for the study group was provided by more than 700 hospital or freestanding clinics and more than 3000 private physicians in 1988. Many sites had low caseloads; 47% of the clinics and 68% of the physicians treating this population saw only one or two patients with the acquired immunodeficiency syndrome who were enrolled in Medicaid. More than half the patients in the study group were seen most frequently in clinics for their ambulatory care during 1988. These data provide reassurance that a wide network of providers is involved in the care of patients with the acquired immunodeficiency syndrome who are Medicaid beneficiaries in New York.     

Evaluation of the Transverse Sinus by Magnetic Resonance Venography: Limitations-An Illustrative Case Report

Many techniques of magnetic resonance angiography depend on flow velocity. The broad normal range of venous flow velocities and preferential patterns of drainage, particularly in the transverse sinuses, may produce images that are diagnostically misleading. This reports such a case, with samples of various flow patterns in the transverse sinuses of other individuals, as demonstrated by one magnetic resonance angiographic technique (time-of-flight).     

Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction

The purpose of this study was to examine individuals 5 years after ACL reconstruction and analyze changes involving strength, stability, function, and sports activities. Nineteen males and six females, mean age = 31.4 +/- 7.31 years, participated in this study. Fifteen subjects had received extraarticular and ten subjects had received intraarticular ACL reconstructions. Subjects completed a 100 point subjective functional activity questionnaire and a sports participation survey. Knee ligament stability was assessed during an objective knee examination. Isokinetic quadriceps and hamstring muscle strength were tested at 240 and 120 deg/sec using the Cybex II dynamometer. Anterolateral rotatory instability and positive Lachman were elicited on the operated leg for 80% of the subjects. No significant relationship was found between objective instability and the functional activity score. For the intraarticular group, a significant correlation (P less than 0.05) was found between increased quadriceps and hamstring strength on the operated leg and return to functional activities. Subjects' functional activity score was positively correlated (P less than 0.001) with their ability to participate in sports. Subjects participating in sports involving cutting and twisting motions were less successful in returning to their preinjury participation levels and reported more subjective complaints of pain, swelling, and/or instability. These results indicate that long-term progressive rehabilitation emphasizing increased quadriceps and hamstring strength to approximate the nonoperated leg may enhance successful return to functional and sports activities after ACL reconstruction.