The prosthetic (Teflon) central aortopulmonary shunt for cyanotic infants less than three weeks old: results and long-term follow-up

The expanded microporous polytetrafluoroethylene (PTFE) 4 mm vascular prosthesis has been used to create a central aortopulmonary shunt in 20 critically ill infants less than 3 weeks old. The infants ranged from 1 to 18 days old (5.25 days), and from 1.5 to 4.0 kg (2.9 kg). Conduit length ranged from 2 to 6 cm (4 cm). Sixteen patients had atresia of the tricuspid or pulmonary valve. There were 6 early deaths (30%), only 1 of which was shunt related. The mean preoperative arterial oxygen saturation was 62% (range, 33 to 80%), and mean postoperative saturation was 87% (range, 78 to 90%). There were 5 late deaths, 1 probably caused by shunt failure. Nine long-term survivors have done well. Follow-up ranges from 1 to 36 months (18 months). Factors influencing conduit function are length, technical considerations, and pulmonary vascular resistance. Late restudy in 5 of 9 survivors confirms patency and demonstrates bidirectional pulmonary blood flow. Since PTFE shunt flow capability is fixed, the infant may require repair or a second shunt within 24 months of the initial procedure.     

Multiphasic checkup evaluation study. 3. Outpatient clinic utilization, hospitalization, and mortality experience after seven years

The Multiphasic Checkup Evaluation Study is a controlled clinical trial aimed at testing the efficacy of periodic Multiphasic Health Checkups in preventing or postponing illness, disability, and death. This paper reports on outpatient clinic utilization, hospitalization, and mortality experience of the study group subjects, who have been urged to undertake annual checkups, and of the control group subjects, who were not so urged, after the first seven years of the project effort.While there has been little difference in utilization of outpatient physician and laboratory services other than those directly connected with the Multiphasic Health Checkups, the study group subjects have had more diagnoses made. Among the men ages 45–54 at entry, hospital usage has been slightly lower in the study group, while the opposite has been the case among the women ages 45–54 at entry. The overall mortality rate has been slightly lower in the study group, while, for a group of causes of death defined as being potentially postponable or preventable, the study group mortality rate has been significantly lower (p < 0.05). There is no strong indication that chance fluctuation, underreporting, differentially selective loss to followup, or an initial study-control group health status disparity accounted for this last difference.     

The effect of hemoglobin F upon glycosylated hemoglobin determinations

Glycosylated hemoglobin (Hgb A1) determinations have been advocated for monitoring the control of diabetes mellitus. The prevalent method today for measuring Hgb A1 for most clinical laboratories has been a "mini-column" utilizing ion exchange chromatography. It has been stated that hemoglobin F (Hgb F) will elute with Hgb A1 and interfere with Hb A1 determinations. This study was designed to determine the quantitative effects of Hgb F upon Hgb A1 determinations. Thirty per cent of the study group had elevated Hgb A1 levels at 2% Hgb F concentration, 66% at 3% Hgb F concentration, and all individuals had elevated Hgb A1 levels at Hgb F concentrations of 4% or greater. The relationship of Hgb F to Hgb A1 concentration was not a simple identity, but could be represented by the equation y = 6.03 + 1.24x. If the ion exchange chromatography methodology is used, Hgb F levels should be determined whenever Hgb A1 levels are elevated, particularly in populations where increased Hgb F levels also might be encountered. The authors determined Hgb F levels whenever the concentration of Hgb A1 was 10% or greater. In their population, they found that approximately 1.5% of samples with elevated Hgb A1 concentrations had increased (greater than 2%) Hgb F levels.     

Successful extraction of large intracaval isthmus of nephroblastoma

The successful removal of a large inferior vena caval isthmus of nephroblastoma is reported. Control of the inferior vena cava was obtained in the pericardial sac through a median sternotomy incision. Complete removal of nephroblastoma can be increased by being well prepared to approach surgically all organs and structures involved.     

Bone and soft tissue abnormalities of the upper extremity in diabetes mellitus.

Roentgenographic evidence of bone and soft tissue abnormalities may be noted in the upper extremities of diabetics. Major shoulder changes, typically associated with peripheral neuropathy, include humeral head deformity due to bone resorption, joint space narrowing, subchondral cysts and sclerosis, subluxation, and juxtra-articular soft tissue bone fragments. Charcot-type joints, characterized by severe joint destruction, sclerosis, multiple bone fragments, and soft tissue swelling may occur. Diabetic neuropathy can produce flexion contractures of the hand. Abnormalities not necessarily associated with clinical neuropathy include cystic bone changes, cortical bone erosions, soft tissue calcification (calcific tendinitis), and vascular calcification.