Preventive cardiology in practice: a device for risk estimation and counseling in coronary disease

A method for the rapid estimation and display of coronary risk is used in counseling and for following progress in the practice of preventive cardiology. The estimator is a slide rule which computes risk of a future coronary event based on current age, smoking habit, serum cholesterol, and blood pressure levels. The device also displays estimated change in risk based on change in risk factors. The estimates are explained to clients as gross approximations. The slide rule is helpful in personalizing the need and the potential of preventive efforts.     

Prophylactic regimens in colorectal surgery: Comparisons between metronidazole used alone or with ampicillin for one or three days

The purpose of this study was to compare as anti-infectious prophylaxis in elective colorectal cancer surgery the effect of metronidazole alone and in combination with ampicillin, and the effect of a duration of 1 or 3 days of prophylaxis. The prophylactic regimens designated regimens A-D given in randomized order were metronidazole 500 mg used alone or with 2.0 g ampicillin administered every 8 hours as separate but simultaneous infusions. All patients studied received preoperative mechanical evacuation of bowel contents. Eight surgical departments participated in the study. Two hundred thirty-three patients were studied. The distribution of sex, age, and type of operation was similar among the groups of patients receiving each regimen, except that there were more cases of sigmoidectomy, low anterior resection, or rectal amputation in the group receiving regimen D. The duration of the operations was comparable, even for each type of operation considered separately. Samples for bacteriological examination were obtained by abscess punctures when relevant. The pus was taken and transported to the laboratory under anaerobic conditions. Moderate or severe infections were observed in 6 (10.3%) of 58 patients on regimen A, in 2 (3.5%) of 58 patients on regimen B, in 4 (7.0%) of 57 receiving regimen C, and in 2 (3.3%) of 60 given regimen D. The highest incidence of postoperative infections was observed in rectal amputation. The bacteria causing postoperative infections were similar in the regimens A and C receiving only metronidazole for 1 and 3 days, respectively and in regimens B and D in which ampicillin was added. Only one anaerobe, aClostridium perfringens, was recovered from regimen C; twenty-two strains of anaerobic bacteria were recovered from regimen A. The number of aerobic bacteria was 25 in regimen A and 16 in regimen C. The yield of bacteria was much more sparse when metronidazole was combined with ampicillin. Eleven isolates (2 anaerobes) were recovered from regimen B, only one isolate was recovered from patients on regimen D, an indole positiveProteus. In conclusion, th'is study indicates that a combination of metronidazole and ampicillin is particularly useful in rectal surgery. Metronidazole alone may suffice in colonic surgery, but a combination with an agent against aerobes is recommended in rectal surgery. The difference between 1-day prophylaxis and 3-day prophylaxis was insignificant for metronidazole plus ampicillin; a single day of this prophylactic regimen would appear advisable.

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Resumen El propósito de este trabajo ha sido el de comparar, en la profilaxis anti-infecciosa en cirugía colorectal electiva, el efecto de: (a) metronidazol solo y en combinación con ampicilina, y (b) la profilaxis de un día con la de tres días de duración. Los 4 regimenes profilácticos designados como regímenes A-D, y suministrados al azar, fueron metronidazol 500 mg utilizado como agente único o con ampicilina 2.0 g en infusiones simultáneas cada 8 horas iniciadas una hora antes de la operación. Todos los pacientes del estudio también fueron sometidos a evacuación mecánica del contenido intestinal según el procedimiento de rutina en cada hospital. Ocho departamentos quirúrgicos participaron en el estudio, el cual incluyó 233 pacientes. La distribución según sexo, edad y tipo de operación fué similar, excepto que hubo un mayor número de casos de sigmoidectomía, resección baja anterior o amputación rectal en el grupo que recibió el regimen D. La duración de las operaciones fué comparable, aún para cada tipo de operación considerado aisladamente. Se obtuvieron cultivos por punción de abscesos cuando se consideró pertinente, y el pus fué tomado y transportado al laboratorio bajo condiciones anaeróbicas. Infecciones moderadas o severas fueron observadas en 6 de 58 pacientes (10.3%) en el regimen A, en 2 de 58 en el regimen B (3.5%), en 4 de 57 en el regimen C (7.0%) y en 2 de 60 en el regimen D (3.3%). La mayor incidencia de infección postoperatoria se encontró en casos de amputación rectal. Las bacterias causantes de las infecciones postoperatorias fueron similares en los regimenes A y C que recibieron sólo metronidazol por 1 o por 3 días respectivamente, y en los regimenes B y D en que se añadió ampicilina. Sólo un anaerobio, unClostridium perfringens, fué recuperado en el regimen C, y 22 cepas de bacterias anaerobias en el regimen A. El numéro de bacterias aeróbicas fué de 25 en el regimen A y 16 en el regimen C. La proliferación bacteriana fué mucho menor cuando se combinó el metronidazol con la ampicilina. Once cultivos positivos (2 anaerobios) fueron logrados en el regimen B, y sólo uno en el regimen D, unProteus indol-positivo. En conclusión, este estudio indica que la combinación de metronidazol y ampicilina es particularmente útil en cirugía rectal. El metronidazol solo puede ser suficiente en cirugía colónica, pero su combinación con un agente efectivo contra los aerobios es recomendable en cirugía rectal. La diferencia entre la profilaxis de un día y la de 3 días fué insignificante para la combinación de metronidazol y ampicilina; un único día de profilaxis parece ser el regimen recomendable.

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Résumé Le but de l'étude entreprise par les auteurs fut de comparer l'effet prophylactique anti-infectieux du métronidazole employé isolement ou en association avec l'ampicilline pendant 1 ou 3 jours. Quatre protocoles différents désignés par les lettres A.B.C.D. ont été ainsi pris en considération. L'étude a été conduite en série par tirage au sort. Cinq cent (500) mg de métronidazole employé isolement ou en association avec 2 g d'ampicilline ont été injectés séparément 3 fois par 24 heures pendant 1 jour ou 3 jours. L'intestin ayant été évacué par les moyens mécaniques classiques.Huit services de chirurgie ont participé à l'étude qui a groupé 233 malades. Le sexe, l'âge, le type et la durée de l'opération ont été sensiblement identiques pour les 4 groupes avec cependant un nombre plus important de sigmoidectomies, de résections abdominales antérieures du rectum ou d'amputations rectales dans le groupe D.Selon les cas, les spécimens de pus ont été prélevés au tampon au niveau de l'incision pariétale ou par ponction en présence d'abcès collectés. Le pus prélevé a été transporté au laboratoire en milieu anaérobie. Les résultats ont été les suivants: chez 6 des 58 malades (10,3%) soumis au protocole A (500 mg de métronidazole × 3 en 24 heures), chez 2 des 58 sujets (3,5%) soumis au régime B (500 mg de métronidazole et 2 g d'ampicilline × 3 en 24 heures), chez 4 des 57 patients (7%) soumis au régime C (500 mg de métronidazole × 3 en 24 heures pendant 3 jours) et chez 2 des 60 opérés (3,3%) soumis au régime D (500 mg de métronidazole et 2 g d'amicilline × 3 en 24 heures pendant 3 jours) fut observée une infection modérée ou grave. Le taux le plus élevé d'infections postopératoires a été constaté après amputation du rectum.Les bactéries à l'origine de l'infection ont été identiques quel qu'ait été le protocole prophylactique anti-infectieux suivi. L'emploi du métronidazole isolé s'est soldé par la présence de 22 types de bactéries anaérobie pour le protocole A et un type seulement pour le protocole C de 25 types de bactéries aérobies pour le protocole A et de 16 pour le protocole C. L'association métronidazole et ampicilline s'est soldé par un nombre plus clairsemé de types bactériens: 11 dont 2 anaérobies pour le protocole B et un seul (protéus) pour le protocole D.En conclusion, cette étude permet d'affirmer que la combinaison du métronidazole et de l'ampicilline est particulièrement efficace dans la chirurgie rectale.Le métronidazole isolé est suffisant en cas de chirurgie colique mais son association avec un agent exerçant son action sur les germes aérobies est recommandé dans la chirurgie rectale. La différence entre le traitement prophylactique d'une durée d'un jour ou de trois jours ayant été insignifiante lorsque le métronidazole était associé à l'ampicilline. Un traitement prophylactique pendant 24 heures suivant ce protocole apparaît suffisant.

     

Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study.

In a controlled, cross-over study the effect of low level laser therapy (LLLT) was evaluated. During a five weeks period forty-seven female laboratory technicians received six laser and six placebo treatments to tender points in the neck and shoulder girdle. Subjects rated the placebo treatment significantly more beneficial than LLLT (p = .04). There was no reduction in consumption of analgesics associated with either laser or placebo treatment. The results indicate no beneficial effect of LLLT for myofascial pain.     

Transcutaneous cardiac pacing in patients with automatic implantable cardioverter defibrillators and epicardial patch electrodes.

In patients with automatic implantable cardioverter defibrillators, insulation of the epicardial patch electrodes (patches) prevents externally applied current from passing through the electrode to the cardiac muscle so that external transthoracic and even internal defibrillation can be unsuccessful. Because emergency cardiac pacing may be required in such a case, a study was performed to evaluate whether, and at what threshold and electrode orientation, transcutaneous pacing is possible in patients with implanted patches. Thresholds for transcutaneous pacing were determined during general anesthesia in nine patients with patches sewn across the heart (anterior right and posterior left ventricles) either before or after surgery, or at both times (automatic implantable cardioverter defibrillator implantation/exchange with or without coronary artery bypass grafting). Because surgery per se can increase the pacing threshold, nine patients of similar body size and weight undergoing routine coronary artery bypass grafting also were evaluated and served as a control group. Pacing thresholds (stimulus duration: 50 ms) were determined during normothermia with a transportable transcutaneous pacer, and adult cutaneous electrodes were placed across the patients' chest in the standard anteroposterior and right-to-left orientations. In all patients with patch electrodes, antero-posterior pacing was possible at a mean threshold of 73 +/- 30 mA standard deviation (range: 40-140 mA). This threshold was not significantly different (Mann-Whitney test) from that in control patients before (57 +/- 20 mA; range: 30-90 mA) or after (94 +/- 24 mA; range: 40-120 mA) coronary artery-bypass grafting. The surgical procedure per se significantly increased the threshold (Wilcoxon test, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Estrogen receptor in breast cancer; its relation to mean nuclear area, age and lymph node status

A study of 378 patients with infiltrating breast carcinoma using linear logistic regression and ANOVA analysis demonstrated a different relation between age at operation and estrogen-receptor (ER) concentration in the lymph-node negative and the lymph-node positive groups. Tumours from patients between 51 and 70 years old had lower median ER concentration in the lymph-node negative group than in the lymph-node positive group. In the group older than 70 years, however, tumours from lymph-node negative patients had higher median ER concentrations than those from the lymph-node positive patients. Patients 50 years and younger had similar median ER concentrations in both lymph-node groups. Low mean nuclear area (MNA) of the tumour cells was associated with high frequency of tumours able to produce ER. No such association was found for age. Independent of age and lymph-node status tumours with low MNA also had high ER concentration. These findings suggest that tumours from different lymph-node/age groups may have different biological properties. The relationship between ER and nuclear size point to a key function of the nucleus, both as regards the ability to produce ER and its level of production.     

Inability of sonography to detect imminent ovulation

Sonographic visualization of the cumulus oophorus or of morphologic alterations in the wall of the dominant follicle have been reported to be reliable signs of imminent ovulation when conventional transabdominal sonography is used. To determine if transvaginal sonography could allow a more frequent and confident prediction of imminent ovulation, we prospectively monitored 22 ovulatory menstrual cycles in four women undergoing artificial insemination and in 13 normally menstruating volunteers. Scanning was done on alternate days in the periovulatory period; a 7.5-MHz transvaginal transducer was used. Despite the improved resolution obtained with transvaginal sonography, confident identification of the cumulus oophorus or of mural changes in the follicle was not possible in any of the cycles followed. No other consistent follicular characteristic predicted imminent ovulation. We conclude that confident prediction of imminent ovulation is not possible with sonographic analysis.     

Computed tomography of pulmonary thromboembolism and infarction

Computed tomographic findings in 18 patients with pulmonary thromboembolism are retrospectively reviewed. In the majority of patients, thromboembolism was not suspected clinically. The CT findings can be divided into two groups: vascular and parenchymal changes. The most frequent vascular findings is an intraluminal filling defect or defects due to thrombus. The most frequent parenchymal finding is a triangular (wedge-shaped) pleural-based soft tissue attenuation lesion. Although CT is not a primary diagnostic tool in the evaluation of pulmonary thromboembolism, CT may be helpful in diagnosis of pulmonary embolism, when evaluating an undiagnosed parenchymal density.     

A comparison of some effects of fluoride on apatite formation in vitro and in vivo

In a liquid (22 degrees C) saturated with and in contact with powdered bone apatite, the fluoride ion activity was adjusted to 1-10 parts/10(6). Due to the fluorapatite (FAP) supersaturation produced hereby, a rapid formation of this salt occurred leading to a decrease of the concentration of the ions involved. When no more fluoride was available in the liquid, the concentrations of calcium and phosphate increased again, due to dissolution of presumably hydroxyapatite (HAP). Fifty four rats were given either 10, 20, or 40 mg NaF per kg body weight intraperitoneally. The animals were sacrificed from 5 min to 96 h after the injection. The fluoride concentration in plasma increased to a peak, after which it decreased. Plasma calcium decreased and remained low until the fluoride had attained normal levels. The intensity of mineralization of the growing dental hard tissue was monitored on microradiographs. Corresponding to the plasma fluoride peak and the decrease of plasma calcium, a hypermineralized layer was formed while a hypomineralized zone was formed during plasma calcium increase after disappearance of fluoride. Similarities and dissimilarities between the in vitro and the in vivo experiments are discussed.     

The ring of Soemmerring in the rabbit

The scanning ultrastructure of the remnants of the lens left in the eye after extracapsular lens extraction was investigated in the rabbit. Extracapsular lens extraction was performed in 25 eyes and the development of after-cataract followed by biomicroscopic examination. After survival times varying between 1 week and 12 months, the eyes were enucleated and the rings of Soemmerring treated for light microscopy and transmission and scanning electron microscopy. Soemmerring's ring consisted of the fused remnants of the dissected anterior and posterior lens capsule, enclosing the equatorial part of the former lens, left behind after the operation. The anterior capsule and, to a lesser extent, also the posterior capsule were multilayered and appeared to be thickened. While the remnant of the anterior capsule was lined by a monolayer of epithelial cells, the posterior part of the capsule was only partly lined by irregularly arranged epithelial cells. All epithelial cells were highly vacuolized. In transection the interior part of the ring consisted of normal fibers, irregularly oriented and irregularly shaped fibers, degenerated fibers, and globular amorphous masses. Many of the normal fibers contained cell nuclei. At the equator and at the posterior side of the fusing anterior and posterior capsule as well, the fiber organization resembled the lens bow region of normal lenses. Frequently, islands of epithelial cells were observed in the center of the ring. The vitreal face of the posterior capsule in the center of the ring (in the optic axis of the eye) seemed to be unchanged and on its pupillary surface, fibers of different size as well as fibroblastlike cells were found. However, clear-cut Elschnig's pearls were absent. Our results are compared with the observations summarized in the literature. It can be concluded that the epithelial cells in Soemmerring's ring retain their capacity for division and differentiation. The newly formed fibers seem to be pushed to the center of the ring and to degenerate.