Case report: bilateral sternalis muscles with a bilateral pectoralis major anomaly

The importance of continuing to record and discuss anatomical anomalies was addressed recently by Hicks & Newell (1997) in the light of technical advances and interventional methods of diagnosis and treatment. Two recent radiological reports (Bradley et al. 1996; Murphy & Nokes, 1996) highlighted the diagnostic dilemma posed by a sternalis muscle in the detection of breast cancer.     

The effect of topical steroids on cutaneous oxygen tension

The precise mode of action of topically applied steroids is unknown. We have applied clobetasol propionate 0.05% ointment (Dermovate; Glaxo Pharmaceuticals) under occlusion to the forearm skin of 10 healthy volunteers for 6 h and monitored transcutaneous oxygen tension at the site for 19 h after its removal. Compared to the ointment base, the steroid-treated area was significantly hypoxic up to 13 h after application. The profound hypoxia present at the site of application of clobetasol propionate 0.05% ointment may account for some of its anti-inflammatory effects, and its atrophogenicity.     

Development of the pre-school child: the validation of a psychomotor screen, and the influence of the home environment on psychomotor development

ABSTRACT. The present study was designed to validate and standardize a short psychomotor screening test on Australian four-year-old-preschool children and to assess their home environment using Caldwell's HOME Inventory. The Adelaide Psychomotor Screen (APS) is a short, 10--15 minute screening test which uses 13 separate items to assess "General" development, "Gross Motor" development, "Social/Emotional Behaviour" and "Speech".
In the area of "General" development, 12 children screened as "abnormal" and 54 children screened as "normal" were further assessed by a psychologist on the McCarthy Scales of Children's Abilities. There was a high correlation between the APS "General" scores and the McCarthy (General Cognitive Index) scores (r = 0.75, p<0.001 for the younger children, and r = 0,90, p <0.001 for the older children).
Caldwell's HOME Inventory takes an hour to complete, and involves a visit by the assessor to each home. The correlation between the HOME total scores and the McCarthy (General Cognitive Index) scores was r =0.06, p < 0.001. It is suggested that the HOME Inventory may be more valuable as a predictor of a child's future development than an index of his present developmental status.
It is suggested that nurses and teachers used the APS as a screening test of the individual child, and use the HOME inventory as an assessment of the home environment.     

Improved Short-Term Outcomes of Primary Coronary Stenting Compared to Primary Balloon Angioplasty in Acute Myocardial Infarction at Experienced Centers: The PAMI Study Group Experience

To study the additive benefits of routine stent implantation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) at experienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in Myocardial Infarction-2 (PAMI-2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI-2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in-hospital death (0.6% vs 2.7%, P = 0.03), reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revascularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 ± 4.4 vs 7.1 ± 6.2 days, P = 0.01). By multiple logistic regression analysis in 1,294 patients, stent implantation versus PTCA only was the strongest predictor of freedom from the composite in-hospital end point of death, reinfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multivariate odds ratio = 0.4, P < 0.0001). These data strongly suggest that despite the excellent results achieved when primary PTCA is performed by experienced operators, the short-term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.     

Design and Objectives of the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events (EXCITE) Study

Clinical trials have demonstrated the efficacy of glycoprotein (GP) IIb/IIIa antagonists in preventing the thrombotic end points of death, myocardial infarction, and urgent revascularization when they are administered at the time of percutaneous coronary revascularization (PTCR). It has been postulated that prolongation of receptor blockade beyond acute intervention would extend the clinical benefit of these agents. The Evaluation of Oral Xemilofiban in Controlling Thrombotic Events (EXCITE) study was a multicenter, international, randomized placebo-controlled trial of the oral GP IIb/IIIa antagonist Xemilofiban administered prior to and after PTCR. The study was designed to assess the efficacy and safety of continuing oral xemilofiban for 6 months to prevent these primary thrombotic end points. More than 7,200 patients were randomized in 29 countries to receive placebo or one of two doses of xemilofiban. Stenting was performed at the discretion of the operator. All patients received aspirin and periprocedural heparin; all stented patients received continuous xemilofiban, or ticlopidine for 2–4 weeks followed by xemilofiban-placebo. Most patients were also evaluated 1 month after conclusion of the study drug treatment. Clinical data from up to 6 months of drug treatment and 1 month posttreatment were used to evaluate the acute and long-term efficacy and safety of xemilofiban. Secondary end points included the need for any revascularization, repeat hospitalization for unstable angina, and nonhemorrhagic stroke. The cumulative incidence of bleeding events and effects of xemilofiban in stented and nonstented patients were evaluated. The efficacy of continuing xemilofiban and aspirin therapy as the sole antithrombotic medications following stent deployment was assessed against a ticlopidine and aspirin control group. The incremental clinical benefit of long-term receptor blockade over acute receptor antagonism was evaluated.     

SCIATICA CAUSED BY ISOLATED NON-HODGKIN'S LYMPHOMA OF THE SPINAL EPIDURAL SPACE: A REPORT OF TWO CASES

Two patients are described in whom sciatica was caused by non-Hodgkin'slymphoma involving the spinal epidural space. Systematic investigationrevealed no evidence of lymphoma in other sites. KEY WORDS: Back pain, Central nervous system, Myelogram, CT scan, Biopsy