Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery

Objective

Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.

DSA—Control of implanted devices for arterial hepatic perfusion

In contrast to conventional film angiography, the perfusion pattern of hepatic arterial chemotherapy was consistently visualized by DSA in 40 patients with implanted Infusaid pump or Port-A devices. Incomplete perfusion of a liver region by the cytotoxic agent was recognized by DSA as accurately as by nuclide scintigraphy. Furthermore, DSA appeared to be more sensitive in determining aberrantly perfused extrahepatic regions; this was especially true when there was a nonligated right hepatic artery. Specific details of vascular lesions and associated complicating events also could be satisfactorily analyzed by DSA only.     

THE DEVELOPMENT OF CRAWLING BETWEEN 18 MONTHS AND FOUR YEARS

Various quantitative and qualitative aspects of crawling were analysed in small groups of carefully selected normal toddlers of 1 1/2, two, 2 1/2, three, 3 1/2 and four years of age in a cross-sectional design. Between two and three years of age, major changes occurred in all observed aspects, resulting in differentiated, adaptive and efficient crawling. It is proposed that these changes are based on so-called adaptive variability, an age-related developmental process which seems to be a prerequisite for the development of cognition.     

An experiment in surgical education--the first international exchange of residents. The letters of Halsted, Küttner, Heuer, and Landois

Dr William Halsted firmly believed that the young physician achieved greater surgical maturity by observing the practice of surgery in countries in addition to his own. To promote this belief, Halsted initiated the concept of exchanging residents between training programs in different lands. This article presents a review of that historic first international exchange of residents. This glimpse into the past is accomplished by presenting previously unpublished letters of Halsted; Hermann Küttner, director of a surgical clinic in Germany; George Heuer, a resident from The Johns Hopkins Hospital, Baltimore; and Felix Landois, a resident from Küttner's clinic.     

Intervention to increase seat belt use at a primary care center.

BACKGROUND: Increasing seat belt use represents an ideal opportunity for preventive health care in family practice. Little evidence exists, however, that primary care physicians can increase safety belt use. METHODS: Three hundred twenty-six patients seen in a rural primary care center were randomized to either a control or intervention group. Before their health care examination, patients completed a short questionnaire concerning seat belt use and then viewed a 6-minute videotape explaining reasons to wear seat belts (intervention) or espousing general preventive health care guidelines with no mention of seat belts (control). In 6 months the questionnaire was again administered with no further intervention. RESULTS: Two hundred forty-three (74.5 percent) patients completed both baseline and 6-month questionnaires. Seat belt use increased significantly from baseline to 6 months for the intervention (22 to 37.3 percent, P = 0.00052) and control (20 to 33.6 percent, P = 0.00085) groups; however, the difference between the increase in the intervention (37.3 percent) and control (33.6 percent) groups at 6 months was insignificant (P = 0.641). The most common reasons for not using seat belts were forgetfulness (40.3 percent), fear of being trapped (26.7 percent), and lack of comfort (21.8 percent). CONCLUSIONS: Seat belt use increased in this study, although the intervention videotape was no better than the control videotape at increasing restraint use. This increase in use supports office-based intervention to improve seat belt use, but further research is needed to clarify the mechanism and extent of change possible.