Cost of management of patients with haemophilia

The cost of managing 114 adult haemophiliacs in the west of Scotland was assessed for the period 1 March 1971 to 28 February 1974. Altogether 23 of them (20%) accounted for 80% of the resources used. The cost of hospital treatment of these patients during the period was compared with the predicted cost of home treatment, given the availability of freeze-dried factor VIII concentrate in sufficient amounts. We calculate that adequate on-demand home treatment would cost only 16% more than the present treatment, which is substantially less efficient.     

Propranolol therapy in patients undergoing myocardial revascularization

The records of 185 consecutive patients having myocardial revascularization were reviewed with regard to preoperative administration of propranolol and intraoperative or postoperative complications. Tachycardia and hypertension before cardiopulmonary bypass were slightly more common in patients never taking propranolol or those who had discontinued it for more than 48 hours before operation. There was no statistically significant difference in the incidence of postbypass hypotension among patients who took propranolol within 24 hours of operation, those who discontinued it more than 24 hours before operation, and those who never took the drug. Operative mortality was not significantly different among patients who received propranolol within 48 hours of operation (3%), those who never took it and those who discontinued it more than 48 hours before operation (4%). Early in the series, five patients had an acute myocardial infarction within 48 hours after routine preoperative withdrawal of propranolol. Because complete withdrawal of propranolol in patients with unstable angina pectoris may lead to acute myocardial infarction, we recommend gradual withdrawal of the drug during 48 hours before operation. If this is not possible because anginal pain recurs or intensifies, then reduced doses may be given safely up to 10 hours before revascularization, provided that the patient is a satisfactory candidate for bypass and that adequate myocardial revascularization can be accomplished.     

Complications and management of methods of dialysis access for renal failure

The management of dialysis access requires the awareness that any single access site is finite. A commitment to maintain access is reasonable with a planned approach. Dialysis for the end-stage renal disease patient must continue acutely during the management of access complications, and chronically. The goal of treatment is to return the patient to a routine dialysis regimen as soon as possible. Suspected infections should be treated immediately with systemic antibiotics specific for resistant Staphylococcus aureus. Systemic infection should be controlled before a new foreign body is implanted. My personal philosophy of access includes the following principles. (1) distal is good, (2) preserve all possible sites, (3) arm is better than leg, and (4) everything is relative.     

Cardiovascular and subjective effects of intravenous cocaine administration in humans

Nine volunteer subjects were tested with intravenously administered cocaine hydrochloride in doses ranging from 4 to 32 mg, as well as 10 mg of dextroamphetamine sulfate. Measures of cardiovascular and subjective effects were made. Generally parallel dose-effect functions were obtained for heart rate, blood pressure, Addiction Research Center Inventory scores, Profile of Mood Scales, and subject ratings. A substantial effect on each of these variables was recorded after 8 mg of cocaine. The increase continued and peaked at approximately 16 mg after which it usually leveled off. Ten milligrams of dextroamphetamine generally had an effect comparable to 8 to 16 mg of cocaine.     

The effects of training specific mnemonics on the metamnemonic efficiency of retarded children

On examination of the thumbs of 20 dissected preparations of ligaments and joints, of ten dry skeletons and of a number of living hands, apoposition (from apo = away from) was distinguished as a position in which the first carpometacarpal joint is fully abducted and laterally rotated and in which one or both distal joints of the thumb are flexed. Apoposition is commonly used in writing and it has a specific osteoligamentous basis for its stability: (1) a Y-shaped intermetacarpal ligament is attached by two crura to the base of the second metacarpal bone and by a common stem to the first metacarpal. Together with the palmar and dorsal oblique ligaments it becomes taut at abduction and establishes thereby a fixed center for the circumduction. Stability is enhanced as the circumduction takes place in the radial flat part of the joint away from the center; (2) of the two palmar prominences of the head of the first metacarpal bone the radial is the larger. At 25-30 degrees flexion in the metacarpophalangeal joint the prominence fits into an excavation on the base of the proximal phalanx in a manner which together with the ulnar collateral ligament locks the joint against mutual abduction and lateral rotation, and (3) the radial part of the trochlea of the interphalangeal joint is larger than the ulnar and secures, together with the ulnar collateral ligament, the joint against a radial luxation. Apoposition does not require activity of the thumb muscles; it is brought about by applying an external force to the ulnar side of the thumb and it is checked by ligaments and the shape of the joints.     

High rates of [1-14C]acetate incorporation into the lipid of isolated spinach chloroplasts

Spinach chloroplasts, isolated by techniques yielding preparations with high O2- evolving activity, showed rates of light-dependent acetate incorporation into lipids 3-4 fold higher than any previously reported. Incorporation rates as high as 500 nmol of acetate/h per mg of chlorophyll were measured in buffered sorbitol solutions containing only NaHCO3 and [1-14C]acetate, and as high as 800 nmol/h per mg of chlorophyll when 0.13 mM-Triton X-100 was also included in the reaction media. The fatty acids synthesized were predominantly oleic (70-80% of the total fatty acid radioactivity) and palmitic (20-25%) with only minor amounts (1-5%) of linoleic acid. Linolenic acid synthesis was not detected in the system in vitro. Free fatty acids accounted for 70-90% of the radioactivity incorporated and the remainder was shared fairly evenly between 1,2-diacylglycerols and polar lipids. Oleic acid constituted 80-90% of the free fatty acids synthesized, but the diacylglycerols and polar lipids contained slightly more palmitic acid than oleic acid. Triton X-100 stimulated the synthesis of diacylglycerols 3-6 fold, but stimulated free fatty acid synthesis only 1-1.5-fold. Added glycerol 1-phosphate stimulated both the synthesis of diacylglycerols and palmitic acid relative to oleic acid, but did not increase acetate incorporation into total chloroplast lipids. CoA and ATP, when added separately, stimulated acetate incorporation into chloroplast lipids to variable extents and had no effect on the types of lipid synthesized, but when added together resulted in 34% of the incorporated acetate appearing in long-chain acyl-CoA. Pyruvate was a much less effective precursor of chloroplast fatty acids than was acetate.