Acute penetrating tracheal trauma

Four hundred seventy blood access procedures performed on 170 dialysis patients during the period 1962-1975 have been analyzed according to survival of access with respect to age, sex and cause of failure. Subcutaneous forms of blood access have a significantly longer life and are more free of complications than external shunts. Although the mode of access can now be tailored to the individual patient, the arterio-venous fistula remains the least expensive and simplest surgical procedure. It should therefore remain as the first choice of access for most patients.     

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.     

An outbreak of giardiasis in a group of campers

Thirty-four of 54 campers on a 2 week trip in mountains of Utah had diarrhea during and after their trip. Twenty-two (79%) of 28 symptomatic campers' stools examined contained Giardia lamblia cysts, whereas 4 (29%) of 14 asymptomatic campers' stools had cysts. The temporal distribution of cases and the absence of clustering among food preparation subgroups suggested a common source exposure. Although the epidemiologic data and fecal coliform counts implicated the remote mountain stream used as water source by the group as the vehicle of transmission, Giardia lamblia cysts were not recovered from stream water nor were they found in intestines or feces of sampled mammals living in the drainage area. Twenty-five other campers had stools examined before and after a subsequent hiking trip in another area of Utah; none had Giardia cysts before, but 6 (24%) had them after return. Questionnaires returned by 133 of the campers showed that 5% had an illness compatible with giardiasis within 2 weeks after their trip. These surveys show that campers exposed to mountain stream water are at risk of acquiring giardiasis.     

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.     

Inbreeding and canine mammary cancer: a retrospective study

Using files of the Animal Neoplasm Registry (ANR) in Alameda and Contra Costa Counties, California, we conducted a retrospective study to compare the degree of inbreeding in the ancestry of purebred dogs with mammary and other cancers, and of those without tumors. Wright's coefficients of inbreeding, calculated for all animals in the three groups, ranged from 0.000 to 0.535. The median inbreeding coefficients of the mammary cancer and comparison groups (consisting of other cancers) were approximately twice that of the nonneoplastic group, but neither difference was statistically significant. Dogs with mammary adenocarcinoma and mixed mammary cancer had similar degrees of inbreeding.