Thromboembolism following total hip-replacement arthroplasty. The efficicy of dextran-aspirin and dextran-warfarin in prophylaxis

The efficacy of two antithrombotic regimens, combined dextran and aspirin and combined dextran and warfarin, was analyzed by comparing the incidence of thromboembolism following total hip replacement in two groups of similar patients. Of the 427 who received dextran and aspirin, 7 per cent had thromboembolic complications, including one case of fatal pulmonary embolus and one case of recurrent emboli that required vena caval ligation, and 15 per cent had wound-healing complications. Of the 197 patients who received dextran and warfarin, 5 per cent had thromboembolism and 24 per cent had wound healing complications. Although both prophylactic regimens seemed effective, dextran and aspirin appeared less effective in reducing thromboembolic complications than dextran and warfarin, but there were fewer wound complications in that group. One-fourth of the patients on dextran-warfarin were not adequately anticoagulated despite close supervision. In forty-five patients with a history of thromboembolism who were excluded from the study and analyzed separately, warfarin alone and the two described regimens were equally ineffective in preventing thromboembolism, and the incidence of thromboembolic complications was high. Dextran-aspirin and dextran-warfarin appear to be satisfactory and relatively simple methods of thromboembolic prophylaxis.     

New finding of Phlebotom uses in the State of S?o Paulo with special reference to Lutzomyia longipalpis]

The removal by centrifugation of epididymal contents from mouse spermatozoa had no deleterious effect on fertilization in vitro, and, depending on the genotype of the gametes, was frequently associated with increased levels of fertility. Washing of the spermatozoa significantly improved the fertilization rate of F1 eggs with TO spermatozoa and of BALB/c eggs with BALB/c spermatozoa, but had no significant effect of F1 spermatozoa with F1 eggs.     

Transsexualism in two male triplets

The authors present clinical and case material on two male triplets with aberrant gender identity. Their findings coincide with those of the few family studies reported in which there were two or more transsexual members; they also reveal patterns generally in keeping with the psychological determinants of transsexualism suggested by Stoller.     

Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines

CONTEXT: Many groups have developed guidelines to shorten hospital length of stay in pneumonia in order to decrease costs, but the length of time until a patient hospitalized with pneumonia becomes clinically stable has not been established. OBJECTIVE: To describe the time to resolution of abnormalities in vital signs, ability to eat, and mental status in patients with community-acquired pneumonia and assess clinical outcomes after achieving stability. DESIGN: Prospective, multicenter, observational cohort study. SETTING: Three university and 1 community teaching hospital in Boston, Mass, Pittsburgh, Pa, and Halifax, Nova Scotia. PATIENTS: Six hundred eighty-six adults hospitalized with community-acquired pneumonia. MAIN OUTCOME MEASURES: Time to resolution of vital signs, ability to eat, mental status, hospital length of stay, and admission to an intensive care, coronary care, or telemetry unit. RESULTS: The median time to stability was 2 days for heart rate (< or =100 beats/min) and systolic blood pressure (> or =90 mm Hg), and 3 days for respiratory rate (< or =24 breaths/min), oxygen saturation (> or =90%), and temperature (< or =37.2 degrees C [99 degrees F]). The median time to overall clinical stability was 3 days for the most lenient definition of stability and 7 days for the most conservative definition. Patients with more severe cases of pneumonia at presentation took longer to reach stability. Once stability was achieved, clinical deterioration requiring intensive care, coronary care, or telemetry monitoring occurred in 1% of cases or fewer. Between 65% to 86% of patients stayed in the hospital more than 1 day after reaching stability, and fewer than 29% to 46% were converted to oral antibiotics within 1 day of stability, depending on the definition of stability. CONCLUSIONS: Our estimates of time to stability in pneumonia and explicit criteria for defining stability can provide an evidence-based estimate of optimal length of stay, and outline a clinically sensible approach to improving the efficiency of inpatient management.     

The effect of the special instruction of bronchial asthma patients on the efficacy of their treatment

As the data collected in a survey we conducted show, a major part of the modern general practitioner's work continues to be in the field of family medicine. This fact is also confirmed by the results of other surveys of general practice today. Patients still appreciate their GPs as a source of good medical care and counseling for the whole family. Our own study has shown that most patients would even like to see an expansion of the GP's counseling activities. The duration of the doctor-family relationship extends over many years, and is frequently longer than a decade.     

A First-Order Model for Depolarization of Propagating Signals by Narrowband Ricean Fading Channels

We show by simulation that when the fading signals observed on orthogonally polarized diversity branches follow Ricean statistics, the distribution of polarization states on the Poincar′e sphere is well-approximated by a Fisher distribution. Further, we show that the Fisher concentration parameter is: (1) completely determined by the corresponding Ricean Kfactors and the cross-correlation coefficient between the diversity branches, both of which can be estimated from simple measurements of received power vs. time, and (2) a good indicator of the level of cross-polar discrimination (XPD) on the channel. The insights gained are potentially useful to those engaged in the development and validation of schemes that use either polarization re-use or polarized MIMO.