An Anglo-American comparison of the scaling of life events

Exact placement is an essential prerequisite for long-term use of a central venous catheter. Reported data show an extremely wide range of catheteral misplacements: from less than 1% to more than 60%. Some approaches appear to be less advantageous than others, but the highest rates of misplacement occur in the cubital, external jugular and saphenous veins. A series is presented of 378 radiographically controlled central venous catheters analysed for aberrant placement and loop formation. The total occurrence of faulty positioning and coiling reached 5.3%, while the respective incidences were 30% for the external jugular vein, 5.7% for the internal jugular vein, 5.5% for the infraclavicular technique of subclavian venepuncture, 5.3% for the innominate vein and 1.4% for the supraclavicular approach of subclavian venepuncture. The total frequency for pure loop formation was 2.9%. The authors discuss numerous reported data on catheter malpositioning, according to the specific techniques used, and compare them with thier own results. The relatively low incidence in the present series is possibly due to the high proportion of cases where the supraclavicular subclavian approach was used, the omission of the sphrenous/femoral and cubital techniques, and to pre-determining the length of the inserted catheteral segments.     

Late instability in cervical spine fractures secondary to laminectomy

Of 256 patients with a major spinal cord injury as a result of fracture of the cervical spine, 38 per cent had a laminectomy. Three months after injury, 33 per cent of the patients with laminectomy required fusion for instability compared to 22 per cent of the nonlaminectomy group. There were no cases of late instability in pure flexion or extension fracture groups. Ninety per cent of the late instability cases were in the groups with hyperflexion and flexion compression fractures. Laminectomy should be avoided for these fractures, but early fusion may be necessary to prevent progressive deformity.     

Cytological studies in pulmonary pathology

Cytological investigations of the bronchial secretion and sputum in particular have acquired in recent years a great practical significance in pulmonary pathology. It is recommended to use cytodiagnosis along with prophylactic X-ray examinations of the population to detect pulmonary pathology, in particular among individuals with a higher risk of developing cancer. A substantiated opinion is put forward that cytodiagnosis should precede examinations of patients with clinico-roentgenologically confirmed changes in the lungs.     

Response of the binding capacity of plasma testosterone-estradiol-binding globulin to norethindrone, 2 mg., and mestranol, 0.1 mg., in polycystic ovarian disease

Two cases of duodenal hematoma secondary to abdominal trauma in children are reported. The latent periods between trauma and the onset of symptoms were two and fifteen days. X-ray studies were conclusive for diagnosis. Pancreatic signs were mild in one case. Both cases were treated surgically, draining the fluid collection extramucosally. The authors advise surgical treatment whenever associated lesions need to be ruled out and when obstruction persists after the first days.     

Natural killer (NK) cell-mediated cytotoxicity: differential use of TRAIL and Fas ligand by immature and mature primary human NK cells

Mature natural killer (NK) cells use Ca2+-dependent granule exocytosis and release of cytotoxic proteins, Fas ligand (FasL), and membrane-bound or secreted cytokines (tumor necrosis factor [TNF]-alpha) to induce target cell death. Fas belongs to the TNF receptor family of molecules, containing a conserved intracytoplasmic "death domain" that indirectly activates the caspase enzymatic cascade and ultimately apoptotic mechanisms in numerous cell types. Two additional members of this family, DR4 and DR5, transduce apoptotic signals upon binding soluble TNF-related apoptosis-inducing ligand (TRAIL) that, like FasL, belongs to the growing TNF family of molecules. Here, we report that TRAIL produced or expressed by different populations of primary human NK cells is functional, and represents a marker of differentiation or activation of these, and possibly other, cytotoxic leukocytes. During differentiation NK cells, sequentially and differentially, use distinct members of the TNF family or granule exocytosis to mediate target cell death. Phenotypically immature CD161(+)/CD56(-) NK cells mediate TRAIL-dependent but not FasL- or granule release-dependent cytotoxicity, whereas mature CD56(+) NK cells mediate the latter two.     

Duration dependence in migration behaviour: cumulative inertia versus stochastic change

"In this paper a new theoretical framework and supporting empirical evidence on the relationship between movement probabilities and length of stay are presented. Individuals' evaluations of the relative value of alternative locations are assumed to evolve stochastically, with a possible tendency either to cumulative inertia or to cumulative stress. In general this yields a nonmonotonic duration function, with probabilities of movement starting at zero, rising and then falling--a pattern consistent with either cumulative tendency, or neither. A version of the model fitted to data on household movement intentions, from the U.K. General Household Survey, confirms the hypothesised form of this function and indicates a dominance of cumulative stress over cumulative inertia."     

Incontinence and vesical neck strictures following radical retropubic prostatectomy

OBJECTIVES: To evaluate the incidence and severity of vesical neck strictures and urinary incontinence after radical retropubic prostatectomy (RRP) for prostate cancer. METHODS: Between August 1983 and December 1991, 481 consecutive patients underwent RRP by 1 of 2 senior surgeons. Strictures were treated by passing a urethral sound. Incontinence was measured by asking patients for a daily "pad count" of pads required to control urinary leakage. Results were compared to patient age, tumor volume, number of neurovascular bundles spared, preoperative urinary complaints, and previous transurethral resection of the prostate. RESULTS: Of 456 patients with adequate follow-up to determine stricture formation, 82.5% had no strictures, 6.8% required a single dilation, 3.7% required 2 dilations, 3.1% required 3 dilations, and 3.9% required more than 3 dilations. Risk of stricture formation was unrelated to every variable studied. Of 458 patients with adequate follow-up to determine recovery of continence, 80.1% required no pads, 8.1% required 1 to 2 pads a day, 6.6% required 3 to 5 pads a day, and 5.2% were totally incontinent 1 year or more after surgery. Incontinence was closely associated with postoperative urinary urgency. CONCLUSIONS: Strictures are a common but easily managed complication of RRP for prostate cancer. Despite substantial surgical experience, we report a somewhat higher rate of postoperative incontinence than other recently reported series. Our experience is more closely matched by published surveys of patient-reported complications after RRP.