Serum enzyme abnormalities in protein energy malnutrition

A semi-quantitative right coronary artery score (RCA score) was derived from the ratio of the number of the major left ventricular branches of the right coronary artery to the total of the right coronary and left circumflex arteries, to stratify the extent of perfusion in patients with right coronary artery dominance. Thirty-seven patients with one-vessel coronary disease involving a dominant right coronary artery proximal to the left ventricular branches were selected for study. Thallium scintigraphy was performed after right intracoronary injection in 11 patients, and 26 patients underwent conventional stress thallium scintigraphy (24 exercise thallium and two dipyridamole thallium scintigraphy). Thallium scores of perfusion region size after right intracoronary thallium injection and perfusion defect size in stress thallium studies were quantitated from planar thallium images. Both the RCA score and the regional thallium scores spanned over a wide range. The RCA score (range 0.23-0.85) correlated best with the posterior (70 degrees left anterior oblique view) plus lateral segment (40 degrees left anterior oblique view) thallium score (r = 0.88 and 0.53 for intracoronary and stress thallium studies respectively). It also correlated with the summed thallium scores in the posterior, lateral, apical and inferior segments (r = 0.73 and 0.54 respectively) but not with thallium scores in the apex or inferior segment alone. The proposed RCA score quantitates the variable posterolateral perfusion territory of the right coronary artery, and could stratify the area of myocardium at risk from coronary stenosis in the majority of patients with right coronary dominance.     

Fine needle aspiration cytodiagnosis of subcutaneous fat necrosis of newborn. A case report

We recently diagnosed subcutaneous fat necrosis in a newborn female infant using fine needle aspiration cytology. The neonate had perinatal asphyxia and her mother a difficult labor, but otherwise the neonate was well developed and healthy and within a few days developed well-defined areas of subcutaneous induration all over. On cytologic examination of the aspirated material, many necrotizing fat cells were found with refractile, needle-shaped crystals arranged in a sheaflike or starburst pattern. Subcutaneous fat necrosis of the newborn is uncommon today, and although the histologic findings from excised tissue are known, this appears to be the first case in which the diagnosis was possible from a sample of fine needle aspirate.     

Sociotropy and autonomy: Differential patterns of clinical presentation in unipolar depression.

We examined the relations between sociotropy and autonomy and clinical features of depression. A. T. Beck (1983) proposed that sociotropy is related to a sense of deprivation and clinical features associated with reactive depression and that autonomy is related to a sense of defeat and clinical features associated with endogenous depression. C. J. Robins et al (see record 1989-19204-001) found support for the hypothesis for sociotropy but not for autonomy, and they suggested that the autonomy scale may be problematic. We administered new measures of sociotropy and autonomy and a more comprehensive assessment of clinical features to 50 unipolar depressed inpatients. The results support the selective relations of both sociotropy and autonomy to the predicted sets of clinical features. This study adds to the growing evidence that these personality dimensions are important to the understanding of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Green Bay cesarean section study. IV. The physician factor as a determinant of cesarean birth rates for the large fetus

OBJECTIVES: Our purpose was to determine those factors affecting the route of delivery decisions and the effect of delivery route on maternal and newborn outcomes with the macrosomic fetus. Do higher cesarean rates result in improved newborn outcomes? STUDY DESIGN: A 10-year (1985 to 1994) retrospective data set was used to analyze patients with newborns weighing > or = 4536 and 4000 to 4535 gm at two Green Bay hospitals. Patients with newborns weighing 2500 to 3999 gm were similarly analyzed for comparison purposes. Individual and obstetrician group cesarean rates and newborn and maternal outcomes were identified. RESULTS: Cesarean birth rates for the fetus weighing > 4000 gm were low and varied from 12.8% in the low obstetrician cesarean rate group to 24.0% in the high group. Higher obstetrician group cesarean rates did not result in improved newborn outcomes. Newborn morbidity and mortality were very low but significantly higher for cesarean birth newborns. Maternal complications were fairly low with cesarean birth and rare after vaginal delivery. CONCLUSION: Patients with a suspected macrosomic fetus should be given the same opportunity to achieve a vaginal delivery as patients with smaller fetuses.     

System considerations favoring rotary artificial hearts with blood-immersed bearings

Hydrodynamic blood pumps provide such advantages as not requiring an air vent or compliance chamber as well as a great reduction in mechanical complexity with the potential for very long durability. The detailed design of their bearings is emerging as the single most important determinant of long-term success. Three categories of bearings include remote force, such as magnetic suspension; blood-isolated, which require a shaft seal; and blood-immersed using either mechanical or hydrodynamic support. Blood-immersed bearings permit maximum simplification and miniaturization of the entire system, require no flush fluid, and require no electronics as with magnetic suspension. The Jarvik 2000 heart represents an example of their potential. The intraventricular titanium pump (25 mm diameter, 25 cc, 85 g), uses blood flow through the motor air gap with blood-immersed bearings. The longest in vitro bearing durability test is ongoing at 20,000,000,000 revolutions with minimal wear (3 years at 15,000 rpm). In vivo results include 5-month calf survival, no thromboembolism, plasma Hb 2-5 mg%, and power under 10 W.