Medical practice guidelines in malpractice litigation: an early retrospective

The role of practice guidelines in malpractice litigation has been discussed in some theoretical detail. Little information is available, however, on how courts use guidelines or on the effort of state legislatures to explicitly link guideline compliance with malpractice defenses. We review all relevant case law and legislative enactments to shed light on the influence of medical malpractice on guidelines. We also use data from a nationwide survey of malpractice attorneys to supplement our legal analysis. Although guidelines are being used for both inculpatory and exculpatory purposes in common-law litigation (a two-way street), legislatures are interested in applying them only for exculpatory purposes (a one-way street).     

Clinical picture and dynamics of psychopathologic disorders in subacute leuko-and panencephalitis

The report contains the results of clinico-dynamic studies of mental disorders in patients with Schilder's leukoencephalitis and subacute sclerosing panencephalitis after van-Bogart. The authors come to the conclusion that only parallel comparisons of the psychopathological symptomatology with focal neurological signs and a simultaneous study of the EEG and other paraclinical indices may facilitate the differential diagnosis of encephalitis.     

Histochemical studies of the development of alkaline and acid phosphatase activities in the ovary and oviduct of the fowl (Gallus domesticus)

Alkaline and acid phosphatase activities were studied in the ovary and oviducts of pullets from the age of 2-32 weeks. Adult fowls were similarly studied. Alkaline phosphatase activity was present only in the glandular grooves and crypts of the immature oviducts. Alkaline phosphatase activity appeared at the pits of epithelial evaginations as glandular formation commenced. The young, non-secreting glands also showed the enzyme activity. But in the mature oviduct, alkaline phosphatase activity was confined to only the uterovaginal glands or sperm host glands and the epithelium of the vagina. In the ovary, alkaline phosphatase activity in the theca interna increased as the diameter of the follicles increased. Acid phosphatase activity was not present in the ovary, but in the oviduct, the enzyme activity was present in the uterine (shell gland) glands and in the uterovaginal epithelium and glands (sperm host glands). Alkaline phosphatase activity in the ovarian follicles and in the immature oviduct is thought to be related to histodifferentiation of these structures.     

Social and medical rehabilitation of patients subjected to surgery on account of aneurysms of the anterior connecting artery

The report contains data concerning occupational and social rehabilitation of 46 patients operated on for aneurysma of the anterior communicative artery. It was established that the occupational prognosis depends upon the severity of the hemmorhage, character of surgical operation. Of significance are the conditions of work, time after the surgical operation. The authors mark that in 2/3 of the operated on patients the working capacity is being restored. A spontaneous restoration of diaturbed functions is slow and is not always sufficient. With this purpose it is expedient to repeat courses of a general tonic and special rehabilitative therapy. A favourable factor in the readaptation of patients is their early engagement in working activities. The authors give their recommendations for medical labour expert testimony for this category of patients.     

Reevaluation of the linkage between acute hemorrhagic shock and bacterial translocation in the rat

The present study was undertaken to determine the conditions under which acute periods of hemorrhagic shock induce bacterial translocation. Rats (at least six per group) were anesthetized intraperitoneally with the barbiturate, pentobarbital (50 or 65 mg/kg), or the inhalation anesthetic methoxyflurane. Following anesthesia, the femoral artery was catheterized, from which blood was withdrawn to maintain a mean arterial blood pressure of 30 mmHg for 30, 60, or 90 min, followed by reinfusion of shed blood. Instrumented, but nonshocked animals served as controls. Rats were sacrificed at 0, 2, or 24 hr postshock, and quantitative bacterial cultures of the mesenteric lymph node complex (MLN), liver, and spleen were made. Within groups, the effects of heparinization were also determined. In pentobarbital-treated animals, regardless of the extent of heparinization, consistent translocation to both MLN and distant organs occurred when shock was prolonged for 90 min, and assessment of translocation was made 24 hr after reinfusion of shed blood. Furthermore, a mortality rate of approximately 30% was found in rats subjected to this protocol. The magnitude of translocation was less consistent, and did not differ from that in sham shock controls, under other conditions of shock and evaluation. In rats anesthetized with methoxyflurane, no mortality occurred, and no statistical significance between the incidence or degree of translocation in shocked animals vs. sham shock controls could be demonstrated, regardless of the shock protocol. In additional studies, effects of these anesthetics on intestinal morphology and superior mesenteric arterial (SMA) flow in the context of hemorrhagic shock were assessed.(ABSTRACT TRUNCATED AT 250 WORDS)     

An improved method for detecting passive pills

One of the principal disadvantages of the passive pill as a telemetric method for measuring various physiological parameters has been its resticted range. The reasons for the restricted range with existing detection methods are discussed. An improved method using a locking spectrometer based on third-order phase-sensitive detection is described and its performance is assessed. A significant increase in the usable range of a high sensitivity passive pill is obtained.