National hospital input price index

The national community hospital input price index presented here isolates the effects of prices of goods and services required to produce hospital care and measures the average percent change in prices for a fixed market basket of hospital inputs. Using the methodology described in this article, weights for various expenditure categories were estimated and proxy price variables associated with each were selected. The index is calculated for the historical period 1970 through 1978 and forecast for 1979 through 1981. During the historical period, the input price index increased an average of 8.0 percent a year, compared with an average rate of increase of 6.6 percent for overall consumer prices. For the period 1979 through 1981, the average annual increase is forecast at between 8.5 and 9.0 per cent. Using the index to deflate growth in expenses, the level of real growth in expenditures per inpatient day (net service intensity growth) averaged 4.5 percent per year with considerable annual variation related to government and hospital industry policies.

Systemic and pulmonary hemodynamic effects of saralasin infusion in hypertension. Predictability of plasma renin status from hemodynamic changes

Hemodynamic measurements were obtained before and after 30 minutes of saralasin infusion in 26 fasting adults with hypertension (25 men and 1 woman). Nine showed a depressor response with a decrease in mean intaarterial pressure greater than 20 mm Hg. Ten were nonresponders and seven had an agonistic response with an increase in mean arterial pressure of greater than 10 mm Hg. Heart rate, pulmonary arterial and wedge pressures and pulmonary vascular resistance were nearly identical in the three groups and remained unchanged. Cardiac index decreased from a mean of 2.76 +/- 0.14 (standard error of the mean) to 2.48 +/- 0.1 liters/min per m2 in the nonresponders (P less than 0.02) but remained unchanged in the groups with a depressor or an agonistic response. The mean systemic vascular resistance decreased from 2,406 +/- 303 to 1,839 +/- 265 dynes sec/cm5 in the group with a depressor response (P less than 0.001) and increased in nonresponders (less than 0.02) and those with an agonistic response (P less than 0.01). However, regardless of the response of mean arterial pressure, systemic vascular resistance decreased only in the 10 patients with a plasma renin activity greater than 5 ng/ml per hour (8 from the depressor response group and 1 each from the nonresponse and agonistic response groups). It is concluded that (1) classification based soley on the response of aterial pressure to saralasin ignores important hemodynamic changes; (2) the response of cardiac index--no change in the patients with a depressor response and a reduction in nonresponders--suggests that endogenous angiotension II supports cardiac output in these groups; (3) a decrease in systemic vascular resistance is better than a decrease in mean arteiral pressure as a predictor of the status of the plasma renin activity; and (4) lack of change in pulmonary vascular resistance suggests that endogenous angiotension II plays an insignificant role in maintaining the resistance of the pulmonary vasculature.

Serotoninergic activation and inhibition: effects on carbohydrate tolerance and plasma insulin and glucagon

Glucose and arginine infusion tests were performed on 12 healthy volunteers (8 males, 4 females) before and after serotoninergic activation [oral administration of L-5-hydroxytryptophan (5-HTP-) for 6 days] and serotoninergic inhibition (oral treatment with D,L-p-chloropenylalanine for 6 days). 5-HTP treatment markedly increased urinary 5-hydroxyindoleacetic acid excretion, increased the mild hyperglycemic effect of arginine infusion, and lowered the glucose disposal rate constant. The adverse effect of serotoninergic activation on glucose tolerance is not sufficiently explained by the observed changes in insulin and glucagon secretion during the fasting state and after intravenous glucose and arginine infusions. Serotoninergic inhibition did not affect the carbohydrate tolerance of normal individuals. The results of this work supports the idea that excessive indoleamine production is probably the main cause for carbohydrate intolerance in carcinoid tumors.

Effects of stimulating the cerebellar surface on the activity in penicillin foci

✓ The effect of stimulating the cerebellar surface on the activity of acute penicillin foci (20,000 units) was investigated in a statistically designed study. All animals were randomly assigned either to an experimental group in which the dura over the posterior lobe was opened and a bipolar surface electrode placed over the vermis of the anterior lobe, or else to a control group in which only the dura was opened. After surgery, the animals in the experimental group were randomly assigned to a stimulated or an unstimulated group. The cerebellar surface was stimulated at a frequency of 10/sec using capacitatively coupled pulses with peak current densities of 26.0 mA/sq cm and a duration of 0.1 msec. The effectiveness of the stimuli for activating neuronal elements in the cerebellum was evaluated 1) by recording the cerebellar evoked response from the sensorimotor cortex, and 2) by measuring the effect of a conditioning cerebellar stimulus on the percent change in the amplitude of the cortical response evoked by stimulating the receptive fields of the trigeminal nerve. A statistical comparison of the mean number of seizures for successive 10-minute intervals between control and experimental groups indicated that any difference in the means of these parameters occurred by chance with a high probability and did not result from any treatment. The duration of the seizures, however, was significantly affected by stimulation of the cerebellar surface. Further, the total number of seizures and the amplitude of the cerebellar evoked response in the same animal were inversely correlated. Thus, stimuli that evoked large-amplitude responses over the sensorimotor cortex may have produced a decrease in the number of seizures, whereas stimuli that evoked small-amplitude responses may have produced an increase in the total number of seizures with respect to the control group.

A trial of clenbuterol in bronchial asthma

Clenbuterol is a beta 2-sympathomimetic bronchodilator. In a double-blind cross-over trial in 19 asthmatic patients with reversible airways obstruction, oral administration of both clenbuterol (40 microgram) and salbutamol (4 mg) caused significantly greater increased in peak expiratory flow rate (PEFR) than placebo, that of clenbuterol lasting longer. The patients' subjective assessment also suggested the relief of their symptoms by the active drugs. Side-effects were minimal.

Monomethylthio analogues of 1-(2,4,5-trimethoxyphenyl)-2-aminopropane

Regiospecific syntheses of the three monomethylthio analogues of 1-(2,4,5-trimethoxyphenyl)-2-aminopropane are described. The three isomeric amines were evaluated for potential psychotomimetic potency using the rabbit hyperthermia assay. Enantiomeric compositions and time-concentration curves in rat brains were determined following intraperitoneal administration of each compound. The biological data are contrasted with the corresponding results obtained with the potent human psychotogen 1-(2,5-dimethoxy-4-methylphenyl)-2-aminopropane (DOM).

Treatment of advanced bronchogenic carcinoma with adriamycin, 5-fluorouracil and methotrexate

The combination of adriamycin, 5-fluorouracil and methotrexate with folinic acid reversal was used to treat patients with advanced bronchogenic carcinoma. Twenty-one of 30 patients showed an objective response. This combination appears to produce useful remissions in patients with non-squamous lung cancer.

The adverse effects of elemental diets on tolerance for 5-FU toxicity in the rat

The effects of a group of elemental diets on the gastrointestinal toxicity of 5-FU in the Sprague-Dawley rat were evaluated. Diarrhea, stomatitis, hypoalbuminemia, and early deaths were more frequent in the animals on elemental diets than in those consuming standard rat chow. Sepsis and hypoalbuminemia were directly related to the extent of protein hydrolysis of the particular elemental diet.

Chest pain as a predictor of coronary artery disease in patients with obstructive aortic valve disease

To clarify the association between chest pain and significant coronary artery disease in patients who have aortic valve disease, 76 consecutive candidates for aortic valve replacement were evaluated prospectively with use of a historical questionnaire and coronary arteriography. Of the 76 patients, 19 (25 percent) had no chest pain, 21 (28 percent) had chest pain that was not typical of angina pectoris and 36 (47 percent) had chest pain typical of anigina pectoris. In 18 of 19 patients the absence of chest pain correlated with the absence of coronary artery disease. The single patient without chest pain who had coronary artery disease had evidence of an inferior myocardial infarction in the electrocardiogram. Thus, absence of chest pain and the absence of electrocardiographic evidence of infarction predicted the absence of coronary disease in all cases. The presence of chest pain did not predict the presence of coronary artery disease, but the more typical the pain of angina pectoris the more likely were patients to have significant coronary artery disease. Of the 21 patients with atypical chest pain, 6 (29 percent) had coronary artery disease, but of the 36 patients with typical angina pectoris 23 (64 percent) had significant coronary artery disease. In addition, when patients with chest pain not typical of angina pectoris also had coronary artery disease, the diseased vessels usually supplied smaller areas of the left ventricle than when the pain was typical of angina pectoris. In 21 of 23 patients (91 percent) with typical angina pectoris and significant coronary artery disease, lesions were present in the left coronary artery. There was no systolic pressure gradient across the aortic valve that excluded the presence of coronary artery disease, although all patients with a calculated aortic valve area of less than 0.4 cm2 were free of coronary artery disease. Patients with severe left ventricular dysfunction were more likely to have normal coronary arteries.

Mobile hearing program in central rural Manitoba

A mobile hearing program was developed to detect and alleviate deafness and rehabilitate deaf individuals in rural Manitoba. The first project was established in central Manitoba in December 1973 for children, whose school performance can be affected by minimal hearing loss. Volunteers from the community, trained by an audiologist, conduct screening procedures, and children with possible hearing impairment receive audiologic and otolaryngologic assessment. Close clinical liaison between audiologist and otologist is important.

Carcinoembryonic antigen: clinical and historical aspects

To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The Ohio State University Hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.

Carcinoembryonic antigen: clinical and historical aspects

To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The Ohio State University Hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.

Effect of decalcifying agents on the staining of Mycobacterium tuberculosis

Lymph nodes from guinea pigs inoculated with Mycobacterium tuberculosis were fixed in buffered formalin, then treated for the recommended times in Gooding and Stewart's fluid, EDTA, aqueous nitric acid, von Ebner's fluid, and rapid decalcifier (RDC). The blocks were processed to paraffin wax and sections were stained by the Ziehl-Neelsen technique. Only in sections of the blocks treated with RDC were no acid alcohol fast bacilli demonstrable. Hydrochloric acid is a known constituent of RDC and it was found that Myco. tuberculosis is altered by treatment with 2-5M solutions of hydrochloric acid and above and cannot subseuqently be demonstrated by the Ziehl-Neelsen stain. From these results it is recommended that calcified tissue from patients in whom there is a suspicion of tuberculosis should be decalcified with an agent other than RDC.

Treatment of advanced bronchogenic carcinoma with adriamycin and 5-fluorouracil

Thirty patients with an advanced bronchogenic carcinoma were treated with a combination of adriamycin and 5-fluorouracil; in eight the size of the tumour or its metastases was reduced by over 50%, and eight further patients experienced useful relief of symptoms. This drug combination is useful in the magagement of lung cancer.

Incidence of paramalignant disorders in bronchogenic carcinoma

The incidence of paramalignant disorders was studied in 280 consecutive patients with early lung cancer confirmed histologically. The commonest disorders were weight loss exceeding 6.4 kg (30.7 percent of the series), finger clubbing (29 percent), fever (21.1 percent), and endocrinopathies (12.1 percent). Paramalignant diseases are common even in early lung cancer and all patients should have investigations for their detection.

The effect of formaldehyde on the toxicity and potency of pertussis vaccine

Storage of concentrated suspensions of Bordetella pertussis organisms at 5 C for long periods of time in the presence of 0.02% thimerosal as well as heating at 56 C for 30 minutes cannot be relied upon to detoxify the vaccines. Our data show that the toxic thimerosal-killed vaccines can be rapidly detoxified by adding formalin to a final concentration of 0.025-0.05% and incubating at temperatures of 5-20 C for from one to three months. These formalin-detoxified vaccines are protective and meet present potency requirements for pertussis vaccine. Addition of larger amounts of formalin at higher temperatures may detoxify the vaccine but may also reduce the protective effect.

Laboratory and clinical characteristics of attenuated strains of influenza virus

Prior to 1967, attenuation of influenza virus was achieved by gradually lowering the incubation temperature until optimal growth at 25 degrees C was obtained. The process of attenuation of a Hong Kong strain was modified and considerably shortened. The temperature of incubation was changed abruptly from 35 degrees C to 25 degrees C and a cold variant was selected using the plaque-assay system.A set of genetic markers was developed for assessing the potential virulence of cold-passaged variants. The cold variant of the Hong Kong strain was temperature-sensitive, acid-labile and produced a small plaque in primary chick kidney cells incubated at 35 degrees C. Additional differentiating biological properties relating to the adaptation of the virus to growth at 25 degrees C and to loss of virulence in a susceptible host are presented.The cold-adapted variant was found to be relatively avirulent and highly antigenic for mice and ferrets, and virus was recovered from the nasopharynx of infected ferrets during the first 3 days. The virus recovered was still unable to grow well at 41 degrees C (rct/41-), was sensitive to acid pH and produced small plaques at 35 degrees C and larger ones at 25 degrees C.After a series of plaque purifications, the cold variant showed further loss of virulence to mice, more vigorous growth at 25 degrees C, complete failure to grow at 41 degrees C and good antigenic potency.The genetic markers were stable in the plaque-purified cold variant after at least 10 consecutive passages either in tissue culture at 35 degrees C, or in mice.Cold variants of type B influenza virus have a narrower range of temperature sensitivity compared with type A strains. Reduced plaquing efficiency and reproductive capacity occurred at 35 degrees C (rct/35-) with the attenuated type B strains instead of at 41 degrees C as with the type A strains.Clinical trials with the attenuated Hong Kong strain of influenza virus (A2/Aichi/2/68) have demonstrated the acceptability and immunogenicity of the strain in man.