[Therapy of the unstable thorax in serial fractures of the ribs]

The histories of patients with flail chest and respiratory insufficiency caused by blunt chest injury have been analyzed. The first group represented patients with surgical stabilization of 3-4 ribs by introduction of "Rehbein plates" into the medullary cavity (10 patients 1972-1975). The patients of the second group have been supported by controlled mechanical respiration (11 patients 1972-1975). Patients with chest and further injuries (polyblessés) of comparable degree have been selected for both groups. The two groups were compared with regard to duration of intubation and artificial ventilation (average of 8.8 days for the operated and 21.4 days for the mechanically ventilated patients), stay in the intensive care unit (15.2 days after operation and 28.3 days for treatment by respirator) and average total hospitalization time (33.5 days after surgical management and 54.2 days after nonsurgical treatment). Severe bronchial infections caused by hospital germs have occurred more frequently in patients on long-term intubation and mechanical respiration. The average age of patients was almost the same in both groups. The technique of surgical stabilization of the ribs is described, and the advantages and limits of surgical and conservative management of respiratory insufficiency caused by flail chest are discussed.

[Indications for the reconstruction of the unstable thorax due to serial rib fractures and respiratory insufficiency]

Because of the impending danger of bronchopneumonial infection caused by hospital germs we consider it of utmost importance in the care and treatment of patients with instable thorax to shorten the period of intubation and artificial respiration. By stabilizing 3 or 4 chozen ribs within the flailing chest wall, we found it possible to significantly reduce the period of intubation, intensive care and hospitalisation. The splinting of several ribs individually by introducing socalled "Rehbein plates" into the medullary cavity of those in question proved to be a trustworthy method in achieving this goal.

Statistics and medical experimentation

Starting from a review of four major experimental areas in medicine (Polio, Coronary Surgery, Diabetes, Breast Cancer), some of the special statistical problems arising in the design and analysis of clinical experiments are reviewed, and the limitations of current formulations are emphasized. Particular attention is given to the ethical dilemma and an alternative formulation of the inference/decision problem is proposed.

Ascorbic acid and the common cold. Evaluation of its efficacy and toxicity

We reviewed the clinical data relating to the efficacy and safety of pharmacologic doses of ascorbic acid in the prevention and treatment of the common cold. Although one study tentatively supports the hypothesis that such doses of ascorbic acid may be efficacious, a second study by the same group did not confirm the significant findings, and no clear, reproducible pattern of efficacy has emerged from the review of all the evidence. Similarly, there is currently little adequate evidence on either the presence or the absence of serious adverse reactions to such doses of ascorbic acid, although many such reactions have been hypothesized. The unrestricted use of ascorbic acid for these purposes cannot be advocated on the basis of the evidence currently available.

The effects of diagnostic X-ray exposure on the human fetus: an examination of the evidence

Epidemiological studies have demonstrated an increased incidence of morbidity and mortality among children exposed prenatally or preconceptually to diagnostic x-rays, as compared to nonirradiated controls. In those studies radiation exposure occurred on a selective basis, as the examination was always medically indicated. Comparisons of those studies and comparable ones in which radiation exposure occurred on a nonselective basis (from routine pelvimetry examinations or atomic bomb radiation) indicate that the latter studies do not confirm the former and a significant discrepancy is present in each instance. Thus, some doubt is cast on the validity of the former studies.