Influence of coronary artery anatomy on survival following resection of left ventricular aneurysms and chronic infarcts

Left ventricular (LV) aneurysms were resected in 27 patients for treatment of congestive heart failure and in five patients for treatment of ventricular arrhythmia. There were eight early (25 per cent) and five late (15 per cent) deaths. Preoperative hemodynamics including analysis of left ventriculograms in the right anterior oblique position did not consistently predict survival. In contrast, coronary artery anatomy appeared to influence the mortality rate strikingly in patients with congestive heart failure. The hospital mortality rate was 6 per cent and the late mortality rate was 13 per cent for 16 patients with one-or two-vessel coronary artery disease, but with unobstructed LV lateral wall blood supply. All but one of the survivors obtained a good late result. In nine patients with two-and three-vessel coronary artery disease and obstructed LV lateral wall blood supply there were six hospital deaths and two late deaths. It is concluded that the presence or absence of occlusive disease in the arteries supplying the LV lateral wall is an important determinant of the mortality rate associated with resection of anterior apical LV aneurysms in patients with severe congestive heart failure.

Licensure, competence, and manpower distribution. A follow-up study of foreign medical graduates

Medical statistics report United States medical graduates licensed at higher rates than foreign medical graduates. This difference is often interpreted to show greater medical competence of United States graduates. This study questions this interpretation by analyzing 1971 licensure rates for both groups who had been interns and residents in 1963. We found that factors unrelated to competence--namely, visa-citizenship status and state of examination--are associated with holding a license. Moreover, quality of medical education is not an accurate predictor of licensure. It follows that the use of licensure rates as measures of medical competence distorts understanding of the quality of medical care in the United States. More probably, the difficulties in obtaining medical licensure experienced by foreign graduates result from the use of such graduates to relieve specific medical-manpower shortages.

Latex test for quantitative determination of Escherichia coli antibody

A latex agglutination test was developed for assay of anti-Escherichia coli antisera. The test is simple, specific, sensitive, and reproducible.

Visual discrimination learning and transfer in rats with hippocampal lesions

Two experiments were performed on rats with hippocampal brain damage and on a control group with neocortical lesions. In the first experiment the hippocampal group learned a difficult visual discrimination as promptly as the controls, and neither group was subsequently impaired by adding relevant or irrelevant background cues to the original stimuli. In the second experiment the animals learned a simultaneous visual discrimination in which the stimuli differed in both brightness and orientation. The hippocampal group was impaired relative to the controls on acquisition, and showed poorer transfer to stimuli differing only in brightness or orientation. The results are incompatible with the hypothesis which attempts to explain the effects of hippocampal damage by a widespread reduction in sensory gating, but they are consistent with a more restricted version of the same hypothesis.