Extrusion of peritoneal catheter through abdominal incision: report of a rare complication of ventriculoperitoneal shunt

A rare complication of a ventriculoperitoneal shunt is reported. The peritoneal catheter extruded through the well-healed abdominal incision. This is the first report of such an occurrence in an adult patient.

Acedapsone in the prevention of leprosy: field trial in three high prevalence villages in Micronesia

The 1,659 non-leprous people in a Micronesian population experiencing an annual leprosy incidence rate of about 7/1,000 were offered 15 acedapsone (DADDS) injections during 1967--1970 for leprosy prevention purposes. Subsequent annual surveillance showed an initial cessation of new cases during the 3-year DADDS campaign, followed by a resumption of cases thereafter at a yearly level of about 2/1,000 with a longer pause and slower rise among those who received the full regimen. A secondary wave of cases that has occurred since 1973 among children born after 1968 shows that post-campaign transmission occurred, probably principally from relapsing multibacillary cases with onset before the campaign. Recommendations are made for a balanced, long-term control program with DADDS preventive treatment limited to contacts of multibacillary cases.

Concurrent quality assurance in hospital care. Report of a study by Private Initiative in PSRO

To test the feasibility and effects of incorporating concurrent quality assurance (CQA) into the concurrent utilization reviews required by PSRO's, adherence to essential criteria of medical care and attainment of expected immediate outcomes were monitored prospectively in 5604 cases of seven conditions in 24 experimental and 26 control hospitals in five PSRO areas. CQA was not consistently associated with improved documentation in records, but was associated with slightly better adherence to treatment criteria in all five PSRO areas (P less than 0.03). Adherence to pooled documentation or treatment criteria was unrelated to outcomes. However, failure to adhere to disease-specific scientifically validated treatment criteria was associated with unsatisfactory outcomes in bacterial pneumonia (P less than 0.01) and acute myocardial infarction (P less than 0.02). CQA was professionally acceptable, technically feasible and compatible with PSRO reviews. Given adequate physician support, CQA can produce slightly greater adherence to treatment criteria. If the criteria are valid, adherence may lead to improved immediate outcomes in some diseases.

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Coronary heart disease risk factors in Japan and Hawaii

Various risk factors were evaluated to explain a significantly greater incidence of coronary heart disease in men of Japanese ancestry resident in Hawaii compared with men resident in Japan. The independent predictors of incidence of coronary heart disease in both Japan and Hawaii were systolic blood pressure, serum cholesterol, relative weight and age. These factors appeared to influence incidence similarly in both areas because in each case the correlation coefficients for Japan and Hawaii did not differ significantly. The hypothesis that the greater incidence in Hawaii could be attributed to differences in levels of these risk factors was tested with the Walker-Duncan method. The four variable multiple logistic function describing the probability of coronary heart disease in Japan was applied to the cohort characteristics observed in Hawaii. The estimated incidence thus obtained was not significantly different from that actually observed in the men resident in Hawaii. Therefore the increased coronary risk profile in Hawaii compared with Japan can account for the greater incidence of coronary heart disease in the former. Current cigarette smoking was significantly related to the risk of coronary heart disease in Hawaii but not in Japan. This difference requires further investigation.

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease

The incidence of myocardial infarction and death from coronary heart disease was studied in defined samples of 45 to 68 year old Japanese men in Japan, Hawaii and California. The incidence rate was lowest in Japan where it was half that observed in Hawaii (P less than 0.01). The youngest men in the sample in Japan were at particularly low risk. The incidence among Japanese men in California was nearly 50 percent greater than that of Japanese in Hawaii (P less than 0.05). A striking increase in the incidence of myocardial infarction appears to have occurred in the Japanese who migrated to the United States; this increase is more pronounced in California than in Hawaii.

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: mortality

Stroke, coronary heart disease (CHD) and total mortality are evaluated from death certificates in enumerated cohorts of 45-64-year old Japanese men in Hiroshima and Nagasaki (1965-1970), in Homolulu (1966-1970), and in the San Francisco area (1968-1972). Total mortality is highest in Japan with no consistent differences between Japanese Americans in Homolulu and San Francisco. Age-specific CHD death rates are markedly lower in all three Japanese groups than in American whites. The CHD rates are consistently and significantly lower in Japan that in American Japanese. Stroke death rates for American Japanese men appear equivalent to figures for US white men of the same age, but are significantly lower than in the Japan cohort for the 60-64-year-old group. The number of stroke deaths below that age are too few as yet for analysis. Validation of mortality ascertainment and of the accuracy of death certification has been carried out in Japan and in Hawaii. The international differences in mortaltiy do not appear to be due to certification or other methodologic artifact.

Bowel perforation due to peritoneal shunt. A report of seven cases and a review of the literature

Seven patients with bowel perforations secondary to ventriculo- or lumbo- peritoneal shunts are described. Five additional patients histories were found reported in the literature making a total of 12 cases. The shunt tubing presented in the anus in seven of 12 patients. Clinical peritonitis was present initially in two patients but developed in four others. Gram negative ventriculitis was present in five of 12 patients. Suggestions for diagnosis and treatment of this complication are made based on analysis of these 12 patients.