Effect of investigator experience on percutaneous transluminal coronary angioplasty

The NHLBI PTCA Registry collected clinical data on 3,101 PTCA procedures performed at 105 clinical centers between September 1977 and September 1981. To investigate the "learning curve" from introduction through the early application of this new therapy for revascularization, success rates and complication rates were examined by calendar year and according to investigator experience. Success rates improved by calendar year, from 54% in 1979 to 66% in 1981. Investigators with fewer than 50 cases had a success rate of 55%. After an investigator had performed 150 procedures, the success rate was 77%. The increase in success rate was largely the result of a dramatic increase in the ability to cross the narrowing with the catheter, and was accounted for by experience and improved equipment. Patient selection for PTCA was characterized by sex, age, previous CABG, number of diseased coronary arteries and stable Canadian Heart classification over time. Reflecting the increase in the success rate was the decrease in the need to perform elective CABG. Emergency CABG, death and MI rates were low (1% mortality, 5% nonfatal MI) and did not change significantly with time or with investigator experience.

Further look at dextropropoxyphene with or without paracetamol in the treatment of arthritis

The analgesic effects of dextropropoxyphene and paracetamol and that of a combination of the two drugs were assessed in 24 patients who suffered from either rheumatoid arthritis or osteoarthritis. Dextropropoxyphene, which had a marginal effect on pain score, led to a more significant effect on patient well-being, particularly when it was the first drug given in the sequence. The addition of paracetamol had more of a negative than a positive effect on pain score and well-being.

Problems of interpretation of serum concentrations of alpha-foetoprotein (AFP) in patients receiving cytotoxic chemotherapy for malignant germ cell tumours

Serial determinations of serum alpha-foetoprotein (AFP) concentrations are well established in monitoring the response to therapy of malignant germ cell tumours. Using a radioimmunoassay (RIA) with a sensitivity down to 2kul-1 the majority (57%) of 28 patients with non-AFP producing germ cell tumours had measurable immunologically-reactive AFP in their serum while on treatment. Follow-up for 11-43 months (mean 27) without evidence of tumour activity indicated that this immunologically-reactive AFP was unlikely to be produced by tumour. In patients where the initial serum AFP was raised prior to chemotherapy the AFP concentration did not fall to the normal range at the end of the treatment in 16 (32%) of 41 patients. Follow-up of these patients for 9-48 months (mean 27) has resulted in 5 (12%) relapses in this group. Serum AFP greater than 20kul-1 three months after stopping chemotherapy was a good indicator of residual active tumour and 4 (57%) of 7 patients in this group relapsed. The production of detectable serum AFP is probably related to the type of chemotherapy used and only 7 (14%) of 51 patients treated for gestational choriocarcinoma had detectable AFP concentrations while on cytotoxic chemotherapy. The problem of interpretation of serum AFP concentration in patients with malignant germ cell tumour stresses the need to determine whether there are differences between AFP produced by germ cell tumours and that produced at other sites as a basis for a sensitive assay system able to discriminate between them.

A counsellor in general practice: a one-year survey

A counsellor was included within the professional staff of a practice of 11,000 patients cared for by five partners. A review of her work over a 12-month period is described. Eighty-seven patients were counselled in 197 sessions. Thirty-five per cent of first appointments and 22 per cent of subsequent appointments were not kept. The problems dealt with most frequently were anxiety and stress, marital troubles and abortion. Patients perceived the service as giving relief by allowing them to talk and helping them to work out their problems.

Septic arthritis caused by Pasteurella multocida

A patient with rheumatoid arthritis developed an infection in the right hand after she administered an antibiotic capsule to her cat. Two weeks after this, septic arthritis developed in her right knee. The organism isolated was Pasteurella multocida, which is part of the feline normal oral flora. The infection was treated with penicillin and drainage.

Effect of antihypertensive therapy on plasma catecholamines in renal failure patients

The influence of antihypertensive therapy on plasma norepinephrine (NE) was examined in 58 patients with moderate chronic renal failure (CRF). Six normotensive patients not receiving antihypertensive medicines (mean serum creatinine 2.4 +/-.2 mg/dl) had a modest but significant increase in NE compared to normals in both supine (230 vs. 173 pg/ml, P greater than .05) and upright (482 vs. 377 pg/ml, P less than .05) positions. A striking increase in NE (supine 673 +/- 55, P less than .001; upright 1089 +/- 88 pg/ml, P less than .001) was observed in 34 CRF patients receiving antihypertensive regimens containing diuretic, beta-blocker, or vasodilator drugs either individually or in combination. Vasodilator therapy was associated with the highest levels of NE. In 17 further CRF patients receiving the sympathetic suppressants clonidine or methyldopa in addition to other medicines, NE values were similar to untreated, normotensive patients (supine NE 254 +/- 40 pg/ml; upright NE 474 +/- 61 pg/ml). The age, degree of renal impairment, plasma renin activity, and number and dosage of antihypertensive medicines did not account for these differences in NE. The results suggests that NE levels are modestly increased in normotensive, untreated CRF patients, but are dramatically increased by antihypertensive therapy, particularly vasodilator therapy. Clonidine or methyldopa therapy, however, is associated with significantly lower NE values in these patients despite the concomitant use of vasodilator agents.

The SCM test for cancer. an evaluation in terms of lymphocytes from healthy donors and cancer patients

The SCM test was established as originally described, and an attempt was made to evaluate it using myelin basic proteins. Various later modifications described by the original authors were incorporated as they were communicated to us. In separate studies attempts were also made to overcome some of the problems which seemed inherent in the technique. In the small series for which valid results were obtained we were unable to confirm the original claim that the method discriminates between cancer patient lymphocytes and those from non-cancer subjects with almost 99% reliability. Indeed, although differences were found between the mean SCM values of cancer patients and of healthy controls, these differences were not significant.

Particulate emboli retained by the Intersept (R) transfusion filter; a sem study

The Intersept (R) transfusion filter is the transfusion filter developed by Johnson and Johnson. Filtration is performed by both adsorption and mechanical retention. Not only microaggregates, but damaged and injured cells are likely to be trapped and/or adsorbed. Such a filter is not injurious to the blood components, but thrombotic material accumulation can occur with fresh blood.

Rationality and control in French eighteenth-century medical views of the peasantry

The eighteenth-century medical view of the peasantry offers clues to a series of problems. This essay will treat one of them, namely the processes by which the French medical community in the declining years of theancien régimeand the early years of the Revolutionary period came to justify proposals for intervention in a rural society generally hostile to its claims and suspicious of its motives. The theme of the present study is an exploration of how the ideology of rationality and control, which was being developed in the learned world of the eighteenth century, was reinforced by a group within it that was gaining prestige and searching for means to enhance its professional status and power.Since the demands of such an inquiry are rather large, many of the related questions which it raises, such as the nature of medical knowledge, the contemporary disputes in medical philosophy, and the movement of change from one form of medicine to another, will be touched on only insofar as they have direct relevance to the major need to clarify the medical contribution to the development of the new ideology. In my present conceptualization of the problem, I am concerned to show that there was a close interaction between medical knowledge and the social values of the members of the medical trade, even if there existed no conscious direction of the elements connecting the two, and in spite of the difficulties there are in establishing the precise links mediating intellectual products and their social configurations.