Changes in average length of stay and average charges generated following institution of PSRO review

A five-year review of accounting data at a university hospital shows that immediately following institution of concurrent PSRO admission and length of stay review of Medicare-Medicaid patients, there was a significant decrease in length of stay and a fall in average charges generated per patient against the inflationary trend. Similar changes did not occur for the non-Medicare-Medicaid patients who were not reviewed. The observed changes occurred even though the review procedure rarely resulted in the denial of services to patients, suggesting an indirect effect of review.

Planning for ambulatory care: simple methods for improving patient flow

A combined patient flow and work sampling study was done at the Ambulatory Pediatric Service of the Medical University of South Carolina. The biggest problem was that almost two thirds of the patient's time was spent waiting to see the doctor. Reasons for delay included too few examining rooms, the single block appointment system, and design of the facility.

Carcinoma of the endometrium: radiation followed immediately by operation

A prospective study was established in August, 1967, to treat all adenocarcinomas of the endometrium by protocols of preoperative radiation followed immediately by operation. Two hundred and ninety-five women have been treated, 220 of whom had Stage I disease. In these cases, factors known to be associated with survival were studied, and their influence upon survival was noted. Preoperative radium followed immediately by operation was the primary method of therapy. Life tables demonstrated a five-year survival rate of 91 per cent with a low complication rate in patients with Stage I disease. Cell type, degree of differentiation, and depth of myomentrial invasion were the primary factors influencing survival.

Melanin in the rat brain

Melanin was measured in various parts of the rat brain by a spectrophotofluorometric assay. This method could detect natural, Sepia melanin as well as melanin synthesized from L-DOPA. Contrary to published expectations of other investigators, measurable amounts of melanin were found in the brain of albino as well as pigmented rats. The highest concentrations of melanin occurred in the pons-medulla and midbrain, but all regions within the blood-brain barrier contained greater concentrations than samples from many other tissues in the body. No significant change in the melanin content was found after various endocrine manipulations such as removal of the pituitary, pineal, adrenals, thyroid, testes, or ovaries, exposure to constant illumination or darkness, and daily injection for 5 weeks of alpha-MSH, Pro-Leu-Gly-NH2 (MIF-I) or melatonin. As expected, retinal tissue from black-hooded rats contained extremely high levels of melanin whereas that from albino rats contained no melanin. It is thought that the presence of melanin in the brain of albino and pigmented rats may have a function which is still unknown.

Modification of renin reactivity by lipids extracted from normal, hypertensive, and uremic plasma

Plasma renin reactivity (PRR), the in vitro rate of angiotensin generation after addition of renin, is greater in plasma of hypertensive patients and uremic patients than in plasma of normotensive control subjects. To determine if this difference is due to different substrate reactivities, substrate was denatured and replaced with homologous substrate. After a 180 min incubation, PRR in normal plasma (73 ng/ml +/- 5 SE) was less (P less than 0.01) than that in hypertensive (112 ng/ml +/- 15 SE) or uremic (123 ng/ml +/- 39 SE) plasma. To determine if uremic plasma lacks a renin inhibitor, buffer or plasma was added to renin-renin substrate. Less angiotensin was generated (P less than 0.05) with normal (72 ng/ml +/- 4 SE) and uremic (88 ng/ml +/- 4 SE) plasma during 30 min than with buffer (107 ng/ml +/- 4 SE). After 180 minutes, less angiotensin was generated with normal (P less than 0.05) but not uremic plasma (P greater then 0.6), than with buffer. In vitro angiotensin generation was inhibited by lipids extracted from normal plasma. Lipids were separated into acetone soluble (neutral lipids) and acetone insoluble (phospholipid) fractions. Acetone soluble lipids, extracted from normal plasma, competitively inhibit renin: renin was not inhibited by acetone insoluble lipids. Acetone soluble lipids extracted from uremic plasma inhibited PRR to a lesser extent than lipids from either normal plasma or hypertensive plasma (P less than 0.01). Increased PRR in uremic plasma may be related to the deficiency of a circulating acetone soluble renin inhibiting factor.

Renal tubular reabsorptive response to hypernatremia

Renal tubular reabsorptive response to rapid infusions of isotonic saline and 5% NaCl solutions were measured during brisk ethacrynic acid diuresis in anesthetized dogs. When adjustments were made for effects of variations in volume expansion, as indexed by plasma protein concentration ([Pprot]), tubular reabsorption of sodium per unit filtrate volume (TNa/GFR) was found to be significantly and positively correlated with plasma sodium concentration ([PNa]) despite hypernatremia and total body surfeit of sodium. The proportions of sodium and water reabsorbed were also homeostatically inappropriate, since the sodium concentration in the reabsorbate was somewhat in excess of that in contemporary plasma ultrafiltrate. These findings signify that glomerulotubular balance holds when the filtered load of sodium is increased by an increment in [pNa] as well as GFR. It is proposed that the moiety of tubular reabsorption (some 75% of GFR) studied here is more closely related to regulation of volume than of osmolality of sodium concentration, and the primary regulation exerted is on tubular volume reabsorption (bulk fluid reabsorption) rather than on the amount of sodium reabsorbed.

Stimulation of luteinising hormone (L.H.) release after oral administration of an analogue of L.H. releasing hormone

An analogue of luteinising-hormone-releasing hormone ([D-Leu-6, desGly-NH2-10]-L.H.R.H.-ethylamide) was administered by mouth to thirteen healthy men. In eight men 10 mg of this superactive L.H.R.H. analogue significantly increased mean plasma-L.H. within 45 minutes of administration. This increase was sustained for more than 5 hours. 2 mg of the analogue did not significantly increase plasma-gonadotrophin concentrations in the five men to whom this smaller dose was given. Oral administration of some L.H.R.H. analogues would seem to be effective in releasing L.H. in man.

Evidence for the existence of an acetone soluble renin inhibiting factor in normal human plasma

After addition of exogenous human renin, the in vitro rate of angiotensin I generation is faster in plasma of patients with chronic renal insufficiency and, to a lesser extent, in plasma of patients with essential hypertension than in plasma from normotensive control subjects. The increased reactivity of renin in hypertensive and uremic plasma is not related to differences of endogenous renin activity, angiotensinase activity, renin substrate concentration, or substrate reactivity. Addition of normal, hypertensive, and uremic plasma to a human renin-sheep renin substrate system inhibited the rate of angiotensin generation, although significantly less inhibition was observed with uremic plasma. The reactivity of renin increased in normal plasma but not in uremic plasma after treatment with 95% acetone. After acetone extraction renin reactivity in normal and plasma inhibited the rate of angiotensin generation in a renin-renin substrate system. Less inhibition occurred with the acetone extract from a pool of uremic plasma. These results provide evidence for the existence of a naturally occurring acetone soluble renin inhibiting factor in normal and uremic plasma. The increased reactivity of renin in uremic plasma may be related to a deficiency of this factor.

Relation of large birthweight to maternal diabetes mellitus

The records of 517 pregnancies which terminated in the delivery of infants weighing 9 lb or more were reviewed. The obstetric patient most likely to deliver a large birthweight infant was characterized. Toxemia, prolonged labor, and puerperal morbidity occurred with increased frequency. Many of the deliveries were complicated by fetopelvic disproportion with resultant increase in mid-forceps deliveries, cesarean sections, and perinatal morbidity. Five of the 517 patients delivering large birthweight infants were known to have diabetes mellitus prior to the pregnancy included in this study. An additional 369 patients were evaluated with intravenous glucose tolerance tests. Thirty-eight (10.3%) of the 369 tested proved to have diabetic glucose tolerance curves. The likelihood of finding maternal diabetes mellitus increased with the infant's birthweight. Multiple regression analysis of other clinical variables failed to predict which patients would prove to have diabetes. Identification of diabetic puerperas requires that glucose tolerance tests be performed in all who delivered large birthweight infants.

Carcinoma of the esophagus

Life tables were computed from the Tumor Registry at the Medical University of South Carolina on 486 patients with histologically proven squamous cell carcinoma of the esophagus. The 5-yr follow-up was available in only 394 patients, or 81% of the total sample. For purposes of comparison with published literature, the traditional crude 5-yr survival percentages in the life-table analyses figures are presented. The life-table calculation utilizes all follow-up information available, in that patients observed for less than 5 yr still may contribute to the estimate of the true 5-yr survival rate in contrast to the past when all patients lost to follow-up were presumed to have died. In this method, patients not observed for the full time of the study are assumed to have had the same risk of dying as patients followed to the end of the fifth year experienced in their fifth-year analyses. The group with the most favorable prognosis in this series was that receiving preoperative irradiation. This operation. They were given 4,500 rads of supervoltage X ray over a period of 3 weeks prior to operation. The differences in surgical or radiation techniques employed by various reporters make comparative data difficult, if not impossible, to evaluate. Supervoltage irradiation has proved itself in some hands equal to surgery. A randomized prospective study would seem appropriate to conclude the best means of managing epidermoid carcinoma of the esophagus.

Dose-response relationship of luteinizing hormone to luteinizing hormone--releasing hormone in man

In previous clinical studies with highly purified porcine luteinizing hormone-releasing hormone (LH-RH), administration of the somewhat arbitrarily chosen doses of 700-1500 mug resulted in increased serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The present study determined the minimum effective dose as well as the relationship of the response of serum LH and FSH to the dose of LH-RH administered. Three normal men received i.v. injections of 1.1-810 mug of LH-RH. A dose of 10 mug of LH-RH caused a statistically significant elevation in serum LH. 30 mug of LH-RH significantly increased serum FSH levels. A highly significant linear trend was observed in the log dose-response curve. The results indicate that both LH and FSH release occurs in man with doses of LH-RH much lower than previously used and that a linear log dose-response relationship can be obtained.