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Results for balloon mitral valvotomy (BMV) are usually reported for large heterogenous groups. Different outcomes are expected for good commissurotomy candidates (Ideal) compared to patients with significant valve deformity who might otherwise be good MVR candidates (Non-Ideal). We defined Ideal as echo score ≤ 6 and Non-Ideal as score ≥ 9/age ≤ 72. Ideal Patients Non-Ideal Patients n 344 154 Age (years) 47 ± 12 54 ± 11 * NYHA 2.8 ± 0.7 2.9 ± 1.6 * Echo Score 4.8 ± 1.4 10.1 ± 1.3 * MVA pre→post 1 ± 0.3→1.8 ± 0.6 1 ± 0.3→1.7 ± 0.6 * MVR 30 days 5.2% 8.1% 3 Yr. Event Free 82% 62% * * = p l 0.01 vs Ideal Conclusions Immediate BMV results for ideal patients with pliable valves and non-ideal patients who would otherwise be MVR candidates are good. Three year event free survival is excellent in ideal patients. Non-ideal patients with significant valve deformity have freedom from death, MVR or repeat PTMC after three years in 62% of cases.

Clinical trials with the Inoue mitral valvotomy balloon have recently begun in the United States. We assessed the effects of 17 demographic, echocardiographic, procedural, and hemodynamic variables on the immediate results, complications, and short-term follow-up of 200 patients in 15 centers undergoing valvotomy with this device. The study population had a mean age +/- SD of 53 +/- 15 years, and the total echocardiographic score was 7.2 +/- 2.4. Valvotomy was technically successful in 96.5% of procedures and increased the mean mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.7 cm2 (p less than 0.001); 72% had an increase in valve area greater than or equal to 50%, and 67% had a final area greater than or equal to 1.5 cm2. Major procedural complications included cardiac tamponade during transseptal puncture (1.0%), systemic embolism (1.5%), and severe mitral regurgitation (2.4%); there were no procedural deaths and one hospital death. Multivariate analysis identified the absence of prior surgical commissurotomy and younger age as significant predictors of the gain in mitral valve area, but the correlation coefficients were low. Although the absence of subvalvular disease on echocardiograms was a predictor of a final valve area greater than or equal to 1.5 cm2, the total echocardiographic score did not correlate well with the immediate outcome (r = 0.01, p = NS). No variable was identified as predictive of restenosis, which occurred according to echocardiographic criteria in 14 of 66 (21%) patients evaluated 6 months after valvotomy. Good hemodynamic results with valvotomy were achieved in the majority of patients with low complication rates by many investigators with the use of the Inoue balloon device.(ABSTRACT TRUNCATED AT 250 WORDS)

Equinus deformity, due to a contracture of the triceps surae, is a frequent problem in cerebral palsy. The authors present a retrospective analysis of the functional status of 27 patients (39 feet) of equinus deformity seen in a 10-year follow-up study. When either a Hoke or White tendo Achillis surgical lengthening procedure was combined with a postoperative management program of night-bracing, the recurrence of equinus deformity was significantly reduced.

(1985). An Empirical Investigation of Leisure Exercise Behavior in Adult Women. Health Education: Vol. 16, No. 5, pp. 29-34.

Hemoccult screening for colorectal carcinoma was begun in 1979 at the Kaiser Permanente Medical Center, Oakland, California, as part of a program for periodic health examinations. A concomitant cost-benefit analysis was conducted to determine the long-term medical care costs and survival benefits of this procedure. Of 14,041 patients greater than or equal to 45 years of age mailed hemoccult slides, 10,255 (70.3%) returned them at the time of their examination. One hundred twelve (1.1%) were positive, and 12 colorectal carcinomas were detected. Additionally, 13 patients with one or more polyps greater than or equal to 1 cm and 45 patients with other gastrointestinal sources of blood were found. Of the screened cases of colorectal carcinoma, 50% were in Dukes' stage A compared with 25% found in this stage in our institution in 1974, when screening was not done. Five-year Dukes' stage-specific medical care costs and mortality rates were developed from the 1974 cases and were then applied to the screened cases of colorectal cancer. A savings in medical care costs of +14,685 and a projected increase of 22 years in life expectancy was found.

James Trussell Office of Population Research, Princeton University, Princeton, New Jersey 08540 Linda G. Martin East-West Population Institute, East-West Center, Honolulu, Hawaii 96848 Robert Feldman Office of Population Research, Princeton University, Princeton, New Jersey 08540 James A. Palmore East-West Population Institute, East-West Center, Honolulu, Hawaii 96848 Mercedes Concepcion University of the Philippines Population Institute Datin Noor Laily Bt. Dato' Abu Bakar National Population and Family Development Board, Malaysia

Examined the health behaviors practiced by psychotherapists (N = 86) themselves and the extent to which they focus on these behaviors with their clients during the course of psychotherapy. The specific health behaviors investigated were dietary habits, physical exercise, relaxation practices, sleeping, alcohol consumption, and smoking. Results indicate that psychotherapists are at this time actively engaged in both evaluating and making recommendations to their clients in the areas of diet, physical exercise, and relaxation practice. In addition, 51% of those who participated in this study evaluate health practices of their clients and make recommendations with regard to their physical health. While only 47% agreed that it is important for the psychotherapist to assess the typical client's physical health status, 72% of this group frequently inquire about chronic illness during an intake session.

In a prospective study, two nutrition behaviors, meat and sodium consumption, were examined utilizing a social psychological model of health behavior suggested by Wallston and Wallston. The model conceptually integrates elements from the Health Belief Model, Fishbein's attitude-behavior model, and Triandis' theory of social behavior. According to the model, behavior is a function of behavioral intent, habit, and facilitating conditions. Behavioral intent is a function of affect, perceived consequences, and social and personal norms. In this study, the model explained a significant proportion of the variance for each self-reported nutrition behavior and behavioral intent. Hierarchical regression analyses indicated that all three factors contributed to the prediction of behavior, and differences between meat and sodium consumption were found. For behavioral intent, each of the components made a significant contribution, with affect being the best predictor.

T3he functional affinity and IgG subclass of antibodies to ss and dsDNA were measured by ELISA in five serial samples from 41 patients with systemic lupus erythematosus (SLE) who were divided into relatively homogeneous disease subgroups. Anti-dsDNA antibodies were restricted to IgG1 and IgG3 in renal disease and levels increased with disease severity. Functional affinity of IgG1 and IgG3 anti-dsDNA fell in patients with severe renal disease, suggesting that the high affinity antibody population lost from the serum was localizing in the kidneys. IgG2 anti-dsDNA were found in patients with joint and skin disease alone and in the thrombotic/spontaneous abortion subgroup. IgG2 antibody levels did not correlate with disease severity but did correlate with the presence of antibodies to Klebsiella K30 and may have represented a cross-reactive antibody population.

The registered nurse is a logical health professional to be trained quickly and easily to assist the physician in adult health evaluation. A formal sixmonth course has prepared nurses to perform adult health appraisals under physician supervision in a large automated health appraisal unit. Their success in discharging this responsibility over an 18-month period suggests that nurse practitioners so trained can be important in health appraisal and other extended adult health care roles.

Although irradiation for the treatment of acromegaly was introduced more than fifty years ago (1, 4), there is still lack of complete agreement on the selection of responsive cases and on optimal technic. Irradiation was first used for pituitary adenomas because of the high mortality and morbidity associated with surgical procedures on the hypophysis. Subsequently, its value was proved and it remains the procedure of choice except in patients with large tumors of long standing or with visual field defects sufficiently critical to require immediate decompression (2). In the latter group radiation is generally administered only after partial hypophysectomy for decompression. At present, external gamma or roentgen rays are commonly used, but surface applications or implants of radium (5), radioyttrium (8), colloidal chromic phosphate (10), and even the collimated proton beam from the synchrotron (7) have been employed. Over the years, two technics of radiation therapy for pituitary adenoma have evolved. The ...

There is increasing evidence that folic acid deficiency in pregnancy is more common than previously recognized and that this condition is associated with certain complications of pregnancy, both maternal and fetal. We have evaluated folate deficiency in pregnancy complications, normal pregnancies, and nonpregnant controls, employing the following procedures: (1) blood and marrow morphology, (2) urinary FIGLU excretion after histidine loading, and (3) fasting serum and whole blood L. casei folic acid activity. Results to date indicate that (1) significant folic acid deficiency may be present without overt megaloblastic anemia, (2) the incidence of deficiency in our population group is 22 per cent, (3) the incidence increases at or near term, and (4) the incidence is markedly increased in pregnancy complications, particularly toxemia. The possible maternal and infant hazards of abnormal folic acid metabolism are summarized, and the therapeutic implications presented.

A 5-yr-old girl with hemoglobin E-β thalassemia was discovered in a family of mixed origin. The father is Iranian (β-thalassemia trait) and the mother is Burmese (hemoglobin-E trait). Hemoglobin synthesis was studied in vitro in the blood of the proposita and family members. In the subjects with hemoglobin E trait the ratio of the quantity of hemoglobin A to hemoglobin E was 3:1. However. the βA/βE synthesis ratio in reticulocytes was in the range of 1.5-2.18, and the specific activity of βE was 31%-49% greater than βA, suggesting instability of hemoglobin E with preferential destruction of abnormal hemoglobin. The blood of the proposita exhibited only hemoglobin F and hemoglobin E and reticulocytes and bone marrow showed no βA synthesis. This Iranian β-thalassemia gene is therefore of the β° type. The βE/α synthesis ratio (approximately 0.74) in blood of the proposita was similar to the βA/α ratio in mildly affected relatives with thalassemia trait. These results suggest that the severity of the hemoglobin E-β thalassemia syndrome is attributable to both instability and defective synthesis of hemoglobin E in association with absent βA synthesis due to a β° thalassemia gene.

High-resolution, divergent-beam x-ray diffraction photographs reveal previously unreported detail in multiple Borrmann (000), (111), (111) reflections undergoing anomalous transmission through perfect germanium crystals. These have been accounted for satisfactorily using the plane-wave formulation of the dynamical theory of x-ray diffraction.

A 23-year-old paraplegic patient experienced two episodes of substantial hemorrhage from an ischial pressure sore. Computed tomography showed that the wound extended into the pelvis and retroperitoneum, and arteriography demonstrated a pseudoaneurysm of the internal pudendal artery. The artery was selectively embolized, permitting debridement and flap coverage uncomplicated by bleeding. Bleeding from a pelvic extension of a pressure sore can be a catastrophic combination of distorted anatomy and relatively inaccessible vessels. As in hemorrhagic complications of pelvic trauma, tumors, and radiation, arteriography and transcatheter embolization can localize and control the source of bleeding.

The inhibitory effect of selenium (Na2SeO3) on the vascularization induced by amelanotic tumor implants (A Mel-4B32) n the Syrian hamster cheek pouch membrane is reported. Among control animals receiving A Mel-4B32 implants, 19 developed tumors out of 19 chambers with capillary proliferation being observed on day 4 after implant. Addition of 50 microgram Se to the chamber at the time of tumor implant delayed the initial observation of capillary proliferation until day 10 after implant. In the 50 microgram Se treated group, tumor-induced vascularization developed in 11 of 15 chamber implants and not in the remaining 4. Intermediate doses of 5 and 10 microgram Se added to the chamber at the time of tumor implant delayed the initial observation of capillary proliferation to days 7 and 9, respectively, with tumors developing in all chambers. Neither sodium nor sulfite altered the vascular pattern. Capillary proliferation was observed on day 4 after tumor implant when either 50 microgram NaCl or 50 microgram S as Na2SO3 were added to the chamber at the time of implant. Provision of Se as a drinking water supplement also delayed the onset of capillary proliferation.

4. Granoff DM, and Roskes S: Urinary tract infection due to Haemophilus influenzae type b, J PEDIATR 84:414, 1974. 5. Doolittle KH, et al: Epididymitis in the prepubertal boy, J Urol 96:364, 1966. 6. Haahr J, et al: Epididymitis in children, Acta Paediatr Scand 60:16, 248, 1971. 7. McDonald JH, et al: Acute pneumococcal epididymitis, Ill Med J 95:304, 1949. 8. Davis WH, and Scardino PL: Meningitis presenting as epididymitis, Southern Med J 65:9360, 1972. 9. DeLeon W: Report of a case of meningitis, arthritis, and epididymitis due to mixed Pfeiffer bacillus and pneumococcus infection, J Phillipine Islands Med Assn 1:195, 1921. 10. Samellas W: Acute epididymo-orchitis associated with bacteremic shock, J Urol 89:370, 1963.

Summary Electrophysiologic studies in one patientwith spontaneous 2:1 atrioventricular block and variable PR intervals revealed two sites of conduction block. Typical 4:3 A-V nodal Wenckebach was present in addition to Mobitz type II infra-His block. The HV of conducted complexes was 120 msec and the shortest recorded AH interval was 250 msec. When 2:1 A-V block with fixed PR interval was present, only 2:1 Mobitz type II infra His-block was present. The mechanism of this example of spontaneous multilevel A-V block is discussed and compared to other previously reported cases.

Summary Hemolytic disease of the newborn infantdue to isosensitization by the S blood group factor in an Rh-positive mother resulted in postnatal hyperbilirubinemia and a “late anemia” syndrome in the infant. In our case, as well as in two of the three previously reported cases, the isosensitized pregnancy followed previous blood transfusions.

Publisher Summary This chapter describes the prophylactic use of oral hypoglycemic drugs in asymptomatic diabetes. In a study described in the chapter, research subjects were randomly assigned to three treatment groups. The asymptomatic nature of the diabetes in the population was emphasized by the mean fasting blood sugar (FBS) of 105 mg/100 ml for all subjects and by a FBS in three-quarters of the total group >110 mg/100 ml. The rest of the glucose tolerance curve was well above normal. While insulin response varied widely, the mean curves were typical of mild maturity-onset diabetes. The treatment groups did not differ in MNC velocities at first testing. A year later, a group difference was noted between placebo and phenformin groups for the ulnar nerve. The mean duration of therapy at the time of second testing for pulse-wave velocity (PWV) and MNC was about 2 ½ years. Individual-paired second and first MNC velocities showed several statistically significant differences between treatment groups and indicated that, in all three tested nerves, the greatest improvement was in the phenformin group.

Lead neuropathy has been considered an infrequent occurrence in children with lead intoxication. Acute encephalopathy may overshadow its recognition, but chronic exposure to lead may produce changes in peripheral nerve fibers that result in altered conduction characteristics. In this study 24 Boston children with known plumbism were found to have reduced mean motor nerve conduction velocities as compared with normal children. This finding may provide a valuable test for discovering minimal peripheral neurotoxic effects of chronic exposure to lead ingestion.

Two infants cases of acute purulent mediastinitis. Symptomatology and pathogenesis, in addition to the description of a peculiar type of respiration, may have early diagnostic significance. Acute mediastinitis should be included in the differential diagnosis of disease which constitutes respiratory emergencies.