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• Albumin replacement to correct hypoalbuminemia in critically ill patients has been controversial. This study was a prospective, randomized trial of 25% albumin administration in 40 hypoalbuminemic (serum albumin, 25 g/L [2.5 g/dL]), critically ill patients. The treatment group (18 patients) received 25% albumin supplementation to achieve and maintain serum albumin levels of 25 g/L (2.5 g/dL) or greater, while the nontreatment group (22 patients) received no concentrated albumin. There was no clinical benefit from albumin therapy when assessing mortality (39% vs 27%, treatment vs control) or major complication rate (89% vs 77% of patients). There were also no significant differences in length of hospital stay, intensive care unit stay, ventilator dependence, or tolerance of enteral feeding, despite significant elevations of albumin in the treatment group. The costly use of exogenous albumin as treatment for hypoalbuminemia in this patient population does not appear to be justified. ( Arch Surg . 1990;125:739-742)

We have determined this item to be in the public domain according to US copyright law through information in the bibliographic record and/or US copyright renewal records. The digital version is available for all educational uses worldwide. Please contact HathiTrust staff at hathitrust-help@umich.edu with any questions about this item., Isles of Scilly (England)--Description and travel., (LCCN)31008101., (OCoLC)ocm06873066., Sdr-ia-srlf625992., DA670.S41 B7., DA670.S2 B74., Http://hdl.handle.net/2027/mdp.39015074814032., Http://hdl.handle.net/2027/uc2.ark:/13960/t77s80r2p.

This study of the records of 193 consecutive patients admitted for penetrating anterior chest wounds was carried out to specifically define the need for emergent thoracotomy or laparotomy. The mechanism of injury was a stab wound in 119 patients and a gunshot wound in 74 patients. Seventy-three of the patients (38 percent) required either early thoracotomy (21 percent) or laparotomy (17 percent). In the upper chest region, 83 percent of the operations were thoracotomies, whereas in the lower chest region, 81 percent were laparotomies. Pericardial tamponade, chest tube output, and hypovolemic shock comprised 91 percent of the decisive signs for thoracotomy. The predominant reason for laparotomy was diagnostic peritoneal lavage (63 percent of patients). Plain abdominal roentgenograms were helpful to confirm diaphragmatic missile traverse. Our findings support selective operative management of anterior chest wounds as guided by injury mechanism and entrance location.

Between 1961 and 1976, 257 patients with cancer of the uterine cervix were treated with fields of irradiation higher than 17.5 cm. During that period, 76 patients had a selective lymphadenectomy as part of an investigation of the potential value of the procedure. Because of excessive diarrhea and late complications, adjustments were made in the treatment schemes. The poor survival rates and the high incidence of distant metastases were to be expected since almost all patients had disease in the regional lymphatics. Severe complications were frequent. Using the Cox logistic regression method, the various parameters involved, i.e. the height of the extended fields, the dose to the extended fields, additional external irradiation boost doses, intracavitary radium therapy doses, and surgical or no surgical procedures, were correlated with the complications. The largest contributor to the high complication rate was found to be the dose to the extended fields. A total dose of 4,500 rad to the extended fields at a rate of 900 rad per week is all that can be given safely. In patients with positive lymph nodes and no massive parametrial disease, intracavitary gamma-ray therapy can be performed without diminution of dose. In patients with massive parametrial disease, the disease outside of 15 × 15 cm fields could be ignored in order to give a higher dose to the pelvis, producing local control and, therefore better palliation. The study results reemphasize that the size of the treatment fields is a very important factor in the complication rate.

Proper diagnostic test selection and logical sequencing can minimize cost without compromising care. This study analyzes the logic for sequencing tests either in series (one after another) or in parallel (simultaneously). A model is created using 2 diagnostic tests for 2 diseases. Tests are assumed to have perfect performance characteristics. Factors involved in cost-effective test sequencing include cost of each test, test performance characteristics, per diem hospital charge, and the clinician's prior probability of the suspected diagnosis based on history, physical examination, and previous laboratory data. At a given point of clinical suspicion, cost-effective sequencing strategy should shift. In general, a cheap test can effectively be used in parallel even at low diagnostic probabilities; an expensive test should, in general, be used in series only when there is a high prior probability of diagnosis. High per diem hospitalization costs--such as for a patient in the intensive care unit--favor in parallel testing. Clinical acumen and suspicion of diagnosis (prior probability) primarily direct cost-effective diagnostic test sequencing. Decision analysis of diagnostic test sequencing represents a technique for making cost-effective decisions for sequencing and, thereby, minimizing costs while achieving optimal patient care.

The address deals with the many problems facing the distribution engineer. To indicate the scope of the work of the Transmission Section, the author draws attention to the enormous possibilities of developing the consumption of electricity both in urban and in rural areas. Reference is made to the all-electric home of the future with a consumption of not less than 24 000 units per annum; and the possibilities of rural development with its present power consumption of the equivalent of 2 147 million units. It is shown that rural electrification, when considered on the basis of consumption per mile of conductor, offers a load of over 18 500 units per mile per annum?a figure which compares favourably with that of suburban districts. The immediate work awaiting the attention of the Section is briefly surveyed and particulars are given of a specification prepared by the Overhead Lines Association for standard outdoor transformers suitable for suburban and rural development. The radical changes taking place in agricultural practice are shown to offer unlimited opportunities to the electricity supply undertakings. As an example of what can be done to reduce the cost of overhead lines, particulars are given of an ?X?-pole line, costing about £70 per mile, which the author is employing on his estate. Thermal-storage cookers and water heaters, specially suitable for use in rural areas, are described, and the applications of an automatic change-circuit system in conjunction with such apparatus is discussed.

There are few pieces of coast scenery in England so little familiar to the tourist as the northern shores of Cornwall. Unexplored, yet well worth exploring, that bleak district still happily remains a “land beyond railways.” Of the treasures it has in store for the geologist, or the lover of natural history, it would be superfluous here to speak; suffice it to say, that, in the shape of cliff castles and tumuli, it presents to the antiquary one continued series of objects of interest. Along the whole line there is scarcely a high piece of cliff or a promontory which does not bear on its rough crest some landmark of pre-historic times. So rapidly, however, is the work of denudation going on, that even within the memory of those now living many a tumulus has fallen a prey to the sea, carrying with it, probably, the bones of some ancient rover, thus rudely restored to that element on which, centuries ago, his bark so gallantly rode. To quote one of the most striking examples of the encroachment of the sea since man left his traces on the cliff, I will take the instance of a “cliff castle” three miles to the north of the town of Camborne. This fortification, in common with all these singular entrenchments, was raised for purposes of defence against the land side, and consists of a double line of earthworks drawn across the neck of what was once a promontory some 70 paces broad. Within these ramparts, where once no doubt there was ample space to accommodate the whole defending force, there is now nothing but a precipice descending abruptly to the sea, some 300 feet below, and leaving scarcely standing room for a single individual between it and the inner side of the earthwork. I mention this instance of the rapidity of the process of denudation on this coast because, from their close proximity to the edge of a similar cliff, it is highly probable that in another half century the very barrows I am about to describe will have shared the same fate.

The coast-line of the extremity of Western Cornwall has been so often laid under contribution of late by the artist's pencil, that its general features are familar to many who have never paid the country a personal visit. The fantastic forms which the weather-worn granite assumes as it rears itself in bosses (or “karns” as they are locally termed) between the deeply-cleft gullies down which the streams of red mine-water find their broken way, are the characteristics of that portion of the cliff which, lying between the promontories of the Land's End and Cape Cornwall, are turned most directly towards the setting sun. It is along this line of coast—some six or seven miles in extent—that the stone cairns which formed the burying-places of an early population are found in greater abundance than is the case in any other portion of the district. Along this same strip of sea-board are no less than three of those fortifications known as cliff castles, defended in each case by lines of ramparts crossing the necks of headlands from side to side, terminating at either end in the abrupt precipice of the cliff, and always intended to resist attack from the land side. Within these lines stone cairns are frequently found—a fact which seems to point to the conclusion that the latter are the more recent of the two; since, were it not so, the castle-builders would have availed themselves of the pile of stone already on the spot and ready to their hand.

The term "electro-farming" is defined, and the importance of agriculture as the world's largest industry is emphasized. Based on experimental work conducted on a commercial scale, the author considers that the highest efficiency in farming can be reached only by electrical methods. The applications of electricity on the farm are many and are shown in an exhaustive table under the following classification:-(1) Uses in the farm buildings, (2) on the farm land, (3) crop treatment, (4) in the farm house. The farmer is really a manufacturer, but his present methods are based on abundant cheap labour and unlimited time. Before the engineer can apply modern manufacturing principles he must understand the technicalities of farming. Data are given to show that the farm load is an attractive one from the central station standpoint, and a simple distribution system is outlined. Restricted maximum demand is advocated as a basis for power rates, as it encourages the extended use of electricity. Simple and robust design is essential in all farm machinery. The use of electric motors is discussed and tables are given of motor sizes required for various duties and of the work done per unit consumed. Inexpensive and simple arrangements of portable motors are described. In the Appendix, which follows the classification stated above, examples are given of the profitable use of electric light, e. g. in avoiding milk loss, increasing winter egg production, etc. A suitable wiring system is described. Other farm-building uses of electricity considered in some detail are milk sterilization, and the incubation and rearing of poultry. Reference is made to the weather reports issued by wireless from the Meteorological Office. Irrigation is considered, and the present position of electric ploughing is discussed at length. Single-rope haulage is the most suitable method at present available and is adapted for use in small fields. In the case of

(1873). Vestiges of Early Habitation in Cornwall. Archaeological Journal: Vol. 30, No. 1, pp. 325-348.

A new industry calls for new methods—autrea jours, autres mceurs—and the aeroplane industry is therefore not exceptional in demanding many departures from recognised woodworking practice. In the first place the number of machines required to–day is so large that their construction should be described as a manufacturing rather than a building operation. That is to say, they should preferably be almost entirely put together by the aid of accurate machinery instead of being dependent to such an extent upon the skill of the individual workman, in trying and fitting one part to another until the whole is built up. In this connection it may be remarked that the design of the metal fittings for aeroplanes is not such as to call for any radical departure from previous high class small metal working practice. It is the woodworking side of the business which presents the new scope for initiative. It is this latter aspect, therefore, which will be considered here.

The reports on surgical techniques that specifically focus on the management and outcome of patients on chronic hemodialysis (CHD) who undergo major intra-abdominal procedures--particularly of an emergency nature--are few. It is hoped that by analysis of our experience the nature of the problem can be further clarified and guidelines for clinical care can be formulated. Thirty-two cases which encompass a 7-year period (1978 to 1985), were reviewed. Seventeen patients underwent elective surgery and fifteen underwent emergency intervention. There was a wide range of cases that were similar to those most generally seen in an acute-care teaching hospital. The morbidity and mortality rates in elective surgery patients were 12% and 6%, respectively, while in the emergency cases, these rates were 62% and 47%. Patients with diabetes had the highest morbidity and mortality. These results were analyzed, and we conclude that CHD patients at risk with a surgically correctable condition should be considered for elective intervention, even if they are currently free of symptoms. This may be particularly true for CHD patients with diabetes.

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MR. LUKIS, in a paper recently read before the Society of Antiquaries, nominally “On certain Erroneous Views respecting the Construction of French Chambered Barrows,” but really a method of criticising severely Mr. Fergusson's work on the “Rude Stone Monuments,” states that it is an “error” to suppose that the Dolmens of that country were ever free-standing; in other word, he lays down the “rule,” “there were no free-standing dolmens in France.” The announcement that, with regard to monuments of whose fashioners we know absolutely nothing, a universal negative of this kind can be safely laid down as a law, would be startling, did it not come from one who is backed by such extensive inductive evidence as is Mr. Lukis. His “rule” was “established by the extreme rarity of the instances.” This being the case, he calls those “in error” who would, from these instances, form a small class, or species of dolmen. As, in an essay on the Cornish sepulchral monuments, which you recently most kindly reviewed at length, I am committed to this latter view—one, by the way, which I had struck out for myself before the appearance of the “Rude Stone Monuments,”—will you kindly permit me to call your attention to one structure which I have ventured to place, and shall still venture to place, in the discarded class? I do so as a protest against the dictum of Mr. Lukis being extended to our British examples, before a careful scrutiny has been made of every monument of the kind from one corner of our islands to the other. On this single instance, such as it is, it must be clearly understood that I build no theory; it will be for others to judge whether it does not afford some evidence of the difference in construction and use of the dolmen or table-stone proper, and the kist-vaen cromlech; one thing only I will add, that, limited as my experience is to the monuments of Britain, I shall not be exposed to the temptation of explaining away any observed fact in order to reconcile a doubtful comparison. Without feeling that I am guilty of “dabbling in archteology,” or of setting forth “any dogmatic expositions of hypotheses” (!!), or of “establishing my proposition from second-hand information,” or in short of being the victim of any very “erroneous view” (all which faults Mr. Lukis finds in those who differ from him), I consider that the following facts justify my statement that the monument I am about to describe always was, as it is now, a free-standing dolmen.

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