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'Nutcracker syndrome' encompasses classical symptoms of hematuria and flank pain resulting from the compression of the left renal vein between the aorta and the superior mesenteric artery. In patients with unexplained left-sided hematuria, flank pain or non-specific abdominal pain, careful interrogation of diagnostic abdominal imaging should be performed to exclude the possibility of external compression on the left renal vein. The patient discussed in this case report is a 19-year-old woman with unilateral hematuria. Her symptoms started 13 months prior with nausea, lower abdominal pain and weight loss. Six months after the nausea began, she started having syncope, sometimes multiple episodes in one day. Syncope is one of the more rarely reported symptoms associated with nutcracker syndrome. As more cases are reported, endovascular repair is becoming an alternative treatment for nutcracker syndrome. The patient was treated with stenting of her left renal vein. At the three-week follow-up, she reported near resolution of nausea and abdominal pain. She had gained four pounds, no longer had gross hematuria and had had no episodes of syncope and her blood pressure had normalized. Endovascular specialists should be aware of the variety of symptoms that can occur with nutcracker syndrome, including syncope. The severity of these symptoms should guide the recommendation for intervention.

Modern health care reform emphasizes efficient resource and facility management and the need to develop strategies to direct patients with lower-acuity concerns away from the relatively cost-inefficient full-service pediatric emergency department (ED). This study examined a pediatric fast track system for triage accuracy and turnaround times. Egleston Children's Hospital is a regional, urban, tertiary-care academic center which is a major teaching affiliate of Emory University School of Medicine. The pediatric ED has an annual census of more than 30,000 patient encounters. During the 9-month period from December 1993 through August 1994, 2,243 lower-acuity patients were evaluated in the fast track section of the ED. Patients assigned to the fast track system maintained a quicker turnaround time than the aggregate of all patients seen in the ED (107 [95% CI 0, 245] minutes versus 149 [95% CI 0, 341] minutes, P < .01). Their total turnaround time was also less than that for patients with similar acuity levels seen during the hours that the fast track system was not in operation (120 [95% CI 0, 300 minutes], P < .01). Only 63 of the 2,243 (2.8%) patients assigned to fast track were found to have higher acuity levels than suspected at initial triage. In all cases they were appropriately cared for in the fast track area. The fast track system appears to be an effective method by which an urban pediatric ED can efficiently maintain patient flow in light of limited resources, space constraints, limited manpower, and an increasing census.

Even with circulatory arrest during pulmonary thromboendarterectomy, continued back-bleeding obscures the operative field. This necessitates frequent interruptions of dissection to allow aspiration with a second instrument. Therefore, pulmonary thromboendarterectomy dissectors are described that allow simultaneous suction of blood from the operative field. Before the use of these dissectors, circulatory arrest time was 59 +/- 23 minutes in 124 consecutive patients. In the last 10 consecutive patients using these dissectors, the mean circulatory arrest time has been 52 +/- 22 minutes (p = not significant). It is anticipated that with a larger database, the ability to aspirate blood simultaneously during the dissecting process will result in a significant shortening of circulatory arrest time.

The acute effects on sexual behavior of oxazepam (16--64 mg/kg), chlordiazepoxide (8--64 mg/kg), chlorpromazine (2--8 mg/kg), and d-amphetamine (0.8--3.2 mg/kg) were examined in intact male and female golden hamsters (Mesocricetus auratus). Intraperitoneal injections were given 45 min before the first behavioral test. In 10-min tests, lordosis was observed in estrous females both before and after copulation, and mounts, intromissions, and ejaculations were observed in males. Dose-response related decrements in male sexual behavior were observed following chlorpromazine and chlordiazepoxide. All dose levels of oxazepam depressed male sexual behavior. The highest dose of chlordiazepoxide and oxazepam attenuated the onset of female sexual behavior, and all dose levels reduced postcopulatory lordosis durations. Amphetamine did not interrupt either male or female sexual behavior, and chlorpromazine disrupted male but not female behavior.