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Among female rats, some individuals show estrus cycle-dependent irritability/aggressive behaviors, and these individual rats may be used as a model for premenstrual dysphoric disorder (PMDD). We wanted to investigate if these behaviors are related to the estrus cycle phase containing moderately increased levels of positive GABA-A receptor-modulating steroids (steroid-PAM), especially allopregnanolone (ALLO), and if the adverse behavior can be antagonized. The electrophysiology studies in this paper show that isoallopregnanolone (ISO) is a GABA-A-modulating steroid antagonist (GAMSA), meaning that ISO can antagonize the agonistic effects of positive GABA-A receptor-modulating steroids in both α1β2γ2L and α4β3δ GABA-A receptor subtypes. In this study, we also investigated whether ISO could antagonize the estrus cycle-dependent aggressive behaviors in female Wistar rats using a resident–intruder test. Our results confirmed previous reports of estrus cycle-dependent behaviors in that 42% of the tested rats showed higher levels of irritability/aggression at diestrus compared to those at estrus. Furthermore, we found that, during the treatment with ISO, the aggressive behavior at diestrus was alleviated to a level comparable to that of estrus. We noticed an 89% reduction in the increase in aggressive behavior at diestrus compared to that at estrus. Vehicle treatment in the same animals showed a minimal effect on the diestrus-related aggressive behavior. In conclusion, we showed that ISO can antagonize Steroid-PAM both in α1β2γ2L and α4β3δ GABA-A receptor subtypes and inhibit estrus cycle-dependent aggressive behavior.

Most neonatologists will be named as a defendant in a medical malpractice lawsuit during their careers. Most are until it happens likely poorly prepared for the process. This article reviews common and uncommon situations that can result in adverse outcomes and potential liability for neonatologists and newborn providers and discusses ways to mitigate this risk in advance. The ramifications of a medical malpractice lawsuit and whether to settle the case out of court or going to trial, followed by potential review by the State's Medical Board are discussed. Finally, knowledge of the process before, rather than after it happens, may help to reduce the stress and uncertainty that naturally follows for the individual involved.

A 5-day-old symmetric severely growth-restricted preterm newborn with thrombocytopenia, anemia, and direct hyperbilirubinemia has abnormal cranial ultrasonography findings (Figs 1A and 1B, 2A and 2B). Figure 1. Cranial ultrasound. A, Coronal view. B, Sagittal view. Showing hyperechoic area (arrows) suggestive of cortical calcification. Figure 2. Cranial ultrasound. A, Sagittal view. B, Coronal view. Showing area of encephalomalacia (arrows) within the upper right temporal/lower parietal lobe and with effacement of the right lateral ventricle due to mass effect. ### Prenatal and Birth Histories

A 15-day old female preterm infant who is tolerating advancing enteral feedings presents with sudden abdominal distension and erythema and edema of the anterior left side of the chest and abdomen. ### Prenatal and Birth Histories ### Presentation after Birth and Postnatal Course (Days 1–15) The neonatology team intubated the newborn in the delivery room, administered intratracheal surfactant, and weaned the infant to low ventilator settings with a fraction of inspired oxygen (FiO2) of 0.21. On arrival at the NICU, the team placed umbilical catheters. As a result of extensive bruising of the entire trunk after a difficult extraction, the neonate was placed under phototherapy. She received a second dose of surfactant at 12 hours of age and underwent extubation on the first day after birth. She needed reintubation on the third postnatal day and received a third dose of surfactant at that time. Six days after birth, the team reattempted extubation, but she had increased respiratory distress and required reintubation, followed by a fourth dose of surfactant. At that time, chest radiography showed pulmonary interstitial emphysema (PIE) and the infant was switched from conventional to high-frequency jet ventilation (HFJV). The PIE was noted to resolve on radiography by 12 days of age. The infant’s postnatal course was also notable for empiric treatment with ampicillin …

Background We reviewed our cases of central edema defined as scalp/facial- and/or truncal edema or anasarca (Ana) hoping to identify prognostic factors that could aid in discussions of futility of care. Case presentation This study was a retrospective chart review of all cases of central edema in our community level-3 neonatal intensive care unit (NICU) between 2006 and 2019. A total of 19 patients with central edema were found. In 6/19 the etiology was due to chylous losses and in 13/19 inflammation was believed to be the major cause. Outcome was known in 17 cases and only 41% survived. Among the survivors, 86% had a gestational age greater than 34 weeks and the edema resolved in less than 2 weeks in the majority. Fifty-nine percent of the patients expired. In those that expired, 80% were born at 30 weeks’ gestation or less and the duration of edema exceeded 2 weeks in all cases and 4 weeks in 60% of the subjects. Conclusion To the best of our knowledge, this is the first retrospective study of the outcome of central edema in a neonatal population and the results can be useful when discussing futility of care in cases of severe and long-standing or worsening edema not responding to medical management.

We present a term infant with the unusual findings of malrotation in combination with both duodenal and pyloric webs of windsock type, thus masquerading as postoperative bowel dysfunction and ultimately requiring three laparotomies. To the best of our knowledge these three findings in combination have not been previously reported. The dilemma of whether to perform a duodenotomy or not during malrotation repair and the importance of instrumenting the intestine from the duodenotomy site in both retrograde and antegrade directions are discussed.

In the mid-nineteenth century, three events coincided to make California the 31st state of the USA: The Mexican-American war of 1846–1848, The Bear Flag Revolt of 1846 and the discovery of gold in 1848. Within a few years a population explosion had occurred and with it came the need for organization of the practice of medicine. This paper outlines the biographies of some physicians who were instrumental in the early years of the Golden State.

Objective Several cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature. Study design A retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017. Results A total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)]. Conclusions To our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

The wear of piston rings in large marine two-stroke diesel engines is a major maintenance cost. Applying coatings with good oxidation, corrosion resistance and high temperature strength, can lower the total maintenance cost. In the past nickel aluminide with chromium carbide have been applied to pistons by thermal spraying. Using laser cladding a suitable microstructure can be formed while at the same time avoiding cracks and bonding issues. In this report powders and coatings were manufactured in order to be able to investigate the dry-sliding wear behavior. Material with three levels of carbides was atomized. Wear test samples were manufactured by laser cladding. The dry sliding wear-mechanism maps are generated by using block on ring test setup where coated blocks slide against cast iron rings. All alloys exhibited regions of plasticity-dominated wear and oxidational wear with a transition region in-between. The carbide-containing alloys showed lower friction and wear in comparison to the carbide free nickel aluminide alloy.

OBJECTIVE The aim of the study was to describe our cases of neonatal chylous effusions and their outcomes and attempt to identify prognostic factors that can aid in the counseling of parents of future patients. PATIENTS AND METHODS A retrospective chart review was conducted on all patients with a diagnosis of chylous effusions admitted to our 16-bed community level-3 neonatal intensive care unit (NICU) between June 2003 and November 2013. RESULTS A total of 10 patients were identified: of these 10 patients, 3 survived and 6 expired. One patient was transferred out and was lost to follow-up. Two-thirds of the survivors had only one site of chylous effusion. The six mortalities were all of gestational age (GA) < 34 weeks; five of the six were low birth weight (LBW) and all six had anasarca/hydrops, two or more sites of chylous effusions, or a genetic syndrome/chromosomal abnormality. The incidence of chylous effusions was 0.03% of all births and these patients constituted 0.37% of the inborn admissions to the NICU. CONCLUSIONS This case series represents a large number of patients considering its single-center community setting. It is prudent to communicate a very guarded prognosis when counseling parents of neonates with chylous effusions. Multiple chylous effusions, hydrops, GA < 34 weeks, LBW, or an accompanying genetic syndrome appear to confer worse prognosis.

Lymphatic (chylous) disorders are rare in neonates, and most clinicians will only experience a handful of cases during their careers. Chylous effusions of the pleura, peritoneum and pericardium, and lymphedema are not diagnoses but rather symptoms of an underlying disease of the lymphatics. Although it is relatively easy to establish whether an effusion is of chylous origin or not, expertise in different imaging techniques of the lymphatic system does not appear to be universally available. This makes it difficult to determine the cause of the effusion and thereby arrive at a prognosis, and whether and when to recommend surgical treatment. The goal of current medical management is to treat symptoms by reducing overall lymphatic flow and to allow enough time to resolve the lymphatic leakage (whatever the underlying cause) without simultaneously risking infectious complications. Most current therapies are not evidence-based. A prospective registry of patients who have chylous effusions and a multicenter randomized controlled trial to evaluate different treatment options are needed.

A premature newborn was found to have a previously unknown lower abdominal defect. ### Prenatal and Birth Histories: ### Presentation: The infant had no respiratory effort at birth and was intubated in the delivery room. A large abdominal defect was noted, and stool was seen passing from a patent anus. Initial heart rate was 55 beats per minute. Positive pressure ventilation, surfactant, and chest compressions were administered without result. An emergency umbilical venous catheter was inserted, and the infant received 5 rounds of epinephrine and empiric bilateral thoracenteses before resuscitation was discontinued because of lack of response. The parents declined autopsy. ### Physical Examination: Postresuscitation examination revealed redundant skin over the scalp and neck. There was a 5-cm-long, transverse, full-thickness infraumbilical abdominal defect with liver and gallbladder exposed. The small intestine was completely eviscerated. Bilateral, symmetrical, 3-cm-long skin defects …

A female newborn infant is admitted to the neonatal intensive care unit at age 40 hours because of respiratory distress and dusky skin color and requires endotracheal intubation. Physical examination findings are significant for indurated pitting edema of the posterior scalp and neck. No other skin lesions are visible. The 37 3/7-week gestational age infant with a birth weight of 2,269 g was born to a 37-year-old, gravida 1, para 1, Group B Streptococcus–negative mother by vaginal delivery. The amniotic fluid was clear, and the duration of rupture of membranes was 12 hours. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. An intrauterine pressure catheter (IUPC) and a fetal scalp electrode were placed 4 hours before delivery. Blood and endotracheal cultures are obtained, and treatment with ampicillin and gentamicin is initiated. The initial white blood cell count is 0.3 × 103/μL (0.3 × 109/L) with 19% segmented neutrophils and no bands, and the C-reactive protein (CRP) level is 156 mg/L. The infant is oliguric and hypotensive and requires support with dopamine. The next day the blood- and endotracheal cultures yield Streptococcus dysgalactiae subspecies equisimilis sensitive to ampicillin, the CRP level peaks at 205 mg/L and thrombocytopenia with a platelet count of 43 × 103/μL (43 × 109/L) develops. Urine and cerebrospinal fluid (CSF) samples are obtained, and the results of the cultures are subsequently …

The Articles of Confederation and Perpetual Union was the interim constitution of the United States of America between 1777 and 1789. The name the United States of America is encountered here for the first time. Three physicians were among the 48 signers – Josiah Bartlett, Samuel Holten and Nathaniel Scudder. All three men started out studying and practising medicine but their lives took very different turns as the new nation emerged.

A 40-week, 4.6-kg male infant was born by elective Cesarean delivery secondary to macrosomia to a 17-year-old G1P1 mother. Pregnancy was uncomplicated. All prenatal laboratory screenings including glucose tolerance test were within normal limits. APGAR scores were 6 at 1 minute and 9 at 5 minutes. He cried spontaneously and was stable breathing room air. At 12 hours after birth, he was noted to have intermittent desaturations to 88% breathing room air with normal heart rate on routine pulse oximetry in newborn nursery. He was transferred to the NICU for the evaluation of desaturations. On admission, oxygen saturations on pulse oximetry oscillated between 85% and 88% while breathing 100% oxygen with flow of 2 L per minute via nasal cannula. On physical examination, he had no dysmorphic features or respiratory distress. Cardiac examination revealed normal heart sounds without murmur on auscultation. Pulses were equal in all extremities. Laboratory tests including complete blood count, serum chemistry, and CRP were within normal limits. Chest radiograph revealed normal lung parenchyma and cardiac silhouette. Subsequently, the neonate developed an episode of supraventricular tachycardia (SVT) with desaturations to 80%. Twelve-lead ECG showed a narrow QRS complex tachycardia, rate of 250 beats per minute, and abnormal P waves. A dose of intravenous adenosine (500 mcg/kg) converted his heart rate to sinus rhythm immediately. Echocardiogram revealed the diagnosis. A 1035 g, 31 5/7-weeks small for gestational age infant was born by Caesarian delivery to a 29-year-old G3P2 woman whose pregnancy was complicated by oligohydramnios and intrauterine growth retardation. The infant displayed mild respiratory distress at birth and required high-flow nasal cannula 1 to 3 L per minute with an FiO2 of 0.21. On the second day after birth, a peripherally inserted central catheter (PICC) was placed on the fourth attempt in the right antecubital fossa. Good …

The Declaration of Independence had 56 signers, four of whom were physicians. The constitutional convention in 1787 had 55 delegates and 39 of them signed the Constitution. Three of these delegates were physicians and two signed the document. The Bill of Rights was a product of the first Federal Congress and three of its members were physicians. This paper presents a biographic outline of these physicians and their contributions to society, within a context of contemporary medicine during the first 25 years of the USA.

Summary Polymorphism of phosphoglucomutase (PGM) in horse erythrocytes was studied by means of starch gel electrophoresis. Three different phenotypes, F, FS and S, were found. Family data supported the genetic theory of two autosomal, codominant alleles PGMF and PGMS controlling the variation. The gene frequencies were estimated to 0.28 and 0.72, respectively, in the North-Swedish Horse breed and to 0.13 and 0.87, respectively, in the Swedish Trotter Breed. The probabilities of excluding a falsely assigned stallion in the PGM system were calculated to 0.16 and 0.10, respectively, in the two breeds.

Summary The cholinesterase activity in horse serum was shown to be controlled by four co-dominant autosomal alleles, ChA, ChB, Chc and ChD. The respective alleles controlled an activity of approximately 40, 76, 126 and 155 units. Nine phenotypes with different enzyme levels were distinguished. Family data with 11 stallions, 108 mares and 128 offspring were consistent with the genetic theory. The gene frequencies in the North Swedish horse breed were 0.32, 0.42, 0.13 and 0.13, respectively.

A new approach in double gate devices processing based on the wafer bonding of a thin SOI film on pre-etched cavities is presented. In this context, wafer bonding parameters are analyzed. The effects of surface activation and annealing conditions are qualified, quantified and a viable solution is proposed.

Objective A neonate with a perforated appendix vermiformis in our neonatal intensive care unit (NICU) (case 1) prompted us to review our cases of exploratory laparotomy due to spontaneous intestinal perforation (SIP), surgical necrotizing enterocolitis (NEC), and other neonatal abdominal emergencies to identify additional cases of pathological appendiceal involvement (appendicopathy). Methods A retrospective chart review was done for all the cases of exploratory laparotomy in our 16-bed community level-3 NICU between June 2003 and May 2014. Results A total of 34 patients with exploratory laparotomies were identified. Among the 11 cases with histopathology of the appendix available, only 3 cases had appendicopathy. Of these, only one was conclusive regarding the etiology. Conclusions A perforated and/or inflamed appendix does not equal a diagnosis of true appendicitis. The term appendicopathy is in our opinion, therefore preferable because it can be either primary or secondary to more common diagnoses, such as NEC and SIP. The possibility of perforation of the appendix must be considered in all cases of appendicopathy but this diagnosis is difficult to make. Once appendicopathy is found, attempts should be made to identify its etiology to optimize treatment and prognosis. We thus propose an etiologic classification of neonatal appendicopathy.

A preterm male infant with a patent ductus arteriosus developed neutropenia during treatment with indomethacin. Afterward, the mother described her own history of indomethacin-associated neutropenia. During the recovery from the neutropenia, the infant became septic with bacteremia caused by Enterobacter cloacae. Although indomethacin-related neutropenia has been described in adults, no case in a neonate has been reported. If neutropenia occurs after indomethacin therapy in a neonate, a familial history of indomethacin-associated neutropenia should be sought and the increased risk of infection should be considered.

An example of general fuel behaviour studies on power reactor fuel is described. Examples of recent non-destructive and destructive hot cell investigation techniques are given, illustrated by an investigation of full-size power reactor fuel rods and by a detailed study of fission product redistribution and release. A review is given of some international research and development projects addressing the pellet-cladding interaction problem.

The tensile properties of a composite consisting of 20 vol.-% short δ alumina fibres in an aluminium matrix (AA 6061) prepared by squeeze casting have been investigated, before and after 30% reduction by forging. By annealing the composite before forging, a 30% forging reduction could be achieved at room temperature, without crack formation. A reduction in mean fibre length from about 65 to 15 μm was observed but most fibre breaks were filled by matrix. By heat treating the composites after forging, their elongation to fracture was increased to about twice that of a similarly heat treated unforged composite of comparable strength. The improvement of ductility is attributed to break-up of the fibre skeleton structure inherited from the fibre preform. A model is presented that predicts that for these fibres an optimum effective reinforcement is achieved at fibre lengths of about 100 μm, which explains why the reduction in fibre length caused by forging does not result in significant strength loss.M...

Tensile tests were performed on individual δ-alumina fibres (Saffil, RF grade). The results revealed a large scatter in strengths and a clear dependence of the fracture strength on the specimen volume. The tests were evaluated on the basis of the Weibull probability function, a special modification of the Weibull analysis being developed that successfully copes with the problem of testing fibres with various diameters and test lengths. For the sample studied the Weibull modulus, m, was found to be 2·2, with a scaling constant δ 0 = 6·0 MPa ( units of volume mm 3 ; i.e. V 0 = 1 mm 3 ) .

A recent on-line discussion asked whether healthcare for Americans is a constitutional right or a privilege. One can debate whether one can extract a legal right to healthcare from the Declaration of Independence depending on whether one sees it is a philosophical or as a legal document. The Constitution of the United States of America lists “promote the general welfare” and protect “ourselves and our posterity” as some of its aims. Perhaps this would demand the inclusion of certain basic health services such as immunizations and antimicrobial therapy for every citizen; even for illegal immigrants, in order to protect the public. America must decide whether health care is a privilege or a right! If it is a privilege, one must accept the exclusion of some individuals and the unintended consequences of epidemics. If it is a constitutional right, one must accept paying for that right with increased taxes and the unintended consequences on the economy. But who should pay, how much and for what?

The antibiotic susceptibility of Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes and Streptococcus pneumoniae was investigated in five different geographical areas of Sweden in 1990 and compared with results from similar investigations performed in 1983 and 1986. Tests on 100 isolates per species and laboratory were performed by the disk diffusion method, and 10% of the strains plus all resistant ones were sent to the central laboratory for determination of MICs of ampicillin, phenoxymethylpenicillin, cefaclor, loracarbef, erythromycin, tetracycline and trimethoprim/sulfamethoxazole. Beta-lactamase production was found in 7% of H. influenzae and 71% of M. catarrhalis, and reduced susceptibility to penicillin in 3% of S. pneumoniae. Low frequencies (1—3%) of tetracycline resistance were found in H. influenzae and in the 2 streptococcal species, in which also > 1% of the strains were resistant to erythromycin. Resistance to trimethoprim/sulfamethoxazole occurred in 7% (range 3—14%) of ...

The major water-soluble arabinoxylan from rye grain has previously been shown to contain a main chain of 4-linked β- d -xylopyranosyl residues in which, on average, every second is substituted at position 3 with terminal α- l -arabinofuranosyl residues. Periodate oxidation, reduction and fragmentation by mild acid hydrolysis produced a series of glycerol xylosides containing 4-linked xylopyranosyl residues linked at the reducing end to position 2 of glycerol. It was shown that a one-step periodate oxidation was incomplete due to the formation of relatively stable hemiacetal linkages. A sequential oxidation and reduction procedure was used to bring about complete oxidation of arabinose and unbranched xylose residues in the intact polysaccharide. Quantitative analysis of the products liberated by mild acid hydrolysis revealed the presence of glycerol xylosides with one, two or three xylose residues in the molar ratio of 1·00:0·86:0·02. The xylose residues must have originated from branched residues in the main chain of the arabinoxylan. The units or small blocks of two residues are therefore distributed mainly as isolated branched residues and not randomly as previously reported.

The effects of soluble pentosans, in the form of the main water-soluble arabinoxylan from rye grain, on the gelatinization and retrogradation of starch were studied. Five different starches, waxy, amylomaize, wheat, maize and potato starches and wheat flour were used. The water contents of the samples varied from 46.5 to 50%. Differential scanning calorimetry (DSC) showed that the arabinoxylan had a negligible effect on the gelatinization. However, the arabinoxylan did affect the retrogradation. The recrystallization process is particularly sensitive to the water content in the sample. The maximum extent of recrystallization occurs when the starch concentration is between 50 and 60%. The effects of the arabinoxylan are probably caused by the water absorption ability of the arabinoxylan. i.e. control of the water availability of the starch which thereby, increases the retrogradation. The effects of arabinoxylan addition are. however, dependent on the initial starch concentration. The results of the rheological measurements agreed with the DSC measurements because potato starch gels (42.–42.8% on dry matter basis (d.b.)), with added (2% d.b.) arabinoxylan, were more rigid after seven days of storage than pure potato starch gels.

Rye grain (cv. Kungs II) was ground and refluxed in 90% aqueous ethanol in order to inactivate endogenous enzymes and remove low molecular weight sugars. The residue was extracted with water at 40°C and a crude arabinoxylan isolated from the extract by precipitations with ammonium sulphate and 67% aqueous ethanol. The crude arabinoxylan constituted 0·74% of the whole-grain and contained 72% arabinoxylans. The crude arabinoxylan was fractionated on a DEAE-cellulose column. The main fraction was eluted with water and contained arabinose and xylose residues in a ratio of 1 : 2·1, together with traces of other components. The quantitatively second most important fraction was eluted with weak borate and contained arabinose and xylose residues in a ratio of 1 : 1·8, together with significant amounts of glucose residues and non-carbohydrate components. Methylation and 1 H- and 13 C-NMR analysis revealed that the water-eluted arabinoxylan contained a main chain of 4-linked β- d -xylopyranosyl residues of which about 50% were substituted at position three with terminal α- l -arabinofuranosyl residues. About 2% of the xylose residues were double-substituted at positions two and three by terminal α- l -arabinofuranosyl residues. The same structural units were found in the fraction eluted with weak borate but the branched and double-branched units were more abundant.

International audience; Since their discovery, carbon nanotubes present many interesting electrical properties and can be candidates for future shrinking devices. Electrode realization on nanotubes remains a challenge. The deposited contacts must present interesting electrical parameters: low contact resistance, low series resistance, low parasitic capacity and low excess noise. The understanding of conduction phenomena induced into or near the metal/nanotube contact is necessary to improve the device. In this paper we present characterization of a Au-Ti deposited contact on a single-wall carbon nanotube. Steady-state current-voltage measurements, impedance and noise measurements lead to the frequency device characteristic. From this study a low frequency noise electrical model is presented. Using this model and the low frequency noise measurements, we show that the measured thermal noise has its origin in the electrode/nanotube contacts

Aim: To describe the association between morphine administration in preterm infants, hydronephrosis, and renal dysfunction. Methods: The findings were based on serial ultrasound examinations and blood studies. Results: Two preterm infants had bladder distension and hydronephrosis after they received intravenous morphine for analgesia. Morphine was used at a low dose. Each patient had a normal urine output and normal serum creatinine before the signs and symptoms of urinary retention were observed. Within 24 h of morphine administration, each infant concurrently developed oliguria and elevation of the serum creatinine. Cessation of morphine and urinary drainage resulted in rapid and complete resolution of the hydronephrosis and the elevated creatinine. Conclusion: Morphine, even at low dosages, can be associated with hydronephrosis in hospitalized preterm infants.

A prospective, randomized study was performed in 559 patients to compare two doses of oral cefadroxil with three doses of intravenous cefuorxime as antibiotic prophylaxis in intra- and subtrochanteric hip fracture surgery. Antibiotic concentrations in the wound fluid were determined at the start and at the end of the operation. The first dose of cefadroxil was given about 2 h before surgery and cefuroxime about 30 min before operation. In 226/242 (93%) patients randomized to oral cefadroxil, the concentration in the wound during surgery was on average 15 micrograms/ml, i.e., well above the minimum inhibitory concentration (MIC-90) for Staphylococcus aureus. In the cefuroxime group, antibiotic levels in the wound exceeded the MIC-90 for S. aureus in 204/210 (97%) of the patients at the start and/or at the end of surgery. All patients were followed up for 4 months. One deep and five superficial infections occurred in the cefuroxime group and no deep but one superficial infection in the cefadroxil group (P = 0.07). S. aureus was cultured in three of the infected cases while cultures were negative in four patients. Four of the seven infected patients had adequate levels of antibiotic in the wound during surgery, and in three patients no antibiotic assay was performed. The infected patients did not differ in age, sex, operation time, bleeding or any other basic variable compared with patients who healed without complications. Two doses of cefadroxil seems to be practical and as effective as intravenously administered cefuroxime as antibiotic prophylaxis in trochanteric hip fracture surgery.

The views of the clinician on security aspects of an electronic patient record are presented. The necessary qualifications are: it should be there, it should be true, it should be trustworthy.