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Durch limitierte finanzielle und personelle Ressourcen ist die effiziente Planung von Patientenstromen, Operationsvorbereitungen und perioperativer Diagnostik von groser Bedeutung. In der vorliegenden Arbeit sollen potenzielle Probleme und Losungsstrategien in der interdisziplinaren Zusammenarbeit zwischen Orthopaden/Unfallchirurgen und Kollegen der Anasthesie und Radiologie aufgezeigt werden. Nach Implementierung eines Prozessmanagements erfolgten die Datenerfassung und Auswertung von Patientenzahlen, Inanspruchnahme von Fremdabteilungen in der Sprechstunde, Wartezeiten und Termintreue der Patienten. Die Patientenzufriedenheit wurde anhand eines Fragebogens bestimmt. Zudem wurde in der aktuellen Literatur zum Thema der Prozessoptimierung und interdisziplinaren Zusammenarbeit recherchiert. Die Wartezeit auf einen Termin in der orthopadisch-unfallchirurgischen Sprechstunde des Universitatsklinikums Bonn betrug zwischen 9,15 und 11,23 Tage. Es stellten sich 10–20 % der Patienten aus der Sprechstunde in der Pramedikationsambulanz vor. Eine Vorstellung in der Radiologie wurde in 22–28 % der Falle durchgefuhrt. Die Patientenzufriedenheit wurde durch einen Fragebogen erfasst, der die Bewertung der arztlichen Behandlung, Organisation und Infrastruktur sowie den Behandlungserfolg beinhaltete. Die Wichtigkeit einer effizienten und digital organisierten Zusammenarbeit wird allseits in der Literatur gefordert. Es liegen aber zu wenige Daten uber die Ablauforganisation und eine wirtschaftliche interdisziplinare Zusammenarbeit vor. Durch die Implementierung eines Prozessmanagements konnen Mangel im Workflow und der interdisziplinaren Zusammenarbeit erkannt und strukturiert optimiert werden. Dadurch ist auch eine Verbesserung der Patienten- und Mitarbeiterzufriedenheit sowie der Behandlungsqualitat moglich.

This work presents unprecedented, high-resolution palaeomagnetic data from the sedimentary record of Lake Levinson-Lessing, the deepest lake in northern central Siberia. Palaeomagnetic analyses were carried out on 730 discrete samples from the upper 38 m of the 46 m long core Co1401, which was recovered from the central part of the lake. Alternating field demagnetization experiments were carried out to obtain the characteristic remanent demagnetization. The relative palaeointensity is determined using the magnetic susceptibility, the anhysteretic remanent magnetization, and the isothermal remanent magnetization for normalization of the partial natural remanent magnetization. The chronology of Co1401 derives from correlation of the relative palaeointensity of 642 discrete samples with the GLOPIS-75 reference curve, accelerated mass spectrometer radiocarbon ages, and optically stimulated luminescence dating. This study focuses on the part > 10 ka but also presents preliminary results for the younger part of the core. The record includes the geomagnetic excursions Laschamps and Mono Lake and resolves sufficient geomagnetic features to establish a chronology that continuously covers the last ∼ 62 kyr. The results reveal continuous sedimentation at high rates between 45 and 95 cm kyr−1. The low variability of the magnetic record compared to datasets of reference records with lower sedimentation rates may be due to a smoothing effect associated with the lock-in depths. Because Co1401 was cored without core segment overlap the horizontal component of the characteristic remanent magnetization can only be used with caution. Nevertheless, the magnetic record of Co1401 is exceptional as it is the only high-resolution record of relative palaeointensity and palaeosecular variations from the Arctic tangent cylinder going back to ∼ 62 ka.

Geriatric patients are currently responsible for almost one third of all emergency hospital admissions. An increase of 50% is expected in the next decade. This age redistribution poses new challenges for inpatient care and discharge management. The requirements of an orthopedic trauma surgery clinic in the care of this patient group can be clarified with the help of this first collaboratively created geriatric orthopedic trauma surgery complex treatment unit of a university hospital.What influence do age and delirium have on discharge management, length of inpatient stay and discharge destination in a geriatric cohort?All patients who received inpatient treatment as part of the orthopedic trauma surgery geriatric complex treatment (GKB) between May 2017 and December 2019 were evaluated. An analysis of the demographics, length of inpatient stay, discharge destinations and evaluation of the Barthel index collected on admission and discharge, the mini-mental state examination (MMSE) and the geriatric depression scale (GDS) were carried out.Out of 312 patients, 110 men and 193 women with a median age of 81 years, 77 patients (24.6%) showed delirium when enrolled in the GKB and 39 (12.5%) dementia. Older patients presented more often with delirium than younger people (p = 0.013), especially those aged 70-79 years (p = 0.037). Dementia patients suffered more frequently from postoperative delirium (p 0.01). The mean hospital stay was 17.79 days (±4.6 days). The GKB was regularly completed in 60.7% of all cases and 39.3% patients dropped out early. Patients with delirium were discharged significantly less often into their own home but into short-term care or nursing homes (p = 0.038). A general correlation between delirium development and the discharge destination was noticeable (p = 0.004).Patients with dementia are more likely to develop delirium postoperatively, which leads to an increase in the length of inpatient stay, an increase in treatment costs and more work for the discharge management team. In addition, the discharge to the patients' home is impaired by delirium, which means that the growing need for places in short-term care and nursing homes also creates socioeconomic burdens.

The cost pressure in a competitive environment forces hospitals and physicians to optimize clinical processes. In order to secure competitive advantages, a continuous evaluation of relevant processes is necessary.Administrative and medical processes in a university outpatient department for orthopedics and traumatology were evaluated using the lean method in order to reduce patient waiting times.Over a period of 2 weeks all patients who were treated in the department for orthopedic and trauma surgery on an outpatient basis were included in the assessment of the process. Personnel in the policlinic were prepared and trained to record times for appointments made by telephone, arrival time at the hospital, first contact, administrative procedure, first contact with the doctor, length of stay in the radiology and anesthesiology departments and completion of treatment. In addition, potential inefficiencies were identified through patient flow analysis and personal interviews with personnel in the administration and outpatient departments as well as residents and senior physicians.A total of 126 patients were enrolled in the study. The average length of stay of patients in the outpatient clinic was 144 min (range 30-371 min). A necessary imaging examination increased the length of stay by an average of 53 min and a necessary premedication by an average of 78 min compared to patients with no further consultations.By analyzing the pathways and times of patients, various reasons for waiting times in the university outpatient clinic could be shown. This study shows that a structured application of lean management and a dedicated analysis create added value for patients by reducing waiting times.

Due to limited financial and human resources, efficient planning of patient flows, operation preparations and perioperative diagnostics are of great importance. In the present study potential problems and solution strategies in the interdisciplinary collaboration between orthopedic surgeons, trauma surgeons and colleagues in anesthesiology and radiology departments are presented.After implementation of a process management system, the data were collated and the number of patients, the utilization of external departments in the consultation, waiting times and patient adherence to appointments were analyzed. Patient satisfaction was determined using a questionnaire. In addition, the current literature was searched regarding the topic of process optimization and interdisciplinary cooperation.The waiting time for an appointment in the outpatient clinic consultation in orthopedics and trauma at the University Hospital Bonn was between 9.15 and 11.23 days. Of the patients 10-20% from the consultation presented in the premedication outpatient department. Radiological imaging was performed in 22-28% of the cases. Patient satisfaction was recorded using a questionnaire gathering information on medical treatment, organization and infrastructure as well as treatment success. The importance of an efficient and digitally organized cooperation is generally promoted in the literature; however, there is insufficient data on the subject of process organization and economic interdisciplinary cooperation.By implementing a process management, deficiencies in the workflow and interdisciplinary collaboration can be identified and optimized in a structured manner. This also improves patient and employee satisfaction and the quality of treatment.

The operating room (OR) accounts for the highest fraction of hospital costs and also has the largest proportion of revenue. Classical goals of optimizing OR efficiency are to increase the quality of treatment and economic success. As the reduction of qualified personnel as the largest cost factor was favored for many years, nowadays a shortage of nursing personnel is threatening the surgery departments in many German hospitals.Which improvements are possible while the OR already suffers from restrictions? What are critical resources, what are the critical burdens and how can they be optimized?An analysis of the OR organization of an orthopedic and traumatology department with reduced OR capacity due to a shortage of OR and anesthesia nursing personnel was performed. This was followed by the evaluation of possible alterations with the corresponding advantages and disadvantages. After selection and implementation, the qualitative and quantitative differences were examined before and after the alterations.Multifaceted problem areas could be identified. The establishment of a fast track OR with concentration of additional resources on many fast points in an OR instead of on a few complex cases was selected and implemented. The installation of a holding area for patients waiting for surgery eliminated transportation delays almost entirely. Alterations in the OR planning and capacity distribution reduced nocturnal operating times. Despite reduction of the OR capacity both the number of operations performed and the incision to suture times could be increased.Optimization of the processes in the OR is possible and necessary, despite the lack of personnel. Even only a few structural changes can eliminate bottlenecks, resulting in qualitative and quantitative improvements.

The aim is to stabilize the thoracolumbar spine with a thoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision.Vertebral burst fractures at the thoracolumbar junction (A4 AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis.Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions.The patient is lying in a right lateral decubitus position. Localization of the fractured vertebra. Minimally invasive transthoracic approach. Perform single lung ventilation and insert the 3D thoracoscope two intercostal spaces above the working portal. Utilization of special binocular glasses for 3D vision of the operation field and secure resection of the fractured vertebra. Measurement of the bony defect and insertion of the expandable cage. Control of correct cage position under fluoroscopy. Insertion of a chest tube and inflate the left lung.Chest × ray Remove chest tube when output is500 ml/24 h Early mobilization on the ward 6 weeks no weight-bearing5 kg RESULTS: Between 2012 and 2017, 12 patients received a VBR under 3D thoracoscopic vision. After a mean follow up of 26 months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with a small pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.

Alagille syndrome patients present with loss of function mutations in either JAG1 or NOTCH2. About 40-50% of patients have kidney abnormalities, with multi-cystic, dysplastic kidneys being one of the more frequent kidney defects. Additionally, gain-of-function mutations in NOTCH2 are associated with cystic kidneys in Hajdu-Cheney syndrome patients. Conditional inactivation of Notch1, Notch2, or RBPJ within the nephrogenic lineage impairs nephrogenesis and produces proximal tubule cysts in mice. How perturbations in Notch signaling cause renal tubular cysts remains unclear. Here we have determined that inhibition of Notch signaling in the kidney increases Akap12 expression. Ectopic expression of Akap12 in renal epithelia results in abnormally long primary cilia similar to those observed in Notch-signal-deficiency. Both loss of Notch signaling and elevated Akap12 expression disrupt the ability of renal epithelial cells to form spherical structures with a single lumen when grown embedded in matrix. We conclude that Notch signaling regulates Akap12 expression to ensure normal primary cilia length and renal epithelial morphogenesis, and suggest that diseases associated with defective Notch signaling, such as Alagille syndrome, maybe mechanistically related to ciliopathies.Translational StatementThe current study examines how a reduction in Notch signaling results in abnormal renal tubule formation, as occurs in Alagille Syndrome patients with mutations in JAG1 or NOTCH2. The finding that reduced Notch signaling results in abnormally long cilia is suggestive that some of the clinical manifestations in Alagille Syndrome, such as small cystic kidneys, may originate due to defective cilia function. Linking Notch to primary cilia also opens up the possibility that coinheritance of mutations in ciliopathy genes along with a mutation in JAG1 or NOTCH2 may enhance the severity of the clinical phenotypes such as cystic kidney disease and may explain the variable occurrence and onset of kidney disease among Alagille Syndrome patients.

The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated.What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine?Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from a first level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging.A higher trauma energy had a significant impact on the number of cervical spine injuries (p = 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; p = 0.022) and high velocity accidents showed more C7 fractures (37%; p = 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (p = 0.012).Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.

Hintergrund Periazetabulare Defekte stellen weiterhin eine grose Herausforderung in der Revisionsendoprothetik des Huftgelenkes dar. Neben der Klassifikation der Defektsituation mit Auswahl des geeigneten Revisionsimplantates ist neben der primarstabilen Verankerung der Implantate der suffiziente biologische Wiederaufbau des Defektes mit Wiederherstellung eines tragfahigen Implantatlagers essenziell fur den Langzeiterfolg der azetabularen Revisionschirurgie. Die biologische Defektrekonstruktion verfolgt das Ziel eines „Downsizing“ des periazetabularen Defektes vor dem Hintergrund moglicher zukunftiger Revisionsoperationen.

Hintergrund: Die Altersstruktur der hausarztlich praktizierenden Arzte stellt eine Herausforderung fur die Sicherstellung der flachendeckenden medizinischen Versorgung fur die Zukunft dar. Ziel dieser Studie ist, die derzeitige hausarztliche Versorgungssituation aus der Sicht von Burgermeistern als Vertreter der kommunalen Ebene zu erheben. Die so erhaltenen Ergebnisse konnen das Thema Uber- und Unterversorgung sowie die andauernde Bedarfsplanungsdiskussion um die Perspektive der kommunalen Ebene bereichern. Methoden: Allen 1101 Burgermeisterinnen und Burgermeistern in Baden-Wurttemberg wurde im Mai 2011 ein selbstentwickelter Fragebogen zugeschickt. Bei der Auswertung wurden der subjektiven Einschatzung der Teilnehmer bezuglich der raumlichen Lage die Siedlungstypen, die durch das Bundesinstitut fur Bau-, Stadt- und Raumforschung (BBSR) vorgegeben sind, gegenubergestellt. Ergebnisse: Die Rucklaufquote betrug 63% (n=698). Eine landliche Gemeindelage gaben rund 70% (n =468) der Burgermeister an, laut BBSR Siedlungstypisierung kamen die Antworten in 26% (n=177) aus landlichen Gemeinden. Nach Angaben der teilnehmenden Burgermeister wurden knapp 54% (n=355) der Gemeinden rein hausarztlich versorgt. Aus den Angaben wurde eine erlebte hausarztliche Unterversorgung fur 13,5% (n=86) der Gemeinden errechnet. Hiervon waren landliche wie nicht-landliche Gemeinden betroffen. In Gemeinden bis 20 000 Einwohner sei das Verhaltnis Hausarzt zu Facharzt annahernd 60:40. In groseren Stadten sind angeblich verhaltnismasig mehr Spezialisten tatig. Schlussfolgerung: In uber der Halfte der Gemeinden scheint kein niedergelassener Spezialist zu praktizieren. Eine Akkumulation von spezialistisch tatigen Arzten in groseren Stadten wurde angegeben. Der Hausarztemangel scheint vor allem subjektiv erlebt zu werden. Die Einschatzung der geografischen Lage einer Gemeinde differiert deutlich zwischen subjektiver Sicht und der BBSR Siedlungstypisierung. Diese Diskrepanz konnte auf die Ausendarstellung der Gemeinden im Wettbewerb um arztlichen Nachwuchs Auswirkungen haben.

Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries.In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases.This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

Erratum to:Oper Orthop Traumatol 2018 https://doi.org/10.1007/s00064-018-0559-3 The article was wrongly published under the article type "Review". Please note that the article is an "Original Paper".The publisher apologizes to authors and ….

Os jalecos são um veículo potencial de transmissão microbiológica e seu uso inadequado traz riscos à saúde de profissionais e da população. O objetivo deste estudo foi o de conhecer as práticas de utiliza- ção e o perfil de contaminação dos jalecos brancos usados como uniforme por docentes e discentes do Centro Universitário Serra dos Orgãos (UNIFESO). Trata-se de um estudo quantitativo, transversal e exploratório. Respeitados os princípios éticos, aplicou-se questionário sobre o modo de uso e se realizou a análise microbiológica. Os dados foram analisados de forma manual, expressos em percentuais e demonstrados por meio de tabelas. Como resultado, 73 (setenta e três) jalecos estudados apresentaram variada flora, com predomínio de cocos Gram positivos. A região do punho, a mais contaminada, apresentou em média 23 UFC por campo. Quanto ao perfil de uso, a maioria, 42, (57%) tem idade entre 18 e 25 anos, 46 (63%) são do sexo feminino, 27 (37%) são acadêmicos de medicina do 3o período e apenas 13 (18%) são docentes. Sobre a frequência de troca do jaleco, 35 (48%) trocam uma vez por semana, entretanto com inadequado manuseio. Após uso, 36 (49%) não lavam o jaleco separadamente, 43 (58%) não usam produto desinfetante e 54 (73%) utilizam a passagem a ferro como medida complementar de contenção microbiológica. Conclui-se que há imperiosa necessidade de conscientização dos acadêmicos e docentes sobre adequados uso e manuseio do jaleco e importância da vestimenta na epidemiologia das infecções intra e extra-ambientes da saúde

The ageing of physicians working in ambulatory care make regional health planning a challenging task. This study examines the current supply of general practitioners (GP) within the communities from the perspective of mayors. The information gained on a community level can be used when discussing over- and undersupply as well as future health care planning.A questionnaire was sent to all 1101 mayors of the Federal state of Baden-Württemberg (BW) in May 2011. For the evaluation of the location of the communities, subjective ratings by the mayors were compared with official criteria, provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR).The participation rate was 63% (n=698). According to the mayors about 70% (n=468) were located in a rural area, according to BBSR criteria were about 26% (n=177) of answers given by rural communities. Of the participating mayors about 54% (n=355) stated that their community is cared for merely by GPs. From this information there was a locally experienced undersupply of GPs calculated for 13.5% (n=86) of the communities. This affected rural as well as non-rural communities. In communities up to 20 000 inhabitants, the ratio between GPs and other specialists seems to be 60:40 whereas in bigger cities the proportion of other specialists appears to be much higher.Half of the participating communities seem to not have a practicing specialised physician. An accumulation of specialised physicians in larger cities was reported. The GP shortage appears to mainly be experienced subjectively. Regarding the location (urban vs. rural) of the community, subjective views differ distinctly from the BBSR criteria. This discrepancy could influence a community's marketing strategy when competing for new physicians.

Neurological deficits after cerebrovascular accidents very frequently disrupt the kinematics of voluntary movements with the consequent impact in daily life activities. Robotic methodologies enable the quantitative characterization of specific control deficits needed to understand the basis of functional impairments and to design effective rehabilitation therapies. In a group of right handed chronic stroke survivors (SS) with right side hemiparesis, intact proprioception, and differing levels of motor impairment, we used a robotic manipulandum to study right arm function during discrete point-to-point reaching movements and reciprocal out-and-back movements to visual targets. We compared these movements with those of neurologically intact individuals (NI). We analyzed the presence of secondary submovements in the initial (i.e. outward) trajectory portion of the two tasks and found that the SS with severe impairment (FM < 30) presented arm submovements that differed notably not only from NI but also from those of SS with moderate arm impairment (FM 30-50). Therefore the results of this pilot study suggest that in SS arm kinematics vary significantly across differing levels of motor impairment. Our results support the development of rehabilitation therapies carefully tailored to each individual stroke survivor.

To characterize a contemporary, nonhospitalized population with angina pectoris, data were obtained from a geographically diverse cohort of 5,125 outpatients with chronic stable angina cared for by 1,266 primary care physicians between September and November of 1990. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction, or an abnormal stress test, either alone or in combination). The mean age of the patients was 69 years and 53% were women. Seventy percent had > 1 associated illness and 64% took > 1 cardiovascular drug. Median angina frequency was approximately 2 episodes/week and increased angina frequency (p < 0.0001) was associated with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 35% had mental stress-evoked angina. Female gender (relative risk [RR] 1.09; 95% confidence interval [CI] 1.02 to 1.16), concomitant illness (RR 1.17; CI 1.09 to 1.25), and pharmacotherapy (RR 1.14; CI 1.07 to 1.22) were associated with excess risk for rest angina. Younger age (RR 1.30; CI 1.20 to 1.41), female gender (RR 1.16; CI 1.07 to 1.26), concomitant illness (RR 1.13; CI 1.03 to 1.24), and pharmacotherapy (RR 1.28; CI 1.15 to 1.93) were associated with excess risk for mental stress angina. These data suggest that contemporary outpatients with angina are frequently women and elderly patients with high rates of associated illness, rest, and mental stress-related angina.

To characterize a contemporary, nonhospitalized population with angina pectoris, data were obtained from a geographically diverse cohort of 5,125 outpatients with chronic stable angina cared for by 1,266 primary care physicians between September and November of 1990. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction, or an abnormal stress test, either alone or in combination). The mean age of the patients was 69 years and 53% were women. Seventy percent had1 associated illness and 64% took1 cardiovascular drug. Median angina frequency was approximately 2 episodes/week and increased angina frequency (p0.0001) was associated with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 35% had mental stress-evoked angina. Female gender (relative risk [RR] 1.09; 95% confidence interval [CI] 1.02 to 1.16), concomitant illness (RR 1.17; CI 1.09 to 1.25), and pharmacotherapy (RR 1.14; CI 1.07 to 1.22) were associated with excess risk for rest angina. Younger age (RR 1.30; CI 1.20 to 1.41), female gender (RR 1.16; CI 1.07 to 1.26), concomitant illness (RR 1.13; CI 1.03 to 1.24), and pharmacotherapy (RR 1.28; CI 1.15 to 1.93) were associated with excess risk for mental stress angina. These data suggest that contemporary outpatients with angina are frequently women and elderly patients with high rates of associated illness, rest, and mental stress-related angina.

Operations of foreign fishing vessels in Brazilian waters chartered to operate on unexploited fishing grounds within the Brazilian EEZ, have contributed to the development of the national fishing industry, as it incremented total fish production as well has allowed the transference of new technologies and other benefits. Nevertheless, it is important to identify, among the information gathered, those of economic nature, which would guide inversions in a national and oceanic deep-sea fishing activity that is both economically viable and sustainable in the long term. We assessed recent Brazilian exports of deep-sea crabs (Chaceon spp.) caught by chartered pot vessels off southern Brazil in 2002. Foreign markets consumption patterns were established through the analysis of exported volumes reported by each State, main harbors used by pot vessels and processing technologies employed. These patterns may contribute to future actions of the national fishing industry, as their awareness tend to reduce risks and uncertainties about the exploitations of new products and markets.

Search of the medical literature has, until recently, most often been conducted by medical librarians. The recent development of "user friendly" systems and competition among an increasing number of commercial and non-commercial vendors now provide the opportunity to personally conduct literature searches using a home or office computer without enormous investment in time, training or equipment. Hardware requirements and general principles of computerized literature searching are described, and the various services available for individual subscription are summarized, including National Library of Medicine (NLM) MEDLINE; Bibliographic Retrieval Services (BRS) and BRS/Saunders Colleague; PaperChase; Dialog/Knowledge Index; American Medical Association (AMA) Minet; and MEDIS.

Nicardipine, 30 and 40 mg thrice daily, was administered to 66 patients with stable angina pectoris in a multicentre, randomised, double-blind, cross-over trial. With nicardipine therapy, duration of exercise and cumulative oxygen consumption increased, while times to onset of angina and 1 mm ST segment depression were prolonged. Anginal frequency and nitroglycerin consumption declined with use of nicardipine, but this did not reach statistical significance. Resting heart rate increased slightly and resting blood pressure decreased. Two patients on nicardipine and one on placebo sustained acute infarction. Otherwise, side effects were generally mild and transient.

The finding at autopsy of typical pathologic features of hypertrophic heart disease (idiopathic hypertrophic subaortic stenosis, IHSS) and mitral valve prolapse (MVP) in a single patient prompted study of a number of close relatives of this patient. Several additional cases of IHSS or MVP were found. The HLA typing of this kindred revealed that four out of seven members tested had the Bw 35 antigen. Although the association might be due to chance, this kindred, together with prior reports of similar bizarre myocardial cellular disarray in HISS and MVP, suggest the hypothesis that in some instances, IHSS and MVP may represent a continuum of hereditary cardiac disorders.

When serum was sampled frequently and soon after acute myocardial infarction, myoglobinemia was extremely common, occurring in 12 of 13 selected patients. Myoglobin first appeared in the serum within a few hours after infarction, but not consistently earlier than creatine phosphokinase. The peak level of serum myoglobin was reached appreciably earlier than the peak values of serum creatine phosphokinase activity. Time of earliest myoglobin appearance in the serum, peak level of myoglobin measured, and duration of detectable myoglobin release all correlated poorly with clinical and biochemical estimates of severity of myocardial infarction. There was no correlation between myoglobin levels and infarct size as estimated from creatine phosphokinase kinetics. Myoglobin appeared in the serum in multiple short "staccato" bursts, or episodes, often lasting only one to two hours. The hypothesis is suggested that the pattern of myoglobin appearance is a reflection of the episodic nature of acute myocardial infarction. Although isolated myoglobin determination may not be useful at present, for quantification of total myocardial damage, its pattern of release may be a sensitive marker for studying the time course of infarction, and may be useful to evaluate therapeutic interventions designed to interrupt an ongoing syndrome of myocardial necrosis.

The clinical responses to 12 months' treatment with verapamil were evaluated in 63 patients with stable and unstable angina pectoris in whom the effectiveness of verapamil had been established in short-term double-blind placebo-controlled randomized clinical trials. In 41 patients with effort-related angina, long-term responses were sustained for periods exceeding 1 year. Twenty patients were evaluated by clinical history and showed a sustained reduction in frequency of anginal attacks and consumption of nitroglycerin with verapamil compared with the initial placebo control periods; the magnitude of this benefit was similar to that observed during double-blind treatment with the drug. Twenty-one patients were evaluated by serial treadmill exercise testing and showed a sustained improvement in exercise duration after 4, 8, 16, 24, and 52 weeks of verapamil treatment; withdrawal of the drug resulted in a deterioration of exercise performance to levels similar to those seen before initiation of therapy. In 22 patients with unstable angina at rest, verapamil produced an amelioration of anginal symptoms that was sustained in most patients for longer than 1 year. However, these patients continued to have a high incidence of death and myocardial infarction in a frequency similar to that previously reported in large clinical studies using either combinations of verapamil and nitrates, nifedipine and propranolol, or propranolol and nitrates. Calcium-channel antagonists may decrease the number of patients requiring coronary artery bypass surgery for relief of refractory angina, but they do not appear to alter the natural history of the disease.

Myoglobin was identified in the serum of 11 of 21 patients after myocardial infarction by a sensitive specific complement fixation technic. This method allowed detection of as little as 0.03 μg of myoglobin. The assay tended to underestimate small concentrations of myoglobin due to serum interference. Myoglobinuria occurred with myoglobinemia but did not reflect the level of myoglobinemia or the duration of elevated serum levels. Larger amounts of myoglobin, 0.4 μg/ml or greater, were found in patients with severe infarctions, three of four of whom died as a result of this illness.

Excerpt To the editor: With regard to the article by Dr. Roberts in the December issue (Ann Intern Med 87:788-789, 1977) on the comparative values of MB-creatine kinase and myoglobin in patients wi...