Bone marrow sampling.

Bone marrow sampling may be indicated in the evaluation of iron metabolism, fever of unknown origin, anemia, leukocytosis and other hematologic abnormalities. The commonly accepted means of marrow sampling are needle aspiration and needle biopsy. The preferred site for obtaining the sample is the iliac crest. Contraindications to the procedure include infection or previous radiation therapy at the sample site, poor patient cooperation and major coagulation defects. The assistance of a skilled technician, use of a prepackaged tray, thorough patient education, use of local anesthesia and attention to aseptic technique help simplify bone marrow sampling.

The effect of a rural family practice preceptorship on medical students' residency selection.

OBJECTIVE: We suspected our senior medical student rural family practice preceptorship was a positive influence on students' selection of family practice as a specialty. METHODS: A five-year study of 598 students' specialty choices before and after their preceptorship was done and compared to eventual residency choice. RESULTS: Of these students, 565 (94.5%) appeared to be uninfluenced by the preceptorship. Of the 33 students who reported a change in residency choice after completing the rural preceptorship, 15 (2.5%) chose a family practice residency. CONCLUSIONS: The rural preceptorship was found to have a positive influence on students' choice of family practice residency positions.

Subclavian steal syndrome.

Subclavian steal syndrome is caused by proximal subclavian occlusion with retrograde filling of the subclavian artery via the vertebral artery. This syndrome is characterized by symptoms due to decreased cerebral blood flow and decreased blood flow to the arm and hand. It is twice as common in men as in women. Diagnosis is confirmed with angiography. Medical management is of limited value. Surgery is the treatment of choice for the symptomatic patient.

Varicella during pregnancy: the timing of effective treatment.

Maternal varicella infections during pregnancy can be either benign or disastrous for the infant according to the timing of infection during gestation. We report a case of varicella occurring at term that was managed successfully. Appropriate management includes tocolysis, unless contraindicated, and varicella-zoster immune globulin (VZIG) administered to the mother within 72 hours of delivery, or to the neonate when the mother's rash appears within 48 hours after delivery. Treatment can markedly decrease the risk of mortality and severe morbidity in the relatively immunocompromised infant.

Hypernatremia in the elderly.

Hypernatremia is common in elderly persons, who may present with signs that are easily overlooked. Prompt diagnosis and appropriate therapy can sometimes lead to a remarkable recovery. To avoid cerebral edema, rehydration must be accomplished gradually over 48 to 72 hours. The recommended replacement for the first 24 hours is approximately 30 percent of the estimated water loss.

RJR Nabisco's cartoon camel promotes camel cigarettes to children.

OBJECTIVES: To determine if RJR Nabisco's cartoon-theme advertising is more effective in promoting Camel cigarettes to children or to adults. To determine if children see, remember, and are influenced by cigarette advertising. DESIGN: Use of four standard marketing measures to compare the effects of Camel's Old Joe cartoon advertising on children and adults. SUBJECTS: High school students, grades 9 through 12, from five regions of the United States, and adults, aged 21 years and over, from Massachusetts. OUTCOME MEASURES: Recognition of Camel's Old Joe cartoon character, product and brand name recall, brand preference, appeal of advertising themes. RESULTS: Children were more likely to report prior exposure to the Old Joe cartoon character (97.7% vs 72.2%; P less than .0001). Children were better able to identify the type of product being advertised (97.5% vs 67.0%; P less than .0001) and the the Camel cigarette brand name (93.6% vs 57.7%; P less than .0001). Children also found the Camel cigarette advertisements more appealing (P less than .0001). Camel's share of the illegal children's cigarette market segment has increased from 0.5% to 32.8%, representing sales estimated at $476 million per year. CONCLUSION: Old Joe Camel cartoon advertisements are far more successful at marketing Camel cigarettes to children than to adults. This finding is consistent with tobacco industry documents that indicate that a major function of tobacco advertising is to promote and maintain tobacco addiction among children.