Electronically excited and ionized states of the CH2CH2OH radical: a theoretical study.

The low lying excited electronic states of the 2-hydroxyethyl radical, CH(2)CH(2)OH, have been investigated theoretically in the range 5-7 eV by using coupled-cluster and equation-of-motion coupled-cluster methods. Both dissociation and isomerization pathways are identified. On the ground electronic potential energy surface, two stable conformers and six saddle points at energies below approximately 900 cm(-1) are characterized. Vertical excitation energies and oscillator strengths for the lowest-lying excited valence state and the 3s, 3p(x), 3p(y), and 3p(z) Rydberg states have been calculated and it is predicted that the absorption spectrum at approximately 270-200 nm should be featureless. The stable conformers and saddle points differ primarily in their two dihedral coordinates, labeled d(HOCC) (OH torsion around CO), and d(OCCH) (CH(2) torsion around CC). Vertical ionization from the ground-state conformers and saddle points leads to an unstable structure of the open-chain CH(2)CH(2)OH(+) cation. The ion isomerizes promptly either to the 1-hydroxyethyl ion, CH(3)CHOH(+), or to the cyclic oxirane ion, CH(2)(OH)CH(2) (+), and the Rydberg states are expected to display a similar behavior. The isomerization pathway depends on the d(OCCH) angle in the ground state. The lowest valence state is repulsive and its dissociation along the CC, CO, and CH bonds, which leads to CH(2)+CH(2)OH, CH(2)CH(2)+OH, and H+CH(2)CHOH, should be prompt. The branching ratio among these channels depends sensitively on the dihedral angles. Surface crossings among Rydberg and valence states and with the ground state are likely to affect dissociation as well. It is concluded that the proximity of several low-lying excited electronic states, which can either dissociate directly or via isomerization and predissociation pathways, would give rise to prompt dissociation leading to several simultaneous dissociation channels.

Acute and chronic urinary tract infections caused by Chlamydia trachomatis.

Chlamydia trachomatis is one of the causes of acute and chronic urinary tract infections and acute or silent salpingitis. Chronic or recurrent female urinary or genital tract infections with Chlamydia trachomatis have been recognised as a significant factor in the development of acute or chronic renal interstitial inflammation or increased risk of ectopic pregnancy. In most cases Chlamydia trachomatis is sexually transmitted. Moreover, it is one of the most common sexually transmitted pathogens. The current estimate is that in the United States there occur 4.5 million new infections each year. We describe 3 cases of recurrent urinary tract infections due to Chlamydia trachomatis.

Anesthesiologist direction and patient outcomes.

BACKGROUND: Anesthesia services for surgical procedures may or may not be personally performed or medically directed by anesthesiologists. This study compares the outcomes of surgical patients whose anesthesia care was personally performed or medically directed by an anesthesiologist with the outcomes of patients whose anesthesia care was not personally performed or medically directed by an anesthesiologist. METHODS: Cases were defined as being either "directed" or "undirected," depending on the type of involvement of the anesthesiologist, as determined by Health Care Financing Administration billing records. Outcome rates were adjusted to account for severity of disease and other provider characteristics using logistic regression models that included 64 patient and 42 procedure covariates, plus an additional 11 hospital characteristics often associated with quality of care. Medicare claims records were analyzed for all elderly patients in Pennsylvania who underwent general surgical or orthopedic procedures between 1991-1994. The study involved 194,430 directed and 23,010 undirected patients among 245 hospitals. Outcomes studied included death rate within 30 days of admission, in-hospital complication rate, and the failure-to-rescue rate (defined as the rate of death after complications). RESULTS: Adjusted odds ratios for death and failure-to-rescue were greater when care was not directed by anesthesiologists (odds ratio for death = 1.08, P < 0.04; odds ratio for failure-to-rescue = 1.10, P < 0.01), whereas complications were not increased (odds ratio for complication = 1.00, P < 0.79). This corresponds to 2.5 excess deaths/1,000 patients and 6.9 excess failures-to-rescue (deaths) per 1,000 patients with complications. CONCLUSIONS: Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. These results suggest that surgical outcomes in Medicare patients are associated with anesthesiologist direction, and may provide insight regarding potential approaches for improving surgical outcomes. (Key words: Anesthesiologists; anesthesia care team; quality of care; mortality; failure-to-rescue; complication; Medicare; general surgery; orthopedics.)

Conditional Length of Stay.

OBJECTIVE: To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available. DATA SOURCES: The 1991 and 1992 MedisGroups National Comparative Data Base. STUDY DESIGN: We use engineering reliability theory traditionally applied to estimate mechanical failure rates to construct a CLOS measure. Specifically, we use the Hollander-Proschan statistic to test if LOS distributions display an "extended" pattern of decreasing hazards after a transition point, suggesting that "the longer a patient has stayed in the hospital, the longer a patient will likely stay in the hospital" versus an alternative possibility that "the longer a patient has stayed in the hospital, the faster a patient will likely be discharged from the hospital." DATA COLLECTION/EXTRACTION METHODS: Abstracted records from 7,777 pediatric pneumonia cases and 3,413 pediatric appendectomy cases were available for analysis. PRINCIPAL FINDINGS: For both conditions, the Hollander-Proschan statistic strongly displays an "extended" pattern of LOS by day 3 (p<.0001) associated with declining rates of discharge. This extended pattern coincides with increasing patient complication rates. Worse admission severity and chronic disease contribute to lower rates of discharge after day 3. CONCLUSIONS: Patient stays tend to become prolonged after complications. By studying CLOS, one can determine when the rate of hospital discharge begins to diminish--without the need to directly observe complications. Policymakers looking for an objective outcome measure may find that CLOS aids in the analysis of a hospital's management of complicated patients without requiring complication data, thereby facilitating analyses concerning the management of patients whose care has become complicated.

[The efficacy of the substitution of carnivit in patients with chronic failure treated with hemodialysis]. / Ocena skutecznosci substytucyjnego stosowania preparatu Carnivit u chorych na przewlekla niewydolnosc nerek leczonych hemodializa.

Low serum concentration of the carnitine is one of the causes of muscle weakness and cardiomyopathy in patients with chronic renal failure treated by hemodialysis. The carnitine facilitate transport of the free fatty acid into the straitened muscle cells where the product of oxidation is energy-ATP. In the present paper we presented the investigation of the influence of L-carnitine substitution on cardiac performance. The results indicate the positive influence of this treatment on metabolic and haemodynamic cardiac parameters. The subjective patients opinion of L-carnitine treatment was also positive.

[Factors causing renal failure in patients with disseminated lupus erythematosus: description of three cases]. / Czynniki wywolujace niewydolnosc nerek u chorych na toczen rumieniowaty ukladowy--opis trzech przypadków.

We describe three cases of patients with systemic lupus erythematosus in which additional infections: mycotic, bacterial and viral deteriorated renal function and patients needed the dialysis treatment. The patients with autoimmunologic disorders are very sensitive for different infections which need rapid diagnosis and intensive treatment.

[Calcified subcutaneous nodules in patients with chronic renal failure as a result of injections with nadroparin (Fraxiparine)]. / Zwapnienia podskórne u chorej z przewlekla niewydolnoscia nerek (pnn) powstale w wyniku wstrzykniec nodraparyny (Fraxiparine).

In this report we describe a case in which after subcutaneously calcium heparin injection, local inflammatory state with secondary calcification appeared. Our report confirms previous observations which suggest that in patients with chronic renal failure with hyperphosphatemia calcium salt heparin ought be avoided.

[Levels of L-carnitine in serum of patients with chronic renal failure treated by hemodialysis (HD)]. / Stezenie L-karnityny w surowicy chorych na przewlekla niewydolnosc nerek (PNN) niedializowanych i leczonych hemodializa (HD).

Low serum levels of the carnitine in chronic uremic patients treated by hemodialysis is one of the causes of muscle weakness. In 50 patients with chronic renal failure treated by HD and in 13 nondialyzed patients EMG and measurement of nerve conduction velocity were performed. In 25 of 50 patients treated with HD and in 13 non-dialyzed patients serum concentration of free and total carnitine were measured. In HD patients serum level of carnitine was significantly lower as compared to the control group of healthy subjects and to the nondialyzed patients. In all patients the EMG investigations showed the traits of the neurogenic atrophy of the muscles. The correlation between the amplitude of muscle potentials and serum levels of carnitine suggests that the depletion of carnitine may play a role in severity uremic myopathy.

["Reversible cholelithiasis" in patients with chronic renal failure treated with ceftriaxone]. / "Odwracalna kamica zólciowa" u chorych z przewlekla niewydolnoscia nerek leczonych ceftriaksonem.

Patients with chronic renal failure were admitted to the Neurological Department and symptoms of cholelithiasis were observed. Ceftriaxone therapy in one case was clinically effective.

Use of a verbal fluency measure in understanding and evaluating ADHD as an executive function disorder.

A primary characteristic of Attention Deficit Hyperactivity Disorder (ADHD) is an inability to establish and maintain sustained attention, which is speculated to reflect frontal lobe involvement. The Knight Verbal Fluency measure was administered to 19 ADHD inpatient boys and to a cohort group of 7 children who were matched for mean age, psychiatric diagnosis (depression), treatment facility, and examiner but were without the diagnosis of ADHD. Analysis indicated that ADHD children performed significantly lower than expected and lower than the similar non-ADHD children. These findings lend support to the hypothesis that frontal lobe dysfunction is involved in attentional process disorders and suggests the potential clinical usefulness in the diagnostic screening of ADHD children of a simply administered measure amenable to interpretation of frontal lobe function.