On the mechanism by which chloride corrects metabolic alkalosis in man.

To determine whether administration of chloride corrects chloride-depletion metabolic alkalosis (CDA) by correction of plasma volume contraction and restoration of glomerular filtration rate or by an independent effect of chloride repletion, CDA was produced in normal men by the administration of furosemide and maintained by restriction of dietary sodium chloride intake. Negative sodium balance (-112 +/- 16 meq) and reduced plasma volume (2.53 versus 2.93 liters, p less than 0.05) developed. The cumulative chloride deficit of 271 +/- 16 meq was then repleted by oral potassium chloride (267 +/- 19 meq) over 36 hours with continued serial measurements of glomerular filtration rate, effective renal plasma flow, plasma volume, body weight, and plasma renin and aldosterone levels. CDA was corrected, even though body weight, plasma volume, glomerular filtration rate, and renal plasma flow all remained reduced and plasma aldosterone was elevated; urinary bicarbonate excretion increased during correction. Administration of an identical potassium chloride load to similarly sodium-depleted but not chloride-depleted normal subjects produced no change in acid-base status. It is concluded that chloride repletion can correct CDA by a renal mechanism without restoring plasma volume or glomerular filtration rate or by altering sodium avidity.

The value of radiographic and computed tomography in the staging of lung carcinoma.

A prospective double-blind study was undertaken to compare computed tomography (CT) and conventional radiographic tomography (RT) in the staging of lung carcinoma. Seventy-five patients had CT and RT of the mediastinum and hilum prior to operation. The presence or absence of metastasis to lymph nodes documented at the time of operation was the standard applied to the studies. CT correctly predicted the presence or absence of mediastinal lymphadenopathy in most cases (sensitivity 91%, specificity 94%), while RT was less helpful (sensitivity 61%, specificity 86%). Metastatic mediastinal lymph nodes in those patients with false negative CT and RT studies averaged only 0.8 cm in diameter, probably accounting for the negative radiographic findings. Both CT and RT had poor predictive values in detecting hilar lymphadenopathy (sensitivity 73% and 47%, specificity 87% and 72%, respectively). The predictive value of CT in the evaluation of mediastinal lymphadenopathy equaled that of mediastinoscopy or mediastinotomy. When CT of the mediastinum demonstrates no lymphadenopathy, invasive staging can be deferred for definitive thoracotomy. Since false positive values were seen with both CT and RT scans of the mediastinum (4% and 8%, respectively), invasive staging will still be necessary in those patients with positive studies.

X-ray reports faster and cheaper.

At Woodhull Hospital, a 600-bed municipal hospital in New York City, the department of radiology uses a computer-based dictation system for transcription of x-ray reports. The system is "trained" to recognize the radiologists' voices and the vocabulary used in the department and can print on command the dictated reports. Outside transcription bills have been reduced significantly, and the success of the unit has initiated the purchase of another system. Moreover, JCAHO surveyors seemed pleased with the method we chose to meet its requirements for the timely delivery of x-ray reports.

A survey of systems for after-hours care.

As part of medical care contracts and in response to patient needs for access, HMOs offer a full system of medical care, with 24-hour-per-day, 365-day-per-year coverage for emergencies. As economic units, HMOs strive to efficiently use staff, facilities and financial resources to provide these services. With high quality a goal for all medical services, the HMO needs to shape its emergency care coverage system to satisfy patient needs. Competitive forces and facility availability will play an important role in shaping the design of emergency and after-hours care in each medical community. This article will focus on patient needs, provider considerations, and HMO plan concerns for emergency and after-hours care.

The use of antibiotics in the initial management of recent dog-bite wounds.

The use of antibiotics in the initial management of dog-bite wounds presented within eight hours of injury was studied. Of 211 wounds occurring in 150 patients seen during the study period, 66 wounds occurring in 33 patients comprised the study sample. All wounds were managed according to a strict protocol that included cleaning, debridement, and pressure irrigation. The wounds studied were randomly assigned to either an antibiotics (penicillinase-resistant penicillin or erythromycin) or placebo group. Two of the 35 antibiotic-treated wounds became infected, and three of the 31 placebo-treated wounds became infected. There was no significant difference in outcome between antibiotic and placebo groups. Hand wounds became infected significantly more often than other wounds. The administration of a penicillinase-resistant antibiotic is not indicated in the initial management of dog-bite wounds presented within eight hours of injury.

The place of health care standards in quality assurance.

Medical care standards are essential building blocks to quality care systems. Involvement of all staff levels in development and implementation will facilitate adherence and make appropriate allowances for deviations. Investing time and energy in these quality tools can yield greater efficiency and patient satisfaction.

Health professionals' attitudes toward abortion.

PIP: The attitudes toward abortion of students and faculty in 3 health related fields--nursing, medicine, and social work--are examined and compared with the views of the population at large. The relation of religious affiliation to attitude toward abortion is also examined. The data was obtained via questionnaire in 47 nursing, 11 medical, and 15 social work schools in the fall and winter of 1971. 7 attitudinal items provided the focus of attention. 5 dealt with conditions under which an abortion should be performed; 2 dealt with the willingness of the respondent to help a client get an abortion. Nursing students and faculty had the most conservative attitude, followed by medical personnel and social workers. The nursing faculty's opinions were most like those of the general public; the medical and social work students and faculty generally mirrored respondents with some college education. Catholic health professionals were even less in favor of abortion than Catholics at large, even those with only a grade-school education. Catholic students, however, were more favorably disposed than Catholic faculty, indicating a more liberal trend in the Catholic Church.^ieng

Growth arrest recovery lines in hypoparathyroidism.

Dense lines paralleling vertebral end plates with a "bone-in-bone" appearance were seen on radiographs of five patients with idiopathic hypoparathyroidism. The lines are similar to those seen in cases in which there is recovery from a growth arrest. The cause of the lines is unclear and may be related not only to the metabolic process itself, but also to its complications and treatment. The finding, although nonspecific, should bring the possibility of idiopathic hypoparathyroidism to mind.

Effects of inguinal hernias upon the bladder and ureters.

The presence of inguinal hernia may be associated with extrinsic defects upon the bladder and ureter in the absence of actual herniation of the urinary structures. The findings are characteristic unless associated with irregularity of the bladder wall or elevation of the bladder floor by prostatic enlargement. In some cases, the possibility of intrinsic bladder pathology is raised, requiring retrograde study for clarification. Ureteral displacements may be either ipsilateral or contralateral, depending upon the segment of bowel involved and the side of the hernia. The bladder findings are best demonstrated when the patient is prone or upright.

Intracortical fissuring in osteomyelitis.

Cortical fissuring, a well-recognized radiographic sign of osteomyelitis, represents spread of infection through the haversian system with osteoclastic bone resorption. In the proper clinical setting this finding may be recognized before there is other evidence of bone destruction or periosteal reaction. Three cases are presented that illustrate the sign at a relatively early stage in the progress of the osteomyelitis. While fissuring was previously considered evidence of sickle cell anemia, only one of our patients had sickle hemoglobin.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.