The Vanderbilt Burn Center: the first 18 months.
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Biomedical subjects
Publications and source records attributed to R Rees.
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A comparison is made between the birth weights, weights, heights, skinfold thicknesses, and head circumferences of two groups of Tokelauan children aged under 15 years. One group was living in Tokelau on their three home atolls and the other group was living in New Zealand. The children living in New Zealand were in general heavier, taller, had more body fat and larger head circumferences than the children living in Tokelau.
A young male patient with bilateral rupture of the diaphragm due to blunt trauma is presented. A separate tear occurred in each hemidiaphragm but recognition and repair of the right side was delayed. After healing of other injuries successful operation was performed 55 days postinjury by a transthoracic approach.
The relation of microbial flora in stomach contents and stomach wall was examined in paired specimens from 10 surgical patients and in specimens of wall from 10 additional patients. The flora of both contents and wall were similar. Paired specimens from five patients contained the same kinds of bacteria. Paired specimens from these patients were sterile. Contents from two patients contained bacteria, but the wall was sterile. Microorganisms isolated were streptococci, lactobacilli, bifidobacteria, bacteroides, staphylococci yeast, and coliforms. Bacterial counts ranged from 0 to 10(7.5) per ml or g in both contents and tissue. Survey of the literature shows that most specimens from patients with gastric ulcers or gastric malignancies are positive for bacteria, while only about 60% of specimens from patients with duodenal ulcers are positive.
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In a prospective clinical trial 312 cases of self-poisoning (276 patients) consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision as to "disposal." Junior doctors and nurses received some instruction in this work. Both groups of assessors asked for help from social workers when necessary. Once the medical teams had completed their assessments, psychiatrists provided most of the hospital treatment. Follow-up at one year showed no significant difference between the two groups of patients in the numbers who repeated their self-poisoning or self-injury (or both), or committed suicide. Provided junior doctors and nurses are taught to assess self-poisoned patients, we think medical teams can evaluate the suicidal risk and identify patients requiring psychiatric treatment or help from social workers, or both. Contrary to the Department of Health's recommendation that all cases of deliberate self-poisoning should be seen by psychiatrists, we have reached the conclusion that physicians should decide for each of their patients if specialist psychiatric advice is necessary.
Of 1,020 consecutive admissions to a regional neonatal center, 38 infants were admitted following elective delivery in which no medical condition of the mother or fetus had necessitated immediate delivery. Twenty infants had problems that were not primarily the result of elective delivery, developed in 18. Fifteen of these 18 infants were delivered by cesarean section; in none of the mothers had any assessment of fetal maturity or size (other than the menstrual history and physical examination) been made. The infants remained in the hospital for an average of 12.7 days at a median cost of $2,678 per patient. One infant died. In the absence of pressing medical indications and without an objective assessment of fetal maturity, elective delivery remains potentially hazardous.
Various analogs of synthetic hypothalamic luteinizing hormone-releasing hormone (LH-RH) were evaluated for agonistic (ovulation-inducing), postcoital contraceptive, and direct uterotrophic activities. All analogs showing agonistic activity also possessed the ability to terminate pregnancy, as did LH-RH; there appeared to be a direct relationship between agonistic and postcoital potency and activity. The highly potent and active LH-RH agonist, D-[Ala]6-des-[Gly]10-pro9-ethylamide-LH-RH, proved to be the most potent and active postcoital preimplantational and postimplantational antifertility agent. In contrast to LH-RH, none of the analogs tested in the hypophysectomized animal produced a uterotrophic effect, revealing a selective extrapituitary effect of the parent hormone. The collective data demonstrate that peptides derived from LH-RH and bearing agonistic properties can terminate pregnancy postcoitally, via disruption of the pituitary-ovarian reproductive complex. Possible mechanisms are discussed, and the use of members of this neurohormonal class as potential profertility agents should be weighed with caution.
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Three rhesus monkeys were trained to press either of two response keys. A response on the reinforcement key during presentation of the reinforced stimulus produced a sucrose pellet followed by an intertrial interval, but during presentation of the unreinforced stimulus produced only the intertrial interval. A response on the switching key changed the discriminative stimulus from reinforced to unreinforced or from unreinforced to reinforced. The reinforced stimulus was presented automatically on half the trials, but could be produced only by a switching response on the other half. Switching tended to occur in three distinct stages during acquisition of discriminative behavior. The first stage was identified as "nondiscriminative switching"; the second as "nonswitching"; and the third as "discriminative switching".
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