Contract law: relationship between dermatologists and third-party payers.

The relationship between third-party payers and dermatologists is generally governed by a written contract. That relationship can be more beneficial to the dermatologist, and chances of liability may be decreased, both for breach of contract and for malpractice, if the dermatologist pays close attention to the language in the contract. All contracts are generally negotiable; detrimental language in the contract often may be removed or changed. This article presents information to help prepare dermatologists to review and negotiate contracts.

The heart in chronic alcoholism: a noninvasive study.

The echocardiogram and systolic time intervals were used to evaluate cardiac function in 73 chronic alcoholic subjects without symptoms of heart disease. All were below the age of 45 years and none had arterial hypertension or history of heart disease. The echocardiograms of chronic alcoholic individuals revealed increased thickness of the left ventricular wall (10.4 mm. +/- 1.05, normal controls 8.76 mm. +/- .86, p less than 0.001), interventricular septum (11.71 mm. +/- 1.33, normal controls 9.63 +/- 1.24, p less than 0.001) and markedly increased left ventricular mass (145 gm./M.2 +/- 32, normal controls 101 +/- 20.7, p less than 0.001). The echocardiographic indices of myocardial contractility (ejection fraction, wall excursion and velocity, circumferential fiber shortening) were normal. Systolic time intervals revealed shortening of ejection time and prolongation of the pre-ejection period. It was found that approximately half of the asymptomatic alcoholic subjects have left ventricular hypertrophy without echocardiographic evidence of decreased myocardial contractility. It is suggested that abnormal systolic time intervals may be due to decreased myocardial compliance.