Variation in stated management of acute myocardial infarction in five countries.

We examined the variation in stated practice in the management of acute myocardial infarction (AMI) among doctors in Australia, Brazil, Chile, India and Thailand. Hospitals were identified as primary, secondary or tertiary by investigators from around their own region. All doctors within each hospital who would be expected to treat patients with AMI were asked to indicate which investigations and treatments they would offer to a patient with an AMI who develops angina on Day 3 after admission. The numbers of hospitals ranged from 5 to 26 per country, and doctor response rates varied from 70 to 100%. Within-country variation was large, and statistically significant variations were seen between countries in the use of most interventions. The large variation both between and within a range of countries across the economic spectrum suggests a widespread need for agreement about what constitutes appropriate management after AMI.

The chromosome 2 distal short arm trisomy syndrome.

A trisomy for the distal short arm of chromosome 2 (2p23 leads to 2pter) resulted in similar phenotypic and developmental abnormalities in three related males. The cytogenetic defect was traced to a familial balanced 2;3 translocation [t(2;3) (p23;27)]. Comparison of these patients with the seven previously published cases of 2p partial trisomy reveals a pattern of common features including severe mental and growth retardation, a characteristics facial dysmorphism particularly affecting the eyes, abnormalities of the sternum, spine, and digits, a heart defect, and, in males, cryptorchidism and a striking genital anomaly consisting of a very small penis buried in dorsally fused scrotal skin.