Health care reform. Pan American Uni-Care Health Insurance Plan.

Something is definitely wrong with the American health care system. Too many citizens are denied health care, and health care costs continue to rise at an uncomfortable and intolerable rate. Ensuring care for all is a paramount goal. There is no way to simultaneously cover everyone; leave the reimbursement of physicians unrestrained; ensure instantaneous access to every imaginable high-technology service; subsidize the world's costliest and least efficient health bureaucracy; and contain costs. Widespread dissatisfaction in all quarters--physicians, hospitals, third-party payers, regulators and consumers--has led to an avalanche of reform proposals. Rapidly changing social, political, and economic environments; rising fiscal pressure; and an evolving understanding of the major determinants of health have also created pressure for changes. There are some new and hopeful signs that America is facing up to the need for changes in the health care delivery system. The Pan American Uni-Care Health Plan that is described in this article may serve as a reasonable balance among these competing priorities.

Histomorphologic evidence of fracture healing after direct electrical stimulation in dogs.

A histomorphologic study was done at intervals up to 10 days after causing a fracture in both hindleg tibiae in dogs and giving direct electrical stimulation in one tibia, the other being used as control (20 microns ampere of direct current were passed in 28 limbs and the current was maintained with the help of a simple regulator developed by the authors). The radiologic and histomorphologic study showed definite evidence of early start and completion of healing processes in the electrically stimulated hindlegs. Negative potentials induced at the fracture sites appeared to be the cause of improved healing. The incidence of infection and focal necrosis at the anode was minimal in this experiment.

Histological and histochemical studies on the ovaries of the red cotton bug, Dysdercus koenigii (Heteroptera: Pyrrhocoridae).

A histological and histochemical study of the ovary of Dysdercus koenigii has been carried out to ascertain the origin of protein, lipid and carbohydrate components of the yolk during vitellogenesis. Germaria of the telotrophic ovarioles of this insect comprise mononucleate and binucleate trophocytes, prefollicular cells and oogonia ensheathed in two membranes. The follicular epithelium derived from the prefollicular cells is multilayered in the beginning of the oocyte development but is progressively reduced to one layer in later stages. Chromatin material in the binucleate trophocytes condenses to form DNA-positive blobs. RNA-positive material flowing from the nutritive cords can be seen at the nutritive cord-oocyte junction. Protein bodies appear first in the intercellular spaces of follicular epithelium during the early vitellogenic stages indicating the supply of yolk protein from the haemolymph. Lipids originate as L1 bodies made up of unsaturated phospholipids in the nucleus (germinal vesicle). These bodies by addition of saturated triglycerides from haemolymph change to L2 bodies, which in turn, knock off phospholipid part and change of L3 bodies. Polysaccharides come as extrusions from the germinal vesicle while glycogen is first seen in the intercellular spaces of follicular epithelium and then passes into the oocyte indicating its origin in the haemolymph.

Studies on the neuroendocrine system of the mangohopper, Idiocerus atkinsoni Leth. (Homoptera : Jassidae).

The neuroendocrine system of the homopteran, Idiocerus atkinsoni has been described, employing a neurosecretory stain. Two groups of medial neurosecretory cells (NSC) of one tinctorial type are present in the pars intercerebralis of the brain. Processes believed to be dendrites of the neurosecretory neurons lie superficially underneath the neurilemma and enclose neurosecretory material (NSM). Both the nervi corporis cardiaci, NCCI and NCCII, are branched. The branches of the former join to form an oesophageal nerve that runs on the oesophageal surface and terminates on the midgut, and those of the latter, innervate the oesophageal dilator muscles. Besides being present in the dendrite-like processes and NSC, the NSM is also seen in the NCCI, anterior part of the aorta and oesophageal nerve but not in the NCCII, corpora cardiaca (CC) and the corpus allatum (CA). It is suggested that the release of NSM into the circulation in this insect occurs through two main routes: the dendrites and the aorta. The evolution of the aorta as an exclusive neurohaemal organ in Hemiptera is discussed.

Neuroendocrine organs of the lemon-butterfly, Papilio demoleus L. III. Metamorphic changes in the retocerebral endocrine organs.

The retrocerebral endocrine organs, the corpora cardiaca and corpora allata were studied in different developmental stages of the lemon-butterfly. The organs were found to undergo several changes in respect of their position, size, structure and the number of nerves associated with them.

Electrical stimulation in delayed union of long bones.

The role of electricity in the promotion of fracture union of long bones in human beings requires further investigation. An electric stimulator was devised through which 15 microamperemeter current was applied to the fractured long bones of 20 patients with delayed union. The best results were obtained in cases where the negative electrode was introduced at the fracture site and the positive electrode was placed proximal to the fracture area. In 90 per cent of cases treated by different methods in this series, union occurred within an average period of 9 1/4 weeks. The rate of infection following introduction of electrodes for electrical stimulation was 20 per cent.

Primary liposarcoma of the skull.

Only 14 cases of primary liposarcoma of bones have been reported in the available world literature. This is the first report of its origin from the calvaria. The tumor showed excellent response to deep x-ray therapy.

Temporomandibular ankylosis.

1. Intraarticular hydrocortisone and passive manipulation under general anesthesia does not help mobilize the jaw. 2. Condylectomy gives good results in selected cases, where the duration of ankylosis is minimal. 3. Longer duration requires wide excision of the condyloid as well as coronoid processes. The opposite side also must be operated on in most late cases. A gap of more than 2 cm is left in order to avoid recurrences. 4. Postoperative physiotherapy of the jaw in the form of active and resistive movements of the jaw, if started early, gives good functional results and helps recover the function of the chewing muscles. 5. Functional results are good even without interposition of soft tissues or use of prostheses. 6. Skeletal traction after operation is unnecessary. 7. The results of adequate resection of bone followed by early and adequate physiotherapy are very gratifying to the patient.

Neuroendocrine organs of the lemon-butterfly, Papilio demoleus L. II. The corpora cardiaca-allata complex of the adult.

The retrocerebral endocrine organs of the adult lemon-butterfly; Papilio demoleus have been described. The organs are subaortic lying closely behind the brain. While the nervi corporis cardiaci I (NCCI) originate from the protocerebrum of the brain, the NCCII seem to take their origin in the tritocerebrum in common with another nerve named earlier as the tegumentary nerve. The corpora cardiaca (CC) and corpora allata (CA) are closely approximated to each other obliterating the nervi corporis allati (NCA) which are conspicuous in the larva of the same species. An intercardiacal bridge (ICB) connects the CC of the two sides and acts as a possible centre of distribution for the neurosecretory material (NSM) to the gut. Histological evidence suggests that the NSM inside the CC remains intraaxonal without being primarily unloaded in the organs for storage. The intrinsic secretory cell of the CC are intimately associated with the neurosecretory fibres from the brain and bear fairly thick axons. No NSM could be detected in the CA of this insect.

Neuroendocrine organs of the lemon-butterfly, Papilio demoleus L. I. The corpora cardiaca-allata complex of the larva.

The histomorphology of the retrocerebral endocrine organs of the larva of the lemon-butterfly, P. demoleus has been described employing a conventional neurosecretory staining technique. The larval organs lie a little away from the brain and oesophagus and, therefore, are not sub-aortic in position unlike most other insects and the adult of this species itself. There are two long NCCs which innervate other target organs in addition to the CC. The recurrent nerve of the stomatogastric nervous system retains its normal connections with the CC even in absence of the hypocerebral ganglion. Histological evidence suggests that the NSM inside the CC remains intraaxonal without being possibly unloaded in the substance of these organs. Axonal transport of NSM to target organs is also in evidence and though NSM is seen in the NCA, it could not be detected inside the CA.

Histological study on the retrocerebral endocrine-aortal complex of the water-bug, Sphaerodema annulatum (Heteroptera: belostomatidae) with reference to secretory inclusions.

Unlike many heteropterans, the retrocerebral endocrine organs of the water-bug, Sphaerodema annulatum are not fused with each other or with the hypocerebral ganglion. The NCC I bypass the CC and also innervate the oesophageal dilator muscles, CA and post-allatal pericardial cells in addition to aorta. Terminall, this nerve dilates into an ampulla showing accumulation of NSM and, therefore, regarded as a transitory storage centre. Each CC is divisible into two histological halves; the anterior half being negative and the posterior half positive to AF. The CA are innervated by two NCAs one of which (the NCA I) ramifies to form a NSM containing nerve-net on the surface of the gland regarded as another transitory storage centre. Three qualitatively different secretory factors are recognised in the retrocerebral endocrine-aortal complex of this insect -- of which one, localised in the posterior half of the CC, is regarded as indigenous and the other two present in the CA, aorta and pericardial cell nerves as cerebral in origin. Of the latter, both the factors are transported to the CA while only one to the aorta and pericardial cell nerves.