The use of self-expandable plastic stents for non-malignant esophago-pleural fistulas.

Anastomotic leaks and fistulas are unfortunate complications of esophageal-gastric surgery and esophageal dilations. Traditional management options have included surgery or a more conservative approach. There have been few reports describing the use of self-expandable plastic stents for the treatment of esophageal perforations and tracheoesophageal fistulas from benign diseases. We are reporting the use of self-expandable plastic stents for the treatment of non-malignant esophago-pleural fistulas occurring after esophagectomy in one case and esophageal perforation post dilation in the other.

The fourth chromosome of Drosophila melanogaster: interspersed euchromatic and heterochromatic domains.

The small fourth chromosome of Drosophila melanogaster (3.5% of the genome) presents a puzzle. Cytological analysis suggests that the bulk of the fourth, including the portion that appears banded in the polytene chromosomes, is heterochromatic; the banded region includes blocks of middle repetitious DNA associated with heterochromatin protein 1 (HP1). However, genetic screens indicate 50-75 genes in this region, a density similar to that in other euchromatic portions of the genome. Using a P element containing an hsp70-white gene and a copy of hsp26 (marked with a fragment of plant DNA designated pt), we have identified domains that allow for full expression of the white marker (R domains), and others that induce a variegating phenotype (V domains). In the former case, the hsp26-pt gene shows an accessibility and heat-shock-inducible activity similar to that seen in euchromatin, whereas in the latter case, accessibility and inducible expression are reduced to levels typical of heterochromatin. Mapping by in situ hybridization and by hybridization of flanking DNA sequences to a collection of cosmid and bacterial artificial chromosome clones shows that the R domains (euchromatin-like) and V domains (heterochromatin-like) are interspersed. Examination of the effect of genetic modifiers on the variegating transgenes shows some differences among these domains. The results suggest that heterochromatic and euchromatic domains are interspersed and closely associated within this 1.2-megabase region of the genome.

Variations in family physicians' and cardiologists' care for patients with heart failure.

BACKGROUND: Improved understanding of the reasons for underuse of diagnostic tests and treatments for congestive heart failure (CHF) may be helpful for designing future interventions to improve quality of care. METHODS: To determine differences between family physicians' and cardiologists' practice styles for diagnosis and treatment of CHF, a random sample of family physicians and cardiologists were surveyed with standardized case scenarios. RESULTS: Survey respondents were 182 family physicians and 163 cardiologists. Family physicians were less likely than cardiologists to rate measurement of left ventricular ejection fraction as "very important" for patients with new CHF, less likely to order an echocardiogram or test for ischemia, and much less likely to identify diastolic dysfunction as a cause of CHF. Family physicians were more likely to prescribe digoxin when it was not indicated (diastolic dysfunction) and less likely to prescribe digoxin and an angiotensin-converting enzyme (ACE) inhibitor when they were indicated (moderately to severely reduced left ventricular ejection fraction). Family physicians expressed more concern over the risks of ACE inhibitors in patients with blood pressure of 100/70 mm Hg or serum creatinine of 2.0 mg/dL and were less likely to prescribe an ACE inhibitor in these settings. Family physicians overestimated the risks of warfarin use for atrial fibrillation and were therefore less likely to prescribe warfarin. CONCLUSIONS: Family physicians appear to have less understanding of CHF pathophysiology (ie, systolic versus diastolic dysfunction) and how treatment differs according to the underlying disease process. Overestimation of the risk of ACE inhibitor and warfarin use may result in underprescribing these medications.

Using unfamiliar clinical settings for RN students.

In light of this experience, I encourage faculty members to help their RN students realize the value in an unfamiliar practice setting. Not only does it provide new knowledge and insights, but it also encourages the application of prior knowledge to new, unfamiliar settings in order to find solutions and implement new strategies. Personal creativity is enhanced as the nursing process is implemented.

Homicide in the workplace in Ontario: occupations at risk and limitations of existing data sources.

This study has identified workplace homicides in Ontario from 1975 to 1985, described those at risk, and examined what existing data sources are most suitable for locating the occurrence of these events. Homicides were identified from two sources: the Office of the Chief Coroner and the Ontario Mortality Database (OMDB). Of the 84 homicides identified, 87% occurred among males; the average annual work-related homicide rate was 0.17 per 100,000 workers, with a male-to-female ratio of 5.2:1. The rates in males were about one-eighth of those reported in California and Texas. The highest rates occurred among policemen, gas station attendants, security guards, and taxi drivers, and in restaurants and in certain retail operations such as jewelry stores. These homicides represented about 4% of all traumatic workplace fatalities. Firearms were responsible for 56% of these homicides and the motive was robbery in 50%. The OMDB proved to be an awkward source from which to identify such deaths because there is no "injury-at-work" field on death certificates. Other existing sources of data were not able to locate work-related homicides. Guidelines to protect those at high risk of assault and homicide should be developed.