C60 fullerene: a powerful antioxidant or a damaging agent? The importance of an in-depth material characterization prior to toxicity assays.

Since the discovery of fullerenes in 1985, these carbon nanospheres have attracted attention regarding their physico/chemical properties. Despite little knowledge about their impact on the environment and human health, the production of fullerenes has already reached an industrial scale. However, the toxicity of C(60) is still controversially discussed. The aim of this study was to clarify the biological effects of tetrahydrofuran (THF) suspended C(60) fullerene in comparison to water stirred C(60) fullerene suspensions. Beyond that, we analyzed the effects on the Crustacea Daphnia magna an indicator for ecotoxicological effects and the human lung epithelial cell line A549 as a simplified model for the respiratory tract. We could demonstrate that water-soluble side products which were formed in THF nC(60) suspension were responsible for the observed acute toxic effects, whereas fullerenes themselves had no negative effect regardless of the preparative route on either A549 cell in vitro or D. magna in vivo.

Temporary coronary artery perfusion catheter during minimally invasive coronary surgery.

STUDY OBJECTIVE: The purpose of this study was to investigate the use of an intracoronary cannula during minimally invasive direct coronary artery bypass (MIDCAB) surgery. DESIGN: Evaluation of the coronary perfusion catheter was conducted during MIDCAB surgery to determine if there was any trauma to the coronary artery. The study was retrospective with 45% follow-up arteriograms. SETTING: A community hospital provided the setting for the study. Twenty patients undergoing MIDCAB surgery were included. INTERVENTIONS: Insertion of an intracoronary cannula was performed during MIDCAB surgery. MEASUREMENTS AND RESULTS: Measurements were determined on 45% follow-up arteriograms, and clinical follow-up was done on patient status. CONCLUSION: The use of an intracoronary cannula during MIDCAB surgery did not result in any trauma to the cannulated coronary artery. The cannula prevented ischemia of the service area of the target coronary artery. ECG changes were avoided as were hypotension and arrhythmias. The cannula also helped stabilize the target coronary area during suturing.

Arrhythmia/ischemia management during minimally invasive cardiac operation.

We present a case of severe arrhythmia and hemodynamic compromise in a patient undergoing minimally invasive coronary artery bypass grafting without cardiopulmonary bypass. This was successfully treated via an extracorporeal shunt from a femoral artery cannula.

Running as fast as they can: organizational changes in home health care.

During the 1980s, as the health care industry experienced what observers have dubbed a revolution, the home health industry also experienced its own transformation. Utilizing three organizational theories (neoinstitutional, resource dependency and population ecology), the authors report on a study of a probability sample of 163 home health agencies (HHAs) that were interviewed in 1986 and again in 1987 on the effects of Medicare policy changes including prospective payment (DRGs). This study tests hypotheses concerning the influence of environmental factors (e.g., state policy and characteristics of the local market) and organizational characteristics of the HHA (e.g., tax status and Medicare reliance) in explaining the propensity of HHAs to be (or become) parts of chains and/or multi-facility systems; and to develop particular types of interorganizational relations. The paper discusses the results in the context of public policy changes and the implications for future research and practice.

Nonunion of the tibial shaft.

Charts of 70 patients with 72 nonunions of the tibial shaft were reviewed, identifying 39 aseptic and 33 infected nonunions. Most nonunions started as an open fracture (76%), although 4 of the 12 patients with closed fractures became infected following surgical treatment. Seven patients (all of the septic group) had a below-knee amputation as their only procedure; amputation was eventually necessary for three other patients. In total, 90% of the aseptic nonunions healed, as did 79% of infected nonunions not amputated at the first procedure. The average time from injury to union was approximately 36 months for both aseptic and infected nonunions. Numerous complications occurred during treatment of tibial nonunions, the most common (61%) being angulation of greater than 5 degrees in at least one plane.

From cottages to condos: the expansion of the home health care industry under Medicare.

The home health care industry has undergone a dramatic period of growth since the passage of Medicare (Title XVIII of the Social Security Act) in 1965. This growth has occurred in both the expansion of the total number of Medicare-certified agencies providing care, as well as the number of clients served and hours of care provided. It has been suggested that the single most important factor in this market expansion was the inclusion of a home care benefit in the original Medicare legislation, thus making it possible for nonprofit home care agencies to rely on a predictable source of government reimbursement. This paper explores the influence that amendments to the Medicare legislation since 1980 have had on market expansion, as well as other federal, state and private policy initiatives that have also influenced this growth. The authors suggest that overall growth does not equate with improved access or availability of needed services in the home for the frail and functionally-impaired elderly. Research findings from the first year of a three year study designed to document the impact of cost containment policies on community-based care for the elderly are reported in summary form to illustrate the authors position.

Patellar whiskers and acute calcific quadriceps tendinitis in a general hospital population.

Described is a case of acute calcific quadriceps tendinitis which presented as monoarticular arthritis. A survey of general hospital patients revealed a 7% incidence of calcification of the superior patellar tendon. The most common concurrent abnormality was degenerative joint disease (94%); concomitant chondrocalcinosis was not seen. The "patellar whisker" is a relatively common x-ray finding that may be the clue to an uncommon cause of acute arthritis.