A survey of poliovirus antibody levels in New Haven, Connecticut, 1957-1958.
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BACKGROUND: Many experts have suggested that blunt splenic trauma in patients older than 55 years should not be managed by observation because of supposed increased fragility of the spleen and decreased physiologic reserve in elderly patients. We sought to determine the outcome of nonoperative management of blunt splenic trauma in patients older than 55 years. METHODS: For the years 1994 through 1996, data for patients with splenic injury older than 55 years from seven trauma centers in a single state were reviewed. RESULTS: Blunt splenic trauma occurred in 41 patients older than 55 years. Eight patients were excluded from further analysis because of death from massive associated injuries within 24 hours of admission. The remaining 33 patients (mean age, 72+/-10 years) were divided into two groups: immediate exploration (10 patients) and observation (23 patients). Observation of blunt splenic injury failed in 4 of 23 patients (17%). No patient deaths were related to the method of management of the splenic injury. CONCLUSIONS: Observation of the elderly patient with blunt splenic trauma has an acceptable failure rate of 17%.
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This article describes a multidisciplinary team approach to the treatment of alcohol and drug dependence and comorbid disorders. The principal aim of this approach is the identification and treatment of patients' chemical dependence, as well as the medical and psychiatric disorders that contribute to and/or stem from the chronic use of alcohol and drugs. The focus of treatment is on the identification of high risk and other problem situations, training coping skills to handle these situations, developing insight, and enhancing patients' motivation for sobriety and ongoing treatment. In this article we describe the features of our program that address these various goals.
Scores on nineteen pre-admission and post-admission performance variables for four classes of medical students were analysed using canonical correlation and regression methods. Detailed interviews with 138 clinical preceptors were included among the criterion variables. National Board Part I scores could be predicted readily from conventional data such as Medical College Admission Test scores and grade point average. However, these same predictors generally correlated negatively with measures of clinical performance. Evidence supports pre-admission interviews and careful analysis of letters of recommendation as useful predictors of the clinical performance variables.
An 8-year-old boy with multiple (up to 12) hemorrhagic and necrotic blisters was eventually diagnosed as being the victim of probable spider bites. Arachnidism, specifically loxoscelism (brown recluse spider bite), is unusual in the northeastern United States.