SUPRACONDYLAR AMPUTATION IN THE AGED

Of 105 consecutive supracondylar amputations done at the San Diego County General Hospital during the five-year period, 1953-58, 88 were in patients more than 60 years of age. Occlusive arterial disease was the reason for operation in 85 of the 88 cases.Presenting complaints at the time of amputation were gangrene in 45 cases, pre-gangrene associated with severe pain in 34. Acute arterial occlusion as a cause of thigh amputation was infrequent.The average age of patients requiring thigh amputation from complications of arteriosclerosis obliterans was 78.3 years; for those with diabetic arteriosclerosis or embolism it was about seven and a half years less.Supracondylar amputation was considered the procedure of choice in the elderly debilitated patients with far-advanced occlusive diffuse arteriosclerosis, complicated by gangrene, ulcer and infection of the toes or feet. Sympathectomy and direct arterial operation if done early in the course of the disease may postpone or prevent subsequent amputation.The surgical mortality rate (first two weeks) for supracondylar amputation was 12.5 per cent. More than two-thirds of the deaths were due to bronchopneumonia.     

UROFLOMETRY IN UROLOGICAL DIAGNOSIS

The automatic recording uroflometer is a simple office instrument which provides an objective record of the rate of voiding. It has proven value as a diagnostic aid in the evaluation of obstructive lower urinary tract problems and in neurotic bladder disorders. Differential uroflometry is used to make relative appraisals of the forces of expulsion of urine and of resistance to the flow of urine through the urethra. It is accomplished by measuring urine flow rate through a catheter of standard size and by comparing this with urine flow rate through the urethra. When used in conjunction with other diagnostic methods, uroflometry adds to the accuracy of urological assessment of a patient.     

FEMORAL NECK FRACTURES IN THE AGED

Clinical data were reviewed on 99 patients with 102 fractures of the femoral neck on the Orthopedic Service of the San Diego County General Hospital. All were elderly. Twenty-one were dead within two month of the time the fracture was reduced and 36 within a year. In 14 cases the fracture was impacted or undisplaced; there was only one of these in which the fracture did not unite following treatment, and that was for iatrogenic reasons. Sixty-one per cent of the displaced fractures healed; only 32 per cent of the total number of patients with displaced femoral neck fractures walked again.     

COMPLICATIONS OF PEPTIC ULCER IN THE AGED

Peptic ulcer is not an uncommon disease among the aged population. Thirty-five per cent of the patients admitted to the Los Angeles County General Hospital in a period of 12 months for treatment of peptic ulcer were more than 60 years of age.The severity of this disease in the elderly group was evidenced by the high incidence of lethal complications requiring operation—one case in every four.The mortality rate from operation for peptic ulcer complications is related to the factors of concurrent disease, the urgency of operation and the selection of a suitable operation.     

分子进化研究中的一些问题

本文在强调生物系统的层次结构和非线性特征的基础上,就分子进化研究中存在的某些认识上的和方法学上的问题,提出了作者的观点和简要分析。     

PROBLEMS IN VENTILATION IN THE IMMEDIATE POSTOPERATIVE PERIOD

In the present day practice of surgical anesthesia, drugs and techniques are used which require or lead to cessation of voluntary respiration by the patient. Respiration is then controlled by the anesthesiologist. At the termination of operation many patients do not breathe adequately for variable periods of time. The causes include obstruction, excessive sedation, muscle relaxants, the effect of controlled respiration itself and various miscellaneous factors. A diagnosis is made by taking into consideration the drugs and techniques which have been used and the character of the patient''s respiratory efforts, if any. The cause may then be treated. In some cases antidotes are available. However, until truly adequate spontaneous respiration is observed for some time the patient must have his efforts assisted. High oxygen concentrations must not be substituted for adequate ventilation.