Use of failure rate databases and process safety performance measurements to improve process safety

Employing equipment reliability databases can generate a process of continual improvement. This paper suggests a methodology that uses equipment reliability databases, and a process of benchmarking to establish a continual improvement procedure by learning "how others are doing it". A simple decision-making procedure is suggested too, to assist in prioritizing the processes/equipment that are considered to be improved as well as a methodology to measure the improvement.

Pneumatoscopy

Pneumatoscopy, the use of the pneumatic otoscope to determine mobility of the tympanic membrane (TM), has not been widely adopted in emergency medicine. The loss of TM mobility occurs with fluid in the middle ear and provides a reliable indication of all forms of otitis media. This communication advocates pneumatoscopy as a simple, safe, and useful technique.

Normal cerebral arteriography in patients with spontaneous subarachnoid hemorrhage

Previous studies have reported that 18 to 27% of patients with spontaneous subarachnoid hemorrhage have normal cerebral arteriograms. Our series of 220 patients from three hospitals demonstrated normal arteriograms in only 16 (7%). Recent improvements in neuroradiologic techniques, such as femoral catheterization, magnification angiography, oblique and basal projections, and subtraction most probably contribute to the improved yield. Nonvisualization of a cerebral aneurysm probably represents the most common explanation for a normal cerebral arteriogram.

The sphiningolipidoses: an overview

An outline of the pathways of catabolism of four sphingolipids to ceramide, along with structural details of a few constituents, serves as a framework for better understanding of the sphingolipidoses. The four sphingolipids are sulfatide, sphingomyelin, globoside, and ganglioside GM1. Diseases which can be incorporated into the scheme include Niemann-Pick disease, Gaucher disease, metachromatic leukodystrophy, Krabbe disease, ceramide lactoside lipidosis, Tay-Sachs disease, generalized gangliosidosis, Fabry disease, and Sandhoff disease. Fucosidosis probably also belongs with this group. GM3 (hematoside) sphingolipodystrophy involves blocks in synthetic rather than catabolic pathways.

Treatment of spasmodic torticollis with amantadine: a double-blind study

Ten patients with spasmodic torticollis participated in a double-blind crossover trial of amantadine hydrochloride for a period of 2 months each. A further regimen of combined amantadine and haloperidol was tried with three patients after the conclusion of the double-blind trial. There were no therapeutic benefits of either treatment. Half of the patients reported minor side effects that resolved promptly when amantadine was discontinued.