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In Reply: As we indicated in our article, our study did not collect information on the process of advanced airway management, which would require independent observers. This information would have been beneficial to assess the potential mechanisms between airway management and survival outcomes. In contrast, our nationwide study reflects the effectiveness of advanced airway management in the setting of current practice in a developed nation.

Objectives. —To provide an update of the international experience with carrier screening and prenatal diagnosis for Tay-Sachs disease (TSD), to assess the impact of these efforts, and to review the recent developments in DNA technology with application to TSD carrier detection and screening. Design. —Through the International TSD Testing, Quality Control, and Data Collection Center, all testing centers in the world were surveyed annually to assess overall experience with carrier testing and prenatal diagnosis. Quality control and laboratory surveillance of testing centers were performed through an annual assessment, using samples provided by the center. Setting. —Tay-Sachs disease testing centers around the world. Participants. —Nearly 1 million young adults from both Jewish and non-Jewish populations. Intervention. —Gene product screening (enzyme testing) and DNA-based mutation analysis (in some populations). Main Outcome Measure. —Impact of screening program on disease incidence. Results. —Data from all centers in the international TSD network on experience with TSD carrier testing and prenatal diagnosis since 1974 indicated that more than 36 000 heterozygotes were identified and 1056 couples found to be at risk for TSD in their offspring. A total of 2416 pregnancies at increased risk for TSD were monitored by amniocentesis or chorionic villus sampling. A dramatic decrease in the incidence of TSD in the Jewish populations was demonstrated. With both serum and leukocyte proficiency testing, there have been only 16 instances (of 845 cumulative laboratory evaluations) of one or more errors reported by a laboratory since 1983 resulting in nonaccreditation. Conclusions. —This analysis represents a prototypic effort in coordinating adult education, carrier testing, and genetic counseling directed toward prospective prevention of a uniformly fatal childhood disease and demonstrates that such an effort can dramatically affect disease incidence. ( JAMA . 1993;270:2307-2315)

The top comes off with a perfect bevel; it won't fall in, ever. A nose close to the edge catches the mysterious air drawn from the ground (it seems) to fill this extravagant space, air sweet as August and cool as October, this unbreathed air. The seeds cling to the sides in their slimy tendrils as if the yellow vortex had slung them there as the flower (long gone) pulled a fecund darkness from behind. But that is not the point tonight. The seeds come our— whether to roast up, salt-encrusted, like a school of fish left high and dry, or throw away, as in the way— there's no tradition here. Out they go this year. The empty belly is made emptier, and the cutting begins. One takes the eyes and nose, the other the mouth; there are no triangles, no cuts for a small hand guiding a blade, but

Small as a day in a year, this trickle has come out of the glacial rocks to make a pool no wider than two spread hands. The sphagnum makes a forest at its edge. The water is cool, dark with shade and tannin; it will stay at least beyond this evening when the sun, holding as much, as much of day as it ever can, lets go to run down its own declivity, as this water will run through blanched roots to the river with equally little choice in the matter. What the hill above will give, or the streams below will take from this pool tomorrow is today beyond our actual knowing. What is here today is what we know: a seep of ancient water just now flowing into this pool, the flecks of larvae swimming, the jay in the tree nervously racing from limb to limb, the spider

Fever, infection, or both occurred at some time during hospitalization in 67% of patients on a referral spinal cord injury service. A single cause of fever was generally found, with urinary tract and soft-tissue infections predominating; these responded well to appropriate management. In contrast, spinal cord injury patients on other services seen in consultation by the infectious disease service had far more complicated and advanced disease. Multiple infections were diagnosed in the majority of these patients, with urinary tract and decubitus ulcers predominating. Complicating osteomyelitis was present in more than half of those who had infected decubitus ulcers. In both groups of patients, diagnosis required careful attention to physical and laboratory examination because multiple potentially infected areas could be identified and because usual symptoms were sometimes masked by altered sensation. (JAMA1982;248:66-70)

Various analogues and isomers of levothyroxin have been shown to be considerably less calorigenic than the naturally occurring hormone, though they retain its lipid-lowering properties. The purpose of this study was to measure the effect of one of these isomers, dextro-triiodothyronine, on the serum lipid levels of 23 patients with ischemic heart disease and with cholesterol levels exceeding 300 mg.%. Cholesterol, triglycerides, and phospholipids were measured in all patients at intervals during the 40 weeks of this study. In doses of 1.5 to 2 mg. daily dextro-triiodothyronine was able to produce effective and prolonged reduction of all 3 lipids. In spite of the absence of evidence of hyperthyroidism in all patients receiving this drug, 8 of the 23 experienced increased severity or frequency of angina pectoris. The frequency and seriousness of this side effect precludes the general use of this drug in patients with ischemic heart disease, but additional analogues of this nature should be sought and studied.