Annals of internal medicine
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Questionnaire II of the National Study of Internal Medicine Manpower was directed to all of the 1502 subspecialty training programs in the United States and Puerto Rico. The overall response rate was 86%. For the years 1972-1973 through 1976-1977 the number of fellows in subspecialty training grew at an average rate of 10.6% per year, or one and one-half times greater than the growth rate of 7.2% in the number of first-year residents in training for the same time period. ⋯ Most of the subspecialty fellowship programs were in large teaching hospitals, which are closely affiliated with the nation's medical schools. The 1976-1977 professional activities of former subspecialty trainees who had finished their training between 1972 and 1976 were distributed roughly in thirds between research-teaching, teaching-practice, and practice. We discuss public policy implications of the data.
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Case Reports
Obstruction of the proximal right coronary artery with acute inferior infarction due to blunt chest trauma.
Two patients developed an acute transmural myocardial infarction due to severe obstruction of the proximal right coronary artery after blunt chest trauma. Neither had a history of ischemic heart disease, and both had an arteriographically normal left coronary artery. In one patient significant resolution of the subtotal obstruction occurred within 3 months. ⋯ Spasm and platelet aggregates may contribute. Despite a large number of automobile accidents, obstruction of the right coronary artery due to blunt chest trauma has not been previously described. This suggests it has been overlooked and should be especially suspected in persons with injury to the sternum and an acute inferior myocardial infarction.