Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital: implications for managing point of care testing.

Purpose: To study the use and cost of bedside capillary glucose testing in a large teaching hospital.

Patients And Methods: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, time, operator, and results of patient and quality control tests. Cost analysis was performed using data from time studies, test tallies in logbooks, and hospital administration records.

Pancreatic cystic islet-cell tumors. Clinical and pathologic features in two cases with cyst fluid analysis.

Cystic islet-cell tumors are rare neoplasms that may be confused with more familiar cystic pancreatic lesions, such as pseudocysts, serous cystadenoma, and mucinous tumors. Analysis of aspirated cyst fluid for tumor markers (carcinoembryonic antigen [CEA], CA-125, and CA-15.3), enzymes (amylase and lipase), viscosity, and cytology has been proposed as an aid to preoperative differential diagnosis.

Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing.

Purpose: To study the implementation of bedside capillary glucose monitoring using a hospital-wide quality control (QC) program.

Methods: A prospective study of QC performance in 7 outpatient and 39 inpatient treatment units was performed in a large teaching hospital over a 2-year period. Approximately 800 nurses were trained to perform bedside capillary glucose monitoring (Accu-Chek II, Boehringer-Mannheim, Indianapolis, IN).

Role of diabetologist in evaluating diabetic retinopathy.

Objective: To evaluate the ability of diabetologists to screen diabetic patients for diabetic retinopathy.

Research Design And Methods: Comparison of eye examination performed by diabetologists with direct ophthalmoscopy through an undilated pupil and by ophthalmologists through a dilated pupil with seven-field stereoscopic fundus photography (gold standard). The study consisted of 67 insulin-dependent and non-insulin-dependent diabetic outpatients attending a diabetes clinic.

Adrenal crisis in the setting of high-dose ketoconazole therapy.

We describe a patient with type I diabetes mellitus and hypothyroidism who developed frank adrenocortical insufficiency while receiving a high-dose ketoconazole therapy for keratitis caused by Acanthamoeba species. While impaired cortisol responses to corticotropin and mildly symptomatic hypoadrenalism have been described previously with ketoconazole therapy, to our knowledge, this case represents the first documented article of an actual adrenal crisis associated with this drug. Two reasons are postulated for the development of this complication in our patient: high-dose ketoconazole therapy given in divided doses during the day, and a possibly impaired central response to stress because of hypothyroidism.