Overuse injuries of the elbow.

Overuse injuries result from repetitive microtrauma that can lead to inflammation and local tissue damage in the form of cellular and extracellular degeneration. The elbow, secondary to its central positioning, is predisposed to an array of injuries that are often companion to associated pathology of the spine, shoulder, and hand/wrist complex. An understanding of etiology and rehabilitative management will assist the clinician in the diagnosis and treatment of common overuse injuries involving the elbow.

Platelet paroxetine binding and fluoxetine pharmacotherapy in posttraumatic stress disorder: preliminary observations on a possible predictor of clinical treatment response.

Recent open clinical trials have found the selective serotonin reuptake inhibitor (SSRI) fluoxetine to be beneficial in the treatment of posttraumatic stress disorder (PTSD) symptoms. We have reported previously that the binding of a newer SSRI, paroxetine, to blood platelets is decreased in PTSD patients compared to normal control subjects. In the current study, pretreatment platelet paroxetine binding data were analyzed for ten Vietnam combat veterans who were treated clinically with fluoxetine for PTSD, diagnosed on the basis of the Structured Clinical Interview for DSM-III-R.

The in vitro differential binding of benzoylecgonine to pigmented human hair samples.

Only fragmentary information on the relationship between hair pigmentation (melanin) and the cocaine/benzoylecgonine content of hair samples is available. The in vitro incorporation of benzoylecgonine into the shafts of black, brown, and blond samples of human hair was accomplished. Post digestion analysis and wash samples demonstrate the relative incorporated ions of benzoylecgonine to be black > brown > blond.

A vulnerability-stress framework for evaluating clinical interventions in schizophrenia.

Symptom management and prevention of psychotic relapse are major treatment concerns in schizophrenia. Research shows a relationship between psychotic symptom levels and several intrapersonal, interpersonal, and environmental factors. These determinants are incorporated into an etiologic causal model of psychotic symptoms based on a vulnerability-stress framework.

Effects of age and aerobic capacity on arterial stiffness in healthy adults.

Background: It has been well established that arterial stiffness, manifest as an increase in arterial pulse wave velocity or late systolic amplification of the carotid artery pressure pulse, increases with age. However, the populations studied in prior investigations were not rigorously screened to exclude clinical hypertension, occult coronary disease, or diabetes. Furthermore, it is unknown whether exercise capacity or chronic physical endurance training affects the age-associated increase in arterial stiffness.

Additive effects of age and silent myocardial ischemia on the left ventricular response to upright cycle exercise.

To separate the independent effects of age and silent myocardial ischemia on the left ventricular response to aerobic exercise, maximal upright cycle ergometry was performed in three groups: 8 clinically healthy older men [76 +/- 3 (SE) yr] with ischemic electrocardiogram (ECG) and Tl scan responses to prior maximal treadmill exercise (old silent ischemic subjects), 16 age-matched men with normal ECG and Tl scan responses (old controls), and 21 healthy young (33 +/- 1 yr) men (young controls). Although the left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were similar in the three groups at rest, with increasing work loads there was a progressive increase in the end-diastolic volume index and a blunted decline in end-systolic volume index in the two older groups, which was most apparent in the old silent ischemic subjects. Thus, at peak effort, end-diastolic volume index was largest in old silent ischemic subjects (101 +/- 6 ml/m2), intermediate in old controls (85 +/- 6 ml/m2), and smallest in young controls (67 +/- 3 ml/m2) (P < 0.

Low back pain in military basic trainees. A pilot study.

Many studies have been done to elucidate risk factors for low back pain in the general population. A review of the literature reveals that no studies have described low back pain in the military. A pilot study was performed to evaluate the incidence, prevalence, and risk factors of low back pain in a group of military basic trainees.

Paroxetine binding in the blood platelets of post-traumatic stress disorder patients.

Platelet serotonin (5-HT) uptake, as determined by 3H-paroxetine (PA) binding, was studied in 20 Post-traumatic Stress Disorder (PTSD) patients and 20 normal controls. Kd (an inverse measure of affinity of 3H-PA binding to uptake sites) and Bmax (maximum number of 3H-PA binding sites) of 3H-PA binding were significantly decreased in PTSD patients as compared to normal controls. However, there was no difference in Kd or Bmax between PTSD patients with and without a diagnosis of major depression.

Cardiovascular responses to lower body negative pressure in trained and untrained older men.

To determine whether aerobic conditioning alters the orthostatic responses of older subjects, cardiovascular performance was monitored during graded lower body negative pressure in nine highly trained male senior athletes (A) aged 59-73 yr [maximum O2 uptake (VO2 max) = 52.4 +/- 1.7 ml.

Five-Step Treatment for Overuse Injuries.

In brief Overuse injuries can be particularly challenging to manage. An athlete's premature return to athletic activity often results in recurrent and recalcitrant injury. A five-step management plan that includes establishing a pathoanatomic diagnosis, controlling inflammation, promoting healing, increasing fitness, and controlling abusive activity offers athletes optimal opportunity to return successfully to athletic performance.

A clozapine treatment program for patients living in the community.

Clozapine treatment for schizophrenic patients living in the community requires strategies to ensure safe use of the medication and to foster patients' emerging social and living skills. The authors describe a clozapine treatment program in a community mental health center that includes a weekly clozapine support group meeting followed by drawing of blood for monitoring of side effects. Case managers and other program staff remind patients to take clozapine as prescribed and help them comply with hematological monitoring requirements, manage side effects, deal with the emotional aspects of improvement, and benefit from emerging capabilities.

Frequency and importance of postprandial blood pressure reduction in elderly nursing-home patients.

Objective: To determine the frequency and importance of postprandial reductions in systolic blood pressure in debilitated, elderly patients receiving nursing home care.

Design: Cohort study.

Setting: Community-based, university-affiliated, teaching nursing home.

Boxing: the preparticipation evaluation.

Boxing is a controversial sport that has drawn public and physician criticism since its inception in 900 BC. The American Medical Association has recently taken a formal position to ban boxing because of the alleged dangers, including the possibility of the long-term effect of dementia pugilistica. Proponents of amateur boxing are working diligently to document this claim both as premature and false.

Determining nursing retention strategy in a large public teaching hospital.

In 1988, the Los Angeles County University of Southern California Medical Center (LAC USC) surveyed 1,102 RNs (75% of its total RN population) to determine factors critical to nursing retention. The Nursing Retention Survey required participants to rank 46 retention factors related to compensation benefits, work environment, amount and type of work, work relationships, availability of support services, management practices, and opportunities for professional growth. This article reports survey responses for the ten most significant and ten least significant retention factors.

Enhancing surgical nurses' patient education: development and evaluation of an intervention.

This research tested whether staff nurses could provide enhanced patient education and whether increases in education improved surgical patient outcomes. A protocol for patient education was developed from earlier research. Then a multifocal intervention was implemented to motivate and teach staff nurses and to increase structural support for patient education.

Medium and long-term complications of endoscopic sphincterotomy for choledocholithiasis.

The medium and long-term complications of endoscopic sphincterotomy for choledocholithiasis were examined in patients referred to an endoscopy centre in an area general hospital. One hundred and thirty-eight patients were reviewed between 6 months and 7 years after successful endoscopic sphincterotomy for choledocholithiasis. The procedure was carried out post-cholecystectomy in 69 (50%) and with the gallbladder in situ in 69 patients.

[Role of intraoperative echo-Doppler color echocardiography in cardiac surgery. Preliminary study].

Intraoperative echocardiography with Doppler color flow imaging technique can provide the surgeon with an immediate and direct assessment of cardiac anatomy and function. To determine the utility of this recent technique, we have examined 15 patients pre, per, and postoperatively with Doppler color flow imaging. The intraoperative study was performed before and after cardiopulmonary bypass.

Clinical and financial effects of psychoeducational care provided by staff nurses to adult surgical patients in the post-DRG environment.

A three-hour, two-stage workshop for staff nurses on providing patient education and psychosocial support was evaluated in terms of its effects on patient welfare and recovery. Subjects were 148 persons who had either a cholecystectomy, other abdominal surgery, or transurethral resection of the prostate (TURP). Two hundred and six additional control subjects were obtained from a nearby hospital.

Extensive aneurysm of the aortic arch and descending aorta. Extra-anatomical reconstruction and exclusion of the aneurysmal sac.

A new technique for repair of extensive aneurysm reaching from the ascending aorta to the diaphragm is presented. The operation consists of the reconstruction of the aortic arch and descending aorta and the exclusion of the aneurysmal sac in a single operation. Two successful cases are presented.

Trends in the severity of self-poisoning.

Of 2947 patients admitted to a district general hospital over an 11-year period for the management of self-poisoning, 148 (5%) required intensive care unit (ICU) treatment. There was a significant increase in the number of self-poisonings admitted each year, whereas the number requiring ICU admission did not change. Therefore the proportion of patients requiring ICU admission fell significantly over the study period (P less than 0.