The laboratory diagnosis of gonorrhoea and syphilis infection.

Following a decline in prevalence during the 1980s and early 1990s, gonorrhoea and syphilis infections are once again posing a threat to public health. In addition, the antibiotic sensitivity pattern for gonorrhoea appears to have changed with an increased prevalence of resistance. Both syphilis and gonorrhoea appear to disproportionately affect MSM and black ethnic minorities, and are concentrated in urban areas.

Incontinentia pigmenti with painful subungual tumors: a two-generation study.

We report 2 cases of painful subungual dyskeratotic tumors occurring in a mother and daughter with incontinentia pigmenti (IP) as a late manifestation of the disease. Both patients had a history of similar lesions appearing over a period of years on the digits of both the hands and feet. Biopsy specimens of the current lesions were examined and compared with the previous material available on both patients.

Magnetic resonance imaging of intracranial hypotension syndrome with pathophysiological correlation.

Objective: To correlate the pathophysiology of intracranial hypotension syndrome with abnormalities in the brain and spine found through magnetic resonance imaging.

Methods: In a series of 11 patients with intracranial hypotension syndrome, brain magnetic resonance scans were evaluated for the thickness, distribution, morphology, and pattern of meningeal enhancement coincident with subdural fluid collections and the descent of the brain toward the skull base. Spinal magnetic resonance studies were reviewed for extra-arachnoid fluid collections, meningeal enhancement, and distended epidural veins.

Sudden death due to tricuspid valve myxoma with massive pulmonary embolism in a 15-month old male.

Myxomas of the tricuspid valve are extremely rare, with only 13 cases reported in the world literature. We report the case of a 15-month old male with tricuspid valve myxoma and massive myxomatous pulmonary emboli discovered at autopsy.

The newer cephalosporins. Aztreonam and imipenem.

Many of the antimicrobial agents described here exhibit great advances over older drugs in terms of antimicrobial spectrum, clinical utility, and, sometimes, safety. The newer cephalosporins are useful for treatment of many common outpatient and inpatient infections. Aztreonam provides excellent coverage against a broad range of aerobic gram-negative bacteria, without the toxicity associated with aminoglycosides.

Cost-containment in cardiovascular surgery through collaborative practice.

There is fierce competition in the healthcare setting to reduce costs and charges while maintaining a viable business. It is not unusual for many hospitals in the same city to offer cardiovascular surgery programs. In an effort to facilitate the achievement of cost-effective, quality outcomes, one hospital instituted a case-management model.

Compound adrenal medullary tumor.

Compound tumors of the adrenal medulla, characterized by a mixture of pheochromocytoma and ganglioneuroma, are rare, only 12 cases having been reported in the literature. We present the case of a 66-year-old woman with a left-sided incidentally discovered adrenal mass that was subsequently shown to contain elements of pheochromocytoma and ganglioneuroma. The patient had no history of hypertension but did have a history of "idiopathic" edema (dependent edema).

Normal magnetic resonance imaging and abnormal discography in lumbar disc disruption.

Study Design: This report describes a clinical series of seven patients who had surgically proven internal disc disruption, normal magnetic resonance imaging, and abnormal discograms morphologically.

Summary Of Background Data: Numerous reports in the literature have described the utility of magnetic resonance imaging and discography in diagnosing degenerative disease within lumbar intervertebral discs.

Results: Discography may be useful in patients with persistent symptoms despite a normal or equivocal magnetic resonance imaging study.

Environmental laws in health care.

Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations.

The ethical responsibility of the hospital to the environment.

The ethical responsibility of the hospital to the environment is a relatively new concept. It is complex and ever changing as the whole field of medicine continues to evolve. The recent dilemmas of medical waste washing up on beaches and waste-laden barges not finding an accepting port should convince us that this issue is becoming more serious.

Disseminated strongyloidiasis in a World War II Veteran with metastatic undifferentiated carcinoma of neuroendocrine type.

This case of disseminated strongyloidiasis illustrates the need for a high index of suspicion and effective screening for this pathogen in certain high-risk patient populations before giving immunosuppressive therapy. A complete travel and military history should be obtained. In the United States, persons with a history of military service in endemic areas, emigrants from endemic areas, patients in institutions, and residents of the Southeast should have careful evaluation for strongyloidiasis.

The use of instant moiré photographs to reduce exposure from scoliosis radiographs.

A total of 258 patients with some degree of idiopathic scoliosis was monitored with both radiographs and moiré photography to determine the degree of progression of spinal curvature. The use of polaroid photography to document moiré fringe patterns proved to be a rapid and useful process for placing an instant photographic record in patient charts while conducting routine physical examinations. Standardization of procedures for making and evaluating moiré photographs reduced patient exposure to X-rays.

Caring for the person receiving ventilatory support at home: care givers' needs and involvement.

Little is known of the needs of family members who provide home care to persons receiving ventilatory support (VS). In a structured interview of 44 care givers of 29 persons receiving VS, finances, provisions for emergencies, information, family relationships, and continuity of care were ranked as the most important needs. Needs for support services were ranked highest in importance to the care givers of persons receiving continuous VS, care givers who did not live in, and children of persons receiving VS.

Diaphragmatic pain in pulmonary endometriosis.

The diagnosis of pulmonary endometriosis is difficult and requires a high index of suspicion in patients with pelvic endometriosis. We have reported a case in which a history of periscapular pain associated with menses proved useful in delineating the cause of the hemothorax.