Tumor lysis syndrome in premature infant prompting early resection of a large sacrococcygeal teratoma: a case report.

Background: Sacrococcygeal teratomas (SCTs) are the most common congenital neoplasm and often require resection soon after birth. There are rare reports of cardiac arrest during surgery due to manipulation of the tumor triggering secondary necrosis and hyperkalemia.

Case Presentation: This case describes a very preterm infant with a SCT who develops spontaneous preoperative tumor lysis syndrome (TLS).

Osteotomy of the Anterior Superior Iliac Spine as an Adjunct to Improve Access and Visualization Through the Lateral Window.

The lateral "window" has previously been described as part of the ilioinguinal and anterior intrapelvic approaches for gaining access to the anterior aspect of the sacroiliac joint, the internal iliac fossa, and upper portion of the anterior column for reduction and placement of fixation. Surgical exposure of this window typically involves release of the external oblique muscle from the iliac crest and elevation of the iliacus muscle from the internal iliac fossa. This exposure is limited by the residual attachment of the external oblique muscle and inguinal ligament to the anterior superior iliac spine, particularly in patients with a large abdomen or in fractures that involve the anterior wall of the acetabulum and pubic root region.

Maximum heat loss potential is lower in football linemen during an NCAA summer training camp because of lower self-generated air flow.

The purpose of this study was to compare the maximum potential for heat loss of football linemen (L) and non-linemen (NL) during a National Collegiate Athletic Association (NCAA) summer training camp. It was hypothesized that heat loss potential in L would be lower than NL because of differences in self-generated air flow during position-specific activities. Fourteen NCAA division 1 football players {7 L (mass: 126 ± 6 kg; body surface area [BSA]: 2.

Teratoma in pregnancy: a case report.

Background: Mature teratoma is a common complication of pregnancy. To the best of the authors' knowledge this is the largest teratoma in pregnancy documented in the literature.

Case: A 19-year-old woman, gravida 1, at 14 weeks' gestational age with a 37-cm fundal height, was found to have a 30 x 28 x 17 cm mass on ultrasound.

Factors associated with breastfeeding initiation in adolescent mothers.

Objective: To identify the most influential factors on breastfeeding initiation in adolescent mothers in order to identify the highest risk population to focus education and support services.

Study Design: Retrospective population-based cohort study of all non-anomalous live births in Ohio (2006-2007). Breastfeeding initiation rates were compared between adolescent mothers age ≤ 19 years and a reference group age >19 years.

Disaster management and physician preparedness.

There are an increasing amount and variety of disasters occurring throughout the United States. Many of these disasters require physicians to provide medical assistance. This article provides a brief introduction to disaster preparedness and its recent history and physicians' obligations, role, education, preparation, and response.

Hemoglobin levels in normal-weight and obese patients during pregnancy.

Objective: To determine if there is a difference in hemoglobin levels in normal-weight patients compared with obese women during the second trimester of pregnancy.

Study Design: This was a retrospective cohort study of hemoglobin levels in the second trimester of pregnancy from 2009 to 2010 in 46 primarily indigent patients (23 normal weight and 23 obese) using the current body mass index classification.

Results: There were no differences in demographic and baseline characteristics between the two study groups except for body mass index as expected (p < 0.

Intrathecal hydromorphone for cesarean delivery: in search of improved postoperative pain management: a case report.

Currently, morphine and fentanyl are the most commonly used intrathecal opioids for the postoperative pain management of patients who underwent cesarean delivery. Unfortunately, the analgesic benefits of these 2 drugs tend to fall into different extremes based on lipid solubility. Intrathecal hydromorphone may provide more consistent analgesia because its lipid solubility falls between that of the other 2 opioids.

Ultrasound guidance in anesthesia.

Sonography addresses a variety of concerns, such as patient safety and comfort, cost-effectiveness, time to complete a procedure, and success rates associated with invasive anesthesia procedures. Ultrasound guidance is commonly being used for the placement of nerve blocks, placement of peripheral and central lines, and arterial catheterization. Recently, it has been applied to preprocedural and imaged-guided spinal and epidural placement.

Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation.

Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.

Use of clevidipine for intraoperative hypertension caused by an undiagnosed pheochromocytoma: a case report.

The acute intraoperative hypertension and tachycardia caused by an undiagnosed pheochromocytoma is a rare event for the anesthesia provider. If treatment is not prompt and successful, permanent and possibly lethal complications can ensue. This article reports what the author believes to be the first case study in which clevidipine (Cleviprex) was successfully used to treat a suspected, and later diagnosed, pheochromocytoma.

Microtubal reanastomosis: success rates as compared to in vitro fertilization.

Objective: To determine the pregnancy rates of microtubal reanastomosis (MTR) and any associated clinical variables, to determine pregnancy rates and live birth rates of MTR as compared to in vitro fertilization (IVF) and to study the rates of ectopic pregnancy and spontaneous abortion (SAB) after MTR.

Study Design: Retrospective chart review.

Results: At our institution, the pregnancy rate in the first 12 months following MTR was 44.

Shortened cervical length as a predictor of preterm delivery in twin gestations.

Objective: To determine if a shortened screening cervical length measurement in twin gestations, measured between 16 and 24 weeks, is a predictor of preterm delivery.

Study Design: A retrospective chart review was conducted on patients who delivered twins at Bayfront Medical Center between January 1, 2006, and April 1, 2008.

Results: One hundred eighty-three patient charts were reviewed.

Seizure management in a complex hospice patient.

Antiepileptic medication use in noncancer hospice/palliative care patients is not well defined. The authors report the case of a human immunodeficiency virus (HIV) patient under hospice care with increased seizure frequency. The patient is a 22-year-old female with advanced HIV disease complicated by tonic-clonic seizures, hypoalbuminemia, gastroesophageal reflux disease (GERD), and gastritis.

Evaluating risk: rabies exposure and occupational implications.

Despite advances in vaccination, rabies remains a significant worldwide public health problem. Although the death rate is low in the United States, treatment and prevention costs are high. Occupational health nurses and occupational health nurse practitioners should consider rabies epidemiology, pathophysiology, and disease prevention and management when evaluating an employee's risk of exposure and subsequent infection.

A case of Evan's syndrome in pregnancy refractory to primary treatment options.

Evan's syndrome is a rare hematological condition defined as immune thrombocytopenic purpura and hemolytic anemia. We describe herein a case of Evan's syndrome diagnosed in a term pregnancy that was refractory to primary therapeutic options. We also describe current treatment options in pregnancy and briefly discuss the pathophysiology of Evan's syndrome and perinatal outcome.

Preventing and managing skin tears: a review.

Skin tears are an increasingly common problem in frail elders, and the wound, ostomy, and continence (WOC) nurse must be knowledgeable regarding both prevention and management of these lesions. A literature review was conducted to identify current concepts regarding management of skin tears. Articles reviewed provided numerous suggested interventions and protocols.

When trauma means a stoma.

Trauma is a leading cause of death and disability. When traumatic injuries require ostomy surgery, the wound, ostomy, and continence nurse acts as a crucial part of the trauma team. This literature review describes mechanisms of injury associated with creation of a stoma, key aspects of wound, ostomy, and continence nursing care in trauma populations and presents suggestions for future research.

Insulin infusion protocol for critical care units.

Purpose: An insulin infusion protocol for critical care units is described.

Summary: Evidence that aggressive glycemic control improves outcomes led physicians, nurses, dietitians, and pharmacists at a trauma center to develop an insulin infusion protocol. Before the protocol, elevated blood glucose concentrations were often not treated until they reached 200 mg/dL or higher.