MRI in Adult Patients with Active and Inactive Implanted MR-conditional, MR-nonconditional, and Other Devices.

Active implanted medical devices (AIMDs) enable therapy and patient monitoring by way of electrical activity and typically have a battery and electrical leads. The most common types of AIMDs include cardiac implantable electronic devices (CIEDs), spinal cord stimulators, deep brain stimulators, bone growth or fusion stimulators, other neurostimulators, and drug infusion pumps. As more patients with AIMDs undergo MRI, it is important to consider the safety of patients who have these implanted devices during MRI.

No Longer Cutaneous T-cell Lymphoma Dermal Nodule.

Primary cutaneous CD4+ small and medium pleomorphic T-cell lymphoproliferative disorder (PCSM-LPD) is a rare and typically asymptomatic proliferation of CD3+/CD4+ small and medium pleomorphic T-cells. In this case report, we share the details of a 41-year-old male presenting with a two-centimeter soft, mobile forehead nodule that was determined by clinical symptoms, histology, and immunostaining to be PCSM-LPD. We would like to emphasize the clinical resolution that was seen with minimal treatment.

Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy-Associated Hepatitis.

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is an inborn error of immunity, resulting from variation in the autoimmune regulator gene (). Pathogenic variants in the gene result in autoimmunity typically involving endocrine organs with nonendocrine organs less commonly affected. Hepatitis associated with APECED has emerged as a potentially fatal complication with higher reported prevalence in the Americas.

Articular Cartilage After Toe Amputation-Protective Barrier or Source of Infection?: A Retrospective Chart Review.

Background: Digital and ray amputations are common surgical treatments for infected bone and traumatic injuries in the foot. When disarticulated, the exposed articular cartilage can be addressed by either leaving the cartilage cap as a "protective barrier" to infection or by remodeling the exposed bone, removing the cartilage to bleeding bone to better fight infection.

Methods: Our objective is to provide the first study in the foot to determine whether leaving exposed articular cartilage after toe amputation results in more returns to surgery and delayed healing.

Amphipathic Liponecrosis Impairs Bacterial Clearance and Causes Infection During Sterile Inflammation.

Background & Aims: Although transient bacteremia is common during dental and endoscopic procedures, infections developing during sterile diseases like acute pancreatitis (AP) can have grave consequences. We examined how impaired bacterial clearance may cause this transition.

Methods: Blood samples from patients with AP, normal controls, and rodents with pancreatitis or those administered different nonesterified fatty acids (NEFAs) were analyzed for albumin-unbound NEFAs, microbiome, and inflammatory cell injury.

A Randomized Controlled Trial of Kinematically and Mechanically Aligned Total Knee Arthroplasties: Long-Term Follow-Up.

Background: The optimal alignment technique for total knee arthroplasty (TKA) remains controversial. We previously reported 6-month and 2-year results of a randomized controlled trial comparing kinematically versus mechanically aligned TKA. In the present study, we report the mean 13-year (range, 12.

Drug-Induced IgA Vasculitis in an Adult.

A 65-year-old man developed palpable purpuric papules and plaques on his lower extremities, which quickly spread to his trunk and upper extremity after being prescribed cephalexin and doxycycline in the emergency room. Here, we define the details of a textbook-like presentation of IgA vasculitis, formerly referred to as Henoch-Schönlein purpura, in an adult.

Pathophysiology and Biomarker Potential of Fatty Acid Ethyl Ester Elevation During Alcoholic Pancreatitis.

Background & Aims: The role of fatty acid ethyl esters (FAEEs) during human alcoholic pancreatitis is unknown. We compared FAEEs levels with their nonesterified fatty acids (NEFAs) precursors during alcohol intoxication and clinical alcoholic pancreatitis. The pathophysiology underlying FAEEs increase and their role as diagnostic biomarkers for alcoholic pancreatitis was investigated.

Negative-pressure wound therapy and diabetic foot amputations: a retrospective study of payer claims data.

Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers.

Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n=3,524) and Medicare (n=12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes.

Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: a case report and review of the literature.

Ampullary carcinoid is a rare tumor that can present with gastrointestinal bleeding, obstructive jaundice or pancreatitis. Some of these tumors are associated with Von Recklinghausen disease. The usual surgical options are a biliary-enteric anastomosis, Whipple procedure or rarely a local resection.

Nursing management and organizational ethics in the intensive care unit.

This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit.

An evidence-based approach to diabetic foot infections.

Foot infections are a major complication of diabetes mellitus and contribute to the development of gangrene and lower extremity amputation. Recent evidence indicates that persons with diabetes are at greater risk for infection because of underlying neuropathy, peripheral vascular disease, and impaired responses to infecting organisms. This article reviews the underlying pathophysiology, causes, microbiology, and current management concepts for this potentially limb-threatening complication.

Accuracy in the diagnosis of short-segment Barrett's esophagus: the role of endoscopic experience.

Background: The diagnosis of Barrett's esophagus is based on histologic demonstration of specialized intestinal metaplasia. Experience may be important in the endoscopic recognition of Barrett's esophagus, including in regard to appropriate procurement of biopsy specimens. The aim of this study was to assess factors that may influence accuracy in the diagnosis of short-segment Barrett's esophagus (SSB).

Cardiovascular disease in diabetes mellitus type 2: a potential role for novel cardiovascular risk factors.

A major consequence of diabetes mellitus type 2 is the accelerated development of atherosclerosis. Assessment of conventional risk factors such as plasma lipids, lipoproteins and hypertension only partly account for the excessive risk of developing cardiovascular disease in this population. Increasing evidence has emerged suggesting that conditions associated with diabetes mellitus type 2, such as insulin resistance, hyperinsulinemia and hyperglycemia, may also play a significant role in regulating 'novel' cardiovascular risk factors.

Lipoprotein modification and atherosclerosis in aging.

The development of extensive atherosclerosis of major arteries of the heart, brain, and lower extremities is a particularly frequent problem in elderly individuals and is responsible for the majority of the cardiovascular morbidity and mortality in this population. Although the frequency and severity of this problem is well recognized, there has been relatively little investigation of the effects of aging on the development of atherosclerosis. Work by a number of investigators over the last 10-15 years has demonstrated that modifications of lipoproteins, resulting from oxidative stress, glycoxidation, formation of AGE, or other processes may play an important role in atherosclerosis.

The short- and long-term efficacy of empirical esophageal dilation in patients with nonobstructive dysphagia: a prospective, randomized study.

Objective: The efficacy of empirical esophageal dilation for nonobstructive dysphagia (NOD) is unknown. Our aim was to assess the efficacy and safety of empirical dilation with a large bougie in patients with NOD.

Methods: Patients with NOD (normal barium swallow, free passage of a 13-mm barium pill, and normal esophagogastroduodenoscopy) were randomized to dilation with either a 50-Fr (Group A) or 26-Fr (Group B) Maloney dilator.

Respiratory complications of gastrointestinal diseases.

Further advances in the ability to diagnose GER disease by use of ambulatory pH monitoring have unveiled a host of extraesophageal manifestations of GERD. These include pulmonary symptoms of asthma, recurrent pneumonia, cough or bronchitis, and infant apnea. Many of these symptoms may be the sole presentations of GER in these patients.

Interdisciplinary collaboration in the special care unit--Part II.

Collaborative interdisciplinary patient care is enhanced as healthcare professionals in special care units work to implement Joint Commission on Accreditation of Healthcare Organizations' standards for improving organizational performance. This second part of a two-part article provides a practical approach to developing a process action team to review the care of patients receiving mechanical ventilation. As a follow-up to the development of one special care unit committee, this was an important step in the transition from multidisciplinary, discipline-specific care to interdisciplinary, collaborative care.

Interdisciplinary collaboration in the special care unit--Part I.

Quality improvement (QI) activities in special care units can serve as a model of interdisciplinary problem identification and resolution for organizations that are moving from service-specific QI activities to organizational-wide activities. The transition from distinct unit-based QI activities to an interdisciplinary collaborative model at the Carl T. Hayden Veterans Administration Medical Center began with recognition of problems that were identified during a Joint Commission survey of the special care units.

Nursing standards of patient care and standards of nursing practice--a practical approach.

With the revision of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) nursing standards in 1991, a new emphasis has been placed on the nursing standards of patient care and the standards of nursing practice (Claflin, 1990). These standards provide the basis for nursing care and the foundation for nursing's contributions to an interdisciplinary quality improvement program. This article will describe how nursing standards of patient care and standards of nursing practice have been developed and integrated into a nursing department's documentation plan and quality improvement program.

33-year follow-up after simple excision of a giant renal oncocytoma with calcifications: case report and review of the literature.

Renal oncocytoma can present with calcification seen on the plain roentgenogram. From a review of the literature (both before and after 1976, when the concept of oncocytoma was popularized in the English literature), 10 cases of calcification in association with renal oncocytoma were found. In three of these 10 cases, the calcifications could be grossly demonstrated on the plain roentgenogram; in the other seven cases, the calcifications were microscopic in nature.

Improved patient care using the A/S/G/E guidelines on quality assurance: a prospective comparative study.

The American Society for Gastrointestinal Endoscopy has promulgated guidelines on quality assurance in gastrointestinal endoscopy. Thorough documentation of endoscopy reports and a peer review process were strongly recommended. We evaluated 1408 dictated endoscopy and colonoscopy reports for deficiency in reference to the guidelines during three periods: 6 months before (group 1), 6 months after the application of the guidelines (group 2), and 5 months of intensive peer review process (group 3).