Failure of the modular neck in a total hip arthroplasty.

Modular femoral necks in total hip arthroplasty are promoted as giving the surgeon more options during surgery and as being safe. We report a case of fatigue fracture in the modular neck of a femoral implant 3 1/2 years after implantation. The probable design errors leading to product failure are discussed.

An uncommon etiology of cholestatic jaundice: intraductal mucinous papillary tumor of the bile duct.

Intraductal papillary mucinous tumors (IPMT) are known to occur in the pancreas but rarely can occur in the bile ducts. These tumors secrete mucin that may form mucous plugs resulting in biliary stasis, biliary duct obstruction and dilation. We report a case of IPMT of the biliary tract that presented with fatigue and a persistent cholestatic pattern of liver enzyme elevation and required a high index of suspicion to make the final diagnosis.

Biopsy techniques for skin disease and skin cancer.

It is increasingly important for clinicians to be proficient at performing skin biopsies because of the prevalence of skin cancers and other skin diseases in the population. With the appropriate knowledge and training, the three major types of biopsies-shave biopsy, punch biopsy, and excisional/incisional biopsy-can be performed. The choice of biopsy type depends on the suspected disease pathology and lesion location.

Introduction to skin cancer.

The incidence of skin cancer has been increasing throughout the United States and much of the world. Although the mortality rate of nonmelanoma skin cancer is low, that type of skin cancer accounts for considerable morbidity, including cosmetic and functional impairment. Melanoma, although less common, is a life-threatening malignancy if not detected and treated early.

Early manifestations of restless legs syndrome in childhood and adolescence.

Objective: To describe the symptomatology reported by a series of children and adolescents who at initial consultation did not meet full diagnostic criteria for pediatric restless legs syndrome (RLS) but subsequently did so over the course of clinical follow-up.

Methods: Retrospective assessment of all patients with pediatric RLS receiving ongoing care in a pediatric sleep/neurology practice at a large multispecialty clinic (n=50). Eighteen children and adolescents who met inclusion and exclusion criteria were identified by chart review.

Restless legs syndrome: prevalence and impact in children and adolescents--the Peds REST study.

Objectives: Restless legs syndrome, a common neurologic sleep disorder, occurs in 5% to 10% of adults in the United States and Western Europe. Although approximately 25% of adults with restless legs syndrome report onset of symptoms between the ages of 10 and 20 years, there is very little literature looking directly at the prevalence in children and adolescents. In this first population-based study to use specific pediatric diagnostic criteria, we examined the prevalence and impact of restless legs syndrome in 2 age groups: 8 to 11 and 12 to 17 years.

Standard cochlear implantation of adults with residual low-frequency hearing: implications for combined electro-acoustic stimulation.

Objective: This study compared preoperative and postoperative cochlear implant benefit in subjects with steeply sloping high-frequency hearing losses (HLs) who were implanted with standard long cochlear implant electrodes to: 1) determine the effect of etiology, 2) compare outcomes in studies exploring the use of combined electrical and acoustic stimulation, and 3) compare outcomes in patients implanted using standard criteria.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Restless legs syndrome, periodic limb movements in sleep, and depression.

Study Objectives: To review the literature on restless legs syndrome (RLS), periodic limb movements in sleep, and depression.

Design: Literature review. SETTING, PARTICIPANTS, AND INTERVENTIONS: N/A.

Naviculocuneiform dislocations treated with immediate arthrodesis: a report of 2 cases.

The authors report on 2 patients who sustained naviculocuneiform dislocations and intercuneiform diastasis, and who were treated with immediate arthrodesis of the midfoot complex. Injury patterns in both cases involved damage to the medial facet of the distal navicular articular surface, separation of the first and second cuneiforms, and an unstable first ray. At the 15- and 18-month follow-up, respectively, both patients attained a stable, solid fusion with maintenance of the medial longitudinal architecture.

Additional collection devices used in conjunction with the SurePath Liquid-Based Pap Test broom device do not enhance diagnostic utility.

BACKGROUND: We have previously shown that use of an EC brush device in combination with the Rovers Cervex-Brush (SurePath broom) offered no significant improvement in EC recovery. Here we determine if use of additional collection devices enhance the diagnostic utility of the SurePath Pap for gynecologic cytology. METHODS: After informed consent, 37 women ages 18-56 receiving their routine cervical examinations were randomized into four experimental groups.

Dual sampling of the endocervix and its impact on AutoCyte Prep endocervical adequacy.

We compared satisfactory for evaluation but limited by (limited by) and unsatisfactory gynecologic cytologic diagnoses for samples collected by conventional smearing with those generated with the AutoCyte Prep in a population with a historic squamous intraepithelial lesion (SIL) rate of less than 1%. Results from 18,819 AutoCyte Preps were compared with 53,835 conventional cervical smears. Furthermore, 23 women ages 18 to 65 years undergoing annual Papanicolaou tests underwent sequential sampling with the AutoCyte Prep and the Surgipath C-E brush.

Ectopic gastric mucosa in the cervical esophagus.

This study describes the clinical presentation and management of ectopic gastric mucosa (EGM) in the cervical esophagus. This is a case report of a 53-year-old male who presented with left-sided odynophagia of 3 months' duration. Office examination, including flexible fiberoptic laryngoscopy, was unremarkable.

Serum heterophile antibodies interfere with prostate specific antigen test and result in over treatment in a patient with prostate cancer.

Purpose: We evaluated how naturally occurring heterophile antibodies in patient serum interfered with prostate specific antigen (PSA) immunoassay, resulting in over treatment for prostate cancer.

Materials And Methods: Serum samples were treated with heterophilic blocking reagent (Scantibodies Laboratory, Inc., Santee, California).

The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults.

Background: This study evaluates the ability of a model of collaborative primary care practice to reduce mortality and hospital use in community-dwelling elderly persons.

Methods: Four rural and four urban clinic sites in east central Illinois were randomized to form treatment and comparison clinics from which patients were enrolled and followed prospectively for 2 years. Patients from the practices of participating physicians were eligible if they were aged 65 and older, were living in the community, and had at least one risk factor as determined prior to the study.

The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit.

Objective: To develop and validate an instrument for identifying community dwelling elderly patients at increased risk for hospitalizations or emergency department (ED) encounters.

Study Design: Prospective cohort study.

Patients And Methods: The development cohort consisted of 411 Medicare fee-for-service patients and the validation cohort consisted of 1054 individuals enrolled in a Medicare Risk Demonstration.

Electrically evoked potentials recorded in adult and pediatric CLARION implant users.

The purpose of this study was to record electrical auditory brain stem responses (EABRs) and electrical middle latency responses (EMLRs) in the clinic from 3 adult CLARION Multi-Strategy Cochlear Implant subjects and to record EABRs in the operating room from 3 pediatric subjects. For 2 of the 3 adult subjects, EABR thresholds were within the subject's behavioral dynamic range, whereas 1 adult subject's EABR thresholds were either absent or, when present, exceeded the upper limit of the dynamic range. For this subject, EMLRs were absent or of poor morphology for the channels tested.

Difficult physician-patient relationships.

Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication.

Management of nursing within a collaborative physician group practice.

Today's changing health care environment suggests the need for integration of high-quality primary medical and nursing care to address the complex psychosocial and environmental aspects of health in the elderly. This article describes a model of geriatric primary collaborative care between nurses and physicians that has been successfully implemented in a large primary care group practice setting.

Population-based research data as a means to address health outcomes.

Health care restructuring efforts have been influenced by changes in public policy, payment mechanisms, and societal values. In today's environment, leading issues focus on quality and cost-effective care. Health care systems are moving from a concentration on structures and processes of care to an expanded view that encompasses the exploration, documentation, and improvement of patient outcomes.