Ultrasonographic diagnosis of testicular torsion by emergency physicians.

Testicular torsion has an incidence of one case per 4,000 men/boys. Most frequently affected are pubescent boys. Average testicular salvage rate is only 50%, and infertility can result Testicular torsion remains problematic for emergency physicians (EPs) as clinical diagnosis can be difficult and other testicular pathology can present similarly.

Lower-extremity Doppler for deep venous thrombosis--can emergency physicians be accurate and fast?

Unlabelled: Clinical diagnosis of lower-extremity (LE) deep venous thrombosis (DVT) requires confirmation by an imaging study before committing the patient to anticoagulation therapy. Studies have shown that demonstrating compressibility of leg veins under ultrasound is accurate for ruling out DVTs when performed by vascular specialists. Although LE Doppler has become the preferred test for diagnosing DVTs, it is not always available 24 hours per day.

Decreasing length of stay with emergency ultrasound examination of the gallbladder.

Objective: To determine whether patients who received emergency screening ultrasound examinations (ESUEs) of the gallbladder by emergency physicians (EPs) have a shorter ED length of stay (LOS) than do those receiving ultrasound studies from radiology.

Methods: A retrospective chart review from July 1995 to August 1998 identified 1,242 patients who received gallbladder ultrasound examinations. Seven hundred fifty-three patients received ESUEs by EPs of varying levels of ultrasound experience.

The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence. Continence Program for Women Research Group.

The purpose of this study was to compare the effect of three conservative interventions: pelvic floor muscle training, bladder training, or both, on urodynamic parameters in women with urinary incontinence. Two hundred four women with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI +/- GSI) participated in a two-site trial comparing pelvic floor muscle training, bladder training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treatment site, then randomized to a treatment group.

The role of angiography in periclavicular penetrating trauma.

Our objective was to evaluate whether physical examination in conjunction with chest X-ray can accurately diagnose the presence of significant vascular injury in penetrating periclavicular trauma. Results from a management protocol for penetrating periclavicular trauma were reviewed for the period January 1992 through December 1996 at an urban Level I trauma center. All patients requiring angiography for periclavicular penetrating trauma with trajectory of the injury falling between the lateral border of the manubrium and the anterior axillary line were entered into the management protocol.

An unusual case of hypoxia from benzocaine-induced methemoglobinemia.

Hypoxemia during bronchoscopy occurs frequently. It can usually be managed by supplemental oxygen and bronchodilators or, in some cases, occasionally stopping the procedure. Benzocaine spray is commonly used as a topical anesthetic agent during bronchoscopy.

A comparison of standardized and narrative letters of recommendation.

Objective: To compare the Council of Emergency Medicine Residency Directors' (CORD's) standardized letters of recommendation (SLORs) with traditional narrative letters of recommendation (NLORs) with regard to interrater reliability, consistency, and time of interpretation.

Methods: In part I of the study, four members of the residency selection committee each evaluated the same 20 SLORs and 20 NLORs from which all identifying characteristics had been deleted. Using Likert-type scales of the global assessment, each letter was assigned a numeric value from 1 to 7.

SDM95--reducing aggregate care team costs through optimal patient placement.

The authors describe a new approach that designs optimal patient placement rules and staffing-to-demand scheduling schemes. The placement rules enable care teams to deliver care at census levels that maximize the productivity of current care models across aggregated units and reduces the number of units experiencing census variation. The scheduling schemes ensure that staff is available to meet patient needs so that work schedules become predictable and premium pay virtually is eliminated.

The role of presacral drainage in the management of penetrating rectal injuries.

Purpose: To compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury.

Methods: During a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group.

Minocycline-induced hepatitis with autoimmune features and neutropenia.

Minocycline can cause various types of hepatotoxicity. We report an 18-year-old male who developed a delayed onset of minocycline-induced cholestatic hepatitis with autoimmune features and neutropenia. He responded to withdrawal of the drug and a short course of corticosteroids.

Role of prophylactic antibiotics for tube thoracostomy in chest trauma.

The objective of this study was to evaluate the efficacy of antibiotic prophylaxis in association with tube thoracostomy for chest trauma patients with Injury Severity Scores of 9 or 10. A double-blind randomized clinical trial of patients requiring tube thoracostomy was performed at an urban Level 1 trauma center. All patients included in this series were patients with Injury Severity Scores of 9 or 10 (hemothorax/pneumothorax) who suffered isolated chest trauma secondary to blunt or penetrating trauma.

Fat embolism syndrome: a complication of orthopaedic trauma.

Fat embolism syndrome is a potentially serious, life-threatening complication of long bone fractures, blunt trauma, and intramedullary manipulation. The orthopaedic nurse needs to have an understanding of fat embolism syndrome (FES), its pathophysiology, the varied aspects of its clinical presentation, and an understanding of treatment protocols and rationale.

Five-color immunophenotyping plus DNA content analysis by laser scanning cytometry.

Laser scanning cytometry is a new laboratory technology similar to flow cytometry but with advantages for certain clinical and research applications. To date, laser scanning cytometry has been successfully used to perform three-color immunophenotypic analysis of hematologic specimens, single-color immunophenotyping plus DNA content analysis of numerous specimen types, and automated analysis of fluorescence in situ hybridization specimens. Several other interesting applications are also in development.

Simplified immunophenotypic analysis by laser scanning cytometry.

Immunophenotypic analysis of hematologic specimens is a useful laboratory adjunct to surgical pathology and cytology to confirm or further characterize diagnoses of leukemia or lymphoma. Laser scanning cytometry is a new laboratory technology that has been adapted to perform immunophenotypic analysis of hematologic specimens, with numerous advantages as compared with flow cytometry. In order to make full use of the laser scanning cytometer's capabilities, a new method of specimen preparation and means of performing the immunofluorescent reactions was developed.

Modified minimally invasive technique for greater saphenous vein harvesting.

A technique is described for minimally invasive harvesting of the greater saphenous vein. This technique requires no new or disposable equipment, thus adding no additional cost to the procedure. It is rapid and reliable, and it can be performed in the majority of patients requiring greater saphenous vein for coronary artery bypass grafting.

Gastric inlet patch containing submucosally infiltrating adenocarcinoma.

We describe a patient with an unusual segment of ectopic gastric mucosa in the proximal esophagus. The gastric heterotopia was circumferential and unusually long at 7 cm. It contained benign rugal-type folds, a stricture at the mid-portion of the gastric inlet patch was lined by normal antral-type gastric mucosa but harbored submucosally infiltrating adenocarcinoma.

Blood and blood product use in perioperative patient care.

A variety of health care personnel are involved in the collection, storage, and administration of the 20 million units of blood products that are transfused into millions of patients each year. This article reviews blood transfusion practices, nursing care guidelines, and new developments to help perioperative nurses prevent or ameliorate adverse transfusion outcomes in surgical patients.

Multiparameter analysis of DNA content and cytokeratin expression in breast carcinoma by laser scanning cytometry.

Objective: The objective of this study was to test a new laboratory technology, laser scanning cytometry, for the purpose of performing multiparameter DNA content analysis of breast carcinomas.

Design: We developed a simplified method of multiparameter DNA content analysis using cytokeratin expression to positively gate epithelial cells. Over 300 consecutive cases of breast carcinoma were analyzed by multiparameter laser scanning cytometry.

Hypertension In The Elderly.

Cardiovascular disease is still the most common cause of morbidity and mortality in the elderly and hypertension is a significant risk factor for CVD such as stroke, myocardial infarction, and chronic renal disease. Fortunately, hypertension is readily treatable. A clear benefit from treating elevated blood pressure has been demonstrated by several clinical trials.

Multiparameter immunophenotypic analysis of fine needle aspiration biopsies and other hematologic specimens by laser scanning cytometry.

Objective: To test the new laboratory technology of laser scanning cytometry with respect to immunophenotyping of all types of hematologic and lymphoreticular specimens and particularly those of limited size, such as fine needle aspiration biopsies and hypocellular body fluids.

Study Design: Over the course of two years, 343 hematologic and lymphoreticular specimens of all types were immunophenotyped by laser scanning cytometry using methodologies modified from those of conventional flow cytometric immunophenotyping. Results for all cases were corroborated with histology and/or cytology and, for some cases, immunohistochemistry and/or flow cytometric immunophenotyping.