Isolated blunt trauma injury to the hepatic duct.

Isolated bile duct injuries are quite rare. The diagnosis may be difficult. The presence of continued abdominal pain, nausea, vomiting, distention and jaundice in addition to abnormal liver function tests and often a leukocytosis mandate that a biliary tract injury be ruled out.

Intrapericardial tumbling bullet.

Foreign bodies of the pericardium are rare and they are associated most commonly with significant trauma. The diagnosis of a pericardial foreign body can be difficult. One must distinguish between foreign matter in the cardiac chamber or free-floating in the mediastinum.

Merkel cell tumor: two cases.

Merkel cell tumors are rare skin lesions that arise from the Merkel cell in the dermal layers. The two cases presented in this report are important in that they add more information to the literature than previously had been recognized. The first case discusses a collision tumor with a basal cell carcinoma.

An invitational counseling approach to diabetes management.

It is important for healthcare professionals to be nonjudgmental and provide a supportive, caring environment both personally and professionally when working with patients with diabetes. The challenge is to invite patients to be successful in managing their diabetes by building helping relationships based on the invitational counseling model. A positive, empathetic, and intentionally inviting healthcare team may be one of the keys to successful management of diabetes.

Care of the traumatized older adult.

Older adults are experiencing excellent health and maintaining active lifestyles. They continue to engage in the activities they have enjoyed throughout their lives, but as they grow older they are at increased risk for injury related to these activities. Older adults suffer injuries of equivalent severity as those of younger patients; however, the consequences are much more severe.

Stool patterns of infants diagnosed with necrotizing enterocolitis.

A retrospective study of the stool patterns of 68 infants was conducted. The sample included 34 infants who developed necrotizing enterocolitis (NEC) and 34 infants who did not. The objective was to compare the stool patterns of the two groups.

Prospective examination of epidural catheter insertion.

Background: Although it is generally accepted that inserting epidural catheters 3-4 cm into the epidural space minimizes complications, no prospective randomized examination of epidural catheter insertion length has been published.

Methods: Eight hundred healthy parturients requesting epidural analgesia were randomized to have open-tip epidural catheters inserted 2, 4, 6, or 8 cm within the epidural space. The incidences of intravenous cannulation, unilateral sensory analgesia, and subsequent catheter dislodgment were recorded.

A proposed staging system for chronic myeloid leukemia.

A staging system was proposed for chronic myeloid leukemia (CML) that groups patients into three stages (I, II, and III), each with two subclasses (A and B). The system uses pathologic parameters, of which the percentage of blasts in the blood and bone marrow is the most important. CML is defined as a myeloproliferative disorder with molecular or cytogenetic evidence of the translocation of the abl oncogene on chromosome 9 to the break-point cluster region gene on chromosome 22.

Vaginal laser surgery.

Vaginal epithelial lesions including endometriosis, cysts, septae, human papillomavirus (HPV) disease, and vaginal intraepithelial neoplasia (VaIN) can be successfully treated by laser surgery. The carbon dioxide laser with a wavelength of 10,600 nm is the ideal laser for these clinical applications. Pretreatment evaluation using colposcopically directed biopsies is mandatory.

Cryotherapy and laser treatment for intraepithelial neoplasia of the cervix, vagina, and vulva.

Over the past 20 years, the incidence of invasive genital neoplasia has decreased, while the incidence of preinvasive, or intraepithelial, neoplasia has increased. These trends are the result of increased cancer screening women and the widespread application of improved diagnostic techniques by physicians. The rapid increase in genital human papillomavirus infections over the past 10 years may also be a factor influencing the increased incidence of intraepithelial neoplasia.

Family stress theory: A perspective on pastoral care.

This article reviews crisis theory from family stress literature and research from medical sociology to advance a rationale for clinical pastoral care of seriously ill patients and families. It describes Reuben Hill's A,B,C,X crisis model and offers it as a conceptual framework for understanding the psychosocial experiences of families facing illness and the role of pastoral care in the coping process.

Cerebral-evoked response from stimulation of dorsal nerve in impotent men.

Cerebral-evoked responses from 128 uncategorized, impotent men were compared with responses from 17 healthy age-height matched controls, after stimulation of two penile sites, and one tibial nerve at the ankle. Our goal has been to establish a simple screening test to identify neurogenic impotence in patients with normal superficial sensation. High-frequency stimulation at 5.

Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures.

The quadriceps femoris angle ("Q angle") has been implicated as a source of several knee disorders, but values for normal knees have not been adequately documented in the literature. This study was designed to provide clinicians with normal values and information regarding the relationships between Q angle, gender, and selected anatomical measurements. The Q angles of 100 individuals (50 men, 50 women), who had no history of knee disorders, were measured goniometrically.