The overlapping spectrum of rett and angelman syndromes: a clinical review.

Rett and Angelman syndromes comprise part of the spectrum of neurologic disorders associated with autism. Their clinical presentations overlap, with both presenting in later infancy with global developmental delays, severe speech and communication impairments, progressive microcephaly, seizures, autistic behaviors, and characteristic albeit different movement disorders and stereotypic hand movements. Although other features can help differentiate these disorders, significant phenotypic overlap and variation in severity sometimes cloud the underlying diagnosis.

Acute cystitis in women: experience with a telephone-based algorithm.

Objective: This paper evaluates short-term (60-day) outcomes for women with symptoms of acute cystitis evaluated and treated with a telephone-based protocol.

Methods: We used a retrospective analysis of medical records of patients evaluated and treated according to a guideline-based algorithm for symptoms of acute cystitis.

Results: The algorithm was utilized in the care of 273 women reporting symptoms of urinary tract infection (UTI), with 75.

Therapy in allergic rhinoconjunctivitis: new horizons.

Allergic Rhinitis (AR) is a common disease that impacts productivity and has significant patient morbidity. We have a variety of agents available for the treatment of AR, but numerous patients still lack good control of symptoms and some are tolerating undesired side effects. Surveys have shown 1/5 of patients with AR are not fully satisfied with their AR medications and almost 1/2 feel they receive insufficient attention from their physicians.

Carotid-subclavian arterial reconstruction: concomitant ipsilateral carotid endarterectomy increases risk of perioperative stroke.

Background: Carotid-subclavian bypass (CSB) and carotid-subclavian transposition (CST) have excellent long-term patency with low perioperative mortality and morbidity. Carotid endarterectomy (CEA) is necessary for severe ipsilateral internal carotid artery stenosis in a small subset of these patients. CEA can be performed as a combined or separate procedure.

An economic analysis of hospital charges for choledocholithiasis by different treatment strategies.

The ideal management of presumed choledocholithiasis is controversial. We hypothesized that patients admitted with presumed choledocholithiasis would be better served financially to undergo laparoscopic cholecystectomy (LC) with possible intraoperative intervention versus preoperative endoscopic retrograde cholangiopancreatography followed by LC. A chart review was performed from September 1, 2000 to August 31, 2003.

Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft.

We report a case of aortoduodenal fistula 5 years after uncomplicated endovascular abdominal aortic aneurysm repair. The diagnosis was confirmed by abdominal computed tomography scan and esophagogastroduodenoscopy. The patient was successfully treated with primary duodenal repair, removal of the infected graft, in situ placement of a bifurcated graft, and omental interposition.

Borreliacidal OspC antibody response of canines with Lyme disease differs significantly from that of humans with Lyme disease.

Humans reliably produce high concentrations of borreliacidal OspC antibodies specific for the seven C-terminal amino acids shortly after infection with Borrelia burgdorferi. We show that dogs also produce OspC borreliacidal antibodies but that their frequencies, intensities, and antigenicities differ significantly. The findings therefore confirm a major difference between the borreliacidal antibody responses of humans and canines with Lyme disease.

The management and outcome of spinal implant infections: contemporary retrospective cohort study.

Background: Spinal implant infections provide unique diagnostic and therapeutic challenges.

Methods: We conducted a retrospective cohort study to evaluate risk factors for treatment failure in patients with early- and late-onset spinal implant infections at the Mayo Clinic (Rochester, MN) during 1994-2002.

Results: We identified 30 patients with early-onset spinal implant infection and 51 patients with late-onset spinal implant infection.

Preventing early-onset group B streptococcal sepsis: efforts to measure and improve compliance with guidelines.

Objectives: We describe strategies employed in achieving a high level of compliance with Centers for Disease Control and Prevention guidelines for the prevention of early-onset Group B streptococcal neonatal sepsis.

Methods: This is a retrospective review of all deliveries at or beyond 37 weeks gestation at Gundersen Lutheran Medical Center to determine (1) whether and when cultures were obtained for group B Streptococcus, (2) whether antibiotics were administered, and (3) the timing of antibiotic treatment relative to delivery, following educational efforts to an integrated medical center's departments of Obstetrics and Gynecology and Family Practice. Changes were made in prenatal records and admission order forms to facilitate compliance.

On call: a survey of Wisconsin obstetric groups.

Objective: The purpose of this study was to identify patterns of obstetric call in order to identify areas of focus for future evaluation of "best practices."

Study Design: A telephone survey of obstetricians in Wisconsin was conducted, attempting to sample 1 physician from each group or call pool in every hospital in the state.

Results: Sixty-six physicians responded to this survey.

Use of transabdominal ultrasound to identify intraabdominal adhesions prior to laparoscopy: a prospective blinded study.

Overview: The aim of the current study was to assess the accuracy of transabdominal ultrasound (TAU) in identifying intra-abdominal adhesions (IAA) prior to laparoscopy in patients with previous abdominal surgery.

Methods: Patients with previous open surgical procedures presenting for laparoscopic gastric bypass (LGB) underwent TAU by 1 radiologist. Attempts were made to identify IAA using TAU.

An institutional approach to maintenance of excellent outcomes for carotid endarterectomy in a setting with moderate-to-low procedure volume.

Background: Institutions and surgeons with high procedure volumes have been reported to have lower morbidity and mortality rates for patients undergoing carotid endarterectomy. Demonstrating comparable results is essential for centers with moderate or low volume. If comparable results cannot be demonstrated, a low- to moderate-volume center should not perform the procedure.

Colonoscopy completion and complication rates in a community gastroenterology practice.

Background: In the United States, colonoscopy completion and complication rates are rarely reported outside academic institutions. Increased transparency of quality measures and outcomes is being driven by professional societies, government agencies, and private enterprise.

Objective: To collect and report the completion and complication rates of colonoscopy in a community gastroenterology practice.

A breast center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines.

Background: National Comprehensive Cancer Network (NCCN) guideline compliance for breast cancer was determined in a breast center.

Methods: A retrospective study of 200 new breast cancer patients seen in 2004 was performed.

Results: NCCN guideline compliance rates for preoperative evaluation, breast surgery, lymph node surgery, radiation treatment, and systemic adjuvant therapy were 87%, 97%, 97%, 77%, and 63%, respectively.

Implementing patient safety practices in small ambulatory care settings.

Background: Improving patient safety in the outpatient setting poses unique challenges for patient safety leaders in clinics and hospitals. Even though ambulatory care may be less technologically complex than inpatient care, it is often more complex logistically.

Methods And Materials: From October 2002 to May 2003, Gundersen Lutheran Medical Center developed a tool kit of best practices and conducted a collaborative to institute these best practices within a regional health care network.

A retrospective analysis of osseotite NT implants in clinical practice: 1-year follow-up.

This article reports the preliminary results from a clinical study involving the use of implants with a natural taper design in edentulous and partially edentulous patients. Implants were followed for at least 12 months after occlusal loading. Three hundred nine implants were placed by two periodontists (176 maxillary, 133 mandibular; 198 anterior, 111 posterior).

Length of stay and impact on readmission rates after laparoscopic gastric bypass.

Background: A decreased length of stay (LOS) is one of the many advantages of laparoscopic over open Roux-en-Y gastric bypass for the treatment of morbid obesity. However, the mean LOS after laparoscopic gastric bypass (LGB) ranges from 1.8 to 4.

The effect of laparoscopic gastric bypass surgery on dyslipidemia in severely obese patients.

Background: Dyslipidemia is common in the morbidly obese population. Lipid parameters typically improve after bariatric surgery, but the effects have been inconsistent and may depend on the surgical procedure performed. If bariatric surgery consistently improves dyslipidemia, there may be associated cost savings in lipid-modifying medications.

Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population.

Background: There is no consensus regarding the optimal rate of follow-up in the post-bariatric surgery patient population.

Methods: The records of all patients who underwent laparoscopic Roux-en-Y gastric bypass from 2001 to 2003 were reviewed. Using patient zip codes, travel distances were calculated between the patients' places of residence and our clinic.