Two new clinical/laboratory protocols for CAD/CAM implant restorations.

Background: Conventional casting technology has some disadvantages for dental laboratory technicians and restorative dentists, including porosity of restorations, miscasting and inaccuracy. It also is labor-intensive. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was developed in the late 1980s for dentistry, and it significantly reduced and/or eliminated problems associated with dental castings.

How should we approach adolescent and adult pertussis?

Previously considered a disease of childhood, pertussis is now also recognized as a significant problem for adolescents and adults; however, diagnosing pertussis remains problematic due to its nonspecific clinical presentation and the time delay, sensitivity/specificity, and expense of testing. To be effective, therapy is best started very early in the illness, when the illness is seldom recognized. Other than chemoprophylaxis in families with a non-immune infant, antibiotic therapy is controversial due to the ubiquitous nature of pertussis, its similarity to other respiratory infections, increased prevalence, prolonged outbreaks, and difficulties in determining true exposures in the general community.

Herbal remedies, nephropathies, and renal disease.

The use of herbal remedies is becoming increasingly popular in the United States. Research has shown that herbal remedy use may be associated with acute renal failure. In addition, the use of herbal remedies may be detrimental for the patient with compromised renal function.

Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury.

Object: This retrospective study was designed to determine whether side of approach during instrumented, one- or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC).

Methods: Records of all patients who underwent one- or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed. Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of RLN injury diagnosed by OVC after referral for persistent dysphonia.

Heterotopic pregnancy: a rare cause of hemoperitoneum and the acute abdomen.

Introduction: Heterotopic pregnancy is the rare coexistence of intrauterine and extrauterine gestation. The incidence may be as high as 1 in 3,889 pregnancies. The diagnosis is difficult to make, but an important one to consider in the presence of acute abdominal pain, hemorrhagic shock, and intrauterine pregnancy.

Impact of perinatal weight change on long-term obesity and obesity-related illnesses.

Objective: To estimate the impact of perinatal weight change on obesity, weight gain, and development of obesity-related illnesses 15 years after pregnancy.

Methods: Pregnancy-related factors and weights of 795 women were recorded at first prenatal visit and 6 months postpartum and were available through medical record review at 4, 10, and 15 years. Obesity-related illnesses were recorded 15 years later.

Outcomes of complex gastrointestinal procedures performed in a community hospital.

Background: Complex gastrointestinal (GI) procedures have been defined as those that are associated with higher morbidity and mortality, require a high level of technical expertise, and occur in less than 6000 patients per year in the United States. Prior studies suggest a direct volume-outcome relationship.

Hypothesis: Complex GI procedures may be performed with good outcomes in a lower volume hospital with a commitment to surgical residency training.

Growing healthy families: family use of pedometers to increase physical activity and slow the rate of obesity.

Objective: We conducted a study to determine if wearing a pedometer affects weight, body mass index (BMI), or mediators of physical activity among families.

Methods: Eighty-seven families were randomized to 1 of 3 treatments: pedometer plus education (PE), pedometer (P), or control (C). Participants in the PE and P groups wore pedometers and were encouraged to walk 10,000 steps daily for 12 weeks.

Implementation and evaluation of a home gavage program for preterm infants.

Purpose: To describe the implementation and evaluation of a home gavage program for preterm infants.

Design: Retrospective chart reviews were used to assess the physiologic progress of infants, and retrospective written questionnaires were administered by mail to families participating in home gavage to assess their experience and solicit advice.

Sample: One hundred forty-three infants born at <37 weeks gestational age with a primary diagnosis of prematurity who met criteria for home gavage, of whom 52 were given home gavage and 91 attained full oral feedings in intensive care before discharge.

Quit and Win smoking cessation contest for Wisconsin college students.

Objective: To determine effectiveness of smoking cessation contests at 3 Wisconsin colleges.

Design: Pre-post program evaluation, with 6-month follow-up.

Setting: Two-year technical college, private 4-year college, and state university in spring and fall of 2000.

Long-term follow-up of a patient with papillary thyroid carcinoma, elevated thyroglobulin levels, and negative imaging studies.

Objective: To describe a patient with papillary thyroid carcinoma who had measurable thyroglobulin (Tg) levels for 20 years without clinical or imaging evidence of a malignant lesion.

Methods: We reviewed the clinical course, pathologic findings, Tg measurements, and results of various imaging studies in our patient and reviewed the literature regarding Tg-positive, diagnostic total-body radioiodine scan-negative patients with thyroid cancer.

Results: Four months after a 3.

Macrocytosis associated with monoclonal gammopathy.

Objective: To report the potential association between unexplained macrocytosis and monoclonal gammopathy.

Methods: We retrospectively reviewed the medical records of patients who had monoclonal protein detected by serum electrophoresis and immunofixation from October 1999 until September 2003 at our institution. Patients with concomitant macrocytosis were included in this study.

Does the use of standardized history and physical forms improve billable income and resident physician awareness of billing codes?

Objectives: Resident physician knowledge of financial reimbursement guidelines for patient encounters is limited. We determined whether the use of standardized history and physical examination forms by residents for hospital admissions plus a brief lecture would increase the level of billing codes, increase billable income, and increase resident awareness of billing guidelines.

Methods: Residents used history and physical examination forms after a brief documentation lecture.

Borreliacidal OspC antibodies specific for a highly conserved epitope are immunodominant in human lyme disease and do not occur in mice or hamsters.

Humans produce highly specific borreliacidal antibodies against outer surface protein C (OspC) shortly after infection with Borrelia burgdorferi sensu stricto. We previously demonstrated the epitope recognized by immunoglobulin M (IgM) and IgG OspC borreliacidal antibodies was located within the 50 amino acids nearest the carboxy (C) terminus. In this study, we show the immunodominant epitope is located in the highly conserved region within the seven C-terminal amino acids.

Nicotine replacement therapy and cardiovascular disease.

Smoking is a well-established and important risk factor for cardiovascular disease. Cessation of smoking clearly decreases the chances of a first or subsequent cardiovascular event. Nicotine replacement therapy (NRT) is a proven adJunctive therapy to increase the probability of quitting smoking.

Training of a minimally invasive bariatric surgeon: are laparoscopic fellowships the answer?

Background: Fellowships in advanced laparoscopy with emphasis in laparoscopic gastric bypass (LGBP) are available for obtaining experience in performing LGBP. The following is the first report in the literature prospectively documenting a single surgeon's experience with LGBP outcomes following completion of an advanced laparoscopic surgical fellowship.

Methods: Outcomes measured prospectively included length of stay, length of operation, complications, reduction in obesity-related co-morbidities, and percentage excess weight loss.

Ultrasound assessment of first-trimester bleeding.

Objective: To assess the outcome (to the end of the first trimester) of pregnancies with vaginal bleeding and the influence of ultrasound-acquired information on care and cost of care.

Methods: A chart review was performed of 1,240 patients receiving care at an integrated medical center for threatened abortion from 1998-2000. Records from 715 patients with adequate follow-up data were reviewed and outcomes studied.

Determination of the peritoneal reflection using intraoperative proctoscopy.

Purpose: Rectal carcinomas are amenable to transanal excision in 3 to 5 percent of cases. Location below the peritoneal reflection is one requirement for transanal excision and transanal endoscopic microsurgery. The location of the peritoneal reflection has not been extensively studied in living patients.

Surgical management of obesity: a review of the evidence relating to the health benefits and risks.

Obesity continues to plague our society in epidemic proportions. Surgery for morbid obesity is considered by many as the most effective therapy for this complex disorder. Today, multiple surgical procedures for the treatment of obesity are available.

Speculations on the pathogenesis of CHARGE syndrome.

To be seriously considered, a theory about the pathogenesis of a multiple congenital anomaly syndrome should meet three criteria: (1) it should explain all of the anomalies associated with the syndrome; (2) it should explain why certain anomalies are not associated with the syndrome; and (3) it should predict anomalies that could be associated with the syndrome, but have not yet been described. The theory must eventually pass the ultimate test, that is, molecular confirmation of the proposed mechanism. Several theories about the pathogenesis of CHARGE syndrome have been proposed, but none of these meet the three criteria stated above.

Idiopathic cyclic thrombocytopenia.

Cyclic thrombocytopenia (CTP) is an uncommon disorder characterized by periodic fluctuations in platelet counts, typically resulting in episodes of thrombocytopenia alternating with normal platelet counts. While some CTP cases are associated with a primary hematologic disease, most are idiopathic. Patients with CTP are frequently misdiagnosed as idiopathic thrombocytopenic purpura (ITP) because CTP has clinical features very similar to ITP.

High prevalence of genital mycoplasmas among sexually active young adults with urethritis or cervicitis symptoms in La Crosse, Wisconsin.

Sexually active young adults in the small college town of La Crosse, Wisconsin, were evaluated for conventional sexually transmitted pathogens and tested for infections with mycoplasmas. The prevalence in 65 symptomatic men or women and 137 healthy volunteers (67 men and 70 women) was compared. Urine specimens from both cohorts were tested by ligase chain reaction for Chlamydia trachomatis or Neisseria gonorrhoeae.