Long-term follow-up of the modified Delorme procedure for rectal prolapse.

Hypothesis: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse.

Design: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation.

Setting: Community-based tertiary referral center with a 5-year general surgery residency program.

Subcutaneous panniculitis-like T-cell lymphoma: complete remission with fludarabine.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an uncommon type of cutaneous lymphoma with an aggressive natural history. It generally carries a poor prognosis despite standard anthracycline-based chemotherapy. The optimum therapy is unknown.

A clinical study of the efficacy of gold-tite square abutment screws in cement-retained implant restorations.

Purpose: The purpose of this study was to record the effectiveness of Gold-Tite square abutment screws, tightened to 35 Ncm with a torque indicator, in maintaining a clinically stable implant/abutment connection.

Materials And Methods: The study consisted of 73 patients who were treated with 110 Osseotite implants. All patients were restored with either pre-machined titanium or customized UCLA hexed abutments.

Continuous axillary brachial plexus analgesia in a patient with severe hemophilia.

Until now, the safety of continuous axillary brachial plexus block in a patient with hemophilia has not been reported. We describe the use of continuous axillary brachial plexus block for postoperative pain control in a patient with severe hemophilia after an elbow surgery.

Paravertebral block: an alternative to general anesthesia in breast cancer surgery.

Alternative forms of anesthesia in breast cancer patients have been sought to reduce the untoward effects of general anesthesia. The purpose of this study was to compare paravertebral block (PVB) and general anesthesia (GA) in terms of pain control, postoperative nausea and vomiting, and resumption of diet in patients undergoing operations for breast cancer. A retrospective chart review was performed on all patients (289) undergoing breast cancer surgery from May 1, 1999 through December 31, 2000 with PVB or GA.

Acute myelogenous leukemia in an adult with thrombocytopenia with absent radii syndrome.

Acute myelogenous leukemia with t(8;21)(q22;q22) developed in a 42-yr-old woman having thrombocytopenia with absent radii syndrome (TARS). Standard induction and postremission therapies were safely administered. With each successive chemotherapy, the onset of platelet recovery was not delayed, but peak platelet counts were persistently suppressed.

Laparoscopic removal of a symptomatic rudimentary uterine horn in a perimenarchal adolescent.

An adolescent patient with a symptomatic, noncommunicating, rudimentary uterine horn is described. Diagnosis was suggested by ultrasonography and treatment was by laparoscopic resection. A review of other pediatric cases as well as the adult literature gives evidence that laparoscopic resection is worth considering in such cases.

A smoking cessation clinic with a 57% success rate: what makes it work?

Objective: To describe an outpatient smoking cessation clinic, and what predicts participant success.

Methods: In 1999, a 12-week smoking cessation clinic was begun. In 2000, the duration was expanded to include an additional 12 weeks of relapse prevention.

Excess pregnancy weight gain and long-term obesity: one decade later.

Objective: To estimate the impact of excess pregnancy weight gain and failure to lose weight by 6 months postpartum on excess weight 8-10 years later.

Methods: Seven hundred ninety-five women were observed through pregnancy and 6 months postpartum to examine factors that affect weight loss. Weight was recorded 10 years later through a medical record review to examine the impact of retained weight on long-term obesity.

Ability of the borreliacidal antibody test to confirm lyme disease in clinical practice.

Highly specific borreliacidal antibodies are induced by infection with Borrelia burgdorferi, and a borreliacidal antibody test (BAT) may be an accurate laboratory procedure for confirming Lyme disease in clinical practice. To investigate this, 34 Lyme disease sera and 34 sera from patients with other illnesses who had presented to a primary-care facility located in an area of borreliosis endemicity were tested by the BAT and Western blotting (WB). The BAT was more sensitive (79% versus 65%; P = 0.

Primary aortoappendiceal fistula: case report and review of the literature.

We report a case of primary aortoappendiceal fistula in a patient with chronic, relapsing abdominal symptoms and acute lower gastrointestinal hemorrhage. The diagnosis was evident with abdominal computed tomographic scan results. The patient's condition was successfully managed with appendectomy, abdominal aortic aneurysm resection, and extra-anatomic bypass grafting.

Reassessment of a midwestern Lyme disease focus for Borrelia burgdorferi and the human granulocytic ehrlichiosis agent.

Previous studies from the late 1980s defined the risk of human Lyme disease by determining the prevalence of Borrelia burgdorferi infection in Ixodes scapularis ticks and Peromyscus sp. mice captured from areas around La Crosse, Wis. High percentages of B.

Understanding and leading the quad matrix: four generations in the workplace: the Traditional Generation, Boomers, Gen-X, Nexters.

Generational diversity is not new, but 4 generations working side by side has not occurred before. This climate of 4 generational workers offers challenges and opportunities for leaders. Leaders must show the opportunities of a diverse workforce and provide the encouragement and enthusiasm of working in a 4-generation environment.

Lansoprazole-induced thrombocytopenia.

Objective: To describe a case of thrombocytopenia associated with the administration of lansoprazole.

Case Summary: An 85-year-old white man presented with an upper gastrointestinal hemorrhage from a gastric ulcer. His platelet count was normal on admission.

Hemorrhage associated with vitamin C deficiency in surgical patients.

Background: Diffuse hemorrhage in surgical patients with normal coagulation parameters may be caused by vitamin C deficiency and is rapidly reversed by vitamin C replacement.

Methods: Patients treated on a surgical service were entered into a clinical registry over a 12-month period if they experienced diffuse hemorrhage in the face of normal coagulation parameters and a plasma ascorbic acid level < 0.6 mg/dL (normal 0.

Physicians and the pharmaceutical industry: a growing embarrassment and liability.

The pharmaceutical industry, comprising corporate-owned, for-profit enterprises, employs nearly one sales representative with a budget of about $100,000 for each 11 practicing physicians. Physician contact with these individuals, epitomized by the drug company "free lunch," results in non-rational prescribing and increases the overall cost of prescription medication to patients. Other influential methods employed by the industry include sponsorship of tainted journal articles, restrictions on research, and biased continuing medical education.

Obesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma?

The hypothesis of this study was that obese and overweight patients undergoing elective resection for colon and rectal cancer have longer operative times, increased intraoperative blood loss, and more postoperative complications compared with normal-weight individuals. Our study cohorts included all patients undergoing elective first-time colon resection for proven colorectal carcinoma. Patients undergoing resection for recurrent disease or for emergent indications such as obstruction, perforation, or hemorrhage and those who underwent an additional surgical procedure at the time of colon resection were excluded from analysis.

Provider attitudes and use of alternative medicine in a midwestern medical practice in 2001.

Objective: To determine the current level of use, referral and desire for service of different complementary and alternative (CAM) therapies among Gundersen Lutheran Medical Center providers.

Methods: A survey was conducted in January of 2001 of all medical and associate staff.

Results: The response rate was 79%; 55% reported using 1 or more of 18 therapies for themselves.

Myocardial infarction in young adults with low-density lipoprotein cholesterol levels < or = 100 mg/dL: clinical profile and 1-year outcomes.

Study Objectives: To define the clinical profile of young adults with optimal low-density lipoprotein (LDL) cholesterol levels who present with acute myocardial infarctions (MIs); to compare and contrast differences in the clinical profiles of young adults admitted to the hospital with MIs who have LDL cholesterol levels < or = 100 mg/dL and those with LDL cholesterol values > or = 160 mg/dL; and to evaluate the clinical outcomes for the two groups at 1 year.

Design: A retrospective chart review was conducted on all young men (55 years) and women (65 years) admitted to the hospital for MIs within a 2-year period (n = 232). A history of cardiovascular risk factors and 1-year outcomes were obtained.

Long Z-osteotomy: a review and new modification to correct troughing.

The long Z-osteotomy (scarf) has proven to be an effective procedure for correction of the metatarsus primus varus component of the hallux abducto valgus deformity. An historical review and technical considerations of the procedure are described. Although technically demanding, it offers the advantages of superior strength with internal fixation, early range of motion, and early weightbearing.

Chronic heart failure in the community: missed diagnosis and missed opportunities.

Background: The aim of this study was to determine the incidence of congestive heart failure (CHF) in patients discharged from a hospital without a diagnosis of CHF who were admitted with shortness of breath and had a low left ventricular ejection fraction (LVEF). CHF is a devastating disease in terms of financial cost, prevalence, and effect on morbidity and mortality. The true incidence rate is not known because of reliance on discharge records and death certificates, and because diagnosis remains a clinical judgment.