Peripheral vascular disease intervention in patients with end-stage renal disease: few complications in those treated with peritoneal dialysis.

Background: We assessed the results of peripheral vascular surgery in patients with end-stage renal disease (ESRD) who were being treated with peritoneal dialysis.

Methods: Sixty-seven ESRD patients on peritoneal dialysis who had peripheral vascular surgery were assessed retrospectively for preoperative risk factors, primary and secondary patency rates, and mortalitv. The study group had 48 proximal femoral-popliteal bypasses, 12 distal femoral-popliteal bypasses, and 7 distal femoral-tibial and/or peroneal revascularizations.

Automating psychiatric tasks: taking quality to the next level.

Advances in information technology have allowed the creation of databases and decision support systems for behavioral health care as well as other areas of medicine. The authors describe the state of the art in automating behavioral health care tasks and how automated information analyses provided in real time can measurably improve patient outcomes.

Diagnosis of unexplained bleeding from tunneled dialysis catheter.

Bleeding after hemodialysis catheter placement is commonly seen and can happen because of anticoagulation, poor platelet function in dialysis patients, and trauma to the vessel and tunnel tract during placement. We wish to present here two cases of prolonged exist site bleeding with tunneled dialysis catheters (SchonCath dialysis catheter, Angio-Dynamics, Queensbury, N.Y.

Neuropathic central pain: epidemiology, etiology, and treatment options.

Background: Nociceptive pain is a major problem in clinical neurology. Peripheral nerve injury may change the physiology of the dorsal horn so that pain becomes progressively centralized.

Objective: To review mechanisms underlying the plasticity of dorsal root ganglia and dorsal horn neurons that lead to central pain from a peripheral nerve injury.

Skin and soft tissues. Management of four common infections in the nursing home patient.

Common skin and soft tissue infections in nursing home patients include herpes zoster, cellulitis, pressure ulcer infections, and scables. Treatment of shingles with an oral antiviral should be started within 24 hours of symptom onset. Dissemination and bacterial superinfection require antibiotic therapy.

Effect of moderate hypocapnic ventilation on nuclear DNA fragmentation and energy metabolism in the cerebral cortex of newborn piglets.

Previous studies have shown that severe hypocapnic ventilation [arterial carbon dioxide partial pressure (PaCO(2)) 7-10 mm Hg] in newborn animals results in decreased cerebral blood flow and decreased tissue oxidative metabolism. The present study tests the hypothesis that moderate hypocapnic ventilation (PaCO(2) 20 mm Hg) will result in decreased cerebral oxidative metabolism and nuclear DNA fragmentation in the cerebral cortex of normoxemic newborn piglets. Studies were performed in 10 anesthetized newborn piglets.

Use of a urethral occlusion device for treatment of incontinence in a patient with heterotopic urinary diversion.

Incontinence is a frequent complication of continent cutaneous urinary diversion that usually requires surgical intervention for correction. We report a novel nonsurgical therapy for reservoir incontinence in a woman who underwent anterior pelvic exenteration with formation of an Indiana pouch urinary diversion for treatment of adenocarcinoma of the urethra. When she subsequently developed urinary incontinence that was only partially responsive to anticholinergic therapy, stomal continence was restored by using a disposable urethral occlusion device.

Use of antibacterial agents in renal failure.

This article reviews the pharmacokinetics of antibacterial agents in patients with normal and decreased renal function. The concepts of volume and distribution, rate of elimination, loading and maintenance doses, and therapeutic drug monitoring are delineated. Special reference is made to the intermittent dosing of cefazolin with hemodialysis.

What nursing has learned from famous traumas.

The deaths of three celebrities shed light on where trauma care needs to improve and remind us how far we have already come.

A novel use of ultrasound in pulseless electrical activity: the diagnosis of an acute abdominal aortic aneurysm rupture.

We report a case of a patient who presented to the Emergency Department with pulseless electrical activity. A rapid diagnosis of ruptured abdominal aortic aneurysm was made by Emergency Medicine bedside ultrasonography. On arrival, the patient was without palpable pulses and bradycardic.

Contemporary Approaches to the Management of Neurosurgical Complications of Infective Endocarditis.

Infective endocarditis can often involve the nervous system, resulting in stroke, intracerebral hemorrhage, infectious aneurysm formation, cerebral abscess, and spinal epidural infection. Many of these problems require neurosurgical attention. Modern advances in neuro- surgical critical care, computerization, instrumentation, and radiologic imaging have affected the treatments available to patients with neurosurgical manifestations of infective endocarditis.

Vagal neuropathy after upper respiratory infection: a viral etiology?

Purpose: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. Patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction.

Effective normalization of complexity measurements for epoch length and sampling frequency.

The algorithmic complexity of a symbol sequence is sensitive to the length of the message. Additionally, in those cases where the sequence is constructed by the symbolic reduction of an experimentally observed wave form, the corresponding value of algorithmic complexity is also sensitive to the sampling frequency. In this contribution, we present definitions of algorithmic redundancy that are sequence-sensitive generalizations of Shannon's original definition of information redundancy.

Current assessment of thromboembolic disease and pregnancy.

This study was undertaken to assess incidence of deep venous thrombosis and pulmonary emboli in an inner-city pregnant population. Thromboembolic disease is believed to occur in 0.05 to 0.

Modification of a choledochoscope for extraction of difficult biliary stones.

Cholelithiasis is a common problem in the United States, affecting 10 to 15 per cent of the population. Although only one per cent of these patients have intrahepatic gallstones their discovery intraoperatively may present a technical challenge for the surgeon. This paper describes a simple method for dislodging difficult intrahepatic biliary stones: modification of a rigid choledochoscope to permit use of a biliary Fogarty catheter and Segura basket under direct visualization.

Chronic dialysis and dialysis doctors in the United States: a nephrologist-historian's perspective.

In an earlier article in Seminars in Dialysis (9:276-281, 1996), the author described the invention of clinical hemodialysis for acute renal failure and its initially equivocal reception by the emerging specialty of nephrology in the United States. A similar story of blunted enthusiasm played out following the invention of the Quinton-Scribner shunt (whose idea "came in the night"), which allowed maintenance treatment for chronic renal failure. Few centers at first could match Belding Scribner's early successes, and some physiology-oriented university nephrologists envisioned how routine dialysis might swamp other activities.

Hemicricoidectomy for voice rehabilitation following hemilaryngectomy with ipsilateral arytenoid removal.

The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent.

The future of pain management in managed care.

Pain management has made great strides in clinical practice and education, and in research documenting its effectiveness on pain relief, functional improvement, and cost. The profile of pain in managed care settings has recently been raised, notably because of the trend toward replacing inexpensive generic drugs with new and expensive drugs for pain treatment. Managed care organizations have greater motivation to focus on pain care because of recent regulatory initiatives, new accreditation standards, and legal precedents.

Viral encephalitis associated with reversible asystole due to sinoatrial arrest.

We report a case of sinoatrial node block associated with syncopal episodes that required a temporary pacemaker. Magnetic resonance imaging (MRI) of the brain showed lesions of both temporal lobes consistent with viral encephalitis, presumably due to herpes simplex virus (HSV). The patient quickly recovered with intravenous acyclovir (Zovirax) therapy.

The role of matrix metalloproteinases in tumor angiogenesis and tumor metastasis.

Although a considerable amount of effort has been placed on discovering the etiologies of cancer, the majority of the basic cancer research existing today has focused on understanding the molecular mechanism of tumor formation and metastasis. Metastatic spread of tumors continues to be a major obstacle to successful treatment of malignant tumors. Approximately 30% of those patients diagnosed with a solid tumor have a clinically detectable metastasis and for the remaining 70%, metastases are continually being formed throughout the life of the tumor.

Impact of bone marrow transplantation on type I diabetes.

Type I diabetes is a systemic autoimmune disease. Evidence is accumulating that autoimmune diseases such as type I diabetes are linked to the bone marrow hematopoietic stem cell (HSC) itself rather than its derivatives. HSC chimerism achieved through bone marrow transplantation (BMT) may affect type I diabetes in two ways: first, to induce tolerance to pancreas and islet cell transplants; and second, to reverse the autoimmune process prior to the development of terminal complications.