Cytomegalovirus endomyocarditis in a transplanted heart. A case report with in situ hybridization.

A 64-year-old man underwent cardiac transplantation for long-standing severe dilated cardiomyopathy. Postoperative complications included primary cytomegalovirus (CMV) infection with several episodes of moderate acute rejection and severe pneumonia. Six months after transplantation, an endomyocardial biopsy specimen revealed focal necrotizing myocarditis with intranuclear inclusions consistent with CMV.

An incentive plan for nurses: linking bonuses to both care and documentation.

Productivity and quality are not mutually exclusive as many nurses believe. Management's responsibility to its staff is to provide systems that will allow for safe and realistic productivity expectations while not compromising quality care. Incentives add to the program, but they are the last step in a series of changes that must be jointly agreed on before nurses can be financially rewarded.

A new technique for the management of vesicorectal fistulas.

We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy.

Diffuse idiopathic skeletal hyperostosis.

The ubiquitous nature of spinal ligamentous calcification in the paleontologic record provides additional support for the suggestion that DISH is a protective phenomenon rather than a musculoskeletal disease, and perhaps represents a normal variant. Clinical assessment of contemporary DISH suggests a protective mechanical effect, paradoxically associated with increased risk of hypertension and cerebrovascular accident. DISH should probably not be considered a satisfactory explanation for back pain, but the presence of spinal ligamentous calcification requires that the patient be assessed for hypertension and that aggressive therapy be instituted for any found.