Is mitral valve prolapse a manifestation of adolescent growth spurt?

The exact aetiology of mitral valve prolapse (MVP) is unknown, although this is the most common cardiac valvular abnormality currently detected. MVP has high incidence in young individuals, particularly during the second and third decades. These individuals are usually of a slender body habitus indicating higher rates of linear growth, reflective of the adolescent growth spurt.

A case controlled study of laparoscopic incisional hernia repair.

Background: Although the feasibility of laparoscopic incisional herniorrhaphy has been demonstrated, its advantages over the open technique are still unproven.

Methods: Fourteen consecutive laparoscopic incisional hernia repairs were compared with 14 matched controls of the open repair done by the same surgeon at the same institution. The controls were selected by a medical record technician not connected with the study.

Solitary spinal intramedullary abscess caused by Nocardia asteroides.

Nocardial spinal cord abscesses are extremely rare. Only three have been reported, one each from Austria, Thailand, and the United States. All three patients also had extraneurologic nocardiosis.

Dyspnea differentiation index: A new method for the rapid separation of cardiac vs pulmonary dyspnea.

Study Objective: To assess the utility of a new parameter in the differentiation of dyspnea of cardiac origin from dyspnea of pulmonary origin.

Methods: The peak expiratory flow (PEF) rate and the partial pressure of oxygen in arterial blood (PaO(2)) were measured in 71 patients with the chief complaint of dyspnea. The patients were treated in the hospital, and the final diagnosis (cardiac or pulmonary) of the cause of dyspnea was made at discharge.

Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs.

Background: Despite randomized controlled trials, the merits of laparoscopic hernia repair remain poorly defined. A meta-analysis may provide a timely overview.

Methods: An electronic MEDLINE search, supplemented by a manual search, yielded 14 randomized controlled trials with usable statistical data, involving 2,471 patients.

Angiotropic large cell lymphoma presenting as fever of unknown origin.

Background: Fever has never before been described as the chief complaint and major finding in angiotropic large cell lymphoma (ALCL). ALCL is a rare and usually fatal intravascular tumor characterized by a widespread proliferation of malignant mononuclear cells within vessels of small caliber, causing their blockage. The majority present as high-grade, B-cell lymphomas with a predilection for the central nervous system and the skin.

Lactic acidosis caused by thiamine deficiency in a pregnant alcoholic patient.

Background: Metabolic acidosis from accumulation of lactic acid is a relatively common condition, whereas its causation by thiamine deficiency is not.

Methods: We studied a pregnant alcoholic patient who presented with hyperemesis and a high anion gap acidosis.

Results: Lactic acidosis and thiamine deficiency were confirmed.

A method of teaching clinical research in a community hospital residency program.

Background: To provide clinical research experience in community hospital programs, we integrated research training with the daily work of surgical residency.

Methods: Teaching conferences and daily care of patients served as a source of projects. Emphasizing team work, high-yield projects are assigned to principal resident investigators, who lead a project team.

Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia.

Background: Doxycycline has a high degree of activity against many common respiratory pathogens and has been used in the outpatient management of lower respiratory tract infections, including pneumonia.

Objective: To evaluate the efficacy of intravenous doxycycline as empirical treatment in hospitalized patients with mild to moderately severe community-acquired pneumonia.

Patients And Methods: We conducted a randomized prospective trial to compare the efficacy of intravenous doxycycline with other routinely used antibiotic regimens in 87 patients admitted with the diagnosis of community-acquired pneumonia.

Kluyvera cryocrescens finger infection: case report and review of eighteen Kluyvera infections in human beings.

We report a case of soft tissue infection with Kluyvera cryocrescens and a critical review of Kluyvera infections. A 31-year-old diabetic man used a new chemical for stripping the floor with his bare hands. Two days later he developed a blister on a finger which progressed to tenosynovitis in spite of intravenous nafcillin therapy.

Esophageal papillomatosis from human papilloma virus proven by polymerase chain reaction.

Human papilloma viruses (HPVs) are known to infect the genitourinary tract, the skin, the anal canal, and the upper respiratory tract. Esophageal papillomas and especially HPV-induced squamous papillomas of the esophagus are rare. The authors report a case of extensive HPV-induced esophageal polyposis, which was probably sexually transmitted.

Unsuspected choledocholithiasis first diagnosed at laparoscopic cholecystectomy: treatment by trans-cystic duct stenting and elective stent-guided sphincterotomy.

Background: Despite advances in laparoscopic surgery, management of unsuspected choledocholithiasis diagnosed at laparoscopic cholecystectomy is controversial. We propose a simple maneuver of laparoscopic trans-cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option.

Methods: We studied retrospectively 16 patients with choledocholithiasis first diagnosed in the course of laparoscopic cholecystectomy, treated with laparoscopic stenting of the papilla via the cystic duct using a short Cotton-Leung stent before completion of cholecystectomy.

A community health practicum model for baccalaureate nursing students.

This article describes the evolution of a practicum for baccalaureate nursing students in a Department of Veterans Affairs home care program. The model includes direct patient care, support to caregivers, and assessment and referral to community resources. Students also assess communities and conduct teaching projects to targeted populations.

Improving home care. A survey on physician and nurse communication.

Home health care is growing, and phone calls between physicians and home care nurses are essential to successful home care patient management. This preliminary study analyzed several aspects of the physician and home health nurse telephone communication, including effectiveness, time expenditure, percentage of calls resolved by physicians, and documentation of phone contacts between 90 medical/surgical physicians and six home health nurses in Cleveland, Ohio. The phone conversations involved 154 patient contacts during a 3-month period.

Acalculous cholecystitis and septicemia caused by non-O1 Vibrio cholerae: first reported case and review of biliary infections with Vibrio cholerae.

The first case of septicemic acute acalculous cholecystitis caused by non-O1 Vibrio cholerae is described in a healthy traveler, and biliary tract infections from V. cholerae are reviewed. Immediately after a vacation in Cancun, Mexico, a 55-year-old man developed acute cholecystitis.

Advanced cardiac life support events in a community hospital and their outcome: evaluation of actual arrests.

To evaluate resuscitation efforts for patients with cardiac and/or pulmonary arrest in our hospital a retrospective study was conducted and compared with available data from other community teaching hospitals. Records of 131 consecutive patients of ages 16-98 who received resuscitation according to Advanced Cardiac Life Support protocols were reviewed. Short-term survival (return of spontaneous circulation) and discharge-from-the hospital survival were measured.

Efficacy of routine laparoscopy for the acute abdomen.

Background: Laparoscopic surgery of selected acute abdominal conditions has been shown to be highly effective. Therefore, we investigated the diagnostic accuracy and therapeutic efficacy of routine laparoscopic surgery for the acute abdomen.

Methods: After appropriate investigations, patients with acute abdomen, with or without a specific diagnosis, were offered the options of either laparoscopic or open surgery.

Laparoscopy-assisted jejunal resection for bleeding leiomyoma.

We report a case of successful resection of a jejunal leiomyoma using a minimally invasive technique. By combining the procedures of push enteroscopy and laparoscopy, jejunal resection can be performed expeditiously without laparotomy.

In vitro effects of simulated gastric juice on swallowed metal objects: implications for practical management.

Background: Swallowed metal objects often pose a technical challenge for the endoscopist. We studied in vitro the effects of simulated gastric juice on metal objects commonly encountered in endoscopic practice and measured the physical-chemical changes.

Method: Razor blades, disc batteries, and pennies were incubated in simulated gastric juice at 37 degrees C.

Second-look laparoscopy for visceral ischemia facilitated by preinstalled ports.

Much of the information of a second-look laparotomy can be obtained by a second-look laparoscopy. We describe the strategy and technique of installing laparoscopy ports at the end of the primary laparotomy for visceral ischemia to facilitate a second-look laparoscopy in the ensuing 72 hours. The advantages and limitations are illustrated by three cases.

Palliative gastrojejunostomy. A minimally invasive approach.

Palliative bypass for neoplastic gastric outlet obstruction should be minimally invasive. We designed a laparoscopically assisted approach that appears to meet the need. The proximal jejunum is exteriorized by laparoscopy via an epigastric trocar-site incision.

A case-controlled study of laparoscopic splenectomy.

Background: The utility of laparoscopic splenectomy (LS) has not been tested in general surgical practice. This is a case controlled study comparing the clinical results and economics of L.S.