Elder abuse and neglect: the experience, knowledge, and attitudes of primary care physicians.

Background And Objectives: Two million elderly Americans are abused or neglected each year. Elderly patients visit their physicians approximately five times each year. Yet physicians initiate only about 2% of the reported cases of abuse and neglect.

Infant botulism.

Although the worldwide incidence of infant botulism is rare, the majority of cases are diagnosed in the United States. An infant can acquire botulism by ingesting Clostridium botulinum spores, which are found in soil or honey products. The spores germinate into bacteria that colonize the bowel and synthesize toxin.

Intraoperative radiographic assessment of ankle fractures.

This retrospective study was performed to determine whether three or two radiographic views are necessary for intraoperative evaluation of low energy, rotational ankle fracture reduction and fixation. Four orthopaedic surgeons independently reviewed two sets of radiographs of 93 low energy, rotational ankle fractures treated by open reduction and internal fixation. The reviewers judged reduction and fixation, without measurement, as if they had been the operating surgeons.

The injured ankle.

Ankle injuries are common presenting complaints in both emergency departments and family physicians' offices. Approximately 1 million ankle injuries occur annually in the United States; most of them are sprains resulting from inversion injuries. Treatment options differ according to the grade of injury--grade I and grade II sprains usually respond to rest and immobilization, while grade III sprains require casting or, possibly, surgery.

The incidence of Mycoplasma pneumoniae pneumonia.

Background: Mycoplasma pneumoniae has been considered a pathogen for humans since the 1940s. Of the 12 species of Mycoplasma found in humans, M pneumoniae is the most widely recognized pathogen. Morbidity from M pneumoniae results from the combined direct effect of cytotoxins produced by the organisms and the indirect effect of inflammatory responses to the presence of the organisms.

Cystic pancreatic neoplasms: report of a case and review of the literature.

Cystic neoplasms of the pancreas are rare tumors. Because of very limited experience even in large medical centers, there is much debate regarding the evaluation and management of patients with these tumors. Recently, a patient presented to our community teaching hospital with an unusual complication of this rare tumor.

Primary hepatic lymphoma: unusual presentation and clinical course.

Although primary hepatic lymphoma is rare, it should be considered in the differential diagnosis of a hepatic tumor, because it is usually associated with a favorable prognosis. This report describes an unusual case of primary hepatic lymphoma with an atypical presentation (only mild, right upper quadrant pain and no hepatomegaly) followed by acute fulminating hepatic failure, metabolic acidosis, followed by a rapidly fatal course. A review of the literature and discussion of the disease are also presented.

Distinguishing conversion disorder from neurologic impairment.

Hysteria/conversion disorder has been described since antiquity. One French neurologist dubbed it "neurological nonsense" because its presentation was so complex and confusing. For nosological purposes for inclusion into the Diagnostic Statistical Manual, multiple revisions of conversion disorder terminology were made for each edition published from 1952-1994.

The effect of intercondylar notchplasty on the patellofemoral articulation.

Using pressure-sensitive film, we measured the patellofemoral contact areas and pressures after increasing degrees of notchplasty in eight fresh-frozen cadaveric knee specimens. Each specimen was stabilized on an axial loading frame with physiologic loads applied through the quadriceps tendon at varying flexion angles. The patellofemoral joint was loaded at 90 degrees, 105 degrees and 120 degrees of knee flexion.

Fluid and electrolyte management in the neurologically-impaired patient.

Maintaining a homeostatic fluid state in patients with neurological disease is a common challenge that nurses encounter when caring for the critically ill patient. The human body regulates fluid and chemical balances within precise ranges. Control mechanisms are found in both the neural and the renal systems.

Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose.

A retrospective study was performed to determine whether there is an increased incidence of hyperglycemia in patients not predisposed to hyperglycemia (n = 102) who receive total parenteral nutrition (TPN) dextrose in excess of 4 to 5 mg/kg/min. Of the 37 subjects administered dextrose at > 5 mg/kg/min, 18 exhibited hyperglycemia. None did so who received dextrose at < or = 4 mg/kg/min (n = 19).

Nonsurgical removal of a rectal foreign body using a vacuum extractor. Report of a case.

Purpose: Rectal foreign bodies can be extracted by nonsurgical methods. However, glass objects require technical considerations to minimize morbidity and may necessitate surgical extraction. We describe a technique that allowed safe transanal extraction of a glass foreign body and avoided laparotomy.

Detecting and treating bulimia nervosa: how involved are family physicians?

Background: Relatively little is known about bulimia nervosa in the primary care setting. Existing medical literature suggests that primary care physicians have limited experience with bulimia nervosa.

Methods: Experiences of family physicians with bulimia nervosa specifically and eating disorders in general were assessed by a questionnaire mailed to a representative sample (596 subjects) of Ohio family physicians.

Major vascular injury as a complication of laparoscopic surgery: a report of three cases and review of the literature.

We retrospectively reviewed all 2201 laparoscopic procedures performed at our community teaching hospital in the 3-year period between 1992 and 1995. There were three major vascular injuries, for an incidence of 0.14 per cent.

Patient satisfaction as an outcome indicator of pain management during labor and delivery.

Increased emphasis is being placed on using various indicators to assess the quality of health care services. The purpose of this study was to assess the use of patient satisfaction in evaluating the pain management of patients admitted for childbirth. Three hundred eighty-nine patients who were admitted to the labor and delivery unit were asked to evaluate the technical and interpersonal aspects of the pain management process.

Angiosarcoma of the heart: review of the literature and report of two cases that illustrate the broad spectrum of the disease.

Two patients with primary angiosarcoma of the heart were treated. The first patient presented with spinal cord compression syndrome secondary to metastatic angiosarcoma of the lumbar spine. The primary tumour was found to be a right atrial mass.

A unique complication following arthroscopic anterior cruciate ligament reconstruction.

The use of the middle third of a patellar tendon with bone blocks is a common and well-accepted technique for arthroscopic reconstruction of the anterior cruciate ligament. We report here a disconcerting fracture/avulsion pattern of the patella/patellar tendon mechanism that occurred in the early postoperative period.

Reversible diaphragmatic eventration following chest tube thoracostomy.

This report describes a case of acquired eventration of a hemidiaphragm after insertion of a chest tube for treatment of an iatrogenic pneumothorax. Partial withdrawal of the chest tube resulted in immediate return of the hemidiaphragm to its original position. This is believed to be the first report of the resolution of this diaphragmatic functional defect.

Transanal endoscopic microsurgery. Results of the initial ten cases.

Transanal endoscopic microsurgery (TEM) permits precise excision of favorable tumors from the mid and proximal rectum, thus avoiding transsacral and low anterior resection in select cases. Ten patients underwent TEM resection of rectal tumors by a single surgeon between April 1992 and August 1993. All patients first underwent endorectal ultrasound.

New trends in the treatment of calculus disease of the biliary tract.

Background: New treatment methods for calculus disease of the biliary tract offer options that can benefit a variety of patients. Laparoscopic surgery, for example, has revolutionized biliary surgery and is now the preferred approach for the majority of patients.

Methods: Using the key words "biliary tract," "calculus disease," and "cholecystectomy," MEDLINE files were searched from 1982 to the present.

Severe occupational traumatic injuries.

Severe occupational traumatic injuries represent a challenge to workers and physicians. Efforts to prevent occupational injuries, such as education, protective equipment, adherence to safety procedures, and personal responsibility, are of critical importance. The physician's role as educator, consultant, and on-site manager of these injuries forms the basis for effective management of severe occupational traumatic injuries.

Anatomic variance in the cholecystic blood supply: a case report.

The cystic artery is known to arise from many possible origins; with the right hepatic artery is the most common. Other origins of the cystic artery include the left hepatic artery, the common hepatic artery, and the superior mesenteric artery. In addition to the variability in origin of the cystic artery, its course can also follow diverse paths, often in close proximity to the common bile duct.