Nonketotic hypertonicity in diabetes mellitus.

Nonketotic hypertonicity (NKH) is one of the most common endocrine emergencies. It is more common in the elderly patient with noninsulin-dependent diabetes mellitus but may occur in insulin-dependent diabetes as well. Although there are many possible precipitating causes, the final common pathway is usually decreased access to water.

How case management can improve the quality of patient care.

In January 1993, The New York Hospital Medical Center of Queens, a 487 bed acute care teaching hospital, created a Case Management Department to provide quality health care for patients that was cost efficient and at the same time reduce length of stay. Registered nurses with extensive medical and surgical expertise who were quality assurance/utilization coordinators and discharge planning nurses were cross-educated to become patient case managers. The case manager coordinates patients care services to improve the quality of the total patient experience.

Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: a long-term follow-up.

Purpose: To evaluate the long-term control of disease and cure rate, complications, second malignancy, and survival of early-stage endometrial cancer patients treated with surgery, high dose-rate brachytherapy, and external beam radiation therapy.

Methods And Materials: From 1969 through 1979, 300 patients with clinically staged Stage I-II endometrial cancer underwent total abdominal hysterectomy and bilateral salpingo-oopherectomy, followed by high dose-rate intravaginal radiation, 7 Gy x 3 to 0.5 cm from the mucosal surface, using a remote afterloading technique.

Credentialing physicians for new technology: the physician's learning curve must not harm the patient.

Laparoscopic Cholecystectomy (L.C.) offers advantages that are realized only when patient safety is assured.

Mycobacterium-avium complex.

The ubiquitous MAC causes disseminated disease in a large proportion of patients with AIDS. It will become an increasingly important clinical pathogen as more patients survive within the context of prolonged immunodeficiency. The primary risk factor for DMAC is CD4 < 100 mm3 and thus the institution of adequate prophylaxis will significantly reduce its presentation in advanced HIV infection.

Identification of TEM-26 beta-lactamase responsible for a major outbreak of ceftazidime-resistant Klebsiella pneumoniae.

An epidemic of nosocomial ceftazidime-resistant Klebsiella pneumoniae was correlated with production of a ceftazidime-hydrolyzing enzyme with an isoelectric point of 5.6 (BMH-1). BMH-1 was encoded on a large transferable plasmid conferring multiple antibiotic resistance.

Nonfatal venous air embolism during cesarean section: a case report and review of the literature.

Venous air embolism occurs in more than half of all cesarean sections. Predisposing factors in pregnancy include uterine surgery and manipulation, hypovolemia, and maternal positioning. The presence of an intracardiac septal defect and use of certain anesthetic agents place the patient at greater risk of fatal air embolus.

Ventricular fibrillation following adenosine administration. A case report.

An 86-year-old woman was treated for atrial fibrillation. A total of 1.00 mg of digoxin and 12.

Metastatic mesothelioma of the oral cavity. Report of two cases.

Malignant mesothelioma is an aggressive neoplasm originating from the serosal surfaces of the pleural or peritoneal cavity. The following article describes two cases of metastatic mesothelioma to the oral cavity; one involves the tongue, the other involves the mandible. The diagnostic criteria for differentiating metastatic mesothelioma from adenocarcinoma are also discussed.

Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins.

Objective: To describe the epidemiology, antimicrobial susceptibility, and control of widespread ceftazidime-resistant Klebsiella pneumoniae infections in a North American hospital and circumstances that led to delayed detection.

Design: A 2-year epidemiologic, microbiologic, and clinical cohort study.

Setting: A 487-bed general hospital in New York City.

Dialysis adequacy versus metabolic factors in the clinical assessment of CAPD.

We performed a cross sectional study of our continuous ambulatory peritoneal dialysis (CAPD) patients (n = 98) to examine the relation between parameters of adequacy of dialysis [KT/V, weekly creatinine clearance (Ccr)], urea kinetics (PCR), biochemical parameters (serum albumin), and clinical status of these patients. We also investigated the predictive value of these parameters in the determination of clinical outcomes. The clinical status of each patient was assessed by patient self-assessment and objectively by physicians and nurses.