Hepatoid adenocarcinoma of the lung: report of five cases and review of the literature.

The current diagnostic criteria for hepatoid adenocarcinoma of lung include typical acinar or papillary adenocarcinoma and a component resembling hepatocellular carcinoma and expressing α-fetoprotein (AFP). Distinguishing hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lung is difficult in patients with both lung and liver masses and in patients at risk for lung and liver cancer because of smoking and viral hepatitis, respectively. We studied morphologic features of hepatoid adenocarcinoma of lung and established an immunohistochemical panel to facilitate distinction of hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lung.

Improving staff compliance with isolation precautions through use of an educational intervention and behavioral contract.

Hospital-acquired infections negatively impact patient outcomes, length of stay, and the economy. Health care systems must find ways to decrease the spread of infection and the development of infection with the use of isolation precautions in an acute care setting. All staff members must be aware of ways to decrease or prevent the spread of infection by the appropriate use of isolation precautions.

Surveillance after surgical treatment of melanoma: futility of routine chest radiography.

Background: Current recommendations by the National Comprehensive Cancer Network and other groups suggest that follow-up of cutaneous melanoma may include chest radiography (CXR) at 6- to 12-month intervals. The aim of this study was to determine the clinical efficacy of routine CXR for recurrence surveillance in melanoma.

Methods: Post hoc analysis was performed on data from a prospective, randomized, multi-institutional study on melanoma ≥1.

Multimodality treatment of a complex cervicocerebral arteriovenous shunt in a patient with CHARGE syndrome: case report.

Objective: We present our management of a unique case of complex arteriovenous shunt with vascular steal in the left-sided head and neck vessels in a child with CHARGE (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness) syndrome.

Clinical Presentation: A 10-year-old girl presented with high-output heart failure. Cerebral angiography revealed high-flow abnormal fistulous connections between the left common carotid artery and innominate vein as well as between the vertebral artery and innominate vein.

Evidence-based practice: fever evaluation and early recognition of systemic inflammatory response syndrome in critical care patients.

Fever is very often the first sign of sepsis and systemic inflammatory response syndrome, both of which can be life-threatening. This article presents various guidelines for the treatment and prevention of fever using evidence-based practice guidelines from a variety of sources.

Innovative solutions: optimal patient outcomes as a result of multidisciplinary rounds.

Multidisciplinary rounds have been shown to improve patient outcomes. The use of a standardized tool in one institution led to a pharmacy cost savings of more than 50,000 dollars and a decrease of 1.5 days for patients receiving mechanical ventilation.

Intraoperative magnetic resonance imaging for ablation of hepatic tumors.

Background: The most significant rise in the use of hepatic ablation has come from image-guided techniques with both computed tomography (CT) and ultrasound (US). The recent development of open-configuration magnetic resonance scanners has opened up an entire new area of image-guided surgical and interventional procedures. Thus the aim of this study was to evaluate the use of intraoperative MRI (iMRI) ablation of hepatic tumors performed by surgeons.

Safety protocols for interventional MRI.

Rationale And Objectives: To review magnetic resonance safety protocols and supplement them for interventional applications.

Materials And Methods: The American College of Radiology White Papers on MR Safety are summarized. Elements relevant to interventional MR procedures are emphasized.

Techniques for repair of gastric prolapse after laparoscopic gastric banding.

Laparoscopic gastric banding is a valuable surgical option for treating morbidly obese patients. Its operative technique is continually being refined. Since its inception, many changes in technique have helped to reduce the complication rate.

Perioperative complications of posterior lumbar decompression and arthrodesis in older adults.

Background: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at increased risk for complications because of their age and associated medical conditions. In this study, we examined the rates of perioperative complications associated with posterior lumbar decompression and arthrodesis in patients sixty-five years of age or older.

Surgeon-led initiatives cut costs and enhance the quality of endoscopic and laparoscopic procedures.

Background: Public perception depicts surgical cost control and quality of care as polar opposites. We describe a program led by practicing surgeons that demonstrates that quality can be maintained, and often improved, while substantial cost reductions are realized.

Methods: A set of evidence-based protocols was developed, revised, and followed for 42 procedures in general, otolaryngologic, urologic, and orthopedic surgery.

Totally laparoscopic feeding jejunostomy.

Background: A feeding jejunostomy should be used for nutritional support in a small subset of patients. Minimal-access approaches for the placement of jejunal tubes have been described, but they often require special equipment not common to all operating theaters. We describe a technique of totally laparoscopic jejunostomy tube (LJT) placement using equipment found in most operating theaters.

Endocervical metaplasias and their association with glandular and squamous abnormalities.

Objective: The presence of endocervical metaplasias and their association with cervical squamous and glandular neoplasias were studied.

Materials And Methods: Cervical specimens were examined microscopically to identify the presence of glandular metaplasias. The type of cervical neoplastic abnormality, when present, also was recorded.

Electroconvulsive therapy in the very old.

At least one study has questioned the safety of electroconvulsive therapy (ECT) in the very old. In this study, the authors reviewed a 5-year experience with ECT at two university psychiatric services for patients 75 years of age or older. Both outcomes and complications were reviewed.

Autotransfusion in the postoperative orthopedic patient.

Transfusion of autologous blood has become increasingly important as an alternative to the use of conventional allogeneic products. Some areas of autotransfusion, like predeposit and intraoperative salvage, are well standardized and generally recommended by physicians. In many orthopedic surgical procedures, the postoperative drainage constitutes a significant percentage of the total perioperative blood loss.

The management of oral mexiletine and intravenous lidocaine to treat chronic painful symmetrical distal diabetic neuropathy.

Intravenous local anesthestics administered to patients with chronic pain have been shown to provide significant levels of systemic analgesia. Furthermore, oral mexiletine which is similar in structure has been demonstrated to be efficacious in the treatment of diabetic neuropathy. It is recommended that this combined form of treatment be considered with those patients whose diabetic neuropathy is resistant to more conventional forms of treatment.

Epidural morphine pruritus reduction with hydroxyzine in parturients.

A majority of patients experience pruritus, nausea and/or emesis following epidural morphine administration post-cesarean section. Naloxone or diphenhydramine are commonly used to treat these side effects. Prevention or reduction in the incidence of side effects of epidural morphine is a clinical goal.

Campylobacter pylori and gastroduodenal disease.

Campylobacter pylori is a newly described, spiral-shaped, gram-negative bacillus that is oxidase positive, catalase positive, and urease positive and grows slowly in culture. Although observed in human tissue at the beginning of the century, it was not cultured until 1982. Because there are significant morphological and genetic differences between this organism and other species of Campylobacter, it will probably be reclassified in a new genus.

Splenic abscess due to Clostridium septicum in a patient with multiple myeloma.

Solitary abscesses of the spleen may occur as a consequence of septicemia from various septic foci, particularly intra-abdominal sites. A variety of causative organisms, including the clostridia, have been isolated. We have described a patient with multiple myeloma who had a solitary splenic abscess due to Clostridium septicum and who failed to survive despite seemingly appropriate treatment.