Intra-articular neurofibroma: an unusual source of anterior knee pain.

The infrapatellar fat pad of the knee is often implicated as a source of anterior knee pain. We present an unusual case of anterior knee pain in an adult patient from a solitary neurofibroma arising in an intra-articular location associated with the infrapatellar fat pad. Clinical, radiographic, magnetic resonance imaging (MRI), and histopathologic features are presented, as well as, a review of the literature.

Ulceration of pyoderma gangrenosum treated with negative pressure wound therapy.

Pyoderma gangrenosum is a skin disease characterized by wounds with blue-to-purple undermined borders surrounding purulent necrotic bases. This article reports on a patient with a circumferential, full-thickness, and partially necrotic lower-extremity ulceration of unknown etiology. Results of laboratory tests and arterial and venous imaging studies were found to be within normal limits.

Review of 125 SiteSelect stereotactic large-core breast biopsy procedures.

Advances in stereotactic breast biopsies have introduced a variety of devices that yield different sizes of tissue samples. The choice of biopsy device should be based on which technique is most likely to yield a definitive diagnosis at the time of the initial biopsy. This is a prospective study of 104 patients who underwent a total of 125 stereotactic breast biopsies using the SiteSelect large-core biopsy device.

SiteSelect: minimally invasive excision of breast lesions.

The goal of screening mammograms is to provide early detection of breast cancer. As mammography technology improves, the ability to detect smaller and smaller suspicious lesions is increased. However, as mammography cannot always differentiate between malignant and benign lesions, biopsies are often needed.

Global endometrial ablation technologies.

The value of extirpative surgery for excessive uterine bleeding is questionable. A number of technologies have been developed that destroy the endometrial lining while preserving the uterus. This article compares and contrasts multiple modalities of global endometrial ablation technology.

Late complications of operative hysteroscopy.

The late complications of operative hysteroscopy result from either persistent endometrium after ablation or myometrial damage during surgery. Residual endometrium can become neoplastic, cause pain, or support a pregnancy. Myometrial damage can produce catastrophic consequences during a later pregnancy.

Intraoperative and early postoperative complications of operative hysteroscopy.

With preoperative evaluation, meticulous technique, and vigilance for impending problems, intraoperative and early postoperative complications of operative hysteroscopy are largely preventable. Fluid overload is the most common serious complication. The hysteroscopist must understand the significant differences between hypotonic, electrolyte-free distention media and isotonic, electrolyte-containing media and their respective sequelae.

Endometrial sampling techniques in the diagnosis of abnormal uterine bleeding.

There have been many advances in sampling of the endometrium. Ideas and technologies have evolved, increasing our ability to gather adequate specimens that provide reliable information about uterine cavity pathologies. No technique surpasses the sensitivity and specificity of hysteroscopy with directed biopsy.

VRE--what every health care provider needs to know.

Enterococci are the second most common cause of nosocomial infections in the United States, and primarily cause urinary tract, surgical wound, soft tissue, and bloodstream infections. Patients at greater risk of acquiring VRE are those with lengthy hospital stays, those who have undergone multi-antibiotic treatment, surgical patients (transplants, cardiothoracic, and intra-abdominal), and the immunocompromised. Because the mode of transmission is via the hands of health care workers, good handwashing technique is key to prevention and control.

MRSA--what every health care provider should know.

Found in both children and adults, MRSA can most often be recognized by abscess formation. MRSA infection results in an increased rate of stay and increased costs to facilities, and has been associated with a higher mortality rate. This isolation of patients, strict handwashing, environmental cleaning, and the use of barrier protections are all methods that prevent the spread of MRSA.

Using graphs to consolidate reports to the board.

Reports to the author's hospital's board of directors on quality, risk management, infection control, and safety issues were complex and lengthy. Board members found the reports uninteresting and difficult to understand. To improve the reports, several ongoing measurements were identified from key areas, teams, and functions, and were reported graphically.

A structure for organizing a facility's annual performance review.

A facility's annual appraisal or report historically has evaluated the traditional quality assurance (QA) role of morbidity and mortality, infection control, tissue review, and medical record data. With the evolution of QA to performance improvement (PI), the traditional annual appraisal has had to expand to address multiple organizational programs, projects, and indicators, as well as the structure and outcome of teams. This article discusses a structure for evaluating various programs and reviewing how well the organization has met its goals.

Coordinating functional chapters of the Joint Commission and performance for departments and teams.

This article reviews the structural changes of the Joint Commission's accreditation manual and relates how organizations can provide documentation that illustrates departmental, team, or hospital-wide efforts to improve quality. The tools reviewed in this article capture systematic performance improvement across functions and departments and include team activity. The tools also can be used as reporting documents to the governing body.

Warm blood cardioplegia.

Between 1990 and 1992, 346 consecutive patients underwent coronary artery bypass procedures. Ninety-eight patients (group A) from 1990 served as historical controls, and 248 patients (group B) from 1991 to 1992 served as a prospective, consecutive cohort for statistical comparison. The two groups varied in the type of myocardial protection used: intermittent cold crystalloid cardioplegia was used in group A and continuous warm blood cardioplegia in group B.

Hemorrhoidectomy--laser vs. nonlaser: outpatient surgical experience.

Two hundred twenty-six patients underwent operative hemorrhoidectomy by a single surgeon in a three-year period. In 170 patients (75.2 percent), the operation was performed utilizing the CO2 laser.

Endobronchial closure of a postpneumonectomy bronchopleural fistula.

Successful permanent endobronchial closure of a serious postpneumonectomy bronchopleural fistula is reported in a patient with a delayed diagnosis of Mycobacterium fortuitum-cheloni infection. Increasing experience, improved plugging agents, and a review of the literature suggest that in selected patients, this procedure can avoid complex repeat operations and reverse life-threatening situations. Although atypical mycobacterial infections occur with infrequency, they are difficult to treat and may lead, as in this patient, to a misdiagnosis.

Delayed sterile keratitis following radial keratotomy successfully treated with conjunctival flap.

Background: A case of sterile keratitis involving three adjacent incisions and intervening stroma occurring 5 years after an eight-incision radial keratotomy is reported.

Methods: Multiple cultures showed no pathogens. Treatment with antibiotics, lubricants, patching, and bandage contact lenses failed to improve the condition.