Prevalence and structure of ultrasound curricula in emergency medicine residencies.

Emergency medicine (EM) residency program directors were surveyed to determine the presence and structure of curricula for teaching ultrasound to EM residents. For those EM programs without an ultrasound curriculum (USC), information was requested on plans to implement one within the next 12 months. Ninety of 116 (78%) EM programs replied to the survey.

A case of Nocardia epidural abscess.

Spinal epidural abscess due to nocardia is extremely rare. We report a patient who presented to our Emergency Department with a complaint of low back pain and fever, who was later found to have a spinal epidural abscess. Tissue cultures from the abscess grew nocardia asteroides.

Neurosyphilis mimicking herpes simplex encephalitis.

We report the case of a 34-year old man who presented with confusion and temporal lobe symptoms and signs without motor neuron involvement, suggesting herpes simplex encephalitis, as a reminder to "think syphilis" in all patients with unexplained neurologic deficits.

Donor leukocyte infusion for treatment of graft rejection post partially mismatched related donor bone marrow transplant.

Graft rejection following bone marrow transplantation is more common in patients who receive their grafts from alternative donors and whose marrow is T cell depleted. Rejection in these patients is mediated by persistent host cells that interfere with successful establishment of donor-derived hematopoietic recovery. We describe a patient with chronic myelogenous leukemia in accelerated phase who rejected a T cell-depleted bone marrow graft, 2 months following partially mismatched related donor bone marrow transplant.

Carcinoma of the bladder in renal transplant patients. A case report and collective review of cases.

Bladder malignancy in the renal transplant recipient is an infrequent occurrence. The 11 previously reported cases reflect an aggressive tumor growth with invasion, requiring partial or complete cystectomy with or without conduit diversion. We report an additional case in a 40-yr-old woman with a living related renal transplant, who experienced rapid progression of her tumor over 3 wk from initial hematuria to a pelvic mass involving the anterior bladder.

Phenotypic and functional reconstitution of peripheral blood lymphocytes following T cell-depleted bone marrow transplantation from partially mismatched related donors.

Myeloablative chemotherapy followed by transplantation of a T cell-depleted bone marrow graft from a partially mismatched related donor provides a potentially curative option for patients with leukemia and other disorders of hematopoiesis, although the patient is faced with a period of sustained immunodeficiency as well as pharmacologic immunosuppression as a result of prophylaxis against graft-versus-host disease. Thirty patients who received one to three antigen T cell-depleted mismatched grafts were evaluated for immune reconstitution. The percentage and numbers of cells expressing lymphocyte subset antigens were determined by flow cytometry at 14, 28, 60, 100, 180, 270 and 365 days post-BMT and at 6 month intervals thereafter.

Bilateral emphysematous pyelonephritis.

In any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.

Late onset Epstein-Barr virus-associated lymphoproliferative disease after allogeneic bone marrow transplant presenting as breast masses.

We report a patient who developed breast masses 17 months after a T cell-depleted partially mismatched related donor (PMRD) bone marrow transplant (BMT) for chronic myeloid leukemia. The patient had severe chronic graft-versus-host disease (GVHD) and the masses were due to Epstein-Barr virus (EBV) lymphoproliferative disease (LPD). The patient expired from fungal pneumonia after chemotherapy for the EBV-LPD.

Medical care for mass gatherings at collegiate football games.

Background: Many articles have reviewed medical care at mass gatherings, but few have specifically looked at care provided during football games. Some of the largest gatherings occur at various stadiums during football season.

Methods: We analyzed the medical care provided for the spectators at Williams-Brice Stadium for the University of South Carolina 1995 football season.

Penicillin dosing for pneumococcal pneumonia.

Most textbook authors still endorse penicillin G as the specific antibiotic of choice for pneumococcal pneumonia. However, problems with early precise etiologic diagnosis of pneumonia and the emergence of drug-resistant pneumococci cause penicillin to be seldom used for this purpose today. A third explanation for the infrequent use of penicillin is lack of clear consensus dosing guidelines.

Pneumomediastinum following penetrating oral trauma.

Pneumomediastinum can result from a puncture wound or laceration to the hypopharynx. This is a case report of an 18-month-old child who fell with a pen in his mouth. Initial physical examination was unremarkable, but the child developed neck swelling, fever, and irritability over the next 12 hours.

Use of partially mismatched related donors extends access to allogeneic marrow transplant.

Most patients requiring allogeneic bone marrow transplant (allo-BMT) do not have an HLA-matched sibling donor. A phenotypically matched unrelated donor graft has been made available for approximately 50% of Caucasians and less than 10% of ethnic and racial minorities in need. However, almost all patients have a readily available partially mismatched related donor (PMRD).

The effect of knee immobilization on degree of hip flexion: a clinical correlation with posterior wall acetabular fractures.

The purpose of this investigation was to determine whether maintaining the knee in extension substantially limits hip flexion. The dominant lower extremity in 22 male subjects was goniometrically evaluated to determine hip flexion both when the knee was allowed to flex and when the knee was held in extension. Pelvic rotation values were subtracted from thigh rotation values to show true flexion of the femur in relation to the pelvis.

Impact of parental anxiety on child emotional adjustment when a parent has cancer.

Purpose/objectives: To describe the relationships among parent anxiety, child anxiety, and emotional adjustment in children who have a parent with cancer.

Design: Correlational.

Setting: A large cancer center in the southeastern United States.

A retreat for families of children recently diagnosed with cancer.

Purpose: The authors describe a clinical intervention program designed for children recently diagnosed with cancer and their families. The rationale for a family weekend retreat, the planning process, and its implementation are outlined.

Description Of Program: Staff members (nurses, social workers, child life specialists, and physicians) at the Children's Center for Cancer and Blood Disorders of the Richland Memorial Hospital in Columbia, South Carolina, conducted a comprehensive needs assessment of the families of children recently diagnosed with cancer.

Quest. An intervention program for children whose parent or grandparent has cancer.

Purpose: The emotional strains and anxiety experienced by a family system when a parent or significant adult member has cancer are well documented. Furthermore, the literature suggests a need for an intervention program for children whose parent or grandparent has cancer. The current article describes Quest, an intervention program for children and teenagers whose parent or grandparent has cancer.

Understanding allergic reactions to local anesthetics.

Objective: To review the pharmacology and mechanisms by which local anesthetics cause allergic reactions. Recommendations concerning appropriate use of local anesthetics and alternative therapies in patients with documented local anesthetic allergies are given.

Data Source: A MEDLINE search of English-language literature identified pertinent clinical studies, case reports, and reviews.

Cyclosporine-induced autologous graft-versus-host disease following autologous blood stem cell transplantation for lymphoma.

Eight consecutive patients with relapsed/refractory non-Hodgkin's lymphoma or Hodgkin's disease received conditioning therapy with BCNU, etoposide, cytosine arabinoside and melphalan (BEAM) followed by autologous blood stem cell transplantation (ABSCT). Cyclosporine was administered from day +1 until day +28 post-ABSCT to induce autologous graft-versus-host disease (GVHD) for a possible antitumor effect. Three patients developed histologically documented grade II GVHD between 22-40 days post-transplant.

A memorial service for families of children who died from cancer and blood disorders.

The grief of staff who work with dying children and the grief of family members after the death of a child has been widely documented. Interventions to facilitate grieving have been extensively developed for parents but less so for siblings and staff. This article describes one approach, a memorial service, for families and staff that has wide applicability for providing support after a death.

Combined in vitro and in vivo T lymphocyte depletion for the control of graft-versus-host disease following haploidentical marrow transplant.

Most patients requiring allogeneic bone marrow transplantation (BMT) lack a human leukocyte antigen genotypically identical sibling and require an alternative donor. This carries an increased risk of graft failure and acute graft-versus-host disease (GVHD). We sought to overcome these problems with transplants by using grafts obtained from the most readily available source: the haploidentical, partially mismatched, related donor.