Management of neutropenic enterocolitis in the patient with cancer.

Neutropenic enterocolitis is a life-threatening condition often seen in patients experiencing prolonged periods of neutropenia from conditions such as leukemia and lymphoma and from aggressive chemotherapy regimens. Its exact pathologic process remains unclear; however, it has been proposed that direct cytotoxic damage occurs to the bowel mucosa with subsequent microbial invasion complicated by the lack of adequate neutrophil response. The damage may progress to bowel perforation and septic shock.

Defibrillation and cardioversion.

To optimize the success of defibrillation, the clinician needs to minimize impedance, choose the proper energy level, apply the proper interface, select the appropriate paddle size, and deliver the shock at the earliest possible time. Other factors that may contribute to effective defibrillation include defibrillation during exhalation, maintenance of an effective airway, and correction of electrolyte abnormalities. Open chest defibrillation can be achieved at a lower dose of between 10 J and 20 J.

Type II congenital cystic adenomatoid malformation of the lung with a mediastinal shift. A case report.

We report a case of an early (22-week) prenatal diagnosis of type II congenital cystic adenomatoid malformation of the lung complicated by a mediastinal shift. Detailed ultrasound examination of the fetus, including fetal Doppler velocimetry and echocardiography, and diagnostic amniocentesis were normal. There was a gradual, spontaneous resolution of the mediastinal shift and improvement in the lung lesions.

Evidence and response to the impact of the Medicaid Drug Rebate Program (OBRA) on hospital pharmacy: a progress report from central Ohio.

Preliminary results of a survey conducted by the American Society of Hospital Pharmacists (ASHP) indicated that hospital drug prices increased since the implementation of rebate agreements between Medicaid and drug manufacturers. The question of how hospital pharmacy directors are planning to respond to the cost-shifting that may occur in the recent future is raised in this article. Open-ended questions posed to Central Ohio Hospital directors assessed their expectations, experience, and proposed strategies in response to the rebate program.

Relationship between radial inclination angle and ulnar deviation of the fingers.

Fifty wrists (thirty-two patients) with rheumatoid arthritis and ulnar drift of the fingers were examined radiologically and compared to fifty normal wrists radiographs. Statistically significant differences were found for measurements of radial inclination angle, carpal-radial distance, third metacarpal-phalangeal angle, and carpal height ratio. Third metacarpal-phalangeal angle of ten degrees or greater on standard posteroanterior radiograph appears to accurately represent digital ulnar drift.

Wrist arthrodesis for treatment of rheumatoid arthritis.

Eighty-seven wrist fusions using the technique of Millender and Nalebuff were reviewed in 79 patients with rheumatoid arthritis. Follow-up averaged 6 years and 97% of all patients had an excellent or good result. Pain was absent or mild in all patients after operation, and 95% of this patient population had improved hand function after wrist fusion.

The QA program evaluation: a powerful punch.

Even the best quality assurance program requires periodic review in order to attain or regain maximum efficiency and effectiveness. The JCAHO standard for annual QA program evaluation adds impetus to this obligation. Riverside Methodist Hospitals' QA program evaluation is constructed in a three year cycle.

Successful management of small cell carcinoma of the bladder with cisplatin and etoposide.

A 63-year-old white man with metastatic small cell carcinoma of the bladder attained a complete remission with a combination of etoposide and cisplatin chemotherapy, which has lasted for more than 2 years.

Interpretation of ICP pulse waves to determine intracerebral compliance.

Recently, several authors have identified the need for monitoring cerebral compliance in addition to intracranial pressure (ICP) when managing patients with neurologic dysfunction. Analysis of the ICP pulse wave is one method for determining compliance. The ICP pulse wave, observed on a continuous real time pressure monitor display corresponding to each heart beat has three components analogous to the components of the arterial pulse wave.