Prospective randomized trial of ACUSEAL versus Vascu-Guard patching in carotid endarterectomy.

Background: Multiple studies have been conducted that demonstrate the superiority of patch angioplasty over primary closure for carotid endarterectomy (CEA). Patch angioplasty with polytetrafluorethylene patches (ACUSEAL) have shown results comparable to patch angioplasty with saphenous vein and polyester patches. This is a prospective randomized study to compare the clinical outcomes of CEA using ACUSEAL versus bovine pericardium patching (Vascu-Guard).

Duplex velocity criteria for native celiac/superior mesenteric artery stenosis vs in-stent stenosis.

Background: Duplex velocity criteria (DVC) to identify in-stent celiac artery (CA) and superior mesenteric artery (SMA) stenosis is not well defined. Only one study has been published which concluded that DVC for native SMA stenosis overestimated stenosis in stented SMAs. The purpose of this study was to analyze DVC in detecting CA/SMA in-stent stenosis (ISS).

Enteric reovirus infection stimulates peanut-specific IgG2a responses in a mouse food allergy model.

IgE-mediated food allergies are an important cause of life-threatening hypersensitivity reactions. Orally administered peanut antigens mixed with the mucosal adjuvant cholera toxin (CT) induce a strong peanut extract (PE)-specific serum IgE response that is correlated with T-helper type 1 (Th1) and type 2 (Th2)-like T-cell responses. This study was conducted to determine if respiratory enteric orphan virus (reovirus), a non-pathogenic virus that induces robust Th1-mediated mucosal and systemic responses could modulate induction of PE-specific allergic responses when co-administered with PE.

Intracranial vascular lesions and anatomical variants all residents should know.

The purpose of this article is to extensively illustrate pathologically and clinically proven cases of intracranial vascular lesions and variants accumulated at a tertiary referral center. These are organized by normal anatomy and variants, arterial lesions, and venous lesions. High-quality computed tomography, computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography, 3D reconstruction, and angiographic figures illustrate the findings and complement a succinct review of this category of disease.

Influence of stress resiliency on RN job satisfaction and intent to stay.

Registered nurse (RN) job satisfaction is a major predictor of intent to stay and job turnover, serious concerns to health care leaders. Predictors of job satisfaction include autonomy, control over daily practice, nurse-physician collaboration, transformational leadership, group cohesion, job stress, structural empowerment, and psychological empowerment. In the model of psychological empowerment, stress resiliency is the product of persons' interpretive styles and influences psychological empowerment.

Processes of care for carotid endarterectomy: surgical and anesthesia considerations.

There are still some vascular surgeons who do not use carotid patching routinely in all patients undergoing CEA, however, based on the data presented in this review, there is Level 1 evidence to support the routine use of carotid patching. Meanwhile, there is no Level 1 evidence to support selective patching for CEA, however a Grade D recommendation may be used to recommend that primary closure can be safely practiced in a large ICA (>6mm). A meta-analysis/systemic review of well-conducted prospective randomized trials (Level 1 evidence) concluded that there was no difference in stroke/death rates between conventional CEA with patch closure and eversion CEA.

Evaluation of a program to increase evidence-based practice change.

Objective: The study evaluated a nursing research program designed to achieve systematic evidence-based practice change. Specifically, change in nurse attitudes about use of research and research conduct, practice change projects, and nurse participation in research-related activities were evaluated.

Background: Evidence indicates that successful evidence-based practice change in an organization requires senior leadership support and a systematic program for practice change.

Reflections on 40 years as a sideline physician.

Object: In this study the author presents his personal observations concerning football injuries in a historical perspective with additional literature citations.

Methods: Aspects of brachial plexus and cervical spine injuries, neurapraxia, face mask infractions, concussion, acute subdural hematoma (SDH), and the so-called second-impact syndrome are addressed.

Conclusions: The list of conclusions presented in this paper is as follows: there is more than one kind of brachial plexus injury; wedging of cervical vertebrae may be normal; neurapraxia presents a problem for return to play; face mask injuries are rarely serious; definitions of concussion vary; acute SDH requires immediate transfer to a hospital; and the second-impact syndrome may be a myth to some.

Extensive upper extremity arterial thrombosis as the initial manifestation of nephrotic syndrome.

The metabolic derangement and resultant hypercoagulable diathesis associated with nephrotic syndrome (NS) has been clearly defined. Although venous thrombosis is frequently encountered in NS, arterial thrombosis is rare. This report describes an index case of a patient without known renal disease who presented with spontaneous arterial thrombosis of an upper extremity as the initial manifestation of NS.

Production of Alexa Fluor 488-labeled reovirus and characterization of target cell binding, competence, and immunogenicity of labeled virions.

Respiratory enteric orphan virus (reovirus) has been used to study many aspects of the biology and genetics of viruses, viral infection, pathogenesis, and the immune response to virus infection. This report describes the functional activity of virus labeled with Alexa Fluor 488, a stable fluorescent dye. Matrix assisted laser desorption-time of flight analysis indicated that Alexa Fluor 488 labeled the outer capsid proteins of reovirus.

Drug-induced phospholipidosis: issues and future directions.

Numerous drugs containing a cationic amphiphilic structure are capable of inducing phospholipidosis in cells under conditions of in vivo administration or ex vivo incubation. The principal characteristics of this condition include the reversible accumulation of polar phospholipids in association with the development of unicentric or multicentric lamellated bodies within cells. There is an abundance of data providing an understanding of potential mechanisms for the induction of phospholipidosis; however, the process is likely to be complex and may differ from one drug to another.

The Reliability of Psychiatric Diagnosis Revisited: The Clinician's Guide to Improve the Reliability of Psychiatric Diagnosis.

Background: The authors reviewed the topic of reliability of psychiatric diagnosis from the turn of the 20th century to present. The objectives of this paper are to explore the reasons of unreliability of psychiatric diagnosis and propose ways to improve the reliability of psychiatric diagnosis.

Method: The authors reviewed the literature on the concept of reliability of psychiatric diagnosis with emphasis on the impact of interviewing skills, use of diagnostic criteria, and structured interviews on the reliability of psychiatric diagnosis.

The Validity of Psychiatric Diagnosis Revisited: The Clinician's Guide to Improve the Validity of Psychiatric Diagnosis.

Background: The authors reviewed the types and phases of validity of psychiatric diagnosis. In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study.

Objectives: The objectives of this paper are to review what has been learned since Robins and Guze's influential article as well as examine the impact of the new discoveries in neurosciences and neuroimaging on the practicing clinician.

Hierarchical and nonhierarchical approaches in psychiatric diagnosis: a case report of change in psychiatric symptoms and diagnosis over time.

The article reports the case of a 39-year-old male who was diagnosed with and treated for bipolar disorder. Over the past 18 months, the patient has experienced new onset of auditory hallucinations and worsening of his psychotic symptoms. The treating psychiatrists changed the diagnosis from bipolar disorder to schizoaffective disorder.

Fatal subclavian stent infection remote from implantation.

We report the unusual case of a 66-year-old alcoholic male who presented with acute arm ischemia 4 months following ipsilateral subclavian artery stenting. The patient had a petechial rash and Janeway lesions in the distribution of the affected subclavian artery. He had been treated for an infected dialysis graft 10 days prior to entry into the hospital.

An update on endovascular therapy of the lower extremities.

Considerable advances have been made over the last decade in percutaneous technology for treatment of atherosclerotic diseases in the iliac, femoropopliteal, and distal tibioperoneal arteries. While treatment strategies are well defined in the iliofemoral segment, where angioplasty and stenting perform well in appropriately selected lesions, the search for a durable transcatheter therapy for femoropopliteal and distal occlusive disease continues. The spectrum of treatment alternatives to angioplasty ranges from transcatheter plaque excision to laser ablation, rotational atherectomy, cryoplasty, brachytherapy, and stenting.

Endovascular repair of abdominal aortic aneurysms using 3 commercially available devices: midterm results.

Purpose: To report the early and midterm results of 3 commercially available stent-grafts for abdominal aortic aneurysm (AAA) exclusion.

Methods: Since fall 1999, 151 patients (137 men; mean age 74 years, range 54-88) have undergone AAA repair using 88 Ancure, 46 AneuRx, and 17 Excluder stent-grafts in elective procedures. All patients were followed clinically and underwent postoperative duplex ultrasound and/or computed tomographic angiography, which was repeated every 6 months.

Hyperprolactinemia associated with risperidone: a case report and review of literature.

This case report describes a 19-year-old Caucasian woman who presented to a state psychiatric facility with symptoms of depression and auditory hallucinations. She was diagnosed with schizoaffective disorder, depressed type, and was treated with risperidone and sertraline. Soon after initiation of drug therapy, the patient developed galactorrhea and dysmenorrhea, and her prolactin level was 171.

Mucosal and systemic immunity to intestinal reovirus infection in aged mice.

Systemic immunity is progressively impaired in aging, predisposing to morbidity and mortality from neoplasia and infectious disease. However, the effect of aging on mucosal immunity is controversial. To assess intestinal immunity in aging, young and aged mice were orally exposed to reovirus or cholera toxin (CT) and specific antibody and reovirus-specific cytotoxic T-cell (CTL) responses were assessed.

Clinical evaluation of immunotherapy: are there differences between papillary and flat in situ bladder cancer?

The advantage of BCG immunotherapy over intravesical chemotherapy in superficial bladder cancer has been most apparent in patients with carcinoma in situ (CIS), where complete response is increased from 50% to more than 70% and the proportion of patients remaining disease free for 5 years is increased from 20% to 40%. Similar advantages have been reported using suboptimal BCG treatment schedules in patients with recurrent stage Ta, T1 tumours. BCG provides long term protection from tumour recurrence and, unlike chemotherapy, reduces tumour progression.

Predictors of patient satisfaction with inpatient hospital nursing care.

The purpose of this predictive nonexperimental study was to investigate the influence of registered nurse (RN) job satisfaction, context of care, structure of care, patient-perceived nurse caring, and patient characteristics on patient satisfaction with inpatient hospital nursing care in an academic medical center in north-central West Virginia. Convenience samples of patients (N = 362) and RNs (N = 90) were recruited from two medical units, two surgical units, and three intensive care step-down units. Causal modeling identified patient-perceived nurse caring as the major predictor of patient satisfaction, with nurse/physician (RN/MD) collaboration as the only other direct predictor.

Medication use in a rural gynecologic population: prescription, over-the-counter, and herbal medicines.

Objective: The purpose of this study was to document current medication use by a rural female population.

Study Design: Over a 42-month period, nonpregnant women were interviewed about medication use. When applicable, interviews on subsequent visits provided a longitudinal study of medication usage and discontinuation, and data were analyzed according to the number of drugs used, age, and payment status.

Angioplasty/stenting of the superior mesenteric artery and celiac trunk: early and late outcomes.

Purpose: To analyze the early results and durability of angioplasty/stenting of the superior mesenteric artery (SMA) and celiac trunk (CT).

Methods: Twenty-two patients (19 women; mean age 69.2 years, range 52-88) with 24 symptomatic SMA or CT stenotic lesions were treated with dilation/stenting over a recent 4.