Stereotactic radiation techniques in the treatment of acoustic schwannomas. 2007.

Medical decision-making is based on benefit-to-cost analysis. Optimally, treatment obtains a high degree of benefit while minimizing the physical, social, and financial costs. The goals of the treatment of acoustic schwannomas are prohibiting tumor growth and alleviation of symptoms caused by damage to local structures.

Juice powder concentrate and systemic blood pressure, progression of coronary artery calcium and antioxidant status in hypertensive subjects: a pilot study.

Because micronutrients from plants may have beneficial cardiovascular effects, the hypothesis that an encapsulated juice powder concentrate might affect several measures of vascular health was tested in free living adults at low cardiovascular risk. Blood pressure, vascular compliance, lipid and antioxidant markers, and serial electron beam tomography (to calculate a coronary artery calcium score as a measure of atherosclerosis burden), were monitored in 51 pre-hypertensive and hypertensive subjects over 2 years. By the end of follow-up, systolic and diastolic blood pressure decreased significantly (-2.

Eliminating adverse drug events at Ascension Health.

Improvement in ADE rate did not occur at either hospital with any one particular intervention, or even after several conventional interventions had time to take effect. Instead, instituting many simultaneous system changes, proactively assessing risk, and expanding the scope of intervention were each essential to sustaining the described reductions in harm. The next step toward eliminating ADEs requires simultaneous communication across systems in a way that is manageable, approachable, and adaptable, and that supports the elements of change.

Preventing falls and eliminating injury at Ascension Health.

Background: For Ascension Health's Healthcare That Is Safe strategy, eight hospitals served as alpha sites in the program to prevent falls and eliminate falls with injury.

Methods: The alpha sites implemented four key strategies: (1) assessment and re-assessment of patient risk factors for falls, (2) visual identification of patients at high risk, (3) communication of patient fall risk status, and (4) education of patients, families, and staff about fall prevention.

Results: The recommendations of the alpha initiative spread rapidly throughout Ascension Health and preceded measurement of the fall ratio.

Statins and C-reactive protein levels.

In patients with or at risk for cardiovascular disease (CVD), including hypertensive individuals, lowering levels of low-density lipoprotein cholesterol (LDL-C) reduces CVD risk. Statins are the most effective of available therapies for lowering LDL-C. Extensive clinical trial data have shown that the degree of LDL-C reduction obtained depends on the particular statin used and that intensive LDL-C lowering reduces the incidence of cardiovascular events compared with more moderate LDL-C lowering.

Pleural fluid exchange in rabbits.

Background And Objectives: The study was designed to better characterize pleural fluid absorption in rabbits with the following two objectives: to determine the relative absorption of saline versus high-protein solutions, and to identify the relative rates of absorption of dextran molecules of varying sizes.

Methods: Twenty New Zealand white rabbits received a 12-mL intrapleural injection of saline solution and a 10% protein solution on opposite sides, each solution containing dextran molecules with varying MWs. At sacrifice at 1, 4, 8, 18 and 24 h, the volume of pleural fluid and the concentrations of the dextran molecules were determined.

Stereotactic radiation techniques in the treatment of acoustic schwannomas.

Medical decision-making is based on benefit-to-cost analysis. Optimally, treatment obtains a high degree of benefit while minimizing the physical, social, and financial costs. The goals of the treatment of acoustic schwannomas are prohibiting tumor growth and alleviation of symptoms caused by damage to local structures.

Radiographic measurements of the intercondylar notch: are they accurate?

Purpose: The purpose of this study was to evaluate the accuracy of radiographic measurements of the intercondylar notch.

Methods: Radiographs of 10 cadaveric knees were obtained via the 3 methods reported in the literature (Holmblad 45 degree, Holmblad 70 degree, and Rosenberg views), after removal of the patella and surrounding soft tissues. The anterior outlet of the intercondylar notch of each knee was then outlined with barium paste, and radiography was repeated.

Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients.

Objective: To test for an association between apolipoprotein E (APOE) genotypes and duration of intensive care unit delirium.

Design: Prospective, observational cohort study.

Setting: A 541-bed, community-based teaching hospital.

The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention.

Introduction: Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals.

Aim: A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic.

Main Outcome Measures: Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations.

Prevalence and characteristics of pleural effusions in superior vena cava syndrome.

Objective And Background: The prevalence and characteristics of pleural effusions occurring in adults with the superior vena cava (SVC) syndrome are unknown. The purpose of the present study was to characterize these pleural effusions.

Methods: Charts of patients diagnosed with SVC syndrome at a tertiary care referral centre were reviewed.

The superior vena cava syndrome: clinical characteristics and evolving etiology.

Malignancy is the most common cause of the superior vena cava (SVC) syndrome. With the increasing use of intravascular devices, the incidence of the SVC syndrome arising from benign etiologies is increasing. We reviewed the etiology and outcome of 78 patients with SVC syndrome over 5 years.

D-dimer levels in pleural effusions.

Introduction: D-dimer is a degradation product of cross-linked fibrin. We hypothesized that hemorrhagic pleural effusions would have greater D-dimer levels than non-hemorrhagic pleural effusions, and that persistently bloody effusions would be distinguishable from thoracentesis-induced bloody effusions by the D-dimer level.

Methods: Forty pleural effusions were studied.

Confirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women.

Posttraumatic stress disorder (PTSD) factor analytic research to date has not provided a clear consensus on the structure of posttraumatic stress symptoms. Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist, a paper-and-pencil measure of posttraumatic stress symptom severity, in a sample of 1,218 women who experienced a broad range of workplace sexual harassment. The model specifying correlated re-experiencing, effortful avoidance, emotional numbing, and hyperarousal factors provided the best fit to the data.

Pleural effusions following cardiac injury and coronary artery bypass graft surgery.

This article discusses the pleural effusions that occur with the post-cardiac injury (Dressler's) syndrome (PCIS) and those that occur after coronary artery bypass graft (CABG) surgery. The PCIS can occur after any type of cardiac injury and is thought to be due to anti-myocardial antibodies. The primary symptoms are fever and chest pain, and pericarditis is frequently present.

[Indwelling catheter for the management of malign pleural effusions].

Symptomatic malignant pleural effusions are most commonly managed by chemical pleurodesis. The primary disadvantage of chemical pleurodesis is that it requires hospitalization for approximately five days. An alternative to chemical pleurodesis is insertion of an indwelling catheter, which can be applied easily on an outpatient basis.

Eosinophilic pleural effusions.

Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion.

Variations in pleural fluid WBC count and differential counts with different sample containers and different methods.

Objective: To compare the results of pleural fluid analysis for WBC counts and differential cell counts as follows: (1) counting performed manually vs that performed by an automated cell counter; (2) cells collected in different types of specimen containers; and (3) cell counts performed at 4 and 24 h postthoracentesis.

Methods: Twenty-eight pleural fluid samples were each collected in five different containers (ie, ethylenediaminetetraacetic acid (EDTA)-treated glass, citrate-treated glass, heparinized glass, plain glass, and plain plastic tubes). The WBC counts and differential cell counts were obtained manually (on the EDTA tube) and with an automated counter on all tubes within 4 h of collection, and again after 24 h of refrigeration.

The role of bone metabolism in osteoarthritis.

Bone is not structurally normal in osteoarthritis (OA). Periarticular bone in OA has increased turnover, decreased bone mineral content and stiffness, and decreased trabecular numbers. The increased turnover of collagen, in particular, may affect the biomechanical competence of bone and is driven by a number of processes, including osteoblast phenotypic expression, chondrocyte apoptosis, matrix metalloproteinases, and growth factors.

Ultrasound-guided thoracentesis: is it a safer method?

Study Objectives: The objectives of this study are as follows: (1) to determine the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital; (2) to evaluate the incidence of vasovagal events without the use of atropine prior to thoracentesis; and (3) to evaluate patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema after ultrasound-guided thoracentesis.

Design: Prospective descriptive study.

Setting: Saint Thomas Hospital, a tertiary referral teaching hospital in Nashville, TN.

Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery.

The present prospective study was designed to determine the prevalence of pleural effusion at approximately 28 days after cardiac surgery and their subsequent course. This consecutive case study included 389 patients; 312 had only coronary artery bypass graft surgery (CABG) surgery, 37 had both valve and CABG surgery, and 40 had only valve surgery. Chest radiographs were obtained approximately 28 days postoperatively.

Rhabdomyolysis associated with cerivastatin: six cases within 3 months at one hospital.

Rhabdomyolysis is an uncommon complication associated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. We observed six cases of cerivastatin-associated rhabdomyolysis: two patients developed acute renal failure requiring hemodialysis, and one patient died. Four of the patients had impaired renal function, and five were prescribed drugs with the potential to interact with cerivastatin.

Pleural effusions after coronary artery bypass graft surgery.

After coronary artery bypass graft surgery, most patients will have a small, unilateral, left-sided pleural effusion, and approximately 10% of patients will have a larger effusion. These large effusions can be separated into (1) early effusions occurring within the first 30 days of surgery that are bloody exudates with a high percentage of eosinophils, and (2) late effusions occurring more than 30 days after surgery that are clear yellow lymphocytic exudates. The primary symptom of pleural effusion after coronary artery bypass graft surgery is dyspnea; chest pain and fever are uncommon.