Pleural sclerosis for the treatment of pneumothorax and pleural effusion.

Pleural sclerosis is indicated to obliterate the pleural space when one wants to prevent the recurrence of a spontaneous pneumothorax or the reaccumulation of a pleural effusion. Although many different agents ranging from antibiotics to antiseptics to antineoplastics to talc have been advocated, none is ideal. It is interesting that in the era when we are mapping the human genome, the agent most commonly used for pleurodesis is talc.

Effect of backrest position on hemodynamic and right ventricular measurements in critically ill adults.

Background: Hemodynamic measurements are often obtained with the patient in a flat, supine position. Reports suggest that these measurements can be reliably obtained at backrest elevations from 0 degree to 45 degrees. However, no study has been performed to evaluate the effects of position change on all the measurements that can be obtained via a pulmonary artery catheter.

Polycythemia vera.

Objectives: To review the proliferative nature of polycythemia vera (PV), clinical features, laboratory findings, treatment options and controversies, and nursing management.

Data Sources: Textbook chapters and review articles that pertain to polycythemia vera.

Conclusions: Polycythemia vera is a chronic myeloproliferative disorder that can evolve into acute leukemia.

Moisaicism in the human preimplantation embryo.

Recent studies have revealed widespread mosaicism in the human preimplantation embryo at the nuclear and chromosomal level arising at fertilization and preimplantation development. Molecular cytogenetic analysis by fluorescent in situ hybridization (FISH), in particular, has for the first time made it possible to analyse all or almost all nuclei in cleavage stage embryos. The genotype of an individual is therefore not strictly defined at conception by the genotype of the germ cells.

Rare complications of vascular access devices.

Objective: To provide an overview of rare complications of vascular access devices in terms of etiology, assessment, management, and follow-up.

Conclusions: Rare complications of vascular access devices are serious and in some cases life-threatening. These complications include pinch-off and catheter fracture, catheter malposition and migration, cardiac perforation, extravasation, breakage, and defective devices.

Current ethical and legal issues in gastrointestinal endoscopy.

The ethical and legal aspects of gastroenterology practice have changed over the past 20 years just as remarkably as the technological features of care. Answers to questions like "May competent adult patients refuse medical treatment?" and "Is the medically-mediated delivery of nutrition and hydration a 'medical treatment'?" must be considered in light of the Cruzan case and new arguments about the benefits and burdens of feeding tubes.

Corneal complications of cataract surgery.

Developments in cataract surgery have stimulated a greater interest in minimizing unwanted effects of cataract surgery on the cornea. The two main areas of concern are protection of the corneal endothelium and minimizing distortion of the anterior corneal surface. Endothelial cell loss is of particular importance where there is a preexisting significantly low cell count due to ocular trauma, surgery, or dystrophy, and in situations where cataract extraction is combined with other procedures that may be prolonged or require extensive manipulation.

The Americans with Disabilities Act: the impact on radiologic technologists and managers.

On July 26, 1990, President Bush signed the Americans With Disabilities Act (ADA) which prohibits discrimination on the basis of disability. The act is being cited as one of the most extensive changes in personnel law since the Civil Rights Act of 1964. The law will impact hiring, promotion, and retention practices in the U.

Central venous catheter "pinch-off" and fracture: a review of two under-recognized complications.

Although uncommon, "pinch-off syndrome" and catheter fracture are reported complications of central venous catheters (CVCs). Pinch-off syndrome is characterized by intermittent catheter malfunction in conjunction with radiologic evidence of catheter compression. Warning signs of pinch-off syndrome include difficulty with-drawing blood samples and resistance to infusion of IV fluids.

Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.

In this retrospective study, we compared the results of 1,283 open cholecystectomies (OCs) performed at our medical center during the pre-laparoscopic era with 1,107 laparoscopic cholecystectomies (LCs) performed from 1990 to 1992. There was no difference in the percentage of cases of acute and chronic cholecystitis in each time period (16.8% in each), nor were there differences in the patient characteristics for each group.

An account of the usefulness of a pilot clinical ethics program at a community hospital.

This article describes the development and implementation of a six-month pilot clinical ethics program at Saint Thomas Hospital (Nashville, Tenn). To assess the impact of this program, baseline data were gathered from a self-selected sample of critical and special care unit nurses and physicians about the "most troublesome" ethical dilemmas in their practices. Nurses and physicians reported facing similar dilemmas in practice.

Continuing problems with patient self-determination.

Cruzan v. Director, Missouri Department of Health, the first "right to do die" case to be decided by the United States Supreme Court, constitutionalizes the principle of patient self-determination. The case encourages competent patients to reflect thoughtfully about the possibility that one day they may be incapacitated just as Nancy Beth Cruzan was and to prepare for that possibility by completing an advance directive.

COAD (clinical outcome assessment documentation) charting: using the quality improvement process to meet the new JCAHO nursing standards.

The shortage of nurses has prompted departments across the nation to examine nursing practices in individual healthcare facilities and to initiate changes where relevant. Saint Thomas Hospital, a 571-bed tertiary-care facility, developed a number of strategies designed to allow nurses to focus on skills consistent with professional practice and to reassign technical and clerical duties to other members of the healthcare team. One of the changes implemented was the clinical outcome assessment documentation (COAD) system, which communicates the plan of care without the use of a separate form, expedites charting times, and eliminates duplication.

Internal mammary artery graft at reoperation: risks, benefits, and methods of preservation.

To determine the effect of a prior internal mammary artery (IMA) graft on coronary artery bypass reoperation (CABR), we reviewed our experience with 410 consecutive patients: 313 received only saphenous vein grafts at initial coronary artery bypass grafting (CABG), and 97 received at least one IMA graft at CABG. Cardiac catheterization data before CABG were available in 110 patients (56 received only saphenous vein grafts, 54 received at least one IMA graft), allowing comparison of left ventricular function at CABG and CABR. Injury of the IMA graft occurred in 5 patients (1 death), but presence of an IMA graft was not an independent predictor of morbidity or mortality.

Physical activity and lean body mass loss following coronary artery bypass graft surgery.

The present study was undertaken to determine the effect of Phase I exercise therapy on lean body mass loss in recovering coronary artery bypass graft (CABG) surgery patients. Thirty male CABG surgery patients volunteered for the study. Subjects were randomly divided into two groups with one group receiving Phase I exercise therapy.