Development of a numeric Health Care Worker Risk-Assessment Scale to evaluate potential for blood-borne pathogen exposures.

Background: An attempt to develop a Health Care Worker Risk Assessment Scale to evaluate potential for exposure to blood-borne pathogens was made in late 1989 through 1990. The research questions were as follows: (1) Can a scale be developed to assign weights to variables that influence health care workers' risk of exposure to blood-borne pathogens? (2) If so, what variables would be included?

Methods: A five-round Delphi technique was used with 26 panel members from 15 U.S.

Heat shock proteins in myocardial stress.

In this overview four questions were discussed related to heat shock proteins and myocardial ischemia. Heat shock proteins are chaperones which associate with malfolded proteins and prevent their aggregation into large damaging complexes. In myocardial ischemia, the inducible heat shock protein 70 (hsp70), the mitochondrial heat shock protein 60 and the small 27 heat shock protein increases after 30 minutes of ischemia of the rat heart and subsequent reperfusion.

Racial differences in epinephrine and beta 2-adrenergic receptors.

This study examined the effects of ethnicity and hypertension on beta 2-adrenergic receptors and on plasma catecholamines in a group of 77 unmedicated mildly hypertensive and normotensive men. Black hypertensive subjects had the most sensitive and white hypertensive subjects the least sensitive beta-receptors (as assessed by isoproterenol-stimulated cyclic AMP in lymphocytes [P = .02]).

Raising the decontamination level for thyroid hormone ingestions.

Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg levothyroxine (T4) equivalent of thyroid hormone and the highest-tolerated milligram-per-kilogram dose. Parameters evaluated included patient weight, amount ingested, drug preparation, treatment type, outcome, management site, and relevant comments. Eight patients had mild symptoms requiring no specific medical intervention and there was no correlation between the amount ingested and symptoms observed.

Sphincterotomy: long-term complications and warning signs.

Transurethral sphincterotomy is a commonly performed operation in spinal cord injury patients. Sixty-three patients who have had transurethral sphincterotomy were evaluated at our spinal cord injury unit for the risk and possible predictors of long-term outcome associated with this procedure. In addition to history and physical examination, all patients had urine culture, blood urea and creatinine, intravenous pyelogram and/or KUB with renal ultrasound, 4 channel videourodynamics, voiding cystourethrogram, and cystocopy when indicated.

Use of a direct thrombin inhibitor (argatroban) during pulse-spray thrombolysis in experimental thrombosis.

Purpose: To evaluate the effectiveness of intravenous and intrathrombic injection of the thrombin inhibitor argatroban during pulse-spray pharmacomechanical thrombolysis (PSPMT) in experimental venous thrombosis.

Materials And Methods: Clots were produced in the inferior vena cava in 52 rabbits by placement of steel coils and balloon injury to the vessel wall. Two days later, clots were treated with PSPMT.

MR imaging assessment of experimental hepatic dysfunction with Mn-DPDP.

Manganese (II) N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'-bis(phosphate) (DPDP) is a paramagnetic magnetic resonance (MR) contrast agent that enhances the liver and is predominantly excreted through the biliary tree. The authors evaluated its utility in diffuse liver disease by assessing liver and gallbladder enhancement in 24 rabbits. Total (n = 6) or segmental (n = 6) biliary occlusion or galactosamine-induced hepatitis (n = 6) was induced 3 days before imaging.

Proteases and the emerging role of protease inhibitors in prohormone processing.

Peptide hormones and neurotransmitters constitute a large class of neurohumoral agents that mediate cell-cell communication in neuroendocrine systems. Their biosynthesis requires proteolytic processing of inactive protein precursors into active neuropeptides. Elucidation of the proteolytic components required for prohormone processing is important for identifying key proteases that may control the production of neuropeptides.

Development of a disposable spray canister for talc pleurodesis. A preliminary report.

Talc pleurodesis has been used for more than 50 years in both the United States and in Europe, and it has proven to be safe and effective in patients with malignant pleural effusions as well as recurrent pneumothorax. In this preliminary report, we describe a disposable, single-use spray canister that allows intrapleural administration of sterile, asbestos-free Luzenac talc, thus facilitating thoracoscopic talc insufflation for pleurodesis, particularly in patients with recurrent malignant effusions. The talc is delivered ready to use, administered via a hollow plastic delivery catheter that can be inserted through the pleural trocars used during thoracoscopy.

Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy.

The Bullard laryngoscope (BL) is a new device for managing the difficult airway. Previous publications on the BL are primarily descriptive, and fail to use internal controls (i.e.

Treatment of postbiopsy pneumothorax with a self-contained pneumothorax treatment device.

Purpose: To evaluate the usefulness of a self-contained pneumothorax treatment device, in which a catheter and a one-way valve compose a single unit, in cases of postbiopsy pneumothorax.

Materials And Methods: Twenty-one patients underwent placement of the device to drain a postbiopsy pneumothorax. Treatment was considered successful when no therapy other than the device was needed.

Cross-sectional imaging of the diabetic foot.

Cross-sectional imaging has played an increasingly important role in the evaluation of diabetic foot disease. This article summarizes the utility and limitations of computerized tomography (CT) and magnetic resonance imaging (MRI) in specific situations, with reference to relevant cross-sectional anatomy. Application of these techniques to soft tissue infection, osteomyelitis, and neuroarthropathy is emphasized.

Establishment of a 900 telephone number at a university-based drug information service.

Effects of converting a free drug information service at a university medical center to a 900 telephone number are described. Calls to a university medical center drug information service had increased beyond the capacity of staff. A telephone survey to recent users of the service indicated that callers outside the institution would be willing to pay a fee for the service, so a 900 number was instituted for outside calls in January 1993.

Magnetic resonance imaging of the shoulder.

MRI has rapidly become a commonly used technique for evaluation of the shoulder. It provides a wealth of information regarding the entire shoulder girdle, and it is the most accurate noninvasive method available for imaging the rotator cuff. There have been numerous technical improvements in MRI in the relatively short time that clinical MRI has been in existence.

Perfluorocarbon-enhanced sonography: value in detecting acute venous thrombosis in rabbits.

Objective: We have previously shown that perfluorocarbon emulsions administered i.v. act as contrast material during sonography by creating moving echoes in veins.

Review article: gastroduodenal bicarbonate secretion.

The gastroduodenal epithelium is covered by an adherent mucus layer into which bicarbonate is secreted by surface epithelial cells. This mucus-bicarbonate barrier is an important first line of defence against damage by gastric acid and pepsin, and has been demonstrated in all species including human. Similar to gastric acid secretion, regulation of gastric and duodenal bicarbonate secretion can be divided into three phases: cephalic, gastric and duodenal.

A new method for cytodestruction of bladder epithelium using protamine sulfate and urea.

Bladder epithelium relies primarily on the presence of a surface glycosaminoglycan (GAG) layer and the structural integrity of cell-cell contact to maintain impermeability to toxic urinary wastes. Previous clinical studies evaluating bladder permeability characteristics in interstitial cystitis patients had indicated that epithelial desquamation occurs after treatment with protamine sulfate (PS) followed by hypertonic urea. The following study was performed using rabbits to further investigate this finding.

Pregnancy, lactation and the use of silicone breast implants.

In the United States alone, an estimated 1-2 million women have used silicone breast implants. Many of these women are of reproductive age. Given the current controversy over the safety of silicone breast implants, medical care providers should be able to advise women if use of these implants affects the use of any of the available contraceptive methods, whether pregnancy is in any way contraindicated and/or might be associated with special complications, whether there are potential risks to the fetus and neonate, and whether breast feeding might be compromised.

Radiography of articular disorders in the foot.

The author reviews various pedal articulations, as well as certain clinical manifestations with which these may be pathologic. Pertinent anatomy is described. Individual as well as multiple articular disorders in the foot are illustrated.

What is the best way to determine oropharyngeal classification and mandibular space length to predict difficult laryngoscopy?

Background: Previous studies have suggested that the degree of visibility of oropharyngeal structures (OP class) and mandibular space (MS) length can predict difficult laryngoscopy. However, those studies were either inconsistent or omit description of how to perform these tests with regard to body, head and tongue position, and the use of phonation, hyoid versus thyroid cartilage and inside versus outside of the mentum. The purpose of this investigation was to determine which method of testing best predicts difficult laryngoscopy.