Left subclavian artery aneurysm: two cases of rare congenital etiology.

Subclavian artery aneurysms are uncommon. The most common causes of these aneurysms are atherosclerosis and traumatic pseudoaneurysm. We report two cases of rare congenial left subclavian artery aneurysms.

Impact of the Multicenter Automatic Defibrillator Implantation Trial on implantable cardioverter defibrillator indication trends.

Since publication of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) in 1996, indications for implantation of implantable cardioverter defibrillators (ICDs) have expanded. Initial criticisms of the study have been addressed, including the need to await the conclusion of several additional ICD clinical trials. These other trials have generally shown an improved survival with ICD therapy when compared with antiarrhythmic agents.

An algorithm for the empirical determination of intracranial stereotactic targets.

The determination of empirical targets for functional brain lesions is usually made with graphical techniques using CT or MR software. Geometrical errors occur in the method when the intercommissural line and plane of the third ventricle are not parallel and orthogonal to transaxial images. A mathematical algorithm can be used to calculate target coordinates from the coordinates of the anterior commissure, the posterior commissure, and the position of a third point within the inferior, third ventricle.

Crush injuries: a case of entrapment.

Crush injuries result from prolonged entrapment or immobilization. The resultant complications can be devastating and fatal. There is significant tissue injury and muscle necrosis that may lead to one or more complications including compartment syndrome, rhabdomyolysis, renal failure, and coagulopathies.

Management of venous ulcers.

As our society ages, critical care nurses will increasingly be exposed to patients with a variety of wounds. One of the most challenging wounds to manage is the venous ulcer, a complication of venous insufficiency. This article will summarize the prevention and management of venous ulcers in a comprehensive and research-based manner.

Initiating therapy for Parkinson's disease.

Accurate diagnosis and individualized assessment of the risks and benefits of available antiparkinsonian medications should guide initiation of treatment for patients with early Parkinson's disease (PD). In general, the goals of treatment for younger patients (less than age 60 years) are control of impairing symptoms, sparing of levodopa to minimize long-term complications, and consideration of neuroprotection. The primary initial medication choices for patients under age 50 years include selegiline, amantadine, and anticholinergic agents.

Indications for implantation of a dual-chamber pacemaker combined with an implantable cardioverter-defibrillator.

Of 122 patients with single-chamber implantable cardioverter-defibrillators (ICDs) reviewed retrospectively, 35 had traditional indications, 14 had other indications, and 18 had ICD-specific indications for dual-chamber pacing therapy. Thus, 67 patients (55%) were potential candidates for dual-chamber pacing, which has only recently become available combined with ICD therapy.

ICD restudy: results and potential benefit from routine predischarge and 2-month evaluation.

Evaluation of ICD function can now be performed noninvasively with intravenous sedation. To determine the value of follow-up electrophysiological studies for ICD implants, we performed a retrospective review of predischarge and 2-month ICD re studies, identifying critical problems uncovered. Of the 123 patients implanted, 122 had a predischarge study, 105 had both predischarge and elective 2-month follow-up studies, and 1 patient expired prior to restudy.

Recurrent Twiddler's syndrome in a nonthoracotomy ICD system despite a Dacron pouch.

Twiddler's syndrome is a highly recognized yet rare complication of pacemaker and cardioverter defibrillator (i.c.d.

Performance improvement with patient service partners.

Once the decision is made to use a patient-focused care delivery system, a variety of methods can be used to successfully design the model. The author describes the process used by a multilevel, multidisciplinary team at a community hospital to design and implement a Service Partner role that would meet and exceed customer expectations. Demonstrated performance improvements included increased patient satisfaction, productive labor dollar savings, and improvements in the work environment for staff members.

The best of both worlds--'resposables'.

Managed care has brought about changes in the way surgical departments function. Minimally invasive surgeries are common, but costly for the surgical department. The use of reusable or resposable instruments can help keep costs down.

Red eye unresponsive to treatment.

Red eyes that fail to respond quickly and completely to topical antibiotic treatment require more extensive evaluation to relieve the symptoms and avert possible sight-threatening complications. The initial differential diagnosis of red eye, which includes iritis, acute glaucoma, keratitis and corneal ulcer, and rarer disorders, must be reexamined. A commonly misdiagnosed cause of red eye is the dry eye syndrome.

Choreographing trauma resuscitation in the OR.

Survival rates are enhanced if severely injured trauma patients are admitted directly to the OR for resuscitation and surgical intervention. To increase the survivability and decrease the morbidity of trauma patients with penetrating trauma to the chest or abdomen, a hospital in La Jolla, Calif, developed a "direct to the OR" resuscitation program. This program substantially increased the survival rate of these trauma patients.

Subfascial endoscopic perforator vein surgery: a preliminary report.

Although the open Linton subfascial perforator vein interruption operation succeeded, for the most part, in preventing recurrent venous ulceration, it was associated with morbidity and prolonged hospitalization. We have attempted to obtain the beneficial effects of perforator interruption by the less invasive procedure of subfascial endoscopic perforator vein surgery using laparoscopic instrumentation and limited or no hospitalization. A total of 31 consecutive operations were performed in 30 patients.

Nursing grand rounds.

Therapeutic touch is an energy-based nursing intervention performed with the goals of restoring harmony and balance in the human energy field and helping the patient self-heal. This article discusses the process of therapeutic touch and describes case studies of CCU patients on whom therapeutic touch was used as part of the treatment plan. Therapeutic touch was applied to help stabilize patients, calm agitated and intubated patients, and relieve pain.

A comparison of craniotomy and Gamma Knife charges in a community-based Gamma Knife Center.

The hospital charges for all craniotomies and transsphenoidal procedures were gathered for a 4-year period from a single, non-profit hospital serving San Diego. Calif., USA.

The micro-laserbot: an alternative method for frameless stereotactic localization.

An alternative method for frameless stereotactic localization which combines an articulating arm for spatial positioning with a three-dimensional laser beam localization technique will be presented. The moveable segments of the arm are counterbalanced, and allow it to smoothly glide to a given position. Micro-brakes in the arm joints permit rigid spatial fixation.

Stability: an ICD detection criterion for discriminating atrial fibrillation from ventricular tachycardia.

Introduction: The purpose of this study was to review a new implantable cardioverter defibrillator (ICD) detection criterion, stability, to determine if it can effectively discriminate rapid rhythms of atrial fibrillation from ventricular tachycardia. Inappropriate shocks for rapid atrial fibrillation limit the acceptance of ICDs. The advent of an additional detection criterion, stability, has been postulated to be of value in discriminating rapid atrial fibrillation, which may not warrant treatment, from ventricular tachycardia, which obviously does warrant therapy deliver.

Palliation of bone pain in patients with metastatic cancer using strontium-89 (Metastron).

Bony metastasis is the most common cause of cancer pain. Strontium-89 (Sr-89), or Metastron, therapy has been shown to be effective for the palliation of pain due to skeletal metastases. By reducing opioid analgesics intake and restoring mobility, Sr-89 improves the patient's quality of life.

The subcutaneous array: a new lead adjunct for the transvenous ICD to lower defibrillation thresholds.

Despite the benefits of transvenous implantable cardioverter defibrillators (ICDs), concern exists that patients with high defibrillation thresholds (DFTs) have an inadequate safety margin between the DFT and the maximum defibrillator energy. A new transvenous ICD lead adjunct, a subcutaneous lead array (SQ Array), was developed to increase safety margins by lowering DFTs. Composed of three lead elements joined in a common yoke, the SQ Array is tunneled subcutaneously in the left lateral chest.

Photorefractive keratectomy to treat myopia and astigmatism after radial keratotomy and penetrating keratoplasty.

Fifteen eyes with an initial myopia between -5.00 diopters (D) and -12.00 D were treated with radial keratotomy (RK) followed by photorefractive keratectomy (PRK) at least 6 months later and observed for 6 months to 24 months.