Pinch-off syndrome: case report and collective review of the literature.

Pinch-off syndrome (POS) occurs when a long-term central venous catheter is compressed between the clavicle and the first rib. The compression can cause transient obstruction of the catheter and may result in a tear or even complete transsection and embolization of the catheter. POS may be preceded by a finding of "pinch-off sign" on chest X-ray (CXR) films in which the catheter is indented as it passes beneath the clavicle.

Cephalexin-induced acute tubular necrosis.

A 24-year-old woman with a history of penicillin allergy developed reversible acute renal failure after receiving cephalexin for 4 days. The patient experienced nausea, vomiting, diarrhea, pruritus, cough, and an elevated creatinine level of 2.2 mg/dl.

Cerebral hypoxia in severely brain-injured patients is associated with admission Glasgow Coma Scale score, computed tomographic severity, cerebral perfusion pressure, and survival.

Background: The purpose of this study was to determine the relationship of cerebral hypoxia with admission Glasgow Coma Scale (GCS) score, brain computed tomographic (CT) severity, cerebral perfusion pressure (CPP), and survival in patients with severe brain injury.

Methods: CPP and noninvasive transcranial oximetry (Stco2) were recorded hourly for 6 days in patients with a GCS score < or = 8 (3,722 observations). CT score was derived from midline shift (0/1) plus abnormal cisterns (0/1) plus subarachnoid hemorrhage (SAH) (0/1) (range, 0-3).

A computer model for the study of breast cancer.

A computer model was designed as a relational database to assess breast cancer screening in a cohort of women where the growth and development of breast cancer originates with the first malignant cell. The concepts of thresholds for growth, axillary spread, and distant sites are integrated. With tumor diagnosis, staging was performed that includes clinical and sub-clinical states.

Tuberculosis of the spine (Pott's disease) presenting as 'compression fractures'.

Study Design: Case reports and survey of literature.

Objective: Case reports of two women with tuberculosis (TB) of the spine (Pott's disease) presenting with severe back pain and diagnosed as compression fracture are described. Physicians should include Pott's disease in the differential diagnosis when patients present with severe back pain and evidence of vertebral collapse.

Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital.

Background: Group B streptococcal bacteremia in nonpregnant adults continues to be a significant infection.

Methods: We reviewed medical records of nonpregnant adult patients with group B streptococcal bacteremia from 1995 to 1999 and compared the findings with data from a similar study in our institution between 1980 and 1984.

Results: There were 36 episodes of group B streptococcal bacteremia.

Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP).

Transitional cell carcinoma manifesting as acute cor pulmonale: cause of microscopic tumor embolism.

Acute cor pulmonale is an uncommon manifestation of microscopic pulmonary tumor embolism. We describe the case of an 84-year-old man with a history of transitional cell carcinoma (TCC) of the urinary bladder who had acute cor pulmonale and died within a few hours after the onset of dyspnea. Autopsy showed that the right ventricle was dilated without hypertrophy.

Cyanide toxicity in the surgical intensive care unit: a case report.

Hypertension is a widespread entity in the surgical intensive care unit. Not only is the clinical spectrum varied, but the armamentarium available to the clinician is also wide-ranging. Sodium nitroprusside, a potent vasodilator with a short half-life, is often used for hypertensive crisis and to deliberately maintain a low blood in certain clinical conditions.

Trauma attending in the resuscitation room: does it affect outcome?

Although there are no Class I data supporting the regionalization of trauma care the consensus is that trauma centers decrease morbidity and mortality. However, the controversy continues over whether trauma surgeons should be in-house or take call from home. The current literature does not answer the question because in all of the recent studies the attendings who took call from home were in the resuscitation room guiding the care.

Clinical impact of continuous renal replacement therapy on multiple organ failure.

Because continuous renal replacement therapy (CRRT) may enhance inflammatory mediator removal, this review assesses its impact on multiple organ failure (MOF). Regarding MOF with acute renal failure (ARF), the overall mortality of 2313 CRRT patients (43 studies) was 62.8% compared with 59.

Lumbosacral plexopathy after dual kidney transplantation.

A 58-year-old man underwent dual kidney transplantation. He was unable to move his right leg after surgery. This was caused by extensive lumbosacral plexopathy on the side of surgery.

Pneumococcal bacteremia associated with an infected central venous catheter.

Pneumococcus (Streptococcus pneumoniae) bacteremia is a serious infection. Pneumococcus has never been implicated as a cause of a central venous catheter-related bacteremia. It has been isolated from the catheter tip only twice before, and in one case caused the infection of an infusion port device.

Pregnancy-induced hypertension and duration of sexual cohabitation.

Objective: To evaluate the possible association between duration of sexual cohabitation and the risk of pregnancy-induced hypertension (PIH).

Study Design: A matched case-control design in which each case of PIH was compared with three controls. Information was obtained about use of barrier contraception, duration of intercourse prior to pregnancy and paternity.

Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression.

An 81-year-old woman who presented with middle lobe bronchiectasis and Mycobacterium avium complex infection is described. She had a history of habitual suppression of cough, as in Lady Windermere syndrome. She was thin and had mild kyphoscoliosis but had no history of smoking or connective tissue disease.

Analysis of three decision-making methods: a breast cancer patient as a model.

Purpose: To compare three decision making techniques using a common clinical problem.

Methods: Two recently developed methods, the analytic hierarchy process (AHP) and the analytic network process (ANP), were compared with a Markov process in the evaluation of the optimal post-lumpectomy treatment strategy for an elderly woman with a mammographically detected, nonpalpable early-stage breast cancer. The following treatment alternatives were considered: observation, radiation, tamoxifen, combination radiation and tamoxifen, and simple mastectomy.

Sarcoidosis: a primary care review.

Sarcoidosis is a multisystemic disorder of unknown etiology that most commonly affects adults between 20 and 40 years of age. Patients with sarcoidosis frequently present with bilateral hilar lymphadenopathy and pulmonary infiltration, and often with ocular and skin lesions. The diagnosis is established when clinical and radiographic findings are supported by histologic evidence of non-caseating epithelioid cell granulomas found on tissue biopsy.

An observational study of hand washing and infection control practices by healthcare workers.

During a 6-week period, a medical student conducted an observational study of hand washing and infection control practices in a community teaching hospital. There was no difference in the prevalence of handwashing practices among the three work shifts. The prevalence of hand washing was higher in surgical (56.

Applying current research to influence clinical practice.

There are continuing controversial issues surrounding the use of midline catheters. Nurses selecting catheter devices need to be knowledgeable about risk factors associated with device use, including catheter materials, site selection, therapy administration, and dwell time. It is critical that nurses review research results and evaluate and apply such results to their clinical practice.