Correction of frontal plane rotation of sesamoid apparatus during the Lapidus procedure: a novel approach.

The Lapidus procedure affords correction of a multitude of first ray pathologic entities. When reconstructing the first ray using the Lapidus procedure, the relocation of the first metatarsal over the sesamoid bones with frontal plane rotation should be considered one of the key components. In the present technical report, we have described a bunion correction with emphasis on sesamoid reduction through indirect frontal plane manipulation.

Laparoscopic management of gallstone ileus.

Gallstone ileus is an uncommon entity that was first described by Bartholin in 1654. Despite advances in perioperative care, morbidity and mortality remain high in patients with gallstone ileus because: 1) they are geriatric patients; 2) they often have multiple comorbidities; 3) presentation to the hospital is delayed; 4) many are volume depleted with electrolyte abnormalities; and 5) the diagnosis of gallstone ileus is difficult to make. Traditional management has entailed open laparotomy with relief of intestinal obstruction by enterotomy and stone extraction.

Sequential test selection in the analysis of abdominal pain.

Numerous decision-making tools exist to assist physicians in diagnosis management. However, the accuracy of available clinical information is often ambiguous or unknown and current analytical models do not explicitly incorporate judgementally defined information. A model encompassing both physician judgment and probability analysis was developed to accommodate such data.

A practical approach to the patient with back pain.

Management of back pain is most likely to be effective when treatment is based on a specific diagnosis, when patients are followed proactively to recovery and when psychosocial factors receive appropriate attention. Selected non-habit-forming drugs are useful, especially when taken on a regular basis rather than on an "as needed" basis. Rest is less useful in the management of back pain than previously believed and may be counterproductive.

Bacteremia due to Providencia stuartii: review of 49 episodes.

We reviewed cases of Providencia stuartii bacteremia at a large community teaching hospital during a 12-year period (1981 to 1992). None of the infections were hospital-acquired. Of the 49 patients, 47 (96%) came from a nursing home, and 45 (92%) had a long-term indwelling Foley catheter.

Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents.

Background: Mupirocin ointment has been shown to be effective in eradicating Staphylococcus aureus nasal carriage in residents of a long-term care facility. Antiseptic soaps have been used as adjunct to this therapy. We compared the efficacy of short-term intranasal mupirocin ointment with and without chlorhexidine baths in the eradication of S.

Ethidium bromide binding to unstructured and structured 2' GMP.

For disordered 2' GMP and 5' GMP the ethidium cation (Etd) was found to form 1:1 and 2:1 Eth:nucleotide complex. For alkali metal solution self-structured 2'GMP and 5'GMP Etd was found to form 1:1 and 2:1 Etd: order nucleotide complex. The best computer fit was obtained for a structured nucleotide stoichiometry of Na4(2'GMP)8.

Postpartum care.

Family physicians have a unique role in helping new mothers and their families manage the changes that occur during the postpartum period. Postdelivery hospital stays are becoming shorter, so anticipation of concerns that may arise is crucial. Instruction about care of the perineum and breasts, the possibility of postpartum depression, resumption of sexual intercourse, contraception, diet and exercise is appropriate in the postpartum period.

Xanthomonas maltophilia and Pseudomonas cepacia in lower respiratory tracts of patients in critical care units.

Xanthomonas maltophilia and Pseudomonas cepacia are Gram-negative bacilli that are considered to opportunistic pathogens. These bacteria may cause colonization and infection, especially in acutely ill patients. Between 1 July 1990 and 30 June 1992 sputum [correction of suptum] culture results from patients in the critical care units were surveyed daily.

Bilateral retrosomatic clefts at multiple lumbar levels.

Low back pain developed in a 44-year-old woman with a history of rheumatoid arthritis. Radiographs of the lumbar spine revealed bilateral pedicle defects at L-3, L-4, and L-5, with widening of the spinal canal and spondylolisthesis of L-5 on S-1. CT more clearly demonstrated bilateral retrosomatic clefts at multiple levels.

Reengineering the laboratory: strategic process and systems innovation to improve performance. Recreating our role on the health-care team.

The author describes reengineering efforts in the laboratory of a 550-bed hospital. Key benefits include reduced costs, improved turnaround time, and redirection of staff into new roles in information management and outreach.

Septicemic shock from urinary tract infection caused by Staphylococcus epidermidis.

Staphylococcus epidermidis septicemia from a urinary source is rare. Two male patients had septicemic shock caused by S epidermidis urinary tract infection. Both patients had recently had indwelling urethral catheterization during severe illness.

Clear cell adenocarcinoma arising from a urethral diverticulum.

Carcinoma of the urethra is rare with only about 1,500 cases in the literature. Even more rare is carcinoma arising from a urethral diverticulum with about 100 cases reported to date. We report a case of clear cell adenocarcinoma arising from a urethral diverticulum.

Spontaneous pneumothorax in weightlifters.

Spontaneous pneumothorax is infrequently caused by strenuous exertion. To our knowledge there has only been one case of spontaneous pneumothorax associated with weightlifting reported in the medical literature. We describe three consecutive cases of spontaneous pneumothorax associated with weightlifting.

Results of laparoscopic versus open cholecystectomy in a community hospital.

In a retrospective study, the first 301 patients who had laparoscopic cholecystectomy (LC) in a university-affiliated community hospital were compared with a historical matched control group of patients who had open cholecystectomy. The patients who had LC had a shorter hospital stay, required less postoperative pain medication, resumed normal activities and returned to work sooner, and had a lower minor and total complication rate. The mean operating time was 45 minutes longer for LC.

Optimal interval for triple-lumen catheter changes: a decision analysis.

A survey of 53 university and community hospitals revealed that 73% of the institutions had no standard policy for the replacement of triple-lumen catheters (TLCs). Since the maintenance of a TLC in place for a prolonged period may lead to infectious complications, it appeared warranted that standards of management be developed. A decision-tree model was constructed for evaluating the optimal time for changing a TLC that would minimize infection.

Pulmonary blastoma in children: report of two cases and review of the literature.

Pulmonary blastoma is a rare primary neoplasm of the lung. Approximately 25% of the reported cases have occurred in pediatric patients. The authors found 45 cases of these tumors in children aged < or = 16 years, and report two more cases of pulmonary blastoma--in a 3 1/2-year-old boy and a 22-month-old girl.

Structure sensitivity of amino proton exchange in 2'- and 5' - guanosine monophosphate dianions.

Proton NMR line broadening methods were used to determine the rates of amino proton exchange for disordered 2'- and 5' - GMP dianions in aqueous solutions containing tetramethylammonium (TMA+) cations. Replacing TMA+ with Na+ does not substantially alter the exchange rates, provided that H-bonded, Na(+)-directed tetramer structures are absent. Activation enthalpies (kcal/mol) and entropies (eu) for 2'-GMP are: delta H not equal to = 18.

Early intervention: coma stimulation in the intensive care unit.

Coma stimulation is a technique that has traditionally been reserved for patients in a rehabilitation setting. Information regarding the use of coma stimulation in the intensive care setting is limited. An individualized coma stimulation program in the early stages of recovery from brain injury is paramount in stimulating the reticular activating system and promoting brain reorganization.

Dermal lymphoplasmacytic/lymphoplasmacytoid lymphoma (immunocytoma) in a 40-year-old man.

The skin may be the site of origin of a lymphomatous process or it may be secondarily involved as a systemic manifestation of a lymphoma arising in an extradermal (extracutaneous) site. Dermal lymphomas are difficult to recognize and differentiate from non-specific chronic dermatitis. Several histologic features have been proposed to help in differentiating between benign and malignant lymphoid dermal infiltrates.

Staphylococcus aureus endocarditis at a community teaching hospital, 1980 to 1991. An analysis of 106 cases.

Background: The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital.

Health status among elderly Hungarians and Americans.

Selected health status data for elderly populations from similar industrial cities-Youngstown, Ohio, USA, and Debrecen, Hungary-were compared. Because of their impoverished health care system, unregulated heavily industrialized society, and unhealthful life-styles Hungarians were hypothesized to have poorer health status than Americans, even after taking into account demographic mediating factors. The study provides a health status baseline for elderly Hungarians shortly after communism's fall in 1989-1990 and shows how great a gap exists between Hungarian health status and that in the West.

Name that tone. The proliferation of alarms in the intensive care unit.

The proliferation of alarms on equipment in ICUs contributes to a level of noise that can disturb both patient and staff. To determine whether these alarms are identifiable by sound alone to our ICU staff, we recorded 33 audio signals commonly heard on the ward, 10 of which we defined as critical alarms. One hundred subjects (25 physicians, 41 nurses, and 34 respiratory therapists) listened individually in a quiet room to the tape recording that consisted of 10 s of audible followed by a 10-s pause for a written response.