Positional vomiting due to a thoracic spinal dural arteriovenous fistula. Case report.

The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related to venous hypertension, and spinal MR imaging revealed markedly dilated veins along the dorsal aspect of the cord. Spinal angiography confirmed the presence of a thoracic spinal DAVF.

Fits, faints and funny turns. Could it be a mental disorder?

Background: Patients who present to primary care with symptoms of fainting and dizziness, for which there is no adequate physical explanation, are frequently suffering from an undiagnosed psychiatric disorder.

Objective: This article aims to improve the recognition of common mental disorders presenting as 'fits, faints and funny turns' (FFFTs) and to encourage general practitioners to view these disorders as a positive diagnosis in need of treatment.

Discussion: Psychiatric disorders, particularly panic attacks and depression, are common in the setting of FFFTs and should be a positive diagnosis rather than a diagnosis of exclusion.

Evidence and leadership: the tools for change.

Evidence based practice is seen to be a vehicle through which nurses can deliver more cost-effective care and improve patient outcomes. Despite this, however, 'evidence' does not always appear to influence policy and practice. Routine and traditional practices such as pre-operative fasting protocols seem particulary resistant to change.

Hydroxyapatite-coated total hip replacements in patients 65 years of age and over.

Prospective review examined 69 patients aged over 65 years (mean: 73 years; range: 65 to 85 years) who underwent 72 primary hydroxyapatite-coated total hip replacements by one surgeon. The femoral component used was titanium alloy coated by hydroxyapatite on the proximal third and the acetabular component was spherical and unthreaded, coated with hydroxyapatite. All patients were evaluated clinically by Harris Hip Score and radiologically using Engh's criteria with a mean follow-up of 86 months (range: 29 months to 10 years).

The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya.

The authors of this paper describe the second phase of the implementation of the Mosoriot Medical Record System (MMRS) in a remote health care facility on the outskirts of Eldoret, Kenya, located in sub-Saharan Africa. We describe of the collaboration between Indiana University (IU) and the Moi University (MU), and the process that led to the development of the computer-based Mosoriot Medical Record System (MMRS) is provided. We then provide the conceptualization and initial implementation of this basic electronic medical record system.

Hydroxyapatite-coated total hip replacement in Paget's disease: 20 patients followed for 4-8 years.

20 patients, who had had total hip replacements for symptomatic osteoarthrosis secondary to Paget's disease, were followed for a mean of 6 (4-8) years. Proximal hydroxyapatite-coated stems were implanted in all patients. 12 patients received hydroxyapatite-coated, 2 cemented (Muller type) and 6 cementless cups (Morsher type).

Nurses' perception and experiences of advocacy.

This small qualitative research study, undertaken for a Bachelor (Honours) Course, was aimed at discovering nurses' perceptions and experiences of advocacy, through focused, in-depth interviews. Thematic analysis identified seven major themes: advocacy as a moral obligation, knowing the patient, triggers to becoming an advocate, considering the consequences, the difficulties of advocating, becoming an effective advocate and outcomes of advocacy. When further examined, these themes suggested that advocacy is a process rather than an event.

The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya.

Mosoriot Health Center is a rural primary care facility situated on the outskirts of Eldoret, Kenya in sub-Saharan Africa. The region is characterised by widespread poverty and a very poor technology infrastructure. Many houses do not have electricity, telephones or tap water.

Analgesia following major gynecological laparoscopic surgery--PCA versus intermittent intramuscular injection.

Background And Objectives: To compare the use of patient-controlled analgesia to intermittent intramuscular injections of morphine following major gynecological laparoscopic procedures in order to assess differences in level of pain, sedation, episodes of nausea and/or vomiting, hospitalization time and patient satisfaction with their postoperative analgesia.

Methods: Seventy-two patients undergoing major gynecological laparoscopic surgery were randomized to receive either postoperative analgesia via intermittent intramuscular injection of morphine (Group 1) or patient controlled analgesia (PCA-Group 2). All patients received anesthesia via a standardized protocol.

Methods of creating pneumoperitoneum: a review of techniques and complications.

The existence of numerous techniques for the creation of pneumoperitoneum at laparoscopy indicates that none have been proven totally efficacious or complication free. These methods include the standard technique of insufflation after insertion of the Veress needle via the umbilicus or less commonly via the transfundal or transforniceal routes, open laparoscopy involving dissection through the linea alba and opening of the peritoneum under direct vision, and direct trocar insertion as well as variations on these techniques. After reviewing the methods available and surveying the existing data concerning the rates of failure and complications, we conclude that no single technique can claim to be overwhelmingly superior, and that laparoscopists should, therefore, acquaint themselves with at least two of these techniques.

Skin closure at laparoscopy.

Study Objective: To discern the best method of wound closure after laparoscopy based on patient acceptability of pain, complications, and cosmetic result.

Design: Randomized, prospective study.

Setting: A university-affiliated hospital.