Resection of lateral temporal lobe arteriovenous malformations.

Background: Cerebral arteriovenous malformations (AVMs) can be formidable lesions to treat. There are four modalities available for treatment: expectant management, radiosurgery, embolization, and microsurgery. In order to make a decision about treatment, the surgeon must consider the natural history of the lesion versus the rate of treated morbidity and mortality.

Efficacy and safety of higher dose stereotactic radiosurgery for functional pituitary adenomas: a preliminary report.

Objective: Single fraction stereotactic radiosurgery (SRS) is a common adjuvant therapy for hormonally active pituitary adenomas when surgical resection fails to control tumor growth or normalize hypersecretory activity. Marginal doses of 20-24 Gy are used at many centers and here we report our outcome data in patients treated with a higher marginal dose of 35 Gy.

Methods: Thirty-one patients with secretory pituitary adenomas (adrenocorticotropic hormone, n = 15; growth hormone, n = 13; prolactin, n = 2; thyroid-stimulating hormone, n = 1) were treated with 35 Gy to the 50% isodose line, and had a mean follow-up time of 40.

Paramedic attitudes regarding prehospital analgesia.

Introduction: Although pain is a major reason why patients summon emergency medical services (EMS), prehospital medical providers administer analgesic agents at inappropriately low rates. One possible reason is the role of EMS provider attitudes.

Objective: This study was conducted to elicit attitudes that may act as impediments or deterrents to administering analgesia in the prehospital environment.

Hispanic older adults' osteoarthritis pain communication.

Better understanding of how Hispanic older adults describe their chronic pain might suggest ways to support Hispanic older adults to talk about important pain information with their practitioner. The study aim was to describe how Hispanic older adults communicate pain information, including the amount of pain information and communication processes employed. A secondary analysis with a descriptive design was used.

Loeys-Dietz syndrome: cardiovascular, neuroradiological and musculoskeletal imaging findings.

Loeys-Dietz syndrome (LDS) is an increasingly recognized autosomal-dominant connective tissue disorder with distinctive radiological manifestations, including arterial tortuosity/aneurysms, craniofacial malformations and skeletal abnormalities. LDS exhibits a more aggressive course than similar disorders, such as Marfan or the vascular subtype of Ehlers-Danlos syndrome, with morbidity and mortality typically resulting from complications of aortic/arterial dissections. Early diagnosis, short-interval follow-up imaging and prophylactic surgical intervention are essential in preventing catastrophic cardiovascular complications.

Morphometric analysis of posterior fossa after in utero myelomeningocele repair.

Object: Myelomeningocele (MMC) is characterized by a defect in caudal neurulation and appears at birth with a constellation of neuroanatomical abnormalities, including Chiari malformation Type II. The authors investigated the effects of antenatal versus postnatal repair of MMC through a quantitative analysis of morphometric changes in the posterior fossa (PF).

Methods: The authors retrospectively reviewed the records of 29 patients who underwent in utero MMC repair, 24 patients who underwent postnatal repair, and 114 fetal and pediatric controls.

Needle-entry angle for lumbar puncture in children as determined by using ultrasonography.

Objective: The purpose of this study was to evaluate the angle for performing lumbar punctures in children aged 0 to 12 years. We hypothesized that the angle changes for different stages of development.

Methods: Children aged 0 to 12 years who presented to the Yale-New Haven Children's Hospital at a low-acuity triage level, in need of a lumbar puncture, their accompanying siblings and authors' children were eligible for the study.

Percutaneous right ventricular support during catheter ablation of intra-atrial reentrant tachycardia in an adult with a mustard baffle--a novel use of the Impella device.

Late sequelea following a Mustard operation for transposition of the great arteries (TGA) include atrial arrhythmias and dysfunction of the systemic right ventricle. Catheter mapping and ablation of atrial tachycardia in the setting of significant right ventricular dysfunction may result in hemodynamic compromise. We report the novel use of the Impella percutaneous microaxial flow pump to support cardiac output in an adult patient with a Mustard operation for TGA who experienced a cardiac arrest during a prior ablation attempt.

Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest.

The application of Advanced Cardiac Life Support (ACLS) in severe hypothermic cardiac arrest remains controversial. While the induction of mild hypothermia has been shown to improve outcomes in patients already resuscitated from cardiac arrest, it is unknown whether ACLS protocols are effective during the resuscitation of the severely hypothermic cardiac arrest patient. We describe a case of a 47-year-old man who was successfully resuscitated from a ventricular fibrillation (VF) arrest with a core body temperature of 26.

Metabolic adverse events in patients with mental illness treated with antipsychotics: a primary care perspective.

Background: Individuals with mental illness are at a higher risk of medical mortality than the general population, primarily due to an increased risk of cardiovascular disease. There are a number of modifiable metabolic risk factors associated with some atypical antipsychotics that warrant careful monitoring and treatment in both psychiatric and primary care practice if the risk of cardiovascular disease is to be effectively reduced.

Data Sources: Previous guidelines have focused on awareness of metabolic risk factors in psychiatry, yet few articles have appeared in the primary care-focused journals.

Perforated viscus in a patient with non-small cell lung cancer receiving bevacizumab.

Bowel metastasis and perforation in patients with non-small cell lung cancer is rare. Bevacizumab has emerged as a new therapy in the treatment of metastatic non-small cell lung cancer. Bowel perforation associated with its use has been described in colon and ovarian cancers.

The fentanyl HCl patient-controlled transdermal system (PCTS): an alternative to intravenous patient-controlled analgesia in the postoperative setting.

Inadequate pain control in the postoperative period not only contributes to patient discomfort, but also causes physiological changes that may result in increased risk of myocardial ischaemia, deep vein thrombosis and pulmonary embolism. These events complicate postoperative recovery and may lead to longer hospital stays as well as increased healthcare costs. Patient-controlled analgesia (PCA) has emerged as an effective way for patients to manage their pain, allowing self-administration of small doses of analgesics to maintain a certain level of pain control.

Teaching telemetry.

For patients on telemetry monitoring, knowledge is power--and comfort. You can develop informative tools to help critical care nurses put these patients at ease.

Effect of diabetes mellitus and insulin use on survival after acute myocardial infarction in the elderly (the Cooperative Cardiovascular Project).

Using data from a retrospective cohort study of Medicare beneficiaries hospitalized with an acute myocardial infarction (AMI), we evaluated the role of diabetes mellitus on 30-day and 1-year mortality. We classified subjects as nondiabetics, diabetics controlled with diet alone, diabetics receiving an oral hypoglycemic agent, and diabetics on insulin at time of admission. We compared baseline admission characteristics of subgroups using chi-square and Wilcoxon rank-sum tests and evaluated the effect of each diabetic state using sequential logistic models.

The burn camp experience: variables that influence the enhancement of self-esteem.

Since 1982, there have been summer camps for children and adolescent burn survivors. Although the primary focus of camp is to have "fun," the principal goal is psychosocial readjustment through peer interactions and the resulting enhancement of self-esteem (SE). This study was initiated to test the hypothesis that the burn camp experience enhances the SE of campers.

Oral-maxillary sinus fistula (oroantral fistula): clinical features and findings on multiplanar CT.

Objective: Oroantral fistula, an abnormal communication between the oral cavity and the maxillary sinus, is infrequently diagnosed radiologically. The purpose of this study was to describe the CT findings and clinical features of oroantral fistula and to show that dental CT multiplanar reformatting programs can be instrumental in diagnosing this condition.

Subjects And Methods: The study included eight patients with clinically confirmed oroantral fistula or with radiologic evidence of oroantral fistula.