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McNulty, Eric J. Gaughan, Melanie B. Elliott, and Ronald Tuma. Rahman, Rebecca Margolis, and Savannah Coe. John H. Gibbon Jr. Talamini, MD. McClowry, MD. J-wave syndromes: Brugada and early repolarization syndromes.

Kallikrein family proteases KLK6 and KLK7 are potential early detection and diagnostic biomarkers for serous and papillary serous ovarian cancer subtypes. Ketamine for the treatment of depression in patients receiving hospice care: a retrospective medical record review of thirty-one cases.

Hirst, and Scott A. Language barriers to informed consent for dermatologic interventions. LEAD 2. Locomotor adaptation is influenced by the interaction between perturbation and baseline asymmetry after stroke. Tyrell, Erin Helm, and Darcy S. Long-term clinical outcome of peripheral nerve stimulation for chronic headache and complication prevention , Linqiu Zhou, Avi Ashkenazi, Joseph W.

Smith, Na Jen, Timothy R. Deer, and Chen Zhou. Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein. Skidmore, and Michael R. Long-term oncological outcomes of a phase II trial of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localised, high-risk prostate cancer.

Silberstein, Stephen A. Poon, Daniel D. Sjoberg, Alexandra C. Maschino, Andrew J. Vickers, Aaron Bernie, Badrinath R. Case, Sean-Paul G. Williams, Jennifer A. Stancati, Lianteng Zhi, Maria E. Rubio, Caryl E. Sortwell, Timothy J. Collier, David Sulzer, Robert H. Edwards, Hui Zhang, and Rebecca P. Manoff, MD. Malcolm C. Kamran Athar, MD. Wenzel, Eric S. Schwenk, Jaime L. Baratta, and Eugene R. Mechanisms of activation of nucleus accumbens neurons by cocaine via sigma-1 receptor-inositol 1,4,5-trisphosphate-transient receptor potential canonical channel pathways.

Abood, Ellen M. Unterwald, and Eugen Brailoiu. Mechanisms of immunological tolerance in central nervous system inflammatory demyelination. Mari, Jason N. Moore, Guang-Xian Zhang, and A. Iozzo, and Andrea Morrione. Altshuler; Adam P. Isenberg, MD; and Scott W. Rothman, James J. Purtill, and Michael Howley.

Meet the Interns. Mesial temporal lobe epilepsy with childhood febrile seizure. Gong, MD; and Ubaldo E. Martinez-Outshoorn, MD. De Cotiis; Norman G. MicroRNA dysregulation and esophageal cancer development depend on the extent of zinc dietary deficiency. Pitcher, Nicholas C. Cavarocchi, and Hitoshi Hirose. Minimal exposure intra-arterial chemotherapy for children with retinoblastoma and 13q syndrome. MiRNA increases therapeutic sensibility to gemcitabine treatment of pancreatic adenocarcinoma cells.

Latona, Kathleen M. Lamb, Michael J. Pucci, Warren R. Maley, and Charles J. Molecular treatment effects of alemtuzumab in skeletal muscles of patients with IBM. Monitoring brown fat metabolic activity using microwave radiometry: antenna design and frequency selection , Dario B. Stauffer, and Paolo F. Morphological assessment of the retina in uveitis.

Altaweel, Sapna S. Gangaputra, Jennifer E. Thorne, James P. Dunn, Susan G. Elner, Glenn J. Jaffe, Rosa Y. Kim, P. Kumar Rao, Susan B. Reed, and John H. Multi-focal control of mitochondrial gene expression by oncogenic MYC provides potential therapeutic targets in cancer. Oran, Clare M.

Gennaro, Harla K. Pfeiffer, Hestia S. Mellert, Hans E. Arnold, Suresh D. Sharma, Ubaldo E. Martinez-Outshoorn, Christopher R. Vakoc, Lewis A. Chodosh, James E. Thompson, James E. Bradner, Craig E. Cameron, Gerald S. Shadel, Christine M.

Eischen, and Steven B. Multiplatform molecular profiling identifies potentially targetable biomarkers in malignant phyllodes tumors of the breast. Palazzo, Sandeep Reddy, and Barbara Pockaj. Multi-scale analyses of molecular network dynamics underlying neuronal excitability, neuroinflammation, and organismal homeostasis , Warren D Anderson.

Bigman, Amy E. Leader, Caryn Lerman, and Joseph N. Franson, PhD, PharmD. Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant. Kraft, Megan W. Stover, and Jonathan M. Network analysis of circular permutations in multidomain proteins reveals functional linkages for uncharacterized proteins.

Network-based stratification analysis of 13 major cancer types using mutations in panels of cancer genes. Neural crest cell-autonomous roles of fibronectin in cardiovascular development. Neuroimaging in Integrative Psychiatry , Andrew B. Newberg, MD. Neuromodulation , Stephen Silberstein. Newborn Examination , Amber S. Weissfeld, MD; and Timothy Bober. New functions for alpha-catenins in health and disease: from cancer to heart regeneration.

Next Generation Payer Strategies. Nitrilase 1 modulates lung tumor progression in vitro and in vivo. Nociceptive neuropeptide increases and periorbital allodynia in a model of traumatic brain injury. Elliott, Michael L. Oshinsky, Peter S. Amenta, Olatilewa Awe, and Jack I. Non-psychotropic cannabinoid based therapy modulates nociceptive signaling molecules, microglia, and pain behavior in a model of post-concussion headache , Jarred M. Tyburski, Jessica Perino, and Melanie B.

Nonthermal atmospheric pressure plasma enhances mouse limb bud survival, growth, and elongation. Novel actions of next-generation taxanes benefit advanced stages of prostate cancer. Berman-Booty, Matthew J. Dicker, William Kelly, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella, and Karen E. Viswanathan, Jennifer Moughan, Brigitte E. Bosch, Ursula A. Matulonis, Neil S. Horowitz, Robert S S. Mannel, Luis Souhami, Beth A. Erickson, Kathryn A. Winter, William Small, and David K. Numerical investigation of novel microwave applicators based on zero-order mode resonance for hyperthermia treatment of cancer , David Vrba, Jan Vrba, Dario B.

Rodrigues, and Paul R. Blomain, Gilbert W. Snook, Tingting Zhan, Terry M. Hyslop, Michal Tomczak, Richard S. Blumberg, and Scott A. Oncogene-induced Nrf2 transcription promotes ROS detoxification and tumorigenesis. DeNicola, Florian A. Karreth, Timothy J. Yu, Charles J. Yeo, Eric S. Calhoun, Francesca Scrimieri, Jordan M. Winter, Ralph H. On the Job: Velvet Cain. On voxel-by-voxel accumulated dose for prostate radiation therapy using deformable image registration.

Bender, Mark A. Ritter, and Wolfgang A. Optimal unified combination rule in application of Dempster-Shafer theory to lung cancer radiotherapy dose response outcome analysis , Yanyan He, M. Rodrigues, Mark D. Hurwitz, Paolo F. Maccarini, and Paul R. Rabinowitz, MD. Organophosphate retinopathy , Hang Pham, Michelle D.

Lingao, Anuradha Ganesh, Jenina E. Capasso, Rosanne Keep, Karthikeyan A. Sadagopan, and Alex V. Vaccaro, Eli Baron, Terrence T. Kim, and J. Patrick Johnson. Outdated dermatologic drug samples and obligations to the patient. Ovarian leydig cell hyperplasia: an unusual case of virilization in a postmenopausal woman. Miller, Anthony J. Cannon, Stacey K. Mardekian, Lawrence C.

Kenyon, and Serge A. Gilliam, PharmD. Overview of bladder heating technology: matching capabilities with clinical requirements. Stauffer and Gerard C. Secrist, Kevin B. Freedman, Michael G. Ciccotti, Donald W. Mazur, and Sommer Hammoud. Panel Discussion: All Together Now? Parametric mapping of contrasted ovarian transvaginal sonography.

Parental and staff perspectives of NICU research procedures. Patient historical risk factors associated with seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy. Rising, MD, MS. People in the News. Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study.

Pessary versus cerclage versus expectant management for cervical dilation with visible membranes in the second trimester. Rochelson, and Vincenzo Berghella. Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults , Tess E.

Cooper, Ian R. Hambleton, Samir K. Ballas, and Philip J. Falchook, Sarina A. Piha-Paul, Jennifer J. Wheler, David S. Hong, Apostolia M. Tsimberidou, Vivek Subbiah, Ralph G. Zinner, Ahmed O. Kaseb, Shreyaskumar Patel, Michelle A. Fanale, Vivianne M M. Pipeline Programs. Jernigan, Alessandro Fatatis, and Marcelo G. Gamma Knife. Andrews MD; James J. Polypharmacy in the Older Adult , Bhavik M. Population average T2 MRI maps reveal quantitative regional transformations in the degenerating rabbit intervertebral disc that vary by lumbar level.

Population Health Matters Fall , Download issue. Population Health Matters Spring , Vol. Postoperative intussusception in year-old presenting as decreased intestinal motility , Arielle Spellun, Loren Berman, and Stephen Murphy. Post-transcriptional modifications to tRNA--a response to the genetic code degeneracy. Practical management of anticoagulation in patients with atrial fibrillation.

Preclinical characterization of DUOC, a cell therapy product derived from banked umbilical cord blood for use as an adjuvant to umbilical cord blood transplantation for treatment of inherited metabolic diseases. Gaspar, Patrick M. Kane, Dechporn Putthiwara, Sidney M. Jacoby, and A. Lee Osterman. Rovner and Robin J. Pressure to publish for residency applicants in dermatology , Jordan V.

Wang and Matthew S. Luginbuhl; William M. Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial. Rodriguez, Robert P. Brislin, Kirk W. Reichard, Suken A. Dabney, William G. Mackenzie, Douglas A. Katz, and Thomas H. Protein-coupled receptor kinase 5 exacerbates cardiac pathology through activation of the nuclear factor of activated T cells pathway , Jonathan E Hullmann.

Purwin, Michael A. Davies, and Andrew E. Racemose neurocysticercosis. Radiation protection of the gastrointestinal tract and growth inhibition of prostate cancer xenografts by a single compound. Williams, Andrew Pridjian, and Robert Den. Radiotherapy for iris metastasis from esophageal carcinoma: A series of three cases. Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines.

Gimovsky and Vincenzo Berghella. Ruby, MD. Anstrom, Kirkwood F. Adams, Lawton S. Cooper, Justin A. Januzzi, Eric S. Leifer, Daniel B. Whellan, and Christopher M. Recent 'advances' in breast and ovarian cancer genetics , Katherine L. Nathanson, MD. Reducing medication related falls: A study of medication timing, medication reconciliation and falls reduction in an acute care hospital.

Reduction of CTRP9, a novel anti-platelet adipokine, contributes to abnormal platelet activity in diabetic animals. Kirshblum, Trevor A. Morse, and Daniel E. Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy. Rabiei, Edward J. Gracely, and Michael R. Resting-state functional connectivity predicts the strength of hemispheric lateralization for language processing in temporal lobe epilepsy and normals.

Return to work after stroke: a nursing state of the science. Reverse genetics of Mononegavirales: How they work, new vaccines, and new cancer therapeutics. Kaiser, Ph. Role of pars plana vitrectomy and membrane peel in vitreomacular traction associated with retinal vasoproliferative tumors.

Merli, MD; and Luis H. Eraso, MD. Levine, Jay Schulkin, Brian M. Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease. Ballas and David Lyon. Feldstein, MD; Robert D. Adamo, MD; Carin F. Salvage brachytherapy in combination with interstitial hyperthermia for locally recurrent prostate carcinoma following external beam radiation therapy: a prospective phase II study. Sarcoidosis activates diverse transcriptional programs in bronchoalveolar lavage cells.

Barna, Mani S. Kavuru, Lynn M. Schnapp, and Mary Jane Thomassen. SciTech News Volume 70, No. Marks, MD; Scott W. Segment and fit thresholding: a new method for image analysis applied to microarray and immunofluorescence data.

Calderone, Galen Hostetter, Jordan M. Winter, David Cherba, Randall E. Brand, Peter J. Allen, Lorenzo F. Sempere, and Brian B. Seizure clusters in drug-resistant focal epilepsy. Seizure outcome after switching antiepileptic drugs: A matched, prospective study. Skidmore, and Scott Mintzer. Semiological classification of psychogenic nonepileptic seizures. Sepsis , Kelly A. Lopez, MD. RFA Registry. Bulsiewicz, Richard I.

Camara, Evan S. Dellon, George Triadafilopoulos, Charles J. Lightdale, Ryan D. Madanick, William D. Lyday, Raman V. Muthusamy, Bergein F. Overholt, and Nicholas J. Shape and position of the node and notochord along the bilateral plane of symmetry are regulated by cell-extracellular matrix interactions. Silencing of GUCY2C through loss of guanylin expression is a necessary step in colorectal tumorigenesis and therapeutic target for chemoprevention , Erik S Blomain. Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score.

Keith, and Hitoshi Hirose. Schwaber, and Rajanikanth Vadigepalli. Social competence in pediatric brain tumor survivors: application of a model from social neuroscience and developmental psychology. Sound Sleep: Research shows we need less as we age but quality could be tied to dementia , Erin Arvedlund. Conklin; Devon M. Raunig; Scott H. Faro; Pallav N. Delalic; M. Mulcahey; and Feroze B. Dixon MA. Panakos, MD; and Gregary D. State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals.

Stratification of a population of intracranial aneurysms using blood flow metrics. Harbaugh, David Hasan, Robert H. Rosenwasswer, Christopher S. Ogilvy, and Madhavan L. Luginbuhl, MD; Ubaldo E. McCue, Edouard J. Student Group Activity. Suppression of progranulin expression inhibits bladder cancer growth and sensitizes cancer cells to cisplatin.

Peiper, Leonard G. Gomella, Antonino Belfiore, Peter C. Black, Renato V. Evans III, M. Symptom Clusters. Table of Contents. Afonso, Die Liu, Daniel R. Machado, Huihui Pan, James E. Jepson, Dragana Rogulja, and Kyunghee Koh. Teaching health advocacy to medical students: a comparison study. Agarwal, David F. Gaieski, Sarah M. Abella, and Brendan G. Conte Jr. Patel, Robert H. Brophy, Rajiv Gandhi, Hue H. The 25th Annual Dr. Grandon Lecture.

Riall, MD, PhD. The Airway Microbiome at Birth. Siracusa and Karen M. The effects of CEP, an inhibitor of focal adhesion kinase, in vitro and in vivo on inflammatory breast cancer cells. The effects of test-enhanced learning on long-term retention in AAN annual meeting courses.

The endogenous cell-fate factor dachshund restrains prostate epithelial cell migration via repression of cytokine secretion via a cxcl signaling module. Lisanti, Chenguang Wang, Richard J. Davis, Graeme Mardon, and Richard Pestell. The evolution of epilepsy surgery between and in nine major epilepsy centers across the United States, Germany, and Australia.

The functional roles of arrestin domain-containing protein 3 in regulating G protein-coupled receptor trafficking and signaling , Xufan Tian. The H. Torigian, John B. Hotez, Thomas R. Klei, Sara Lustigman, and David Abraham. AlHazmi, MD. The impact of mindfulness on the quality of parenting behaviors and reported parental stress of newly parenting mothers in medication assisted treatment for opioid dependence: Results and policy implications for federal spending , Meghan Gannon.

The interactions of alcohol, sex, and stress , Tara A Retson. The landscape of pancreatic cancer therapeutic resistance mechanisms , Saswati N. Evans, Karen E. Knudsen, Michelle T. Paulsen, Mats Ljungman, Theodore S. Lawrence, Arul M. Chinnaiyan, and Felix Y. Rivadeneira, M. Kossenkov, Lucia R. Languino, and Dario C. Then and now: the progress in hepatitis B treatment over the past 20 years.

The paradox of the serrated sickle erythrocyte: The importance of the red blood cell membrane topography. Ballas and Philippe Connes. Arfaa PhD. Learning from the Past, Present, and toward a brighter future! The public health crisis in Greece and its ties to a failing economy , Anna M. Therapeutic modulation of the tumor-promoting immune type 2 microenvironment in malignant glioma by the induction of a type 1 response to attenuated rabies virus , Emily K Bongiorno.

The relationship between body positioning, muscle activity, and spinal kinematics in cyclists with and without low back pain , Gabriel Streisfeld, SPT; Caitlin E. The retinal determination gene network: from developmental regulator to cancer therapeutic target. Pestell, Kongming Wu, and Gaosong Wu. The rise and fall of poly ADP-ribose : An enzymatic perspective. Pascal and Tom Ellenberger. Fried, PhD; Michael L. Thermal dosimetry for bladder hyperthermia treatment.

An overview. Geijsen, Josefin Hartmann, Maarten C. Hulshof, H. Petra Kok, Margarethus M. Thermoluminescence study of Mn doped lithium tetraborate powder and pellet samples synthesized by solution combustion synthesis , A. Altunal, V. Ankam, MD; E. The role of perlecan and endorepellin in the control of tumor angiogenesis and endothelial cell autophagy.

The structure and regulation of Cullin 2 based E3 ubiquitin ligases and their biological functions. Avedschmidt, Anna M. Harocopos, Yali Dou, and Rajesh C. The transcription factor RUNX2 regulates receptor tyrosine kinase expression in melanoma. The tuberculosis necrotizing toxin kills macrophages by hydrolyzing NAD. The use of pharmacologic ascorbate in the treatment of hepatocellular carcinoma: mechanism of cytotoxicity and synergism with the multikinase inhibitor sorafenib , Lauren L Rouleau.

Bowman, Yang Du, Manojkumar A. Puthenveedu, Mark von Zastrow, and Jeffrey L. Joseph Hill. Time for an active antiviral therapy for hepatitis B: An update on the management of hepatitis B virus infection. Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

Reed, Matthew P. Briggs, Daniel E E. Polsky, Felicia L. Graham, Margaret T. Bowers, Sara C. Paul, Bradi B. Granger, Kevin A. Schulman, David J. Whellan, Barbara Riegel, and Wayne C. Transfusion medicine illustrated: Transfusion interference by cold agglutinins.

George and Jay Herman. Treatment of dental complications in sickle cell disease. Poser, MD. Trends in survival of chronic lymphocytic leukemia patients in Germany and the USA in the first decade of the twenty-first century. Tumor-associated stromal cells as key contributors to the tumor microenvironment.

Tumor bed brachytherapy for locally advanced laryngeal cancer: a feasibility assessment of combination with ferromagnetic hyperthermia , Paul R. Stauffer, Ilya L. Vasilchenko, Aleksey M. Osintsev, Dario B. Goldberg, MD; P. Prior; and Amity L. Isenberg, MD. Type of preoperative aura may predict postsurgical outcome in patients with temporal lobe epilepsy and mesial temporal sclerosis.

Understanding infection prevention and control in nursing homes: A qualitative study. Stone, Carolyn T. Bjarnadottir, Patricia K. Semeraro, Catherine C. Cohen, Jasmine Travers, and Steven Schweon. Understanding nucleus pulposus cell phenotype: a prerequisite for stem cell based therapies to treat intervertebral disc degeneration. Johnson, and Makarand V. Use of mediation analysis to evaluate the role of adherence on the comparative effects of atypical antipsychotics in schizophrenia , John Michael Fastenau.

Awsare, M. Jackson, Jr. Rodrigues, and Paolo F. Jacoby, and Eon K. Water Crisis in Vietnam , Jordan M. What are the characteristics that explain hospital quality? A longitudinal Pridit approach , Robert D. Lieberthal and Dominique M. Buehler, MD. Brody, PhD. What's in it for me? Where are we now and what is the future of obstructive sleep apnea surgery?

Who Makes the Call? Lam; and Amity L. Zika virus-associated seizures , Ali Akbar Asadi-Pooya. Zinc intake, microRNA dysregulation, and esophageal cancer. Fong, John Farber, and Carlo M. Dicker, Roger J. Altieri, and Lucia R. Advanced Search. Privacy Copyright. Anthony Seibert, PhD PDF A case-control genome-wide association study identifies genetic modifiers of fetal hemoglobin in sickle cell disease. Stickle, MD Link Analysis of thyroid malignant pathologic findings identified during 3 rounds of screening of a cohort of children and adolescents from belarus exposed to radioiodines after the Chernobyl accident.

Snow PDF A novel comparative pattern analysis approach identifies chronic alcohol mediated dysregulation of transcriptomic dynamics during liver regeneration. Lombardi; and Vittorio Maio, PharmD, MSPH Link Aspartate aminotransferase to platelet ratio index as a prospective predictor of hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection. Waldman and Andre Terzic Link Biology of advanced uveal melanoma and next steps for clinical therapeutics.

Sharkey Link CCR5 receptor antagonists block metastasis to bone of v-Src oncogene-transformed metastatic prostate cancer cell lines. Khouri PDF Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies.

Ballas, and Mariane de Montalembert PDF Consecutive bilateral decompression retinopathy after mitomycin C trabeculectomy: a case report. Iozzo and Thomas Neill Link Cost-effectiveness of a community-integrated home-based depression intervention in older African Americans. Karakousis, and Rajesh Aggarwal PDF Development, assessment, and evolution of an interprofessional activity with senior nursing and pharmacy students: application of quality improvement in interprofessional education IPE , Michelle R.

Eisenbrey Link Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine. Jaynes and Miki Fujioka Link Dr. Guilarte PDF Effects of diabetes mellitus and chronic kidney disease on major outcomes in patients undergoing cardiac surgery , Mark W. Sperling PDF Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic.

Rosenwasswer MD, and Lorraine Iacovitti Link Functional connectivity evidence of cortico-cortico inhibition in temporal lobe epilepsy. Rodrigues PDF Hyperthermia, radiation and chemotherapy: the role of heat in multidisciplinary cancer care. Sperling PDF Ictal kissing: occurrence and etiology. Fletman PDF Ictal pain: occurrence, clinical features, and underlying etiologies.

Jimenez Link Increased microstructural white matter correlations in left, but not right, temporal lobe epilepsy. Fotsing PDF Language barriers to informed consent for dermatologic interventions. Sperling PDF Long-term oncological outcomes of a phase II trial of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localised, high-risk prostate cancer.

Palazzo, MD PDF Mechanisms of activation of nucleus accumbens neurons by cocaine via sigma-1 receptor-inositol 1,4,5-trisphosphate-transient receptor potential canonical channel pathways. Unterwald, and Eugen Brailoiu PDF Mechanisms of immunological tolerance in central nervous system inflammatory demyelination. McMahon PDF Multiplatform molecular profiling identifies potentially targetable biomarkers in malignant phyllodes tumors of the breast. Aplin PDF Nitrilase 1 modulates lung tumor progression in vitro and in vivo.

Five months following the initial hospitalisation the patient was nearly in full recovery with respect to her cardiac function and biochemically there were no signs of Cushing's syndrome. Interventional cardiology live case presentations : regulatory considerations. Live case presentations are increasingly common at interventional cardiology conferences. Taking advantage of significant advances in communication technology, broadcasts of procedures can be viewed as an extension of traditional medical education targeted to large groups of practitioners.

However, there are important ethical, commercial, and patient safety issues associated with live cases that deserve attention. Use of investigational devices in live case demonstrations is subject to review and approval by FDA's Center for Devices and Radiological Health CDRH , and the outcomes of patients participating in live cases are considered in the overall clinical study results.

This article discusses CDRH's regulatory view of live case presentations with a focus on patient safety, clinical trial integrity, and concerns regarding improper medical device promotion. Interventional cardiology live case presentations regulatory considerations. Published by Elsevier Inc. A case of a power failure in the operating room. In the operating room, safely administering anesthesia amidst a major power failure can instantly present one with a formidable challenge.

A case is presented involving a year-old healthy woman who underwent a complex oral and maxillofacial surgery to correct a dentofacial deformity. Three hours into the case and with the patient's maxilla downfractured, the overhead surgical lights blacked out, and there was an apparent loss of the anesthesia machine's ability to function.

Providing adequate oxygenation, ventilation, anesthesia levels, monitoring of vital signs, and transportation of the patient were some of the challenges faced, and the response to this unexpected event is recounted. The importance of one's familiarity with an anesthesia machine's backup battery supply, routinely checking machinery, ensuring that appropriate and sufficient supplies are readily available, exercising calm leadership with clear communication, and formulating a clear plan with backup alternatives are discussed.

Various recommendations are proposed with respect to the preparation for and the prevention of a power failure in the operating room. This report's account of events is aimed to "shed some light" on this topic, serve as a check of one's own preparedness, and facilitate the optimal management of a similarly unexpected incident.

Intravascular large B-cell lymphoma presenting with anasarca-type edema and acute renal failure. Intravascular lymphoma IVL is a rare extra nodal subtype usually of B-cell origin presenting with infiltration of large neoplastic lymphocytes into lumina of blood vessels, leading to vascular occlusion.

The early diagnosis is very crucial, however it is usually diagnosed postmortem investigation in most of the cases. A year-old female presented with elevated creatinine level, and anasarca-type edema that superimposed with hard, indurated, erythematous plaques extending to inguinal region, abdomen, anterior aspect of chest, and face.

B-cell IVL was confirmed with skin biopsy. The patient had some degree of clinical improvement following chemotherapy. B-cell IVL presenting with anasarca edema was not previously reported in the literature. Even if its rarity, IVL should be considered in the differential diagnosis of renal failure with anasarca edema.

Cameron, M. Laplace-like resonances among Ganymede, Europa, and Io may have once led Ganymede to have an eccentricity as high as 0. For the present -day model, we assume a spherical ice shell of thickness km upper 10 km is cold, stiff ice , underlain by a 40 km deep global subsurface ocean. For the warmer past model, we assume a km ice shell upper 2 km is cold, stiff ice , and a km ocean.

We resolve normal and shear stress components onto discrete fault segments of specified orientation and assess Coulomb failure stress criteria along three previously inferred shear zones: Dardanus Sulcus, Tiamat Sulcus, and Nun Sulci. Models of stress contributions from only the diurnal tidal cycle are strongly dependent on eccentricity, while combined diurnal and NSR stress models are largely insensitive due to large MPa NSR stresses.

For the diurnal only model, failure is not expected for the present eccentricity along any of the three shear zones. For the past, high eccentricity case , failure is predicted in isolated diurnal slip windows and limited to very shallow depths Frostbite: an overview with case presentations.

Much of the interest in frostbite has arisen from various military experiences including the Korean war, World War II, and Napolean's battles in Russia and Poland. Historically frostbite has been not only a military problem, but also a problem in high-altitude climbers and the more recently investigated homeless population. However, the physician should not disregard frostbite as only victimizing the poor and indigent.

Anyone who is exposed to harsh winter conditions over a long period of time can suffer from frostbite. Many milder cases of frostbite presented to Cook County Hospital in Chicago were simply due to prolonged winter exposure when a motorist's care broke down.

The authors present a review of the variants, pathophysiology, classifications, predisposing factors, and treatment of frostbite. Intrapartum diagnostic of Roberts syndrome - case presentation. Roberts syndrome is a rare disease, with multiple limb and skeletal abnormalities called "pseudothalidomide disease". There are only around cases described in literature. We present a case of Roberts syndrome, diagnosed in moment of delivery, after a pregnancy without prenatal follow-up.

The stillborn baby was naturally delivered by a year-old primiparous woman at 38 weeks of amenorrhea. The pregnancy was not followed due to socioeconomic and family situation, and no prenatal ultrasound was performed. The male baby has g and presented several morphological abnormalities and tight double umbilical abdominal loop. The macroscopic evaluation showed: dolichocephaly, hypoplastic inferior maxilla with micrognathia, antimongoloid palpebral slant, pterygium colli, abnormal and lower implanted ears, superior limbs phocomelia, syndactyly at lower left limb and tetradactyly in all limbs, bilateral cryptorchidism, pancreatic aplasia.

Roberts syndrome is a rare genetic disease with recessive autosomal transmission generated by mutations in ESCO2 gene, located on chromosome 8. The disease should be easy to diagnose by antenatal ultrasound examination, but in our case , the lack of prenatal follow-up determined the diagnostic at term.

We believe consider this case is an argument towards introducing ultrasound-screening compulsory to all pregnancies. To identify a possible genetic mutation, further investigations of the parents are in progress, but classically the disease has a recessive autosomal transmission.

A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension PAH. Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature.

All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of Grave's disease. The treatment of Grave's disease, initially by medications and subsequently by radioiodine therapy, was associated with a significant reduction in the pulmonary artery systolic pressure. The purpose of this case report is to highlight one of the unusual and underdiagnosed presentations of Grave's disease.

Comprehension and retrieval of failure cases in airborne observatories. The research has resulted in the development of an experimental system that acquires knowledge of failure analysis from input text, and answers questions regarding failure detection and correction. The system's design builds upon previous work on text comprehension and question answering, including: knowledge representation for conceptual analysis of failure descriptions, strategies for mapping natural language into conceptual representations, case -based reasoning strategies for memory organization and indexing, and strategies for memory search and retrieval.

These techniques have been combined into a model that accounts for: a how to build a knowledge base of system failures and repair procedures from descriptions that appear in telescope-operators' logbooks and FMEA failure modes and effects analysis manuals; and b how to use that knowledge base to search and retrieve answers to questions about causes and effects of failures , as well as diagnosis and repair procedures.

A year-old woman presented in her first pregnancy was admitted with severe hyperemesis gravidarium. Increased nuchal translucency with cardiac anomaly and omphalocele at the first trimester was observed at the ultrasound examination. Chorionic villus biopsy confirmed triploidy. The combination of type I and type II triploidy patterns were seen together in the second trimester of the pregnancy.

Although the symptoms due to increased human chorionic levels occured, at the pathologic investigation there were no molar changes in the placenta. Here we report a case of uncommon presentation of triploidy. Epidemiology of invasive pulmonary aspergillosis in patients with liver failure : Clinical presentation , risk factors, and outcomes. Objective Invasive pulmonary aspergillosis IPA is a severe and often lethal infection. The possible risk factors, clinical presentation , and treatment of patients with simultaneous liver failure and IPA have received little attention in previous studies.

The aim of this study was to investigate the epidemiology of IPA in patients with liver failure in an effort to reduce patient mortality. Methods The patients with liver failure including acute liver failure , sub-acute liver failure , acute-on-chronic liver failure and chronic liver failure were recruited from to The clinical data of these patients were retrieved for the study. Results In total, patients with liver failure were included in this study.

Of the patients, 53 4. Conclusions IPA is a fatal complication in patients with liver failure. Male sex, hepatorenal syndrome, antibiotic use, and steroid exposure were independent risk factors for IPA. When patients with liver failure have these risk factors and symptoms of pneumonia such as cough or hemoptysis, clinicians should be cautious about the possibility of IPA.

The ABCs of managing systolic heart failure : Past, present , and future. Heart failure management is complex and constantly evolving. This review presents an evidence-based approach to current heart failure management.

Bartter syndrome Type III is a rare autosomal recessive disorder resulting from an inherited defect in the thick ascending limb of the loop of henle of the nephrons in kidney. The typical clinical manifestations in childhood are failure to thrive and recurrent episodes of vomiting.

Typical laboratory findings which help in the diagnosis are hypokalemic metabolic alkalosis, hypomagnesemia and hypercalciuria. We report a case of Type III Bartter syndrome not responding to repeated conventional treatment of failure to thrive. Central neurocytoma presenting with gigantism: case report. We report a case of central neurocytoma presenting with gigantism. The patient was a year-old man with a 2-year history of rapid growth.

Computed tomography revealed a round, slightly enhancing calcified tumor in the septal region. This lesion was resected, and postoperative radiotherapy was given. The preoperative serum growth hormone level was Pituitary dysfunction was not noted either before or after the operation.

A low level of production of growth hormone releasing factor was detected when tumor cells obtained during surgery were cultured. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning.

While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication.

We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning.

Norwegian crusted scabies: an unusual case presentation. Scabies is a contagious condition that is transmitted through direct contact with an infected person and has been frequently associated with institutional and healthcare-facility outbreaks.

The subtype Norwegian crusted scabies can masquerade as other dermatologic diseases owing to the heavy plaque formation. Successful treatment has been documented in published reports, including oral ivermectin and topical permethrin. A nursing home patient was admitted to the hospital for severe plaque formation of both feet. A superficial biopsy was negative for both fungus and scabies because of the severity of the plaque formation on both feet.

The patient underwent a surgical, diagnostic biopsy of both feet, leading to the diagnosis of Norwegian crusted scabies. A second surgical debridement was then performed to remove the extensive plaque formation and aid the oral ivermectin and topical permethrin treatment. The patient subsequently made a full recovery and was discharged back to the nursing home.

At 2 and 6 months after treatment, the patient remained free of scabies infestation, and the surgical wound had healed uneventfully. The present case presentation has demonstrated that surgical debridement can be complementary to the standard topical and oral medications in the treatment of those with Norwegian crusted scabies infestation. Diode laser cyclophotocoagulation: histopathology in two cases of clinical failure.

Diode laser photocoagulation is an alternative technique to Nd:YAG laser or cryotherapy in cycloablation. It may be more titratable with fewer local side effects. The effect is not, however, always maintained in the long term. The authors wished to establish histologic correlates with in vivo clinical outcomes of failure.

Histologic findings in two cases of clinical failure of a single treatment with contact diode laser cyclophotocoagulation are presented. A recurrence of uncontrolled intraocular pressure IOP finally led to enucleation of the eyes 5 and 6 months after laser treatment. Histologic examination demonstrated preservation in both specimens of some ciliary processes outside the treatment zone, which was evidently over the pars plana in a case with a relatively low axial length.

Persisting damage of treated ciliary processes was seen. Some efforts at ciliary epithelial regeneration were made in these, but in a disorganized and presumably nonfunctional fashion, so that a histologic explanation for the gradual postoperative rise in IOP was not evident.

Diode laser cyclophotocoagulation may lower IOP by mechanisms other than destruction of ciliary epithelium. Reversal of a laser-induced increase in uveoscleral outflow may explain the gradual rise in IOP seen postoperatively in these two cases , given the ineffectual secretory epithelial regeneration in one case and the treatment over the pars plana in the other.

Methods to enhance probe placement, such as ultrasound biomicroscopy, transillumination, or axial length measurement, may be useful to ensure that treatment is directed to the pars plicata. Saphenous vein graft aneurysm fistula formation causing right heart failure : an unusual presentation.

Saphenous vein graft aneurysm SVG formation after coronary artery bypass grafting is a rare complication of the surgery. We present a case of a year-old man with an unusual presentation of such an aneurysm. Thirty-four years after his initial bypass surgery, the patient presented with a fistula formation into his right atrium from a vein graft aneurysm. Late aneurysm formation is thought to occur secondary to atherosclerotic degeneration of the SVG with background hypertension and dyslipidaemia accelerating the process.

Diagnostic modalities used to investigate SVG aneurysms include computed tomography, transthoracic echocardiogram, magnetic resonance imaging and cardiac catheterisation. Aneurysms with fistula formation historically require aggressive surgical intervention. Resection of the aneurysm with subsequent revascularisation if required is the surgical norm. SVG aneurysm with fistula formation into a cardiac chamber is a rare complication of coronary artery bypass grafting CABG , which can occur with atypical presenting symptoms.

Physicians should keep in mind the possibility of this occurring in post-CABG patients presenting with heart failure and a new murmur. Incidental finding of single coronary artery in a patient with alcoholic cardiomyopathy presenting as acute heart failure. Single coronary artery is a rare clinical finding. Diagnosis is typically made incidentally after the patient presents with symptoms and undergoes coronary angiography, coronary computed tomography angiography CTA , or post-mortem during autopsy.

Several high-risk features of anomalous coronary arteries have been described in the literature. Our paper describes a case of dilated alcoholic cardiomyopathy presenting as heart failure with diagnostic workup incidentally revealing single coronary artery. Loeffler endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis.

Although an uncommon entity, it is still a disease with significant morbidity and mortality. Often identified only at late stages, treatment options are limited once fibrosis occurs, usually requiring heart failure medications or surgical intervention. We present a unique case of a woman with remote history of hypereosinophilic syndrome, attributed to treatment of rheumatoid arthritis with infliximab, who presented with symptoms of heart failure refractory to medical management and was found to have Loeffler endocarditis.

The severe progression of the disease required surgical intervention with endocardial stripping to treat the right-sided diastolic heart failure. A case presentation ]. Burkitt lymphoma, is described as an aggressive form of non-Hodgkin lymphoma of B cells which occurs most often in children and young adults, ovarian lymphoma can appear as a primary lesion or more commonly referred to as a metastasis. Primary ovarian lesions are rare manifestations corresponding to 0.

Abdominal computed tomography shows a solid aspect tumor which affects the right pelvic cavity. Bilateral ovarian tumors were removed. Microscopically, both lesions show a "starry sky" pattern composed by a monotonous infiltration of lymphocytes mixed with large and clear macrophages, several atypical mitoses, and necrosis and hemorrhage areas. Bilateral ovarian Burkitt's lymphoma was diagnosed. Bilateral ovarian Burkitt's lymphoma is a rare entity, with a variability of presentations , the abdominal pain and abdominal tumors are the most frequent.

The patient's prognosis at short term is poor, therefore it's necessary to know this entity and make an early diagnosis. Darling, Chad; Saczynski, Jane S. Background Patients with acute decompensated heart failure ADHF often wait a considerable amount of time before going to the hospital.

Prior studies have examined the reasons why such delays may occur, but additional studies are needed to identify modifiable factors contributing to these delays. Purpose To describe care-seeking delay times, factors associated with prolonged delay, and patient's thoughts and actions in adult men and women hospitalized with ADHF. Methods We surveyed 1, patients hospitalized with ADHF at 8 urban medical centers between and The median duration of pre-hospital delay prior to hospital presentation was 5.

Patients who delayed longer than the median were older, more likely to have diabetes, peripheral edema, to have symptoms that began in the afternoon, and to have contacted their medical provider s about their symptoms. Prolonged care seekers were less likely to have attributed their symptoms to ADHF, less likely to want to have bothered their doctor or family, and were more likely to be concerned about missing work due to their illness all p values cases may represent efforts to manage ADHF symptoms at home.

More research is needed to better understand the detrimental effects of these delays and how best to encourage timely care-seeking behavior in the setting of ADHF. Hepatitis E virus HEV usually causes self-limiting acute liver infections from fecal or oral transmission, though other routes of infection exist vertical transmission, blood transfusion, zoonosis.

Cases have recently been reported of chronic infection evolving to cirrhosis in immunosuppressed patients, such as those with a liver or kidney transplant. Nonetheless, development of acute liver failure in these patients is exceptional, with few cases published. We present a case of acute liver failure due to HEV in a liver transplant patient who required a liver retransplant 9 years after receiving the original transplant.

Makes a theoretical comparison between Adlerian and analytic formulations of family assessment in a case study involving a recently divorced couple and a child with encopresis. Discussed the family relationship in terms of object relations theory emphasizing intrapsychic experience, and Adlerian theory emphasizing the purposes of behavior. Salmonella myocarditis in a young adult patient presenting with acute pulmonary edema, rhabdomyolysis, and multi-organ failure. The mortality and morbidity of salmonella infections is seriously underestimated.

Salmonella myocarditis is an unusual complication of salmonella sepsis in adults. Cases that do occur may be associated with high morbidity and mortality. We present a rare case of salmonella myocarditis with multi-organ failure in a previously healthy young adult man who was brought to the emergency room with fever, diarrhea, shortness of breath, and altered sensorium, discovered to have acute pulmonary edema and respiratory compromise for which he was assisted with mechanical ventilation for 8 days.

Blood culture grew Salmonella typhi. Biochemically he exhibited myocardial, hepatic, and muscular enzymatic surge with renal failure , features of rhabdomyolysis, and disseminated intravascular coagulation. The patient showed a progressive improvement on treatment with ceftriaxone for 2 weeks in addition to decongestive therapy. He was discharged in good condition afterward. Acute liver failure ALF treated with conservative therapy has a poor prognosis, although individual survival varies greatly.

In these patients, the eligibility for liver transplantation must be quickly decided. The aim of this study was to assess the role of transjugular liver biopsy TJLB in the management of patients with the clinical presentation of ALF. Seventeen patients with the clinical presentation of ALF were referred to our institution during a 52 month period. Clinical data, procedural complications, and histologic findings were evaluated. TJLB was technically successful in all patients without procedure-related complications.

Tissue specimens were satisfactory for diagnosis in all cases. In 14 of 17 patients the initial clinical diagnosis was confirmed by TJLB; in 3 patients the initial diagnosis was altered by the presence of unknown cirrhosis. Four patients died, 3 had cirrhosis, and 1 had submassive necrosis. TLJB using an automated device and frozen section examination can be a quick and effective tool in clinical decision-making, especially in deciding patient selection and the best timing for liver transplantation.

A teenager presents with fulminant hepatic failure and acute hemolytic anemia. A teenager was admitted to an outside hospital ED following an episode of melena. He had been complaining of intermittent abdominal pain, nausea, malaise, and easy fatigability for 2 months, with significant worsening of symptoms 2 weeks prior to this episode. He had no significant medical, surgical, or family history. On presentation at the outside ED, he was found to be profoundly icteric and encephalopathic.

Initial laboratories suggested anemia, acute kidney injury, and acute liver failure , leading to a presumptive diagnosis of acute fulminant liver failure necessitating transfer to our institution. Congenital scoliosis - presentation of three severe cases treated conservatively. In view of the very limited data about conservative treatment of patients with congenital scoliosis CS available, early surgery is suggested already in mild cases with formation failures in the first three years of life.

Two patients with rib synostosis denied surgery before entering the pubertal growth spurt. These patients have been treated conservatively with braces and Scoliosis In-Patient Rehabilitation SIR and now are beyond the pubertal growth spurt. Severe decompensation was prevented in the two patients with failure of segmentation, however a severe thoracic deformity is evident with underdeveloped lung function and severe restrictive ventilation disorder. The patient with failure of formation is well developed, now without cosmetic or physical complaints although his curve progressed at the end of the growth spurt due to final mal-compliance.

Failures of segmentation should be advised to have surgery before entering the pubertal growth spurt. In case they deny, conservative treatment can at least in part be beneficial. For patients with failures of formation conservative treatment should be suggested in the first place because long-term outcomes of early surgery beyond pubertal growth spurt are not yet revealed. Clinical presentation , management, in-hospital and day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry.

To evaluate the presentation , management, and outcomes of patients hospitalized for heart failure HF in Trivandrum, India. Clinical characteristics at presentation , treatment, in-hospital outcomes, and day mortality data were collected. Mean standard deviation age was The day all-cause mortality rate was 2. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of day mortality.

Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.

An outline of an instructional media project for grades Kindergarten through 12 is presented. The author describes the major steps involved in the program by which educational television ETV productions and 16mm films were transferred to videotape cassettes so that they could be used more easily to enrich curriculum and to support library and….

Kindler syndrome is a very rare disease caused by mutations resulting in defects in the extracellular matrix-actin link. It usually presents with acral blistering from birth in trauma-prone areas, pronounced photosensitivity that improves with age and the development of poikiloderma and cutaneous atrophy. Mucosal involvement and degeneration have been described with relative frequency. Transtibial prosthesis suspension failure during skydiving freefall: a case report. This report describes the unusual case of an everyday-use prosthesis suspension system failure during the freefall phase of a skydiving jump.

The case individual was a year-old male with a left transtibial amputation secondary to trauma. He used his everyday prosthesis, a transtibial endoskeleton with push-button, plunger-releasing, pin-locking silicon liner suction suspension and a neoprene knee suspension sleeve, for a standard recreational tandem skydive. Within seconds of exiting the plane, the suspension systems failed, resulting in the complete prosthesis floating away.

Several factors may have led to suspension system failure , including an inadequate seal and material design of the knee suspension sleeve and liner, lack of auxiliary suspension mechanisms, and lack of a safety cover overlying the push-button release mechanism. This is the first report, to our knowledge, to discuss prosthetic issues specifically related to skydiving.

While amputees are to be encouraged to participate in this extreme sport, special modifications to everyday components may be necessary to reduce the possibility of prosthesis failure during freefall, parachute deployment, and landing. Ground control failures. A pictorial view of case studies. In each case , the year of occurrence is stated in the beginning so that the environment or technological background under which it occurred are reflected.

The narrative than begins with the mining and geological conditions, followed by a description of the ground control problems and recommended solutions and results, if any. Although the clinic picture is often indicative of muscle manifestations in patients with hypothyroidism, signs and symptoms of this condition are variable from simple elevation of serum muscle enzymes with myalgia, muscle weakness, cramps to rhabdomyolysis with acute renal failure which remains a rare event.

Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Hypothyroidism is associated with significant effects on the kidney which the pathophysiology seems to be multifactorial, but the exact mechanisms remain poorly understood. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. The main objective of our observation is to report a case of acute renal failure revealing an autoimmune hypothyroidism in which thyroid hormone substitution led to a significant improvement in muscular, thyroid and renal disorders.

Published by Elsevier SAS. Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax. The objective was to evaluate if existence of hydrothorax in initial chest radiograph predicts treatment outcome in patients with primary spontaneous pneumothorax who received needle thoracostomy. This is a retrospective cohort study carried out from January to August in 1 public hospital in Hong Kong. All consecutive adult patients aged 18years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration performed as primary treatment were included.

Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial radiograph were included in the analysis. The outcome was success or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration.

There were a total of patients included. Seventy-three patients Among 54 failure cases , 13 patients Forty-one patients Hydropneumothorax, previous history of pneumothorax, and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax. Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis.

It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation.

We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. The TRAP twin reversed arterial perfusion sequence - case presentation. We present a particular case of TRAP twin reversed arterial perfusion syndrome, which has a very rarely association of the simultaneous existence of a rudimentary malformed heart and brain, and also other malformations like abdominal wall abnormality, absent bladder with present kidneys, and absence of the lungs, which appear only in a few cases on the receptor twin from this sequence, malformations incompatible with life.

A Caucasian year-old pregnant woman, at the first pregnancy, with a monochorionic-diamniotic pregnancy, 26 weeks of gestation was referred to our hospital, for polyhydramnios. The patient delivered a living female newborn, weighing g, with an Apgar score of 2 at one minute - the donor fetus and a second female newborn with multiple malformations, no signs of life and who weighed g - the receptor fetus. The anatomopathological examination confirmed the TRAP sequence associated with severe facial dysmorphism, bilateral phocomelia and cardiac malformations rudimentary hypoplastic, univentricular and a vascular anastomosis between the two umbilical cords.

Anemia and cardiac complications which can lead to cardiac failure , appear early during pregnancy and caused the death of the pumping twin. We emphasize that in our case of TRAP sequence, the ultrasound examination established the diagnosis of the syndrome with high accuracy. Therefore, we can conclude that the existence of a rudimentary heart and a vascular anastomosis between the two umbilical cords supports the apparition of TRAP sequence. The early diagnosis of this pathology, the observation of the pregnancy with the help of weekly ultrasounds and the intrauterine interventions can increase the survival chances of the donor fetus from the TRAP sequence.

Coexistence of chronic renal failure , hashimoto thyroiditis and idiopathic hypoparathyroidism: a rare case report. Hypoparathyroidism is an uncommon disease and its coexistence with chronic renal failure is quite rare. Hypocalcemia and hyperphosphatemia are seen in both diseases.

Diagnosis of hypoparathyroidism may be overlooked when parathormone response is not evaluated in patients with chronic renal failure. A year-old female patient who had been receiving hemodialysis for 3 years because of chronic renal failure was diagnosed as idiopathic hypoparathyroidism and hashimoto thyroiditis. When her medical records on the first admission and medical history were evaluated, hypoparathyroidism and hashimoto thyroiditis were seen to be present also when she was started hemodialysis.

Idiopathic hypoparathyroidism should be suspected in case as absence of parathormone response to hypocalcemia in patients with chronic renal failure. It should be taken into consideration that hashimoto thyroiditis may accompany and required analysis should be done.

Communication failures during clinical handovers lead to a poor patient outcome: Lessons from a case report. In the emergency department, communication failures occur in clinical handover due to the urgent, changing and unpredictable nature of care provision.

We present a case report of a female patient who was assaulted, and identify how various factors interacted to produce communication failures at multiple clinical handovers, leading to a poor patient outcome. Several handovers created many communication failures at diverse time points. The bedside medical handover produced misunderstandings during verbal exchange of information between emergency department consultants and junior doctors, and there was miscommunication involving plastic registrars.

There was a failure in adequately informing the general practitioner and the patient relating to follow-up care after discharge. Deficiencies of communication occurred with conveying changes in an investigative report. Communication could be improved by dividing the conduct of handover in a quiet room and at the bedside, ensuring multiple sources of information are used and encouraging role-modelling behaviours for junior clinicians.

A novel risk assessment method for landfill slope failure : Case study application for Bhalswa Dumpsite, India. Rapid population growth of major urban centres in many developing countries has created massive landfills with extraordinary heights and steep side-slopes, which are frequently surrounded by illegal low-income residential settlements developed too close to landfills.

These extraordinary landfills are facing high risks of catastrophic failure with potentially large numbers of fatalities. This study presents a novel method for risk assessment of landfill slope failure , using probabilistic analysis of potential failure scenarios and associated fatalities. The conceptual framework of the method includes selecting appropriate statistical distributions for the municipal solid waste MSW material shear strength and rheological properties for potential failure scenario analysis.

The MSW material properties for a given scenario is then used to analyse the probability of slope failure and the resulting run-out length to calculate the potential risk of fatalities. In comparison with existing methods, which are solely based on the probability of slope failure , this method provides a more accurate estimate of the risk of fatalities associated with a given landfill slope failure.

The application of the new risk assessment method is demonstrated with a case study for a landfill located within a heavily populated area of New Delhi, India. Stress and reproductive failure : past notions, present insights and future directions.

Problem Maternal stress perception is frequently alleged as a cause of infertility, miscarriages, late pregnancy complications or impaired fetal development. The purpose of the present review is to critically assess the biological and epidemiological evidence that considers the plausibility of a stress link to human reproductive failure.

Methods All epidemiological studies published between and that tested the link between stress exposure and impaired reproductive success in humans were identified. Study outcomes were evaluated on the basis of how associations were predicted, tested and integrated with theories of etiology arising from recent scientific developments in the basic sciences.

Further, published evidence arising from basic science research has been assessed in order to provide a mechanistic concept and biological evidence for the link between stress perception and reproductive success. Results Biological evidence points to an immune—endocrine disequilibrium in response to stress and describes a hierarchy of biological mediators involved in a stress trigger to reproductive failure.

Epidemiological evidence presents positive correlations between various pregnancy failure outcomes with pre-conception negative life events and elevated daily urinary cortisol. Strikingly, a relatively new conceptual approach integrating the two strands of evidence suggests the programming of stress susceptibility in mother and fetus via a so-called pregnancy stress syndrome.

Conclusions An increasing specificity of knowledge is available about the types and impact of biological and social pathways involved in maternal stress responses. The present evidence is sufficient to warrant a reconsideration of conventional views on the etiology of reproductive failure. Physicians and patients will benefit from the adaptation of this integrated evidence to daily clinical practice.

A major breakthrough in AIDS treatment occurred with the advent of antiretroviral therapy. However, several vulnerabilities may be present in the path experienced by patients during treatment. To interpret the data, it was used the technique of content analysis. In the speeches, it was realized that the deponents faced conflicts in the family and, difficult relationships with people and stigma at work. It was observed that patients had experienced various situations that made them more susceptible to HIV infection and illness.

A unique case of Shwachman-Diamond syndrome presenting with congenital hypopituitarism. Shwachman-Diamond syndrome SDS is an autosomal recessive bone marrow failure syndrome typically characterized by neutropenia and pancreatic dysfunction, although phenotypic presentations vary, and the endocrine phenotype is not well-described. We report a unique case of a patient with SDS who initially presented with hypoglycemia and micropenis in the newborn period and was diagnosed with congenital hypopituitarism.

We are not aware of any other cases of SDS documented with this combination of complex endocrinopathies. Case report: heavy metal burden presenting as Bartter syndrome. Maternal transfer of heavy metals during fetal development or lactation possibly contributed to the clinical manifestations of Bartter syndrome and developmental delay in the offspring.

An month-old child diagnosed with Bartter syndrome and failure to thrive was treated concurrently for elevated metal burden while he was undergoing standard medical interventions. Treatment with body-weight doses of meso-2,3-dimercaptosuccinic acid DMSA reduced the body burden of lead, beryllium, copper, mercury, and cadmium at the three- and sixth-month follow-up tests. During the course of the six-month treatment, the patient gained 2. His weight shifted from significantly below the 5th percentile in weight to within the 5th percentile, and from below the 5th to within the 10th percentile for length.

The child's acquisition of lead, beryllium, and copper correspond to his mother's history of stained glass assembly and occurred during fetal development or lactation, since there were no other identifiable sources that could have contributed to the heavy metal burden. Tests for known genetic mutations leading to Bartter syndrome were all negative.

This case report highlights the potential benefit of DMSA for treatment of heavy metal body burden in infants who present with Bartter syndrome. Urolithiasis presenting as right flank pain: a case report. Urolithiasis refers to renal or ureteral calculi referred to in lay terminology as a kidney stone. Utolithiasis is a potential emergency often resulting in acute abdominal, low back, flank or groin pain.

Chiropractors may encounter patients when they are in acute pain or after they have recovered from the acute phase and should be knowledgeable about the signs, symptoms, potential complications and appropriate recommendations for management. A 52 year old male with acute right flank pain presented to the emergency department. A ureteric calculus with associated hydronephrosis was identified and he was prescribed pain medications and discharged to pass the stone naturally.

One day later, he returned to the emergency department with severe pain and was referred to urology. He was managed with a temporary ureteric stent and antibiotics. This case describes a patient with acute right flank and lower quadrant pain which was diagnosed as an obstructing ureteric calculus. Acute management and preventive strategies in patients with visceral pathology such as renal calculi must be considered in patients with severe back and flank pain as it can progress to hydronephrosis and kidney failure.

A rare case of choledochal cyst with pancreas divisum: case presentation and literature review. Pancreas divisum results from a fusion failure of the pancreatic buds. The coexistence of pancreas divisum and choledochal cyst in adults has been reported in less than 10 well documented cases. This article presents a case of a year-old Peruvian man with intermittent episodes of abdominal pain, initially diagnosed with choledocholithiasis, who underwent open cholecystectomy.

During surgery, a diagnosis of choledochal cyst and pancreas divisum was made, and therefore a hepaticoduodenostomy was performed. The patient was referred to our hospital due to persistence of abdominal pain. After admission, a papillectomy was achieved without further complications. A cyst resection and dismantling of hepaticoduodenostomy with Roux-en-Y was performed 8 years later.

During the subsequent month follow-up, the patient remains asymptomatic. Relative adrenal insufficiency in severe congestive heart failure with preserved systolic function: a case report. Relative adrenal insufficiency in critically ill patients is an important syndrome in septic shock. The insufficient stress response of the hypothalamic-pituitary-adrenal axis in acute illness contributes to hemodynamic instability. Treatment of this state in septic shock improves patient outcomes.

In this report, we describe the case of a patient with severe diastolic dysfunction who presented in cardiogenic shock associated with relative adrenal insufficiency and had a complete recovery with corticosteroid replacement. Alteration of the hypothalamic-pituitary-adrenal axis may be more prevalent than suspected in end-stage heart failure , and the diagnosis and treatment of this syndrome may ultimately improve outcomes in a subgroup of heart failure patients.

Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study. Objectives To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department ED with a principal symptom of dyspnoea.

Participants Patients with an ED diagnosis of heart failure. Outcome measures Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes hospital length of stay LOS and mortality. Results Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries. Addison disease presenting with acute neurologic deterioration: a rare presentation yields new lessons from old observations in primary adrenal failure.

To report a rare case of Addison disease presenting with acute neurologic deterioration, and to discuss previous reports and illustrative clinical lessons drawn from the case. We detail the clinical presentation and sequence of events leading to diagnosis of Addison disease in a year-old man whose initial symptoms were those of acute neurologic deterioration.

A year-old man presented with acute, rapid neurologic deterioration. The patient required intubation, but his condition responded very well to mannitol and dexamethasone. Head computed tomography showed a fourth ventricle reduced in size and basal cistern effacement, changes consistent with mild cerebral edema.

Primary adrenal insufficiency was diagnosed after a low morning cortisol concentration prompted a corticotropin-stimulation test and serum aldosterone measurement undetectable. The diagnosis was almost missed because of suspected confounders of dexamethasone and etomidate use. Subsequently, the patient tested positive for anti hydroxylase antibodies.

Cerebral edema rarely occurs with Addison disease and is most likely secondary to hyponatremia. Diagnosis in such cases may be complicated by resuscitative therapies; however, low cortisol levels should always be thoroughly investigated.

This patient's presentation was also unique in that he maintained a normal electrolyte profile despite hypoaldosteronism, a phenomenon that may be explained by enhanced mineralocorticoid activity of exogenous cortisol. The diagnosis of primary adrenal insufficiency may not be suspected in the absence of classic hyperpigmentation and hyperkalemia, but should remain in the differential diagnosis of acute confusion. While the use of dexamethasone and etomidate in initial resuscitation can transiently suppress adrenal function, any unusually low cortisol level merits thorough investigation.

Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy. Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure MOF.

A year-old female patient with a year history of Graves' disease was transferred to our emergency department ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension.

Because of hepatic and renal failure with refractory hypotension, we reduced the patient's dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy CRRT with intravenous albumin and plasma supplementation.

We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment. The presenting manifestations of thyroid storm vary and can include cardiac arrest with multiorgan failure in rare cases.

In some patients with thyroid storm, especially those with severe complications, conventional medical treatment may be ineffective or inappropriate. During thyroid storm, the initiation of CRRT can immediately lower body temperature and subsequently stabilize vital signs. Case report].

Neonatal hyperthyroidism is usually a self-limited condition frequently associated with transplacental passage of thyroid stimulating antibodies secondary to maternal autoimmune disorders. To timely detect mothers with this medical antecedents decreases the risk for fetal adverse events. To report a case of neonatal hyperthyroidism associated with intrauterine growth restriction and heart failure.

A 36 week-old newborn with birth weight of 1, g. Symptoms were tachycardia, distal coldness, exophthalmos, hepatomegaly and tremors. Echocardiogram ruled out structural heart disorders. Due to maternal symptoms suggestive of hyperthyroidism, TSH tests were performed showing 0. It was treated with methimazole and propanol, alleviating the symptoms and decreasing the levels of free T4. To know the maternal history helps identify and manage neonatal complications of hyperthyroidism.

Heart failure and other cardiopulmonary disorders are determinants of mortality during early neonatal period. High-risk newborns should receive follow up assessments. The first reported case of possible Haemophilus influenzae type b vaccine failure from Kuwait and literature-review.

Pheochromocytoma presenting with rhabdomyolysis and acute renal failure : a case report.

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Hudson, Shuchisnigdha Deb, Daniel W. Educational Resources Accessible on the Tele-rehabilitation Platform. Opportunities of Digitalization for Productivity Management. Back Matter Pages Other volumes Advances in Affective and Pleasurable Design. Advances in Neuroergonomics and Cognitive Engineering.

Advances in Design for Inclusion. Advances in Ergonomics in Design. Advances in Human Factors in Simulation and Modeling. Advances in Human Factors and Systems Interaction. Advances in Human Factors in Cybersecurity. Advances in Human Aspects of Transportation. Advances in Interdisciplinary Practice in Industrial Design. Advances in Safety Management and Human Factors.

Advances in Social and Occupational Ergonomics. Advances in Human Factors in Communication of Design. About these proceedings Introduction This book reports on cutting-edge research into innovative system interfaces, highlighting both lifecycle development and human—technology interaction, especially in virtual, augmented and mixed-reality systems.

Susan, welcome to Weekend House Call. And you can go ahead with your question. Campbell, good morning. My question is about alternative treatments for fibromyalgia and also is there a theory on the cause of fibromyalgia?

Fibromyalgia, just a few years ago, wasn't even on the map for most doctors as a diagnosis. Most doctors would say it really doesn't exist. I think increasingly now, though, doctors are appreciating that this is a real disease. We don't know what the cause is and there are things we can do to help fibromyalgia symptoms. But most of these don't necessarily go to the root cause because we simply don't know what that is.

But there are medical treatments. There are things like trigger point injections and other psychological therapies that may be helpful for treatment of this very difficult and very prevalent problem. COHEN: Doctor, we've been talking a lot about different drugs that people can take to get rid of pain. But many people are worried about getting addicted to those drugs.

Can you address that? The liability for addiction in taking opiods depends on how those drugs are delivered. So if heroin is delivered in the vein, there is, in fact, a high liability for developing an addiction syndrome because the person has the chance of developing a craving for that drug. But the slow acting opiods do not have that liability. So if the drug is introduced to the brain very gradually, as happens with the slow release opiods, it appears that the liability for developing addiction is, in fact, very, very small, and shouldn't be a barrier to using these powerful drugs to treat serious pain.

Grab a pen. When we come back, we'll give you a phone number and a Web site to help you find a pain specialist in your area. Stay with us. If you click on finding support you'll see links to pain specialists and support groups, or you can call them at PAIN. That's PAIN. Thanks so much for joining us this morning to talk about chronic pain.

And we've been talking with Dr. Campbell, the head of the American Pain Foundation. Campbell, any final thoughts about what chronic pain sufferers can do to get some help? Go in there, indicate how this pain is impacting on your life and insist on getting answers. And often this will be rewarded by finding some solutions, because the fact is that the majority of pain problems can be addressed better than what they are currently. I want to thank Dr. Campbell and I want to thank all the viewers who called and e-mailed us with their questions.

We'll talk about the costs, the risks and how to find the best eye surgeon. Plus, we'll help you figure out if you're a good candidate for Lasix. That's tomorrow at a. Eastern, Pacific. Thanks for watching. I'm Elizabeth Cohen. Pet aerobics - When Dad drinks. A with a lizzle studied condition called thalam- icpain syndrome IPS. With TPS, the chal. WA wer ya ryte on fire, even though I know nothing's wrong with it," says Reicer.

To cope with her condition, she takes several different medications, including Dilaudid, 2 narcodc. She's worked with a psychotherapist to fight the depres- sion so common in chronic pain patients. She's sampled a variety of non-tradition at therpies, such as biofeedback, nedi- cation, acupuncture, and massage "Many times while I'm meditating, when I'm cocally relaxed, the pain is zased," says Reiter, who volunteers rhree days a week and sie is herself to attend the symphony and theirer per formances she loves despite her con- dition.

Fifty million Americans suf- fer from chronic pain lascing six months or longer and another 25 million suffer from acure pain such as that from injuries or surgery. Most are 50 ind over. The first problem: patient adtudes. Although pain is invisible and can be masured only by the It's almost an evolutona thing, a protective device. Admit one subtinuit.

Twenty-seven years ago, she reported tremendous headaches and neck pain to her family doctor. The doctor at first thought she nigho have an aneurysm mulople sclerosis, even leukemia, after a battery of tests came up negative, he suggested that she was simply depressed. Meanwhile, the debilitating pain spad ro her joints--and Cowan started sceng more doctors.

What they didn't understand was that severe chronic pain takes tonal controi of your life dad the guilt and pow. REED itinimas m your head is almost as bad as the pain itself. Kathleen Foley, M. Advocacy groups Kettering in New York. Pacients who smile through their are slowly succeeding in making the treatineat of pain nor pain and try to be pleasant only make matters worse. Just a medical issue but a moral imperative.

Health care "Too often thar's interpreted, even by doctors who should providers have been asked to consider pain the "fith viral 58 HR-julyjaugust Confidential Treatment Requested by Cephalon, Inc. Try these techniques for using your brain as a pain reizer ton psychologist Dave Bresler,.

S GA imagine a clook with a single hand. Ncom represents the sharest, most uncomfortable. Six o'clock rep resents total relief. When you're in pain, set the pointer at the pain's leve o'clock, for instance, anale deeply, and as you slowly exhale imagine the pointer sinking down towards 6 o ciock, Repeat as needed and feel your cain melt away. Take a couple of deep slow breaths and allow every pan of your body to let go and relax. Imagine a ball oi pure energy resting on your lower abdomen that gently rises up the front of your body to your iorehead.

As you exhale, roll the ball down your spine and the back of your legs and onto the floor. Think of the ball as a pain-absorcing sponge. With each inhalation, it moves up your body absorbing the pain. As you exhale, it absorbs and drains all the pain down your spine and legs into the ground. Close your eyes and breathe deeply, allow ing your body to let go and relax more deeply with each breath. Imagine a beautiful place that is peaceful and sale, where you can do anything you want.

Anchor this place in your mind, making it as vividi as possible, noticing all the sights, sounds, and smells you experi- ence there. Notice how good it feels to be in this place where there is no pain, and remem- ber that you can return here anytime simply by imagining it. For more techniques on coping with pain, go to www. But acknowledging pain ultimately isn't as important as The American Pain Foundation has published a "Pain Care creating it.

The gold standard for pain drugs: morphine. Bill of Rights," which tels padeats they have the "righ to Derived from opium, morphine is cypically used to treat have your report of pain taken seriously The pain thoroughly assessed and promptly created big concern svith morphine has always been addiction, but Those words gained reach last year when the Joint Com. We're lucky: We have a physician or aurse asking, Are you in pain" says Cha- many agents to choose from, so if a patent doesn't respond lene Hil, a spokesperson for the body.

Full Height Wall Screens! PAIN headache pain, but not for cancer, hem. Another great reliever 3. Nor long after it hit the market in my bethe mind itself see sidebar. Sace , OxyConrin went from derapeu: When dousers began phins may be Many doctors are now of these methods, with varying degrees reluctant to prescribe the drug, patients of sucess. Her message to people strug are ury of the sigma aunched to talcing gling with chronic pain: "There are a lot it, and Congress and some statehouses of us who suffer, who understand the might curb who gets it or how much fear of being a burden or being seen as gouemmenr health issurers will pay for ir.

American Academy of Pain Management Can help you tocate a nearby pain specialist. Many pain sufferers are com- Cassideth, M. Memorial Sloan-Kettering Can www. But you can't just settle seems that selecting a therapy, and for being in pain.

I'd like to give my doing it, gives patients a sense of con. I guarantee he'd betrer than one. These patients often change his tune. Acupuncture, for Marc-Aprel Sue. SunPorch Structures Inc Sox NW, Suite Holo pesoie cene up thelr driving skills and remain sare on today's roads. Training and expanse renoursement provided. PagelD : Come. Join us. Let's work together to improve pain management in our communities.

The time to take action is now! The project is designed to provide you with tools to implement action-oriented public aware- ness campaigns in your state or community. It provides ideas for activities as well as a media guide and other resources that give the "facts" about pain and pain management. Information about Power Over Pain will be updated regularly on the website at www. You will be able to download the Action Kit as well as power point presentations and find out what others around the country are doing.

We hope you will join us in this exciting, action-oriented effort to improve public awareness about pain management-state-by-state, community-by-community. PagelD : I thought I was going - to have to bite on a stick and endure it- until the pain busters arrived by J. Reed was diagnosed with lung straight because oi the pain. Also, liie seemed to mellow Five months later, I was out a bit. Watching TV in the pronounced cancer free. In morning seemed like a good the dizzying, emotionally super idea, and becoming suddenly charged weeks between those bald wasn't so bad.

Initially, milestones, I was treated for had been wary of such several kinds of pain. Ironically, effects. Seinfeld caused me as much as a reruns, you name it-and twinge. The pain, some of it painkilers are high on the list intense, came solely from the or substances i treat with treatments that saved my life. Over time, and many cider health profes: though, the body becomes sonals as a self-inflicted dis tolerant of such drugs, and case.

As a longtime smoker,! Siopping a drug like regarded the coming treatment oxycodone cold can cause almost as punishment. If it was withdrawal problems. Within painful, then I should bite on a 24 hours the leg pain sub. Gayle Holtz out the codeine. I had two man, of the Cancer Institute more injusions of Taxol over of New Jersey near my home the next six weeks, and each in Princeton, had more time needed the drug to get enlightened ideas: Moral flag through the first day.

Cancor cessful and it was time for sur is cancer is cancer. The focus gery. Thoracic surgeon John is on treatment with a mini Langenfeld, who practices at mum of suffering. Also, the Robert Wood Johnson Univer- less pain, the less stress and sity Hospital, a teaching and the quicker the recovery, treatment facility in New Hoitzman explained that Brunswick, New Jersey, would the chemotherapy I was to remove wo lobes of my right receive, including large doses lung.

He suggested an epidural of the drug Texoi, had a num catheter for postoperative pain ber of side effects. In addition control. The standard intra- io hair loss, the drug can also venous morphine drip, he told produce nausea and severe me, suppresses respiration, leg pain.

After my first six-hour which can be a problem in infusion of Taxol, I was sent recovering from lung surgery. I did not cises that prevent pneumonia become nauseated, but 1 Placed in the chest cavity experienced crippling leg through a small filament-like pain. First, I tried large doses catheter in the upper back, the of Advil. It's as if the dentsi hed hit your chest with a massive shot of Novocain.

After surgery. I found that the epidural wasn't perfect. There were occasional prob. Within minuies aiter i complained, a pair of res- idents from the hospital's pain management department were at my bedside. Eight," I said, They fiddled with the settings on the epidural pump and was soon comfortable again, When I expressod surprise thai. Pain management is a recent development, an off- shoot of anesthesiology, and departments are found mostly in large hospitals. The epidural was removed after four days and I was sent home with refillable prescrip tions for oxycodone as well as OxyContin, the controversial time-release fomn of codeine.

The drugs were given to me for what the nurses apty called breakthrough pain. Two weeks after thai! I had a sore chest but a clear- headed new lease on life. After 25 years with Time Inc. Reed is a freelance writer. He remains cancer free.

PageID : Table of contents Tab 1 Getting Started The Problem The Opportunity Key Messages Tab 3 Pain Facts, Action Ideas Pain Care Bill of Rights Distribution At Work Lunch and Learn Tab 4 Making "Pain" News! Media Guide Writing Letters to the Editor and Op-Eds Statements from Organizations Tab 5 Resources PagelD : half of Louisiana residents experience pain on a monthly basis and nearly 7 in 10 expect to live with some pain the rest of their lives.

Report any allergies. Ask the doctor to work with you to develop a pain management plan. According to the survey, three-quarters 74 percent of those polled consider pain a major health problem in Louisiana. More than half 56 percent of patients with pain do not know where to go for help. As a result thousands of Louisiana residents suffer needlessly.

And, 62 percent find that it interferes with their ability to work and their productivity. More than 72 percent responded that pain causes them to lose sleep. Additionally, a majority of those surveyed 75 percent indicated that pain makes them sometimes feel anxious, irritable, or depressed, and it interferes with their sexual relations 40 percent.

More than 37 percent said pain interferes with their ability to do everyday things such as dress themselves, drive a car or grocery shop, and one-third 33 percent find that pain has negatively affected their relationship with loved ones and family. More 2. PageID : Those surveyed who report having a close family member suffering from chronic pain note the dramatic impact pain has as well.

Eighty-five percent reported that their family member's pain interferes with their work, and 93 percent said that their family member's pain prevents them from doing some of the things they once enjoyed. Pain can steal everything but hope. Many say they can't afford treatment or have no insurance 21 percent , or they thought it would go away 13 percent. Although 71 percent are satisfied that their healthcare provider thoroughly discussed the causes of their pain and gave them various treatment options, three-quarters of the respondents 75 percent had never been referred to a pain specialist for treatment.

And, 62 percent were not even aware of any pain specialist in their community. But, 77 percent did believe that the best option for treating pain was to see a health professional as opposed to treating their pain with over-the-counter medicine. We are going in the wrong direction.

LPI also seeks to provide practical information for people with pain and pain issues, inform healthcare professionals about pain management, develop a pain resource center, and serve as an advocate for people experiencing pain. Their website is www. The American Pain Foundation is the nation's leading nonprofit organization serving people with pain through information, education, and advocacy.

APF may be contacted at www. State Pain Initiatives are inter-disciplinary organizations that work to remove the barriers that impede effective pain relief through professional and patient education, advocacy, and institutional and practice change. In Florida, 75 percent of respondents said they suffer pain on at least a monthly basis compared to 57 percent of Americans who responded similarly in a recently released national survey.

In total, the Florida Pain Survey found that four out of five Florida households had a member who experienced at least monthly pain and more than a third of the sufferers described their pain as moderate to severe. Significantly, of those who say they personally experience pain, 65 percent say it causes them to feel anxious, irritable or depressed and 42 percent say it interferes with their ability to work and be productive.

University of South Florida professor Susan MacManus, who directed the study, said the greater percentage of Floridians pain sufferers could be a result of the state's sizeable senior population.

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Traditional male role, age, race, and sexual orientation are all relevantinfluences discussed by Pirl and Mello, and the authors are right on target withtheir exposition. When the age group and common physical symptoms of prostatecancer patients are considered, the influence of the traditional male role isextremely important. As noted by Pirl and Mello, the physical symptoms and lossof control associated with the disease can be humiliating, frequently resultingin a sense of shame, demoralization, and social withdrawal.

The authors do not mention several other relevant factors that meritdiscussion. To begin with, the health-care system is not friendly to men. Mostmen and many women perceive psychosocial interventions as being overly focusedon the extraction of emotions and personal information rather than on solvingthe myriad of practical problems created or exacerbated by cancer.

This is not to say that feeling emotionally connected to loved ones is notvalued by men; for most men, it is the ultimate value. But meaningful andfocused activity is more highly valued and is experienced by men as havinggreater therapeutic value as they attempt to communicate and emotionally connectwith others during a time of crisis. This is borne out by the relative successof educational and problem-solving groups for men, as opposed to the echoingreverberations of empty rooms housing support groups.

The messages from the health-care community to men and their caregivers aboutpsychosocial concerns have been ambiguous at best. Two recent books that focuson the needs of patients and their caregivers are Dr. In Dr. Thechapter on watchful waiting says nothing about how to cope with this incrediblydifficult process and never discusses dealing with the often humiliatingphysical symptoms endemic to prostate cancer and its treatment.

If health-care professionals do not initiate the conversation and sanctionthe importance of psychosocial concerns, men will feel that they are on theirown in managing their fears and problems. This powerful message from thehealth-care community reinforces the traditional male role of exaggeratedself-reliance that all too frequently leads to unnecessary isolation for thepatient, and distress and frustration for the caregivers.

These basic concerns are the essence of what living is all about, and are asimportant as extending life itself. Although the prostate gland is only the sizeof a walnut, the psychosocial implications of the disease and resulting sense ofexposure and fear ripple throughout the universe of the man and his family. Clinical pharmacists are key sources of information forcancer patients and their families, and they greatly influence how theprescribed treatments are perceived.

The US Food and Drug Administration hasidentified at least deaths directly related to "natural"supplements, which further supports the importance and timeliness of this study. It is not unusual for consumer magazines with widecirculations to cover similar stories. Interest in CAM has grown well beyondthe intense but always ephemeral attention of the mass media. CAM has only recently gained the somewhat sluggish andresentful attention of the premier medical institutions.

The article by Bernstein and Grasso provides a helpfulliterature review of the importance of CAM, for an intended audience of"health-care professionals, especially pharmacists. The information provided by theirsurvey is also helpful but falls prey to many of the same language problemsidentified in their article.

The terms "complementary" therapy usedin addition to conventional treatments and "alternative" therapyused instead of conventional treatments are used interchangeably, despite thefact that all patients in the sample were receiving medical care leftundefined at a South Florida Hospital. The authors acknowledge that the sample was small 96 or ,depending on who is actually included and comprised primarily of whites andHispanics 91 of the 99 who responded to the race question.

However, the dataare presented in a somewhat confused manner. The reader has to work hard toextract what can be valuable information. The patient questionnaire is also problematic. Complex termsare used but not defined, and it is impossible to decipher what is part ofnormal self-care such as taking a daily multivitamin and what is actuallybeing used with the intent of enhancing immune function or as an antineoplasticagent. Given that patients in the sample were being cared for at a hospital, theterm alternative used throughout the article and in the questionnaire shouldprobably be replaced with complementary.

There is also inadequate explanation asto why prayer, for example, was excluded from the questionnaire. Perhaps onlythose agents that most relate to the practice of clinical pharmacy were listed. Given the intended audience, a discussion of practicalinformation that would aid pharmacists in protecting patients from dangerouscomplementary and alternative agents would have been helpful. Also, pharmacistsshould be encouraged and taught to routinely ask patients if they are taking anyagents in addition to their prescribed medicines.

Such a dialog could revealessential information for the treating health-care team. Hopefully, theinvestigators will pursue this strategy in a follow-up study. Overall, the study is helpful in beginning to identify whichCAM therapies cancer patients are currently using. Some other areas that werealluded to but not adequately discussed follow.

As with the early hospice movement, CAM has evolved in aclosely parallel but distinctly nonintersecting orbit with that of establishedmedicine. Hospitals are now scrambling to develop credible CAM programs thatattract patients and managed-care contracts, but they have not been able tofigure out how to pay for these services. This is a significant problem forhospitals and universities confronting dwindling reimbursements, agingpopulations, and fiercer competition for educated patients with resources.

Virtually all CAM programs use existing staff who perform these services inaddition to their regular assignments , or refer to outside practitioners overwhom they have little quality control. The few CAM programs that actually dohave full-time staff are supported primarily by research grants or philanthropy.

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