Mycobacterium fortuitum infection occurring after a punch biopsy procedure.

Mycobacterium fortuitum is a rapidly growing atypical mycobacterium frequently reported as a postsurgical wound complication from a major surgical procedure. We present a unique case of M. fortuitum infection occurring in a 4-year-old boy after a minor punch biopsy surgical procedure. As far as we know there has been no published case of M. fortuitum occurring after a punch biopsy procedure.

A case of chrysiasis.

Chrysiasis and chrysoderma are terms used to describe permanent pigmentation of the skin due to the parenteral administration of gold salts. A case of chrysiasis, including a photomicrograph of the characteristic orange-red birefringence of gold in tissue when viewed under cross-polarized light, is presented. A review of the literature on the pathogenesis of the pigmentation seen in this disorder is also presented.

Trichostasis spinulosa: a clinical simulant of acne open comedones.

Trichostasis spinulosa is a disorder of the pilosebaceous follicles that may simulate acne open comedones. It is a commonly reported cosmetic annoyance in adults but not children. A review of the literature and a case of trichostasis spinulosa in a 13-year-old black girl with a history of onset at 18 months of age are presented.

The epidemiology of dermatologic and venereologic disease in a deployed operational setting.

We studied the epidemiology, morbidity, and etiology of dermatologic and non-human immunodeficiency virus venereologic disease (Derm/STD) aboard a deployed aircraft carrier to revise Derm/STD training objectives for shipboard primary care providers. Onboard supplies for treatment of Derm/STD were also evaluated. Over 3 months, 929 Derm/STD patients were treated for 1,320 diagnoses generating 2,011 visits. Derm/STD caused 22% of the total morbidity. Pyoderma alone accounted for nearly one-half of that morbidity and involved many work-center groups. Air wing, aircraft maintenance, and engineering work-center groups had lower burdens of pyoderma. Bacterial cultures were performed on 248 exudative dermatoses. Staphylococcus aureus was the dominant pathogen and was overwhelmingly sensitive in vitro to common, inexpensive antibiotics. Strategies to encourage prevention, earlier diagnosis, and rapid treatment of Derm/STD by deployed primary care providers are discussed.

An atypical piloleiomyoma presenting as a nonhealing ulcerated nodule.

Piloleiomyomas are benign smooth muscle tumors arising from the arrectores pilorum muscles in the skin. They vary in size and number, and are often spontaneously painful or sensitive to touch and cold. An unusual case of an ulcerated and painless piloleiomyoma is presented.

Unilateral Beau's lines associated with a fractured and immobilized wrist.

Beau's lines are transverse depressions of the nail plates. They are usually bilateral and result from a temporary cessation in the growth of the nail plate during severe systemic illnesses. Although transverse grooves can occur on the nails of one extremity, this has not been a commonly reported phenomenon. An unusual case of unilateral Beau's line associated with a metaphyseal fracture of the distal radius extending into the growth plate with wrist immobilization is presented. Other related causes of Beau's line are reviewed.

Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?

PURPOSE: To assess replacement of barium enema examination with colonoscopy in relation to age- and sex-related risk factors, place of service, physician specialty, and cost. MATERIALS AND METHODS: Between 1985 and 1992, 894,777 insurance claims for barium enema examination and lower gastrointestinal endoscopy were retrospectively examined. Changes in use were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy, two office-based endoscopic procedures, was also examined. RESULTS: Use of diagnostic colonoscopy increased from 191 to 406 services per 100,000 persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy with lesion removal, from 77 to 202 services. Barium enema examination use declined from 929 to 511 services per 100,000 persons; diagnostic proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in patients aged younger than 40 years were greater than overall increases. CONCLUSION: Colonoscopy has been replacing barium enema examination as the initial colorectal examination since 1985. Increased use of colonoscopy in patients with lower risk of neoplasia suggests that indications have become overly broad.

Tyrosine reverses a cold-induced working memory deficit in humans.

Acute exposure to cold stress has been shown to impair short-term, or working, memory, which may be related to reduction in, or disruption of, sustained release of brain catecholamines. Administering a supplemental dose of the catecholamine precursor tyrosine may alleviate cold stress-induced memory impairments by preventing cold-induced deficits in brain catecholamine levels. The present experiment determined whether administration of tyrosine would prevent a cold-induced working memory deficit, using a computer-based delayed matching-to-sample (DMTS) memory task. Eight male volunteers performed the DMTS task for 30 min at an ambient temperature of either 4 degrees C (cold) or 22 degrees C following a 30-min preexposure period and 2 h after ingesting 150 mg/kg of L-tyrosine or placebo. Subjects demonstrated a decline in matching accuracy on the DMTS task as delay interval increased, such that matching accuracy following a 16-s delay between sample and comparison stimuli was lower than that following a delay of 2 or 8 s. Consistent with previous research, and relative to 22 degrees C exposure sessions, matching accuracy during 4 degrees C exposure sessions was reduced significantly following placebo administration, which is attributed to the effect of cold exposure on short-term, or working, memory. Administration of tyrosine significantly improved matching accuracy at the longest delay interval most affected by cold exposure, such that matching accuracy in the cold following tyrosine was at the same level as matching accuracy following placebo or tyrosine administration at 22 degrees C. Tyrosine administered prior to 22 degrees C exposure had no effect on DMTS performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost containment in the use of low-osmolar contrast agents: effect of guidelines, monitoring, and feedback mechanisms.

PURPOSE: To describe a program for controlling intravenous use of low-osmolar contrast agents (LOCAs). MATERIALS AND METHODS: The department of radiology at the authors' institution adopted a policy of selective use of intravenously administered LOCAs. Clinical indications for LOCA use were specified after consultation with the administration, risk managers, legal department, and ethics committee of the hospital. The guidelines were then publicized throughout the department and hospital, and a contrast agent data form was developed to collect data on all cases. Monitoring mechanisms were instituted. RESULTS: Over the next 23 months, 11,373 patients received intravenous iodinated contrast agents, of whom 28.1% were deemed to be at high risk and were given LOCAs. Monthly tracking showed no evidence of a trend toward increasing use of LOCAs. CONCLUSION: Clear definition of use guidelines, close monitoring, and feedback can stabilize LOCA use at acceptably low levels.

Self-referral in private offices for imaging studies performed in Pennsylvania Blue Shield subscribers during 1991.

PURPOSE: To define the frequency of physician self-referral for diagnostic imaging studies. MATERIALS AND METHODS: High-volume radiographic (n = 65) and ultrasound (US) (n = 29) procedural codes in claims filed by Pennsylvania Blue Shield subscribers were analyzed to determine private-office (nonhospital) utilization of these examinations by radiologists and nonradiologists during 1991. A total of 787,703 radiographic and 159,281 US claims were filed. RESULTS: Nonradiologists self-referred 550,878 radiographic examinations (69.9%) and 99,931 US examinations (62.7%). Patterns of utilization varied considerably by anatomic category: The imaging studies with the highest rates of utilization by nonradiologists were skeletal radiography, vascular US, and obstetric and pelvic US. Aggregate reimbursement allowance by Pennsylvania Blue Shield for all examinations in these 94 codes was approximately $68 million, of which $44 million (65%) went to non-radiologists.

Relationship between changes in serum thyrotropin and total and lipoprotein cholesterol with prolonged Antarctic residence.

Antarctic residence (AR) is associated with a 50% increase in the thyrotropin (TSH) response to TSH-releasing hormone (TRH) and an expanded triiodothyronine (T3) distribution volume and extravascular hormone pool, collectively called the polar T3 syndrome. To investigate the possible biologic significance of this syndrome, we studied the relationship between nonstimulated TSH and serum lipid profiles in nine subjects, once while in California and monthly during 9 months of AR. We measured serum levels of TSH, total thyroxine (TT4), free T4 (FT4), total T3 (TT3), free T3 (FT3), thyroid-binding globulin (TBG), total cholesterol (T-CHOL), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), dietary cholesterol (D-CHOL), dietary fat (D-FAT), and dietary kilocalories at each month. The paired mean monthly change from baseline was used to determine significance. The group's mean levels of TSH (approximately 30%), TBG (approximately 16%), T-CHOL (approximately 4%), HDL-C (approximately 10%), and D-CHOL (approximately 19%) increased with AR (P < .05). Small but significant decreases (P < .05) were observed in the mean changes of TT4 (approximately 8%), FT4 (approximately 6%), and TT3 (approximately 6%). FT3, D-FAT, dietary kilocalories, body weight, TG, and the calculated low-density lipoprotein (LDL-C) were unchanged with AR. A significant rate of change (P < .05) during AR was also calculated from the slope of a fitted logarithmic function for TSH (0.96 +/- 0.31 mU.L-1 x mo-1), TBG (61.19 +/- 12.29 nmol.L-1 x mo-1), TT3 (0.09 +/- 0.04 nmol.L-1 x mo-1), TT4/TBG (-0.06 +/- 0.01/mo), TT3/TBG (-8.49 +/- 1.98 x 10(-4)/mo), and TG (-0.33 +/- 0.15 mmol.L-1 x mo-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Disparities in reimbursement to radiologists and nonradiologists for 65 common outpatient imaging studies.

The authors examined global charges (incorporating both technical and professional components) and global reimbursement allowances for all radiographic and ultrasound (US) examinations performed on Pennsylvania Blue Shield subscribers in the Lehigh Valley area of Pennsylvania during 1990. Data for radiologists and nonradiologists were compared with respect to all procedure codes for which at least 25 claims were submitted, yielding a sample of 40,619 radiographic examinations (54 procedure codes) and 9,761 US examinations (11 procedure codes). Radiologists' mean charges were higher than those of nonradiologists for 38 of the 54 radiographic codes. However, nonradiologists received higher mean reimbursement allowances for 39 of the 54 codes. Among the 11 US codes, nonradiologists' mean charges were higher for 10 and they received higher mean reimbursement allowances for seven. The averages of the mean reimbursement allowances for individual codes were higher for nonradiologists in both the radiographic and US categories. Pennsylvania Blue Shield has begun steps to eliminate disparities in reimbursements to providers who submit claims for imaging examinations.

Comparative validity of random-interval and fixed-interval urinalysis schedules.

Accurate detection of unprescribed drug use by addicts in treatment may facilitate their rehabilitation. Many clinics collect urine samples at random, using fixed-interval collection schedules, which are not free from sampling error. Random-interval schedules minimize sampling error and consequently increase detectability of drug use by eliminating safe periods during which drug use cannot be detected. We compared these two methods by observing rates of detected opiate- and quinine-positive samples preceding and following implementation of random-interval schedules. Detected drug use doubled initially. As detection and clinical sanctions became more certain, drug use declined to well below its former level. Programs that use fixed-interval schedules may underdetect drug use by more than 50%. If patients can reliably predict safe periods, the possibility of using drugs without fear of detection may impede their rehabilitation.

Effects of legal pressure on prognosis for treatment of drug dependence.

The authors found that four measures of legal pressure were either unrelated or negatively related to retention and outcome in five drug abuse treatment modalities. This suggests that nonvolunteer clients are likely to be insufficiently motivated to benefit fully from treatment and their presence may adversely affect staff morale and prognosis of volunteer clients. The authors recommend that legal pressure not be used as a basis for assigning applicants to treatment modalities and suggest that treatment outcome might be improved by procedures that 1) deal clinically with motivational differences between volunteers and nonvolunteers, 2) establish stricter motivational criteria for admitting nonvolunteers, or 3) encourage enforcement of existing sanctions against violations of stipulations to treatment.

Sex guilt and preferences for illegal drugs among drug abusers.

This study investigated the relationship between sex guilt and drug preferences. Seventy polydrug users completed a drug preference inventory and the Mosher Forced-Choice Sex Guilt Subscale. Results indicated that individuals who prefer sedatives are higher in sex guilt than either individuals who prefer stimulants or individuals with no definite preference.