Ectrodactyly-ectodermal dysplasia-clefting syndrome.

Ectrodactyly-ectodermal dysplasia-clefting syndrome is a rare congenital anomaly that affects tissues of mesodermal and ectodermal origin. Musculoskeletal involvement frequently requires orthopedic intervention. The authors present a review of the literature pertaining to this rare syndrome as well as a case report of a female patient who exhibited the complete clinical triad. A description of the surgical management of her condition is also presented.

A pain management documentation tool.

PURPOSE/OBJECTIVES: To describe the development, implementation, and evaluation of a tool to standardize assessment, monitoring, management, and documentation of acute and chronic pain in hospitalized patients. DATA SOURCES: A multidisciplinary hospital committee, nursing staff, a pain consultant, published standards, and hospital standards. DATA SYNTHESIS: A comprehensive pain flow sheet and pain protocol was developed to assess, monitor, document, and evaluate clients at risk for or with actual pain. The tool was designed to assess and document acute and chronic pain in patients with cancer. CONCLUSIONS: Based on an initial review of quality assurance indicators, the tool has demonstrated increased consistency in documentation of pain management activities. IMPLICATIONS FOR NURSING PRACTICE: The use of a pain assessment and management flow sheet with a pain protocol provides an organized, consistent approach that maximizes quality, cost-effective care.

A regional survey of intravenous therapy practices.

In this article, the authors share the results of a survey developed by a group of nurses in a 400-bed community hospital and distributed to 25 health care agencies throughout the northeastern New York region. The survey is comprised of six major categories, with questions pertaining to flushing and dressing protocols, types of vascular access devices used, and the availability of equipment and resources. Sixty percent of the agencies responded, including hospital, home care, hospice, and physician office settings. Major findings identified a lack of consistency in flushing and dressing protocols and in the types of equipment used. Implications for future practice will be presented along with the results of the survey.

The relationships between high-risk and problem drinking and the occurrence of work injuries and related absences.

A review of studies on the relationship between alcohol and work injuries revealed that the evidence is contradictory and that many of the studies contain methodological flaws. The present study aimed to determine whether there are relationships between problem drinking and high alcohol consumption and outcomes such as work injuries and related absences. The sample consisted of 833 employees at an industrial worksite. Problem drinking was measured by the Mortimer-Filkins test, while alcohol consumption was measured by a 7-day retrospective diary. Work injury data were obtained from medical reports completed at the worksite medical center, while absences data were obtained from company records. Chi-square analyses revealed significant relationships between problem drinking and work injuries and injury-related absences, but not between high alcohol consumption and work injuries and related absences. Logistic regression analysis revealed that no variables were significant predictors of work injuries. However, when uninjured subjects were excluded, a second analysis revealed that Mortimer-Filkins test scores, recent stressful life events, age and job satisfaction were significant predictors of two or more injuries. Injured subjects were almost twice as likely to have two or more injuries if they had high numbers of recent stressful life events and low levels of job satisfaction. Logistic regression analysis revealed that age, Mortimer-Filkins test categories and job satisfaction significantly predicted injury-related absences. Problem drinkers were 2.7 times more likely to have injury-related absences than non-problem drinkers, and subjects with low levels of job satisfaction were 2.2 times more likely than others to have injury-related absences. The implications of the results for workplace alcohol policies and programs are discussed.

Two- to five-year follow-up of 100 total hip arthroplasties using DF-80 implants.

In an uncontrolled prospective study, 100 primary total hip arthroplasties (THAs) using the DF-80 implant were followed up for a minimum of 2 years with rigorous clinical and radiographic examinations to define the natural history of this prosthetic system. Three groups were identified: (I) hips requiring revision because of failure (n = 3); (II) "impending" failures with radiographic indices of loosening (n = 8); and (III) clinically and radiographically benign, stable implants (n = 89). The preoperative Harris hip score was similar for all groups. Postoperatively, the failure group demonstrated early progressive clinical and radiographic deterioration with surgical revision at an average of 33 months. Male sex, increased weight, and greater intraoperative hemorrhage correlated positively with failure. The impending-failure group developed limited radiolucencies in the later postoperative period. Calcar resorption was noted in 26% of the total population and heterotopic ossification in 46%. We conclude that this series of THAs using DF-80 implants included a subset of patients demonstrating early clinical failure and widespread aggressive bone-cement radiolucencies that required early surgical revision.

Suboptimal (thin) distal cement mantle thickness as a contributory factor in total hip arthroplasty femoral component failure. A retrospective radiographic analysis favoring distal stem centralization.

One hundred cemented total hip arthroplasties (THAs) were evaluated regarding the potential benefit of THA femoral component distal stem centralization, specifically regarding cement mantle thickness. Factors potentially predictive of femoral component mechanical loosening, both relating (22 factors) and not relating (41 factors) to cement, were analyzed on initial postoperative radiographs. Nine THAs with femoral component mechanical failure (group 1) were compared to (1) 88 non-failed THAs (group 2) and (2) 9 matched-paired, nonfailed THAs (group 3). Significant differences were evident regarding minimum and maximum cement mantle thickness in Gruen zone 5 and combined zones 5/6 (groups 1 vs 2 and groups 1 vs 3), with failed femoral components having thinner cement mantles. Discriminate analysis determined minimum cement mantle thickness in zone 5 to be the factor most predictive of femoral component failure. These data indicate that a suboptimal (thin) cement mantle at the medial diaphysis (Gruen zones 5 and 6) contributed to femoral component mechanical loosening in this THA series. This relationship may not pertain to femoral stems of different materials or cross-sectional characteristics. Many THA systems currently provide for a method of centralization of the femoral component distal stem as a mechanism to ensure an adequate circumferential distal cement mantle. Continued investigation into techniques directed toward centralization of the distal femoral stem is warranted by the findings of this study.

Benzodiazepine use in older, community-dwelling southern Californians: prevalence and clinical correlates.

OBJECTIVE: To determine the use of benzodiazepines (BZDs) in an older, community-dwelling sample and to examine the sociodemographic and clinical correlates of BZD use. DESIGN: A cross-sectional study of 1752 elderly people (aged > or = 65 y) who completed a mailed medication survey and a telephone health status survey. PARTICIPANTS: Participants were invited to participate in a large Medicare demonstration project on prevention by their private physicians, who were also enrolled in the larger study. Participants had to be English-speaking, could not have dementia or a terminal illness, and had to give informed consent to participate in the study. MAIN OUTCOME MEASURES: Sociodemographic and health status variables that predicted BZD use were examined. Sociodemographic variables included age, gender, ethnicity, education, and income. Health status variables included functional status, with measures of mental, social, and physical health. Influenza immunization status was used as an indicator for preventive health services use and self-reported chronic illness was used as a measure of comorbidity. RESULTS: Twenty percent of the participants used BZDs at least twice in the past year. We found that those who used BZDs were more than twice as likely to take ten or more drugs, two-and-a-half times more likely to have difficulty falling asleep, and over twice as likely to be depressed. BZD users were also more likely to be white, to have a college education, and to have received a recent influenza shot, but were not more likely to be women when controlled for health status. CONCLUSIONS: Further clinical research should explore the relationship between BZD use among older patients and the BZD-associated adverse clinical factors we observed, as well as the association between multiple drug use and potential adverse outcomes in older BZD users.

Investigation of the Knoll Assessment Scale in a tertiary care facility.

The purpose of this study was to assist in assessing the validity and reliability of adaptation of the Knoll Tool, Assessment of Pressure Ulcer Potential. Data were retrospectively collected from charts of a random sample of patients (n = 62) who were admitted to a tertiary care facility. Total risk scores ranged from 0 to 22 with a mean of 8.7 and a standard deviation of 6.37. The alpha for the total assessment tool was .6352 with a standardized item alpha of .5973. Discriminant analysis predicted group membership at 62.9%. Group membership was most accurately predicted in Group 1 (76.9%). Discriminant analysis using a score of 11 predicted only 46.8% of group membership, although Group 1 predicted 88.5% and Group 4 predicted 85.7%. Low predictions may be related to small sample size.

Steroid-related osteonecrosis of the knee. Two case reports and a literature review.

Steroid-related osteonecrosis of the knee has been only rarely reported, especially without concomitant hip involvement. Two such cases are documented with correlated roentgenographic and magnetic resonance imaging. A comprehensive review of the literature illustrates the diverse circumstances in which this rare condition may occur.

A light and scanning electron microscopic study of osteocyte activity in calcium-deficient rats.

The material herein is an extension of an earlier study of osteocyte lacunae in calcium-deficient rats, utilizing morphometric measurements in undecalcified bone sections and scanning electron microscopy. The results confirm our earlier finding that bone resorption resulting from a low-calcium diet is not accompanied by osteocytic resorption.

Gait laboratory analysis of a posterior cruciate-sparing total knee arthroplasty in stair ascent and descent.

Successful posterior cruciate ligament-sparing total knee arthroplasty functions in an equivalent fashion to a contralateral normal limb during the mechanical stresses of stair ascent and descent. Motion and force plate analysis reveal highly symmetric gait patterns. Sagittal angles are greater than previously reported for the total condylar prosthesis and are nearly equal to those recorded for the age-matched normal population.

Homologous oxypiperidines as inhibitors of protein synthesis in vitro and ex vivo.

The antioxidant nitroxyl-2 (2,2,6,6-tetramethyl-4-oxypiperidine-1-oxyl) is an active inhibitor of protein synthesis both in vitro (rabbit reticulocyte lysate cell-free translation system) and ex vivo (mouse liver). Demethylated derivatives of this agent demonstrate a significantly lower inhibitory activity. There is a strong positive correlation between quantitative parameters of toxicity, the ex vivo and in vitro inhibitory effects on translation, and the total number of methyl groups per drug molecule.

In vitro and in vivo protein synthesis inhibition by methylated derivatives of 4-oxypiperidine-1-oxyl.

A new Soviet experimental antioxidant, nitroxyl-2 (2,2,6,6-tetramethyl 4-oxypiperidine 1-oxyl), is a potent inhibitor of protein synthesis in vivo (mouse liver) and in vitro (reticulocyte lysate). Demethylated derivatives of this agent demonstrate a significantly lower inhibitory activity. The HPLC estimation of ATP/ADP ratio in a mouse liver tissue homogenate shows that nitroxyl-2 and its demethylated derivatives possess a similar antioxidant effect. In cell-free translation, the drugs have no effect on the ATP/ADP ratio. The acute drug toxicity (LD50 and the protein synthesis inhibitory activity in vivo (ID50) and in vitro (IC50) were determined and were shown to be highly correlated with the number of methyl groups of the drug molecule. These results are discussed.

The in vitro screening of methylated 4-oxypiperidine compounds for inhibition of protein synthesis in a rabbit reticulocyte cell-free translation system.

A variety of methylated 4-oxypiperidine derivatives were tested for their ability to inhibit protein synthesis in vitro. A direct correlation was found between the extent of methylation of these compounds and their inhibitory activity in a rabbit reticulocyte lysate cell-free translation system.