[Robot-assisted biopsies in a high-field MRI system - first clinical results]. / Roboterunterstützte Punktion in einem Hochfeld-Kernspintomografen - erste klinische Ergebnisse.

PURPOSE: The purpose of this study was to examine the clinical use of MR-guided biopsies in patients with suspicious lesions using a new MR-compatible assistance system in a high-field MR system. MATERIALS AND METHODS: Six patients with suspicious focal lesions in various anatomic regions underwent percutanous biopsy in a high-field MR system (1.5 T, Magnetom Espree, Siemens) using a new MR-compatible assistance system (Innomotion). The procedures were planned and guided using T 1-weighted FLASH and TrueFISP sequences. A servopneumatic drive then moved the guiding arm automatically to the insertion point. An MRI compatible 15G biopsy system (Somatex) was introduced by a physician guided by the needle holder and multiple biopsies were performed using the coaxial technique. The feasibility, duration of the intervention and biopsy findings were analyzed. RESULTS: The proposed new system allows accurate punctures in a high-field MR system. The assistance device did not interfere with the image quality, and guided the needle virtually exactly as planned. Histological examination could be conducted on every patient. The lesion was malignant in four cases, and an infectious etiology was diagnosed for the two remaining lesions. Regarding the differentiation of anatomical and pathological structures and position monitoring of the insertion needle, TrueFISP images are to be given preference. The average intervention time was 41 minutes. Lesions up to 15.4 cm beneath the skin surface were punctured. CONCLUSION: The proposed MR-guided assistance system can be successfully utilized in a high-field MR system for accurate punctures of even deep lesions in various anatomic regions.

Verrucous carcinoma of the foot associated with human papillomavirus type 16.

BACKGROUND: We present 2 patients with verrucous carcinoma (VC) of the foot, a malignancy of unknown origin. OBJECTIVE: Molecular studies from the VCs were undertaken to determine the presence, type, and physical state of human papillomavirus (HPV) as well as the expression levels of certain oncogenes and antioncogenes. METHODS: Synthetic consensus and type-specific primers were used to determine the HPV type from both VCs via polymerase chain reaction (PCR). Verification of fragments was accomplished by means of specific isotope-labeled oligonucleotide probes. The physical state of HPV DNA was determined by two-dimensional gel electrophoresis. Quantitative oncogene and antioncogene expression studies were performed with the use of reverse transcriptase PCR. RESULTS: HPV type 16 was identified in episomal and integrated forms in both tumors. Expression studies revealed increased messenger RNA levels of c-Ki-ras oncogene and the p53 antioncogene and decreased messenger RNA levels of the Rb antioncogene in both VCs. CONCLUSION: Episomal and integrated forms of HPV-16 DNA were found in VCs of the foot, along with alterations of c-Ki-ras, p53, and Rb genes.

Population-based survey of complementary and alternative medicine usage, patient satisfaction, and physician involvement. South Carolina Complementary Medicine Program Baseline Research Team.

BACKGROUND: With an increasing proportion of Americans using complementary or alternative medicine (CAM), physicians need to know which patients are using CAM to effectively manage care. METHODS: In this cross-sectional study, telephone interviews were conducted with 1,584 South Carolina adults (ages 18 and older); 66% responded to the survey of demographics, general health, frequency of CAM use, perceived CAM effectiveness, and physician knowledge of CAM use. RESULTS: A total of 44% had used a CAM during the past year. Increasing age and higher education were significantly associated with CAM use. More than 60% perceived CAM therapy as very effective, and 89% said they would recommend CAM to others. Physicians were unaware of CAM use in 57% of their patients using CAM. CONCLUSION: Complementary or alternative medicine use in this rural Southern state is similar to national usage. Users view CAM as effective. Physicians are frequently unaware of patients' CAM use. More research is needed to establish CAM effectiveness and how CAM affects medical care, training, and public health.

Management competencies required of administrative and clinical practitioners in the new millennium.

Changes in the health care environment necessitate revisiting management-related competencies for both clinical and administrative practitioners. Major changes include the shift from recruitment to reengineering, direct service to multiple service models, department to program management, professional standards to market-driven standards, and single-system to multisystem management. Important competencies include the ability to identify and implement flexible staffing, to use communication technologies to support staff members across multiple sites, to understand of the business of health care, and to create innovative service delivery models consistent with the core values of the profession.

Organizational environment and perceptions of teaching quality in seven South Carolina family medicine residency programs.

PURPOSE: To explore the relationship between organizational environment and teaching quality in seven family medicine residency programs. METHOD: In 1995, a questionnaire on organizational environment was administered to the faculties at all seven family medicine residency programs in South Carolina. Eighty-seven percent of the faculty members participated, as did convenience samples of residents, nurses, and administrative staff. The questionnaire measured seven variables: teaching quality, job satisfaction, organizational climate, employees' autonomy, goal attainment, organizational commitment, and job-related stress. RESULTS: Residents, nurses, and administrative staff who were connected to programs at which faculty expressed high levels of job satisfaction assessed teaching quality as higher than did those at other programs. The residents' perceptions of teaching quality were positively correlated with high ratings of organizational climate and job-related stress. The staffs' ratings of goal attainment were also associated with teaching quality. Faculty satisfaction was associated with their reported employee autonomy and goal attainment. CONCLUSION: The organizational characteristics of family medicine residency programs significantly influence the perceptions of teaching quality: specifically, there perceptions are correlated with the degree to which faculty are satisfied with their work environments. In addition, residents' and staffs' perceptions of teaching quality are associated with their attitudes toward their organizations' environments.

Clinical feasibility of a free-weight strength-training program for older adults.

BACKGROUND: An emerging trend in the field of gerontology is the recognition that older adults, especially the frail elderly population, can increase their levels of strength and thus improve functional capability. Social acceptance of physical frailty and provision of care and assistance to dependent persons has now turned to helping the frail elderly adults maintain or improve functional independence. METHODS: The purpose of our study was to show the feasibility and effectiveness of a low-cost strength-training program using free weights for increasing strength and functional fitness among older adult volunteers. Participants aged 73 to 94 years were residents of a multilevel care retirement community in Columbia, SC. The strength-training program, led by an instructor, used dumbbells and ankle weights and was conducted in a multipurpose recreation room at the retirement facility. RESULTS: Functional performance measures (timed chair stand, 6-meter walk, stair climb, balance) handgrip strength, and self-assessment of activity level were outcome measures. All 25 participants completed the strength-training program. The average program adherence rate of all participants was 87 percent. No participant injuries or other adverse effects were observed. Functional performance measures improved significantly among program participants, with the greatest improvement in the timed chair stand (33.5 percent improvement) and the stair climb (17.6 percent improvement). CONCLUSION: Free-weight strength-training programs are appropriate for older adults, can be implemented in community settings, and are associated with significant improvement in functional performance.

Anti-inflammatory activity of antifungal preparations.

BACKGROUND: Although steroid/antifungal combination medications are used extensively, they are associated with potential disadvantages. Antifungal preparations possessing inherent anti-inflammatory activity, leading to rapid symptomatic relief while providing mycologic cure, would be very useful. OBJECTIVE: Our purpose was to investigate the anti-inflammatory activity of proprietary antifungal preparations in an in vivo, human experimental model. METHODS: Using a double-blind, controlled protocol, we assessed the comparative ability of antifungal preparations to suppress the expected delayed erythema response following in vivo human exposure to ultraviolet B (UVB) irradiation generated by a solar stimulator. RESULTS: Currently available allylamine preparations and ciclopirox olamine proved to be the most anti-inflammatory, while ketoconazole was intermediate in anti-inflammatory activity under these experimental conditions. These agents were superior to oxiconazole, econazole, and 2.5% hydrocortisone. CONCLUSIONS: Some antifungal preparations possess inherent anti-inflammatory activity, although the exact mechanism remains uncertain.

The role of facial proportion in hair restoration surgery.

Facial aesthetics involve basic artistic principles that relate individual features to the face as a whole. These principles, such as balance and proportion, are key elements in the development of hair restoration surgery and can be applied to reconstructive procedures for the trauma or burn patient. This paper describes the application of anthropometric and artistic principles used in hair reconstruction. Attention has been directed to the procedures used to determine hairline contour and placement, and certain aspects of frontotemporal recession management. The frontal hair has a profound effect on facial balance because of the major role hair plays in framing and visually enhancing the face. The presence of frontal hair and facial framing also serves to retain a vital element of autonomy in appearance for the individual.

Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study.

The results of postoperative epidural administration of saline solution (a placebo), morphine, methylprednisolone, and a combination of morphine and methylprednisolone for the reduction of pain after an operation for spinal stenosis or a herniated intervertebral disc were compared in a prospective, randomized blinded study. Epidural administration of morphine and methylprednisolone--either alone or in combination--significantly reduced the need for analgesia after an operation for spinal stenosis (p < 0.05) but not after an operation for a herniated intervertebral disc. Morphine and methylprednisolone did not have an addictive effect on the reduction of pain. Itching was significantly more common in the patients who had received morphine than in those who had received the placebo (p = 0.04). Although urinary retention was more frequent after the use of morphine than after the use of the placebo, the difference was not significant with the size of the sample that was analyzed (p = 0.25).

Evaluation of acetowhitening in Bowen's disease.

BACKGROUND: From a clinical standpoint, the lesions of Bowen's disease (squamous cell carcinoma in situ) are generally sharply demarcated. Following excision, however, contiguous extension and/or small foci of Bowen's disease are occasionally found, located outside the clinically apparent margins. Acetowhitening has been suggested as a means of delineating the extent of involvement and identifying subclinical lesions of condyloma acuminata. More recently, acetowhitening has offn similarly reported to be of potential value in the presurgical evaluation of Bowen's disease. OBJECTIVE: The purpose of this investigation was to further evaluate the use and reliability of acetowhitening both to delineate margins of Bowen's disease and to identify subclinical foci of involvement. METHODS: Eight patients with histologically confirmed Bowen's disease were studied. Six percent acetic acid was applied to the lesions and the surrounding skin. Histologic examination of acetowhite lesions and adjacent acetowhite skin as well as adjacent, nonwhitened normal appearing skin was performed. RESULTS: Our results were inconsistent, and included both false positives and false negatives. CONCLUSIONS: Acetowhitening is unreliable in identification of Bowen's disease. Clinically normal, acetowhite-negative skin adjacent to a lesion of Bowen's disease may be involved.

Clinical reasoning in occupational therapy: an integrative review.

The occupational therapy literature has been comprehensively reviewed to identify various theoretical answers to the question of what is clinical reasoning. Authors to date have two primary answers to this question, which we labeled scientific reasoning and narrative reasoning. Additional literature addresses the influence of personal and practice contexts on clinical practice. These are labeled pragmatic reasoning and are proposed to be an integral part of clinical reasoning. Pragmatic reasoning considers issues such as reimbursement, therapists' skills, and equipment availability. To be comprehensive, further study of clinical reasoning should include these contextual issues as an inherent part of the clinical reasoning process.

The output and outcome of two types of formal health structures--health post and creche--for nutritional interventions for preschool children in two urban, low-income communities of Belo Horizonte, Brazil (1986).

In order to observe the nutritional and health status of pre-school children, the output and outcome of two formal health services -health post and creche- for this vulnerable group in two urban slum areas of Belo Horizonte, Brazil were studied in 1986. A total of 420 children were surveyed, 254 children randomly selected from the communities and 156 from three creches. Growth monitoring was not undertaken systematically, and mothers did not have growth control charts. When a child had diarrhea, mothers preferred to apply home remedies or to buy proprietary drugs rather than to consult medical personnel. 72% of mothers reported using ORT, and 11% suspending feeding completely. After three month of life, 50% of infants were receiving some breast milk. 75% of children were immunized completely. The prevalence of health and nutrition indicators such as anemia (50% vs. 30%), parasitosis (87% vs. 70%), and stunting (28% vs. 20%) was worse in the creches than in the communities.

The output and outcome of two types of formal health structures health post and creche for nutritional interventions for preschool children in two urban, low-income communities of Belo Horizonte, Brazil (1986) / Resultados y rendimiento de dos tipos de estructuras formales de salud, puestos de salud y guarderías que intervienen en la nutrición de niños en edad preescolar en dos comunidades urbanas de bajos ingresos de Belo Horizonte, Brazil (1986)

In order to observe the nutritional and health status of pre-school children, the outcome of two formal health services-health post and creche- for this vulnerable groupin two urban slum areas of Belo Horizonte, Brazil were studied in 1986. A total of 420 were surveyed, 254 children randomly selected from the communities and 156 from three creches. Growth monitoring was not undertaken systematically, and mothers did not have qroeth control charts. When a child had diarrhea, mothers to apply home remedies or to buy proprietary drugs rather that to consult medical personnel. 72% of mothers reported using ORT, and 11% suspending feeding completely. after three month of file, 50% of infants were receiving some breast milk. 75% of children were inmunized completely. The prevalence of health and nutrition indicators such as anemia (50% vs. 30%), parasitosis (87% vs. 70%), and stunting (28% vs. 20%) was worse in the creches that in the communities

Task-achievement, obsessive-compulsive, type A traits, and job satisfaction of professionals in public practice accounting.

This paper contains a description of the results of a two-year study of task-achievement, obsessive-compulsive, Type A traits, and job satisfaction within randomly selected groups of 499 public practice accountants in Ontario, Canada. The results supported the notion that this profession attracts and conditions personalities with task-oriented, order-driven, Type A characteristics. With the exception of those who were advanced partners, the majority of public practice accountants were only moderately job-satisfied and were reportedly not committed to staying in their present jobs until retirement.

Helicopter wire strike accident and high voltage electrocution: a case report.

Helicopter wire-strike accidents usually involve high-voltage lines or telephone wires where the resulting impact is low velocity with minimal loss of occupiable space. Death and injury in these mishaps is often due to blunt force trauma to the head. In a recent wire strike accident investigated by the Division of Aerospace Pathology at The Armed Forces Institute of Pathology, the circumstances suggest that death of both aviators was due to high-voltage electrocution. Evidence surrounding the case and high-voltage electrocution are discussed.

The impact of improvement of water supply and sanitation facilities on diarrhea and intestinal parasites: a Brazilian experience with children in two low-income urban communities.

During the second half of 1986 the impact of the improvement of water supply and excreta disposal facilities on diarrheal diseases and intestinal parasitosis was studied in 254 children up to six years of age from two favelas (shanty towns) of Belo Horizonte, Brazil. The estimated incidence of diarrhea was 6.2 episodes/child year and the estimated period prevalence reached 31.0 episode days/child/year. The point prevalence of parasitosis was 70.7% (Ascaris lumbricoides: 55.4%, Trichuris trichiura: 19.6%, Giardia lamblia: 17.9%). The estimated prevalence of diarrhea decreased with improvement of water supply and sanitation facilities to 45% and 44% respectively, but no statistically significant impact was observed in the case of parasitosis. School education and weaning practice were found to be other important determinants of diarrhea.