Heparin lock for nighttime intravenous fluid management in a dysphagic patient.

Dysphagia, with its inherent risk of aspiration, is a clinical problem frequently encountered in patients with brain injury from trauma or cerebrovascular accident. The use of nasogastric tubes and intravenous lines for nutrition and hydration can be cumbersome and uncomfortable for the patient, and can interfere with rehabilitation therapy. With the advent and increased use of video- and cinefluoroscopy to evaluate swallowing, the type of dysphagia can be defined more readily. This article describes the use of a heparin lock at night to provide fluids intravenously to a patient who could swallow solid or semisolid food, but aspirated thin liquids. This approach insured adequate hydration while keeping the patient free of parenteral lines and nasogastric tubes during therapy. This technique was continued for 3 1/2 weeks until the patient's dysphagia improved and a full oral diet could be resumed. The authors recommend the use of nighttime intravenous feeding via a heparin lock as an option for managing this subset of dysphagic patients in a rehabilitation setting.

Cardiomyopathy and Cerebrovascular Accident Associated With Anabolic-Androgenic Steroid Use.

In brief: This case report describes a 32-year-old bodybuilder who sustained an ischemic cerebrovascular accident and showed signs of cardiomyopathy. No cause was found for either condition, but he had been using steroids for 16 years. Questions remain about the association between the two conditions and steroid use, and the full effects of long-term, high-dose steroid use have yet to be elucidated. As steroid use becomes more popular among athletes, the medical community must be alert to the possible adverse effects of these substances.

Lytic clavicular lesions in fibromatosis colli.

Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases.

Patellar complications following total knee arthroplasty.

We studied the complications involving the patella following total knee arthroplasty in eighty-six knees in which thirty-four unconstrained and fifty-two offset hinge prostheses had been implanted. The abnormalities that we studied included: patellar dislocation, five knees; subluxation, eighteen knees; localized wear, three knees; and generalized wear, four knees. In twenty-three patients these complications were associated with patellar malalignment, and occurred predominantly when the offset hinge model of prosthesis was used. The complications were attributed partly to mechanical factors inherent in the prosthetic design and partly to anatomical abnormalities. Failure of the surgeon to compensate adequately for both of those factors at the time of operation was a factor in most of the complications.

Total hip arthroplasty in the cardiac transplant patient.

Osteonecrosis of the femoral head following cardiac transplantation has led to bilateral total hip arthroplasties in 2 patients. The clinical course and rejections of these patients are outlined. The pathological changes in the femoral heads suggested that the process leading to osteonecrosis in the cardiac transplant patient is the same as that following renal transplantation, both being due to immunosuppression probably related to steroid dosage. Successful joint replacement can be carried out in the cardiac transplant with careful monitoring of anesthesia. Both patients have done well, being followed for 14 and 6 months respectively.