In vitro human skin irritation test for evaluation of medical device extracts.

The aim of this study was to determine if the EpiDerm™ reconstructed human skin model (MatTek Corp.) could be an acceptable alternative to the ISO 10993-required rabbit skin irritation test for assessing medical device biocompatibility. Eleven medical device polymers were tested. Four extracts were prepared per polymer, two each with saline and sesame oil; half were spiked with two R-38 irritants, lactic acid for saline extracts and heptanoic acid for the sesame oil extracts. Tissue viability was assessed by MTT reduction and the proinflammatory response was assessed by IL-1α release. LOAELs of 2% for lactic acid in saline and 0.7% for heptanoic acid in sesame oil were determined. A cell viability reduction of >50% was indicative of skin irritation. Cells exposed to saline extracts spiked with 3.25% lactic acid had significantly reduced mean cell viabilities (12.6-17.2%). Cells exposed to sesame oil extracts spiked with 1.25% heptanoic acid also exhibited reduced mean cell viabilities (25.5%-41.7%). All spiked cells released substantial amounts of IL-1α (253.5-387.4pg/ml) signifying a proinflammatory response. These results indicate that the EpiDerm™ model may be a suitable in vitro replacement for the assessment of the irritation potential of medical device extracts.

Injection therapy for management of stenosing tenosynovitis (de Quervain's disease) of the wrist.

Stenosing tenosynovitis of the first dorsal compartment of the wrist (de Quervain's disease) is a common cause of radial wrist and hand pain and disability. Nonoperative management of the disease has been thought to provide only temporary relief of pain and swelling, while surgical intervention has been viewed as a more definitive treatment. This retrospective study examines the results of 58 patients who presented with de Quervain's disease from January 1993 through December 1995 and were initially treated with a combination steroid/lidocaine injection. After 1 to 3 years of follow-up, 35 patients had complete relief of symptoms with a single injection, 14 had relief of symptoms with two injections, 2 are still under observation, and 7 patients had to undergo operative management. These results indicate that in most patients with de Quervain's disease, treatment with a steroid/lidocaine injection can provide complete relief of symptoms.

Attitudes of referring physicians regarding total joint replacement: a preliminary report.

More than 800,000 artificial hip joints have been implanted in Americans. Similarly, a large and increasing number of artificial knee joints are being implanted. The successful replacement of deteriorated and severely injured joints permits continued mobility and independent living for many patients who would otherwise be disabled. Recent changes in the delivery of health care raises certain questions regarding access to specialty care. These questions may be even more critical in the African-American community where recent studies have shown that hip and knee replacement are underused in African Americans. This article describes a study undertaken to ascertain the attitudes of referring physicians (primary care) regarding joint replacement.

Total joint arthroplasty in a predominantly African-American population. Part two: Hip arthroplasty.

This second part of a two-part series examines total hip arthroplasty in an African-American population. Total hip arthroplasty has revolutionized orthopedic surgery since it began more than two decades ago. The quality and durability of results have enabled patients to pursue a more normal lifestyle, greatly relieved of their pain. Although many studies have reviewed the long-term results of total hip arthroplasty, none have addressed the results in a predominantly African-American population. This study retrospectively reviews the results of total hip arthroplasty in 62 African-American patients. Patients' attitudes toward this surgery, their co-morbid conditions, complications, and results were examined with regard to activity level and acceptance of the procedure.

Total joint arthroplasty in a predominantly African-American population, part one: knee arthroplasty.

A total of 128 total joint arthroplasties performed on a predominantly African-American population by a single surgeon between 1987 and 1992 were reviewed. Of these, 66 were total knee replacements and 62 were total hip replacements. Total hip replacement will be presented in Part Two. The African-American patients' attitudes toward joint replacement, comorbid states, complications, and overall results were examined. All patients were evaluated objectively and subjectively both clinically and radiographically. Ninety-five percent of the patients had good to excellent results, confirming our belief that despite the coexistence of medical illnesses, advanced age, presence of moderate obesity, and severity of disease, total joint arthroplasty is an effective and satisfying method of treatment for the African-American patient with severe arthritis.

Experience with the Keller bunionectomy.

The Keller resection arthroplasty was first described in 1904. Ninety years later, this operation continues to be useful to orthopaedic surgeons and their patients. This article presents the results of Keller bunionectomies in a private practice setting. Indications, surgical techniques, postoperative management, and results are discussed. The outcome in this series shows the Keller bunionectomy to be a useful operation when properly performed for the right indications.

Carpal tunnel syndrome: issues and answers.

Carpal tunnel syndrome has received a lot of attention recently in both the medical literature and the lay press. This is due, in large part, to increased recognition and treatment of this condition and its acceptance in the 1980s as being a work-related injury. The latter has been a source of confusion for patients and for many physicians, and signifies a real need for a clearer understanding of the entity known as carpal tunnel syndrome. This article addresses some of the current major issues regarding carpal tunnel syndrome and provides answers to those important issues.

Carpal tunnel syndrome: update.

Since reports in the late 1940s of surgical treatment for compressive neuropathy of the median nerve at the wrist, carpal tunnel release has become one of the most commonly performed surgical procedures. Despite the frequency of this surgery, controversy remains regarding diagnosis and management. Fifty consecutive surgically treated cases performed under local anesthesia. Ninety percent of patients (45/50) obtained complete relief of symptoms. The success rate is related to proper patient selection and complete division of the transverse carpal ligament under direct vision at surgery.

Stresses and rewards experienced by employed mothers.

As an increasing percentage of mothers of preschool children enter the labor force, there is a need for a better understanding of the experience of employment and its impact on women and their families. In the present study, employed women enacting multiple roles were asked to describe their perceptions of the stresses and rewards of the experience. One hundred eighteen employed mothers of preschool children were interviewed. The major stresses that emerged from the responses included lack of time, child-related problems, and maternal guilt. Rewarding aspects included personal benefits, financial rewards, and improved family life. Implications for families, health practitioners, and researchers are discussed.

Mentor, mentee, mentoring: building career development relationships.

An understanding of the process of mentoring can be useful for career development in the clinical, research and educational arenas of the nursing profession. The roles of mentor and mentee/protege as guide and learner are described. Several purposes for mentoring are discussed and five stages of the mentoring relationship are delineated. Potential problems, obstacles and factors which facilitate successful mentoring are explored. Through mentoring, individual, organizational and professional development can be fostered in cost-effective and fulfilling ways.

An unusual case of dermatofibrosarcoma protuberans.

A dermatofibrosarcoma protuberans involving the thumb of a nondominant hand is reported and represents the first case reported in this location. Dermatofibrosarcoma protuberans is a soft tissue neoplasm. It is a slow growing, locally aggressive fibrous tumor that occurs with equal frequency on the chest, abdomen, back, and proximal aspect of the extremities. Only two cases involving the hand are reported in the literature.

Acquired rotational digital deformity in children as a result of finger sucking.

Although most attention to the harmful effects of finger sucking by infants has been on the potential dental deformities, finger deformities also occur. The three cases presented in this article describe radial rotation of the index finger as a result of persistent finger sucking. In the majority of cases rotational deformities spontaneously resolve once finger sucking ceases. In a few cases, particularly when the habit is unduly prolonged, deformities may persist and cause functional impairment. In these patients surgical intervention is indicated. In our cases the rotational digital deformities were treated successfully by rotational osteotomy of either the metacarpal or the proximal phalanx.

Locking of the metacarpophalangeal joint.

Intrinsic finger metacarpophalangeal (MP) joint locking is infrequent, although not rare. Our experience and the recent literature suggest that metacarpophalangeal locking is being recognized with increasing frequency. The various mechanisms responsible for intrinsic finger MP locking, as well as the diagnosis and treatment of this condition, are reviewed. Four additional cases of the condition are presented.

Psychiatric/mental health nursing.

From a historical perspective, psychiatric/mental health nursing as a specialized area of practice is in its early developmental stages. Within the discipline of nursing and on the interdisciplinary scene, the range and scope of actions of the psychiatric/mental health specialists is still being debated. Professional roles and responsibilities are somewhat blurred. But the role is expanding. Contemporary psychiatric nursing practice has moved to a position of collegial support among the disciplines with shared responsibility. The attitudes of society, of the nursing profession, and of the health care providers will continue to influence the maturation process of the psychiatric/mental health nursing specialty.