Integrating nonindigenous aquatic plant control with protection of snail kite nests in Florida.

The endangered snail kite (Rostrhamus sociabilis) feeds primarily on the freshwater apple snail (Pomacea paludosa) in Florida. The nonindigenous, floating water hyacinth (Eichhornia crassipes) and water lettuce (Pistia stratiotes) impede kites from finding snails. Effective control of these aquatic plants in the littoral zone of central and south Florida lakes benefits kites by maintaining open foraging habitat. However, incidental herbicide spraying of nesting substrates result in nest collapse when kites breed in nonwoody, emergent plants [cattail (Typha spp.) and giant bulrush (Scirpus validus)] in the outer littoral zone during lower lake levels. Many endangered species recovery plans and their implementation have experienced problems due to inaction and/or noncooperation by various governmental agencies and their personnel. Herein, we describe the development and implementation of a buffer zone strategy to prevent secondary impacts from an aquatic plant control program to snail kites nesting on lakes in central and south Florida. A strategy was jointly developed by personnel of five state and federal agencies to control herbicide application near kite nesting areas during the normal breeding season. Although requiring various modifications during its implementation, this cooperative effort successfully integrated aquatic plant control objectives with snail kite conservation on Lake Okeechobee during 1988. The program was expanded the following year to lakes Kissimmee and Tohopekaliga. Since the implementation of the snail kite impact preclusion program, no nest loss was attributed to incidental herbicide applications on lakes Okeechobee, Kissimmee, and Tohopekaliga.

Preoperative physical therapy in primary total knee arthroplasty.

In order to evaluate the efficacy of preoperative physical therapy for patients undergoing elective primary total knee arthroplasty, 10 patients completed 6 weeks of physical therapy before surgery (PT group). Ten patients served as controls (C group). Subjects were tested at baseline (PT only), before surgery, 6 weeks after surgery, and 3 months after surgery using the Hospital for Special Surgery knee rating scale, range of motion, thigh circumference, walking speed, Cybex II isokinetic knee flexion, and extension testing, and computed tomography scanning for cross-sectional muscle area. Hospital stay and need for physical therapy after inpatient rehabilitation were also compared. Physical therapy produced modest gains in isokinetic flexion strength in these severely arthritic knees but no difference in extension strength. The decrease in isokinetic strength after surgery was not affected by preoperative physical therapy. Muscle area did not decrease significantly for the PT group, but it did decrease for the C group after surgery. While postoperative strength differences could not be demonstrated, preoperative physical therapy preserved thigh muscle area after surgery. The clinical significance of this finding is uncertain. Consequently, this study failed to support the routine use of preoperative physical therapy in knee replacement surgery.

Functional distal interphalangeal joint splinting for trigger finger in laborers: a review and cadaver investigation.

This two-part study evaluates the efficacy of functional distal interphalangeal joint (DIP) splinting for the treatment of trigger finger. Thirty-one fingers from 21 meat packing plant workers were treated with DIP splinting. A single corticosteroid injection was offered if triggering was stage 4 or greater. All workers returned to work immediately. Eighty-one percent of the digits were treated successfully (mean follow-up: 1 year). Treatment failure correlated with duration of symptoms and stage of triggering but did not correlate with age, race, sex, disease in multiple digits, or prior treatment. For the second part of the study, the effect of DIP splinting on flexor digitorum profundus (FDP) tendon excursion was studied in 16 fingers from 4 fresh cadavers. Excursion decreased 4.8 mm for the Stax splint and 4.2 mm for the dorsal Alumafoam splint. We conclude that DIP splinting provides a reliable and functional means of treating work-related trigger finger without lost time from work. Our cadaver investigation supports our theory that DIP splinting significantly decreases FDP excursion.

Rotator cuff disorders.

The supraspinatus, infraspinatus, teres minor and subscapularis muscles form a musculotendinous rotator cuff that provides dynamic stability to the shoulder joint. Symptoms of rotator cuff injury include limitation of motion, weakness and pain that often radiates down the upper arm and is present at night. Examination may reveal deltoid and rotator cuff atrophy, tenderness, limited passive range of motion and weakness on abduction and external rotation. Radiographs may show degenerative changes of the acromion or acromioclavicular joint, cysts, sclerosis and spurs of the greater tuberosity, and calcific deposits within the supraspinatus tendon. In most patients with subacromial impingement, conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs and subacromial injections, is successful. Failure of conservative therapy after six to 12 weeks merits further evaluation with magnetic resonance imaging or arthrography, and consideration of surgery.

Toxic shock syndrome as a complication of breast prostheses.

A case of a 21-year-old woman who developed toxic shock syndrome 6 days after augmentation mammaplasty with saline breast implants is reported. The infecting organism was S. aureus that was toxic shock syndrome exotoxin 1-negative and staphylococcal endotoxin B-positive. The causes and etiology of this rare postoperative complication are discussed.

Intraarticular fracture of the calcaneus.

The treatment of displaced intraarticular fractures of the calcaneus continues to challenge the orthopaedic community. The recent development of prognostic classification systems based on computerized tomography has clarified the roles of non-operative and operative treatment. It has also opened the door for further prospective study of the appropriate treatment of this injury and comparison of operative methods. Based on current literature and our experience, we recommend CT evaluation of all intraarticular fractures of the os calcis in patients who are operative candidates with treatment guided by fracture classification.

A dyadic remediation program for care recipients with dementia.

A cognitive remediation intervention was tested for its effect on functional outcomes of older care recipients with the diagnosis of dementia of the Alzheimer's type. The 78 community-dwelling care recipients were assessed on cognitive and behavioral functioning and randomly assigned to one of three conditions. Care recipients were expected to benefit most from active cognitive stimulation training as compared to placebo (passive) activity or wait-list control conditions. Following each weekly instruction session, the intervention was executed in the home by the family caregiver. Care recipients in the experimental group improved in cognitive and behavioral performance with treatment, but returned to former level of functioning by the 9th month. In contrast, the control group declined, while the placebo group remained static on these variables. These findings support the viability of remediation interventions in dementia despite the trajectory of cognitive decline.

Marginal mandibular nerve palsy due to compression by a cervical hard collar.

A case history of a trauma patient who developed a palsy of the marginal mandibular nerve from compression by a cervical spine hard collar is presented. After clinical and radiographic screening found no evidence of occult cervical spine pathology, the collar was removed; the palsy resolved uneventfully during the next 2 days.

Heavy metal and selenium levels in endangered wood storks Mycteria americana from nesting colonies in Florida and Costa Rica.

Colonially-nesting birds often nest in coastal areas, along rivers, or near other bodies of water that also are potentially polluted from industrial, agricultural or urban development. The levels of heavy metals and selenium were examined in the feathers of young wood storks Mycteria americana nesting in Northeastern Florida and from adult and young storks nesting on the Tempisque River on the west coast of Costa Rica. There were no significant yearly differences among the chicks from Costa Rica. Concentration of mercury, cadmium, and lead were significantly higher in the chicks from Florida compared to those from Costa Rica. Adult wood storks at Costa Rica had significantly higher levels of lead, cadmium, selenium, and manganese than young from the same colony.

Neuropsychological analysis of a case of crossed aphasia: implications for reversed laterality.

We present a case of crossed aphasia and reversed laterality in a 60-year-old right-handed man. Neuropsychological assessment was conducted both prior, and three months subsequent, to the removal of a right temporal lobe tumor. Results, using the Luria-Nebraska Neuropsychological Battery, Wechsler Memory Scale and WAIS Block Design, plus various drawings from copy and to command revealed: (1) presurgery Luria profile very close to the mean profile for dominant temporal lobe dysfunction, (2) preserved visuospatial and visuoperceptive skills, (3) preserved limb praxis, and, (4) good postsurgery functional recovery. These findings are discussed in relation to literature on crossed aphasia and reversed laterality.

Women and the fear of being envied.

Nursing is very much concerned with the health and status of women. Perhaps at the same time we are attempting to work therapeutically with this very large portion of humankind, it would be beneficial for us to more closely analyze our own difficulties as a profession made up almost exclusively of women. What is the relationship between the level of our self-esteem and our problem with envy--envy of and fear of being envied by other nurses and health care providers? In terms of professional achievement, to what extent is fear of success related to fear of being envied? Lastly, if we open the affective windows and allow some honest dialogue to blow through about a subject we tend to repress, will we be able to outgrow our "one-down" position?