Cholecystogastrocolonic fistula with intrahepatic abscess: a rare complication of biliary stone disease.

A 52-year-old woman exhibited both a cholecystogastrocolonic fistula and intrahepatic abscess. Biliary-enteric fistulas are unusual complications of gallstone disease, and multiple, complex fistulas are extremely uncommon. Hepatic abscesses are also unusual complications of gallstone disease. The combination of a complex biliary-enteric fistula and hepatic abscess arising from gallstone disease has not been reported. In our patient, surgery was prompted by the hepatic abscesses; the fistula was not recognized preoperatively. We elected to resect gallbladder, gastric antrum, and transverse colon en bloc with primary closure of the gastric defect and, because the colon had not been "prepped," we created a right transverse colostomy and left mucus fistula. Under ideal circumstances, the anatomy of biliary fistulas is characterized preoperatively and managed definitively with a single procedure.

Repetitive strain injury: A new definition and treatment strategy based on the client-centered practice.

RSI is defined by the authors as a biopsychosocial disorder, under the umbrella of cumulative trauma disorder, involving a non-specific, potentially chronic pain syndrome of the upper extremity. Evaluation and treatment will focus on the client-centered practice. Patients are enrolled in an 8-week course of treatment, which focuses on patient involvement, education, relaxation, diaphragmatic breathing, exercise, postural modification, as well as assessing vocational and psychosocial issues.

A new approach to comprehensive safety management

This paper describes how safety programs can be designed so that weaknesse in the program can be identified by the management program is described. The remainder of the paper describes how the various management processes identify weaknesses in the overall safety management program (AU)

Human factors in chemical containment laboratory design.

A human factors engineering analysis of a chemical containment laboratory was performed to develop appropriate standards for future laboratory design. In order to perform this evaluation, a state-of-the-art facility was studied in depth. Measurements and observations were made of key operating areas. In addition, technicians were observed and interviewed as they performed various tasks. Compiled data were compared to existing ergonomic standards. The occupational implications of instituting ergonomically developed laboratory design standards are as follows: increased worker health, safety and productivity, improved work quality and reduced stress.