Massive periorbital lymphedema after excision of cutaneous malignancy.
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Aged↗
Biomedical subjects
B D Haas
Publications and source records attributed to B D Haas.
Clinical bacteriology of dacryocystitis in adults.
To better define the spectrum and relative incidence of pathogens causing dacryocystitis in adults, samples of purulent lacrimal sac contents were obtained from 236 patients undergoing dacryocystorhinostomy for a clinical diagnosis of dacryocystitis. Positive culture results were obtained in 52.5%. Cultures were pure, consisting of a single organism in 71%, and were mixed in 29%. Gram-positive organisms were most common, accounting for 64.5% of the isolates. Staphylococcus epidermidis, comprising 27.3% of the isolates and Staphylococcus aureus, comprising 22.1% of the isolates, were the most frequently encountered organisms. Gram-negative organisms were present in 27.3% of the isolates with Pseudomonas aeruginosa the most common, accounting for 8.7% overall. Anaerobic organisms were found in 7.0% of the isolates with Propionibacterium acnes the most frequent, recovered in 4.7% overall. Unexpected findings included the paucity of Streptococcus pneumoniae organisms recovered and the high incidence of involvement by gram-negative and anaerobic organisms.
Acute Disease↗
PharmaTrend as a management tool: experience with the program.
A hospital's experiences with two pharmacy workload measurement systems, PharmaTrend and the pharmacy productivity unit (PPU) system it replaced at the institution, are compared. In 1976 a 352-bed general acute-care hospital implemented the locally developed PPU system. Typical drug distribution-related activities were defined and were assigned standard times per work unit; miscellaneous activities were assigned constant times per month. The PPU system served the institution well but had three important limitation: (1) new pharmaceutical services were not adequately represented, (2) the data collected had to be manually manipulated in order to calculate indicators, and (3) it was not possible to compare the data with those of similar institutions. In January 1988 the hospital implemented PharmaTrend. PharmaTrend was found to be a useful management tool because of the relative ease of data collection and the system's report-generation capabilities. By combining pharmacy workload data (including non-drug-distribution-related components) with data on finance, personnel hours, and patient admissions, PharmaTrend calculated indicators that were used for determining staffing and other needs and for financial reporting. The limitations of the PPU system were eliminated, except that it was still not possible to make valid comparisons with other hospitals because of the small number of participating hospitals that consistently report data to the PharmaTrend database. PharmaTrend offers advantages over previous pharmacy workload-monitoring systems by allowing for the expanded analysis and application of data.
Colorado↗
Diffuse choroidal melanocytoma in a child. A lesion extending the spectrum of melanocytic hamartomas.
A 10-year-old white boy presented with a diffuse pigmented lesion of the choroid of his right eye that had led to a partial secondary retinal detachment. Because of the fear of a diffuse choroidal melanoma (a lesion never before reported in an individual within the first two decades of life), the eye was enucleated. An incisional P-32 study, compared with an uninvolved region, was positive at 154% uptake. Pigmented tissue was discovered surrounding the distal meninges of the optic nerve, on the posterior surface of the eye, and within the orbital soft tissues adherent to the globe. This led to fear of extraocular extension of a malignant melanoma. Light microscopic examination of the enucleated globe demonstrated that the choroid was diffusely and massively thickened by polygonal, hyperpigmented tumor cells that were also present in compressed spindled forms between the lamellae of scleral collagen, in the scleral emissaries, on the surface of the eyeball, and in the distal optic nerve dura. The choroidal tumor cells had the features of those normally encountered in localized optic nerve head benign melanocytomas. Electron microscopy demonstrated the presence of large, well-melaninized melanosomes (but no macromelanosomes), confirming the diagnosis of a diffuse uveal melanocytoma. The differential diagnosis of this new entity and its relationship to previously reported pigmented lesions of the uvea is discussed.
Child↗