Treating pain: new guidelines for using controlled substances.
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Chronic Disease↗
Biomedical subjects
J F Arnold
Publications and source records attributed to J F Arnold.
Meckel's diverticulum: a ten-year experience.
Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine, occurring in up to 4 percent of the population. The majority of MD cases are discovered incidentally; however, they can occasionally cause serious bleeding or obstructive or inflammatory complications. We reviewed the charts of 58 patients with MD from 1984 to 1994 collecting data on age, sex, presentation, therapy, pathology, and surgical complications to try to identify factors suggestive of the need for surgical therapy and the associated morbidity and mortality of resection. There was a 1.3:1 male:female ratio, and although patients with MD were found at all ages, the majority were found in patients in the 4th and 5th decade of life. Forty-five of 58 were incidental, and 13 of 58 were symptomatic. The most common symptom was bowel obstruction (10 of 13). Forty-five of 58 MD cases were managed surgically, 71 percent by diverticulectomy and the remainder by segmental resection, with no associated morbidity or mortality. Symptomatic patients were more often male (77 vs 23%; P 0.06, Fisher's exact test), more often had ectopic mucosa (31 vs 16%; P, not significant), and were evenly distributed over all ages. These data suggest that, with the possible exception of male sex, there is no factor predictive of the development of symptoms in incidentally found MD. In light of this finding, the low operative morbidity and mortality, and the even age distribution in patients with complications of their MD, we recommend that MD be resected when found incidentally in the absence of an absolute contraindication.
Adolescent↗
The appropriate use of the duplex scan in carotid arterial disease.
The duplex scan has become the definitive test in the diagnosis of carotid arterial disease. Its significance, however, has been diminished its extensive use for inappropriate indications. We performed a retrospective study over a four year period at two major hospitals to evaluate the different indications for carotid duplex scans. Symptoms which prompted the test, associated diseases, the type of physician ordering the test, and demographic data were recorded on all patients. Statistical analysis was used to indicate which symptoms and associated diseases were significant in predicting carotid disease. A total of 4,764 scans were reviewed. There were 4,289 studies (90%) which were negative for disease requiring surgery. There were a total of 12 indications for the carotid duplex scan in this study; the most common indications were dizziness, (20%) transient ischemic attack symptoms (19%) and a bruit (16%). Vascular surgeons (28%), Internal Medicine physicians (27%) and Family practice physicians (15%) ordered the duplex scan most frequently, but 39% of the positive scans were ordered by vascular surgeons. A history of seizures, confusion, stroke and as a preoperative evaluation all had a very low yield and should not be used as an indication for a duplex scan. However, a long smoking history, a history of known carotid disease, and peripheral vascular disease all had a statistical correlation with an abnormal duplex scan. The use of the duplex scan to rule out carotid arterial disease for patients with vague, uncommon symptoms is inappropriate and wasteful.
Adolescent↗
[Peroperative autotransfusion].
Intraoperative autotransfusion was used in 15 patients undergoing peripheral vascular, porta-caval and liver surgery. This technique is blood saving in these indications. The most important physiopathological consequence is disseminated intravascular coagulation, whatever anticoagulation protocol is used. Low-dose heparin continuously administered is considered.
Acute Kidney Injury↗
Legislation: regulation and strangulation or option for innovation?
Frequently, we in the health professions are reactive (or even reactionary) in response to the evolutions and revolutions in our system of health care. In fact, at times the best that can be said for us is that we are responsive (and we hope, responsible) to the need for change. I would suggest that we must be innovative in dealing with the plethora of health legislation.
Humans↗
Vaporized hydrogen peroxide sterilization of freeze dryers.
The feasibility of using vapor hydrogen peroxide (VHP) as an alternative to steam sterilization has been examined using a pilot plant freeze dryer equipped with a prototype vapor generator. Specific objectives of the study discussed in this presentation were to: 1. Identify critical process variables affecting the lethality of VHP to Bacillus stearothermophilus spores, particularly within dead legs in the system. 2. Measure the efficacy of system degassing after sterilization. 3. Determine the effect of repeated sterilization cycles on the integrity of elastomeric components of the freeze dryer. Penetration of adequate concentrations of hydrogen peroxide vapor into small diameter piping, such as tubing connected to pressure gauges, is the most challenging aspect of VHP sterilization of freeze dryers. Prior to equipment modifications, spore strips placed within such dead legs remained positive irrespective of the number of gas/degas pulses and system pressure. Equipment modifications necessary to effect complete kill of biological indicators placed in system dead legs is discussed. Results of this study support the conclusion that vaporized hydrogen peroxide shows promise as an alternative sterilization method for freeze dryers.
Equipment Design↗