The purpose of the study described in this article was to compare the effectiveness of two bowel training programs for patients who had experienced a cerebrovascular accident (CVA) and to determine the length of time required to establish a regulated program. A quasi-experimental design was used to compare the existing bowel program that incorporated every-other-day digital stimulation (DS) with a program using daily DS. The convenience sample of 48 CVA patients included 23 in the control group who had DS every other day and 25 in the experimental group who had daily DS. Demographic data showed no significant differences between the two groups. The t-test showed that more subjects in the experimental group established regularity; however, the subjects in the control group who did achieve regularity took less time to do it. Subjects with right-side hemiplegia and less mobility required more time to become established. As a result of these findings, the routine protocol for bowel training in this rehabilitation unit has been changed to include daily digital stimulation.

Aged↗

PubMedDate not supplied

Structure of the serine chemoreceptor in Escherichia coli.

Many biological processes depend on the function of proteins that detect changes in a cell's environment and transmit the information to the cytoplasm, for example, peptide hormone receptors. In Escherichia coli this class of proteins is exemplified by the sensory transducers (also called signalling proteins or methyl-accepting chemotaxis proteins) which have a central role in mediating chemotactic behaviour. The sensory transducers are the products of four genes: tsr, tar, tap and trg. Each transducer detects changes in the environmental concentration of one or a very few attractants: Tsr, serine; Tar, aspartate and maltose; Tap, unknown; and Trg, ribose and galactose. Tsr and Tar act directly as chemoreceptors for the amino acid attractants and signal changes in their degree of occupancy to the flagellar apparatus. Detection of these changes in occupancy is made possible as the transducers are methylated at multiple glutamate residues such that their level of methylation reflects the most recent chemoeffector concentration. Biochemical and genetic information concerning the serine transducer protein has been accumulating rapidly but little is known about the structure of the molecule. We present here the nucleotide sequence of the tsr gene of E. coli; the amino acid sequence derived from it suggests that the Tsr transducer protein has a relatively simple transmembrane structure that may place limits on the mechanisms available for the transmission of sensory information into the cell.

Amino Acid Sequence↗

PubMedDate not supplied

A unique case of the rapid onset of a large cystic hygroma in the adult.

Cystic hygroma is an uncommon lymphatic tumor seen rarely in adults, with less than 100 cases reported in the literature. The etiology and pathophysiology of this lesion is still in question. The majority of cystic hygromas occur in the head and neck, particularly in the posterior triangle. Although cystic hygromas tend to enlarge progressively over a span of weeks or months, relatively rapid enlargement over a span of days has been described. We present the unique case of an adult woman who experienced sudden onset of a large cystic hygroma in the neck without history of antecedent swelling, infection, or trauma. Successful surgical removal of the hygroma was performed. A brief review of the literature is presented.

Adult↗

PubMedDate not supplied

Nursing and psychosocial issues of patients on mechanical support.

Mechanical support technology continues to evolve. Ongoing research has led to more efficient devices allowing for discharge to outpatient or home settings. From December of 1991 to July 31, 2000 the Cleveland Clinic Foundation has placed 240 mechanical support devices. These include 173 HeartMate devices of the Pneumatic or Vented Electric models, 56 Novacors, and 11 Thoratecs. Patients placed on mechanical support potentially proceed through six phases of support. This begins with the evaluation process and progresses through the perioperative phase, the intensive care phase, the regular nursing floor phase, discharge, and transplantation. We have developed a specialized team to care for this patient population. As a result, the nursing and psychosocial care of patients on mechanical support has advanced over years of experience. We have been able to identify specific nursing and psychosocial issues that develop through the phases of support. Becoming aware of these issues will assist in a successful outcome for the patient.

Critical Care↗