Ureteral calculi: percutaneous removal using modified basket extractors and fluoroscopy

Two modified helical basket extractors are described that have increased the success rate of removing ureteral calculi using fluoroscopy from 63% to 92%. Initially a rather stiff and expandable basket with a 20-cm filiform tip is used with coaxial catheters and sheath (stage 1). If this procedure is unsuccessful, a basket with two long cable ends is passed from the nephrostomy out through the urethra (stage 2). When used with coaxial bladder catheters, this technique allows dilatation of the vesicoureteric junction and retrograde catheterization and injection of fluids or gas to dislodge the stone prior to extraction. In a series of 38 patients, stones were removed in all but three (a success rate of 92%). In five cases small stones (less than 5 mm) were not retrieved but subsequent studies were normal. Ureteral stones were found in the abdominal ureter in 28 cases, in the pelvic ureter in seven cases, and in multiple sites in three cases. Stones were larger than 1 cm in 27.7% of cases. Postextraction mucosal edema with reduced ureteral patency was common but usually cleared in 2-3 days. Occasional complications were related to the nephrostomy.     

Retrorenal colon: implications for percutaneous diskectomy

It has been recommended that computed tomography (CT) with the patient prone be performed in every patient undergoing percutaneous diskectomy; this would enable detection of a retrorenal location of the colon, which could interfere with the percutaneous procedure. In this evaluation of 346 prone CT studies, only one patient (0.29%) was found to have retrorenal or retropsoas bowel that would have been perforated at diskectomy. Because of this extremely low prevalence, the performance of prone CT in every patient undergoing percutaneous lumbar diskectomy is not believed to be necessary.     

Hypogonadotropic hypogonadism.

Gonadotropin-releasing hormone (GnRH) and olfactory neurons migrate together from the olfactory placode, and GnRH neurons eventually reside in the hypothalamus. Hypogonadism in male infants may be diagnosed in the first 6 months of life but cannot be diagnosed during childhood until puberty occurs. Patients with low serum testosterone and low serum gonadotropin levels have idiopathic hypogonadotropic hypogonadism (IHH). Mutations in three genes (KAL1, FGFR1, and GNRHR) comprise most of the known genetic causes of IHH. Treatment with testosterone is indicated if fertility is not desired, whereas GnRH or gonadotropin treatment induces spermatogenesis and fertility.     

The effects of automated encoders on coding accuracy and coding speed

Encoded data on diagnoses and procedures are put to a broad range of uses. Coding accuracy and speed are imperative. One method that coding experts have recommended to improve coding accuracy and speed is automated encoders. The article describes the effect of automated encoders on coding accuracy and speed when used by trained coding staff. A study involving six Veterans Administration medical centers found that, overall, coding accuracy improved 19.4 percent after implementation of encoding software. The effect on coding speed, however, depended on the system set-up, with some set-ups actually reducing the number of discharges coded per day.     

Reducing your risk of burnout

Burnout is a common phenomenon of today's workplace. Burnout is attributed to stress in the work environment. Today's health care environment with its rapidly changing requirements is an especially obvious example. Prevention of burnout, then, becomes particularly crucial. Certain personality types are resistant to burnout; unfortunately, other personality types are susceptible to burnout. However, managers and supervisors can use knowledge of personality types and their corresponding strengths and vulnerabilities to protect themselves and their subordinates from burnout. There are also general and type-specific coping efforts that people can use.     

The effects of long-term psychotherapy on patients' self-perception.

A review of the literature regarding the effects of long-term psychotherapy indicates that it has rarely been examined purely from the standpoint of the patient. This study attempts to determine how the patients perceive attitudinal change in themselves and their therapists during the treatment process. Twenty patients who received dynamically oriented psychotherapy in excess of one year in a typical outpatient clinic participated. These patients were randomly assigned a therapist who was either a Clinic staff member or senior resident in psychiatry. Slightly more than half the patients included in the study had a diagnosis of psychoneurosis, while the remainder were viewed as possessing characterological or psychotic disturbances. Evaluation of patient attitudes was achieved through the use of a modified version of Osgood's Semantic Differential Scale. It was determined that patients perceived themselves as becoming significantly more like their therapists after one year of psychotherapy. They saw themselves as more active, independent, dominant, outgoing, realistic and happy. This "psychic shift" is discussed in terms of identification, transference and counter-transference phenomena.     

Toxic cardiogenic shock in a patient receiving weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin

A 54-year-old man was treated with weekly 24-h infusion of high-dose 5-fluorouracil (2600 mg/m2) and leucovorin (100 mg/m2) for metastatic colon cancer. At first, he tolerated the treatment well and no significant toxicity was identified. After a total of eight courses of treatment, a stable disease was observed, but mild shortness of breath was found on occasion. The patient had no previous history of cardiac disease and the heart performance assessed by left ventricular ejection fraction before treatment was normal. Unfortunately, acute pulmonary edema with lethal cardiogenic shock occurred during the ninth course of treatment, in spite of intensive medical treatment. The chest X-ray showed extreme cardiomegaly. Repeated assessment of his heart function by echocardiogram and ventricular ejection fraction revealed a very poor cardiac performance. Toxic cardiogenic shock during weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin is extremely rare. To the best of our knowledge, no case has been reported in the English literature. We report a case and the relevant literature about the incidence, clinical picture and possible pathophysiology on 5-fluorouracil-related cardioxicity is reviewed.