The dental manager's role in a hospital

Ten years ago, the administrative leadership of Booth Memorial Medical Center recognized the institution's potential for growth in a rapidly changing economic environment. A decision was made to develop strong middle management to encourage excellence, efficiency, and accountability.
It was determined that the strength of the midsection of the hospital's administration could keep the hospital stable and lean, to withstand the pressures of inflation and regulatory restraints.     

Radiation-induced malignant fibrous histiocytoma of the brachial plexus

Summary Brachial plexopathy is a common and disabling complication in cancer patients most often attributed to metastasis or radiation-induced fibrosis. Occasionally, other rare but potentially treatable causes are found. A 73 year old woman had a left radical mastectomy followed by radiation to the chest wall and axilla 24 years ago. She recently presented with left arm pain, chronic, nonprogressive lymphedema, profound distal arm sensory loss and progressive severe hand weakness. There was moderate atrophy of all intrinsic hand muscles, anesthesia of the hypothenar eminence and 4th and 5th digits, and no adenopathy or palpable mass in the axilla. EMG confirmed a brachial plexopathy. MRI showed loss of tissue planes consistent with radiation fibrosis, but CT showed a discrete mass in the brachial plexus. Open biopsy showed pleomorphic spindle shaped cells with immunoperoxidase stains consistent with malignant fibrous histiocytoma.Radiation-induced malignant fibrous histiocytoma may present with a brachial plexopathy in the absence of a palpable mass and should be considered in the differential diagnosis of brachial plexus lesions in cancer patients. CT scanning through the plexus may be useful when MRI is normal or equivocal.     

Emotional cognizance & the type a behaviour pattern: Urinary catecholamine excretion and self-reported frequency of emotional signs/symptoms

Thirty-eight, first year osteopathic medical students provided a morning and afternoon urine sample (analyzed for norepinephrine and dopamine) on a school day. Change from morning baseline served as a measure of naturally induced arousal (i.e., ?stress”?) to a routine school day. They were also asked to fill out questionnaires assessing mood state during the morning session and, during the afternoon session, Type A Behavior, the frequency of 61 signs/symptoms of emotional arousal since the morning session and control data. One hundred and twenty-two Emotional Dyscognizance Indices (cross-sample t-scores for the two urinary amine measures minus t-scores for the 61 emotional frequency scores) were calculated. Each was then correlated with the Type A measure and 21 (17.2%) proved positive and statistically significant (p < .05). None were negative and statistically significant. The probability of such a finding is less than .001. Current results are consistent with the hypothesis of a heightened sympathoadrenomedullary arousal threshold for experiencing a given intensity of negative emotion in the Type A person. Such emotional dyscognizance would cause problems for both diagnosis and treatment.     

The effect of pregnancy and two different contraceptive pills on serum lipids and lipoproteins in a woman with a type III hyperlipoproteinaemia pattern

We report a woman who had a moderate elevation of serum triglycerides with a type III pattern of hyperlipoproteinaemia when taking a normal diet. She developed eruptive xanthomata with a grossly raised serum triglyceride concentration and chylomicronaemia when pregnant and also when taking a combined oral contraceptive pill containing 50 microgram of oestrogen. The xanthomata cleared and the triglyceride level fell when the combined oral contraceptive pill was changed to one with a lower oestrogen content, clofibrate was prescribed and the diet was restricted in carbohydrate and fat. Persistent chylomicronaemia is a serious complication of pregnancy because of the risk of pancreatitis and the potential risk of fetal malnutrition. Treatment with diet and clofibrate is indicated. High oestrogen-containing contraceptive pills appear to be contraindicated in patients with type III or other hypertriglyceridaemic states.     

OUTCOME OF INFANTS SHUNTED FOR POST-HAEMORRHAGIC VENTRICULAR DILATATION

Between April 1980 and March 1986, 19 infants underwent cerebrospinal fluid (CSF) shunting procedures for post-haemorrhagic ventricular dilatation at the Hammersmith Hospital, London. A total of 58 shunt-related procedures have been performed on these children. The major perioperative complication was seizure activity (eight children). Postoperative complications included infection (12 shunts) and blockage (29 shunts). Prophylactic antibiotics failed to prevent shunt infection. The likelihood of the first shunt failing was significantly reduced by greater weight of the infant and lower CSF protein at surgery. Long-term outcome was poor: three have died and another four are quadriplegic with severe mental retardation. Only four children are developmentally normal. These outcomes cannot be related to the shunt surgery or its complications, but correlate best with pre-operative parenchymal brain-lesions, as shown on ultrasound scans.     

Hiding Worries from One's Spouse: Associations Between Coping via Protective Buffering and Distress in Male Post-Myocardial Infarction Patients and Their Wives

The relationship between protective buffering, a style of coping in which the individual hides his/her concerns from spouse, and level of distress was studied among post-myocardial infarction (MI) patients and their spouses. Forty-three male married MI survivors and their wives completed measures of psychological distress and protective buffering at 4 weeks and 6 months post-hospital discharge. At both time periods, a greater propensity for protective buffering by the patient was related to higher levels of patient distress. Protective buffering by wife was also associated with higher levels of wife distress. In addition, patient buffering at 4 weeks predicted increased patient distress at 6 months. The results suggest that male MI patients who conceal their worries from their spouses adjust more poorly over time.