Osteosarcomatosis

A review of the 690 cases of osteosarcoma in the radiographic file of the Armed Forces Institute of Pathology revealed 29 cases of "osteosarcomatosis" (multiple skeletal sites of osteosarcoma). Fifteen of these patients were 18 years old and under and manifested rapidly appearing, usually symmetric, sclerotic metaphyseal lesions. The remaining 14 patients were more than 18 years old and had fewer, asymmetric sclerotic lesions. In most patients (28 of 29), a radiographically dominant skeletal tumor was seen. Pulmonary metastases occurred in the majority of patients and were detected at the same time as the bone lesions. These 29 patients were studied with regard to demographic data and skeletal distribution and radiographic appearance of their lesions. As a result of the findings, a metastatic origin from a primary dominant osteosarcoma is favored over a multifocal origin as the basis for osteosarcomatosis. Osteosarcomatosis is more commonly encountered in the mature skeleton than has been previously recognized.     

Using systems thinking to extend continuous quality improvement

Traditional CQI tools have proven effective in improving discrete processes, but the strengths of these tools often render them inappropriate to improve complex systems made up of multiple processes. After finding that CQI tools failed to reduce emergency department waiting times, a QI team applied systems thinking tools and learned that the cause of delays was rooted in interrelationships among processes, such as the impact on laboratory testing when emergent and routine patients arrived back to back. Computer modeling allowed the team to reject some quick fixes--such as adding ED beds--that simulations showed would be ineffective. By reorganizing patient flow and automating hospitalwide bed control, the team so far has reduced waiting times 19 percent and increased patient satisfaction despite an increase in census.     

Testosterone implantation reduces the motor effects of cocaine

The abuse of anabolic-androgenic steroids noted in recent years has been correlated with an increased likelihood of abuse of other drugs, including cocaine. This research was designed to investigate whether manipulation of androgen levels would alter the unconditioned behavioral effects of cocaine. The influence of testosterone on the locomotor activating effect of oral cocaine was evaluated. Subjects were male gonadally intact and castrated Wistar rats, implanted s.c. with either placebo or 100mg testosterone 30-day pellets. Beginning 7 days after pellet implantation, each animal in the four subgroups randomly received 0, 20, 40 and 80mg/kg cocaine (once, each dose). Cocaine 80mg/kg significantly enhanced locomotor activity in all groups except the intact testosterone-treated group. Of the four groups, this subgroup would have the highest plasma level of testosterone. These data suggest that chronic exogenous androgen administration may reduce the behavioral effects of cocaine.     

Cost-benefit analysis of transesophageal echocardiography in cardiac surgery

This article evaluates the costs and outcomes associated with TEE during and after cardiac surgery. The costs include the direct and indirect costs--the complications of TEE. The outcomes include the positive consequences or the benefits: money and lives saved. The article uses liberal (high) estimates of the direct and indirect costs of TEE and conservative (low) estimates of the benefits. The exact cost or benefit depends on the number of cases performed. The analysis shows that patients having surgery for congenital heart disease derive the greatest overall benefit: around $600 per case studied. Patients having valvular repair surgery derive the next greatest benefit: around $450 per case studied. In contrast patients having valve replacement have an overall cost of around $150 per case studied. Patients having surgery for coronary artery disease also derive an overall benefit: around $100-$300 per case studied, depending upon assumptions regarding TEE's role in prevention of intraoperative strokes. This analysis indicates that the financial benefits of TEE are substantial and frequently outweigh costs in patients requiring cardiac surgery.