Adenolipoma of the breast

We here report a patient with an adenolipoma of the breast. The radiological features appeared to be characteristic. On mammography the mass was surrounded by a radiolucent ring and on ultrasonography the lesion was revealed as a well-defined, hypoechoic, lobulated and solid mass.     

Anatomic considerations of pin placement in the proximal tibia and its relationship to the peroneal nerve.

Peroneal nerve impalement is a recognized complication of percutaneous placement of wires, which is gaining increased usage with the application of the techniques of Ilizarov, Monticelli, and Spinelli. Dissections of the peroneal nerve in the proximal tibia were performed in ten anatomic specimens (20 legs) to define (1) its relationship to palpable landmarks, (2) distribution of major branches to the musculature, and (3) safe zones of placement of percutaneous wires in the proximal tibia. The anterior recurrent tibial nerve was frequently in an area of risk where it courses proximally in the anterior compartment. A safe zone is located anterior to the palpable portion of the fibular head and up to 2 cm distal to the tip of the fibular head.     

Hypertension in the emergency department

Hypertensive emergencies are now rare and are recognized by the deleterious effect on end-organs. Prompt, efficacious treatment is critical, and the current drug of choice for most episodes is sodium nitroprusside. Hypertensive urgencies are more common than are emergencies, and are distinguished by diastolic pressures greater than 115 mm Hg without end-organ dysfunction. Although there are many efficacious agents, one excellent choice is nifedipine.     

Platelet utilization in a university hospital

Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions.     

The listening healer in the history of psychological healing.

OBJECTIVE: The purpose of this paper is the assessment of the healer's listening as an aspect of the history of caring and curing, with particular attention to its place in psychological healing. METHOD: An extensive range of philosophical, religious, and medical sources from antiquity to the present were studied. RESULTS: Over the centuries, listening has been a crucial aspect of the various endeavors undertaken by healers in the interest of acquiring information from, achieving understanding of, and bringing about healing effects for sufferers. Yet it has been vision rather than hearing that has been emphasized in knowing and understanding, and looking rather than listening that has been emphasized in healing endeavors. Only around the turn of the twentieth century did there emerge the focused study of care in listening, of listening beyond the words themselves, and of the significance of the interested listener as a soothing, empathic force. CONCLUSIONS: The place of listening in depth and with empathy is a crucial element in healing. While the emphasis on looking remains significant in the gathering and appraisal of data, at times it threatens to overwhelm the need for an attentive and concerned listener. There appears to be a natural tension between the two modes that has, in modern times, been translated into a tension between the two modes that has, in modern times, been translated into a tension between a scientific mode of gaining information and a humanistic mode of knowing sufferers. A healer neglects either one at his or her peril--and at the peril of his or her patients.     

Effects of exercise training on men seropositive for the human immunodeficiency virus-1.

We examined the effects of chronic exercise on fitness and immune status in Caucasian males (34.9 +/- 5.6 yr) diagnosed by Western blot as seropositive for the HIV-1 virus. The exercise regimen involved 12 wk of 1 h sessions 3 d.wk: 20 min of cycle exercise at 60-80% HRreserve was followed by 35 min of strength and flexibility training. After matching subjects on health status (modified Walter Reed criteria), subjects (N = 37) were randomly assigned to exercise or a counseling control condition. Changes in strength, responses to the YMCA cycle test, and serum lymphocytes were tested by MANOVA in a condition (exercise or counseling)-by-time (pretest, posttest) design with repeated measures on time. Results indicated significant (P less than 0.001) group-by-time interactions for strength (N.m) (chest press and leg extension) and for HR (beats.min-1) and total time (TT) on the cycle test at 150 W. Strength and TT increased and HR decreased in the exercise condition, while control subjects did not change. Total leukocyte, lymphocyte, CD4+, and CD8+ cell counts, and the CD4+/CD8+ ratio were statistically unchanged for each condition. We conclude that HIV-1+ men, including those symptomatic for AIDS-related complex, can experience significant increases in neuromuscular strength and cardiorespiratory fitness without changes in lymphocyte phenotypes or clinical diagnosis when the exercise regimen is prescribed and monitored in accordance with ACSM guidelines for healthy adults.