Complications of endoscopic examinations of the upper segments of the gastrointestinal tract

A ten-year experience with 106610 diagnostic esophagogastroduodenoscopies provided evidence of a 0.03% rate of relevant complications and 2.38% mortality. Out of 39 patients with endoscopy-related complications 5 were operated on: 4 had esophageal perforations, 1 had hemorrhage following biopsy of the ulcer. Out of 7384 therapeutic and operative endoscopies none were associated with lethal outcome. Surgery was avoided either. Complications developed in 45 patients (0.036%): in 44 patients hemorrhages occurred after electroexcision of the polyps.     

Common forefoot deformities. How to treat, when to refer

Initial assessment of common forefoot deformities by the primary care physician is quite feasible. A thorough history, examination of the foot with the patient standing and seated, assessment of the patient's footwear, and radiographic evaluation can often lead to gratifying relief with use of simple office measures. Even in cases that require referral to an orthopedic surgeon, interim relief of symptoms and the patient's increased awareness of the problem and its cause enhance the patient's understanding and the final outcome as well.     

Tetanus: an uncommon cause of dysphagia

A 53-year-old woman was examined at our medical center because of progressive dysphagia of 14 days' duration and a severe inability to open her mouth and swallow saliva. A barium esophagogram showed no obstruction, but pooling of barium in the hypopharynx suggested a neuromuscular disorder. The clinical diagnosis of tetanus was confirmed by electromyography. With appropriate therapy, the patient recovered during a period of 6 weeks. This case illustrates both an uncommon cause of dysphagia and an uncommon initial manifestation of tetanus.     

A digital test for pelvic muscle strength in older women with urinary incontinence

A digital test of pelvic muscle strength for evaluation of a pelvic muscle exercise (PME) program was developed with a sample of 338 incontinent women living at home. Factors of perceived pressure, alteration of the vertical plane, and time were combined to form a 7-point scale ranging from 0 to 4. Test-retest for the anteroposterior score was r = .65, p less than .01 with interrater reliability, r = .91, p less than .01. Relationship to other variables and further development of the measure are discussed.     

Three different pathogenic mechanisms for paraparesis in association with bacterial infections

Three different pathogenic mechanisms are apparent for paraparesis in association with a bacterial infection: a spinal cord compression caused by either an epidural abscess or a vertebral collapse due to spondylitis, an ischaemic spinal cord lesion as a result of septic thromboembolus in abdominal aorta, and a nonspecific, probably immunological, cause in association with reactive polyarthritis. An example of each of these mechanisms is described by means of case histories.     

Liability for infectious diseases in day care: legal and practical considerations

A lawsuit directed by parents at a day care program following an outbreak of infectious disease would most likely be based on the legal theory of negligence--the failure to exercise due care as required by circumstances. In the determination of liability for infectious diseases in child day care, the element of causation is most critical. Did the day care facility's actions or failure to act cause the harm? Another important question is whether an infectious disease can be occupational and under what circumstances. Although worker's compensation laws initially had no provisions for occupational disease, now all states recognize responsibility for them. Awareness of potential problems with legal liability and establishment of procedures to minimize risk are important for day care providers, public health officials, clinicians, and parents.