Percutaneous cholecystostomy: anatomic considerations

In 100 consecutive patients undergoing abdominal computed tomography, the anatomic relationships among the gallbladder fundus, liver, and right hemicolon were evaluated to assess the feasibility of direct transperitoneal versus percutaneous transhepatic cholecystostomy. In only 17% of patients was there no interposition of colon or liver between the skin and the gallbladder fundus. In 13% of patients the right hemicolon lay between the gallbladder fundus and skin. In the remaining 70% of patients, the gallbladder fundus was positioned posterior to the liver margin. Thus, in 83% of patients studied, percutaneous cholecystostomy would necessitate a transhepatic approach.     

A new species Of Hexamastix (Protozoa) parasitic in the spiny-tailed lizard,Uromastix hardwickii

Summary Hexamastix lacertae n. sp., a parasite in the large intestine of the spiny-tailed lizard, Uromastix hardwickii Gray, 1827, is described. The parasite ranges (in microns) in length from 4.5–12.0 (average 7.5) and in breadth 2.5–10.0 (average 5.1). There are five unequal anterior flagella and a recurrent flagellum, which ends in a long acroneme. The axostyle is thick and projects outside the body for some distance (average 4.8). The pelta is crescentic in shape and is bordered by two fibrils. All the flagella, the axostyle and the pelta originate from a blepharoplastic complex situated in front of the nucleus. The nucleus is 2 in diameter. It has a vesicular structure with a central endosome and a peripheral ring of chromatin granules. Large round forms without axostyles are also seen. Variations in the number of anterior flagella both in forms with and without the axostyle are noticed.With 9 Figures in the Text     

Transfusion therapy: improved patient care and resource utilization

Improving the quality of medical care while reducing costs is one of the major challenges facing the health care system in the United States. At a 1020-bed, tertiary-care, teaching hospital, the Transfusion Committee modified transfusion practice by establishing new transfusion guidelines based upon national standards rather than local practices and by implementing educational and monitoring systems. Over a 3-year period, the number of transfusions decreased, the types of transfused components changed, and the waste due to unused components decreased. From the baseline of Fiscal Year (FY) 1989 (89), the number of exposures to components from allogeneic blood donors for the patient population decreased by 11,015 in FY 90, 14,067 in FY 91, and 16,990 in FY 92, thereby decreasing the risk of transfusion-transmitted disease, transfusion reaction, and alloimmunization. As compared to costs in FY 89, the altered transfusion practices resulted in cost savings of $376,269 in FY 90, $566,375 in FY 91, and $684,704 in FY 92. Over the 3- year period, exposures to components from allogeneic blood donors for the patient population were reduced by 42,072, and the total cost savings was $1,627,348. The methodology and results should be reproducible at other hospitals.