Electronic and disposable patient-controlled analgesia systems

We have compared the performance of the Baxter disposable with the Graseby electronic patient-controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.     

Impact of a shielded safety syringe on needlestick injuries among healthcare workers.

OBJECTIVES: Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers. DESIGN: Surveillance study. SETTING: Three medical centers. RESULTS: The total number of needlesticks from all sources rose from 134 during the baseline period to 140 during the study phase. However, the overall rate of needlesticks involving 3 cc syringes decreased from 14/100,000 inventory units to 2/100,000, and the frequency declined substantially at each of the participating medical centers. CONCLUSIONS: These results suggest that shielded syringes and related technology may offer potential for reducing the risk of needlestick injuries among hospital and other healthcare employees. This study should be viewed as a preliminary effort to assess the potential of shielded-syringe technology for reducing the risk of needlestick injuries among healthcare workers. The results are encouraging, but more clinical experience with this new device and longer follow up are essential to provide the data necessary for a definitive assessment of efficacy.     

Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation.

The case of a 49 year old man presenting with rapidly progressive interstitial lung disease is described. Radiological findings and the lung biopsy specimen were compatible with an acute interstitial pneumonia, as was the relentless clinical course culminating in hypoxic respiratory failure. After right single lung transplantation there was considerable improvement in lung function and radiographic clearing of disease in the native left lung.     

Auditory brainstem evoked potentials in leprosy

An electrophysiological study of conduction in the auditory nerve and brainstem auditory pathways using the brainstem auditory evoked potential was undertaken in a group of 47 leprosy patients. There were no statistically significant differences between mean conduction times (interpeak latencies) in the leprosy and the control groups. Abnormal interpeak latencies were encountered in 3 leprosy patients, 1 of whom had a positive serological test for syphilis. In the remaining 2 patients, caudal pathway dysfunction (I-III interpeak latency abnormality) was indicated but specific auditory nerve involvement (an abnormally prolonged I-II interpeak latency) was not demonstrated. An explanation for these findings, other than the patients' disease, was not apparent.     

Phenomenology and clinical correlates of delusions in Alzheimer disease.

OBJECTIVES: The objectives of this study were to determine whether anosognosia, depression, and elevated mood are associated with delusions in Alzheimer disease (AD), and to examine the validity of standardized diagnostic criteria for psychosis of dementia. METHOD: The authors assessed a consecutive series of 771 patients with AD attending a dementia clinic with a comprehensive neuropsychologic and psychiatric evaluation that included specific measures of delusions, hallucinations, anosognosia, depression, and elevated mood. RESULTS: Delusions were found in one-third of the patients and hallucinations in 7%. Most patients with hallucinations also had delusions. A principal component analysis of the Psychosis Dementia Scale, which rates the presence and severity of delusions, produced the factors of paranoid misidentification and expansive delusions. Paranoid, but not expansive, delusions increased across the stages of the illness. Anosognosia and depression were significantly and independently associated with the presence of delusions, whereas elevated mood was significantly associated with expansive, but not paranoid, delusions. A multiple logistic regression analysis demonstrated that delusions in AD were significantly associated with depression, anosognosia, overt aggression, and agitation. CONCLUSIONS: Anosognosia, depression, global cognitive deficits, and elevated mood are the main psychiatric correlates of paranoid misidentification and expansive delusions in AD, whereas overt aggression and agitation are the most frequent behavioral concomitants of psychosis in AD.