Multiple dimensions of caring for a patient with acute necrotizing fasciitis.

Critical care nurses within acute care settings are responsible for providing healthcare to a wide variety of patients and, consequently, knowledge regarding how to care for a patient with acute necrotizing fasciitis is imperative. A case study is presented to evidence the need for a multidisciplinary approach. Necrotizing fasciitis is defined and treatment options are presented. Caring for this patient is very challenging and demands a multidisciplinary team to coordinate all aspects of care to promote better patient outcomes.     

Adult rat seminiferous tubules secrete a fraction greater than 30 kDa to regulate spermatogenesis

The present study was designed to examine the effects of a >30kDa fraction of medium conditioned for 2 days by adult rat seminiferoustubules on inhibin secretion by cultured tubules, and on spermatogenesisand fertility of male rats. Inhibin secretion was assayed byadding the >30 kDa fraction to 5 cm segments of adult ratseminiferous tubules and measuring inhibin by radioimmunoassayat 2 day intervals. Fertility was assayed by injecting malerats daily for up to 45 days with the >30 kDa fraction andthen mating them with a proestrus female, or by injecting for15 days and mating them with two female rats. The assay usedto evaluate the in-vivo effect of the >30 kDa fraction onthe testis involved an assessment of frequencies of seminiferoustubule stages scored by transillumination on intact tubules.The addition of the >30 kDa fraction to the adult rat seminiferoustubules cultured for 2 days resulted in an inhibition of inhibinsecretion into the medium. This effect was reversed when thefraction was removed and changed with fresh medium and culturedfor a further 4 days. The >30 kDa fraction administered i.p.to adult male rats resulted in a low fertilization rate comparedto control rats (67%) (P < 0.05). The assessment of frequenciesof seminiferous tubule stages scored by transillumination showedan increased frequency of stage VI and decreased frequency ofstages VII and VIII after treatment. The results of the presentstudy provide additional evidence that local regulation of Sertolicell function is mediated by a >30 kDa component or componentssecreted by adult seminiferous tubules which could arrest spermatogenesis.     

Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study

The functions of the meniscus and subsequently the importance of meniscus preservation are well known. Thirty-one of 105 patients who underwent (closed) arthroscopic meniscus repair between 1982 and 1986 using an inside-out technique previously described were studied. Evaluations were based on The Hospital for Special Surgery knee rating system. Eighty-eight percent of the study population had a good-to-excellent outcome at an average 4.1 years follow-up. Most of these patients had no Fairbank changes on follow-up radiographs. Factors affecting outcome were analyzed. From this series, the at-risk factor for failure of meniscus repair is chronicity of injury (lasting longer than 2 weeks). Factors not noted to significantly influence results in this series include (a) age of the patient; (b) sex of the patient; (c) rim width up to 6 mm from the synovial meniscal junction; and (d) anterior cruciate ligament insufficiency. History of a reinjury and noncompliance with the postoperative rehabilitation protocol may also adversely influence results, but this is difficult to prove.     

Congenital torticollis: Evaluation by fine-needle aspiration biopsy

Fine-needle aspiration biopsy, used extensively for evaluating head and neck masses in adults, also provides an excellent minimally invasive means of evaluating infants with neck masses and torticollis. Three cases of torticollis involving infants are presented. In each case, fine-needle aspiration revealed a benign fibrous lesion, ruling out malignancy. The remaining cytologic differential diagnosis between infantile fibromatosis, fibromatosis colli, and calcifying aponeurotic fibrosis is discussed, with mention of the possible causes of and treatment for congenital torticollis. We conclude that fine-needle aspiration provides a fast and accurate diagnosis of neck masses in infants who have congenital torticollis, thereby avoiding surgical procedures in this very young age group.