Arthroscopic rotator cuff repair:Indications and technique

Arthroscopic repair of rotator cuff tears is now possible. By using the biomechanical principles of margin convergenceand the balance of force couples, even large cuff defects can be repaired. Suture anchors are particularly suitable for arthroscopic repairs, and a corkscrew anchor design lends itself to a trans-tendon approach     

Decreased Efficacy of Topical Anesthetic Creams in Presence of Benzoyl Peroxide

Background. Topical anesthetics are widely used to diminish the sensation of pain from various medical cutaneous procedures. Any topical agent that reduces the desired effect has clinical ramifications.
Materials and Methods. Topical 6% benzocaine cream was applied to both inner forearms of five persons and covered with a bandage. One of the arms was additionally treated simultaneously with 5% benzoyl peroxide. The areas were tested with a pinprick examination every 10 minutes for the ensuing hour.
Results. There was an estimated 75% increased perception of pain on the forearm to which benzoyl peroxide was applied in consort with the topical anesthetic at all examination times.
Conclusions. Benzoyl peroxide chemically reacts with topical anesthetics such as tetracaine, procaine, pramoxine, prilocaine, and lidocaine, causing a significant reduction in their numbing effect. Clinically, make sure that the skin area to be topically anesthetized is devoid of any previous treatment with benzoyl peroxide or insist that the skin is thoroughly washed prior to application of the anesthetic.
CRAIG G. BURKHART, MPH, MD, AND CRAIG N. BURKHART, MSBS, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.     

The nurse's role as clinical coordinator for the Center for Cranial Base Surgery

The newly created position of clinical coordinator for the Center for Cranial Base Surgery at Presbyterian-University Hospital is detailed in this article. The position evolved in response to needs of this specialized center, because the complexities of cranial base tumors (CBTs) require optimal patient care be a collaborative effort. The clinical coordinator works with the neurosurgeon in all phases of treatment. From the preoperative visit, through admission and surgery, and then in postoperative care and follow-up, patient care is centered not only on the physical aspects inherent in surgery and recovery, but also on psychological support and attention which must be maintained throughout the patient's treatment course. In addition, the clinical coordinator has important input concerning research activities, particularly in clinical implementation of new therapies, as well as patient data management. Inservice education of other health professionals in their dealings with CBT patients further enhances quality of and continuity in patient care. Patient-care responsibilities as well as related research and training activities are discussed.