How to recruit--and retain--physicians for rural hospitals.
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Hospitals, Community↗
Biomedical subjects
M Hamm
Publications and source records attributed to M Hamm.
3D-surface reconstruction of intravascular ultrasound images using personal computer hardware and a motorized catheter control.
A system for three-dimensional (3D) presentation of intravascular ultrasound (US) images was designed. A standard hardware configuration based on personal computer equipment was used for acquisition and processing of image data. Pullback imaging with the US catheter was controlled by a specially designed motor assembly and performed either in equidistant 1-10 mm steps or at a constant retraction speed. Curvature of the vessel was documented on biplane digital subtraction angiograms and the US images were arranged according to the vessel shape in the angiograms. 3D reconstruction appears essential for spatial orientation of intravascular US and may be helpful in the planning of vascular interventions for a better appreciation of the extent and morphology of vascular lesions.
Blood Vessels↗
Chronic ethanol treatment of rats and the myocardial beta-adrenoceptors.
We examined the effect of chronic treatment with ethanol on the dynamics of beta-adrenoceptor binding in left ventricular myocardium of rats. After treatment with BAAM (20 mg/kg i.p.), an irreversible inhibitor of beta-adrenoceptors, the inhibition of beta-adrenoceptor binding was less, and the recovery of receptor binding was faster in chronically ethanol-treated rats compared to the control animals given equicaloric dextrin maltose treatment. When intracellular beta-adrenoceptor recycling was inhibited with colchicine, cytoplasmic left ventricular beta-adrenoceptor binding was greater in ethanol-treated compared to dextrin maltose-treated animals. We conclude that the previously reported decreased functional activity of the beta-adrenoceptor-mediated system probably reflects the contribution of ethanol-mediated effects not entirely restricted to the receptor-binding mechanisms.
Adrenergic beta-Antagonists↗
[Nocardia brasiliensis leg ulcer and nodular lymphangitis in France].
INTRODUCTION: Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. CASE REPORT: A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. DISCUSSION: The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.
Accidental Falls↗
The QA program evaluation: a powerful punch.
Even the best quality assurance program requires periodic review in order to attain or regain maximum efficiency and effectiveness. The JCAHO standard for annual QA program evaluation adds impetus to this obligation. Riverside Methodist Hospitals' QA program evaluation is constructed in a three year cycle. Internal evaluation in year one and external expert evaluation in year three are balanced in year two with a combined internal/external program review. The year one internal evaluation discussed in the article outlines a framework for evaluation which includes positioning the evaluation for maximum influence, identifying key QA program components and designing meaningful, comprehensive evaluation inputs. The informed judgments of professionals, as well as traditional documentation review, provide powerful evaluative insights. Evaluation outputs include a program rating, an identification of program strengths and weaknesses, and targeted recommendations for QA program improvements.
Forms and Records Control↗
Radical prostatectomy: survival outcome and correlation to prostate-specific antigen levels.
BACKGROUND: This paper reviews a 10-year experience with radical retropubic prostatectomy (RP) focussing on survival outcome related to pre- and postoperative levels of prostate-specific antigen (PSA). PATIENTS AND METHODS: 739 patients who underwent RP between 1987 and 1998 were prospectively investigated. Kaplan-Meier analyses were performed and correlated to pre- and postoperative PSA concentrations. RESULTS: In a follow up period of 11 years duration, (mean 3 yrs.) 57 of 739 patients died (20 from prostate disease progression, 37 from other causes). Correlation between low pre-operative PSA and pathological organ-confinement was significant (p < 0.001). Of 175 patients with PSA progression, 53 (30%) had never reached undetectable levels of PSA. 57% of PSA relapses were detected during the first year, and 3% later than 5 years post-operatively. Kaplan-Meier analysis yielded an average 3 years advantage in estimated prostate-cancer-specific survival when pre-operative PSA levels were below 50 ng/ml. Overall, prostate-cancer-specific and PSA-free 5-year survival-rates were 88%, 96% and 67% respectively. CONCLUSIONS: Survival-rates after RP are high even in conjunction with unfavourable PSA outcome. Merely one third of deaths resulted from prostate cancer, since men at risk frequently suffer from concomitant diseases that affect survival.
Aged↗
[Imatinib-induced purpuric vasculitis].
INTRODUCTION: Imatinib (Glivec) is a new molecule that specifically inhibits tyrosine-kinase activity and is used in the treatment of chronic myeloid leukemia. Cutaneous side effects with imatinib are frequent. We report the first case of purpuric vasculitis probably due to this drug. OBSERVATION: A 65 year-old man was treated for chronic myeloid leukemia with imatinib. After two months of treatment, he developed an erythematous and squamatous on the trunk, which regressed spontaneously one week after suspension of the product. Imatinib was reintroduced two months later. The patient immediately developed a painful, infiltrated, purpuric eruption on the legs. Histological examination revealed vasculitis compatible with the diagnosis of toxiderma. Since treatment could not be suspended, oral corticosteroids were introduced and the lesions cleared within three weeks. DISCUSSION: Adverse cutaneous reactions to imatinib are frequent. Their physiopathological mechanism is unknown.
Aged↗