Vascular disorders of the upper extremity present a complex and challenging problem to the treating physician. The presentation is often subtle and the consequences of misdiagnosis or mistreatment can be severe. A thoughtful and through approach combining the history, physical findings, and use of appropriate diagnostic aids will provide the physician and patient with the greatest opportunity for a satisfactory outcome.

Acute Disease↗

PubMedDate not supplied

Periprosthetic humeral fractures: mechanisms of fracture and treatment options.

In 20 patients, 21 periprosthetic humeral fractures were reviewed retrospectively. The mean follow-up time was 27.1 months. Mild osteopenia was present in 45% of the patients, whereas 30% had severe osteopenia. Five mechanisms of fracture were identified, including 3 intraoperative causes that are avoidable. Treatment with stable intramedullary fixation utilizing the humeral stem and cerclage wiring provided superior results in terms of time to union, adverse effect on rehabilitation, and occurrence and severity of surgical complications. Diaphyseal fractures that were treated with standard stem arthroplasty with or without supplemental fixation had a longer time to fracture union, a higher complication rate, and prolonged rehabilitation. Fractures of the proximal humeral metaphysis can be treated with standard stem arthroplasty and cerclage wiring if the stem extends distal to the fracture site by at least 3 cortical diameters. Anatomic reduction of fractures treated by surgical means results in shorter healing times. Cast or brace immobilization can be used for management of postoperative fractures that occur distal to a well-fixed and stable prosthetic stem. Cast or brace immobilization results in fracture union but rehabilitation may be greatly impaired, and there is an increased risk of complications associated with immobilization of the extremity. Long-stem intramedullary fixation with cerclage wiring is the preferred surgical option for treatment of unstable humeral shaft fractures.

Adult↗

PubMedDate not supplied

Roundtable discussion on metabolic support of the cancer patient. Regional centers of excellence.

Home TPN has undergone a dramatic evolution over a relatively short period. It is unfortunate that the current system is barely realizing the potential to enhance patient care while keeping costs reasonable. Although industry has made the mistake of not demonstrating how important quality is for outcome, third-party reimbursement policy is making a more critical mistake of encouraging the implementation of poor-quality care through reimbursement levels so low that factors that ensure high quality must be cut if the provider is to survive. We must recognize that the provision of product is only part of the large system needed to deliver this expensive therapy. The institution of centers of excellence will allow consumers to make intelligent choices in the future application of health care dollars.

Humans↗

PubMedDate not supplied

Therapeutic effects of music and mother's voice on premature infants.

Aversive environment auditory stimuli is a common concern in neonatal intensive care. Recently, interest has developed regarding the use of music applications to mask such stimuli and to reduce the high risk for complications or failure to thrive. In this study of 20 oxygenated, low birth weight infants in a Newborn Intensive Care Unit of a regional medical center in the Southeastern United States, 10 infants listened to lullabies and 10 infants to recordings of their mother's voice through earphones for 20 minutes across three consecutive days. Oxygen saturation levels and frequency of oximeter alarms were recorded. Results indicated a differential response to the two auditory stimuli as listening time progressed. On Day 1, the infants listening to music had significantly higher oxygen saturation levels, but these effects disappeared by Days 2 and 3. On Days 2 and 3, however, the babies hearing music had significantly depressed oxygen saturation levels during the posttest intervals after the music was terminated. Infants hearing music had significantly fewer occurrences of Oximeter alarms during auditory stimuli than did those listening to the mothers' voice. Implications for the therapeutic use of auditory stimuli in the Newborn Intensive Care Unit are discussed.

Female↗