Pain and somatic symptoms are sequelae of sexual assault: results of a prospective longitudinal study.

BACKGROUND: Cross-sectional studies have shown that chronic musculoskeletal pain and somatic symptoms are frequently reported by sexual assault (SA) survivors; however, prospective studies examining pain and somatic symptoms in the months after SA have not been performed. METHODS: Women SA survivors 18 years of age or older who presented for care within 48 h of SA were recruited. Pain in eight body regions (head and face, neck, breast, arms, abdomen, back, genital and pelvic, and legs) and 21 common somatic symptoms (e.g., headache, nausea, insomnia, persistent fatigue) were assessed (0-10 numeric rating scale in each body region) at the time of presentation, 1-week, 6-week and 3-month interview. Post-traumatic stress disorder (PTSD) symptoms were assessed at the 6-week and 3-month interview. RESULTS: Clinically significant new or worsening pain (CSNWP) symptoms were common among study participants 6 weeks after SA [43/74, 58% (95% CI, 47-69%)] and 3 months after SA [40/67, 60% (95% CI, 48-71%)] and generally occurred in regions not experiencing trauma. Women SA survivors also experienced an increased burden of many common somatic symptoms: 8/21 (38%) and 11/21 (52%) common somatic symptoms showed a significant increase in severity 6 weeks and 3 months after SA, respectively. Correlations between PTSD, CSNWP and somatic symptoms were only low to moderate, suggesting that these outcomes are distinct. CONCLUSIONS: New and/or clinically worsening pain and somatic symptoms, lasting at least 3 months, are sequelae of SA. Further studies investigating pain and somatic symptoms after SA are needed.

Symptomatic thrower's exostosis. Arthroscopic evaluation and treatment.

A long-term follow-up was performed on 22 patients treated for a posterior glenoid osteophyte and symptomatic posterior shoulder pain during either the late cocking, acceleration, or follow-through phases of throwing. Arthroscopic evaluation of these patients revealed undersurface tearing of the rotator cuff in all but one. Fifteen patients also had tearing of the posterior labrum. Anterior labral fraying was noted in four patients. Treatment consisted of debridement of the rotator cuff and labral tears. The posterior glenoid osteophyte was removed arthroscopically in 11 patients. Eighteen of 22 throwers treated were available for long-term follow-up at a mean of 6.3 years (range, 1 to 12). Only 10 of 18 (55%) throwers evaluated had returned to their premorbid level of throwing. All 10 were asymptomatic and had maintained a high level of performance for a mean of 3.6 years (range, 1 to 8). At the time of latest follow-up, five players were still participating at the major league level and five had retired. One patient had recurrence of the exostosis 8 years after surgery. Among our patients a trend existed toward a poorer result and failure of return to activity with a posterior osteophyte greater than 100 mm2. A posterior glenoid exostosis, when identified in the symptomatic shoulder of the throwing athlete, can be considered a definite marker of internal impingement.

Concept mapping: promoting science learning in BN learners in Australia.

BACKGROUND: We reviewed the process of using concept mapping as a methodology to teach science to RNs in a bachelor degree of nursing program in Australia. METHOD: The technique was used for two classes of students in the science unit during 1995 with work packages and independent student learning being the focus of the unit. RESULTS: Both instructors and students found the experience mainly positive. It helped the students become more independent learners, have a greater confidence in their knowledge of science, and allowed their understanding of science in their practice to become more meaningful and personalized. For the instructors it allowed them to concentrate on students with learning difficulties because they had less face-to-face teaching hours. Major issues arising from the process related to how to balance science content and the techniques of concept mapping and how to more effectively assess the learning outcomes of the students. CONCLUSION: Concept mapping is a useful technique to link science and nursing practice. Not only can it be used in academic programs to teach the science underlying practice, it can be used in the clinical area to teach patients. As a technique it works well in staff development and continuing education where the focus is on elucidating the rationale for inuring practice and providing evidence for the value of this practice.

Caudal slope of the tibia and its relationship to noncontact injuries to the ACL.

To determine the role that an increased caudal slope of the tibia might have on the incidence of anterior cruciate ligament (ACL) injury, tibial slope was measured in 49 patients (50 knees), with noncontact ACL injury mechanisms (group 1) and an age-matched group of 39 patients (50 knees) with a diagnosis of patellofemoral pain syndrome (group 2). No significant difference was noted in mean posterior slope between the two groups (group 1: 9.7+/-1.8 degrees and group II: 9.9+/-2.1 degrees) or after controlling for bilateral patients in two separate trials. These results indicate that increased caudal tibial slope does not appear to be a risk factor in the creation of noncontact injuries to the ACL.

Nurses' understanding of physical science in nursing practice.

When science educators teach nurses, their primary aim should be to help them to develop understanding of their world of nursing. From a study of registered nurses' conceptions of the physical science underlying their clinical practice, we assert that nurses' understanding of the physical sciences is inadequate in terms of the competencies required of them as nurses. Rather than respond to this contention by altering the content of physical science units in nursing courses, we propose that those who teach nurse students should look more carefully at factors that influence nurses' learning: these factors are images of nursing, shared experience and shared language. We maintain that these factors should not be ignored but can be used to advantage in teaching science to nurses.

Significance of increased Tl-201 uptake by the lungs in patients undergoing oral dipyridamole-thallium myocardial imaging.

The purpose of this study was to evaluate the significance of increased Tl-201 uptake by the lungs after oral dipyridamole testing. In conjunction with myocardial perfusion scintigraphy, intravenous dipyridamole has been recently approved as an alternative to exercise for the evaluation of coronary artery disease in patients who cannot adequately exercise, and it will largely replace oral dipyridamole testing. This study contributes to the understanding of the significance of increased lung thallium uptake during pharmacologic stress testing. Oral dipyridamole, 400 mg, was administered to 192 patients undergoing Tl-201 imaging for clinical indications. Mild adverse effects occurred in 31% of patients (chest pain, nausea, headache, or flushing). Dipyridamole had minimal hemodynamic effects. The lung/heart thallium activity ratio was determined in 152 patients. These were subdivided into four groups according to the presence or absence of ischemia, transient myocardial perfusion defect, or scar as indicated by a fixed myocardial perfusion defect. In 61 patients without transient myocardial perfusion defect or fixed myocardial perfusion defect (group 1), the lung/heart thallium activity ratio was 0.39 +/- 0.01 (mean +/- SEM). In 31 patients without transient myocardial perfusion defect but with fixed myocardial perfusion defect (group 2), the lung/heart thallium activity ratio was higher, 0.44 +/- 0.02 (P less than 0.05). In 27 patients with transient myocardial perfusion defect but no fixed myocardial perfusion defect (group 3) and in 33 patients with both transient myocardial perfusion defect and fixed myocardial perfusion defect (group 4), the lung/heart thallium activity ratio was 0.51 +/- 0.03 and 0.52 +/- 0.03, respectively, both significantly higher than either group 1 or group 2 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Improving compliance in an inner-city hypertensive patient population.

Because hypertension is a "silent" disease process, compliance with therapy is always a problem. In the inner city, where socioeconomic factors such as poverty, illiteracy, and substance abuse raise additional barriers to effective health care, poor compliance with antihypertensive regimens can reach epidemic proportions--as it did in our clinic in the early 1970s. After identifying the major causes of poor compliance in our patients, we instituted measures that led directly to greatly improved compliance and control, among them the expansion of clinic hours, the expediting of laboratory services, and the training of nurse-therapists to assume many of the responsibilities of running the clinic. In recent years a number of new antihypertensive agents have been introduced, and these new drugs have afforded patients better blood pressure control through less complex drug regimens with fewer serious side effects. Indeed, we observed a strong correlation between patient compliance and the administration of agents with longer dosing intervals and improved side effects profiles. This observation led us to consider whether transdermal clonidine--which requires weekly, rather than daily, administration--might not be an especially effective means of controlling blood pressure in inner-city patients. To test this hypothesis, we enrolled 20 patients, all of them blacks, in a pilot study of this unique delivery system. Blood pressure was adequately controlled in all 18 patients who completed the study, and patients were uniformly enthusiastic about this alternative to daily dosing. As a result, compliance with this mode of therapy was excellent.

Centrally acting alpha-2 agonists, peripherally acting adrenergic-blocking drugs, and direct vasodilators in the treatment of mild and moderate essential hypertension.

The experience with three groups of antihypertensive agents in a large hypertension clinic serving a black patient population is reported. A retrospective review of clinic records was undertaken to determine the efficacy and adverse effects of the centrally acting adrenergic agonists methyldopa and clonidine, the alpha-1 antagonist prazosin, and the direct vasodilator hydralazine in patients with mild and moderate hypertension. Treatment with methyldopa, clonidine, or prazosin, usually in combination with a diuretic produced a 30 to 38 mmHg decrease in systolic blood pressure, and a 24 to 28 mmHg reduction in diastolic blood pressure. Similar declines in blood pressure levels occurred when hydralazine was used with an alpha-2 adrenergic agonist or beta-adrenoceptor blocking agent. Evidence of clinical efficacy, defined as a decrease in systolic blood pressure to below 140 mmHg and in diastolic blood pressure to below 90 mmHg, was observed in 80% or more of the patients. An 88% efficacy rate was seen with methyldopa. Effective doses of the drugs varied considerably; most patients, however, responded at a dose close to the average dose for each agent. The most serious adverse effect observed was elevation of hepatic enzyme levels in patients receiving methyldopa, which necessitated withdrawal of the drug. Two patients treated with 0.4 mg clonidine twice a day experienced "rebound" hypertension when the drug was abruptly discontinued. Overall, good clinical efficacy and patient acceptance were found with these three groups of antihypertensive agents.

Evaluation of a new direct latex agglutination tube test (UCG-Macrotube) for pregnancy.

PIP: A new direct latex agglutination tube test for pregnancy, the UCG-Macrotube, was compared with the UCG-LYPHO test and the UCG-SLIDE test. 328 urine specimens were evaluated by each test, and results were compared with a quantitative gonadotropin assay performed at an independent laboratory. All 3 tests were negative in 136 cases and all were positive in 174 cases, there being 1 false positive and 1 false negative identified by all 3 tests. UCG-Macrotube was positive for 10 samples where the other 2 tests were negative, the positive result being confirmed subsequently. In 8 borderline cases where UCG-Macrotube showed only weak agglutination and was judged negative, the independent assay showed human chorionic gonadotropin levels to be below the claimed limit of sensitivity (.5-1.0 IU/ml urine) in 7 of the 8 cases. UCG-Macrotube appears to be both more sensitive and less vulnerable to interfering substances than the comparison tests.^ieng

Correlation between first morning sample and 24-hour urinary estriol excretion.

The estriol concentration of a morning sample of urine from high-risk pregnant women was correlated with the total 24-hour estriol excretion. One hundred seventy sample pairs compared the estriol concentration of the morning specimen with those of a 24-hour specimen of the previous day, while 110 sample pairs compared the value of morning specimen with those of a 24-hour specimen of the following day. Although there is highly significant statistical correlation between those sample pairs, they are of modest magnitude. The mean values of the sample pairs are significantly different. Also, the morning sample estriol concentrations are significantly more variable than those of the 24-hour specimen.

Significance of amniotic fluid corticosteroid levels in human pregnancies.

Retrospective analysis of 103 samples of amniotic fluid was performed. Twenty-four samples were obtained prior to midtrimester abortion, 31 were from patients who delivered spontaneously, 14 were from patients in whom labor was induced, and the remaining samples were obtained from patients who were delivered by cesarean section. In all normal pregnancies, there was a rising trend in corticosteroid levels in amniotic fluid as the gestation advanced. This was less marked in abnormal pregnancies. There is a suggestive fetal role in initiation of normal spontaneous labor, as reflected by a significant increase in amniotic fluid corticosteroid levels, in patients immediately prior to vaginal delivery as opposed to abdominal delivery. There was a significant correlation between the birthweight of babies born vaginally with the amniotic fluid corticosteroid levels, as compared to the weight of babies born by cesarean section.

PIP: Corticosteroid levels in amniotic fluid in patients delivered spontaneously, by labor induction, or by Caesarean section, in relation to the onset of labor, were studied. Amniotic fluid was obtained from 103 women in several stages of gestation. 24 samples were obtained prior to midtrimester abortion, 31 from patients who delivered spontaneously, 1 from patients in whom labor was induced, and 34 from patients delivered by elective Caesarean section. Details of the chemical technique used are given. This fluorometric method measured free unconjugated corticosteroid in the amniotic fluid. The method was shown to be specific for 11-hydroxy-corticosteroids. It was found that cortisol and corticosterone constitute about 90% of the total corticosteroids in the amniotic fluid. The amount of corticosterone was 3.5 times the level of cortisol. There was a rising trend in the level of corticosteroids in the amniotic fluid just prior to the onset of normal spontaneous vaginal delivery. In the Caesarean section group no rising trend of the level of corticosteroids in the amniotic fluid was found. There was a highly significant correlation (p less than .01) between birth weights of babies born spontaneously and the amniotic fluid concentration of corticosteroids. The higher the birth weight the greater the corticosteroid level in the amniotic fluid. This correlation was not found in babies born by Caesarean section. Results suggest that amniotic fluid corticosteroids may denote the maturity of the fetus and may be related to the onset of parturition in humans. The maternal contribution to amniotic fluid corticosteroids has not been ascertained.

Chorioamnionitis.

Chorioamnionitis is an inflammatory reaction occurring in the fetal membranes of the placenta. It is usually associated with premature rupture of the membranes, whether spontaneous or artificial. Rupture of the fetal membranes sets off a time bomb that threatens both maternal and fetal welfare. The seriousness of this threat is dependent upon several variables: the length of gestation, economic status of the patient and the duration of the rupture. There is a controversy about the relative importance of these variables and about the proper degree of aggressiveness necessary to achieve optimum fetal salvage. When chorioamnionitis occurs, most obstetricians agree that the uterus should be evacuated by the most expeditious route. Usually oxytocic induction will accomplish delivery without difficulty, but should it fail to effect cervical ripening and dilatation within a reasonable time, cesarean section should be performed without further delay. If cesarean section is necessary in the presence of gross infection, hysterectomy is advocated by some.

An unusual foreign body in the pelvic cavity after laparotomy.

An unusual case of a glass bottle remaining in the pelvic peritoneal cavity for 6 years after laparotomy is reported, and the prevention of such occurrences is emphasized.

PIP: The case report of a glass specimen bottle which accidentally dropped into the peritoneal cavity at time of laparotomy for a ruptured right tubal pregnancy is presented. It had come to rest on the fundus, open end upward, and during respiration loops of small intestine entered and exited the bottle. When the complaint of pain brought the patient to the authors 6 years later a diagnosis of fibroid uterus was made. It is suggested that all materials used in the abdomen be radio-opaque and that routine postoperative X-rays be taken before the patient leaves the surgical suite.

Ovarian hemorrhage complicating warfarin sodium anticoagulant therapy.

Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparatomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.

A case of cyclopia.

PIP: This article is the first account of an infant malformation in a case where a mother had been receiving injected medroxyprogesterone. The D-trisomic (47,XY, D+) infant, born in February 1970 and dead 1 hour after birth, had cyclopia and multiple extracerebral congenital defects. However, a look at the relevant literature suggests the association between the abnormalities and the injected medroxyprogesterone was probably coincidental. The 32-year-old woman has received 50 mg of parenteral medroxyprogesterone every 3 months for 3 years. The last injection was administered about 1/2 of a year before conception. The neurological and physiological abnormalities of the infant are detailed.^ieng

Hospital-based family planning program.

PIP: To improve the family planning program at Temple University Hospital, the charts of 1526 service patients were analyzed in 1966. Total ward deliveries showed 855(56%) were married, while 671(44%) were single, separated, divorced or widowed. 834(55%) accepted some method of birth control. 44% of the 1526 returned for postpartum visits. It was revealed that a large number of welfare recipients accepted family planning than did those whose hospital bill was paid. Family planning services should be made an integral part of already established obstetric and gynecologic programs. The addition of indigenous personnel from the community serving the team of physicians, nurses, and social-workers will expedite the accepting of family planning information and services.^ieng