The Guide to Community Preventive Services: update on development and dissemination activities.

The Guide to Community Preventive Services (Community Guide) aims to improve public health practice by increasing the use of effective interventions. The Community Guide summarizes what is known regarding the effectiveness of selected population-based interventions and information about additional benefits and harms of the interventions. Community Guide reviews of interventions for improving vaccine coverage rates and reducing tobacco use have been recently completed and released. Interventions that have been recommended for use based on these reviews are being implemented via national projects. This article describes the status of development of Community Guide reviews and the initiation of dissemination, implementation, and evaluation efforts.

Bedside placement of postpyloric feeding tubes.

Postpyloric placement of feeding tubes into the duodenum or jejunum is often recommended to support early feeding, improve tolerance of enteral nutrition, and decrease the risk of aspiration pneumonia. Achieving small bowel feeding tube placement can be a difficult, time-consuming, and costly process that may delay the initiation of enteral nutrition. Various bedside techniques, including air insufflation, pH assisted, and spontaneous passage with or without motility agents are available to facilitate transpyloric feeding tube passage. A discussion of these methods is presented in this article, including a hospital-based quality initiative project designed to facilitate early enteral nutrition.

Blockade of sensory neuron action potentials by a static magnetic field in the 10 mT range.

To characterize the inhibitory effect of a static magnetic field, action potentials (AP) were elicited by intracellular application of 1 ms depolarizing current pulses of constant amplitude to the somata of adult mouse dorsal root ganglion neurons in monolayer dissociated cell culture. During the control period, < 5% of stimuli failed to elicit AP. During exposure to an approximately 11 mT static magnetic field at the cell position produced by an array of four permanent center-charged neodymium magnets of alternating polarity (MAG-4A), 66% of stimuli failed to elicit AP. The number of failures was maximal after about 200-250 s in the field and returned gradually to baseline over 400-600 s. A direct or indirect effect on the conformation of AP generating sodium channels could account for these results because 1) failure was preceded often by reduction of maximal rate of rise, an indirect measure of sodium current; 2) recovery was significantly prolonged in more than one-half of neurons that were not stimulated during exposure to the MAG-4A field; and 3) resting membrane potential, input resistance, and chronaxie were unaffected by the field. The effect was diminished or prevented by moving the MAG-4A array along the X or Z axis away from the neuron under study and by increasing the distance between magnets in the XY plane. Reduction of AP firing during exposure to the approximately 0.1 mT field produced by a MAG-4A array of micromagnets was about the same as that produced by a MAG-4A array of the large magnets above. The approximately 28 mT field produced at cell position by two magnets of alternating polarity and the approximately 88 mT field produced by a single magnet had no significant effect on AP firing. These findings suggest that field strength alone cannot account for AP blockade.

Inadvertent administration of rtPA to a patient with type 1 aortic dissection and subsequent cardiac tamponade.

Administration of thrombolytic agents to patients with misdiagnosis of acute myocardial infarction can result in serious side effects. A case of aortic dissection that was misdiagnosed as acute myocardial infarction and received rtPA is reported. Within 1 hour of rtPA infusion, the patient developed cardiac tamponade. Type 1 aortic dissection was diagnosed by aortic angiogram. The patient underwent emergency resection of the dissection and evacuation of the pericardial and anterior mediastinal hematoma. Although he required massive transfusion of blood products intraoperatively, he is doing well 22 months after his surgery.

Factors influencing the outcome of balloon aortic valvuloplasty in the elderly.

This study describes the short- and long-term outcome of 44 consecutive percutaneous balloon aortic valvuloplasty procedures performed in 42 elderly patients (age 77.8 +/- 7 years) with calcific aortic stenosis. The initial success rate was 95%, with the peak aortic valve pressure gradient declining from a mean of 82 +/- 32 mm Hg to 44 +/- 23 mm Hg and aortic valve area increasing from a mean of 0.59 +/- 0.15 cm2 to 0.83 +/- 0.40 cm2. One procedure-related death occurred and an additional three patients died less than or equal to 30 days after balloon aortic valvuloplasty. These patients all had New York Heart Association (NYHA) class IV heart failure symptoms prior to the procedure and their mean left ventricular ejection fraction (LVEF) (28 +/- 7%) was lower than that of hospital survivors (52 +/- 13%) (as was their ratio of left ventricular [LV] wall thickness-to-cavity ratio [0.50 +/- 0.10 versus 0.70 +/- 0.15]). At the time of hospital discharge after valvuloplasty, 76% of patients were asymptomatic or markedly improved (NYHA class I or II). After a mean follow-up of 15.5 months (range 2 to 26 months), however, 10 patients had died and 15 had undergone aortic valve replacement for recurrence of NYHA class III or IV symptoms. The adjusted 1- and 2-year survivals were 0.68 and 0.62, respectively, and adjusted 2-year event-free survival was 0.25. Proportional hazard regression analysis indicated that LVEF less than 40% was the only variable affecting survival (p less than 0.01) and was a possible indicator of event-free survival (p = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)

Segmental replacement of the ureter using Sparks' mandrils. An experimental study.

Segmental ureteral replacement with free autogenous fibroelastic Dacron tube grafts in three dogs was unsuccessful during preliminary trials. However, a proliferation of urothelium, smooth muscle, and blood vessels throughout the length of the grafts was demonstrated, providing an encouraging potential for further investigations. Technical refinements are suggested that may provide for improved success with experimental ureteral replacement.

Traumatic lymphangitis of penis.

The appearance of a firm, nodular, cord-like structure in the coronal sulcus of the penis has heretofore been considered and reported in the urologic literature as thrombophlebitis of the superficial veins. Further study and review of the literature reveal this condition to be a traumatic lymphangitis which is directly related to sexual trauma and runs a short, asymptomatic, self-limited course.