Telehomecare rewards and risks.

Telehomecare offers improved access to home care at lower costs and promises unique opportunities for home care patient empowerment and improved care outcomes. Telehomecare programs must be carefully designed to comply with licensure requirements, minimize liability risks, protect patient privacy, and capitalize on reimbursement trends. Providers willing to invest in the development of well-designed telehomecare programs and to document the merits of their initiatives should be well-positioned to serve the country's aging population under any of the care models that will dominate health care delivery in the next century.

Osteoid osteoma in the medial malleolus.

A case of osteoid osteoma in an unusual location is reported. The osteoma was diagnosed, and the nidus was localized to the anterior colliculus of the medial malleolus based on the clinical symptoms and on the findings in radionuclide bone scanning, tomography, and computerized tomographic (CT) scanning. After precise radiographic localization of the nidus, it was determined that the lesion could be excised surgically without compromising the ankle joint. The tumor was removed by en block excision and curettage. At 10 months follow-up, the patient was free of pain without impairment of function.

Acute gouty arthritis in a first metatarsophalangeal joint replaced with a flexible-hinge implant: a case report.

Use of the flexible-hinge, double-stemmed implant has eliminated many of the complications that followed correction of an arthritic first metatarsophalangeal joint caused by hallux valgus. There were no reports in the literature of acute gout after this type of correction. The authors present such a case in a patient with a history of gout, and they suggest that, when a synovectomy is performed in a patient with gouty arthritis, the joint should be freed of synovial tissue in which a uric acid crystal-induced synovitis could occur.