Collaborative research and action to control the geographic placement of outdoor advertising of alcohol and tobacco products in Chicago.

Community activists in Chicago believed their neighborhoods were being targeted by alcohol and tobacco outdoor advertisers, despite the Outdoor Advertising Association of America's voluntary code of principles, which claims to restrict the placement of ads for age-restricted products and prevent billboard saturation of urban neighborhoods. A research and action plan resulted from a 10-year collaborative partnership among Loyola University Chicago, the American Lung Association of Metropolitan Chicago (ALAMC), and community activists from a predominately African American church, St. Sabina Parish. In 1997 Loyola University and ALAMC researchers conducted a cross-sectional prevalence survey of alcohol and tobacco outdoor advertising. Computer mapping was used to locate all 4,247 licensed billboards in Chicago that were within 500- and 1,000-foot radiuses of schools, parks, and playlots. A 50% sample of billboards was visually surveyed and coded for advertising content. The percentage of alcohol and tobacco billboards within the 500- and 1,000-foot zones ranged from 0% to 54%. African American and Hispanic neighborhoods were disproportionately targeted for outdoor advertising of alcohol and tobacco. Data were used to convince the Chicago City Council to pass one of the nation's toughest anti-alcohol and tobacco billboard ordinances, based on zoning rather than advertising content. The ordinance was challenged in court by advertisers. Recent Supreme Court rulings made enactment of local billboard ordinances problematic. Nevertheless, the research, which resulted in specific legislative action, demonstrated the importance of linkages among academic, practice, and grassroots community groups in working together to diminish one of the social causes of health disparities.

The role of the nurse manager in ambulatory care: results of a national survey.

Increasing complexity in ambulatory care settings requires nurse managers who can function at higher levels. Little agreement currently exists regarding the role expectations and academic preparation needed for nurse managers in ambulatory care settings. The majority of surveyed ambulatory care nurse managers (40%) have an AD or diploma as their highest level of academic preparation, and have thus acquired the majority of their management skills in the practice setting. The authors express concern that there are pressures to employ non-nurses as managers in ambulatory health care settings and that ambulatory nurse managers are often seen as not needing advanced academic preparation. A wide variety of settings including university and community hospitals, outpatient departments, physician group practices and HMOs, currently employ nurse managers in their multidisciplinary ambulatory care sites. The majority of ambulatory care nurse managers describe their model of care as either the medical model or the functional model.

Dimensions of the staff nurse role in ambulatory care: Part IV--Developing nursing intensity measures, standards, clinical ladders, and QI programs.

Ambulatory care nurse executives must design valid mechanisms to support new models of nursing care delivery. Data from a national survey of practicing ambulatory care nurses can assist in this process. Research data can be used as a resource for developing ambulatory nursing intensity measures, standards, clinical ladders, and quality improvement programming. This is Part IV of a four-part series.

Dimensions of the staff nurse role in ambulatory care: Part III--Using research data to design new models of nursing care delivery.

A national survey of 606 practicing staff nurses provides the basis for a data set that delineates the desired future role for nurses in ambulatory care. The core dimensions of future practice can be used to develop new models of ambulatory nursing care delivery, such as primary prevention, primary health care, and primary nursing as well as a case management and paired-partners model. The final part in this series, which will be published in the September/October issue, will examine the development of nursing intensity measures, standards, clinical ladders, and quality improvement programs.

Dimensions of the staff nurse role in ambulatory care: Part II--Comparison of role dimensions in four ambulatory settings.

Ambulatory care nursing is one of the fastest growing and least studied areas of nursing practice. Information from a national survey of ambulatory nurses has been used to delineate the core dimensions of the current staff nurse role. Comparison of practice patterns of ambulatory staff nurses employed in university hospitals, community hospitals, physician group practices, and health maintenance organizations can provide insights for nurse managers interested in improving ambulatory nursing care delivery. Part III of this series, which will be published in the July/August 1995 issue, will examine how to use research data to design new models of nursing care delivery.

Dimensions of the staff nurse role in ambulatory care: Part I--Methodology and analysis of data on current staff nurse practice.

Defining the core dimensions of the current staff nurse role is a critical first step in demonstrating the worth of professional nurses in ambulatory settings. Data generated by a 1992 national survey of 606 ambulatory staff nurses provides insight into current practice. Managers may use this information to attract and retain staff nurses, remove barriers to clinical practice, and modify practice patterns to improve the quality of care in ambulatory settings. Part II of this series, which will be published in the May/June 1995 issue, will examine the scope and dimensions of the staff nurse role in different practice settings.

Tobacco and alcohol billboards in 50 Chicago neighborhoods: market segmentation to sell dangerous products to the poor.

This paper describes a study of billboard advertising of tobacco and alcohol products in the city of Chicago. All billboards were counted and their advertising themes noted. These data were matched with information on population and race from the 1990 census in order to document which geographic areas of the city, if any, had excess tobacco or alcohol billboards. The data revealed that minority wards were burdened with three times as many tobacco billboards and five times as many alcohol billboards when compared to white wards. The findings are congruent with studies conducted in other urban areas, which demonstrate a consistent pattern of tobacco and alcohol advertisers targeting poor and minority neighborhoods for outdoor advertising of their dangerous products. Chicago legislative initiatives based on the billboard study are described.

Extensile triradiate approach for complex acetabular reconstruction in total hip arthroplasty.

The triradiate approach as described by Mears has been used for open reduction of complex dual-column acetabular fractures. Mears extended the anterior limb of this incision to the symphysis pubis by the ilioinguinal approach. From a consecutive series of 43 total hip revisions, this approach was used successfully in seven cases in which extensile exposure was necessary to revise complicated acetabular reconstructions for arthroplasty. The approach was used also to perform complex acetabular reconstruction after en bloc tumor resection. Three patients had severe intrapelvic component protrusio and anterior column deficiency where close proximity of the prosthesis and femoral neurovascular bundle were detected before surgery. Massive allograft and pelvic reconstructions were used to span large anterior column defects and to stabilize pelvic dehiscence. Complications included one hip dislocation and one posterior flap tip necrosis. Follow-up ranged from six to 34 months. No graft failure has been noted.

High-resolution bone scintigraphy of the adult wrist.

Bony anatomic landmarks of the wrist (e.g., pisiform, hook of hamate, radioulnar joint, and styloid processes of the radius and ulna) were routinely identified in 28 adult patients examined for wrist pain. With the wrists prone and immobilized, bone scintigrams were obtained for 500,000 counts with an asymmetric (133 to 161 keV) Tc-99m energy window and either a converging (best choice) or straight-bore, high-resolution collimator. High-resolution scintigraphy precisely localized degenerative joint disease (nine patients), scaphoid fractures (five), pisiform fracture (one), lunate avascular necrosis (one), radioulnar arthritis (one), septic or inflammatory arthritis (six), ulnocarpal impingement (two), and reflex sympathetic dystrophy syndrome (two). Images obtained palm down with the wrist in ulnar deviation helped identify increased uptake within the scaphoid. Fracture and significant bone or joint disease were excluded in one patient.

MR imaging in fibromatosis: results in 26 patients with pathologic correlation.

Fibromatoses are a diverse group of soft-tissue lesions that have been inconsistently categorized and treated. The purpose of our study was to establish the range of appearances of fibromatoses on MR images and perform a pathologic correlation to explain the variable signal-intensity patterns. During a 3-year period, 26 patients with deep fibromatoses were examined with MR. The MR images were evaluated for signal-intensity characteristics, and findings were correlated retrospectively with the pathologic diagnoses. The results showed that the MR appearance of fibromatoses is similar to that of other soft-tissue lesions, and the signal intensities vary greatly from lesion to lesion and within lesions themselves. The fibromatoses were either hyperintense, isointense, hypointense, or of mixed signal intensity relative to adjacent skeletal muscle. The hypointense areas appear to be zones of hypocellularity and dense collagen deposition. Microscopically all of the lesions invaded adjacent structures, but the MR appearances of the margins varied and were judged to be well demarcated (n = 14), intermediate (n = 5), or poorly demarcated (n = 6). Our experience shows that fibromatoses have a variable MR appearance no different from that of other soft-tissue lesions, and this variability reflects the composition and cellularity of the lesions.

Resections and reconstructions for tumors of the distal radius.

The primary objective in surgical management of the patient with a distal radius tumor is control of the disease. Accurate staging and diagnostic methods applied preoperatively will predict not only the amount of resection necessary to obtain adequate tumor margins, but also the amount of remaining bone and soft tissues to assist reconstruction. With this information, a method of reconstruction can be chosen that provides the patient optimal long-term function and stability with predictable results and the fewest potential complications.

Recurrent pigmented villonodular synovitis of the hip joint. Case report and review of the literature.

A case report of recurrent pigmented villonodular synovitis of the hip joint, which was treated with en bloc resection of the acetabulum and proximal femur, followed by allograft acetabular reconstruction and total hip arthroplasty, is presented. The allograft united and, at 2 years, revealed an excellent clinical result. Treatment rationale and literature are reviewed.

Angiosarcoma of the forearm definitively treated by hyperfractionated irradiation.

A case report of an angiosarcoma treated definitively with hyperfractionated irradiation is presented. Radial and ulnar aspects of the proximal forearm, wrist, and digits were diffusely involved on angiography. Hyperfractionated irradiation totaling 7,440 cGy was delivered to the entire circumference of the hand, forearm, and distal 5 cm of the arm; a confluent dry erythema without moist desquamation was observed at completion of therapy. No significant local or systemic toxicity was noted with the administration of an Adriamycin-containing adjuvant chemotherapy regimen following irradiation. Local regional control at 2 years is documented both clinically and by angiographic examination and the patient otherwise is free of disease. Function remains excellent with no lymphedema or joint fibrosis observed and grip strength of treated and untreated hands is comparable at 35 pounds. For patients refusing amputation or who are otherwise inoperable, hyperfractionated irradiation provides a therapeutic option.

Comparison of dose distribution by means of bolus versus water bath phantom techniques in treatment of cutaneous sarcoma of an extremity.

Cutaneous involvement by Kaposi's sarcoma (KS) is frequently diffuse, requiring large field irradiation. Selective tissue compensation techniques, accomplished with either a 1.5 cm bolus cast or water bath phantom, are compared. Dosimetric determinations were performed using 6 MVX with bone heterogeneity corrections. Application of 1.5 cm bolus effectively eliminated dose buildup and provided tissue compensation equivalent to water bath phantom technique. Treatment of other cutaneous malignancies, such as angiosarcoma, requiring higher total doses, should be accompanied by dosimetric evaluation, because cutaneous and midline dose inhomogeneity may result in a significant total dose differential over the target volume. Application of 1.5 cm bolus improved accuracy in treatment positioning, eliminated concerns regarding infection control in AIDS-related KS, and provided dose homogeneity comparable to the more standard water bath phantom technique.

Primary skeletal Ewing's sarcoma in Down syndrome.

Primary skeletal Ewing's sarcoma that occurred in two teenage patients with Down syndrome are reported. Cytogenetic analysis of one of these tumors showed the 11;22 translocation characteristic of Ewing's sarcoma as well as other complex karyotypic changes. The possible role of constitutional trisomy 21 in development of these sarcomas is discussed.

The effect of radiation therapy on von Willebrand factor in patients with angiosarcoma.

Radiation damages endothelial cells (EC) of malignant and normal tissues. Shortly after radiation injury platelet thrombi cause small vessel obstruction. Radiation doses of 20 Gy or higher release von Willebrand factor (VWF) from cultured human umbilical vein EC. Angiosarcoma (AS) is a vascular tumor with abnormal appearing EC which have detectable cytoplasmic VWF. We examined the effect of radiation therapy on VWF in three patients with AS. Each patient's malignant tissue was demonstrated to have cytoplasmic VWF present. Venous blood samples were drawn immediately before and at weekly intervals during treatment. Patient 1 received 80 Gy over 6 weeks and had no alterations in the VWF. Patient 2 received 64 Gy over 6 weeks and was noted to have loss of the high molecular weight multimers of VWF without loss of FVIII:C, VW: RIST, or von Willebrand antigen activity (VW:Ag). Patient 3 was treated with 64.4 Gy over 9 weeks and had a disproportionate increase of the VW: Ag and VW: RIST to FVIII: C. This returned to normal after completion of therapy. These changes were minimal and might be explained by either limited local release or no increased release of VWF from the irradiated tissue. The minimally abnormal multimeric pattern in patient 2 may be due to the release of an abnormal VWF in normal amounts or small amounts of proteolysis. The alteration in the VW: RIST and VW: Ag to FVIII: C ratio can be explained by activated coagulation secondary to radiation injury.

Mediastinal involvement by myxoid liposarcoma.

Metastatic involvement of the mediastinum by liposarcoma is uncommon, and clinical experience in its management is limited. A patient with liposarcoma of the lower extremity having a concomitant anterior mediastinal mass as the only manifestation of distant metastatic involvement is described.