Endoscopic transnasal removal of migrated dental implants.

We report a case of migration of a dental implant into the maxillary sinus and discuss the benefits of endoscopic transnasal removal of such implants. As the sole approach, this technique has rarely been described. The most commonly used technique for retrieval of dental implants is the Caldwell-Luc procedure. This, however, has certain morbidity associated with it and may compromise subsequent implant insertion.

Multiple acyl-CoA dehydrogenase deficiency: a rare cause of acidosis with an increased anion gap.

Metabolic acidosis is encountered frequently in intensive care and common causes include lactic acidosis, ketoacidosis, or renal failure. We describe a patient presenting to intensive care with a rare cause of metabolic acidosis associated with an increased anion gap: multiple acyl-CoA dehydrogenase deficiency. The pathophysiology of this condition is discussed along with potential treatment options.

Childrens' distress during burn treatment is reduced by massage therapy.

Before dressing changes, 24 young children (mean age = 2.5 years) hospitalized for severe burns received standard dressing care or massage therapy in addition to standard dressing care. The massage therapy was conducted to body parts that were not burned. During the dressing change, the children who received massage therapy showed minimal distress behaviors and no increase in movement other than torso movement. In contrast, the children who did not receive massage therapy responded to the dressing change procedure with increased facial grimacing, torso movement, crying, leg movement and reaching out. Nurses also reported greater ease in completing the dressing change procedure for the children in the massage therapy group. These findings suggest that massage therapy attenuates young childrens' distress responses to aversive medical procedures and facilitates dressing changes.

Nanoliter volume, high-resolution NMR microspectroscopy using a 60-micron planar microcoil.

Previous studies demonstrated the feasibility of using 100-microns inner diameter planar spiral inductors (microcoils) as detectors in 1H nuclear magnetic resonance (NMR) microspectroscopy. However, high-resolution NMR applications were not possible due to poor spectral resolution and low signal-to-noise ratio (SNR). These limitations in performance have now been largely overcome by using a nonconductive liquid fluorocarbon (FC-43) to minimize the effects of susceptibility mismatch between materials, and by carefully optimizing the microcoil geometry for maximum SNR. In this study, liquid samples were loaded into a fused silica capillary (75-microns inner diameter, 147-microns outer diameter). The capillary was positioned 50 microns above a 3.5-turn microcoil so that approximately 1 nL of the sample was present in the sensitive region of the microcoil. The microcoil was fabricated on a gallium arsenide substrate with an inner diameter of 60 microns, an outer diameter of 200 microns, trace width of 10 microns, trace spacing of 10 microns, and trace height of 3 microns. At 5.9 T (250 MHz) in 1H-NMR microspectroscopy experiments using a spectral width of 1 kHz, 4096 sampled data points, and a recovery delay of 1 s, a SNR of 25 (per acquisition) and a spectral linewidth of less than 2 Hz were obtained from a sample of water. These results demonstrate that planar microcoils can be used for high-resolution NMR microspectroscopy. Such coils may also be suitable for localized NMR studies at the cellular level and as detectors in capillary electrophoresis or microbore liquid chromatography.

On-line NMR detection of amino acids and peptides in microbore LC.

The combination of liquid chromatography (LC) and nuclear magnetic resonance (NMR) offers the potential of unparalleled chemical information from analytes separated from complex mixtures. However, the application of LC-NMR has been hindered by poor detection sensitivity. We develop a theoretical model for predicting signal-to-noise ratio (SNR) performance while scaling NMR detection cells for flowing experiments. The model includes the effects of separation parameters, coil geometry, and NMR acquisition parameters on SNR performance. Although the detector cell should be as large as possible to ensure adequate efficiency for a given separation, reducing the detector cell volume does not significantly degrade SNR. For example, our model predicts a 2-fold reduction in SNR for a 400-fold reduction in cell volume. The results of static NMR measurements of amino acids and peptides in a 50-nL-volume cell (approximately 1 microgram of each) demonstrate the performance of such a small-volume NMR microcell. Using this 50-nL detector cell with microbore LC, two-dimensional LC-NMR chromatograms are shown for amino acid and peptide separations.

Design and analysis of microcoils for NMR microscopy.

The signal-to-noise ratio achieved in a nuclear magnetic-resonance microscopy experiment is directly related to the performance of the radiofrequency coil. An accurate determination of coil performance requires that the resistance of the coil be well characterized. Traditional high-frequency electric-circuit models used to describe larger NMR coils are inadequate when the diameter of the conductor is reduced to the dimensions of the electrical skin depth (delta) at the frequency of operation. A more extensive model based on a scaling parameter that includes delta is presented. This model complements other existing circuit models that represent sample losses, ground-loop and parasitic losses, and the signal induced in the RF coil. Experimental verification is accomplished using a series of solenoidal microcoils in 1H NMR microspectroscopy experiments at 4.7 T (200 MHz). This study demonstrates for the first time that a predictable performance enhancement is achieved using microcoils as small as 50 microns in diameter.

Helping homeless men begin a new life. A program on Chicago's West Side provides substance abuse rehabilitation and job training.

The MARSEPH program, named for the two principal program collaborators--the Marillac Social Center and Saint Joseph Health Centers and Hospital--provides life and work skills to homeless men who visit a day shelter operated by the Marillac Social Center. Participants gain work experience at Saint Joseph. One of the most important aspects of the MARSEPH program is the removal of obstacles to the newly employed. Each MARSEPH participant receives housing assistance, a uniform, transportation to Saint Joseph Health Centers and Hospital, and a meal pass to the hospital's cafeteria. Through this assistance, the men can get off the streets, get to their jobs, be nourished, and look presentable. The MARSEPH program carefully monitors each participant's progress, to ensure his success. Case workers meet weekly with the men to discuss problems and concerns. Every week case workers also visit each participant's residence to monitor his living conditions and offer emotional support. At the end of the six-month training program, MARSEPH helps graduates find employment.

NMR microspectroscopy using 100 microns planar RF coils fabricated on gallium arsenide substrates.

A family of planar gold RF microcoils were fabricated using microlithography on a gallium arsenide substrate. The microcoils were used in 1H nuclear magnetic resonance (NMR) spectroscopy experiments at 300 MHz (7.05 T). These new microcoils are a key component in the design of integrated MR coils and amplifiers for NMR microspectroscopy.

Hospital managed care performance standards.

If hospitals do not establish their own managed care direction and contracting performance standards, they will inevitably find themselves in a reactive position. This must be avoided as managed care is one of the few payor segments that hospitals still have the opportunity to influence.

Accounting for charity care on a systemwide basis.

The Daughters of Charity National Health System (DCNHS), St. Louis, has developed a systemwide model which formally sets a policy statement, goals, and procedures that enable the 42 DCNHS health-care ministries to effectively serve the poor in their communities on a daily basis, while addressing the long-term challenges of providing charity care for the sick poor. One of the first steps was forming a task force known as the Working Group on Care of the Poor. Its goal was to set the stage for the expansion and accountability of charity care at every level within the new national system. The group outlined these objectives: To identify and recommend several advocacy models. To recommend test models of healthcare delivery for the poor. To recommend strategies for involving the private sector. To develop a method of documenting charity care. To recommend linkage models to jointly provide charity care with related organizations. To gain a firm knowledge of charity care actually provided by the Daughters of Charity After hours of discussions and research, the task force developed a cohesive, workable set of goals and policies that today is helping individual health-care ministries nationwide meet local needs for care of the sick poor. By identifying specific programs and determining how to report charity care in terms of money and services, individual health-care institutions gain insights into their annual operational planning and reporting for the present and the future. This approach ensures that charity care remains in the forefront at every level of planning.

Constant intravenous insulin infusion during labor and delivery in diabetes mellitus.

We treated 30 diabetic women (31 pregnancies) during the peripartum period with a continuous insulin infusion. A mean infusion rate of 1.0 micron/h maintained the mean plasma glucose concentration below 100 mg/dl in 84% of the patients; the plasma glucose concentration was below 100 mg/dl within an hour of delivery in 71% of the women. Mild hypoglycemia developed during the infusion in three women and after delivery in another patient. Only two infants of the diabetic mothers developed transient and asymptomatic hypoglycemia. We conclude that continuous insulin infusion is a practical, safe, and effective method for treating diabetic mothers during the peripartum period and suggest that this technique may decrease the frequency and severity of neonatal hypoglycemia.

Physicians' subjectivity in evaluating oxytocin challenge tests.

Five physicians subspecializing in maternal-fetal medicine individually evaluated 50 oxytocin challenge tests (OCTs), of which 33 were originally read as positive. There was considerable disagreement among the study physicians (SPs) such that 2 SPs would agree, on the average, only 52% of the time on any one OCT. The SPs were also asked to evaluate fetal heart rate (FHR) reactivity patterns, if present. Again, there was great disagreement. When the majority (3 of 5 or more) of SPs agreed on the OCT result and/or reactivity, there was reasonable correlation with neonatal outcome, indicating the validity of the physiologic premise of the test. In particular, the presence or absence of FHR accelerations with fetal motion, regardless of the OCT reading, correlated extremely well with eventual neonatal outcome. This indicates that the most significant variable in antepartum FHR monitoring is the FHR acceleration pattern.

Electronic monitoring evidence of fetal distress in high-risk pregnancies.

The oxytocin challenge test (OCT) has been shown in other studies to be valuable in evaluating high-risk pregnancies. The purpose of this study was to show the relationship of various disease states and clinical conditions with OCT results and fetal performance in labor. Of a group of normal patients, 4% had positive OCTs or late decelerations (LDs) in labor. The incidence of positive OCTs or LDs in labor in patients with diabetes mellitus (DM) class B-R was 23.2%; in DM class A, 27.6%; in intrauterine growth retardation (IUGR), 26.2%; in pregnancy-induced hypertension (PIH), 27.6%; in chronic hypertension (CH), 13.6%; and in prolonged gestation, 10.8%. This study shows that DM of all classes, IUGR and PIH are the most likely conditions in which persistent LDs will occur.