The lateral notch sign associated with acute anterior cruciate ligament disruption.

We prospectively studied all of the patients with anterior cruciate ligament disruptions who sought treatment at the senior author's office during a 36-month period. Plain radiographs identified depressions measuring 2 mm or more in the lateral femoral condyle (lateral notch sign) in 9 of 120 knees (7.5%) with acute anterior cruciate ligament disruption and in 2 of 44 knees (4.5%) with chronic pivot shift instability. The depression ranged from 2 to 6 mm deep and from 20 to 25 mm long. The mean age for acutely injured patients with lateral notch signs was 17.2 years, 6 years younger than the mean age of the group with acutely injured anterior cruciate ligaments as a whole. Ten of the 11 patients (91%) with lateral notch signs were men, and all 6 patients with depressions shallower than prior descriptions of the notch sign were men. In contrast, 67% (N = 110) of the entire group of patients who had anterior cruciate ligament disruption were men. Ten of the 11 patients (91%) with the lateral notch signs and 4 of the 6 patients (66%) with minimal depressions also had lateral meniscus tears, while 58 of 147 patients (39%) without lateral femoral condyle depression had lateral meniscus tears. Previous reports that the lateral notch is a sign of chronic anterior cruciate ligament deficiency with recurrent pivot shifts are not supported by the number of prospectively recognized acute lateral femoral notch signs in this series. We found the presence of radiographic changes in the lateral femoral condyle to have statistically significant correlations with young age, male sex, lateral meniscus tears in general and anterior-horn lateral meniscus tears specifically, and lateral femoral chondral lesions.

In situ dissection of cadaver kidneys.

Major anatomic injuries occurred in 18 of 151 (12%) en bloc kidneys. No injuries occurred among the in situ kidneys. The rates of delayed graft function were equal. All the kidneys removed by the in situ method were removed by one surgeon (ALH). The results are good enough to recommend the technique even without a randomized study.

Prevention and treatment of lightning injuries.

Lightning ranks first among natural disasters in terms of fatalities and property damage each year. If fortunate enough to survive, the victim of a lightning or electrical accident often presents with numerous complicated clinical manifestations. The astute nurse practitioner will be challenged to identify the immediate signs and symptoms of possible system disruption, and to institute the follow-up management necessary to prevent further complications. This article explores the nurse practitioner's role in the physical assessment of the client and the protocol for management and follow-up care. Case studies are presented to illustrate the various multisystem findings of clients struck either directly or indirectly by lightning. Environmental precautions to decrease the likelihood of lightning's harmful effects are also discussed. It is easier to prevent a lightning and/or electrical accident than to treat the victim.

Water quality indices as indicators of ecosystem change.

The operational management of water quality requires a methodology that can provide precise information on cycles and trends in water quality in an objective and reproducible manner. Such information can be provided by the adoption of a water quality indexing system. The continuous scale afforded by a water quality index allows changes in river water quality to be highlighted. At the same time the sub-division of this scale into a series of water quality and water use categories provides an easy means of relating information to government and public.The development of four independent water quality indices (WQIs) is outlined. These have been applied to data for a number of UK river reaches. The results of these applications indicate the utility of these indices in the classification of water quality and the monitoring of ecosystem change.

Thrombolytic therapy for acute myocardial infarction: the elderly population.

Coronary artery disease is the most common cause of death in persons older than 65 years. More than half of all patients hospitalized for acute myocardial infarction (AMI) are now older than 65, with this percentage expected to increase significantly in subsequent years. The current evidence regarding the treatment of AMI indicates that early thrombolytic therapy can limit the extent of myocardial necrosis, preserve left ventricular function, decrease the incidence of congestive heart failure, and reduce mortality in patients with AMI. Most studies have adhered to empiric recommendations to exclude elderly patients, based on the assumption that in the elderly the risks of serious hemorrhagic complications after thrombolytic therapy outweigh the potential benefits of early reperfusion. This article reviews the current literature regarding use of thrombolytic agents in treating AMI in the elderly population with some guidelines for protocol formation.

Cardiovascular effects of cocaine.

This article reviews the chemical nature of cocaine, an increasingly abused stimulant. Following a description of the clinical manifestations of drug use, cardiovascular effects as well as routes of administration are described. Clinical complications of acute and chronic cocaine abuse include dysrhythmias, acute myocardial ischemia and infarction, sudden death, myocarditis, and cardiomyopathy. Clinical manifestations and assessment protocols are summarized. Treatment protocols remain focused on symptom presentation at this time, as there is no known antidote for cocaine toxicity or overdose.

Multiple organ retrieval: impact on staff and institutions.

Perioperative nurses, along with other nurses, and health care institutions, are affected directly and indirectly by the present day process of multiple organ retrieval from a declared brain dead donor. The recognition of potential stress and impact situations in the retrieval process may assist in the planning of effective interventions to enable optimal organ retrievals.

Cardiovascular effects of methamphetamine.

Stimulant abuse has grown in popularity, particularly since the advent of crack cocaine. Another commonly abused drug is methamphetamine (MAP) hydrochloride. Known as crank, crystal, ice, crystal meth, and speed, MAP can be produced easily from ephedrine, and it is widely available. This article describes the pharmacology, cardiovascular effects, and toxicology of MAP, as well as the management principles of MAP abuse.

Cardiovascular implications of anabolic steroid abuse.

Anabolic steroids are synthetic derivatives of the hormone testosterone. Anabolic effects such as anticatabolism, increased skeletal muscle mass, and increased aggressiveness are usually desired; however, androgenic effects also result. Decreases in high-density lipoprotein, increases in low-density lipoprotein, changes in total serum cholesterol, hematocrit, and clotting factors, and the development of hypertensive diseases have all been implicated as resulting from anabolic steroid use. Research does not directly link anabolic steroids with cardiovascular diseases, but steroid use can significantly increase risk factors for atherosclerotic cardiovascular disease.

Acute crack cocaine intoxication: a case study.

The survival of a patient with acute crack intoxication requires the dynamic and ongoing collaboration of the nurse and physician to facilitate aggressive treatment. The prevention of ominous complications in the patient exhibiting multisystem failure requires advanced physical assessment skills. It is the integration of these physical findings along with the interpretation of laboratory data and invasive monitoring techniques that enables the critical care nurse to constantly evaluate the patient's response. This ongoing evaluation further directs care planning to potentiate optimum patient outcomes.

Uplift in the Fiordland region, New Zealand: implications for incipient subduction.

Low-temperature thermochronometry reveals regional Late Cenozoic denudation in Fiordland, New Zealand, consistent with geodynamic models showing uplift of the overriding plate during incipient subduction. The data show a northward progression of exhumation in response to northward migration of the initiation of subduction. The locus of most recent uplift coincides with a large positive Bouguer gravity anomaly within Fiordland. Thermochronometrically deduced crustal thinning, anomalous gravity, and estimates of surface uplift are all consistent with approximately 2 kilometers of dynamic support. This amount of dynamic support is in accord with geodynamic predictions, suggesting that we have dated the initiation of subduction adjacent to Fiordland.

Transmission of human immunodeficiency virus (HIV) by transplantation: clinical aspects and time course analysis of viral antigenemia and antibody production.

The human immunodeficiency virus (HIV) was transmitted to a patient who received a cadaveric renal transplant from a donor who had received massive blood component replacement. A negative HIV antibody test was obtained on serum drawn immediately after transfusion. After transplantation, pretransfusion sera and sera obtained several hours after transfusion tested positive for HIV antibody, suggesting that transfusions had transiently diluted the patient's serum and resulted in a false-negative HIV antibody test. Immediately after transplantation, the recipient showed a transient increase in HIV antigen levels followed by a more sustained increase representing de-novo antigen synthesis. Antibodies to HIV were detected 51 days after transplant. The recipient has shown no signs or symptoms of HIV infection after 1 year. In potential cadaveric organ donors, HIV antibody testing should be performed on pretransfusion sera or on sera obtained several hours after massive transfusion of blood products.