Femoral artery profundaplasty.

In advanced ischemia of the lower extremity, the deep femoral artery is rarely completely occluded, but may have a hemodynamically significant occluding plaque at its origin. Detection of this lesion requires biplanar arteriographic views. As indicated in this report, the related simple procedure of femoral artery profundaplasty may salvage limbs and lower amputation sites, and it is suitable for poor risk patients.

Alcoholics Anonymous and nursing. Lessons in holism and spiritual care.

Alcoholic Anonymous (AA) is a worldwide, million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism. Based on spiritual principles known as the "Twelve Steps" and "Twelve Traditions," AA has provided a model for other recovery programs such as Narcotics Anonymous (NA), Gamblers Anonymous (GA), and Sex and Love Addicts Anonymous (SLAA). Recovery in AA appears to involve a process of self-transcendence. In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice. This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA's spiritual approach to recovery.

Forgiveness. A concept analysis.

This article provides an operational definition of forgiveness as a first step in the systematic analysis of the concept. Using the method described by Walker and Avant (1995), the authors identify the attributes and characteristics of forgiveness and its theoretical and practical implications for nursing. Sample cases from clinical practice help illustrate the concept further. Further nursing research needs to test the theoretical relationships between forgiveness and nursing practice outcomes.

Stereotactic breast biopsy: a six-year surgical experience.

A retrospective review was done of all stereotactic breast biopsies performed at the Central Baptist Hospital Breast Center from February 1994 through December 1999. A total of 1,080 biopsies were performed in 1,026 patients, all by surgeons working independently. Masses were biopsied in 54% and calcifications in 40%. Eighteen percent of biopsies were malignant. The most common benign diagnosis was fibrocystic disease (72%), followed by fibroadenoma (19%), lymph node (2%), and papilloma (2%). The most common malignant diagnosis was invasive ductal carcinoma (40%) followed by ductal carcinoma in situ (32%) and mixed invasive and in situ ductal carcinoma (19%). A prebiopsy BI-RADS mammographic Category III was associated with a 2% incidence of malignancy; Category IV--17%; Category V--90%. Atypical ductal hyperplasia on stereotactic biopsy was upgraded to a malignant diagnosis after reexcision in 19% of the cases. The false-negative rate was 0.4% (sensitivity 99%) and the complication rate was 3%, mostly related to bleeding. Stereotactic biopsy is a safe and accurate technique for the minimally-invasive diagnosis of abnormal mammograms.

Evaluating the spiritual perspectives of homeless men in recovery.

The purpose of this study was to describe the self-reported spiritual perspectives of 100 homeless male residents living in a communal shelter. The residents, in recovery from substance addiction, were asked to complete Reed's 10-item Spiritual Perspective Scale (SPS) as part of their initial health database. Their responses were described within the context of their participation in 12-Step recovery programs, demographic characteristics, and perceived health status. Findings suggest that spirituality is an important health component for this population.

The Expanded Care for Healthy Outcomes (ECHO) Project: addressing the spiritual care needs of homeless men in recovery.

As the nation's homeless population continues to rise, new practice models will need to address the specific health care needs of the homeless while providing cost-effective wellness-oriented quality care. This article describes the early development of one such model. The Expanded Care for Healthy Outcomes (ECHO) Project is an interdisciplinary curriculum/practice model that explores the vital intersection of spiritual and primary care in promoting health among homeless guests at the Pine Street Inn Nurses Clinics in Boston, Massachusetts. The authors describe the incorporation of spiritual assessment and care in clinical practice with homeless men to maximize patients' physical, psychosocial, and spiritual wellness.

Unified approach to carcinoma of the esophagus.

The reversed gastric tube is advocated as a technique to be used in all patients who have carcinomas of the esophagus, whether the lesion is located in the upper, middle or lower esophagus. The tube, constructed out of the greater curvature of the stomach and supplied by the gastroepiploic vessels, invariably has adequate length and sufficient blood supply to heal per primum or to close anastomotic leaks spontaneously when they occur. Since the procedure requires a celiotomy and an incision in the neck, the presence and extent of metastatic disease below the diaphragm and above the clavicle can be evaluated. With prompt resumption of eating, the patients' nutritional status rapidly improves so that they can maintain weight during postoperative irradiation or further surgical procedures, e.g. esophagectomy. It is also effective as a palliative procedure since the patients handle their saliva and other secretions adequately after the procedure.

Breast conservation versus mastectomy: patient preferences in a community practice in Kentucky.

Recent studies have indicated a relatively low rate of breast-sparing surgery for carcinoma in the Southeastern United States. From 1987 through 1991, 289 patients from Eastern and Central Kentucky with breast carcinoma were treated by the authors. Despite being fully informed of treatment options of breast cancer, 82% of patients with stage II disease or less and no medical contraindications to breast conservation preferred mastectomy. Overall, 10% of patients underwent breast-sparing surgery, although this figure had risen to 20% by 1991. The most frequent reasons for preference of mastectomy were fear and inconvenience of radiotherapy and a perception that survival would be diminished if mastectomy was not done.