Ocular injuries in battered women

PURPOSE

The purpose of this article is to examine the occurrence of battered women seen by ophthalmologists in an eye emergency department, and to make ophthalmologists aware that these women are not a rarity but often go unrecognized.

METHODS

This retrospective study reviews a large urban eye center's emergency room charts over a 6-month period for documentation of injuries to women as a result of domestic violence. Seventy-nine charts were selected as part of this study. In 18 of these charts, battered women definitely were identified, and in 61 charts abuse was suspected but the abuser was not specifically identified.

RESULTS

The patients ranged in age from 15 to 90 years. The abuser was most commonly a boyfriend using a fist as the means of inflicting the injury. Injuries ranged from lacerations and contusions to more serious injuries, including three hyphemas and three ruptured globes. Six patients were hospitalized because of their injuries. Substance abuse was documented in 5 of 79 patients.

CONCLUSIONS

Many of these female victims of intentional violence in their homes go unrecognized or uncharted by physicians. Ophthalmologists see many of these women because of the high frequency of head and neck injuries in these cases, and should therefore maintain a high index of suspicion and be prepared to act appropriately with recognition and documentation of the injury and provision of social service referrals.

Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia

To examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post-dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively. Three groups were identified: Group I (n = 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n = 17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only for the duration of caesarean delivery; Group III (n = 13) patients had an immediate conversion to spinal anaesthesia and received post-caesarean section continuous intrathecal patient-controlled analgesia consisting of fentanyl 5 micrograms.ml-1 with bupivacaine 0.25 mg.ml-1 and epinephrine 2 micrograms.ml-1 with catheterization lasting > 24 h. No parturient in group III developed a PDPH. This was substantially lower (P < 0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization > 24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.

Evaluation of a training course on sexual counselling in a drug work setting

It has been repeatedly reported that while risks associated with the injecting behaviour of drug users has been reduced, no parallel changes have been made in sexual risk behaviour. Counselling advice to clients attending drug unit services has not focused sufficiently on the sexual behaviour of this client group. The present study evaluates the impact of a 4-day tailored training course on the counselling practices of two teams of drug workers at a London hospital. The course was designed following the experience and evaluation of a more general training course on sexual issues, and included information, group discussions, experiential learning and skills training. Results indicate that though there were no significant behavioural changes, some attitudinal changes have taken place; training appears to have increased the staff's awareness of the importance of sexual counselling and reduced the perceived difficulty of discussing certain specific sexual issues. The implications of single-agency training courses are discussed and recommendations are made for future training courses on the basis of the findings of this study.

Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine

We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.

Health care indicators

Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.

Health care indicators

Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more comprehensive data.

Measuring hospital input price increases: the rebased hospital market basket

The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed.

Emergency thoracotomy. Care of the patient in the OR: a case study

As an OR staff nurse at Cook County Hospital, some of my most challenging and rewarding nursing experiences have come from caring for emergency open-chest trauma patients. From the moment we receive a call that an open-chest patient is on the way, everyone assigned is in a high state of tension. Every decision takes on exaggerated importance. The circulating nurse, by virtue of his or her position during an emergency, is the "hub of the wheel" of activity. He or she is privy to all facets of care that are being administered to the patient. The nursing challenge of the emergency open-chest trauma is great, but it is not an impossible task.

The value of chromosome analysis in cases of neural tube defects: a case of anencephaly associated with fetal dup(2)(p24----pter)

A family is described in which two anencephalic fetuses were identified in two pregnancies. Autopsy revealed kidney anomalies in both fetuses. Chromosome analysis was performed only on the second fetus, which had a 46,XY,10q+ karyotype. Parental chromosome analysis showed the maternal karyotype to be 46,XX,t(2;10)(p24;q26) thus demonstrating that the fetus was carrying a duplication 2(p24----pter). Recurrence risks for anencephaly based on the cytogenetic abnormality were much higher than those which would be quoted for isolated anencephaly. This points out the necessity for complete diagnostic studies when a fetus with a neural tube defect is identified. The literature in regard to the 2p duplication phenotype is reviewed. It is possible that the duplication of the distal segment of 2p results in a neural tube defect/kidney anomaly phenotype.

Pseudomosaicism for trisomy 13. Three case reports

Pseudomosaicism is of particular concern in prenatal diagnosis when it involves mosaicism for a cytogenetic abnormality associated with a clinical syndrome which is compatible with postnatal life, such as trisomies for chromosomes 13, 18, and 21. The lack of data regarding the outcome of pregnancies involving these specific kinds of pseudomosaicism makes genetic counselling difficult. Three cases of prenatal diagnosis of pseudomosaicism for trisomy 13, each of which had a normal outcome, will be presented (Tables 1 and 2). The three main areas for consideration are: (1) the genetic counselling issues, (2) the additional prenatal diagnostic options available to evaluate the status of the fetus in an attempt to identify some of the clinical features of trisomy 13, and (3) the outcome of the pregnancies.

Immediate and unexplained fetal death during mid-trimester amniocentesis

Immediate and unexplained fetal death during mid-trimester amniocentesis for prenatal diagnosis was found to be an uncommon though real phenomenon. A survey of programmes in the United States detected 5 cases from 7524 at 4 centres. Postmortem examination was not helpful and a neurogenic mechanism is postulated. Awareness of this phenomenon and routine pre- and post-amniocentesis ultrasound monitoring may clarify the actual prevalence and etiology.

Negative findings concerning Alcaligenes faecalis as an etiologic agent in acute respiratory disease of turkeys

An acute respiratory disease of turkeys in Israel was first reported in November 1978. Alcaligenes faecalis was isolated from sick turkeys and from chickens not affected by the disease. Plate agglutination tests with A. faecalis antigen of 1,067 turkey and 494 chicken serum samples gave variable results: healthy turkeys gave positive reactions and sick turkeys sometimes gave negative ones. All isolated strains were highly sensitive in vitro drug sensitivity tests, but chemotherapy failed in the field. Pathogenicity trials with A. faecalis, given alone or in combination with Yucaipa virus to 8-day-old turkey poults, failed to reproduce the disease.

Effects of probenecid on blood levels and tissue distribution of ampicillin in fowls and turkeys

The effect of probenecid (a benzoic acid derivative which competitively inhibits active secretion of weak organic acids by the renal tubules) on serum ampicillin concentrations and the distribution of ampicillin in body organs was examined in fowls and turkeys. An aqueous solution of probenecid coadministered intramuscularly, at 200 mg/kg, with sodium ampicillin solution, at 25 mg/kg, resulted in peak serum antibiotic concentration of 16.5 microgram/ml. A similar dose of ampicillin administered alone produced a peak level of 4.6 microgram/ml. Subcutaneous injections of sodium ampicillin at 25 mg/kg with aqueous probenecid at 200 mg/kg resulted in a peak serum ampicillin concentration (12.8 microgram/ml) three times as high as the peak produced by the subcutaneous injection of ampicillin alone at 50 mg/kg (4.2 microgram/ml). The elimination half-life (t 1/2) of the drug (30 min) was increased to 1.5 hr by coadministration of probenecid parenterally, and serum antibiotic levels greater than or equal to 5.0 microgram/ml were maintained during 3 hours. Ampicillin seemed to be poorly absorbed from the gastrointestinal tract of fowls. A single oral bolus administration of ampicillin trihydrate aqueous suspension produced a peak of 0.6 microgram/ml, and coadministrations of aqueous probenecid suspension at 20, 50, and 100 mg/kg respectively produced peaks of 0.9, 1.25, and 1.5 microgram/ml. During 4 and 5 days, when ampicillin was added to the drinking water at rates of 200 and 50 mg/liter, serum ampicillin levels were rather low (peaks of 0.20 and 0.12 microgram/ml, respectively), and although these levels were increased by 50% with the coadministration of probenecid they were considered to be of limited clinical value for treating systemic bacterial infections. Probenecid did not change the distribution of ampicillin in the organs.