Polydactyly of the foot in adults: literature review and unusual case presentation with diagnostic and treatment recommendations

The authors present an unusual case of polydactyly of the foot in an otherwise healthy adult male. The modern literature describing polydactyly of the foot is reviewed, as well as a review and critique of various classification schemes for foot polydactyly deformities. The authors applied the classification criteria of Blauth and Olason to an atypical case and to other varied, yet typical, presentations of polydactyly of the foot in adults. Nonsurgical and surgical treatment options are reviewed, and a rational treatment plan is proposed based upon use of the classification scheme. They then apply the management plan for symptomatic polydactyly of the foot to the unusual case, and make recommendations for surgical management of this deformity.

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Measuring and validating a nurse's caring performance

This article describes the importance of clear, specific methods of evaluating nursing care. Nursing standards and job descriptions are explained within the context of performance evaluations for nurses.

Effectiveness of teaching breast self examination during office visits

In a randomized clinical trial a comparison was made of two BSE teaching interventions delivered by primary providers during office visits in a group nursing faculty practice. Patients who reported no regular BSE (n = 121) received either individualized teaching focused on reducing perceived barriers and reinforcing benefits of BSE, or routine teaching limited to usual instruction in BSE technique. Patients reporting frequent/monthly BSE during the past year were comparison subjects (n = 81). Self-reported data on BSE behavior were obtained in questionnaires administered before the interventions and via telephone interviews three months after the visit. Analysis using chi square showed that, contrary to expectation, individualized and routine teaching were equally effective: 61.4% of the individually taught and 63.5% of the routinely taught reported frequent or monthly practice at followup. Both groups were significantly more confident in technique and ability to detect change in the breast. The previously non-practicing women remained significantly less likely than comparison subjects to be performing BSE monthly at followup. The perceived benefit of BSE giving peace of mind predicted non-practicers most likely to change.

Evaluation and management of the muscle contraction headache

Headache was the seventh most frequent reason for a visit to primary care providers specified in the 1977-1978 National Ambulatory Care Survey. Muscle contraction headaches (MCH) constitute 90 percent of all headaches. Following a discussion of the epidemiology of headache, this article describes the pathophysiology, history, psychological profile of the typical MCH patient, common objective findings of MCH versus intracranial mass, physical findings and diagnosis. The management section includes a discussion of education and appropriate pharmacologic treatment, along with non-pharmacologic treatments such as massage, acupressure, biofeedback and stress management. Acupuncture is briefly described. Referral criteria for the MCH is included.

Altered phosphate metabolism in myocardial infarction: P-31 MR spectroscopy

The high-energy myocardial phosphate metabolism of four patients with acute anterior myocardial infarction after coronary angioplasty and drug therapy was evaluated with cardiac-gated phosphorus magnetic resonance (MR) depth-resolved surface coil spectroscopy (DRESS) 5-9 days after the onset of symptoms. Significant reductions (about threefold) in the phosphocreatine (PCr) to inorganic phosphate (Pi) ratio and elevations in the Pi to adenosine triphosphate (ATP) ratio were observed in endocardially or transmurally derived MR spectra when compared with values from epicardially displaced spectra and values from seven healthy volunteers (P less than .05). High-energy phosphate metabolites and Pi ratios did not vary significantly during the cardiac cycle in healthy volunteers. However, contamination of Pi resonances by phosphomonoester components, including blood 2,3-diphosphoglycerate, precluded accurate spectral quantification of Pi and pH. The results indicate that localized P-31 MR spectroscopy may be used to directly assess cellular energy reserve in clinical myocardial infarction and to evaluate metabolic response to interventions.

The fate of inorganic phosphate and pH in regional myocardial ischemia and infarction: a noninvasive 31P NMR study

To determine the characteristic appearance of phosphorus (31P) nuclear magnetic resonance spectra in acute and chronic myocardial infarction in situ, cardiac-gated depth-resolved surface coil spectroscopy (DRESS) at 1.5 T was used to monitor 31P NMR spectra from localized volumes in the left anterior canine myocardium for up to 5 days following permanent occlusion of the left anterior descending coronary artery. Coronary occlusion initially produced regional ischemia manifested as significant reductions in the phosphocreatine (PCr) to inorganic phosphate (Pi) ratios and intracellular pH (P less than 0.05, Student's t test) in endocardially displaced spectra acquired in periods as short as 50 to 150 s postocclusion. Spectra acquired subsequently revealed either (i) restoration of near-normal phosphate metabolism sometime between 10 and about 50 min postocclusion or (ii) advancing ischemic phosphate metabolism at about an hour postocclusion, and/or (iii) maintenance of depressed PCr/Pi ratios for up to 5 days postocclusion with a return of the apparent pH to near normal values between 6 and 15 h postocclusion. Postmortem examination of animals exhibiting the first type of behavior revealed the existence of coronary collateral vessels. The last type of behavior indicates that Pi remains substantially localized in damaged myocardium for days following infarction. The location and size of infarctions were determined postmortem by staining excised hearts. The smallest infarctions detected by 31P DRESS weighed 4.9 and 7.5 g. The most acidic pH measured in vivo was 5.9 +/- 0.2. Infarctions aged 1/2 day to 5 days were characterized by elevated but broad Pi resonances at 5.1 +/- 0.2 ppm relative to PCr and significantly depressed PCr/Pi ratios (P less than 0.002, Student's t test) relative to preocclusion values. Contamination of Pi resonances by phosphomonoester (PM) components is a significant problem for preocclusion Pi and pH measurements. These results should be applicable to the detection and identification of human myocardial infarction using 31P NMR and DRESS.