Gastrointestinal complications of gastroschisis

The mortality of infants with gastroschisis has been reduced markedly in the last decade with the application of new surgical techniques, improved metabolic monitoring, and total parenteral nutrition. The late complications of repaired gastroschisis are now emerging. In this series of 30 infants with gastroschisis (20% mortality) significant gastroesophageal reflux was identified in seven of 10 infants with the appropriate barium study. The clinical symptom complexes of dysmotility, a recognized problem in gastroschisis, and gastroesophageal reflux can be easily confused. In addition, 11 episodes of necrotizing enterocolitis were identified in seven infants, four with perforations. The children with necrotizing enterocolitis had a deceptively benign clinical presentation, which was easily misinterpreted in these ill infants. Awareness of these two significant gastrointestinal complications and close cooperation of clinicians and radiologists to detect them should insure better survival in the infant with gastroschisis.

Hiring patterns for non-faculty clinical staff pharmacist positions in institutions greater than 500 beds

A survey was mailed to 150 randomly-selected hospitals greater than 500 beds to determine: 1) the type of pharmacists currently in non-faculty clinical staff positions; and 2) to assess the hiring philosophy toward such positions. Seventy-two surveys were used to tabulate results. Fifty-eight per cent of the non-faculty clinical positions in the institutions surveyed are held by BS pharmacists. Top preference if rehiring was an advanced degree PharmD or an entry level PharmD with a specialized residency. However, BS pharmacists with clinical experience also ranked high in preference, showing a definite competition with advanced degree pharmacists. Personality and experience seem to become important factors. MS graduates ranked very low, unless their degree was accompanied by a specialized residency. Implications of the survey results are discussed in respect to graduating pharmacy students, academe, and pharmacists currently in the work force.

In vitro antibacterial properties of BRL 36650, a novel 6 alpha-substituted penicillin

BRL 36650 is a new type of penicillin in which a formamido group has been introduced into the 6 alpha-position of the nucleus. The compound is highly active against aerobic gram-negative bacteria and is stable to a wide range of beta-lactamases produced by these organisms. Against members of the family Enterobacteriaceae, BRL 36650 was considerably more active than piperacillin, particularly against beta-lactamase-producing strains, and showed a similar level of activity to moxalactam, aztreonam, and the third-generation cephalosporins cefotaxime and ceftazidime. Against Pseudomonas aeruginosa and other Pseudomonas species, BRL 36650 was more active than piperacillin, cefoperazone, and aztreonam and compared favorably with ceftazidime. BRL 36650 was highly active against Haemophilus influenzae and Neisseria gonorrhoeae, including beta-lactamase-producing strains, and against Acinetobacter calcoaceticus. Clinical isolates of Enterobacter species and P. aeruginosa which showed markedly reduced susceptibility to cefotaxime, ceftazidime, and aztreonam were only slightly less susceptible to BRL 36650. Against Bacteroides fragilis and most gram-positive bacteria, BRL 36650 showed only a low level of activity. BRL 36650 was found to be only 35% bound to human serum protein, and the antibacterial activity was little affected by the presence of serum. In contrast, the composition of the test medium influenced the activity of BRL 36650 slightly, and an antagonistic effect could be demonstrated between the compound and a component of certain Mueller-Hinton media.

Central carpal instability-capitate lunate instability pattern: diagnosis by dynamic displacement

Eleven patients have been diagnosed as having a central carpal instability that has, to our knowledge, not been previously described. The clinical symptom complex is one of pain and clicking in the region of the midcarpus and, at times, frank snapping, usually while lifting heavy objects. Tight grasping, especially in supination, tends to provoke the symptoms. In ten of the patients, the diagnosis of instability was demonstrated by a dynamic traction displacement technique with the aid of fluoroscopy, in one patient the instability pattern was recognized only at the time of surgical exploration of the carpus. One patient has undergone a surgical procedure to reinforce the dorsal ligamentous support at the capitate lunate area. The other ten patients have become asymptomatic as a result of modifying their activities. The capitate lunate instability pattern (CLIP wrist) is a definite and distinct entity, which may be diagnosed with appropriate studies.

CT evaluation of chondroblastoma

Chondroblastoma is a rare benign primary bone tumor with generally characteristic plain radiographic features. In some cases, however, the benign nature and the extent of the lesion may not be appreciated using conventional radiography. We report the CT findings of chondroblastoma in three patients. In one patient CT clearly defined cortical destruction, which was not well visualized on plain radiography or conventional tomography. In a second patient CT showed a sclerotic rim absent on plain radiography; this suggested the benign nature of the lesion. Other advantages and potential pitfalls of CT in evaluating chondroblastoma are discussed.

Progressive discipline

A structured, stepwise approach to employee discipline is described in which penalties increase in severity if problems are not corrected. Managers should apply all disciplinary measures consistently and should comply with hospital, union, or personnel department procedures where applicable. The steps of progressive discipline include oral counseling, written warning notices, suspension without pay, and termination of employment. Disciplinary sessions should be documented and follow-up sessions should be held to evaluate progress. An oral counseling session should be held immediately after a problem appears and should include a specific description of the problem and its implications by the supervisor, an explanation and suggestions for correction by the employee, and agreement on a specific plan of action. If the problem persists, the manager should give a written warning notice and again discuss the problem and a specific plan of action. One or more suspensions for three or five days may be used, depending on policy and the manager's judgment. When firing an employee, the manager should review previous disciplinary measures and explain the institution's appeal process. If all disciplinary steps have been followed, the appeal should be denied. Use of the progressive discipline process encourages satisfactory employee performance. The specific steps ensure that employees are treated fairly, and documentation of the process supports the manager's action when an employee must be fired.

Capitate-lunate instability: recognition by manipulation under fluoroscopy

Videotape fluoroscopy was used to diagnose a previously undescribed carpal dissociation, the capitate lunate instability pattern. In eight patients with midcarpal pain and clicking, the examiner simultaneously applied pressure to the scaphoid tuberosity while applying longitudinal traction and flexion to the wrist under fluoroscopic control. This maneuver revealed dorsal subluxation of the proximal carpal row and capitate lunate subluxation in each of the eight patients. Plain radiography and arthrography were not helpful in the diagnosis. All eight cases were managed conservatively. Videotape fluoroscopy is the best radiologic method of diagnosing capitate-lunate instability.

Motivating pharmacy employees

Concepts from theories of motivation are used to suggest methods for improving the motivational environment of hospital pharmacy departments. Motivation--the state of being stimulated to take action to achieve a goal or to satisfy a need--comes from within individuals, but hospital pharmacy managers can facilitate motivation by structuring the work environment so that it satisfies employees' needs. Concepts from several theories of motivation are discussed, including McGregor's theory X and theory Y assumptions, Maslow's hierarchy of needs theory, Herzberg's motivation hygiene theory, and Massey's value system theory. Concepts from the Japanese style of management that can be used to facilitate motivation, such as quality circles, also are described. The autocratic, participative, and laissez faire styles of leadership are discussed in the context of the motivation theories, and suggested applications of theoretical concepts to practice are presented.

An analysis of bowel perforation in patients with intussusception

A barium colon examination is recommended for the diagnosis and reduction of intussusception in children, except when bowel perforation is evident either radiographically or clinically. In our experience and contrary to recent reports neither radiographic evidence of bowel obstruction nor an age of less than six months is a contraindication. We reviewed 40 patients diagnosed as having had intussusception and found five children aged more than six months with perforations discovered at operation. Three of the five children had plain radiographic findings of small bowel obstruction as did nine other children. In four of the 12 children with evidence of small bowel obstruction a successful hydrostatic reduction of the intussusception was carried out. Barium studies were performed for diagnosis and therapy in eight children with ileo-colic intussusception aged six months or less, four of whom had evidence of small bowel obstruction. In five, including two with obstruction, reduction of the intussusception was successful. The major contraindication to barium examination is radiographic or clinical evidence of perforation.

Recruiting, interviewing, and hiring pharmacy personnel

A practical approach to recruiting, interviewing, and hiring pharmacy personnel is presented. Recruiting applicants should be an ongoing function, and personnel departments can serve as an important resource. A good pool of applicants can be developed by contacts, referrals, and advertising and through schools of pharmacy and placement services. Federal and state regulations regarding equal employment opportunity and affirmative action are discussed. The first step of the interview process involves comparing the applications with a current job description. A strategy for conducting the interview should be developed before the meeting takes place. Some examples of basic questions and questions that can be used to explore the applicant's work experience, background, and motivational level are presented. Suggestions are made for documenting interviews. Details on making the hiring decision on the basis of the interview are discussed, and the process of actually offering the position is covered. Hiring new employees is a major commitment that demands careful consideration. Each step in the process of recruiting, interviewing, and hiring must be performed diligently to avoid problems later on.

Managing the pharmacy manager

Methods of self-assessment, self-development, and coping with stress in the role of hospital pharmacy manager are described. Personal development and career growth should be systematically appraised; goals and priorities should be continually re-evaluated; and time management, response to change, and impact on others should be examined. Questions for assessment in each of these areas are provided. Advice for reducing stress and avoiding burnout is given. Managers' attitudes affect employee productivity; positive attitudes and related actions that are applicable to hospital pharmacy management are described. Managers' personal and professional goals and priorities and their methods of using time and coping with stress affect management of their departments.

Patterns of calcification in childhood dermatomyositis

The radiographs of 40 patients with childhood dermatomyositis, an uncommon inflammatory disease, were reviewed. Four distinct patterns of calcification were identified: deep calcareal masses, superficial calcareal masses, deep linear deposits, and a lacy, reticular, subcutaneous deposition of calcium encasing the torso (not emphasized in recent literature). This linear reticular pattern of calcification was associated with a severe unremitting clinical course. Soft-tissue calcification was identified in 40% of cases, a lower incidence than previously reported. No patient in this series had acroosteolysis or pulmonary parenchymal disease, radiographic findings more commonly associated with childhood scleroderma.

Personnel management for hospital pharmacists

This paper launches a seven-part series of articles on personnel management for hospital pharmacists. The series is designed to help hospital pharmacists who supervise other workers improve their skills in handling personnel matters. Methods of managing the pharmacy manager will be reviewed, including the establishment of goals and priorities, time management, and mechanisms for coping with stress. Techniques for recruiting, interviewing, and hiring and for training new employees will be presented. Several motivation theories will be examined and applied to professional and supportive personnel in the pharmacy department. Methods of evaluating performance and disciplining employees will be reviewed. Each article will include typical examples from hospital pharmacy practice to illustrate the concepts.

Effect of stypoldione on cell cycle progression, DNA and protein synthesis, and cell division in cultured sea urchin embryos

We have found that stypoldione, a bright red o-quinone isolated from the brown alga Stypopodium zonale, inhibits the division of sea urchin embryos in a concentration-dependent manner (IC50 approximately 2.5 X 10(-6) M). Although previous studies have shown this marine natural product to inhibit beef brain microtubule assembly in vitro [Fed. Proc. 39:26-29 (1980); Mol. Pharmacol. 24:493-499 (1983)], we have found that stypoldione does not accumulate sea urchin embryos in mitosis and hence does not act like a mitotic spindle poison. We have also shown this marine natural product to inhibit both amino acid and nucleoside uptake. By preloading sea urchin embryos with nucleoside (i.e., [3H]thymidine) in order to dissociate effects on uptake from those on incorporation, we found that stypoldione in fact produces no significant inhibition of the M phase-independent S1 period of DNA synthesis, a result which suggests that stypoldione has no direct effect on DNA synthesis. In contrast, stypoldione did reduce the extent of amino acid incorporation in embryos preloaded with [3H]leucine. An inhibition of incorporation was apparent as early as 20 min after fertilization, and incorporation was reduced to 50% of control by 40 min postfertilization. This result suggests that stypoldione might inhibit cleavage via an inhibition of translation, although the existence of other inhibitory mechanisms cannot yet be ruled out. Cytological examination revealed that sea urchin embryos did not progress beyond-interphase or very early prophase when incubated in the presence of 1.0 X 10(-5) M stypoldione. The nuclear membranes remained intact, and chromatin did not condense into chromosomes in these arrested embryos. These results indicate that embryos exposed to stypoldione early in the cell cycle initiate and complete the M phase-independent S1 period of DNA synthesis, but stop cell cycle progression prior to the start of prophase of mitosis. The period between S phase and mitosis is referred to, by definition, as the "G2" phase of the cell cycle. The result therefore suggest that stypoldione blocks cell cycle progression (and, ultimately, cell division) by inhibiting progression through G2. This compound may represent a new class of G2-accumulating agents.

Sonography of neuroblastoma

Sonograms of 21 children with neuroblastoma were reviewed with attention to the following sonographic criteria: size, location, internal echo pattern, anechoic areas, and margination. Fourteen primary tumors were evaluated before therapy. All tumors were heterogeneously echogenic; all had poorly defined margins. Tumor calcification was identified in three, and 10 of 14 primary tumors contained discrete anechoic areas ranging from 0.5 to 4 cm in diameter. The average greatest dimension of primary tumor masses was 7.7 cm.

Interventional ultrasound in detection and treatment of renal inflammatory disease

Fifty-one patients with acute inflammatory renal disease were examined with ultrasound. The spectrum of findings seen in acute pyelonephritis is described, with emphasis on the evolution of the disease from acute focal inflammation to perinephric extension. There were 26 cases of acute bacterial nephritis, 15 cases of abscess formation, and 10 cases of pyohydronephrosis. Pathologic correlation was obtained. The impact of percutaneous needle puncture on the diagnosis and treatment of all stages of renal disease is discussed. Prompt diagnosis can be made, and specific antibiotic therapy can be instituted on the basis of information obtained by ultrasound examination and percutaneous aspiration. If necessary, treatment may be aided by ultrasonically guided placement of drainage catheters. Serial examination will show resolution of the disease, and it avoids exposure of the patient to ionizing radiation and intravenous contrast agents.

Intussusception: additional observations on the plain radiograph

The plain radiographs of 40 patients with intussusception were reviewed with special attention to diagnostic features previously reported in this condition. Sixty percent of the cases demonstrated a soft-tissue mass on the radiograph. However, fully one-half of all masses were seen only on a horizontal beam radiograph. The use of plain radiographs to exclude the diagnosis of intussusception is not advocated. Nevertheless, attention is drawn to the frequency of abnormal plain findings, especially a soft-tissue mass on the horizontal beam examination.

Method for testing aseptic technique of intravenous admixture personnel

A method of checking the aseptic technique of personnel that prepare i.v. admixtures is described. The following sterile dosage forms of trypticase soy broth (TSB) were prepared: (1) single-strength ampuls 5 ml, (2) six-times (6X) concentrated broth ampuls 10 ml, (3) lyophilized broth sufficient to make 5 ml single-strength broth in 10-ml vials, and lyophilized broth sufficient to make 10.6 ml 6X concentrated broth in 20-ml vials. Admixture personnel were told these were investigational products, and they were given simulated orders to prepare syringes and 50-ml piggyback admixtures of the products. The specimens containing the broth were intercepted by an investigator, incubated for seven days at 37 degree C, and observed for turbidity on days 2 and 7. To verify that the broth supported the growth of bacteria, two common contaminants were inoculated into the broth in the syringes and admixtures to serve as positive controls. At least 100 samples from each of four procedures were processed during the three-month study period. A total of 405 samples prepared by 13 individuals were tested. None of the samples became turbid; hence, the bacterial contamination rate was 0%. Among the positive controls, 98% inoculated with one species and 100% inoculated with the other became turbid. This method is now used for monitoring the aseptic technique of new admixture personnel. This unique method of checking the aseptic technique of personnel is accurate and cost effective, and it avoids the risk of adventitious contamination.

Wilms tumor: ultrasonic features, pathologic correlation, and diagnostic pitfalls

The gray-scale ultrasonic features of Wilms tumor are reported with pathologic comparison. The most consistent ultrasonic features are large size, sharp margination, and echogenic heterogeneity. The frequently observed anechoic areas correlated with hemorrhage and necrosis. A rare case of mesoblastic nephroma is included for comparison. Pitfalls in diagnosis are discussed.

Antenatal ultrasound findings in cystic adenomatoid malformation

A case of congenital cystic adenomatoid malformation of the lung is presented with prenatal ultrasound findings. The present case appears to be the third instance reported in which the diagnosis was made antenatally by ultrasound, and the first which resulted in a live birth, although the patient succumbed to pulmonary hypoplasia.

Calcification in the soft tissues of the chest after thoracotomy

We have observed soft-tissue calcification of the chest in 4 of 54 patients following thoracotomy in the neonatal period for a Blalock-Taussig or a Blalock-Hanlon procedure. The time of appearance ranged from 2 weeks to 11 months. This calcification is similar to myositis ossificans in having a traumatic origin. In one of the patients, it resolved spontaneously.

Non-Hodgkin lymphoma of bone

Refinements in the pathologic classification of non-Hodgkin lymphoma (NHL) have led to reevaluation of radiographic findings. Radiographs of 147 patients with NHL were reviewed, and bone destruction was found in 24. Patients with primitive or poorly differentiated tumors were more likely to have bone involvement than patients with well differentiated lymphomas. Permeative destruction was most common. There was no radiographic correlation between cortical bone destruction and disseminated marrow involvement. The relationship of conventional radiographs to technetium bone scans and gallium scans was assessed. Radiographic response to therapy was noted.

Statistical errors in papers in the British Journal of Psychiatry

In the 12 months from July 1977 to June 1978, out of 168 papers in the British Journal of Psychiatry, 139 (83 per cent) presented numerical results. A total of 63 papers contained statistical errors and at least one drew unsupportable conclusions. In many cases the errors were not considered to be severe, but they were often sufficient to raise doubts about some inferences. It is suggested that more consultation of investigators with medical statisticians, a basic training in statistical methods in the preclinical years, and more extensive statistical refereeing are needed.

Anticonvulsant drugs and cancer. A cohort study in patients with severe epilepsy

Over 2000 epileptic patients admitted to the Chalfont Centre for Epilepsy between 1931 and 1971 and taking anticonvulsants were followed up to the end of 1977. Mortality between 1951 and 1977 was greatly in excess of that in the general population of England and Wales in that period allowing for age and sex. Some of the excess was directly attributable to epilepsy, but there were also more deaths from suicide and circulatory, respiratory, and malignant disease than would be expected. Apart from the brain and central nervous system, no particular site had a significant excess of tumours. In particular, there were no liver tumours (and only one gallbladder carcinoma). This makes it unlikely that the liver tumours produced on feeding phenobarbitone to mice are indicators of major human risk.