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Two patients had paracolostomy abscesses limited to the abdominal wall. Adequate drainage was obtained surgically using local anesthesia, but wound contamination from the fecal stream continued. Intravenous hyperalimentation and/or elemental diet reduced fecal volume, promoted wound healing and weight gain, and prevented the need for a proximal defunctionalizing colostomy. During follow-up periods of more than ten months, colostomy revision has not been necessary. [ABSTRACT FROM AUTHOR]

Home care clinicians face a daunting challenge in attempting to prevent falls among the frail, elderly population. This article outlines how one agency used evidence-based strategies to develop a program that identified patients at risk for falls and intervened with the goal of decreasing injury from falls by using a multidisciplinary approach.

The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.

Research in Parkinson's disease has given little attention to the reliability of subjective-qualitative assessment, or to the empirical aggregation of physical signs to supraordinate indexes of motor disturbance. We illustrate methods for examining observer reliability and discuss the importance of reliability to the interpretation of results. Observers rated patients (n = 70) for physical signs (selected Columbia Scale scores), disability stages, and abnormal involuntary movements. Observer agreement was achieved for Columbia scores and disability stages (range of Spearman rho = 0.67-0.95), but not for dyskinesias or dystonic postures. A factor analysis of Columbia scores revealed two indexes of motor disturbance: motor deficiency and tremor.

Three classes of Medex were followed during their preceptorship training and subsequent employment to assess the impact of adding such physician assistants on 13 private practices. The data suggest that the Medex are readily incorporated into the practice, seeing a similar spectrum of patients and generally functioning as a semicolleague. Although the Medex was almost universally a contributing addition to the practice, increasing patient volume, the specific effects varied with the setting.

The late presence of contour defects, as well as one eye being lower than the other, were directly related to a lack of interosseous wire fixation in this series of mid-facial fractures. In orbital floor fractures, the use of alloplastic material was found to give more satisfactory long-term results than bone grafts. The direct approach through the lower lid produced no complications of its own in this series. Associated injuries and preexisting disease were found in 61 percent of these patients, supporting the thesis that an M.D. should direct their care. The late presence of diplopia and/or enophthalmos was directly related to an underestimation and undertreatment of orbital floor fractures, or to treatment with bone grafts. The use of a shoulder strap, in conjunction with the lap belt, seems to almost completely prevent the occurrence of mid-facial fractures in automobile accidents.

Preliminary clinical studies have been carried out to determine whether the monoclonal antibody 791T/36 would localize in primary lung cancer to an extent sufficient for external detection by gamma scintigraphy. Radiolabelling of the antibody with 131I permitted visualization of three out of eight (38%) tumours using planar imaging with 99Tcm-labelled blood pool subtraction. Radiolabelling of the same antibody with 111In permitted visualization of tumour uptake in nine out of 13 (69%) tumours, without the need for image subtraction. Single photon emission computed tomography (SPECT) studies of seven patients demonstrated concentration of 111In-labelled antibody at the tumour site in each case, four of which were visualized on the planar images. The present study demonstrates localization of the 791T/36 antibody in primary lung carcinoma and confirms the superiority of 111In over 131I as a radiolabel for antibody imaging, especially when emission tomography is performed. These data indicate that further work will be required to determine whether this antibody will be a suitable carrier for cytotoxic agents in the therapy of lung cancer.