Search

This study analyzed tourniquets used for orthopedic surgery in our hospital to determine the frequency and type of microbial contamination. Group A tourniquets were from our main operating room, Group B tourniquets were from our ambulatory surgicenter, Group C tourniquets were unused, prepackaged, sterile tourniquets from our main operating room, and Group D tourniquets were sterilely packed tourniquets from our ambulatory surgicenter. Tourniquets from Groups A, B, C, and D had 100%, 40%, 0%, and 0% microbial growth, respectively. For Group A tourniquets, coagulase-negative staphylococci, Bacillus, and Staphylococcus aureus were present in 100%, 60%, and 20% of tourniquets, respectively. Twenty percent were contaminated either with Streptococcus sanguis, Aerococcus viridans, or Cornyebacterium species. Coagulase-negative staphylococci and Bacillus were present in 40% and 30% of Group B tourniquets, respectively. Tourniquet contamination may be a risk factor for the development of surgical site infection in orthopedic surgery.

Ulnohumeral arthroplasty (UHA) is considered a satisfactory surgical treatment option for patients with primary degenerative arthritis of the elbow. Most series have used categoric elbow scoring systems to evaluate the outcome of this procedure. The purpose of our study was to evaluate the outcome of UHA with patient-derived functional and general health status outcome instruments. We evaluated 17 patients (18 elbows) with primary degenerative arthritis of the elbow at a mean of 85 months after UHA. The mean age at the time of surgery was 42 years (range, 26 to 58 years). At the follow-up evaluation, the patients were assessed with a physical examination, outcome assessment tools, and plain radiographs. The mean elbow flexion arc improved by 16 degrees (range, -15 degrees to 60 degrees ; P = .012), and the mean forearm rotation arc (supination/pronation) improved by 35 degrees (range, -20 degrees to 90 degrees ; P.001). Of the elbows, 11 were painless, 4 were painful with motion, and 3 were painful at rest and with motion. The mean Hospital for Special Surgery elbow score was 70 (range, 40 to 99), and the mean Mayo Elbow Performance Score was 83 (range, 50 to 100). The mean Disabilities of the Arm, Shoulder and Hand score was 9.75 (range, 0 to 43.48). The Short Form-36 scores were better than the mean age- and sex-adjusted normal values. Patient self-assessed outcomes and general health status after UHA for primary degenerative elbow arthritis appear to be better than those determined by some categoric scoring systems. Consequently, the clinical utility of UHA may be underrepresented if physician-derived categoric scoring systems are the only measures of outcome assessment.

Past research on manufacturing has not generally included research on the attributes of outstanding manufacturing managers. This information is important as the success of the manufacturing function depends to an extent on the quality of the manager. This study sought then to identify the attributes of an outstanding manufacturing manager. The methodology adopted included reviewing relevant literature, analysing job advertisements and surveying senior manufacturing managers. The profile of the outstanding manufacturing manager that emerged contained 12 specific attributes. These were classified into three groups i.e. attributes related to the position; attributes related to people management; and attributes related to the individual manager. The profile identified in this study is quite different from the traditional profile of an old‐fashioned autocrat who has risen from the ranks. Today’s manufacturing manager requires a strong academic background to understand and implement leading manufacturing and management techniques, good interpersonal skills and high levels of energy and drive.

Discusses the best practices adopted by some of the leading manufacturers in four Asian countries – Japan, South Korea, Singapore and Taiwan. Data were gathered from visits to 22 companies during 1992, 1993 and 1994. Presents the continuing and emerging best practices under the headings: leadership and planning; customer focus; people management and process management. Discusses future developments and progress in the four countries. The analysis shows that these companies are quite advanced in the areas of leadership, planning, customer focus and people development and management. The companies had adopted a very wide range of strategies and improvement programmes and had planned significant improvement programmes for the future.

Many receptors located within the intra-articular knee structures contribute to the neuromuscular responses of the knee. The purpose was to compare the automatic postural response induced by a perturbation at the foot before and after an intra-articular injection of a local anesthetic (bupivicaine), after a saline (sham) injection, and after no intra-articular injection (control) in the knee.Muscle onset latencies and automatic response magnitudes for the vastus medialis, vastus lateralis, biceps femoris, medial hamstrings, tibialis anterior, and gastrocnemius were measured using electromyography (EMG) when anteriorly directed perturbations were applied to the feet of 30 subjects. All subjects then received a lidocaine skin injection followed by: an intra-articular bupivicaine injection (treatment group); an intra-articular saline injection (sham group); or no injection (control group), depending on their randomized group assignment. The perturbation tests were then repeated.Muscle onset latencies and automatic response magnitudes did not change as a result of the intra-articular injections. Latencies were significantly greater for the vastus medialis and vastus lateralis when compared to the medial hamstrings, biceps femoris and tibialis anterior (P0.001). Automatic response magnitudes for the tibialis anterior were significantly greater than those of the hamstrings, which were greater than those of the quadriceps (P0.001).There were no differences in muscle response when anteriorly directed perturbations were applied to the foot with or without an injection of local anesthetic in the knee. Intra-articular receptors were either unaffected by the anesthetic or the extra-articular receptors or receptors of the other joints were able to compensate for their loss.

Background Many patients with chronic tendinosis have experienced early pain relief after application of bipolar radiofrequency treatment. Pathologic nerve ingrowth or nerve irritation in the tendon has been considered as a possible cause of the pain experienced with tendinosis. Hypothesis Bipolar radiofrequency treatment will ablate nerve fibers, resulting in pain relief. Study Design Controlled laboratory study. Methods Eighteen Sprague-Dawley rats were used in this study. Eight rats were treated with 2 points of bipolar radiofrequency applications applied to the hind paws with the Topaz microdebrider device, 6 sham rats had a needle applied to the hind paws, and there were 4 control rats. Tissues were processed for neural class III β-tubulin (TUJ-1) or calcitonin gene-related peptide (CGRP) immunohistochemistry by using the free-floating avidin-biotin complex technique. The numbers of TUJ1-immunoreactive and CGRP-immunoreactive nerve fibers in the epidermis were counted and compared with sham and control. Results The number of nerve fibers demonstrated by both the antibodies of TUJ1 and CGRP were significantly decreased (P = .0002-.002) during the first 2 weeks after bipolar radiofrequency treatment. Macroscopically, the foot pad showed 2 dimples on the surface after bipolar radiofrequency treatment. Although it still showed a scar after 7 days, after 14 days it looked no different than the untreated contralateral control foot pad and foot pad of the sham group. Conclusion Bipolar radiofrequency treatment induced acute degeneration and/or ablation of sensory nerve fibers. Clinical Relevance Degeneration or ablation of nerve fibers after bipolar radiofrequency treatment may explain the early postoperative pain relief after microtenotomy for tendinosis.

In attempting to account for the ability of most solid tumors to restrict the absorption of WR-2721, aminopropylaminoethylphosphorothioate, we examined a number of drug characteristics which might allow for this restriction, and observed that drug hydrophilicity was a major contributing factor. When the highly hydrophilic WR-2721 was dephosphorylated, the drug became less hydrophilic and could readily cross tumor cell membranes. In addition, conventional radio protectants, such as cysteine and mercaptoethylamine, were shown to be less hydrophilic than WR-2721 and also to cross tumor membranes readily. Therefore, drug hydrophilicity would appear to be the factor underlying the abillity of W R-2721 to selectively protect normal tissues while most other protectors alter the radiation resistance of normal and tumor tissue alike. A red blood cell model for studying this problem in greater detail is described.

Internet use is increasing and its applications to medicine and patient information are widening daily. Previous studies have focused on the quality and quantity of medical information on the Internet. The current study focuses on a population of 120 new patients presenting to a hand surgery practice. A questionnaire was used to analyse patterns of Internet access, use of the Internet to look up personal symptoms, and patients' opinions on the use of electronic mail by office staff. Results showed that approximately 90% of the group had some form of Internet access, with a significant age-related decrease in Internet access. Only 17% used the Internet to look up their symptoms, but this group was more likely to correctly match their self-diagnosis to the surgeon's diagnosis. On average, 65% of the study group favoured the use of electronic mail for office staff's communications with patients.