Volume 93, Issue 8

Atelectasis is a preventable complication that often occurs after upper abdominal surgery. In our I-year randomized, researcher-blinded trial, low-risk cholecystectomy patients were subjected to either the thoracic lymphatic pump (n=21) or incentive spirometry (n=21) to prevent atelectasis. The treatment groups were equal with respect to risk factors for atelectasis and deviation of preoperative respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in one second [FEVI ]) from the predicted values. Atelectasis occurred in 2 (5%) of 21 patients regardless of whether incentive spirometry or thoracic lymphatic pump treatment was used. Study patients treated with the thoracic lymphatic pump technique had an earlier recovery and quicker return toward preoperative values for FVC and FEVI than patients treated with incentive spirometry.

The "Standards for Pediatric Immunization Practices," recommended by the National Vaccine Advisory Committee and approved by the US Public Health Service, provides guidance to clinicians as to what the National Vaccine Advisory Committee considers optimal practice. Each of the 18 recommendations reflects the ideal; unfortunately, life in the trenches is less than ideal. Providers must reflect on each point and consider how they might modify their own practices to help us to realize the goal of Healthy People 2000, that is, 90% immunization coverage by the child's second birthday. The Standards are clear. They are reprinted herein from MMWR (April 23, 1993;42[5]). Following each is a response, sort of a reality check, from the author, a practicing clinician and practice administrator.

Efforts to fully integrate physicians infected with the human immunodeficiency virus (HIV) into residency programs have been complicated by concerns of the potential risks of viral transmission from physician to patient. Despite numerous studies, this potential risk has not been quantified. This article addresses the issue of HIV-infected interns and residents, classifying HIV as a potential disability. The suggested recommendations emphasize routine monitoring and evaluation of professional competence and compliance with proper infection control procedures, as delineated by the Centers for Disease Control and Prevention. The need for hospital-wide guidelines and adequate health and disability insurance are also discussed.

Keloids are disfiguring deformities that occur after trauma or wounding of the skin, most commonly among blacks. The case presented here is unusual because of the number of keloids and the massive size of one. The patient underwent full surgical excision together with intraoperative and postoperative steroid injections with good cosmetic results. Various causes of keloids are reviewed as are the histopathologic differences between hypertrophic scars and keloids. Alternative surgical and nonsurgical treatment techniques are examined.