British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy.

Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation.

The Estimated Cost of Maintenance of Certification.

Background: Maintenance of Certification (MOC) is a controversial topic in medicine for many different reasons. Studies have suggested that there may be associations between fewer negative outcomes and participation in MOC. However, MOC still remains controversial because of its cost.

Is Total Elbow Arthroplasty Safe as an Outpatient Procedure?

Ambulatory surgery centers are the preferred setting for many procedures formerly performed in a hospital setting. This study sought to determine whether outpatient total elbow arthroplasty (TEA) is as safe as inpatient TEA. A retrospective analysis was performed of inpatient (IP) versus outpatient (OP) TEA by a single surgeon over a period of 18 years.

Infection rate and risk factor analysis in an orthopaedic ambulatory surgical center.

Surgical site infections (SSI) are a costly problem. The purpose of this study was to determine the rate of infection and identify patient and technical risk factors for SSI in an orthopaedic ambulatory surgical center. Over 11,000 consecutive orthopaedic surgeries over 5 years were reviewed for SSI as well as demographic, medical, and surgical risk factors.

The "clenched pencil" view: a modified clenched fist scapholunate stress view.

Traditional radiographic imaging of the scapholunate interval is complicated by the lack of a view that combines the dynamism of the clenched-fist stress view with the ability to reliably duplicate the precise angle of pronation that shows optimally the scapholunate interval. We describe a simple radiographic technique that combines these 2 criteria that we have found helpful in the office diagnosis of scapholunate dissociation.

Idiopathic heterotopic ossification in the intensive care setting.

Heterotopic ossification is characterised by the periarticular deposition of ectopic bone. It typically occurs after trauma, neurogenic injury, or congenital causes. Idiopathic heterotopic ossification has been rarely reported.

Hereditary neuropathy with liability to pressure palsies mimicking multifocal compression neuropathy.

Hereditary neuropathy with liability to pressure palsies (HNPP) is a recurrent disorder of the peripheral nervous system characterized by reversible episodes of sensorimotor deficits after neural compression injuries. Also known as tomaculous neuropathy, HNPP is further characterized ultrastructurally by multiple focal thickenings (tomacula) of peripheral myelin and has an autosomal dominant inheritance. The neuropathology of HNPP includes a partial deletion encoding the peripheral myelin protein 22 (PMP-22) gene on chromosome 17, resulting in underexpression of PMP-22.

Flexor tenosynovitis due to Mycobacterium asiaticum.

Mycobacteria other than tuberculosis infections of the hand are seen with increasing frequency. A case of Mycobacterium asiaticum flexor tenosynovitis is described. Successful management included radical flexor tenosynovectomy and therapy with oral minocycline and clarithromycin.

Publication pattern of papers presented at the American Society for Surgery of the Hand annual meeting.

Publication of research results in peer-reviewed journals represents the consummation of the scientific method. In order to determine the rate of publication of oral presentations at the annual meeting of the American Society for Surgery of the Hand, every presentation (n = 397) from the 1990, 1991, and 1992 annual meetings was subjected to a Medline Plus computer search in January 1995. Meeting abstracts were grouped by program designation to scientific session, research session, and residents and fellows conference categories, and a Kaplan-Meier survivorship curve was formulated for each category.

Deep infection of the hand with Mycobacterium avium-intracellulare: two case reports.

Two case reports of deep hand infections with Mycobacterium avium-intracellulare are presented. Both occurred in elderly men. Aggressive surgical débridement combined with antitubercular chemotherapy resulted in an excellent outcome in both cases.

Orthopedic casualties in an activated National Guard Mechanized Infantry Brigade during Operation Desert Shield.

From November 1990 to April 1991, the 48th Infantry Brigade (Mechanized), an Army National Guard unit, was activated under Operation Desert Shield and deployed to the National Training Center, Fort Irwin, California, for training in desert warfare. All casualties requiring care beyond the battalion aid stations were evacuated to the medical company organic to the 48th Brigade. Each of 727 orthopedic patient visits were grouped into one of eight etiologies: trauma, degenerative, overuse, infectious, neoplastic, congenital/pediatric, miscellaneous, and psychiatric.

Outcome following epineurotomy in carpal tunnel syndrome: a prospective, randomized clinical trial.

To assess the efficacy of an adjunctive epineurotomy in carpal tunnel syndrome, 36 wrists in 33 patients were prospectively randomized into epineurotomy and non-epineurotomy treatment groups. The operating surgeons and evaluating therapist were double-blinded. Patients were evaluated preoperatively and at either 6 or 12 months postoperatively, with 15 patients examined at both postoperative time points.

Congenital constriction band syndrome: a seventy-year experience.

Seventy-one cases of congenital constriction band syndrome (CCBS) were reviewed. The year of birth, sex, ethnic background, gestational history, family history, and concurrent diagnoses were obtained. The anatomic patterns of involvement, degree of impairment, and number and type of surgical interventions were recorded.

Allograft salvage of failed total elbow arthroplasty. A report of two cases.

Infection after total elbow arthroplasty (TEA) is a devastating complication. Current management options include (1) salvage of the implant with debridement and parenteral antibiotics, (2) resection arthroplasty, and (3) arthrodesis. Most infected TEA patients ultimately require resection arthroplasty.

Utilization of the extended rectus abdominis myofasciocutaneous free flap in upper extremity reconstruction.

Degloving injuries of the upper extremity may require extensive soft tissue coverage. Free tissue transfer is often useful in the management of these injuries. We describe the use of an extended rectus abdominis myofasciocutaneous vascularized free flap in the management of a massive longitudinal upper extremity traumatic soft tissue defect.

Intraoperative dexamethasone irrigation in lumbar microdiskectomy.

In 45 lumbar hemilaminectomy/microdiskectomy patients, a control group of 23 patients had the standard operative procedure. The remaining 22 patients were treated with intraoperative irrigation of long-acting dexamethasone before incision closure. Age, weight, gender ratio, mean postoperative hospital stay, mean in-hospital narcotics usage, and incidence of perioperative complications among the two groups were compared.

Fusobacterium osteomyelitis associated with intraosseous gas.

The diagnosis of acute anaerobic osteomyelitis was made in a 57-year-old hypertensive diabetic woman complaining of groin pain and fever. Roentgenograms and computed tomography demonstrated intraosseous gas in the right femoral head and surrounding soft tissue. Cultures obtained from open biopsy were positive for the anaerobic gram-negative bacillus Fusobacterium necrophorum, a normal inhabitant of the mouth, bowel, and urogenital tract.