Normative Data of Pulmonary Function Tests and Radiographic Measures of Chest Development in Children Without Spinal Deformity: Is a T1-T12 Height of 22 cm Adequate?

Study Design: Retrospective case series.

Objectives: To develop normative data of pulmonary function tests (PFTs) and radiographic measures of chest development in normal children and to determine if the prior proposed T1-T12 height of 22 cm for spinal fusion in a growing child is adequate for pulmonary function based on normative PFT values at skeletal maturity.

Summary Of Background Data: Shortening of the spine from T1-T12 is a concern with early thoracic fusion for spinal deformity, as it has a deleterious effect on the development of the pulmonary system.

Role of race and sex in diagnosis and one-year follow up of deep venous thrombosis.

This study examines the role of sex and race in the diagnosis and outcome of deep vein thrombosis (DVT). A retrospective study was performed of 632 patients who underwent venous duplex ultrasound from August 1998 to July 1999. Comparisons were made by Chi-square analysis.

Unexpected economics of ulcer care protocols.

The cost of managing chronic ulcers, both venous leg and decubiti (sacral pressure), was reviewed using 36 randomized, controlled studies with a focus on saline, hydrocolloid, and a human skin construct. When one includes the labor intensiveness of dressing changes three to four times per day, the application of hydrocolloid dressings becomes the most cost-effective.

Economics of quality ulcer care.

Venous leg ulcers may affect up to 3.5% of the general patient population. The purchase price for dressing is not the true indication of cost effectiveness of any given method of care; rather cost is a combination of the price of the dressing plus labor required.

Wound care after radiation therapy.

More than 50% of all cancer patients receive some form of radiotherapy for tumor control preoperatively, postoperatively, or as sole treatment. Radiation-induced wounds are a concern for patients and practitioners. Current research investigating alternative treatment strategies offers the hope of improved wound healing and enhanced quality of life for patients with these wounds.

The silent worker.

The patient in this case was diagnosed as having a myocardial infarction, exacerbated over time. It has been reported in medical literature that women in such cases may have atypical symptoms that mimic those of other medical conditions and deceive providers into misdiagnosis. A few women present with the classical chest pain, a symptom most people relate to a feeling of a heart attack.

Development of a severity scale for evaluating the need for Graftskin in nonhealing venous ulcers.

Objective: To construct an easy-to-use severity scale based on data from a multicenter venous leg ulcer trial to predict which wounds will progress toward closure and which will remain unhealed.

Design: Factors that have an impact on wound healing (eg, ulcer duration, depth, area, location, and fibrin) were identified in the literature. A severity scale was constructed based on these factors.

Validation of venous leg ulcer guidelines in the United States and United Kingdom.

Background: Venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of 3 billion dollars and loss of 2 million workdays per year. The purpose of this study was to validate the clinical efficacy and cost effectiveness of multidisciplinary guidelines for the diagnosis and treatment of venous leg ulcers.

Methods: Eighty (40 retrospective, 40 prospective) patients from the United States and United Kingdom were enrolled.

Wound treatment with human skin equivalent.

Skin grafting provides an effective means of closing chronic wounds. Autografts and allografts are used most often in skin grafting, but Apligraf, a tissue-engineered bilayered human skin equivalent, provides another safe and effective grafting option for treating diabetic, venous, and pressure ulcers. This skin equivalent has an epidermis and dermis similar to human skin, largely due to its derivation from neonatal foreskin.

Current controversies in shock and resuscitation.

Many controversies and uncertainties surround resuscitation of hemorrhagic shock caused by vascular trauma. Whereas the basic pathophysiology is better understood, much remains to be learned about the many immunologic cascades that lead to problems beyond those of initial fluid resuscitation or operative hemostasis. Fluid therapy is on the verge of significant advances with substitute oxygen carriers, yet surgeons are still beset with questions of how much and what type of initial fluid to provide.

Peripheral vascular disease intervention in patients with end-stage renal disease: few complications in those treated with peritoneal dialysis.

Background: We assessed the results of peripheral vascular surgery in patients with end-stage renal disease (ESRD) who were being treated with peritoneal dialysis.

Methods: Sixty-seven ESRD patients on peritoneal dialysis who had peripheral vascular surgery were assessed retrospectively for preoperative risk factors, primary and secondary patency rates, and mortalitv. The study group had 48 proximal femoral-popliteal bypasses, 12 distal femoral-popliteal bypasses, and 7 distal femoral-tibial and/or peroneal revascularizations.

Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms.

Purpose: Endovascular repair of aortoiliac aneurysms may be limited by extension of the aneurysm to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including gluteal claudication, erectile dysfunction, and ischemia of the sigmoid colon and perineum.

Management of failed or failing infrainguinal bypasses with distal correctable lesions.

The goal of this study was to assess the management of failed or failing infrainguinal bypasses with distal correctable lesions. A retrospective analysis of 94 procedures was performed for 72 (77%) failed and 22 (23%) failing infrainguinal bypasses with distal correctable lesions in 94 patients. The 94 procedures included 50 (53%) balloon angioplasties and 44 (47%) distal vein graft extensions from the previous graft to the distal artery.

Acute management of exposure to liquid ammonia.

Ammonia injury is an uncommon injury, but it is associated with high morbidity and mortality. This case report demonstrates the pathophysiology and treatment of both cutaneous burn wounds and inhalation injury caused by ammonia. Frequent bronchoscopy was used to attempt to avoid intubation and its associated morbidity.

Lemierre's syndrome.

We describe a 32-year-old woman who had temperatures increasing over 7 days from 100.7 degrees F to 104.0 degrees F.

Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: preferred treatment for a complex problem.

Purpose: Standard surgical repair of para-anastamotic aneurysms (PAAs) of the abdominal and thoracic aorta and the iliac arteries has been associated with high morbidity and mortality rates. We reviewed our continuing experience with endovascular repair of these lesions to determine whether this approach is favorable and durable.

Methods: All patients with PAAs of the aorta or iliac arteries who underwent endovascular treatment of their lesions between August 1993 and July 1999 were prospectively followed up, and data on age, previous aortic pathology and surgery, size of PAA, time to diagnosis, and symptoms at presentation were recorded.

Pneumothorax after nasoenteral feeding tube placement.

Nasoenteral tubes are placed routinely for feeding in patients in intensive care units and medical-surgical floor settings. Safe placement in the stomach/postpyloric location is performed by a wide array of medical personnel. We report a patient with placement of a nasoenteral tube into the pleural cavity.

Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms.

Purpose: The safety of intentional occlusion of patent internal iliac arteries (IIAs) to facilitate the endovascular repair of aortoiliac artery aneurysms (abdominal aortic aneurysms [AAAs] and iliac aneurysms [IAs]) was evaluated.

Methods: We analyzed the techniques and clinical sequelae of selective occlusion of one or both IIAs in 103 patients and correlated these findings with the results of preoperative angiograms to identify vascular anatomy that may predict postoperative pelvic ischemia. To quantify the clinical presentation of pelvic ischemia, we developed these criteria: class 0, no symptoms; class I, nonlimiting claudication with exercise; class II, new onset impotence, with or without moderate to severe buttock pain, leading to physical limitation with exercise; class III, buttock rest pain, colonic ischemia, or both.

Buerger's disease affecting mesenteric arteries: a rare cause of intestinal ischemia--a case report.

Buerger's disease is a recurrent, inflammatory, segmental, vasoocclusive disease. Typically, the disease affects middle-aged male smokers and involves arteries and veins of extremities. Buerger's disease involving visceral vessels is rare.