Surgery in the Horn of Africa: a 1-year experience of an American-sponsored surgical residency in Eritrea.

Objective: To describe the 1-year experience of a unique postgraduate medical education program set in Eritrea, a recently war-torn country.

Design: The Partnership for Eritrea, a cooperative between The George Washington University Medical Center, Physicians for Peace, and the Eritrean Ministry of Health, formed a surgical residency program, launched January 2, 2008, in Asmara, Eritrea, to train native Eritrean surgeons. No prior residency program (to our knowledge) had existed in Eritrea.

Treatment and survival outcome for molecular breast cancer subtypes in black women.

Objective: To analyze whether the local-regional surgical treatments (breast-conserving therapy, mastectomy) resulted in different overall survival, distant metastasis-free survival, and locoregional recurrence-free survival rates for the various molecular breast cancer subtypes.

Summary Background Data: Molecular gene expression profiling has been proposed as a new classification and prognostication system for breast cancer. Current recommendation for local-regional treatment of breast cancer is based on traditional clinicopathologic variables.

Basal cell-like (triple-negative) breast cancer, a predictor of distant metastasis in African American women.

Background: The aim of this study was to evaluate the prognostic significance of the basal cell-like molecular breast cancer subtype with respect to locoregional recurrence and distant metastasis in African American women treated for breast cancer.

Methods: A retrospective analysis was performed of the tumor registry database for all African American women diagnosed and treated for breast cancer from 1998 to 2005 who had assessable data for all 3 markers: estrogen, progesterone, and Her-2/neu.

Results: A total of 372 patients were included in our study sample.

Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival.

Background: Breast cancer is currently regarded as a heterogeneous disease classified into various molecular subtypes using gene expression analysis. These molecular subtypes include: basal cell-like, Her-2/neu, luminal A, and luminal B.

Objectives: To analyze the prevalence and clinicopathologic associations for molecular breast cancer subtypes in premenopausal and postmenopausal African-American women.

Molecular breast cancer subtypes in premenopausal African-American women, tumor biologic factors and clinical outcome.

Introduction: Breast cancer is currently viewed as a heterogeneous disease made up of various subtypes, with distinct differences in prognosis. Our goal was to study the distribution and to characterize the clinical and biological factors that influence the behavior and clinical management of the different molecular breast cancer subtypes in premenopausal African-American women.

Methods: A retrospective analysis of Howard University Hospital tumor registry, for all premenopausal African-American women aged less than 50 years, diagnosed with breast cancer from 1998-2005, was performed.

Epidemiology of trauma deaths in an urban level-1 trauma center predominantly among African Americans--implications for prevention.

This is a retrospective review to determine demographics, presentation and injury characteristics of trauma deaths at Howard University Hospital over an 1-year period (1994-2005) and to make recommendations for education and prevention in the community based on our findings. Data was obtained from the Howard University Hospital trauma registry. From the study period 1994-2005, there was a total of 365 trauma deaths.

Is 30 minutes the golden period to perform emergency room thoratomy (ERT) in penetrating chest injuries?

Background: Emergency room thoracotomy (ERT), a controversial procedure, was introduced to improve resuscitation of trauma patients. No study has been conducted to evaluate the importance of the time in the field (down time) in the initial survival of penetrating chest trauma requiring ERT. In addition to this, many factors have been considered to predict the success of ERT, but they are multiple and are not easy to assess in the brief period of decision making to perform an ERT.

Aminoglycoside pharmacokinetics in African-Americans with normal renal function.

Objective: To compare aminoglycoside pharmacokinetics in African-Americans with normal renal function with published adult population values.

Design: An Institutional Review Board approved concurrent study.

Setting: The study was conducted at Howard University Hospital, Washington DC.

Appropriateness of a 4 mg/kg gentamicin or tobramycin loading dose in post-operative septic shock patients.

Objective: To determine the frequency with which early adequate peak serum concentrations (6-12 mg/ litre) can be achieved following a 4 mg/kg loading dose of gentamicin or tobramycin in post-operative septic shock patients.

Method: Eleven post-operative septic shock patients were grouped into (i) a control group (n=7) who received the conventional gentamicin or tobramycin dosing regimen of 2 mg/kg loading dose followed by a maintenance dose of approximately 1.5mg/kg (peak and trough levels were measured after the third dose), and (ii) a study group (n = 4) who received a tobramycin or gentamicin 4 mg/kg loading dose, followed by 30 min, 3 h and 16 h serum drug level measurements.

Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients.

In critical care settings, arterial catheters (ACs) are very useful in monitoring the blood pressure and are often used for repetitive blood sampling. No studies have been performed that compare the approach and complication rates of ACs in a medical intensive care unit (MICU) to those in a surgical intensive care unit (SICU). Over a 24-month period, 3255 patients were admitted to the MICU and 1677 to the SICU of Howard University Hospital.

Gallbladder carcinoma: a 28 year experience.

Background: Despite the fact that several studies have been conducted to demonstrate advancements in the treatment and prognosis of gallbladder carcinoma, no standard method of treatment has been identified or agreed upon.

Objective: The aim of this study were to review the presentation, staging, treatment and prognosis of subjects with cancer of the gallbladder at Howard University and its affiliated Institutions over the last three decades to see if there were any improvement in the survival.

Methods: A retrospective analysis of a 28 year experience at Howard University was performed.

Consumer product-related ocular trauma.

Leading causes of consumer product-related ocular trauma have not been well described. To delineate these causes in a nationally representative sample, data collected by the US Consumer Product Safety Commission (USCPSC) were reviewed. Data were obtained from the National Electronic Injury Surveillance System (NEISS), a national probability sample survey conducted by USCPSC that continuously monitors consumer product-related injuries treated in hospital emergency rooms across the United States.

Retinal hemorrhage secondary airbag-related ocular trauma.

A case is presented in which a driver, who was wearing a three-point restraint system, was involved in a collision that triggered deployment of the vehicle's driver's-side airbag. The victim complained of blurred vision after the crash and on examination was found to have suffered a retinal hemorrhage in his right eye. Since no other cause could be determined, his injury was considered to be a result of contact with the deploying airbag.

Asymptomatic pneumoperitoneum diagnostic and therapeutic dilemma.

The most common cause of pneumoperitoneum is iatrogenic postsurgical free air that enters the abdominal cavity during laparotomy. In these patients, pneumoperitoneum usually resolves within the first week of surgery and laparoscopic procedures. In patients who have not had recent laparotomy or laparoscopy, pneumoperitoneum indicates rupture of an intra-abdominal viscus in about 90 per cent of the time.

Actinomycosis of the neck: diagnosis by fine-needle aspiration biopsy.

A patient with actinomyces infection of the posterior neck was diagnosed by fine-needle aspiration biopsy. The lesion presented as a recurrent, firm, and indurated mass that was clinically diagnosed as adenitis and cellulitis and was thought to be a lymphoma 6 months after the onset of his illness. Smears and cell block sections of the aspirate showed characteristic colonies ("sulfur granules") of actinomyces.

Selenium deficiency in long-term total parenteral nutrition.

Although selenium is an essential trace element, it is often not routinely added to total parenteral nutrition (TPN) formulations. When selenium is not added, patients are at risk for selenium deficiency. This report describes such a patient.

Tracheopleuropulmonary injuries following enteral tube insertion.

Eighty-three cases of tracheopleuropulmonary injuries complicating enteral tube feeding are analyzed to identify the patterns of injury, and precipitating factors and ways to avoid them. Six new cases observed by the authors and 77 other cases cited in British literature between 1976 and 1987 are presented. In recent years, reports of this complication have been increasing, apparently in a geometrical progression: 8%, 18%, and 74% were reported between 1976 to 1979, 1980 to 1983, and 1984 to 1987, respectively.