Severe small intestinal bacterial overgrowth syndrome after jejunal feeding requiring surgical intervention: a case report and review of the literature.

Background: Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention.

Case Presentation: A 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition.

Surgical trends of groin hernia repairs performed for recurrence in medicare patients.

Background: The recurrence rate after groin hernia repair (GHR) has been estimated to be between 1-10% in adult patients. Neither national rates nor trends in recurrence over time have been reliably established for Medicare patients in the USA.

Materials: We evaluated patients undergoing GHR (inguinal = IHR; femoral = FHR) from 2011 to 2014 from the Medicare Provider Analysis and Review database.

Proportion of femoral hernia repairs performed for recurrence in the United States.

Purpose: Recurrence rates after femoral hernia repair (FHR) have not been reliably established in the USA. We sought to determine this trend over time.

Methods: The proportion of primary and recurrent FHRs was determined for patients age ≥ 18 from: ACS-NSQIP (1/2005-12/2014), Premier (1/2010-09/2015), and institutional (1/2005-12/2014) data.

Trends of inguinal hernia repairs performed for recurrence in the United States.

Background: One of the main complications of inguinal hernia repair continues to be recurrence. Commonly cited prior reports from relatively small studies estimate this rate to be 1% to 5% in the United States. Although some reports have found higher recurrence rates, they get little attention on the national stage or in other large studies.

Functional gallbladder disease: Operative trends and short-term outcomes.

Background: Due to increasing rates of functional gallbladder disease (FGBD), we used national data to compare rates, patient characteristics, and outcomes of cholecystectomy for FGBD with the more defined diagnosis of biliary colic.

Methods: The American College of Surgeons National Surgical Quality Improvement Program was reviewed for elective cholecystectomies from 2005-2013. The proportion of cholecystectomies performed for FGBD was assessed over time using a 2-sided Cochran-Armitage test for trend.

First Report of Syzygites megalocarpus (Mucorales) Web Mold on the Commercial Portabella Button Mushroom Agaricus bisporus in North America.

Agaricus bisporus (Lange) Imbach mushrooms, which are cultivated commercially under environmentally controlled conditions, are the most valuable crop in Pennsylvania. In August 2011, we first observed a mucoraceous mold colonizing primordia and mature basidiocarps of a new brown portabella strain of A. bisporus at two commercial mushroom farms in Chester County, PA.

Unna sleeve for neurotic excoriations.

Neurotic excoriations are self-induced skin lesions produced because of compulsive scratching or picking. We present the successful use of the venerable technique of an Unna boot used as an Unna sleeve for neurotic excoriations of the upper extremities.

Adolescent female acne: etiology and management.

Acne vulgaris, a multifactorial condition often conferring significant psychosocial morbidity, affects an estimated 40 million people in the United States. The majority of these individuals are adolescents and young adults. The pathophysiology of the condition is still not fully known, but it is believed to be related in part to excess sebum production, follicular hyperkeratinization, microbial colonization by P acnes, and inflammation.

Delayed diagnosis of epidermal nevus syndrome associated with substantial brain malformations: a case report and review of the literature.

Epidermal nevus syndrome (ENS) often describes a spectrum of different clinical and histologic subtypes of epidermal nevi as well as their genetic and systemic associations. Although the true incidence of ENS is unknown, it is estimated that 8% to 18% of patients with epidermal nevi have systemic disorders. We report a case of ENS in adulthood; on further workup, our patient was found to have substantial central nervous system (CNS) abnormalities.

Cutaneous B-cell pseudolymphoma due to paraphenylenediamine.

Lymphomatoid contact dermatitis is a form of pseudolymphoma that was first described in 1976 by Orbaneja et al. Since that initial report, a number of allergens have been reported to cause this type of pseudolymphoma. Most cases involve hyperplasia of T cells.

Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff.

The purpose of this article is to describe the outcome of an arthroscopic examination and the pathology in symptomatic shoulders of 41 professional overhand throwing athletes. With the arm in the position of the relocation test, 100% of the subjects had either contact between the rotator cuff undersurface and the posterosuperior glenoid rim or osteochondral lesions. Other key findings included undersurface cuff fraying in 93%, posterosuperior labral fraying in 88%, and anterior labral fraying in 36% of the subjects.

A pitfall of coronal computed tomographic imaging in evaluation of calcaneal fractures.

Computed tomographic (CT) coronal images of the posterior talocalcaneal joint were compared with lateral radiographic views and intraoperative findings in 35 patients with 36 intra-articular calcaneal fractures. The severity of articular incongruity and rotational displacement of the posterior facet fragment were not well appreciated in coronal CT images of nine patients, although Bohler and Gissane angles were significantly decreased in lateral radiographs. This disparity between the radiographic and coronal CT scans can be explained by the intraoperative finding of rotation of the fractured central or lateral portion of the convex posterior calcaneal facet along a horizontal axis in the coronal plane.

Comparison of bone contusion seen by MRI in partial and complete tears of the anterior cruciate ligament.

Objective: Bone contusions are frequently found in association with complete tears of the anterior cruciate ligament (ACL) and can be a helpful secondary sign in diagnosis. We compare the frequency, location, and significance of bone contusions in complete and partial ACL tears.

Materials And Methods: Twenty-nine patients with complete and 42 patients with incomplete tears of the ACL were examined by MRI for the presence of accompanying bone contusions within 1 month of injury.

Spontaneous tibial compartment syndrome: case report.

We report the case of an obese 34-year-old woman who spontaneously developed compartment syndrome in her right calf. The patient was treated with four-compartment fasciotomy and debridement of necrotic tissue. Four months after treatment she was ambulating without the use of aids and had full range of motion and muscle strength.

Severe displacement of a calcaneal apophyseal fracture.

Calcaneal apophyseal fractures are rare injuries. Careful review of radiographs are necessary to make the correct diagnosis and initiate prompt treatment. The authors report the case of an adolescent with a severely displaced calcaneal apophyseal fracture that was missed on initial evaluation due to significant soft tissue swelling and misinterpretation of radiographs.

Transportation of children with special seating needs.

As of 1986, all 50 states had implemented mandatory child restraint laws. When used correctly, restraint systems have been proven to reduce the number of fatalities, hospitalizations, and injuries. To date, there is little information regarding compliance with restraint systems for disabled children.

Penetration of the distal femur by the distal locking device of Brooker Wills interlocking nail.

Of seven patients with complications caused by penetration of the distal locking device through the distal femur, three had penetration of the distal locking device into the knee joint. Two patients had penetration into the patellofemoral joint. One patient had penetration into the lateral cortex of the distal femur and another patient had penetration into the medial cortex of the distal femur.

Comminuted fracture of the calcaneus associated with subluxation of the talus.

Two cases of complex fracture dislocation of the calcaneus having an unusual pattern of injury are described. The cases exhibit the following special characteristics: (1) fracture dislocation of the calcaneus where the primary fracture line separates the calcaneus into an anteromedial fragment that maintains its normal relationship to the talus and a posterolateral fragment that is dislocated from the subtalar joint. This posterolateral fragment moves laterally and lies adjacent to the fibula; (2) a secondary fracture line separating the lateral portion of the posterior facet from the tuberosity of the calcaneus.

Case report 802: Ewing's tumor of the proximal phalanx of the third finger with radiographic progression documented over a 6-year-period.

In summary, a case of Ewing's tumor of the proximal phalanx of the long finger of the right hand was presented. This case is unusual because of its location as well as the unusually long clinical course before the correct diagnosis was made. The major point to be stressed is that Ewing's tumor may initially present with a "benign" appearance mimicking a bone cyst [17] or angioma [12].