Nurturing Context: TRACE, the Arts, Medical Practice, and Health Literacy.

This chapter builds upon prior research on the interconnectedness of context to content as it relates to health and health literacy. The authors focus on the use of the arts as a novel way to engage with and to promote health and health communication. Most published efforts exploring the humanities and health emphasize how healthcare practitioners can enhance their clinical skills, promote wellness, and prevent burnout through engagement with the arts.

Solid noninfectious growing masses over cerebrospinal fluid shunts: report of 3 cases.

The authors describe 3 children who presented with progressively enlarging skin-covered solid masses over the shunt catheter in the neck/clavicular region. The authors reviewed the clinical, laboratory, pathological, radiographic, and follow-up data for all 3 patients and reviewed the literature on the subject. The patients had no clinical evidence of an infectious process.

Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report.

Objective: This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities.

Methods: We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications.

Ultrasound-aided fixation of biodegradable implants in pediatric craniofacial surgery.

Purpose: Bioresorbable implant systems have been used for the rigid fixation of cranial and facial bones. A relatively recent advancement has been the fixation of these implants using an ultrasonic device. Published reports with such a device in pediatric craniofacial surgery have been limited.

Initiating, developing and evaluating a comprehensive spinal defects clinic: a clinical report.

Objective: The Division of Pediatric Neurosurgery of the University of Florida College of Medicine - Jacksonville developed a multidisciplinary clinic for the better management of pediatric patients with spinal defects. The purpose of this report is to assist neurosurgeons in those regions and countries where there are no spinal defects clinics (SDC).

Methods: We induced a staged process to develop a comprehensive multidisciplinary clinic for pediatric patients with spinal defects: phase I - during December 2003 to June 2004, the organizational planning, multiinstitutional recruitment of health care personnel and location of clinic space occurred; phase II - the SDC sessions initiated in June 2004 and have consequently been held on a monthly basis; phase III - this consisted of a quality improvement program during which parents/caregivers were surveyed.

Ultrasound-aided fixation of a biodegradable cranial fixation system: uses in pediatric neurosurgery.

Object: Bioresorbable implant systems have been used in neurosurgery for the rigid fixation of cranial and facial bones. A relatively recent advancement has been the fixation of these implants using an ultrasonic device. The experience with such a device in neurosurgical practice has been limited.

Ventriculogallbladder shunts in pediatric patients.

Object: The authors report a clinical protocol for the application of ventriculogallbladder (VGB) shunts in children who may be unable to maintain or receive ventriculoperitoneal (VP) shunts.

Methods: Eighteen patients underwent placement of VGB shunts as an alternative to VP shunt therapy for the following reasons: malfunction of the VP shunt due to suspected failure of the peritoneum to absorb cerebrospinal fluid (17 cases) and multiple intraabdominal general surgical procedures (1 case). The patients ranged in age from 4 months to 17 years (mean 6.

Spinal peritoneal shunts for conditions other than hydrocephalus and pseudotumor cerebri: a clinical report.

Background: To treat with minimally invasive surgery, recurrent spinal arachnoid cysts, progressive syringomyelia, cranial and spinal cerebrospinal fluid fistulas.

Patients And Methods: This is a clinical report that describes the management of recurrent spinal arachnoid cysts (2 patients), progressive syringomyelia (11 patients), postoperative spinal cerebrospinal fluid fistulas (15 patients) and postoperative cranial cerebrospinal fluid fistulas (2 patients) that were treated with spinal peritoneal shunts. The spinal arachnoid cyst and syringomyelia patients promptly resolved the signs and symptoms.

Primary treatment with temporary subcutaneous peritoneal shunts for postoperative spinal cerebrospinal fluid fistulas.

Object: The authors describe a series of attempts to treat with minimally invasive surgery cerebrospinal fluid (CSF) fistulas that develop following operations of the spine for congenital anomalies.

Methods: Sixteen patients in whom CSF fistulas developed following repair of congenital spinal disorders (nine lipomeningoceles, one arachnoid cyst, two myelocystoceles, three tethered cords after myelomeningocele repair, and one scoliosis surgery) underwent placement of a temporary subcutaneous peritoneal shunt. The CSF fistulas resolved in all instances.

Polypoid tumor of the esophagus.

Five cases of an uncommon esophageal tumor consisting of a mucosal squamous cell carcinoma that surrounds a polypoid mass of spindle cells were examined. The spindle cell component was composed of elongated cells with blunt nuclei, admixed with multinucleated giant cells. Reticulin fibers enveloped individual cells, and abundant collagen was present.

Adenocarcinoma of the stomach. Changing patterns over the last 4 decades.

A retrospective study was performed on 255 consecutive patients admitted to a single hospital from 1953-1983 with a follow-up of 100%. The number of proximal esophagogastric junction and fundus tumors increased significantly over the last 4 decades from 21% to 44% (p less than 0.001), accompanied by a significant decrease in antral carcinomas from 60% to 33% (p less than 0.

Esophageal cancer staging by CT: long-term follow-up study.

To evaluate the utility of computed tomographic (CT) staging in patients with esophageal cancer, the length of patient survival was compared with pretherapy CT findings in 89 patients. Regardless of therapy, patients with evidence of mediastinal invasion, liver metastases, or abdominal adenopathy had a statistically shortened survival (P less than .05).

Diagnosis and recommended management of esophageal perforation and rupture.

Over the past 47 years (1937 to 1984), a total of 127 patients with esophageal perforation or rupture were evaluated at Duke Medical Center or the Durham Veterans Administration Medical Center. In 13 patients, the diagnosis was established at the time of autopsy and in the remaining 114, the diagnosis was established clinically. The etiology, radiological findings, underlying esophageal disease, time interval between onset of symptoms and therapy, and eventual outcome were evaluated.

Surgical treatment of H-type tracheoesophageal fistula diagnosed in an adult.

A new method is described for the repair of a congenital tracheoesophageal fistula in an adult. This technique uses a fiberoptic bronchoscope and passes a flexible vascular guidewire across the tracheoesophageal fistula. This maneuver then simplifies the intraoperative identification of the tracheoesophageal fistula, which is exposed and repaired through a left transcervical approach.

Pancreaticobronchial fistula. Case report and review of the literature.

Fistulas between the pancreas and bronchial tree are uncommon examples of internal pancreatic fistulas. We describe a case of pancreaticobronchial fistula in which the diagnosis was made by bronchoscopy and biochemical analysis of respiratory secretions. Endoscopic retrograde cholangiopancreatography was confirmatory and guided treatment by internal drainage of the pancreatic duct.

Recurrent inguinal hernia.

An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia, incomplete dissection or improper ligation of the sac, failure to narrow the cord, or inadequate reconstruction of the internal ring.

Effect of lubrication of frictional properties of sutures.

The results of this study have provided an insight into the behavior of sutures in the environment of fluids. It has been shown that friction could both increase or decrease with lubrication, depending upon the nature of the application. In tests on straight sutures, lubricants have generally led to an increase in friction.

Management of an infected mucocele occurring in a bypassed excluded esophageal segment.

An infected mucocele of an excluded retained esophageal segment is an infrequently reported complication of esophageal bypass surgery. The subtle symptoms of this entity and its management are discussed.

Effect of suture material and construction on frictional properties of sutures.

The results overwhelmingly support the view that the coefficient of friction is not a material constant of the sutures but a function of several variables, including applied tension, suture construction and suture material. The coefficient of friction decreased with an increase in applied tension with the rate of change depending upon the suture material. Prolene and Ethilon had the highest frictional values among all sutures at low tension, but dropped to a position of lowest values at high tension.

Esophageal lesions after total laryngectomy.

Clinical and endoscopic evaluation of the post-total laryngectomy patient with dysphagia may be limited by postoperative fibrosis or strictures. The barium esophagogram is a valuable adjunctive tool in further assessing these patients, as both functional and anatomic abnormalities can be evaluated. A 10-year retrospective review yielded 204 patients who had had total laryngectomies for squamous cell carcinoma of the larynx; 85 of these patients had postoperative barium esophagograms.

The continuing problem of carcinoma of the pancreas.

The courses of 208 patients with adenocarcinoma of the pancreas were reviewed. The lesion was located in the head of the pancreas in 142 patient, (68%) and of these, in 22 patients the diagnosis was confirmed histologically at postmortem examination; 21 patients underwent laparotomy and biopsy with a 33% operative mortality and a 3.4-month average survival; 89 patients underwent biliary and/or gastric bypass with a 24% mortality and 4.

Stapled esophagogastric anastomosis.

In a consecutive, nonrandomized series of 92 patients, esophagogastric anastomosis was performed with a suture technique in 32 patients and with a stapler in 60 patients. Only one anastomotic leak occurred in each group. Stricture later formed in three sutured anastomoses and in eight of the stapled anastomoses.

Pseudosarcoma of the esophagus: barium swallow and CT findings.

Two new patients with pseudosarcoma of the esophagus are presented with the first report of the findings on computerized tomography (CT). The radiographic appearance in the two patients, with 24 previously reported, is reviewed. Barium esophagograms typically demonstrate a large, elongated polypoid mass in the middle or lower third of the esophagus that distends the lumen at the level of the lesion, but does not produce marked obstruction.

Computed tomography for staging esophageal and gastroesophageal cancer: reevaluation.

A reevaluation of computed tomography (CT) for staging carcinoma of the esophagus and gastroesophageal junction was performed in 76 patients. For comparison 26 patients without carcinoma of the esophagus with a normal mediastinum at surgery were included in the evaluation. Four radiologists evaluated the CT scans without knowledge of the diagnosis.