Central Coalition Osteotomy of Phalangeal Synostoses in the Management of the Type III Apert Hand.

Purpose: We report a technique in the management of the type III Apert hand. The proposed approach facilitates the creation of a 5-fingered hand in 3 stages.

Methods: We reviewed records of patients with Apert syndrome and type III hands surgically treated at our institution from 1995 through 2014.

Is There Bias against Simulation in Microsurgery Training?

Background While other surgical specialties have embraced virtual reality simulation for training and recertification, microsurgery has lagged. This study aims to assess the opinions of microsurgeons on the role of simulation in microsurgery assessment and training. Methods We surveyed faculty members of the American Society of Reconstructive Microsurgery to ascertain opinions on their use of simulation in training and opinions about the utility of simulation for skills acquisition, teaching, and skills assessment.

Discrepancies between meeting abstracts and subsequent full text publications in hand surgery.

Purpose: Research abstracts presented during the proceedings of an annual meeting are often cited and can influence clinical practice. Prior studies show that roughly 50% of abstracts at American Society for Surgery of the Hand meetings are eventually published. Yet, it is unknown how often the results or conclusions of published studies differ from the podium presentation.

Upper extremity anomalies in Pfeiffer syndrome and mutational correlations.

Background: Pfeiffer syndrome is characterized by craniosynostosis and a variety of associated upper and lower extremity anomalies. The authors reviewed presentation and treatment of upper extremity anomalies in a series of genotyped patients with Pfeiffer syndrome.

Methods: Medical records of patients with Pfeiffer syndrome seen at the authors' institution over a 16-year period were reviewed.

Why we are here: early reflections on the role of reconstructive plastic surgery in the 2013 Boston marathon bombings.

The 2013 Boston Marathon bombings resulted in a large and unexpected influx of patients requiring acute multidisciplinary surgical care. The authors describe the surgical management experience of these patients at Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital, with a particular focus on the important role played by reconstructive plastic surgery. The authors suggest that this experience illustrates the value of reconstructive plastic surgery in the treatment of these patients specifically and of trauma patients in general, and argue for the increasing importance of promoting our identity as a specialty.

Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography.

Objective: To determine the natural history and treatment of high-grade small bowel obstruction (HGSBO). Small bowel obstruction is a frequent complication of abdominal surgery. Complete and strangulating obstructions are managed operatively while partial obstructions receive a trial of nonoperative therapy.

The role of the calcium-sensing receptor in bone biology and pathophysiology.

Bone cells, particularly osteoblasts and osteoclasts, exhibit functional responses to calcium (Ca(2+)). The identification of the calcium-sensing receptor (CaR) in parathyroid glands as the master regulator of parathyroid hormone (PTH) secretion proved that cells could specifically respond to changes in divalent cation concentration. Yet, after many years of study, it remains unclear whether this receptor, which has also been identified in bone, has functional import there.

PTH(1-34) replacement therapy in a child with hypoparathyroidism caused by a sporadic calcium receptor mutation.

Autosomal dominant hypocalcemia (ADH) is an inherited form of hypoparathyroidism caused by activating mutations in the calcium-sensing receptor (CaR). Treatment with PTH(1-34) may be superior to conventional therapy but is contraindicated in children, and long-term effects on the skeleton are unknown. The patient is a 20-yr-old female with ADH treated with PTH continuously since 6 yr and 2 mo of age.

Diet-induced obesity causes innate airway hyperresponsiveness to methacholine and enhances ozone-induced pulmonary inflammation.

We previously reported that genetically obese mice exhibit innate airway hyperresponsiveness (AHR) and enhanced ozone (O(3))-induced pulmonary inflammation. Such genetic deficiencies in mice are rare in humans, and they may not be representative of human obesity. Thus the purpose of this study was to determine the pulmonary phenotype of mice with diet-induced obesity (DIO), which more closely mimics the cause of human obesity.

Long-term palliation of tetralogy of Fallot in dogs by use of a modified Blalock-Taussig shunt.

Objective: To describe a modified Blalock-Taussig shunt (mBT) procedure and assess its use in dogs with clinical signs associated with tetralogy of Fallot (TOF).

Design: Descriptive report.

Animals: 6 dogs with severe TOF-associated clinical signs.

Allergic airway responses in obese mice.

Rationale: Epidemiologic data indicate an increased incidence of asthma in the obese.

Objectives: To determine whether obese mice exhibit augmented pulmonary responses after allergen sensitization and challenge.

Methods: Lean, wild-type (C57BL/6), obese ob/ob, and obese db/db mice were sensitized to ovalbumin (OVA), and then challenged with aerosolized OVA or phosphate-buffered saline (PBS).

The effect of preoperative clopidogrel on bleeding after coronary artery bypass surgery.

Introduction: Clopidogrel treatment is associated with a reduction in thrombotic complications in coronary stent placement, improved outcome after acute coronary syndromes, and decreased mortality in patients with coronary artery disease. The purpose of this study was to analyze the effect of preoperative clopidogrel exposure on bleeding complications, blood transfusions requirements, and reoperations in patients undergoing coronary artery bypass grafting (CABG).

Patients And Methods: This study included 320 patients from a single institution that underwent an isolated CABG who were discharged between July 2003 and June 2004.

Pulmonary responses to acute ozone exposure in fasted mice: effect of leptin administration.

Leptin is a satiety hormone that also has proinflammatory effects, including augmentation of ozone-induced pulmonary inflammation. The purpose of this study was to determine whether reductions in endogenous levels of leptin can attenuate pulmonary responses to ozone. To reduce serum leptin, we fasted mice overnight before ozone exposure.

Increased pulmonary responses to acute ozone exposure in obese db/db mice.

Epidemiological studies indicate the incidence of asthma is increased in obese and overweight humans. Responses to ozone (O(3)), an asthma trigger, are increased in obese (ob/ob) mice lacking the satiety hormone leptin. The long form of leptin receptor (Ob-R(b)) is required for satiety; mice lacking this receptor (db/db mice) are also substantially obese.

Augmented responses to ozone in obese carboxypeptidase E-deficient mice.

We reported previously that mice obese as a result of leptin deficiency (ob/ob) have enhanced ozone (O3)-induced airway hyperresponsiveness (AHR) and inflammation compared with wild-type (C57BL/6) controls. To determine whether this increased response to O3 was independent of the modality of obesity, we examined O3-induced AHR and inflammation in Cpe(fat) mice. These mice are obese as a consequence of a mutation in the gene encoding carboxypeptidase E (Cpe), an enzyme important in processing prohormones and proneuropeptides involved in satiety and energy expenditure.

Splenic injury after intraoperative transesophageal echocardiography.

A 55-year-old woman underwent coronary artery bypass grafting and mitral valve repair using intraoperative transesophageal echocardiography (TEE). Postoperatively she had hemodynamic instability associated with an increase in abdominal size and a drop in hemoglobin. At laparotomy, a splenic hilar laceration was discovered, which was presumed to be associated with intraoperative TEE.

Intraoperative flow rate measurements of T-grafts: calculating a flow reserve.

Objective: To evaluate the inflow of the left internal thoracic artery (LITA) and the effect of adding a radial artery T-graft to distal LITA flow, and to calculate the LITA flow reserve.

Methods: Twenty-two patients underwent myocardial revascularization using the radial artery-LITA T-graft in which intraoperative flow measurements were recorded. An ultrasonic flowmeter was used to directly measure flow rates in the T-graft: 1) before completion of the distal anastomoses to measure maximum flow rates (free flow), and 2) after completion of distal anastomoses.

Effect of autotransfusion on fibrinolysis in open heart patients.

Autotransfused blood is often used as an alternative to banked blood. The fibrinolytic consequences of autotransfused blood are undefined. This prospective study was designed to determine the effect of intraoperative autotransfused blood on fibrinolysis and other coagulation parameters.

Profound hypothermia and circulatory arrest in excision of renal cell carcinoma invading the vena cava.

Two patients with renal cell carcinoma invading the inferior vena cava to the level of the right atrium underwent complete excision of their renal tumours. Clearance of the caval extension was accomplished using cardiopulmonary bypass, profound hypothermia and circulatory arrest. The use of these techniques visually improved the operative field without extending operating time.