To B or not to B: is tylosis B truly benign? Two North American genealogies.

Tylosis is a rare, autosomal dominant syndrome presenting with hyperkeratosis of the palms and soles of the feet. Two types have been identified. Late onset tylosis (type A) is reported to be associated with a high incidence of esophageal carcinoma, whereas early onset tylosis (type B) appears to be a benign disorder.

Plain and buffered lidocaine for neonatal circumcision.

Objective: To determine if buffered lidocaine provided a more effective nerve block in a short time than plain lidocaine for neonatal circumcision.

Methods: One hundred ninety-four newborn males were studied in a randomized trial using two dorsal penile nerve block preparations for circumcision. Ninety-two received plain lidocaine, and 102 received buffered lidocaine.

Can scintimammography reduce "unnecessary" biopsies?

99Tc-sestamibi prone scintimammography (SMM) is a new, noninvasive method of imaging breast tumors. A pilot study has suggested that SMM increases the specificity of mammography, and that SMM could be used as an adjunct to mammography to reduce the number of mammographically indicated biopsies. The goal of this study was to further evaluate the efficacy of SMM in diagnosing or excluding breast carcinoma.

Using continuous improvement to obtain and document informed consent.

This article describes a continuous improvement team's activities to improve the process of obtaining and documenting informed consent and to decrease the incidence of communication errors during the surgical scheduling process. Integrating surgeons' informed consent process at their office sites with hospital records was the key to success.

Coronal transacromial osteotomy surgical approach for shoulder arthroplasty.

Thirty-one shoulder arthroplasties in 24 patients were reviewed in which a coronal transacromial osteotomy surgical approach was used. Three total shoulder and 28 hemiarthroplasty procedures were performed. The average follow up was 5 years, 2 months.

Carpal bone titanium implant arthroplasty. 10 years' experience.

In 1984, in an effort to address the silicone wear particle problem, titanium implants were developed for the scaphoid, lunate, and trapeziometacarpal joint. The design of these implants closely resembled their silicone counterparts, though some modifications were made to accommodate the properties of unalloyed titanium and enhance their stability. Carpal bone implants act as articulating spacers to help maintain the relationship of adjacent carpal bones after local resection procedures.

Use of grommets for flexible implant resection arthroplasty of the metacarpophalangeal joint.

In 1987, after 11 years of research, press fit titanium circumferential grommets were introduced for arthroplasty of the metacarpophalangeal joint to protect the flexible hinge implant midsection from sharp bony edges and shearing forces that can initiate implant abrasions and tears leading to implant fracture and formation of silicone wear particles. The effectiveness of the titanium circumferential grommets was assessed by comparing the results of 170 metacarpophalangeal joint implant (high performance) arthroplasties performed with (139 joints) and without (31 joints) grommets in 38 patients presenting an average 5.8 years followup.

Coronary artery compression by teflon pledget granuloma following aortic valve replacement.

We describe a massive fatal posterior myocardial infarct resulting from compression of the right coronary artery by a Teflon pledget granuloma in a patient who had undergone aortic valve replacement six months before death. Other iatrogenic causes of coronary artery occlusion or compression are discussed in this paper. To our knowledge this is the first report of this surgical complication.

Use of grommets for flexible hinge implant arthroplasty of the great toe.

A double stemmed flexible hinge implant was designed in 1974 for use with the Mayo type resection arthroplasty of the first metatarsophalangeal joint. Press-fit titanium grommets were developed in 1985 to protect the implant midsection from sharp bony edges and shearing forces that can lead to implant abrasion or fracture, and particulate synovitis. The study of 90 first metatarsophalangeal joint implant arthroplasties performed with encircling press fit titanium grommets showed favorable bone response around the implant stems and the bone to grommet interface, with absence of complications relating to particulate reactivity, implant or grommet fracture.

Congenital absence of the scaphoid without other congenital abnormality: a case report.

Congenital absence of the scaphoid without associated thumb or radial hypoplasia is a rare condition. This report is the third case presented in the literature of this condition. The case presented is of a patient who presented initially with wrist pain.

Development of a patient-centered preprocedure program.

Staff members at Blodgett Memorial Medical Center, Grand Rapids, Mich, developed and implemented a prototype for a new patient-centered preadmission testing (PAT) program. Using continuous improvement principles, an implementation team improved the existing PAT program by increasing patient satisfaction, reducing duplication of care and services, and avoiding delayed or canceled surgical procedures in the OR. The implementation team then designed a preprocedure learning process in which nurses performed patient assessments, coordinated information between departments, and made appropriate referrals.

Pericardial tamponade and death from Hickman catheter perforation.

In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed.

Prospective comparison of gastric emptying after laparoscopic-aided colectomy versus open colectomy.

Laparoscopic colectomy has been associated with a shorter postoperative ileus when compared to open colectomy, although the mechanism is unclear. This study is designed to evaluate gastric emptying following open colectomies (OC) versus laparoscopic-aided colectomies (LAC) using serial serum acetaminophen levels (ACE), which correlate with gastric emptying. The study groups were limited to patients undergoing either right or left colectomy who received general anesthetic.

Myasthenia gravis-associated systemic vasculitis and myocarditis with involvement of the cardiac conducting tissue.

We describe unexpected autopsy findings in an elderly woman with myasthenia gravis (MG) who had myocarditis of the working and conducting myocardium and coronary and renal vasculitis. Myasthenia gravis, characterized by autoantibodies to the acetylcholine receptor in the postsynaptic cell membrane, may be associated with other autoimmune disorders. An additional manifestation of autoimmunity is the presence of heart muscle antibodies, which may be the basis for myocarditis, which has been reported in up to 60% of MG patients at autopsy.

The effects of semirigid Air-Stirrup bracing vs. adhesive ankle taping on motor performance.

The impact on athletic performance is a critical consideration when choosing ankle support devices for competitive athletes. The purpose of this study was to determine if Air-Stirrup ankle bracing and adhesive ankle taping differed in their effects on motor performance. An additional purpose was to determine if there was a subjective preference toward the use of one support method over the other.

DNA heterogeneity determined by flow cytometry in prostatic adenocarcinoma--necessitating multiple site analysis.

Although DNA ploidy analysis of prostate cancer is generally associated with grade, stage, clinical outcome, and responsiveness to androgen therapy, one possible reason cited for contrary reports may be tumor heterogeneity. A preliminary report using flow cytometric analysis of punch biopsies demonstrated DNA heterogeneity in five of nine patients. We evaluated 75 patients by cutting whole mounts of formalin fixed prostatectomy tissue every 0.

Advance directives in the medical intensive care unit of a community teaching hospital.

Study Objective: To evaluate the frequency with which advance directives (ADs) are available at the time of admission and their impact on subsequent care in a medical intensive care unit (MICU) setting before and 9 months after the implementation of the Patient Self-Determination Act (PSDA).

Design: Prospective nonrandomized cohort data collection and analysis.

Setting: Thirteen-bed MICU of community teaching hospital providing primary and referred care.

Homicidal cardiac lacerations in children.

We report six cases of intentionally inflicted cardiac laceration. The victims ranged in age from 9 weeks to 2 1/2 years. Five victims were girls and in five cases the right atrium was lacerated.

Diagnostic ultrasound for suspected appendicitis: does the added cost produce a better outcome?

Acute appendicitis is one of the most common abdominal surgical emergencies in North America. Although the treatment of appendicitis has remained the same for over 250 years, diagnostic techniques have changed immensely. Most recently, graded compression ultrasonography has received much support.

Can preoperative and postoperative CEA predict survival after colon cancer resection?

Although elevated preoperative carcinoembryonic antigen (CEA) levels are associated with a poor prognosis, little has been written regarding the correlation of CEA response following curative resection of colorectal cancer and its relationship to survival. The purpose of this study, therefore, was to retrospectively evaluate survival in three groups of patients undergoing curative resection (Dukes B and C) for colorectal carcinoma: 1) elevated preoperative CEA/elevated postoperative CEA (EL/EL); 2) elevated preoperative CEA/normal postoperative CEA (EL/NL); and 3) normal preoperative CEA/normal postoperative CEA (NL/NL). A normal CEA was defined as a value < 5.

Lingual tonsillar hypertrophy causing failed intubation and cerebral anoxia.

Hypertrophy of the lingual tonsils is an unusual condition that may cause complications such as airway obstruction, abscess, sleep apnea, and recurrent epiglottitis. There have been reports of difficult anesthesic intubation in children with enlarged lingual tonsils. We describe a 24-year-old woman whose markedly hypertrophied lingual tonsils prevented intubation after anesthesic relaxation during preparation for appendectomy.

Dissection of the aorta and coronary arteries associated with acute cocaine intoxication.

Acute myocardial ischemia, cardiac arrhythmias, and conduction disturbances are the most common cardiovascular complications of cocaine and its alkaloidal freebase "crack." Cocaine abuse-related acute aortic dissection has been reported only rarely: three cases in the last 5 years. Described herein, to our knowledge, is the first case of cocaine intoxication-associated acute aortic dissection that also involved the coronary arteries, causing sudden death.

Sudden death associated with aortitis and fibrosclerosing disease of the conduction system.

Aortitis is known to complicate a number of autoimmune diseases and syphilis. In most patients with autoimmune disease, arthritis is the initial presentation followed by aortic insufficiency. We report two cases of ostensibly healthy, middle-aged men in whom the initial manifestation of aortitis was sudden death.