Teratogenic hearing loss: a clinical perspective.

Objective: The Joint Committee on Infant Hearing recently published a series of indicators that place a neonate at risk for hearing loss. Included among these risk factors are environmental teratogens capable of negatively impacting the developing auditory system. This article serves to revisit and update potential environmental teratogens.

Case report: reversible mitral regurgitation and congestive heart failure complicating thyrotoxicosis.

Congestive heart failure is a relatively uncommon manifestation of thyrotoxic heart disease, and different mechanisms have been proposed. The authors present a possible explanation of congestive heart failure in some cases of thyrotoxicosis. A 39 year-old woman with Graves' disease was hypermetabolic, in atrial fibrillation, and had signs of congestive heart failure.

Acute asthma.

The number of patients presenting to the emergency department with severe acute asthma exacerbations is increasing. Prompt and aggressive therapy often ameliorates the symptoms and decreases the morbidity and mortality associated with this disease. A directed history and physical examination should be performed, often simultaneously with treatment.

Centralized off-premise transcription service: a model.

The use of typewritten records in emergency departments can provide better documentation and can impact reimbursement, continuous quality improvement, and medicolegal aspects of emergency care. An easily accessible system, which provides for a uniform, typewritten record within a short turnaround time, has been implemented by a private emergency medicine group. The system has had a positive impact on reimbursement and efficient patient care.

Case conference: complete heart block in a young man.

A previously healthy 32-year-old man presented to the ED in complete heart block. Ischemic, infectious, and inflammatory conditions were considered in the differential diagnosis. Management options for complete heart block, the etiology of heart block in young adults, and treatment guidelines are reviewed.

Acute injuries of the extensor tendons proximal to the metacarpophalangeal joints.

The results of acute repair of the extensor tendons proximal to the metacarpophalangeal joint vary with the degree of associated injuries. Shortening should be kept to a minimum at the time of repair. The Kleinert modification of the Bunnell technique affords the greatest tensile strength.

Early flexion routine. An alternative method of continuous passive motion.

One hundred knees that underwent primary total knee arthroplasties were divided into 2 groups: the first 50 consecutive knees were assigned retrospectively to Group I (control), and the following 50 knees were assigned prospectively to Group II (early flexion). All procedures were cementless meniscal-bearing total knee arthroplasties and were performed by the same surgeon. Maximum early flexion (Group II) resulted in decreased length of stay, decreased hospital costs, and increased range of motion at 1 year.

Caloric requirements of a spastic immobile cerebral palsy patient: a case report.

This article documents the reduced caloric requirements for a spastic, immobile, cerebral palsy patient. We report an 11-year-old immobile, spastic, quadriparetic patient who remained obese despite receiving less than one half of the recommended basal caloric requirements for age. Basal metabolic rate was determined by indirect calorimetry using a Sensor Medics 2900 instrument.

Avascular necrosis of the talus in a toddler.

Avascular necrosis (AVN) of the talus is a controversial complication of trauma in children. A case of AVN is presented with a 2-year follow-up. More aggressive initial treatment may be indicated to avoid this complication.

Development and initial application of a real time thermal control system for laser tissue welding.

The ability to sense and control continuously surface temperatures of a tissue being exposed to laser radiation could standardize parameters and eliminate subjective interpretation of results during laser tissue repair. We describe the development and testing of a control system that enables the operator to maintain relatively specific tissue temperatures for the purpose of laser welding. After initial development, the infrared thermal control system combined with an argon laser was used to repair urethral defects in 45 adult male rats.

High-voltage electrical injury: a role for mandatory exploration of deep muscle compartments.

Patients sustaining high-voltage electrical burns involving the upper extremities were evaluated for deep muscle compartment necrosis by early surgical exploration. Following resuscitation, patients were taken to the operating room where mandatory exploration of volar and extensor forearm and hand compartments was done to evaluate muscle viability. It was observed that deep muscle layers sustained the greatest thermal injury and that extended fasciotomies were required to obviate compartment syndrome and the potential for continued ischemia.

Dr. C. Miller Fisher's description of acute cerebellar hemorrhage.

The clinical picture of acute cerebellar hemorrhage and the necessity for rapid recognition and intervention were described by Dr. C. Miller Fisher over 25 years ago.

Spinal epidural hematoma associated with cocaine abuse.

A 41-year-old man rapidly developed quadriparesis moments after injecting cocaine. Investigation discovered a cervical spinal epidural hematoma. This complication of cocaine abuse has not been previously reported.

Judicial outcome for the intoxicated driver admitted to a regional trauma center.

Objective: To examine the judicial outcomes for intoxicated drivers who were admitted to regional trauma centers as a result of motor vehicle collisions (MVCs).

Methods: A retrospective review of the trauma registry of a Level I trauma center was conducted for the period from January 1, 1989, through December 31, 1990. Inclusion criteria for entry into the study were 1) identification of the patient as the driver involved in an MVC, 2) a blood alcohol content (BAC) above 0.

Volar dislocation of the distal radioulnar joint.

Emergency physicians occasionally encounter dislocations of the distal radioulnar joint when these are associated with fractures of the forearm, such as the Galeazzi fracture. Isolated dislocations of the distal radioulnar joint without fracture are rare and are described in terms of the position of the ulna in relation to the radiocarpal joint. Radiographs may be difficult to interpret if a true lateral view is not obtained.

Intraoperative glove perforation. A comparative analysis.

A prospective study was conducted to determine the rate of puncture of the inner glove when various double-gloving protocols were used for elective total joint procedures. Group 1 consisted of 22 cases in which two pairs of regular latex gloves were used. Group 2 consisted of 25 cases in which outer "orthopaedic" gloves were used over regular latex gloves.

Successful management of traumatic false aneurysm of the extracranial vertebral artery by duplex-directed manual occlusion: a case report.

A 32-year-old man was transferred to our hospital after a 2.0 by 2.5 cm traumatic false aneurysm of the distal extracranial vertebral artery was noted after a stab wound of the posterior side of the neck.

Taping of foot and ankle for Korean karate.

In the practice of Korean karate, the foot is often used as a weapon in self defense. Injuries to the foot are common. Analysis of patterns to these injuries and requirements of the sport led to the development of a strapping technique for protecting the foot from the most common injuries.

The role of serum amylase in the diagnosis of acute pelvic inflammatory disease.

The use of serum amylase levels in the diagnosis of acute pelvic inflammatory disease (PID) was investigated prospectively. Eighty-five women presenting with the chief complaint of lower abdominal pain were entered into the study; all patients were examined by one of the principal investigators. In addition to the usual laboratory studies, a serum amylase level was obtained on all patients; the investigators were blinded to the results.

Soft tissue reconstruction. Coverage of lower leg. Rotational flap.

The combined orthopedic and plastic surgical approach to the injured lower extremity has permitted successful salvage of otherwise severely injured limbs. Although numerous muscle and fascial flaps have been described for all regions of the leg between the knee and foot, specific treatment regimens have become popular based on the location of the wound. Refinements in flap surgery have permitted the approach discussed in this article to become standard in the care of patients with either chronic osteomyelitis or acutely injured limbs.

An anatomical variation of the palmar cutaneous branch of the median nerve.

A case is presented of an anomalous course of the palmar cutaneous branch of the median nerve. Wide and meticulous exposure is necessary to avoid injury to all variations of this nerve and the use of a "safe" incision will not always avoid risk of injury.

Pharyngitis in children.

Although the group A beta-hemolytic streptococcus is the most important treatable cause of pharyngitis, other organisms, including viruses and groups C and G streptococci, should always be considered in the diagnosis of pharyngeal symptoms. Clinical findings and a rapid strep test aid in making the diagnosis of group A streptococcal pharyngitis. In nonallergic patients with the latter, penicillin V potassium is the antibiotic of choice; for those allergic to penicillin, erythromycin is my preferred alternative.