Improved healing efficacy in canine ulnar segmental defects with increasing recombinant human bone morphogenetic protein-2/allograft ratios.

Objectives: A validated canine critical-sized segmental defect model was used to compare efficacy of volumetric ratios of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge (ACS) with cancellous allograft bone or biphasic calcium phosphate ceramic granules using radiographic, biomechanical, and histologic analyses.

Methods: Eighteen mixed-breed hounds received bilateral critical-sized ulnar segmental defects. The six treatment groups included 1:5, 1:2, and 1:1 volumetric ratios of rhBMP-2/ACS to cancellous allograft chips; a 1:1 volumetric ratio of rhBMP-2/ACS to biphasic calcium phosphate ceramic granules; iliac crest autograft alone; and cancellous allograft chips alone (n = 6 ulna per group).

Gastric duplication cyst: a unique presentation.

Duplications of the alimentary tract are rare and occur in 1 of 4500 births (Duplication of the stomach: report of a case and review of the English literature. Arch Surg 1961; 82:634-640). Gastric duplications constitute 8% of these or roughly 17 of every 1,000,000 births (Shew SB, Holcomb GW.

HIV-associated nemaline rod myopathy: role of intravenous immunoglobulin therapy in two persons with HIV/AIDS.

Nemaline rod myopathy is a rare disease associated with muscle weakness and the presence of rod-shaped structures in the muscle fibers. Various acquired conditions have been associated with slow progressing presentations during adulthood. Several cases have been diagnosed in adults with HIV infection.

An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass.

We report a case of pronator syndrome with an ipsilateral supracondylar process, where the median nerve was compressed as it pierced an abnormal muscle bundle that originated from the supracondylar process.

Effect of Center of Excellence requirement by Centers for Medicare and Medicaid Services on practice trends.

Background: To report the effect of the American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence designation in Michigan on our practice trends and patient populations. As of February 2006, weight loss surgery for Medicare beneficiaries are reimbursed when procedures are performed at American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence.

Methods: Patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by an individual surgeon from June 1 to October 31 in 2004, 2005, and 2006 were stratified according to use of private third-party insurance versus Medicare (MC) insurance.

Sternal salvage with rigid fixation in the setting of a massive mediastinal aortic pseudoaneurysm: a case report and review of the literature.

Reconstruction of sternal nonunion following surgical resection can be difficult. Presented here is a case of sternal salvage with rigid fixation in the face of a massive aortic pseudoaneurysm. Plating is a safe and efficient technique that provides bone approximation and results in long term rigid sternal fixation.

Necrotizing colitis caused by systemic aspergillosis in a burn patient.

The incidence of invasive fungal infections has continued to rise over the past three decades, especially in the immunocompromised and intensive care unit population. Candida species are the most common pathogen to cause such invasive infections. However, Aspergillus species are currently on the rise and constitute a much more aggressive and serious infection.

Hallux metatarsophalangeal joint fusion for the rheumatoid forefoot.

Forefoot problems in patients who have rheumatoid arthritis are common. The progressive joint destruction causes a redistribution of weight about the forefoot, with a diminished weightbearing capacity of the first metatarsophalangeal (MTP) joint. Changes around the first MTP joint include synovitis, joint instability with subluxation, and arthritic change.

Pediatric germ cell tumors.

Pediatric germ cell tumors are a diverse group of neoplasms with variable clinical behaviors, depending upon the age and site of presentation. Most result from sporadic mutations, although environmental exposures and other genetic aberrations may play a role. Platinum-based chemotherapy has dramatically improved the event-free and overall survival outcomes of pediatric patients with malignant germ cell tumors over the past two decades.

Comparative study of airway management techniques with restricted access to patient airway.

Objective: To determine which airway endotracheal tube (ET), Combitube (CT), or Laryngeal Mask Airway (LMA) has the shortest time to successful ventilation in three nontraditional prehospital airway scenarios.

Methods: Prospective randomized cohort study of emergency medicine (EM) residents, faculty EM physicians, and paramedics (EMT-P). Subjects were instructed to place an airway in a mannequin in three scenarios: mannequin supine under a table with head abutting a wall, mannequin sitting upright with access from behind, and mannequin lying on its side with access facing the mannequin.

Microsatellite instability and MLH1 hypermethylation - incidence and significance in colorectal polyps in young patients.

Objective: Microsatellite instability (MSI) is observed in most hereditary nonpolyposis colorectal cancer-related colorectal cancers (CRC). The original Bethesda criteria recommends MSI testing in patients View Article and Find Full Text PDF

Proximal esophageal adenocarcinoma presenting as a thyroid mass: case report and review of the literature.

Metastatic disease to the thyroid is not an unusual finding at autopsies, but it is rare to be found in clinical situations. We present the first case of adenocarcinoma of the proximal esophagus presenting as a thyroid mass in a young healthy patient without any previous history of malignancy. This case highlights the importance of thorough work-up when addressing a thyroid mass.

A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparoscopic Roux-en-Y gastric bypass.

Background: Intraperitoneal local anesthetics have been investigated in several laparoscopic procedures that demonstrate improved postoperative pain control and reduced length of hospital stay. No published studies to date address the effectiveness of IP local anesthetics in laparoscopic gastric bypass patients (LRYGB).

Study Design: Between October 2004 and March 2005, 133 patients were prospectively studied to evaluate the efficacy of IP bupivacaine (IPB) in LRYGB.

Carotid angioplasty and stenting versus redo endarterectomy for recurrent stenosis.

Background: Carotid angioplasty and stent (CAS) is an alternative to redo carotid endarterectomy (RCEA) for recurrent carotid stenosis (RCS). The purpose of this study was to evaluate the outcomes of CAS in the treatment of RCS.

Methods: In an 8-year period, all patients presenting for treatment of RCS were followed-up prospectively.

Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity.

Background: Operative treatment of stage II posterior tibial tendon insufficiency (PTTI) is controversial. Many soft-tissue and bony procedures and various combinations of the two have been reported for treatment of stage II PTTI. Orthopaedists recognize the lateral column lengthening component of the procedure as a successful reconstructive technique.

Effect of digital radiography on emergency department radiographic examinations.

The purpose of this paper is to determine the time-savings realized as a result of conversion from film-based radiography to digital radiography (DR) in emergency department patients receiving multiple radiographic examinations. We retrospectively reviewed the computer records of 69 patients from the preconversion group (January 2004) and 62 patients from the postconversion group (January 2005), calculated the mean examination time per image from each group, and used a one-tailed t test to compare the two means. The preconversion (a mix of screen-film and computed radiography) group had a mean examination time of 3.

An approach for using full thickness skin grafts for complex penile surgeries in children.

Purpose: Many problems in pediatric urology derive from a paucity of penile skin resulting from prior surgical interventions. While hypospadias surgery is most often responsible for creating this problem, excessive circumcision also can leave a patient with too little skin to cover the penis. To our knowledge we describe the first series of pediatric patients in whom FTSGs were used in a variety of difficult circumstances where penile skin was lacking.

First ray injuries.

The first ray differs from the other rays in its position and its importance with weight bearing. Because it is a critical structure in the formation of the tripod of the foot, injuries to this ray can cause critical alterations in the biomechanics of the foot. This allows for pathologic weight-bearing points of contact and deformity that lead to a disabling gait.

Calcaneus fractures: a review article.

Calcaneus fractures are a significant burden to society. Assessment and treatment of these injuries has improved significantly. The use of CT scanning has allowed a greater understanding of the pathologic anatomy of these fractures, and has provided for prognostic classification systems with respect to outcome.

Recombinant factor VIIa for the treatment of severe postoperative and traumatic hemorrhage.

Background: The aim of this study was to determine the dose of recombinant factor VIIa (rFVIIa) that has been used in our institution to successfully control hemorrhage in trauma and postoperative patients.

Methods: This was an 8-month retrospective cohort study of 13 patients with acute hemorrhage and no known history of coagulopathic disorders.

Results: Administration of factor VIIa resulted in the cessation of life-threatening hemorrhage at dosages approximately one half those recommended for the management of hemophilia.