Comparison of FOLFIRI with or without cetuximab in patients with resected stage III colon cancer; NCCTG (Alliance) intergroup trial N0147.

Background: Two arms with FOLFIRI, with or without cetuximab, were initially included in the randomized phase III intergroup clinical trial NCCTG (North Central Cancer Treatment Group) N0147. When other contemporary trials demonstrated no benefit to using irinotecan as adjuvant therapy, the FOLFIRI-containing arms were discontinued. We report the clinical outcomes for patients randomized to FOLFIRI with or without cetuximab.

Management of benign paroxysmal positional vertigo: a randomized controlled trial.

Background: Benign paroxysmal positional vertigo (BPPV) is a common presenting problem.

Objective: Our aim was to compare the efficacy of vestibular rehabilitation (maneuver) vs. conventional therapy (medications) in patients presenting to the emergency department (ED) with BPPV.

Follicular mucinosis.

Follicular mucinosis is an uncommon inflammatory disorder that characteristically presents as follicular papules and/or indurated plaques. The face, neck, and scalp are the most frequently affected sites, although lesions may occur on any site of the body. Histologically, the disorder is characterized by mucin deposition in the follicular epithelium.

Creating moments that matter: strategies to combat compassion fatigue.

Understanding compassion fatigue and devising and implementing interventions to address the subject are important for nurses and patients. However, few literature reports exist that address interventions for nurses who experience compassion fatigue. This article discusses how nurses on a medical-surgical oncology unit in an academic, community Magnet™ hospital adopted these themes as a conceptual framework on which to focus actions to avoid and mitigate compassion fatigue.

Evidence-based medicine: lower extremity acute trauma.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the steps for evaluation of a patient with a lower extremity wound before initiating medical or surgical intervention. 2.

Unique obstacle race injuries at an extreme sports event: a case series.

Obstacle course endurance events are becoming more common. Appropriate preparedness for the volume and unique types of injury patterns, as well as the effect on public health these events may cause, has yet to be reported in emergency literature. We describe 5 patients who presented with diverse injuries to illustrate the variety of injuries sustained in this competitive event.

Simultaneous surgical repair of a tibialis anterior tendon rupture and diabetic charcot neuroarthropathy of the midfoot: a case report.

The combination of simultaneous rupture of a tibialis anterior tendon and Charcot neuroarthropathy of the midfoot in a diabetic patient is a rare and challenging condition that can lead to major complications if not addressed appropriately. This article discusses a tibialis anterior tendon rupture that may have developed before or after the incidence of the diabetic Charcot neuroarthropathy midfoot deformity and raises awareness to potential spontaneous tendon ruptures that may be associated with the diabetic Charcot foot.

Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI.

Aim: To determine if early cardiac catheterization (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent.

Methods: We conducted a retrospective observational study of a prospective cohort of 754 consecutive comatose patients treated with therapeutic hypothermia (TH) following cardiac arrest.

Results: A total of 269 (35.

Training mothers in infant cardiopulmonary resuscitation with an instructional DVD and manikin.

Context: Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly.

Objective: To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR.

Design: Quasi-experimental study with enrollment between January and December 2008.

Autologous bone plugs in unilateral total knee arthroplasty.

Background: The purpose of this study was to compare blood loss, declines in hemoglobin (HgB) and hematocrit (HcT) levels, and required homologous transfusions for patients who either had the femoral intramedullary defect left open or filled with an autologous bone plug during total knee arthroplasty (TKA). We hereby present our results of autologous bone plugs in unilateral TKA.

Materials And Methods: A retrospective chart review was performed on 55 patients diagnosed with osteoarthritis (OA) who had undergone unilateral TKA.

Warfarin users prone to coagulopathy in first 30 days after hospital discharge from gastric bypass.

Background: Lehigh Valley Health Network (LVHN), a nonprofit tertiary care facility in Allentown, Pennsylvania, is an accredited American College of Surgeons Bariatric Surgery Center Network (ACSBSCN) Level 1 site performing 400+ bariatric procedures annually. Bariatric data submission began in April 2008. Complication review revealed that approximately 17 % of patients on chronic anticoagulation (warfarin) therapy preoperatively were readmitted with supratherapeutic international normalized ratios (INRs), postsurgical bleeding, anastomotic ulcer, or other intraluminal hemorrhage.

Circumscribed palmar or plantar hypokeratosis: first report on a nonacral site with unique histologic features.

Circumscribed palmar or plantar hypokeratosis was first described by Pérez et al in 2002 as a unique entity of the skin in which they reported 10 patients who presented with well-circumscribed areas of erythematous depressed or eroded skin mostly over the thenar or hypothenar eminences of the palms and less commonly on the soles. Histologically, the lesions demonstrated an abrupt drop-off in the cornified layer resulting in a broad area of hypokeratosis. Pérez et al hypothesized that these lesions were a distinctive epidermal malformation.

Association of dietary and supplemental iron and colorectal cancer in a population-based study.

We evaluated the role of dietary iron, heme iron, and supplemental iron on colorectal cancer (CRC) risk in a population-based case-control study in Pennsylvania, including 1005 incident cases and 1062 controls. Diet was assessed through a modified food frequency questionnaire that included supplement use and a meat-specific module. Cases reported intakes for the year before diagnosis, whereas controls reported intakes for the year before interview.

Concomitant osteomyelitis and avascular necrosis of the talus treated with talectomy and tibiocalcaneal arthrodesis.

The goal with Lisfranc fracture-dislocations is to regain joint congruity and reestablish midfoot stability to avoid debilitating posttraumatic arthrosis and chronic pain in the sensate patient. In the diabetic population, dense peripheral neuropathy and/or vascular disease are equally important and may alter the surgical approach to traumatic tarsometatarsal injuries. The initial diagnosis in the diabetic population may be delayed due to subtle radiographic findings and/or patient unawareness of trauma in the insensate foot.

Residents as teachers: residents' perceptions before and after receiving instruction in clinical teaching.

Context: Residents play an integral role in educating junior residents, medical students, and patients.

Objective: To determine how residents describe their training, proficiency, and comfort level in teaching before and after receiving instruction in clinical teaching.

Methods: Emergency medicine residents at a 980-bed suburban hospital system filled out a 12-question survey on their training as teachers and their self-perceptions of themselves as teachers.

Effect of subcutaneous epinephrine/saline/local anesthetic versus saline-only injection on split-thickness skin graft donor site perfusion, healing, and pain.

The technique for split-thickness skin graft harvest varies among surgeons. Even though there is scientific evidence that the subcutaneous injection of modified tumescent solution reduces blood loss during burn surgery, the technique has not been unanimously adapted because of, in part, fear of healing retardation. This study prospectively examines the effect of tumescent injection on donor site perfusion, healing, and pain.

Island thoracodorsal artery perforator-based V-Y advancement flap after radical excision of axillary hidradenitis.

Chronic axillary hidradenitis invariably ultimately requires surgical intervention to ameliorate this often painful, unrelenting, recurrent disease that can be disabling. The treatment of choice requires radical excision of at least all hair-bearing skin and its associated apocrine sweat glands. The ensuing large defect often is amenable to closure using a local flap instead of a skin graft to better expedite healing, to allow more rapid rehabilitation, and to minimize the risk of later scar contracture.

Teaching the value of continuity of care: a case conference on long-term healing relationships.

The Continuity Case Conference provides a model for teaching family medicine residents the value, importance, and impact of developing long-term doctor-patient relationships. A resident's presentation of challenging patient cases and the ensuing group interaction with resident peers, faculty, and medical staff are designed to offer residents alternate perspectives on complex, multiproblem cases while validating the often emotional process of patient care. This learning model is designed to demonstrate how a physician, in the context of the cumulative progression of contacts with a patient, can better manage myriad health issues, chronic and acute, and improve patient outcomes.

A paradigm shift for soft-tissue coverage of the zones of the abdominal wall using perforator flaps.

Background: A team approach is essential to properly restore the integrity and function of the complete abdominal wall defect. If additional vascularized tissue coverage following this reconstruction is imperative, knowledge of all potential flap alternatives to achieve this goal becomes critical to ensure healing and reduce the risk of recurrent hernia.

Methods: A historical review of algorithms for the management of complex abdominal wall defects was undertaken.

Validation of a triage algorithm for psychiatric screening (TAPS) for patients with psychiatric chief complaints.

Context: The process of medical clearance screening for patients with psychiatric chief complaints has not been standardized.

Objective: To investigate the validity of a triage algorithm for psychiatric screening (TAPS) as a method to screen for the absence of acute medical illness in these patients.

Methods: The current study was a structured, retrospective medical record review in a suburban community teaching hospital with 37,000 emergency department visits per year.

Analysis of sex differences in preadmission management of ST-segment elevation (STEMI) myocardial infarction.

Background: Many reports suggest gender disparity in cardiac care as a contributor to the increased mortality among women with heart disease.

Objective: We sought to identify gender differences in the management of Myocardial Infarction (MI) Alert-activated ST-segment elevation myocardial infarction (STEMI) patients that may have resulted from prehospital initiation.

Methods: A retrospective database was created for MI Alert STEMI patients who presented to the emergency department (ED) of an academic community hospital with 74,000 annual visits from April 2000 through December 2008.