Rash decisions can be life-saving: a case of disseminated histoplasmosis in an immunocompromised patient.

Histoplasmosis is the most prevalent endemic mycosis in the United States with the highest incidence in the Mississippi and Ohio River Valleys. Most infections are asymptomatic or self-limited. However, in immunocompromised patients, severe and progressive disseminated infection can occur.

Acute Liver Failure due to Disseminated Varicella Zoster Infection.

Acute liver failure (ALF) can be due to numerous causes and result in fatality or necessitate liver transplantation if left untreated. Possible etiologies of ALF include ischemia, venous obstruction, medications, toxins, autoimmune hepatitis, metabolic and infectious causes including hepatitis A-E, varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and adenovirus with VZV being the most rarely reported. Pathognomonic skin lesions facilitate diagnosis of VZV hepatitis, but definitive diagnosis is secured with liver biopsy, tissue histopathology, culture, and specific VZV polymerase chain reaction (PCR).

Abdominal wall abscess formation two years after laparoscopic cholecystectomy.

Background: Spillage of gallstones within the subcutaneous tissue during laparoscopic cholecystecomy may lead to considerable morbidity.

Methods: We describe an abdominal wall abscess formation in a 50-year-old female that developed 24 months after a laparoscopic cholecystectomy.

Results: Spilled gallstones at the umbilical port site went undetected.

Managing breast cancer in the renal transplant patient: a unique dilemma.

Improvements in immunosuppression have increased patient and graft survival in transplant recipients. As a result, there is greater risk of neoplastic processes such as breast cancer. Treatment in this population is complicated by the necessary immunosuppression, vascular accesses, and transplant grafts.

Families' perception of the value of timed daily "family rounds" in a trauma ICU.

Daily communications between the ICU trauma patients' families and the trauma team are often limited due to the unpredictable nature of subsequent patient admissions and operative procedures. In order to improve the lines of family-physician communication and educate residents regarding family communication, our level I trauma center instituted daily "Family Rounds" (FR). FR occur at the same time every day, in the patient's ICU room.

Juvenile tillaux fracture in an adolescent basketball player.

Forced external rotation of the foot may cause a syndesmosis or high ankle sprain in an adult, but in a teenage patient, a juvenile Tillaux fracture may occur if the tibial physis has not yet closed. Diagnosis is made with plain radiographs, but CT may be necessary to determine the true articular displacement. Closed reduction with casting for 6 weeks is usually sufficient for most nondisplaced or minimally displaced fractures.

The epidemiology of skydiving injuries: World freefall convention, 2000-2001.

The purpose of this study is to describe the prevalence and types of injuries incurred by civilian skydivers using contemporary equipment under conventional conditions. Injury data were collected at the World Freefall skydiving convention (WFFC), during two consecutive periods of operation, August 4-13, 2000 and August 3-12, 2001. During the study periods, 8976 skydivers made 117,000 skydives.

Are negative appendectomies still acceptable?

Background: The goal was to ascertain if there was a significant change in the negative appendectomy (NA) rate in our community hospital with the increased use of computed tomography (CT).

Methods: This was a retrospective chart review of all appendectomies for acute disease performed at our institution from January 2000 to December 2002. There is no established protocol; therefore, CT scans were performed at the discretion of the involved physicians.

Endovascular repair of an aortopulmonary artery fistula with use of controlled-release coils.

Aortopulmonary artery fistula is traditionally treated surgically. The present case report describes endovascular repair of an aortopulmonary artery fistula in a patient in whom two thoracotomies had been performed. The fistula occurred at the site of a pseudoaneurysm from the proximal anastomosis of a graft placed to treat a type B aortic dissection.

Endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy without the use of radiation.

Background: Biliary disease in pregnancy is a relatively uncommon condition; the diagnosis of this condition is not standardized. Furthermore, the use of radiographic imaging studies and therapeutic approaches in pregnancy is limited because of the possibility of fetal exposure.

Study Design: During a 2-year interval of 2001 to 2002, we successfully performed endoscopic retrograde cholangiopancreatography (ERCP) studies in 6 pregnant women between 6 and 30 weeks of gestation with symptomatic acute cholangitis or pancreatitis without irradiation exposure or major maternal complications.

Biliary stent causing colovaginal fistula: case report.

Objectives: Perforation of the bowel during placement of a biliary stent is a known complication of this procedure. We report the endoluminal loss of a biliary stent during routine stent extraction that ultimately led to a chronic colovaginal fistula. This case emphasizes the need for evaluation of fecal passage of stents in patients with a known dislodged prosthesis.

The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries.

Background: The evaluation of multitrauma patients for blunt truncal injuries remains open for debate. We sought to evaluate the role of routine computed tomography (CT) of the chest, abdomen, and pelvis as a screening tool for patients already undergoing cranial CT studies.

Methods: Charts of blunt trauma patients admitted from June 2000 to June 2001 were reviewed for demographics, Glascow Coma Scale (GCS), physical and radiological findings, and length of stay.

Endovascular repair of acute innominate artery injury due to blunt trauma.

The utility of endovascular techniques has expanded greatly over the past decade. Physicians now have choices regarding the treatment of many injuries that have traditionally required open surgical repair. Technological advances in materials as well as improved training and expertise among practitioners has led to increased availability of endovascular procedures that can often provide an effective and less invasive means of management.

CT guided percutaneous fixation of sacroiliac fractures in trauma patients.

Background: Open reduction and internal fixation of unstable pelvic fractures has been advocated to minimize complications and avoid further injury. We have recently performed CT guided percutaneous fixation of sacroiliac joints as an alternative to open repair.

Methods: From May 1, 1998 to April 30, 1999, our Level II trauma center admitted 76 patients with pelvic fractures, all due to blunt trauma.

Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach?

Management of biliary disease in the octogenarian has evolved over the last decade. Laparoscopic cholecystectomy is now more commonly performed in this patient population. Octogenarians with biliary pathology frequently present with complications of acute disease such as biliary pancreatitis, choledocholithiasis, and acute cholecystitis.

Early versus delayed repair of facial fractures in the multiply injured patient.

The management of facial fractures in the polytrauma patient requires the coordination of multiple surgical disciplines to optimize the functional and cosmetic outcome while minimizing overall morbidity and mortality. Although the plastic surgery literature historically advocates the early repair of facial fractures, the risk of general anesthesia in patients with associated injuries sometimes makes early repair unsafe. We compared early operative repair versus delayed operative repair of facial fractures in multitrauma patients.

Laparoscopic placement and revision of peritoneal dialysis catheters.

Chronic peritoneal dialysis is an option for many patients with end stage renal disease. Laparoscopy offers an alternative approach in the management of dialysis patients. Over an 18-month period, laparoscopy was used for placement or revision of seven peritoneal dialysis catheters.

Schistosomiasis masquerading as carcinoma of the breast.

Mammography of an asymptomatic Filipino woman revealed microcalcifications suggestive of carcinoma. Excisional biopsy of the breast showed that the mass was caused by calcified ova of Schistosoma japonicum.