Metastatic colorectal carcinoma: an unusual presentation.

Cutaneous metastases from colorectal carcinomas occur infrequently, usually in the setting of disseminated disease. They most commonly appear on the abdominal wall or perineal area; metastases to other locations of the skin are rare. We describe a case of colorectal signet ring carcinoma with metastasis to the upper lip.

The diagnosis of wheezing in children.

Wheezing in children is a common problem encountered by family physicians. Approximately 25 to 30 percent of infants will have at least one wheezing episode, and nearly one half of children have a history of wheezing by six years of age. The most common causes of wheezing in children include asthma, allergies, infections, gastroesophageal reflux disease, and obstructive sleep apnea.

Dual inferior vena cava: two inferior vena cava filters.

The formation of the venous drainage system of the human body is a complex process involving structures forming and regressing in a predefined order. Interruption of any one of these steps results in the formation of a congenital anomaly. Knowledge of these anomalies can prevent us from potential serious and sometimes fatal complications.

Anterior tarsal tunnel syndrome.

Compression of the deep peroneal nerve is commonly referred to as anterior tarsal tunnel syndrome. Although rare, this syndrome remains poorly diagnosed. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle.

Midfoot osteotomies for the cavus foot.

Midfoot osteotomies have long been used for a wide variety of congenital and acquired deformities. Severe pes cavus often necessitates some form of surgical correction, and no single procedure can be used exclusively. Midfoot osteotomies may be combined with adjunctive procedures to form an appropriate strategy for the treatment of these deformities.

Bilateral facial palsy in a case of leptospirosis.

When returning from a 5-month trip to China, a 21-y-old Dutch male developed clinical signs, symptoms, and an antibody response compatible with leptospirosis. On d 15 of disease, he also developed facial palsy with a bilateral Bell's phenomenon. Facial palsy is a rare finding in leptospirosis, and if a causal relation exists, the delay of onset in the present case would suggest vasculitis rather than a direct neurotoxic effect.

The traveling family.

Traveling as a family can be an extraordinarily rewarding experience. Providing good pretravel counsel--and travelers' adherence to it--can decrease the likelihood that illness or injury of the more vulnerable family members will disrupt the adventure!

Iselin's disease: a case presentation of nonunion and review of the differential diagnosis.

The confusing pathology of the proximal fifth metatarsal can make Iselin's disease difficult to distinguish from Jones', avulsion, or stress fractures, or os vesalianum. While lselin's disease appears to be rare due to the scarcity of cases in the medical literature, this may be due to misdiagnosis. The case report discusses the course of treatment for a young male with Iselin's disease that developed into a nonunion.

Awake aortic aneurysm repair in patients with severe pulmonary disease.

Background: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients.

Methods: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests.

Mechanical analysis of midline sternotomy wound closure.

Objective: Unstable median sternotomy closure can lead to postoperative morbidity. This study tests the hypothesis that separation of the sternotomy site occurs when physiologic forces act on the closure.

Methods: Median sternotomy was performed in 4 human cadavers (2 male) and closed with 7 interrupted stainless steel wires.

Mood disorders. Is your primary care patient depressed?

Treatment of patients with mood disorder can be one of the most rewarding experiences in medicine. Optimal treatment is contingent on accurate diagnosis according to current criteria and terminology. Major depression needs further categorization in reference to atypical or psychotic features, seasonal aspects, melancholia, mania, or dysthymia.