A safe, alternative technique for inferior turbinate reduction.

Objective: Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates.

Change in cognitive function in older persons from a community population: relation to age and Alzheimer disease.

Objective: To examine change in cognitive function in older persons sampled from a community population, and its relation to age and Alzheimer disease.

Design: Prospective cohort study with an average of 3.5 years of follow-up.

Are we overusing the diagnosis of psychogenic non-epileptic events?

In order to determine how often results of video/EEG (V-EEG) studies may change the clinical diagnosis of paroxysmal events, we prospectively studied 100 consecutive patients (75 females, 25 males) admitted for diagnosis of recurrent paroxysmal spells. The presumed diagnosis of the referring physician was obtained. Episodes were classified as epileptic seizures (ES), psychogenic non-epileptic events (PNEE), or physiologic non-epileptic events (PhysNEE).

Long-term memory in Alzheimer's disease.

Recent findings have further characterized the neural and psychological bases of long-term memory failure in Alzheimer's disease. Convergent volumetric neuroimaging studies indicate that loss of episodic memory is specifically related to early-stage limbic-diencephalic pathology, and that non-mnemonic impairment is specifically related to later-stage temporal-neocortical pathology. Recent studies of Alzheimer's disease have also reported informative cognitive dissociations in semantic memory and implicit memory.

A preliminary report: cementless trapeziometacarpal arthroplasty.

A cementless ball and socket trapeziometacarpal arthroplasty was used for the treatment of Eaton and Littler stage II and III trapeziometacarpal osteoarthritis. Forty-two joints were placed in 36 patients between 1986 and 1992. Five joints in 4 patients required revision.

Foveal outer retinal function in eyes with unexplained visual symptoms or acuity loss.

Objective: To determine whether foveal outer retinal dysfunction is common in eyes with unexplained visual symptoms or acuity loss.

Design: Prospective study.

Participants: Seventy-three eyes of 44 consecutive patients with unexplained visual symptoms or acuity loss, 39 eyes of 39 control subjects, and 12 eyes of 7 patients with known maculopathy.

Orthopedic residents' perceptions of the content and adequacy of their residency training.

The content and adequacy of orthopedic surgery residency training can be evaluated by several means. The Accreditation Council for Graduate Medical Education and the Residency Review Committee set standards with which residency programs must comply in order to be accredited. Residents' perceptions of the content and adequacy of their training is another means of evaluating orthopedic residency training.

Intraocular mass simulating a retained foreign body.

Purpose: To present an unusual case of a preretinal mass that simulated a retained metallic foreign body.

Method: Case report.

Results: A 30-year-old man presented with unilateral iridocyclitis and an ipsilateral preretinal mass with ultrasonographic and computed tomographic characteristics of a metallic foreign body.

De novo psychogenic nonepileptic seizures after epilepsy surgery.

Purpose: The occurrence of de novo nonepileptic seizures (NES) after epilepsy surgery have been reported only twice in the literature (one article and one abstract).

Methods: We report three patients whose de novo NES were documented by video-EEG telemetry after epilepsy surgery. These patients were drawn from a sample of 166 consecutive patients who underwent epilepsy surgery at our center between 1989 and 1996.

Colonic perforation by ventriculoperitoneal shunt tubing: a case of suspected silicone allergy.

Background: A case of colonic perforation by a ventriculoperitoneal shunt is presented in a patient with several previous complications associated with shunt tubing.

Case Description: Initially managed by intravenous antibiotics, shunt externalization, and colonoscopy, the entire ventriculoperitoneal shunt system was subsequently replaced after cerebrospinal fluid cultures had grown Propionibacterium acnes and Streptococcus sanguis organisms. The patient has had three episodes of skin breakdown over his shunt tubing (two prior and one subsequent to colonic perforation) without evidence of shunt infection or malfunction.

An approach to the treatment of recurring polyarthralgia after jejunoileal bypass.

Polyarthralgia after jejunoileal bypass (JI) is a well-documented complication. In the past, this was treated by antibiotic therapy, but definitive therapy uncommonly necessitated surgical reversal of the JI bypass. This case report discusses the etiology of arthralgias and presents a technique for its treatment without bypass reversal.

Laparoscopic assisted placement of peritoneal dialysis catheter: a preliminary experience.

Materials And Methods: Peritoneal dialysis catheters have been successfully placed via an open surgical technique, the percutaneous method, and the peritoneoscopic-assisted percutaneous methods. The latter two techniques produced lower complication rates, quicker use of the catheter, and longer functional survival, but also carried the risk of vascular and visceral injury during blind entry with a Varess needle or other penetrating instrumentation. A new technique is described which reduces the incidence of this iatrogenic complication and provides greater visualization of the peritoneal cavity.

Perforation of terminal ileum diverticulitis: a case report and literature review.

Terminal ileum diverticulosis is a rare entity, but it can be complicated by diverticulitis and perforation, which clinically can be indistinguishable from acute appendicitis. A case report and review of the literature is presented.

Weekly 5-fluorouracil and interferon-alfa-2b in metastatic cancer.

Twenty-four patients with advanced cancer were treated with 5-Fluorouracil 600 mg/m2 intravenously and interferon-alfa-2b 3 MU subcutaneously both given weekly for 6 weeks followed by a 2-week hiatus. The median age of patients treated on this study was 66 years. Mild to moderate leukopenia, nausea/emesis, and anemia were the most common toxicities.

Cardiopulmonary arrest after retrobulbar anesthesia in a patient with an orbital roof defect.

Purpose: Cardiopulmonary arrest developed after injection of bupivacaine hydrochloride, lidocaine, and hyaluronidase in a 78-year-old woman who had previously undergone ipsilateral transcranial orbital surgery with removal of the bone of the orbital roof.

Methods: The patient required immediate cardiopulmonary resuscitation and intubation. Mechanical ventilation was necessary for 18 hours before spontaneous respirations resumed.

Lichen planus associated with topical beta-blocker therapy.

Purpose: We studied two clinical cases that demonstrated an association between topical beta-blocker therapy and lichen planus.

Methods: Two patients developed skin lesions while on topical beta-blocker therapy for open-angle glaucoma. They underwent skin biopsies to determine the origin of the lesions.

Breast cancer in women following mantle irradiation for Hodgkin's disease.

The increased risk of developing solid malignant tumors following treatment of Hodgkin's disease has been established in the literature. The association between mantle irradiation for the treatment of Hodgkin's disease and breast carcinoma has only recently been studied in large populations of cured patients. Several factors including age at radiation treatment, the time between treatment and discovery of the cancer, and radiation dosimetry affect the relative risk of the patient for developing breast cancer.

Transcranial gunshot wounds: cost and consequences.

Poor outcomes following transcranial gunshot wounds (TC-GSW) and the perception of significant financial loss have led some institutions to adopt a fatalistic attitude towards these patients. This study was undertaken to define those factors predictive of mortality following TC-GSW as well as to determine the costs and benefits associated with providing care to these individuals. We reviewed the medical records of 57 TC-GSW patients seen at our Level I Trauma Center between January 1990 and December 1992.

Pseudoaneurysm complicating knee arthroscopy.

Pseudoaneurysm formation is a rare complication of knee arthroscopy. Cases reported in the literature have involved the popliteal, superior and inferior medial geniculate, and the inferior lateral geniculate arteries. These cases have all been described as presenting within 2 to 3 weeks of the arthroscopic procedure.