Contact alternatives to nickel.

Allergic contact dermatitis to nickel is a continued health concern internationally. Nickel has been found to be the most prevalent and relevant allergen in tested populations for the last 3 decades. Furthermore, recent data from the North American Contact Dermatitis Group demonstrate positive patch-test reactions to nickel at approximately 19.

Pleomorphic adenoma of the palate in a child.

Presented is a pleomorphic adenoma of the palate in a 12-year-old boy. Pleomorphic adenoma is usually found in adults and is rarely found in patients under 20 years of age. We present initial exam, diagnosis, treatment and a review of literature.

The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study protocol.

Background And Purpose: Epidemiological studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, age at presentation, and outcomes among non-Hispanic white, black, and Hispanic populations. We report here the design and methods for this large, prospective, multi-center case-control study of ICH.

Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multi-center, prospective case-control study of ICH.

Acquiring credentials in bedside ultrasound: a cross-sectional survey.

Objective: Although there are training guidelines to credential emergency physicians in bedside ultrasound, many faculty groups have members who completed residency without a mandatory curriculum. These physicians are therefore required to learn bedside ultrasound while out in practice. The objective of this descriptive report is to illustrate a single academic facility's experience with acquiring credentials for emergency physicians in bedside ultrasound and the faculty's impressions on the motivators of and barriers to completion of the requirements.

Effect of body mass index on outcome in patients with suspected coronary artery disease referred for stress echocardiography.

In patients with hypertension, heart failure, or coronary artery disease (CAD), obese patients have been shown to have a lower cardiac event rate compared with normal weight counterparts. This phenomenon has been termed the "obesity paradox." We sought to determine whether the obesity paradox exists in a cohort of patients referred for stress echocardiography.

Bedside ultrasound diagnosis of acute embolic femoral artery occlusion.

Background: Acute limb ischemia is both a limb-threatening and life-threatening disease process. Nontraumatic acute peripheral arterial occlusion is most commonly caused by a thrombosis or an embolism.

Objectives: There is limited evidence on the use of bedside ultrasound for the detection of acute limb ischemia, but duplex ultrasonography is standard in the diagnosis and operative planning in chronic limb ischemia.

Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation. A pictorial essay.

Patients commonly present with orthopedic injuries to the emergency department (ED). Although radiographs are the standard of care for evaulating these injuries, point-of-care ultrasound is being increasingly used to make the diagnosis. This modality can be useful in patients who are too clinically unstable to leave the acute care ED and in nonverbal pediatric or geriatric patients who are unable to isolate their injuries.

A brief primer on acne therapy for adolescents with skin of color.

The majority of adolescents with skin of color in the United States and other westernized civilizations develop acne vulgaris. Indigenous populations of children and teenagers with skin of color may not develop acne when raised on a paleolithic diet, suggesting the Western diet is the rudiment of acne vulgaris. Differences exist in the presentation of and therapy for acne in teenagers with skin of color, largely due to the increased risk for hyperpigmentation, scarring, and keloid formation, as well as style- and skin care-related exacerbating factors.

Preimplantation genetic screening (PGS) with Comparative genomic hybridization (CGH) following day 3 single cell blastomere biopsy markedly improves IVF outcomes while lowering multiple pregnancies and miscarriages.

Purpose: To determine benefits of cleavage-stage preimplantation genetic screening (PGS) by array comparative genomic hybridization (CGH).

Methods: A retrospective case-control study was performed at a tertiary care university-affiliated medical center. Implantation rate was looked at as a primary outcome.

Revision of Wise pattern breast reductions with vertical procedures.

A small percentage of patients who undergo Wise pattern mammaplasties request revisions to address recurrent macromastia or poor breast shape. Reuse of the Wise pattern method at times results in disappointing aesthetic results. Recently, in a series of 15 consecutive patients, we used vertical techniques with glandular reshaping to perform these revisions.

Focused cardiac ultrasound diagnosis of thoracic aortic aneurysm: two cases.

Background: Thoracic aortic aneurysms (TAAs) are less prevalent than abdominal aortic aneurysms. Symptomatic TAAs need to be identified quickly by the emergency physician (EP) since mortality rates increase dramatically once complications such as rupture or dissection occur. Compared with validated EP-performed ultrasound of the abdominal aorta, EP-performed focused cardiac ultrasound that includes evaluation of the thoracic aorta is relatively unreported.

Text message reminders to improve outpatient therapy attendance among adolescents: a pilot study.

High rates of missed appointments and attrition are common barriers to treatment for adolescents attending outpatient mental health treatment. Such figures indicate a need for innovative strategies to engage youth in treatment. The current quasi-experimental pilot study examined the feasibility, acceptability, and preliminary efficacy of text message (TM) appointment reminders to improve attendance in a sample of 48 adolescents attending outpatient therapy.

Neuroimaging of gastric distension and gastric bypass surgery.

Several neuroimaging studies are presented, which derive from prior work on gastric distension. Using a nonsurgical approach, we inserted gastric balloons into rats, which led to a marked decrease in food intake that normalized at 8 weeks. Body weight, however, remained below controls, which encouraged pursuit of studies in humans.

Buprenorphine implants for treatment of opioid dependence: randomized comparison to placebo and sublingual buprenorphine/naloxone.

Aims: To evaluate the safety and efficacy of buprenorphine implants (BI) versus placebo implants (PI) for the treatment of opioid dependence. A secondary aim compared BI to open-label sublingual buprenorphine/naloxone tablets (BNX).

Design: Randomized, double-blind, placebo-controlled trial.

A blind spot in the eye of imaging technology: penetrating atheromatous ulcer.

Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that may have different underlying pathophysiological mechanisms. It includes classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer. We describe the case of a 77-year-old female who presented with syncope of unknown duration.

Misconceptions and facts about pericardial effusion and tamponade.

Several common misconceptions can make the clinical diagnosis of subacute pericardial tamponade challenging. Widely known physical findings of pericardial tamponade lack sensitivity and specificity. Interpretation of echocardiographic signs requires good understanding of pathophysiology.

Transmission of chimeric HIV by mating in conventional mice: prevention by pre-exposure antiretroviral therapy and reduced susceptibility during estrus.

Heterosexual transmission accounts for the majority of new human immunodeficiency virus (HIV) cases worldwide. The current approach to investigate HIV heterosexual transmission in animals involves application of virus stock to the vaginal surface, a method that does not reproduce the physiological conditions of vaginal intercourse that influence the rate of transmission. We have previously described efficient infection of conventional mice using EcoHIV/NL4-3 and EcoHIV/NDK, chimeric HIV molecular clones constructed to express all HIV structural and regulatory genes except envelope, which is replaced by a rodent-tropic envelope gene.

The consequence of undertreatment of patients treated with breast conserving therapy for ductal carcinoma in-situ.

Background: The use of clinical features to allocate adjuvant therapy in the treatment of ductal carcinoma in situ with breast-conserving therapy remains controversial.

Methods: A review of patients with ductal carcinoma in situ treated with breast-conserving therapy was performed. The recurrence rate was examined in relation to patient age, tumor characteristics, Van Nuys Prognostic Index, and the receipt of prescribed adjuvant therapies.

Mutations in DSTYK and dominant urinary tract malformations.

Background: Congenital abnormalities of the kidney and the urinary tract are the most common cause of pediatric kidney failure. These disorders are highly heterogeneous, and the etiologic factors are poorly understood.

Methods: We performed genomewide linkage analysis and whole-exome sequencing in a family with an autosomal dominant form of congenital abnormalities of the kidney or urinary tract (seven affected family members).

Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation.

CORD-AEUS: consensus document for the emergency ultrasound milestone project.

In 2012, the Accreditation Council for Graduate Medical Education (ACGME) designated ultrasound (US) as one of 23 milestone competencies for emergency medicine (EM) residency graduates. With increasing scrutiny of medical educational programs and their effect on patient safety and health care delivery, it is imperative to ensure that US training and competency assessment is standardized. In 2011, a multiorganizational committee composed of representatives from the Council of Emergency Medicine Residency Directors (CORD), the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine (SAEM), the Ultrasound Section of the American College of Emergency Physicians (ACEM), and the Emergency Medicine Residents' Association was formed to suggest standards for resident emergency ultrasound (EUS) competency assessment and to write a document that addresses the ACGME milestones.

Safety and feasibility of intra-arterial bivalirudin bolus administration during primary angioplasty.

Aim: We investigated the feasibility and safety of intra-arterial bivalirudin bolus during primary angioplasty.

Background: Bivalirudin has been shown to be an effective and safe anticoagulant during angioplasty. However, in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial, the bivalirudin group experienced higher acute stent thrombosis rate compared with the heparin and glycoprotein IIb/IIIa inhibitor group.