Emergent surgical airway: comparison of the three-step method and conventional cricothyroidotomy utilizing high-fidelity simulation.

Background: Surgical airway creation has a high potential for disaster. Conventional methods can be cumbersome and require special instruments. A simple method utilizing three steps and readily available equipment exists, but has yet to be adequately tested.

Minimally invasive approach to median arcuate ligament syndrome in a patient with HIV/AIDS.

Mesenteric ischaemia is most commonly caused by atherosclerotic disease, but extrinsic compression on the coeliac axis (CA) can also lead to similar symptoms as mesenteric ischaemia. This is usually created by the pressure of the fibrous diaphragm on the CA, which can cause abdominal pain and weight loss referred to as 'median arcuate ligament syndrome'. This syndrome is not typically associated with any underlying disease process.

Comparison of the TDx-FLM II and lecithin to sphingomyelin ratio assays in predicting fetal lung maturity.

Objective: We evaluated the usefulness of the TDx-FLM II and lecithin to sphingomyelin (L/S) ratio assays in predicting fetal lung maturity.

Study Design: We retrospectively reviewed 218 consecutive paired TDx-FLM II and L/S ratio results. Women who delivered viable infants within 72 hours of amniotic fluid collection (n=109) were included in the analysis of sensitivity and specificity.

Optimizing resynchronization therapy: can we increase the number of true responders?

Cardiac resynchronization therapy is now considered a standard therapy for patients with cardiomyopathy, heart failure, and interventricular conduction delay. Despite the demonstrated benefits in multiple large-scale trials, there is a clear nonresponder rate. This brief review will address some of the issues associated with maximizing the benefit of biventricular pacing, and whether or not advances in programming of such devices will increase the number of true responders.

Multiple inverted follicular keratoses as a presenting sign of Cowden's syndrome: case report with human papillomavirus studies.

Inverted follicular keratosis is characterized by a squamous epithelial expansion of the infundibular portion of the hair follicle in an exophytic and endophytic pattern. The lesion is often associated with squamous eddies similar to an irritated keratosis and may have a superficial papillomatous architecture. The lesion most often arises as a solitary nodule on the face of middle age to elderly individuals.

Emergency redo mitral valve replacement in a 27-year-old pregnant female with a clotted prosthetic mitral valve, preoperative fetal demise and postoperative ventricular assist device: a case report.

A 27-year-old Laotian woman with a St Jude mechanical mitral valve became pregnant, requiring a change in her anticoagulant after the first trimester when her warfarin sodium (coumadin) was replaced with enoxaparin sodium (lovenox). Her prosthetic valve clotted and became dysfunctional. She was 16 weeks pregnant and was taken to the operating room for emergency surgery for replacement of the valve.

Long-term results of permanent indwelling wallstents for benign mid-ureteral strictures.

Background: Benign ureteral strictures are a potentially difficult problem that typically has been solved by open surgery. However, minimally invasive methods would be preferable.

Patients And Methods: Three patients with benign ureteral strictures were treated with endoscopic placement of self-expanding permanent indwelling stents (Wallstents).

Characterization and management of paraesophageal hernias in children after antireflux operation.

Purpose: The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH).

Methods: A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points.

Persistent gastroesophageal reflux disease after antireflux surgery in children: I. immediate postoperative evaluation using extended esophageal pH monitoring.

Purpose: There is a paucity of quantitative and reproducible follow-up data on childhood operations for gastroesophageal reflux disease (GERD). With the development of minimally invasive techniques for antireflux operations in children, there is a need to quantitatively determine immediate outcomes for such operations performed by laparotomy for comparison.

Methods: A retrospective review of 385 children (age range, 1 week to 15 years) who had a primary antireflux operation in a Children's or University Hospital performed by laparotomy between 1983 and 1997, and who also had an extended esophageal pH study performed within the first 12 postoperative weeks, was conducted.

Palliative care in the acute hospital setting.

Palliative care, associated with the hospice movement, has achieved wide acceptance in many countries. Its focus has been care of cancer patients and more recently, those with AIDS. Most acute hospitals do not have avenues to care for these patients or others in the end of life stages.

A protocol for palliative care measures. Part 2.

A bioethics committee and a palliative care subcommittee addressed all aspects related to the care of the dying patient, thus establishing a standard of care. In Part 2 of "A Protocol for Palliative Care Measures," ethical guidelines to use when beginning palliative care for the terminally ill patient are given.

A protocol for palliative care measures: Part 1.

Most physicians and nurses realize that the current patient-care delivery system does not meet the needs of the terminally ill. Is the kind of suffering often experienced and witnessed in hospitals needless? A bioethics committee and a palliative care subcommittee discuss aspects related to the care of the dying patient.

Gastroesophageal reflux disease as a cause for emesis in infants.

Vomiting is a very common symptom associated with gastroesophageal reflux disease (GERD) in infancy, although no longer the most common symptom seen in infants with GERD. A thorough evaluation of these patients with clinical history, physical examination, and sophisticated diagnostic procedures is necessary to identify that the vomiting is from GERD. Extended esophageal pH monitoring is the most reliable diagnostic procedure used to confirm the presence or absence of GERD, and provides additional information regarding prognosis and the relationship of the GERD to respiratory complaints.

Pharyngeal and swallowing disorders in infants.

Although true vomiting is an unusual manifestation of pharyngeal or swallowing disorders in infants and children, the forceful regurgitation of feedings seen with respiratory distress in these children may be interpreted by the clinician as vomiting episodes. This scenerio usually is caused by structural abnormalities of the upper airway or swallowing discoordination placing food as an obstruction in the airway during feedings. A good clinical history and physical examination of affected children often will disclose an anatomic cause for regurgitated feedings, but swallowing disorders are more subtle and usually require a complete swallowing evaluation.

Disorders of the central and autonomic nervous systems as a cause for emesis in infants.

Vomiting in infants can be caused by a wide variety of neurological disorders. All involve stimulation of a central pattern generator for vomiting located in the brainstem, the nucleus tractus solitarius. This, in turn, projects to multiple motor nuclei involved in the vomiting reflex.

Acetabular defect classification: a detailed radiographic approach.

This classification system was developed based on clinically significant recurrent patterns of acetabular bone loss. The classification has now been refined with four specific radiographic parameters that provide specific criteria to classify each defect accurately. This detailed radiographic analysis is based on findings on the plain anterior-posterior pelvis radiograph and eliminates the need for costly computed tomography scans.