An Uncommon Diagnosis in a Child Presenting With Double Vision and Imbalance.

Acute disseminated encephalomyelitis (ADEM) is exceptionally uncommon, with approximately 3 pediatric cases reported in the United States each year. Given the uncommon nature of ADEM, most of the current data rely heavily on case reports. The overwhelming majority of cases have been reported after an acute viral infection or vaccination.

Cranium-Penetrating Mass Detected by Ultrasound Expedited Management of Langerhans Cell Histiocytosis.

A 6-year-old boy presented to the pediatric emergency department with a unilateral 5 × 3-cm superficial mass on the postauricular region growing for 1 month. Point-of-care ultrasound was used to evaluate the mass, which revealed a complex cystic mass penetrating the temporal bone. After confirmatory magnetic resonance imaging, the patient was transferred for neurosurgical evaluation, and the tumor was excised.

Labia Minora, Labia Majora, and Clitoral Hood Alteration: Experience-Based Recommendations.

Aesthetic alteration of the genitalia is increasingly sought by women unhappy with the size, shape, and appearance of their vulva. Although the labia minora are usually the focus of concern, the entire anatomic region--minora, labia majora, clitoral hood, perineum, and mons pubis--should be evaluated in a preoperative assessment of women seeking labiaplasty. Labiaplasty is associated with high patient satisfaction and low complication rates.

A review of the federal guidelines that inform and influence relationships between physicians and industry.

The effective delivery and continued advancement of health care is critically dependent on the relationship between physicians and industry. The private sector accounts for 60% of the funding for clinical research and more than 50% of the funding sources for physician education. The nature of the physician-industry relationship and the role of the physician as a gatekeeper for health care make this association vulnerable to abuse if certain safeguards are not observed.

Exercise testing in the presence of complete heart block.

A 28-yr-old female presented for preoperative evaluation. The resting ECG revealed sinus arrhythmia with complete heart block with a junctional escape rhythm and a ventricular rate of 43 bpm. The patient was in no apparent distress, and resting blood pressure was 80/50 mm Hg.

Acute reversible cardiomyopathy and thromboembolism after cisplatin and 5-fluorouracil chemotherapy--a case report.

Acute development of cardiomyopathy and occlusive thromboembolic events following cisplatin and 5-fluorouracil (5-FU) is rare but frequently lethal. The authors report the successful management of such an event in a 52-year-old man with squamous cell carcinoma of the soft palate. The possible pathophysiological mechanisms are discussed.

The lids influence on corneal shape.

Background: The lids are in contact to the corneal surface in normal viewing. Refractive surgery, however, is performed with a speculum in place and thus the lids are not in contact with the cornea.

Purpose: To investigate central corneal shape with and without the lids touching the corneal surface.

A mathematical model for laser in situ keratomileusis and photorefractive keratectomy.

Purpose: The purpose of ablation refractive surgery is to remove the refractive error from the inherently asymmetric aspheric cornea. Although the technique is gaining wide acceptance and popularity, some patients are left with irregular corneas. Our objective was to develop a methodology to analyze corneal shape, reduce the shape to arcs, modify the local arc value to the desired new arc value, and render a new continuous Euclidean surface without discontinuity.

Spiral computerized tomography and video thoracoscopy in catamenial pneumothorax.

Catamenial pneumothorax is a rare disease that is usually diagnosed on clinical grounds. Delay in diagnosis can lead to considerable morbidity. We describe a case in which spiral CT scan and videothoracoscopy led to early objective diagnosis and management.

An unusual case of multiple right atrial thrombi in a patient with a dual-chamber pacemaker--a case report.

The authors present an unusual case of multiple large atrial thrombi attached to permanent pacemaker leads identified by transesophageal echocardiography. Pathogenesis, clinical implications, and therapeutic options of pacemaker thrombi are discussed.

Ethnic and racial factors in cobalamin metabolism and its disorders.

A growing body of data indicates the importance of ethnic and racial factors to many clinical and scientific considerations of cobalamin metabolism and its disorders. Blacks have significantly higher cobalamin and transcobalamin (especially transcobalamin II) levels than whites. Because serum cobalamin levels are often influenced by factors unrelated to cobalamin intake, stores, or deficiency, it is unclear whether the differences in levels reflect cobalamin status or not.

Perceived value of the American Board of Surgery certificate: a survey of 2,000 Fellows of the American College of Surgeons.

Background: This study was undertaken to identify perceptions of surgeons of the value of the American Board of Surgery (ABS) certificate.

Study Design: Two-thousand Fellows of the American College of Surgeons received a 30-item survey designed to identify their demographics and their assessments of the functional and financial value of the certificate. Functional value was assessed using a 5-point scale in the areas of professional recognition, personal satisfaction, court proceedings, job security, mobility, and advancement, whether the certificate was necessary to obtain an academic or a clinical position, and whether it served as an indicator of depth or breadth of surgical knowledge or of clinical competence.