Management of blunt peripheral arterial injury.

The recognition of blunt vascular injury has increased in recent years due to an improved understanding of blunt mechanical forces, mechanisms of injury, and awareness that such injuries are often occult. This has been aided by improved quality and expanded availability of noninvasive studies. As a result, outcomes following blunt vascular injury have improved.

Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction.

Objectives: The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia.

Methods: We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature.

Urogynecology practice patterns among Air Force obstetricians and gynecologists: survey results.

The objective of this study was to describe the practice patterns of physicians in the United States Air Force regarding the evaluation and treatment of female pelvic floor disorders including urinary incontinence and pelvic organ prolapse. A self-administered survey of 22 questions was electronically mailed to all active duty Air Force obstetricians & gynecologists. Fifty-one surveys were returned for a 51% response rate.

Cyclic stretch attenuates effects of hyperoxia on cell proliferation and viability in human alveolar epithelial cells.

The treatment of severe lung disease often requires the use of high concentrations of oxygen coupled with the need for assisted ventilation, potentially exposing the pulmonary epithelium to both reactive oxygen species and nonphysiological cyclic stretch. Whereas prolonged hyperoxia is known to cause increased cell injury, cyclic stretch may result in either cell proliferation or injury depending on the pattern and degree of exposure to mechanical deformation. How hyperoxia and cyclic stretch interact to affect the pulmonary epithelium in vitro has not been previously investigated.

Emergencies in adolescents: management guidelines for four presentations.

The cases presented in this article are representative of adolescent emergencies that may be encountered by the office practitioner. Many more examples in the area of adolescent gynecology could have been presented, including ectopic pregnancy and pelvic inflammatory disease. Substance abuse issues will be addressed in the second part of this topic, which will be published in the December 2005 issue of Pediatric Annals.

Use of porcine small intestinal submucosa in Ehlers-Danlos syndrome Type IV.

Ehlers-Danlos syndrome (EDS) Type IV results in inadequate production of type III collagen and can lead to devastating vascular, gastrointestinal, and uterine complications. A case is presented of spontaneous colonic perforation in a patient with EDS Type IV complicated by multiple intestinal fistulas managed with porcine small intestinal submucosa. Early success with this technique would suggest additional applications in a variety of complicated gastrointestinal problems.

Lateral gluteal myonecrosis in a patient undergoing partial nephrectomy in the modified flank position.

This is the first report of postoperative rhabdomyolysis occurring in a patient positioned in the "modified flank position," with the kidney rest positioned under the top of the iliac crest. The patient was treated with aggressive intravenous fluid hydration and hyperbaric oxygen therapy with maintenance of normal renal function and near complete recovery of gluteal muscle function.

CT and MR imaging characteristics of intravestibular lipoma.

Background And Purpose: Intracranial lipomas are uncommon congenital malformations that most often are asymptomatic. A rare subset of intracranial lipomas arises within the vestibule of the inner ear, which can cause sensorineural hearing loss. We present the CT and MR imaging characteristics of lipomas within the vestibule of the inner ear and propose a pathogenetic mechanism for this malformation.

Thymectomy for Myasthenia Gravis.

No Class I studies of the effectiveness of thymectomy for myasthenia gravis (MG) have been performed. Most Class II studies comparing outcomes in MG patients with and without thymectomy demonstrated higher MG remission and improvement rates in patients undergoing thymectomy. However, these Class II studies were also consistently confounded by important differences between MG patients in surgical and nonsurgical groups.

Cesarean scar endometriosis. A report of two cases.

Background: Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment.

Development of antibodies to topical bovine thrombin after abdominal hysterectomy. A case report.

Background: Topical thrombin spray is frequently used as a hemostatic agent in surgery, particularly following cardiovascular, orthopedic and neurologic surgery. Acquired coagulation factor inhibitors to thrombin and factor V may develop following gynecologic surgery with repeat topical thrombin use.

Case: A 45-year-old woman underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy.

Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair.

Background: The laparoscopic repair of inguinal hernias remains a controversial subject. Advantages in terms of reduced postoperative pain and improved functional status have been demonstrated in some studies and refuted in others. We performed a prospective study of a group of young healthy patients to measure pain levels and time to return to normal activity following totally extraperitoneal laparoscopic (TEP) hernia repair and compared these outcomes to those seen following conventional anterior repair.

Placenta increta/percreta associated with uterine perforation during therapy for fetal death. A case report.

Background: Placenta accreta involves abnormal adherence of the placenta to the myometrium. Placenta increta and percreta are defined by the degree of trophoblastic penetration of the myometrium. These conditions are rarely observed in the first trimester; placenta increta and percreta are exceptionally infrequent.

Melanosis of the vagina. A case report.

Background: Melanosis is a term given to lesions in which melanin pigment is confined to the basal layer of squamous epithelium and on visual inspection may have an appearance similar to that of malignant melanoma. Although relatively common in the oral and gastrointestinal tract, melanosis is an uncommon finding in the female genital tract and especially rare in the vagina; most reported cases have been vulvar.

Case: A 43-year-old, nulliparous woman was noted to have a pigmented lesion at the vaginal cuff during a routine annual examination one year after a hysterectomy.

Recurrence of dysplasia after loop electrosurgical excision procedures with long-term follow-up.

Objective: The aim of this study was to determine the rates of recurrent dysplasia with longer follow-up durations and to determine whether margin status and other variables were associated with recurrence.

Study Design: A retrospective chart review was performed for all women who underwent a loop electrosurgical excision procedure at Wilford Hall Medical Center, Lackland Air Force Base, Texas, between January 1993 and December 1994. Extracted information included age, parity, indication for the loop electrosurgical excision procedure, histologic classification of the loop electrosurgical excision procedure specimen, margin status, and whether a "deep" (endocervical) pass had been performed.

Anterior cruciate ligament reconstruction in an 84-year-old man.

Anterior cruciate ligament (ACL) reconstruction is typically reserved for younger patients. Several recent articles have reported expanding traditional age barriers for ACL reconstruction in patients up to 62 years old. We report a case of a successful ACL reconstruction in an active 84-year-old rancher.

Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report.

Background: Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus.

Imaging techniques for the evaluation of glenohumeral instability.

The ability to image lesions associated with glenohumeral instability has evolved significantly over the past 2 decades. In the past, several imaging techniques ranging from conventional radiography to computerized axial arthrography and, most recently, to magnetic resonance imaging have been used to depict various labral abnormalities. In most instances, conventional radiography remains the initial imaging study for evaluating the patient with persistent shoulder pain and instability.

Oxygen induces S-phase growth arrest and increases p53 and p21(WAF1/CIP1) expression in human bronchial smooth-muscle cells.

Hyperoxia increases free radical production, leading to DNA damage. Recent studies indicate that oxygen augments the expression of p53 and p21(WAF1/CIP1), and increases apoptotic labeling of airway epithelial cells. Similar changes in regulatory gene products have not been reported in other pulmonary cells, nor have these changes been investigated in conjunction with alterations in cell-cycle distribution.

Perianal lymphoma in a heterosexual and nonimmunocompromised patient: report of a case and review of the literature.

Purpose: This study was conducted to report a rare case of anorectal pathology.

Methods: We report a case of perianal lymphoma in a nonimmunocompromised, heterosexual patient and review the literature.

Results: A 67-year-old white male was found to have an ulcerated posterior anal mass.

Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance.

The case of a 59-year-old man with chronic lateral ankle pain following an inversion injury is presented. MR imaging performed to evaluate for soft tissue injury revealed an unsuspected fracture of the lateral process of the talus. The patient underwent surgical exploration of the fracture with debridement of adjacent loose bodies and is currently undergoing aggressive physical rehabilitation.

"Cigar Wrap" technique for gracilis augmentation in hamstring anterior cruciate ligament reconstruction.

The use of Hamstring grafts for anterior cruciate ligament reconstruction is becoming increasingly popular. Most surgeons use a four-stranded graft consisting of double-stranded semitendinosus and gracilis tendons. The gracilis tendon, in addition to being smaller in diameter, is often shorter and more diminutive at its muscular end.

The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation.

Objective: The purpose of this study was to describe the MR arthrography appearance of the glenolabral articular disruption (GLAD) lesion. Proper diagnosis of this lesion is important because it can be a source of persistent shoulder pain that requires surgical repair and because it is often difficult to diagnose clinically.

Materials And Methods: Findings on MR arthrography were retrospectively correlated with the clinical histories and physical examination findings of six patients in whom we saw the typical appearance of the GLAD lesion.

Emergency intravascular ultrasound to locate a stent during primary angioplasty.

A 62-year-old man underwent primary PTCA with bail-out stent placement for an acute anterior wall myocardial infarction. After initial deployment of one half of a Palmaz-Schatz stent, the stent could not be visualized fluoroscopically. Emergency intravascular ultrasound (IVUS) showed the stent to be located proximal to the intended site of deployment.