The effect of fibrin sealant on the strength of tendon repair of full thickness tendon lacerations in the rabbit Achilles tendon.

The influence of fibrin sealant on healing was investigated in the suture of Achilles tendons of 24 rabbits. The Achilles tendon cut through was anastomosed with a 4-0 prolene suture alone in one group and fibrin sealant was applied to the cut surfaces of the tendon prior to suture repair in the second group. After 17 and 27 days, five animals in each group were sacrificed.

Laparoscopic cholecystectomy in the pregnant patient.

Laparoscopic cholecystectomy has rapidly replaced open cholecystectomy as the preferred surgical treatment of symptomatic cholelithiasis. Although the indications are similar for both procedures, some surgeons believe that pregnancy is a contraindication for the laparoscopic approach. Several recent reports in the literature have shown that laparoscopic cholecystectomy can be performed safely in the pregnant patient.

Failure of acute perinatal asphyxia or meconium aspiration to produce persistent pulmonary hypertension in a neonatal baboon model.

Objective: Our purpose was to determine whether perinatal asphyxia or meconium aspiration, or both, can produce the physiologic and histologic pulmonary vascular changes associated with the meconium aspiration syndrome.

Study Design: Twenty neonatal baboons were studied in four groups: 1, control; 2, meconium aspiration; 3, asphyxia (intermittent cord compression); and 4, asphyxia with meconium aspiration. Animals were ventilated for 24 hours under ketamine, diazepam, and pancuronium.

Cholesteatoma in children.

Cholesteatoma in children is a particularly difficult disorder because of the special developmental issues unique to the age group and the long-term follow-up implications of surgical changes to the ear. The two basic controversies are canal-wall-up versus canal-wall-down surgery, and staged versus single-stage surgery. No single philosophy is applicable to all children with cholesteatoma.

High-dose oxytocin: 20- versus 40-minute dosage interval.

Objective: To determine whether an increase in the oxytocin dosing interval would decrease the incidence of uterine hyperstimulation.

Methods: This study included 1801 consecutive pregnancies receiving high-dose oxytocin. Oxytocin was used for labor augmentation in 1167 and induction in 634 women.

Vascular grafts in head and neck reconstructive surgery.

The best management of advanced head and neck tumors invading the carotid artery utilizes a collaborative, anticipatory approach. Preoperative characterization of the anatomy and extent of tumor involvement, coupled with the physiologic assessment of the cerebrovascular circulation through the variety of adjunctive studies, facilitates operative planning. Careful preoperative evaluation allows the surgeon to make the most informed decision regarding extracranial carotid artery reconstruction, should carotid artery resection be required for adequate tumor removal.

Soft-tissue response to synthetic biomaterials.

The soft-tissue response to an implanted synthetic material is an inflammatory reaction to foreign body; factors that minimize this inflammation will maximize biocompatibility. The ideal implant is selected from a material that is non-toxic, nonantigenic and in chemical proximity to calcium or carbon on the periodic table. If it is porous, the pores should be large enough to admit immune and phagocytic cells and ideally, to allow native tissue ingrowth.

The effect of immunotherapy on the cutaneous late phase response to antigen.

Background: This study used the skin chamber model to evaluate prospectively the effect of immunotherapy (IT) on the cutaneous early and late phase response (LPR) to epicutaneous antigen challenge.

Methods: Nine subjects with allergic rhinitis were studied at three time points: before starting IT, after 3 months of IT, and after 6 months of IT. Skin chamber histamine content was measured hourly for 12 hours, and cell counts performed hourly during hours 6 to 12.

Improving the quality of emergency medicine rotation/clerkship evaluations.

The process of evaluating the performance of medical students and/or residents during emergency medicine clinical rotations is constrained by several potential shortcomings. These constraints can limit the quality of the information provided to the student/resident, as well as that provided to the sponsoring institution. During the course of an academic year at United States Air Force Medical Center, Wright-Patterson, a number of medical students, interns, and residents rotate through the emergency department.

Meconium-stained amniotic fluid and respiratory complications: impact of selective tracheal suction.

Objective: To determine prospectively the incidence of several pulmonary diagnoses among infants born through clear or meconium-stained amniotic fluid (AF) managed by a selective approach to tracheal intubation.

Methods: All live births greater than 36 weeks' gestation occurring between January 1990 and December 1992 were included. Diagnostic criteria for several respiratory disorders were determined prospectively and monitored.

Handlebar problems in bicycling.

Handlebar problems are common among serious bicyclists. Compression neuropathy, more commonly ulnar than median, is frequent but seldom produces permanent injury or deficit if promptly recognized and managed by attending to bicycle fit, energy-absorbing gloves and handlebar treatments, and cycling technique. Overuse symptoms may be seen if bicycle design and fit couple with repetitive motion to aggravate wrist tendons or connective tissues of the neck and shoulder.

The use of electrosurgical techniques in the management of premalignant diseases of the vulva, vagina, and cervix: an excisional rather than an ablative approach.

In recent years electrosurgical excision techniques have been advocated for the evaluation and treatment of premalignant diseases of the vulva, vagina, and cervix. Technologic advances in electrosurgical generators and in fine wire loops have made these techniques feasible in the outpatient setting, and considerable experience has been accumulated in Europe and the United States. This article discusses the advantages and disadvantages of this "new" technology with emphasis on the available scientific literature.

An 11-year-old girl with a left-ankle injury.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on this page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Pulmonary eosinophils express HLA-DR in chronic eosinophilic pneumonia.

Background: Chronic eosinophilic pneumonia is a rare idiopathic disorder. role the eosinophil plays in the pathogenesis of this disease is unknown. The recent finding that nature eosinophils can express the class II major histocompatibility complex molecule HLA-DR suggests an immunologic role, perhaps through antigen presentation.

Karyotypic abnormalities and hydramnios. Role of amniocentesis.

Hydramnios complicates up to 1.6% of pregnancies, with major fetal malformations found in an average of 20% of patients with hydramnios. Chromosomal abnormalities, although associated with some conditions in which hydramnios is present, have not been reported to complicate a significant percentage of hydramnios cases.

Induction of human neonatal pulmonary fibroblast cytokines by hyperoxia and Ureaplasma urealyticum.

Multiple insults may induce bronchopulmonary dysplasia (BPD) in premature infants, including the recently reported association of BPD with neonatal Ureaplasma urealyticum colonization. One mechanism of damage could involve stimulation of proinflammatory cytokine release from pulmonary fibroblasts. We therefore compared the effects of U.

Loss of external rotation following anterior capsulorrhaphy of the shoulder.

A retrospective study was performed on twenty shoulders in nineteen patients who had been managed for severe loss of external rotation of the glenohumeral joint after a previous anterior capsulorrhaphy for recurrent instability. All patients had noted a restricted range of motion, and seventeen shoulders had been painful. In seven shoulders, the humeral head had been subluxated or dislocated posteriorly, and sixteen shoulders had been affected by mild to severe glenohumeral osteoarthrosis.

Volar carpal ligaments of the wrist: normal appearance on multiplanar reconstructions of three-dimensional Fourier transform MR imaging.

Objective: Three-dimensional Fourier transform MR imaging techniques can produce much thinner contiguous slices than are obtainable with standard two-dimensional Fourier transform MR imaging techniques. The improved spatial resolution and capabilities for interactive multiplanar displays allow better visualization of small, complex anatomic structures, such as the carpal ligaments. The purposes of this study were twofold: (1) to determine if the volar carpal ligaments can be consistently visualized when using three-dimensional Fourier transform MR imaging techniques with multiplanar reconstructions and (2) to evaluate the size, shape, orientation, and right-to-left symmetry of the volar carpal ligaments in both wrists of 25 asymptomatic volunteers as a basis for future comparison when patients with suspected ligament injuries are seen.

Functional characteristics of enterocystoplasty after interruption of the mesenteric blood supply.

Previous studies have suggested that small (5 to 7 cm.) enteral patches used for bladder augmentation could remain viable following ligation of the mesenteric vascular pedicle. We performed subtotal cystectomy and ileocystoplasty in 5 female mongrel dogs using a 25 cm.

Dorsal carpal ligaments of the wrist: normal appearance on multiplanar reconstructions of three-dimensional Fourier transform MR imaging.

Objective: Three-dimensional Fourier transform MR imaging techniques can produce much thinner contiguous slices than are obtainable with standard two-dimensional Fourier transform MR imaging techniques. The improved spatial resolution and capabilities for interactive multiplanar displays allow improved visualization of small, complex anatomic structures such as the carpal ligaments. The purposes of this study were twofold: (1) to determine if the dorsal carpal ligaments can be visualized consistently with three-dimensional Fourier transform MR imaging techniques with multiplanar reconstructions and (2) to evaluate the size, shape, orientation, and right-to-left symmetry of the dorsal carpal ligaments in both wrists of 25 asymptomatic volunteers as a basis for future comparison when patients with suspected ligament injuries are seen.

Sudden death in a young adult: sequelae of childhood Kawasaki disease.

A case of sudden cardiac death in a young adult secondary to sequelae of childhood Kawasaki disease is presented. At autopsy, proximal coronary artery aneurysms typical of Kawasaki disease with recent and remote myocardial infarction was found. Although the acute diagnosis and management of Kawasaki disease has received attention in recent literature, little has been written about the implications of the disease in long-term survivors.

Successful oral acyclovir desensitization.

A 65-year-old woman with the acquired immunodeficiency syndrome (AIDS) complicated by recurrent mucocutaneous herpes simplex virus (HSV) infection developed angioedema on the initiation of her second course of oral acyclovir therapy. Oral rechallenge in hospital three days later confirmed acyclovir hypersensitivity. Vidarabine and foscarnet therapies were abandoned after treatment failure and unacceptable toxicity.

Acute superior vena cava syndrome after central venous catheter placement.

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. Acute cases of SVC syndrome have been described, with the majority of these being precipitated by thrombosis after central venous catheterization. The authors report a case of acute SVC syndrome after central venous catheter placement, which was not due to thrombosis, but rather caused by a catheter occluding a previously subclinical stenosis of the SVC.