Parametric mapping of contrasted ovarian transvaginal sonography.

The purpose of this study was to assess the accuracy of parametric analysis of transvaginal contrast-enhanced ultrasound (TV-CEUS) for distinguishing benign versus malignant ovarian masses. A total of 48 ovarian masses (37 benign and 11 borderline/malignant) were examined with TV-CEUS (Definity; Lantheus, North Billerica, MA; Philips iU22; Philips Medical Systems, Bothell, WA). Parametric images were created offline with a quantification software (Bracco Suisse SA, Geneva, Switzerland) with map color scales adjusted such that abnormal hemodynamics were represented by the color red and the presence of any red color could be used to differentiate benign and malignant tumors.

Errors in administrative-reported ventilator-associated pneumonia rates: are never events really so?

Ventilator-associated pneumonia (VAP) is a common problem in an intensive care unit (ICU), although the incidence is not well established. This study aims to compare the VAP incidence as determined by the treating surgical intensivist with that detected by the hospital Infection Control Service (ICS). Trauma and surgical patients admitted to the surgical critical care service were prospectively evaluated for VAP during a 5-month time period.

Management of enteroatmospheric fistulae in the open abdomen.

There are few complications dreaded more by the general surgeon than the development of an enteroatmospheric fistula in the face of the open abdomen. The open abdomen has become a valuable tool in the treatment of trauma and complex surgical patients. The development of enteroatmospheric fistulae leads to increased cost, morbidity, and mortality.

Advancements in cardiopulmonary resuscitation: increasing circulation and improving survival.

Clinicians, as well as lay people, have realized the importance of resuscitative maneuvers throughout recorded history. Cardiopulmonary resuscitation has evolved from a relatively primitive technique to one now dictated by data from evidence based medicine. Recent advancements include changes in life support guidelines, the development of an impedance threshold device, and the initiation of therapeutic hypothermia.

Supplements and sports.

Use of performance-enhancing supplements occurs at all levels of sports, from professional athletes to junior high school students. Although some supplements do enhance athletic performance, many have no proven benefits and have serious adverse effects. Anabolic steroids and ephedrine have life-threatening adverse effects and are prohibited by the International Olympic Committee and the National Collegiate Athletic Association for use in competition.

A departmental experience in promoting oral and poster presentations.

Background: Residency programs must demonstrate resident and faculty involvement in scholarly activity. One acceptable method is delivering presentations at scientific meetings.

Description: A prospective database and retrospective search of all prior presentations.

Residency applicants misinterpret their United States Medical Licensing Exam Scores.

Proper interpretation of the results of the United States Medical Licensing Exam (USMLE) is important for program directors, residents, and faculty who advise applicants about applying for residency positions. We suspected that applicants often misinterpreted their performance in relationship to others who took the same examination. In 2005, 54 consecutive applicants to the University of Tennessee, College of Medicine internal medicine residency program were asked to complete a brief survey about their performance on Parts 1 and 2 of the USMLE exam.

Peer chart audits: a tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement.

Background: The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus.

Methods: A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004.

When race matters: disagreement in pain perception between patients and their physicians in primary care.

Patients and physicians often disagree in their assessment of pain intensity. This study explores the impact of patient factors on underestimation of pain intensity in chronic noncancer pain. We surveyed patients and their physicians in 12 primary care centers.

The simultaneous occurrence of deep vein thrombosis and pulmonary and arterial embolization.

Introduction: A 45-year-old female presented with 8 hours of right lower extremity pain and dyspnea. She was tachycardic and her right lower extremity was dusky, cold, and pulseless.

Discussion: Computerized tomography of the venous and arterial systems revealed massive pulmonary embolism and right lower extremity arterial and left lower extremity venous thromboses.

The Merci Retrieval System for acute stroke: the Southeast Regional Stroke Center experience.

Introduction: The Merci Retrieval System was cleared for use in patients with stroke in August 2004. However, there are few published results of "real world experience" with the device.

Methods: We captured single-center data on 25 consecutive patients with acute ischemic stroke treated with the Merci Retrieval System according to the MERCI trial except that we treated some patients with tandem proximal carotid and intracranial lesions with carotid angioplasty and stenting and some patients were treated within the 3-hour window.

Internal medicine residents do not accurately assess their medical knowledge.

Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown.

Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well accepted method to assess medical knowledge to study resident assessment accuracy. Ordinary least squares regression was used to study the association between the absolute accuracy of their predictions of their percentile performance on the ITE examination and their actual percentile performance.

An unusual presentation of methotrexate-induced B-cell lymphoma of the metacarpophalangeal joint: a case report and literature review.

We report a unusual presentation of B-cell lymphoma in the chronically inflamed synovium of a 64-year-old man with an 18-year history of rheumatoid arthritis that was treated with methotrexate.

Glucocorticoid rescue for late-phase acute respiratory distress syndrome in trauma/surgical critical care patients.

High-dose glucocorticoid therapy (GCT) for the late fibroproliferative phase of acute respiratory distress syndrome (ARDS) is controversial and has shown mixed results in medical patients. No studies have evaluated GCT in trauma/surgical critical care patients. The purpose of this study is to review the outcomes of trauma/surgical critical care patients with refractory ARDS treated with GCT.

No poinsettia this Christmas.

Poinsettia is one of the most delightful decorations during the Christmas season. Natural rubber latex and poinsettia share some common allergen proteins. Hence, people with latex allergy may develop cross-reactivity with poinsettia.

Management of a circumferential lower extremity degloving injury with the use of vacuum-assisted closure.

A 58-year-old male presented with a large circumferential degloving injury and was immediately taken to the operating room for further assessment of his wound. At that time, a plastic surgeon was consulted to manage the wound due to its size and significant soft tissue loss. The decision was made to manage the patient's wound with the vacuum-assisted closure (VAC) device to prepare the wound bed for grafting.

Elevated maternal serum alpha-fetoprotein, umbilical vein varix, and mesenchymal dysplasia: are they related?

Objectives And Methods: Variceal dilatation of the umbilical vein is a rare vascular anomaly of the umbilical cord. We present a patient case where dilatation of the umbilical vein was associated with an elevated maternal serum alpha-fetoprotein on prenatal testing and mesenchymal dysplasia on pathological evaluation of the placenta.

Results: Alterations in the villous structure of the placenta as in mesenchymal dysplasia may lead to increased placental permeability causing an elevated maternal serum alpha-fetoprotein on antenatal testing.

Refractory hypoxemia in right ventricular infarction: a case report.

Right ventricular infarction has many clinical features. Although hypoxemia is a common presenting symptom with multiple causes in the setting of myocardial infarction, the authors present a case resulting from an acute right-to-left shunt secondary to a previously dormant patent foramen ovale. A 74-year-old male presented to the hospital after feeling unwell for the previous 2 days.

A 5-year experience with influenza prevention and containment in a program of all-inclusive care for elderly adults.

Background: Influenza causes mortality and morbidity in the frail elderly population. Influenza prevention and mitigation models need to be developed for this population.

Methods: An observational study at a Program for All-Inclusive Care for the Elderly (PACE) during years 1999-2004.

Public perceptions of alcohol use by physicians.

Objectives: The objective of this study was to assess public perceptions of alcohol use by physicians on duty.

Methods: A random telephone survey of 408 adults in one Tennessee county was used.

Results: Only 1% of the respondents reported that they suspected that a physician with whom they were in professional contact during the last year had used alcohol.

A guide to assessing decision-making capacity.

Many patients have uncertain capacity to make decisions about their care. Determining whether a patient possesses decision-making capacity challenges even the most seasoned of physicians. We illustrate an algorithm devised by Miller and Marin (Emerg Med Clin North Am 2000; 18:233-241) that assesses the patient's understanding of his or her condition, ability to process information, and stability of decision-making to determine whether he or she possesses adequate decision-making capacity.

A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members.

Objective: The goal of this survey was to establish a benchmark for trauma surgeons' level of operational understanding of the command structure for a pre-hospital incident, a mass casualty incident (MCI), and weapons of mass destruction (WMD). The survey was distributed before the World Trade Center destruction on September 11, 2001.

Methods: The survey was developed by the authors and reviewed by a statistician for clarity and performance.

The application of statistical process control to horizontal strabismus surgery.

Purpose: Although originally developed to evaluate quality in manufacturing, statistical process control (SPC) techniques may be applicable to other frequently performed standardized processes. SPC analysis has rarely been used in medicine. We employed SPC charts to analyze the outcomes of one- and two-muscle horizontal strabismus surgery for esotropia and exotropia.