Complications of needle thoracostomy: A comprehensive clinical review.

Needle thoracostomy (NT) is a valuable adjunct in the management of tension pneumothorax (tPTX), a life-threatening condition encountered mainly in trauma and critical care environments. Most commonly, needle thoracostomies are used in the prehospital setting and during acute trauma resuscitation to temporize the affected individuals prior to the placement of definitive tube thoracostomy (TT). Because it is both an invasive and emergent maneuver, NT can be associated with a number of potential complications, some of which may be life-threatening.

Cessation of hairline recession following open forehead rejuvenation.

Background: The senior author (B.G.) observed that patients who underwent forehead rejuvenation using a pretrichial incision did not experience hairline recession.

An unusual form of superficially disseminated glioma in children: report of 3 cases.

Three children, aged 4, 5, and 9 years, had an insidious onset of ataxia. Magnetic resonance imaging (MRI) showed hydrocephalus and countless foci of high T2 signal coating the cerebellum, basilar cisterns, brainstem, and fourth ventricle. Similar lesions were present in the spinal cord.

Technique for preservation of penile skin in genital reconstruction: free graft to the scrotum.

Objective: To describe a new technique to preserve the penile epithelium with good cosmetic results when additional surgery is a significant possibility. Complex genital reconstruction can require multiple procedures.

Methods: Seven patients underwent grafting of the penile epithelium to the scrotum during genital reconstruction to bank the tissue for potential future use.

Real-time ultrasound elasticity of the breast: initial clinical results.

Purpose: To determine the sensitivity and specificity of a real-time elasticity imaging (EI) ultrasound (US) system in the characterization of breast lesions as benign or malignant.

Methods: A total of 208 patients with 251 lesions were scheduled to undergo a US-guided breast biopsy for a mass identified on B-mode US, and each received a real-time elasticity image of the lesion before the biopsy. The lesion size measurements were obtained, and the EI/B-mode size ratio was obtained.

Aeroallergen sensitization in healthy children: racial and socioeconomic correlates.

Objective: Allergic sensitization is very prevalent and often precedes the development of allergic disease. This study examined the association of race with allergic sensitization among healthy children with no family history of atopy.

Study Design: Two hundred seventy-five children, predominantly from lower socioeconomic strata, from Cincinnati, Ohio, ages 2 to 18 years without a family or personal history of allergic diseases, underwent skin prick testing to 11 allergen panels.

The cardiomyopathy of iron deficiency.

Iron-deficiency anemia can have deleterious effects on the heart. Herein, we describe the effects of iron deficiency on the heart as corroborated with electrocardiography, radiology, echocardiography, and cardiac catheterization. We review the pathophysiology, clinical features, and management of iron-deficiency-induced cardiomyopathy.

Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.

The American Diabetes Association recommends routine screening for albuminuria to detect early nephropathy in all patients with diabetes mellitus. If nephropathy is identified, treatment with an antiangiotensin agent decreases progression and improves renal outcomes. Concordance with guidelines for nephropathy screening and antiangiotensin therapy among diabetic patients in a primary care setting of an academic community medical center was evaluated.

Infliximab-induced headache and infliximab-induced meningitis: two ends of the same spectrum?

This report describes a case of aseptic meningitis induced by the tumor necrosis factor-alpha inhibitor infliximab. The patient, a 51-year-old female, was being treated for Crohn's disease. After an infliximab infusion, she had headache, fever, arthralgia, myalgia, and meningismus.

Shortness of breath, syncope, and cardiac arrest caused by systemic mastocytosis.

During a 3-month period, a 33-year-old man presented to the emergency department on 4 occasions with dyspnea, palpitations, and syncope. His initial presentation was accompanied by acute myocardial injury and ventricular fibrillation. An extensive evaluation spanned the 3 months and included echocardiography, cardiac catheterization, electrophysiology study, tilt-table evaluation, pulmonary angiography, electroencephalography, and serum and urine analysis.

Bacterial Pyomyositis.

Bacterial pyomyositis has been defined as a subacute, deep bacterial infection of the soft tissues. The entity was originally described only in tropical climates, but it is increasing in incidence in temperate climates, such as in the United States. This is mainly attributed to the presence of immunocompromising states such as HIV/AIDS or liver disease.

Comparative antiplatelet activity of COX1 NSAIDS versus aspirin, encompassing regimen simplification and gastroprotection: a call for a controlled study.

This study was conducted to assess the feasibility of COX1 NSAID substitution for aspirin for preventative therapy related to circulating anticoagulants, as manifest by inhibition of platelet aggregation. There was no difference in platelet aggregation inhibition between aspirin, naproxen, ketoprofen or diclofenac and misoprostol (in combination in the form of Arthrotec). As COX1 NSAIDs appear equivalent in platelet inhibition efficacy to aspirin, therapeutic regimens can be simplified in those individuals who require an NSAID for other problems.

Origins of spondyloarthropathy in Perissodactyla.

Objective: Spondyloarthropathy has clearly been documented as not limited in occurrence to humans. Transmammalian in nature, it is of interest to understand the antiquity, and perhaps the origins, of this disorder in animal groups sufficiently represented in the skeletal record.

Methods: Fossil and recent skeletons of perissodactylae from North America were systematically examined to determine the occurrence and population frequency of spondyloarthropathy.

Do facet joint capsular ligaments contain estrogen receptors? Application to pathogenesis of degenerative spondylolisthesis.

Studies showing that degenerative spondylolisthesis is 4 to 5 times more common in females than in males have suggested that hormonal influences account for this gender difference. Estrogen has been shown to play a role in other instabilities, such as those of the anterior cruciate ligament and the shoulder capsular ligaments, and estrogen receptors have been identified in these tissues. We wanted to assess facet joint capsular ligaments for the presence of such receptors.

Persistently positive culture results in a patient with community-acquired pneumonia due to Legionella pneumophila.

We describe a patient with community-acquired pneumonia due to Legionella pneumophila serogroup 6. This patient was found to have bronchoalveolar carcinoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar lavage samples, but no lesions were visible on bronchoscopy. Despite intravenous administration of azithromycin to the patient, repeat culture and polymerase chain reaction showed persistence of Legionella; the isolates remained susceptible to azithromycin.

A comparison of costs associated with screening for gestational diabetes with two-tiered and one-tiered testing protocols.

Objective: The Fourth International Workshop on Gestational Diabetes recently suggested that two techniques, a 2-tiered protocol and a 1-tiered protocol, to screen for gestational diabetes mellitus are acceptable alternatives. This study was undertaken to compare the direct costs and patient time expenditures associated with implementing both techniques.

Study Design: A MEDLINE search was undertaken to determine the prevalence of positive and negative screening results.

Legionella.

Since the identification of Legionella two decades ago, a vast amount of information has accumulated concerning the microbiology, clinical manifestations, and therapy of infections due to these organisms. There are now more than 40 species of Legionella identified. The spectrum of legionellosis ranges from asymptomatic infection to serious pneumonia.

Using O2 to probe membrane immersion depth by 19F NMR.

A fluorinated detergent, CF(3)(CF(2))(5)C(2)H(4)-O-maltose, was reconstituted into a lipid bilayer model membrane system to demonstrate the feasibility of determining solvent accessibility and membrane immersion depth of each fluorinated group by (19)F NMR. Apolar oxygen, which is known to partition with an increasing concentration gradient toward the hydrophobic membrane interior, exhibits a range of paramagnetic relaxation effects on (19)F nuclei, depending on its depth in the membrane. This effect, which is predominately associated with spin-lattice relaxation rates (R(1)) and chemical shifts, can be amplified greatly with minimal line broadening by increasing the partial pressure of O(2) at least 100-fold (i.

Laparoscopic port site implantation with ovarian cancer.

We report the cases of 3 patients in whom tumor implantation developed at the port site at which ovarian cancer was removed laparoscopically. The 3 patients, who were aged 30, 32, and 40 years, all had an ovary that did not appear cancerous removed by laparoscopy through a port site. All 3 patients underwent re-exploration within 3 weeks and were found to have tumoral spread and port site implantation of tumor.

Spondyloarthropathy identified as the etiology of Nubian erosive arthritis.

Slight variation in manifestation of different diseases may allow a single individual with one disease to mimic the "classic" appearance of another, as evidenced by the frequent confusion of spondyloarthropathy with rheumatoid arthritis. Analysis of population occurrence of arthritis (rather than isolated skeletons) facilitates more precise diagnosis. Northeast Africans living around 2,000 years before present were clearly afflicted with a form of spondyloarthropathy.

Uninstrumented posterolateral lumbar fusion for single level isolated disc resorption and/or degenerative disc disease.

The limited soft-tissue envelope technique for an uninstrumented single-level posterolateral lumbar fusion has been studied in a group of 23 patients. It resulted in a solid fusion in 21 of 23 (91%) patients. Overall, 18 of 23 (78%) patients had a satisfactory outcome to this fusion technique, which can be performed in any community-based hospital.

Clues potentially distinguishing lytic lesions of multiple myeloma from those of metastatic carcinoma.

This study was conducted to determine whether individual bony lesions are specific for recognizing multiple myeloma and thereby distinguish it from metastatic cancer and leukemia. The lytic skeletal lesions of multiple myeloma are characterized by sharply defined, spheroid lesions. They have smooth borders and effaced/erased trabeculae.