The last decade has witnessed a burgeoning interest in case management services to people with severe mental illness. While the literature on case management is proliferating, there remains a paucity of rigorously designed outcome research. This paper provides a methodological review of that outcome research on case management, which found ...

Lumbar disc prolapse managed surgically is occasionally complicated by a recurrent ipsilateral prolapse of the residual disc material at the same level, but only rarely by prolapse on the contralateral side at that level. We present a case of the latter, successfully managed by a second microdiscectomy, and review the ...

A case of tracheal agenesis diagnosed at birth is discussed in which surgical correction was attempted. Both main bronchi were divided and anastomosis of the main right bronchus to the larynx was attempted, after intrapericardial release of the right lung and severing of the lower pulmonary ligament: bronchoplastic reconstruction of ...

Emphysematous pyelonephritis is an uncommon and serious infection associated with gas-forming coliform bacteria. Bilateral involvement is rare with only 10 reported cases in the English literature. Prompt and aggressive management is required to salvage these patients. Preservation of renal function using broad-spectrum antibiotics and surgical drainage provide the greatest benefit ...

The authors present an unusual case of polydactyly of the foot in an otherwise healthy adult male. The modern literature describing polydactyly of the foot is reviewed, as well as a review and critique of various classification schemes for foot polydactyly deformities. The authors applied the classification criteria of Blauth ...

Five cases of symptomatic cavernous angioma involving the brainstem are reported. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indication. All cases were treated by radical extirpation. All of them improved postoperatively. The surgical indications for this lesion of the brainstem are briefly discussed ...

Untreated pontine hematoma is always fatal, while surgical evacuation is effective and safe. After surgical intervention, immediate improvement and full or nearly full recovery may be observed. In this report, three successfully removed pontine hematomas are presented. The cause of this pathological entity, surgical interventions and their results are discussed ...

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease ...

Condylectomy accompanied by either simultaneous or postponed surgical correction of facial asymmetry is the treatment of choice in cases of condylar hyperplasia in its active stage. However, spontaneous remodeling processes in facial structures following the elimination of an actively growing hyperplastic condyle may bring about improvement in symmetry without further ...

Nonoperative salvage of a surgically resistant case of established nonunion of a fracture of the lateral condyle of the humerus in a child is described. Solid union was achieved by treatment with pulsed electromagnetic fields. A review of the literature indicates that this is the first published report of such ...

A bleeding diathesis need not be a contra-indication to elective surgical correction of facial deformities. Preoperative haemostatic assessment and management of haemostasis during and after surgery is described. Two cases of mild von Willebrand's disease and one case of factor XI deficiency who successfully underwent orthognathic surgery for the correction ...

We report a case of pyoderma gangrenosum presenting as Fournier's gangrene. Although both processes have a similar presentation effective management is markedly different. Whereas broad-spectrum antibiotics and aggressive surgical débridement are necessary to control Fournier's gangrene, immediate institution of corticosteroids and local wound care are indicated for pyoderma gangrenosum.

Rectal prolapse is not a common surgical disorder. The complication reported here, of evisceration of small bowel through a prolapsed rectum, is extremely rare and is the first case reported in the West Indies. Some of the features of rectal prolapse are described, and the surgical management of this particular ...

Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method.

Management of bites requires both local wound and systemic considerations. The authors will highlight their experience in 32 cases. Interestingly in this series, human bites were more common than animal bites. The bacteriology, antimicrobial therapy, and surgical treatment of human and animal bites will be reviewed. A management protocol that ...

Hemophilic pseudotumor of bone is a rarely encountered lesion associated with hemophilia. To date, only eight cases in the mandible have been reported in the literature. A rare case occurring in the mandible of a 2 1/2-year-old child required the fabrication of a customized wound obturator for postoperative wound care ...

The clinical experience of a patient with a large exostosis who had a chief complaint of difficulty in opening the mouth is reported. Radiographic examinations, especially tomography and a CT scan, were useful in the diagnosis. Surgical removal is the treatment of choice. The lesion is usually approached by a ...

Two nursing home patients with difficulty breathing because of occlusion of the mouth and nares by an involuntary snout reflex-like mannerism have previously been described. In both cases advanced dementia, edentia, and a downward-angled nasal base were present. Life-threatening hypoxia occurred intermittently in one case, and after becoming severe, was ...

A case of facial palsy with lagophthalmos with exposure keratitis was corrected surgically by a method of temporalis transfer. When the slings were tightened leaving 1 cm gap in the palpebral aperture, lagophthalmos persisted. A secondary tightening procedure causing overlap of the upper lid over the lower yielded good results.

The authors have developed a menu-driven dBASE III system for surgical pathology reporting and encoding in Systematized Nomenclature of Medicine (SNOMED). The system requires no knowledge of dBASE and is readily installed on any IBM-standard personal computer equipped with a fixed disk. The use of dBASE memo fields provides the ...

We report the case of a 22-year-old parturient with myotonia dystrophica. She underwent two separate intraabdominal surgical procedures in one day, both under lumbar epidural anaesthesia. Management was directed toward prevention of shivering, a known trigger of myotonic crises. Measures used included warm ambient atmosphere, warmed IV fluids, warming blankets ...

Fournier's gangrene, or synergistic gangrene of the male external genitalia is a rapidly spreading necrotising infection of the penis and scrotum. Although not so frequent in our civilized world it is by no means rare. In early days it was characterised by a high mortality. Aggressive surgical debridement, broad spectrum ...

The history of mandibulotomy is reviewed. The surgical steps involved and the variations of techniques are discussed. Two illustrative cases are reported and the clinical applications of the approach are discussed. It is concluded that mandibulotomy has a place in the management of malignancies as well as awkwardly situated benign ...

This paper describes the diagnostic investigations and surgical treatment of a patient with bilateral lesions of the petrous apices. Many surgical methods were considered before choosing one that would allow simultaneous drainage and hearing preservation. A transsphenoidal, transclival route was used and the surgical goals achieved. A review of the ...

The rarity of sternal tumors makes a good comparative study a difficult task. Controversies exist on questions of method of surgical diagnosis, the extent of the surgical procedure, and the different ways and means of reconstruction. We describe a case that was believed to be a clear case of chondrosarcoma ...

Children between 6 and 8 years of age with metatarsus adductus deformity have been considered to be in the gray zone for surgical correction. Should osseous or soft tissue procedures be implemented to reduce the adducted attitude of the metatarsals? The literature clearly describes one or the other and the ...

Mediastinitis is not a new disease, however, the occurrence was rare especially in children. Focal infection, which considered to be insignificant, can result in diffuse dissemination involving mediastinum leading to fatal condition. This paper reported a case of mediastinitis with very critical condition. Fast and accurate diagnosis as well as ...

The term VMR is used to describe a nonimmunologic, noninfectious, chronic type of rhinitis without nasal eosinophilia. The causes are diverse and, in many cases, never identified. Before the diagnosis of VMR can be made, AR and ENR must be ruled out. A thorough history and physical examination in association ...

Ligation under controlled hypotension is a simple, quick and effective surgical management of patent ductus arteriosus. In this study 413 cases are reviewed: clinical presentations, cardiac catheterization and operative findings are studied in relation to the surgical procedures. Ligation of the ductus was the treatment of choice in 357 cases ...

A modification of the commonest surgical procedure to restore Abduction-Rotation using the flexor superficialis transfer with Y-insertion is described. The modification consists of doing a triple insertion at the thumb instead of Y-insertion. After introducing the triple insertion the procedure shows 80-90% or more good results, whereas 50% or more ...

Quality assurance professionals at Wayne County (Pennsylvania) Memorial Hospital have successfully implemented a surgical case review system for evaluating all inpatient surgical and same-day surgical procedures (including those where no tissue is removed) as well as post-hospitalization infections or complications that may signal unusual events or potential risk factors. The ...

A historical review of the literature for the surgical correction of mandibular prognathism is presented, together with a list of ideal conditions for the successful treatment of this condition. This is a report of a new surgical technique which satisfies the majority of these principles and demonstrates stability at the ...

Current trends in bovine fracture repair are reviewed with reference to 59 cases. Thirty-one cases were managed surgically, 14 by external fixation, and six by stall confinement. Eight animals were slaughtered without treatment being attempted. A successful outcome was achieved in 90 per cent of the surgically treated cases, compared ...

Fifty-one cases of brainstem haematoma that have undergone neurosurgical intervention since Finkelnburg's first exploration in 1905, are presented, together with five new cases. The location, incidence, aetiological and pathological factors, as well as clinical syndromes are reviewed. Diagnostic criteria are presented. The distinction between brainstem "haematoma" and "haemorrhage" is stressed. ...

Three cases of cervicofacial necrotizing fasciitis have been reported, two of dental etiology, and one the result of blunt and abrasive facial trauma. All cases responded well to aggressive surgical intervention in combination with broad spectrum antibiotic coverage and supportive medical therapy. The presence of increased vascularity in the head ...

Angiokeratoma of the vulva is a rarely reported, benign condition that usually presents as one or a few isolated, 2- to 3-mm papules on the vulva. This case represents an extensive lesion that was managed surgically. Such extensive disease and its treatment have not been described before in detail in ...

Following the Allman and the Zlotsky and Ballard classifications, 85 cases of acromioclavicular disruptions (ACD) have been treated. Types I and II have been conservatively managed, while type III was treated by a special surgical technique described in the text. Types I and II were reviewed by a questionnaire form ...

Hypertrophic scars along the plantar aspect of the foot can be extremely painful and disabling, especially if located on weight-bearing areas. The authors suggest a rotation skin flap as one form of surgical management for this problem. A brief review of rotational skin flaps is presented along with a case ...

Complete urethral duplication is a rare anomaly in boys. About 60 cases have been reported in the literature, of which approximately one-third were managed with a surgical procedure of total excision of the accessory urethra. Another third were managed by partial excision, and the rest were managed conservatively. Here 2 ...

Over a 2 year period, 90 cases of potential fetal pathologic conditions were presented to a multidisciplinary fetal board. Members, including persons from perinatology, neonatology, genetics, radiology, pathology, pediatric surgery, neurosurgery, and urology, met monthly to discuss new referrals, follow-up ongoing cases, and present findings and treatment in delivered cases. ...

Several modifications of the traditional treatment of endomyocardial fibrosis have been made based on a personal experience of 51 surgical cases and on the reports of others in the surgical literature during the last decade. Description of these techniques and the author's current concept of the pathological processes are reported ...

The authors of this article present a case of acute rheumatic fever in an adult and review the diagnostic criteria for this illness. They emphasize the prevention of acute rheumatic fever by the adequate treatment of streptococcal pharyngitis with penicillin.

Angiosarcoma of the scalp is a rare lesion and generally has a poor prognosis, but it may be controlled by wide surgical ablation, local lymph-node excision and perhaps palliated by adequate radiotherapy. The author describes a 52-year-old woman with this condition who underwent multiple surgical procedures over a 16-year period. ...

Although acute pseudoobstruction of the colon is a rare entity, a large percentage of the reported cases have occurred following obstetric and gynecologic surgical procedures. Early recognition is mandatory to avoid severe and potentially fatal complications and can allow successful decompression by means of colonoscopy, thus avoiding surgical intervention, as ...

The surgical treatment of choice in Dupuytren's contracture is radical aponeurectomy. The clinical and pathological reasons for this are discussed. The authors propose precise indications for operative intervention and describe an original surgical technique. They present a review of 76 comparable cases treated by this method and followed up for ...

Postlaminectomy disc space infection is a relatively modern disease that is frequently mentioned, rarely encountered, sometimes not recognized, and unquestionably iatrogenic. A total of 125 cases have been reported since 1947. The bulk of the evidence favors a bacteriologic agent, but the route of infection is still not clear, because ...

The proper treatment of necrotizing perineal infections (Fournier's gangrene) remains unclear in the surgical literature. This study reports a technique that emphasizes anatomic considerations in the diagnosis and treatment of these infections together with mandatory use of colostomy in selected cases. Eight cases treated at William Beaumont Hospital from 1977 ...

Stenosing tenosynovitis of the extensor carpi ulnaris, to our knowledge, has not been previously reported. This condition, although uncommon, should be considered in the differential diagnosis of pain over the dorsoulnar aspect of the wrist. We report three cases with good response to surgical decompression of the sixth dorsal compartment ...

A case of a surgically retained towel within the peritoneal space is reported. Computed tomography demonstrated an unusual appearance not unlike that previously described for retained surgical sponges. Computed tomography of the gastrointestinal tract served as a useful adjunct to barium radiography in this case, suggesting the correct diagnosis of ...

A retrospective study on surgical cases of colic in horses (n = 216) revealed that 42 (19.4%) developed post-surgical diarrhoea. Salmonella spp. were isolated in 6 (16.2%) of the cases (n = 37) exhibiting diarrhoea. In 35.7% of the cases (n = 42) recovery from surgery was disturbed by other ...