Encounters with the jugular bulb in ear surgery are uncommon. This communication relates three cases where the author was confronted with the bulb in middle ear surgery--one in relation to the external auditory canal when raising a tympanomeatal flap and two in the hypotympanum when entering the middle ear. The ...

Intravenous injection of the oral formulation of Temazepam is a common form of drug abuse. At the request of the Home Office, manufacturers have developed solid dose forms to replace the liquid filled capsules, but a number of cases of accidental intra-arterial injection of the new formulation have been reported, ...

BACKGROUND: A dramatic case of infected emphysema involving multiple deep cervical and mediastinal fascial planes following surgical extraction of a lower third molar in an otherwise healthy man is presented. METHODS: The differential diagnosis and management of this condition are discussed, specifically contrasting it to necrotizing fasciitis. RESULTS: The direct ...

Since the late 1970s, the author has had the opportunity to prospectively study, document, and surgically manage 40 cases of congenital cholesteatoma. All cases met strict criteria for inclusion in the study, all were surgically and pathologically confirmed, and were definitively followed. During that same period, 38 cases were managed ...

Vascular malformations are infrequent findings in the foot, especially the plantar medial foot. Deeper vascular malformations may be more difficult to diagnose due to the depth and oblique course of the medial neurovascular structures into plantar aspect of the foot. The authors present an interesting case report of a vascular ...

OBJECTIVE: To describe case managers' perceptions of the physician-case manager relationship. DESIGN: A qualitative field study using in-depth open-ended interviews was used to elicit case managers' experiences and practices. A multidisciplinary team analyzed transcripts using an adaptation of the "grounded theory" approach of Glaser and Strauss. PARTICIPANTS/SETTING: Case managers were ...

A 19-year-old Arab woman who was previously operated on to desyndactylize her right second and third digits is presented in this case report. The patient's toes resyndactylized postoperatively and a keloid scar developed on the dorsum of her incision site. Syndactylism of digits is often discussed when involving the hand. ...

Equinovarus is the most common residual deformity of the lower extremity in patients who have sustained intracranial injury. Appreciation of the pathophysiology of the deformity aids in surgical management of selected cases. Gait analysis is a valuable tool for preoperative management. Three case reports illustrate the principles of surgical treatment.

Cholecystitis, a frequent diagnosis in emergency departments, has been discussed extensively in the medical literature. We report a case of emphysematous cholecystitis, an unusual form of this disease process, including the classic radiographic findings. We also offer a review of the literature, emphasizing the proposed pathophysiology and the life-threatening nature ...

BACKGROUND: Pseudocyst of the auricle is characterized by an asymptomatic swelling caused by an intra-cartilaginous accumulation of fluid. Treatments include aspiration, steroid injection, and surgical intervention. OBJECTIVE: To present two cases of pseudocyst of the auricle treated surgically with an open, deroofing technique. METHODS: Two cases are presented and the ...

Chronic recurrent synovial fistulae of the knee are uncommon. They can occur as a surgical complication or as a consequence of traumatic injuries. Conservative treatment is usually adequate for initial management, but no consensus exists about the treatment for chronic or recurrent cases and the literature on the subject is ...

We report a case of osteoblastoma arising in the petrous temporal bone of a 16-year-old boy. Attempts at surgical resection were unsuccessful. The patient was treated with radiotherapy and is now well 10 years later. A review of the literature indicates that radiotherapy has been used rarely for this tumour ...

The authors report a case of surgical repair of total anomalous pulmonary venous connection in a 36-year-old male. This is a very rare disease in adulthood since over 80% of the infants die before one year of age. Fifty-two surgical cases were previously reported in the literature. An extensive review ...

A nationwide survey on the treatment for esophageal varices was performed in 1990 jointly by the Japanese Research Society for Portal Hypertension and the Japanese Research Society for Sclerotherapy of Esophageal Varices to clarify the present status and strategy of this treatment in Japan. A total of 12,675 cases, including ...

The surgical findings observed in a series of 209 consecutive patients with craniovertebral anomaly are presented. The high prevalence of basilar impression in the Northeast of Brazil is noteworthy. There were 28 (13.3%) patients with basilar impression alone, 10 (4.7%) cases of pure Arnold-Chiari malformation and in 171 (81.8%) cases ...

Transjugular intrahepatic portosystemic stent shunts (TIPSS) procedures can be a significant non-surgical treatment for patients with liver cirrhosis, portal hypertension and at least one episode of bleeding from gastroesophageal varices. This article presents an in-depth description of the TIPSS procedure and reports results obtained from 15 attempted TIPSS cases.

Four patients with a superior mesenteric artery (SMA) embolism were successfully treated with intraarterial urokinase. Angiography showed partial SMA occlusion by intraluminal thrombus in two cases and almost total occlusion in two cases. Laparotomy was performed in the latter two cases, one of which required resection of infarcted bowel. Several ...

There has been considerable confusion in the literature regarding the proper treatment of auricular hematoma. This has stemmed from an inadequate understanding of the mechanisms involved in the formation and propagation of this condition. This article reviews the literature and give suggestions as to the proper surgical management of this ...

A case of uterine Mullerian tumor in an adolescent is described. Surgical and clinical management is discussed, based on the experience gained by the analysis of cases described in the literature. A review of the different age groups, primary sites, surgical management and biological behavior of cases described in the ...

A review of the literature and a case report of follicular lymphoid hyperplasia (FLH) of the hard palate has been presented. This entity should always be considered when confronted with a hard-palate swelling. A diagnosis of FLH generally can be made after a thorough medical and dental examination and immunocytochemical ...

The authors report 2 cases of localized xanthogranulomatous pyelonephritis (XGP) in which computed tomography (CT) permitted to raise a motivated clinical suspicion of inflammatory disease: the surgical exploration documented absence of neoplasm and allowed a conservative therapy implying only the removal of the mass. A literature review confirms that some ...

Recently, many cases of Fluoxetine induced mania have been reported in the literature. The detailed analysis of these case reports demonstrates that these patients had either positive family history of affective disorder (Lebegne, 1987), past history of affective illness (Settle and Settle, 1984; Lebegne, 1987; Nakra el al., 1989) or ...

The Robert Wood Johnson Foundation's AIDS Health Services Program uses case management to provide community-based care for people with AIDS. This article reports data concerning implementation of case management, based on interviews with program clients in nine communities. Some clients receive case management from a community-based organization (CBO), while others ...

Sialolithiasis rarely occurs in children; it is observed more commonly in adults. Various treatment modalities for sialolithiasis have been reported in the world dental and medical literature; most rely upon surgical intervention. This case report demonstrates that surgical intervention is not always indicated. We describe an 8-year-old child with a ...

Fibromatoses are uncommon infiltrative lesions affecting musculoaponeurotic structures, most often of the limbs and trunk. Lesions involving the cranial cavity are rare and require the same aggressive surgical management as elsewhere in the body. This case illustrates their clinical and neuroradiological features and underscores the necessity for aggressive resection to ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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.

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 ...

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 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 ...

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 ...

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 ...

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 ...