Biomedical subjects
Publications and source records attributed to E Beatty.
Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.
The Kodak SureCell Herpes Test Kit (SC-HSV) was evaluated in a high-risk sexually transmitted disease clinic population. A total of 97 lesion specimens (from 94 patients) were tested for the presence of herpes simplex virus by SC-HSV and by spin-amplified tissue culture confirmed by an enzyme immunoassay. The overall sensitivity of SC-HSV compared with that of spin-amplified tissue culture-enzyme immunoassay was 81.1%; the specificity was 100%. For vesicular lesions only, SC-HSV sensitivity was 100%; for nonvesicular lesions, sensitivity was 75.6%, SC-HSV was rapid (less than 15 min) and very easy to perform.
When accidents occur, the hand is the part of the body most often thrust out to lessen the consequences, resulting in a wide array of combinations of soft-tissue and chondro-osseous injuries. Pediatric wrist and hand skeletal injuries discussed in this article include growth mechanism injury, fractures and dislocations, nailbed injuries, fingertip injuries, burns, and frostbite.
Accepted therapy for intermediate-thickness melanomas is wide local excision and regional lymphadenectomy for nodes known to be in the lymph drainage basin. Lymphoscintigraphy has been shown to be of great help in predicting the drainage pattern of truncal, shoulder, proximal extremity, and head and neck melanomas. Lymphoscintigraphy using Technetium-99 antimony sulfur colloid was performed on 17 patients with cutaneous melanomas at H. Lee Moffitt Cancer Center at the University of South Florida. Of 13 patients with primary truncal and shoulder lesions, drainage patterns were discordant 54 per cent of the time and resulted in dissection of nodal groups different than would otherwise have been planned. This resulted in several lymph nodes positive for metastatic disease removed from operative sites not expected to show metastatic spread by clinical experience alone. The discordant rate for head and neck drainage was also high with 2 of 3 forehead studies showing drainage to both anterior and posterior cervical chains when only anterior chain drainage was expected, while only one of these drained to the preauricular nodes. Again, this led to elective lymph-node dissections of nodal basins not anticipated on clinical grounds alone. After a mean follow-up of 2 years, in which 60 to 75 per cent of all recurrences from melanoma are expected to occur, there has been no lymph-node metastasis development in basins that were not predicted by the scan. It is clear from our data that well-known historical patterns of lymph drainage in addition to the clinical impression of experienced surgeons cannot reliably predict the lymphatic drainage of many truncal, shoulder, and head and neck melanomas.(ABSTRACT TRUNCATED AT 250 WORDS)
The development of computer-based simulations of the patient-physician encounter has made it possible to give students the opportunity to manage a case without jeopardizing a real patient's life. At the University of Wisconsin Medical School simulated patients have been an integral part of the third-year teaching program for the past five years. They have been used to permit the students to gain clinical experience, as part of a series of structured teaching conferences, and in a medical testing program. Student and faculty response to the program generally has been favorable.
An 11-year-old girl developed cholangiocellular carcinoma in association with biliary cirrhosis due to congenital biliary atresia. An exploratory laparotomy and an operative cholangiogram at 3 months of age had confirmed the diagnosis of extrahepatic biliary atresia. A liver biopsy specimen taken at 6 months of age showed biliary cirrhosis. The subsequent clinical course was characterized by persistent moderate jaundice, anemia, malnutrition, rickets, pathologic fractures, and recurrent gastrointestinal bleeding. The presence of cholangiocellular carcinoma of the liver with advanced biliary cirrhosis was established at an exploratory laparotomy a week before her death. We discuss here the pathogenesis of biliary cirrhosis and carcinoma of the liver; there may be a relation between the two in the childhood population.
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