Epithelioid hemangioendothelioma of the common femoral vein: Case report and review of the literature.

A young competitive skier had venous claudication. A stenosis of the left common femoral vein was revealed by means of an examination. Exploration and vein patch angioplasty were performed, and because of both the unusual appearance (focal thickening of vein wall) and the unclear etiology of the lesion, frozen and permanent sections of the wall were obtained. Epithelioid hemangioendothelioma, a rare intravascular sarcoma, was revealed by means of an examination of the permanent sections. Two additional procedures were required to completely excise the epithelioid hemangioendothelioma. We discuss these rare vascular malignancies and include a review of the available literature. Also, oncologic principles important in both the diagnosis and therapy of intravascular sarcomas are discussed.

Timing of surgery in acute anterior cruciate ligament tears on the return of quadriceps muscle strength after reconstruction using an autogenous patellar tendon graft.

To determine if patients who delayed anterior cruciate ligament reconstruction until a convenient time regained quadriceps muscle strength allowing them to return to sports participation at a different rate than patients who had early surgery for anterior cruciate ligament reconstruction, we studied 143 patients who had the same surgical procedure and postoperative rehabilitation program. Group I delayed surgery at a mean of 40 days after injury; Group II had early surgery at a mean of 11 days after injury. Statistically, Group I patients had significantly better mean quadriceps muscle strength at 2 months (P = 0.017) and at 4 months (P = 0.0055) postoperatively. At least 65% quadriceps muscle strength was achieved by 40 of the 50 patients (80%) tested in Group I at 2 months, allowing the patients to progress to sport-specific rehabilitation. Only 35 of the 66 patients (53%) tested in Group II were able to progress toward sports activities at 2 months. By 6 months, 29 of the 40 patients (73%) tested in Group I compared with 27 of the 58 patients (47%) tested in Group II had 80% quadriceps muscle strength. This study demonstrates that the return of quadriceps muscle strength was faster for our patients who delayed anterior cruciate ligament reconstruction than for our patients who had early reconstruction. Thus, despite delaying their early reconstructions, Group I was able to progress sooner from the date of surgery to sport-specific rehabilitation.

The use of caudal epidural anesthesia in clubfoot surgery.

We reviewed records of 31 children who had surgical release of 41 clubfeet under general anesthesia with supplemental caudal epidural anesthesia. Compared to an equivalent group of 27 children (39 feet), the caudal epidural group exhibited a statistically significant decrease in intraoperative narcotic requirement. One child had a bloody tap, and caudal epidural anesthesia was abandoned, but there were no other complications. Excellent postoperative pain relief persisted for > or = 8 h. Twenty-five of 31 caudal epidural patients were discharged safely on the same day as surgery without any surgical complications. Use of caudal epidural supplementation and outpatient surgery (where indicated) met with a high degree of parent satisfaction. Cost savings of outpatient clubfoot surgery, when compared to overnight stay, were disappointingly low.

Diaphyseal humerus fractures: natural history and occurrence of nonunion.

We reviewed 38 fractures of the humeral shaft which had been treated non-operatively to identify factors prognostic of nonunion. Of these, 23 healed uneventfully and 15 progressed to nonunion. Factors prognostic of nonunion included long oblique fracture pattern, alcohol abuse, and obesity. In patients with these risk factors, lack of clinical and radiographic evidence of healing 8 to 10 weeks post-injury suggests an impending nonunion, and operative intervention should be considered.

Fracture of the trochlea.

Isolated fracture of the humeral trochlea is rare. Recent fracture classification schemes do not specifically address this injury in regards to treatment. This case report describes an isolated fracture of the humeral trochlea treated with open reduction internal fixation. Radiographic union was present at 13 weeks, and at 20 weeks post-op, the patient had regained full elbow range of motion minus 5 degrees of terminal flexion. Open reduction and internal fixation can be performed with success if the trochlear fragment is large enough.

Needle sharing for the use of therapeutic drugs as a potential AIDS risk behavior among migrant Hispanic farmworkers in the eastern stream.

In the United States, 41 percent of the AIDS cases are found in ethnic minorities. While it is true that AIDS is disproportionately represented among minorities, not enough research has been directed at identifying risk factors peculiar to different ethnic groups. This study explored critical knowledge of AIDS, patterns of sexual behavior, and self-injection for therapeutic reasons among migrant workers. Data were collected through face to face interviews with 378 hispanic migrant workers. Respondents, seventy-nine (21.4 percent), reported self-injecting antibiotics and vitamins for medicinal reasons while only 2.6 percent self-injected recreational drugs. The likelihood of contracting AIDS escalates as the number of risk factors increase. Self-injection of therapeutic agents is a great risk when considered in concert with the other risk factors present in the migrant farmworker population. Exposure to additional factors such as sexual promiscuity, frequenting prostitutes, homosexual behavior and having vaginal or anal intercourse without a condom creates a potentially dangerous situation. Hence, each of the individual AIDS risk factors may be multiplied and broadcast through the needle risk. AIDS health education needs to deal with this cultural pattern of self-injection in its intervention programs.

Getting to the heart of rural EMS.

The Rural EMS Task Force was formed by the National Rural Health Association to investigate critical issues in the rural EMS response system. The task force felt that many issues were at play and should be investigated in the form of a survey to determine nationwide needs. The EMS Today Working Conference in March became a forum to address potential solutions to those needs. Much work remains to better conditions for volunteer personnel who are expected to meet greater and greater expectations with fewer and fewer resources.