Subject(s)
Hospital Mortality , Insurance Coverage/economics , Wounds, Gunshot/mortality , Wounds, Gunshot/surgery , Academic Medical Centers , Adult , Databases, Factual , Female , Hospitals, Public/economics , Humans , Insurance Coverage/statistics & numerical data , Logistic Models , Male , Medicaid/economics , Medically Uninsured/statistics & numerical data , Medicare/economics , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Survival Analysis , Trauma Centers/economics , United States , Young AdultSubject(s)
Firearms/statistics & numerical data , Trauma Centers/statistics & numerical data , Wounds, Gunshot/epidemiology , Adolescent , Age Distribution , Child , Child, Preschool , Firearms/classification , Firearms/legislation & jurisprudence , Humans , Infant , Infant, Newborn , Louisiana/epidemiology , Ownership/legislation & jurisprudence , Ownership/statistics & numerical data , Retrospective Studies , Sample Size , Sex Distribution , Wounds, Gunshot/classification , Wounds, Gunshot/etiology , Young AdultABSTRACT
BACKGROUND: There were over 110,000 leg laceration cases reported in the United States in 2011. Currently, muscle laceration is repaired by suturing epimysium to epimysium. Tendon-to-tendon repair is stronger, restores the muscle's resting length, and leads to a better functional recovery. Tendons retract into the muscle belly following laceration and surgeons have a difficult time finding them. Many surgeons are unfamiliar with leg muscle anatomy and the fact that the leg muscles have long intramuscular tendons that are not visible in situ. A surgical anatomic guide exists to help surgeons locate forearm tendons; no such guide exists for tendons in the leg. MATERIALS AND METHODS: The leg tendon ends of 11 cadavers were dissected, measured, and recorded as percentages of leg length. High-frequency ultrasound was used to locate tendon ends in three additional cadavers. These locations were compared with the actual tendon ends located via dissection. RESULTS: There was little variation in tendon end position within the cadaver group, between men and women or right and left legs. The data are presented as an anatomic guide to inform surgeons of the tendon ends' likely locations in the leg. CONCLUSION: The location of leg intramuscular tendon ends is predictable and the anatomic guide will help surgeons locate tendon ends and perform tendon-to-tendon repairs. Ultrasound is a potentially effective tool for detection of accurate location of repairable tendon ends in leg muscle lacerations.
Subject(s)
Lacerations , Leg , Muscle, Skeletal , Plastic Surgery Procedures , Tendons , Aged , Aged, 80 and over , Cadaver , Dissection , Female , Humans , Lacerations/diagnostic imaging , Lacerations/pathology , Lacerations/surgery , Male , Middle Aged , Muscle, Skeletal/anatomy & histology , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/surgery , Suture Techniques , Tendons/anatomy & histology , Tendons/diagnostic imaging , Tendons/surgery , UltrasonographyABSTRACT
OBJECTIVES: This study reviews the published outcomes regarding sinonasal undifferentiated carcinoma (SNUC) since the initial description in 1986. This article attempts to (1) understand and better describe the benefit and survival advantages associated with using radiation, chemotherapy, and surgical treatment and (2) support the recommendations of a treatment regimen with current available data in the literature. DATA SOURCES: Published English-language literature. REVIEW METHODS: A PubMed search for articles related to SNUC, along with the bibliographies of those articles to avoid missing articles. All articles were examined for an independent patient data meta-analysis. Thirty studies with 167 cases from 1986 to October 2009 were identified. Demographics, disease extent, treatment, follow-up, and survival were analyzed. Patient cohorts mirroring Kadish staging were created. Kaplan-Meier curves were constructed. RESULTS: Follow-up range was 1 to 195 months (mean 23.4 months, median 15 months). At last follow-up, 26.3% of patients were alive with no evidence of disease, 21.0% were alive with disease, and 52.7% were dead of disease. The use of surgery was found to be the best single modality, but chemotherapy and radiation were important as adjuncts in extensive and aggressive disease. The presence of neck metastases was a poor prognostic sign. CONCLUSION: This study, containing the largest pool of SNUC patients, confirms a poor overall prognosis. The data suggest that the optimal treatment should include surgery, with radiation and/or chemotherapy as adjunct treatments. Neck disease in advanced local disease is a poor prognostic sign and merits aggressive treatment with multimodality therapy.
Subject(s)
Carcinoma/therapy , Maxillary Sinus Neoplasms/therapy , Humans , Treatment OutcomeABSTRACT
PURPOSE: Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. METHOD: Students in the Class of 2009, at a university-based medical school, were surveyed at the end of their 2nd and 3rd year. Students completed the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a self-administered scale, and were evaluated for demonstrated empathic behavior during Objective Structured Clinical Examinations (OSCEs). RESULTS: 97.6% and 98.1% of eligible students participated in their 2nd and 3rd year, respectively. The overall correlation between the JSPE-S and OSCE empathy scores was 0.22, p < 0.0001. Students had higher self-reported JSPE-S scores in their 2nd year compared to their 3rd year (118.63 vs. 116.08, p < 0.0001), but had lower observed empathy scores (3.96 vs. 4.15, p < 0.0001). CONCLUSIONS: Empathy measured by a self-administered scale decreased, whereas observed empathy increased among medical students with more medical training.
