Repositioning maneuver for benign paroxysmal positional vertigo (BPPV).

With vertigo, the symptom of unsteadiness is a common presenting complaint and the etiology protean. However, the specific subset of this patient population with benign paroxysmal positional vertigo (BPPV) is more defined. Cupololithiasis and canalithiasis are perhaps the best known and best described pathologic conditions resulting in vertigo. This condition occurs when otoconia from the utricle are displaced into the Posterior semicircular canal-cupula. The abnormal position of the otoconia often results in a pathological condition. The location of displacement is most often in the posterior semicircular canal. A better understanding of the etiology of BPPV has led to a simple and effective particle repositioning maneuver that allows the practitioner to alleviate vertigo symptoms for most patients using a simple manipulation.

Edlich's academical village.

Dr. Richard F. Edlich, Distinguished Professor of Plastic Surgery and Biomedical Engineering, recently received the Thomas Jefferson Award, the highest honor that can be bestowed upon a faculty member at the University of Virginia. Reflections of his "Academical Village" are presented to share ideas from the teaching environment he has created.

Use of immediate postoperative mastectomy prostheses.

From materials readily available in the operating room, a temporary breast prosthesis can be fashioned for use in the immediate postoperative period. These materials yield a prosthesis with good shape and form, filling a brassiere cup and providing the general pressure needed on skin flaps in the immediate postoperative period. Psychologically, filling the absent breast cup helps patients adjust to their new body image and eliminates the shock of gross asymmetry.

Laparoscopic repositioning of malfunctioning peritoneal dialysis catheters.

Continuous ambulatory peritoneal dialysis is commonly used for the maintenance of patients with chronic renal failure. A common complication associated with this treatment is outflow obstruction of the catheter. Noninvasive approaches to outflow obstruction such as enemas, infusions of saline, and body position changes are rarely successful in the management of these complications (1). Herein we report a review of our experience with the use of laparoscopy for the evaluation and management of peritoneal dialysis catheters with outflow obstruction.

Metallurgically bonded needle holder jaws. A technique to enhance needle holding security without sutural damage.

A new needle holder jaw face has been specifically designed and developed to increase needle holding security without sutural damage. Tungsten carbide particles have been metallurgically bonded into the stainless steel jaw to create a fine granular surface. This bonded jaw enhances needle holding security by limiting either twisting or rotation of the clamped needle. In addition, compression of the monofilament synthetic sutures by the bonded jaws does not reduce suture breaking strength.

Carburetor burns: preventable injuries associated with high morbidity and frequent litigation.

We have identified carburetor burns as a significant cause of preventable morbidity, both from long-term functional and cosmetic standpoints. The epidemiology of carburetor burns and our experience are described. All of our patients were male, with a mean age of 35 years. Average burn size was 11.3%. The anatomic distribution of these burns, most often on the dominant hand and on the face, contributes to the morbidity of these burns. This injury has been associated with increasingly frequent litigation. We believe that an active education campaign and the addition of warning labels to car engine compartments would make an impact in decreasing the incidence of carburetor burns.

Peritoneal dialysis catheter outflow obstruction due to oviductal fimbriae: a case report.

Outflow obstruction is a common cause of peritoneal dialysis catheter malfunction. We report an unusual case of outflow obstruction caused by oviductal fimbriae. Mini-laparatomy and repositioning of the catheter without excising the fallopian tube resulted in good outcome.

Injection of illicit drugs into the granulation tissue of chronic ulcers.

Chronic skin ulcers are rare among healthy young adults. Local injection of cocaine and heroin has been identified as a cause of chronic skin ulcers in young adults abusing intravenous drugs. These patients use both engorged veins surrounding the ulcers and the granulation tissue itself for the injection of drugs. We believe that chronic skin ulcers in young adults should be a marker for intravenous drug abuse, and should be considered in the differential diagnosis of nonhealing wounds.

Needle holder damage to surgical needles.

Clamping surgical needles between the jaws of needle holders with teeth markedly weaken the needles, making them prone to breakage. In contrast, clamping surgical needles between either smooth needle holder jaws or jaws embedded with tungsten carbide particles did not alter the ductility of surgical needles.

Emergency physician's needle holder.

A new needle holder is described that has jaws metallurgically bonded with tungsten carbide particles that enhance needle holding security without causing sutural damage during instrument ties. Scissors have also been incorporated into the needle holder to cut sutures. One ringlet on a handle has been offset to facilitate retrieval of the needle holder from a flat surface.

A new compound curved needle for intradermal suture closure.

A new compound curved needle has been designed and developed for intradermal suture closure from a unique stainless steel alloy, American Society of Testing Materials (ASTM) 45500. This needle has a short, straight, sharpened point with a reverse cutting edge, followed by a curved distal section. Despite its geometry, it exhibited a similar resistance to bending and breakage as did a curved needle with a single radius of curvature manufactured from the same alloy. The design of this new needle enabled the physician to pass it through the dermis with a greater accuracy to a controlled depth and length of bite than curved cutting edge needle with a single radius of curvature.

Emergency medicine magnifying loupes.

A magnifying loupe system has been evaluated for use in emergency medicine. Physicians uniformly preferred a Keplerian lens system over that of the Galilean lens system. The advantages of the Keplerian lens were its increased field of view and its brighter and clearer peripheral image. The Keplerian loupes allowed the physician to visualize the exquisite details of wound configuration and to perform wound closure using microsurgical techniques.

Computed tomography diagnosis of acute facial swelling in an adult hemophiliac.

Acute facial swelling can be life-threatening due to airway obstruction. Hemophiliac patients presenting with acute facial swelling must have accurate and expedient diagnosis. We report the case of acute nontraumatic swelling in a hemophiliac patient that was easily and accurately diagnosed by the use of computed tomography scan.

Biomechanics of curved surgical needle bending.

Because needle bending resistance is such an important factor in the selection of surgical needles, a standard quantitative test of needle bending has been devised to study the biomechanics of deformation of needles from three different commercial manufacturers. The superior resistance to deformation of needles made by one manufacturer has been related to the specific alloy, ASTM 45500 stainless steel, employed in its production. The needles produced from ASTM stainless steel 45500 have stronger tensile and yield strengths than those of the other alloys, accounting for their greater resistance to bending.