Portal venous thrombosis in a backpacker: the role of exercise.

Effort thrombosis usually afflicts an extremity and is caused by compression. This case report, in contrast, involves superior mesenteric and left portal vein septic thrombosis in a backpacker following prolonged hiking and abdominal straining. The condition may have been caused by localized splanchnic venous ischemia, erosion of the bowel-blood barrier, and release of bacterial endotoxin in this dehydrated and detrained athlete. Diagnosis of this disorder is aided by noting characteristic abdominal pain, fever, nausea, and vomiting, as well as by imaging with MRI, CT, or duplex ultrasonography. Antibiotics and anticoagulants are key to treatment.

Teamwork improves breast cancer management in the community.

The weekly breast cancer conference has clearly improved this community's ability to care for breast cancer patients. The range of issues has been broad. Some of the discussions are related to various aspects of surgical care, pathology issues such as specimen marking and evaluation, the use of prognostic indicators, adjuvant treatment, hormone replacement, bone marrow transplantation, post lumpectomy mammography, etc. The list is endless and expands every week. This conference format is very feasible in a community setting and has ongoing in-depth benefits. Each host hospital designates one person to regularly coordinate preparation of the host hospital's conference. This ensures timely retrieval of all related diagnostic information for review by the radiologist and pathologist. Additionally, the case history is typed and available only on the morning of the conference.

Cortical screws versus absorbable pins for fixation of the short Z-bunionectomy.

Fifty-four Z-bunionectomies were performed on 43 patients. Twenty-nine osteotomies were fixated with Orthosorb pins, and 25 were fixated with a single 2.7-mm. cortical screw. Postoperative pain, edema, bone callus, and complications were evaluated for each fixation method. All patients were followed for more than 1 year. The incidence of metatarsal head dorsiflexion in screw fixated osteotomies was double that of Orthosorb. Radiographic evidence of pin tracts persisted beyond 1 year in about half the Orthosorb fixated osteotomies. The authors conclude that in properly selected patients, Orthosorb is as effective as a screw in fixating the osteotomy.

L-osteotomy with absorbable fixation for correction of tailor's bunion.

A procedure is described for correction of tailor's bunions. The L-osteotomy is a transpositional neck osteotomy that is inherently stable. Fixation of choice is the Orthosorb absorbable pin (Johnson & Johnson Orthopedics, Raynham, MA). A retrospective study was undertaken of 12 patients who underwent 21 osteotomies. All patients believed that the pain and deformity associated with the tailor's bunion were resolved by the surgery. One asymptomatic nonunion, and one asymptomatic malunion occurred. At final follow-up, radiographic lucency at the Orthosorb pin sites persisted in 62% of the feet.

Enhanced prevalence of ankyloglossia with maternal cocaine use.

A series of 500 term neonates was examined in a well-baby nursery, 68 of whom tested positive for maternal cocaine use. From logistic multiple regression equations, weight and crown-heel length were significantly smaller in the maternal cocaine-use subset of this case-control study. Partial ankyloglossia, with a prevalence of 4.4 percent in the overall series, was significantly more common in males than in females (6.0% versus 2.3%), while race (black or white) had no influence on trait frequency. Controlling for race and sex, ankyloglossia was 3.5 times more likely to occur in the drug-use series, perhaps as a function of diminished mitotic rates.

Natal primary molar: case report.

The case of an immature natal maxillary first primary molar is reported. Natal molars are rare occurrences, the present instance being only the eighteenth reported case. Clinical and histologic examination revealed that the tooth was rootless, incompletely mineralized, and acutely inflamed. Subsequent radiographs showed that the tooth was actually the primary first molar.

Oral anomalies in the neonate, by race and gender, in an urban setting.

A broad range of developmental anomalies and morphologic variants may occur in the oral cavity of the newborn. Because many of these are transient (e.g.: palatal and alveolar cysts, lymphangioma), self-correcting with age, conventional assessments of older children can yield significantly altered trait incidences. A total of 500 normal full-term newborns (blacks and whites) were assessed by standardized criteria for 11 oral conditions, in addition to collating data on maternal conditions (age, gravidity, tobacco and alcohol use). Leukoedema and median alveolar notches were significantly more common in blacks, whereas palatal cysts were 2.5 times as likely to occur in whites. Ankyloglossia, three times as common in males, was the one trait to exhibit a significant predilection by gender. Low maternal age (less than 20 years) significantly enhanced the risk of alveolar lymphangioma in these data.

Correction of iatrogenic floating toe following resection of the base of the proximal phalanx.

For many decades, resecting the base of the proximal phalanx was a popular method of correcting hammertoes. The long-term result of the procedure, however, is a flail, proximally retracted, "floating" toe. Correction of this challenging surgical problem can be accomplished with a V-Y advancement flap and specific releases.

Correction of elongated underlapping lesser toes by middle phalangectomy and skin plasty.

A procedure is described for correction of a digital deformity that consists of both a congenitally elongated lesser toe and an acquired adductovarus of that toe. This elongated underlapping toe is often treated by arthroplasty of the distal interphalangeal joint with resection of the head of the middle phalanx. The author proposes middle phalangectomy through specifically described incisions as a better way to resolve this deformity. The procedure is not technically difficult and can be performed as an outpatient.

Selenium in human tissues from New Zealand.

Selenium concentrations were measured in tissue samples obtained at autopsy from 45 New Zealand residents aged 4 months to 74 yr. Materials included liver, kidney cortex, skeletal muscle, heart, lung, and spleen. Samples of liver and brain were obtained from 16 fetuses (gestational ages, 27-42 wk). Except for kidney cortex, which contained high levels, concentrations of selenium were similar to those reported in other low-selenium areas, and lower than values obtained in selenium-adequate localities.

Sequential metatarsal stress fractures after Keller arthroplasty with implant.

The occurrence of single stress fractures after Keller arthroplasties has been documented. This paper presents a case of sequential stress fractures of metatarsals two and three after Keller arthroplasty with hemi-phalangeal implant. It is the author's view that failure to recognize and properly treat the fracture of the second metatarsal led to the additional fracture of the third metatarsal. Furthermore, the use of a nonrigid orthotic with metatarsal padding is recommended postoperatively to decrease the probability of this complication.

On supplementing the selenium intake of New Zealanders. 2. Prolonged metabolic experiments with daily supplements of selenomethionine, selenite and fish.

1. The daily intake of selenium by three subjects was supplemented with 100 microgram Se as selenomethionine (Semet-Se) or sodium selenite (selenite-Se)/d for 10-11 weeks, or with 65 microgram Se as in mackerel (Scomber japonicus) (fish-Se)/d for 4 weeks. 2. Urinary and faecal excretion of Se was measured and also Se concentration in whole blood, plasma and erythrocytes. Measurements on blood were made at intervals after supplementation had ceased. 3. Selenite-Se was not as well absorbed (0.46 of the intake) during the first 4 weeks as Semet-Se (0.75 of the intake) and fish Se (0.66 of the intake). 4. Blood Se increased steadily with Semet-Se, from 0.08 to 0.18 microgram Se/ml, but more slowly with selenite-Se, reaching a plateau in 7-8 weeks at 0.11 microgram Se/ml. Plasma Se increased more rapidly with Semet-Se than with selenite-Se, so that initially with Semet-Se plasma Se was greater than erythrocyte Se. 5. Daily urinary excretion increased with all forms of supplement, with initially a greater proportion of absorbed selenite-Se being excreted than Semet-Se or fish-Se. A close relationship was found between plasma Se and 24 h urinary excretion. The findings suggested that there was a rapid initial excretion of presumably unbound Se then a slower excretion of residual unbound, loosely bound or bound Se. 6. Total retentions of 3.5 mg selenite-Se and 4.5 mg Semet-Se were large when compared with an estimate of body content of 6 mg Se, derived in another paper (Stewart, Griffiths, Thomson & Robinson, 1978). Retention of Semet-Se and fish-Se appeared to be reflected in blood Se, whereas for selenite-Se, blood Se reflected retention for only a short period after which Se appeared to be retained without altering the blood Se. This suggested that Semet-Se and selenite-Se were metabolized differently. 7. A double blind-dosing trail with 100 microgram Semet-Se was carried out for 12 weeks on twenty-four patients with muscular complaints in Tapanui, a low-Se-soil area. Blood Se increased in the experimental group (from 0.067 to 0.143 microgrm Se/ml); clinical findings were not conclusive and will be presented elsewhere. 8. Bood Se was measured in New Zealand residents before travelling to Europe or to North America. On return their blood Se was increased, and depending upon the period of time spent outside New Zealand some values reached concentrations found in visitors and new settlers to New Zealand. 9. The results from these studies and the earlier studies of single and multiple dosing have been used to look at the various criteria in use for assessing Se status of subjects. It is suggested that plasma Se be used in preference to 24 h urinary excretion, and in addition to whole blood Se and glutathione peroxidase (EC 1.11.1.9) activity.