Verrucous carcinoma arising in ulcerative lichen planus of the soles.

Verrucous carcinoma is a low-grade squamous cell carcinoma. Chronic inflammation is an important factor in its pathogenesis. This is the first case of plantar verrucous carcinoma arising in a lesion of ulcerative lichen planus. This paper also lends further support to the successful use of Mohs micrographic surgical technique as the treatment of choice for verrucous carcinoma.

Familial occurrence of eruptive vellus hair cysts.

A 15-year-old white male had an extensive skin eruption that had been present since age 2 years. Physical examination revealed flesh-colored, rough-textured papules surrounded by faint erythema. These lesions were present diffusely over the upper trunk, arms, thighs, face, ears, and neck. Evaluation of four immediate family members revealed a similarly affected brother and father. A biopsy of the papules showed the presence of a mid-dermal epithelial cyst containing numerous vellus hairs.

Echocardiography performed by emergency physicians: impact on diagnosis and therapy.

Echocardiography is the "gold standard" for diagnosing many cardiac and pericardial abnormalities. It is noninvasive and accurate, but in most emergency departments is only as available as the technician or the cardiologist. We describe our experience in training emergency physicians to perform cardiac ultrasound, and clinical situations in which we have found echocardiography to be useful.

Phenytoin: does it reverse tricyclic-antidepressant-induced cardiac conduction abnormalities?

Case reports have appeared describing a beneficial effect of phenytoin in reversing cardiac conduction abnormalities induced by tricyclic antidepressant (TCA) overdose. Controlled studies have not been published. The following questions were addressed using intravenous amitriptyline and phenytoin in a rabbit model: Can prophylaxis with phenytoin before amitriptyline poisoning forestall the onset of cardiac abnormalities? Would such prophylactic phenytoin administration allow a higher dose of amitriptyline before death occurs? Would phenytoin reverse the cardiotoxic effects of amitriptyline once in progress? Animals were used in repeated trials with one-week "washout" intervals and served as their own controls in all but the final trial. Prophylactic phenytoin did not change the potency of amitriptyline in inducing abnormal cardiac performance, nor did it allow the animals to be titrated to a higher dose of amitriptyline before death occurred. In 12 animals, phenytoin "rescue" at the point of a widened QRS or arrhythmia was attempted. Two showed improvement; the remainder did not. Because this portion of the experiment was neither blinded nor controlled, nor were respirations or blood pressure monitored, these results must be viewed cautiously. Although our results suggest that prophylactic phenytoin is not useful, its role in therapy of occasional cases requires further investigation.

Are urine dipsticks reliable indicators of hematuria in blunt trauma patients?

Dipstick results in patients with blunt trauma have not been demonstrated to be predictive of the amount of microscopic hematuria. Our study examined the relationship between dipstick results and the degree of microscopic hematuria in 185 patients admitted to our emergency department following blunt trauma. Urine samples of 169 were dipsticked; the remaining 16 were grossly bloody. A wide range of microscopic hematuria results was obtained for each dipstick value. Of the 80 patients with negative dipsticks, 15 (18.7%) actually had microscopic hematuria. Conversely in 16 of 32 patients (50%) with a "trace" positive dipstick value, no microscopic hematuria was present. Similarly the dipstick value of 1+ had three of 14 (21%) false positives. False positives were recorded seven of 26 times (27%) for 2+, and three of 17 times (18%) for 3+ dipstick readings. We conclude that dipstick results do not correlate well with the presence or absence of hematuria in patients with blunt trauma. Microscopic urinalysis is a better test on which to base the decision to perform further diagnostic tests in the evaluation of the urinary tract.

Tissue-fat pulmonary embolism occurring in a patient with a severe pelvic fracture.

The fat embolism syndrome following trauma is associated with fat droplets in the pulmonary microvasculature. This is the first case report of a large adipose tissue embolus obstructing a pulmonary artery after blunt injury. This embolism occurred during the resuscitation of a patient with a laceration of an iliac vein and disruption of the adjacent fatty tissue secondary to a severe pelvic fracture. Theories of the pathogenesis of the fat embolism syndrome and implications for early therapeutic modalities are discussed.

The 911 emergency telephone number: impact on emergency medical systems access in a metropolitan area.

The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. Paul provides a unique opportunity to examine this assumption. Prior to the introduction of the 911 emergency telephone number on December 1, 1982, the area was serviced by over 100 different seven-digit emergency telephone numbers. Before the introduction of 911, 347 callers who activated the emergency medical services (EMS) system were interviewed, and after 911 was introduced, 305 callers were interviewed. Activation of the EMS system by making one call in less than 1 minute was achieved by 219 of 347 callers (63%) in the pre-911 phase and by 251 of 305 callers (82%) in the post-911 phase (P less than 0.001). Compliance (use of an appropriate emergency number for the first call) was demonstrated by 139 of 347 callers (40%) in the pre-911 phase, and 225 of 305 callers (74%) in the post-911 phase (P less than 0.001). Rapid activation of the EMS system was rarely achieved by calling a hospital or physician first. Overall, 911 was found to be a more efficient means of activating the EMS system.

Random distribution of centromere regions at mitosis in cultured cells of Muntiacus muntjak.

The manner in which centromere regions of mitotic chromosomes are distributed with respect to the age of their DNA was studied. Cells of the Indian deer Muntiacus muntjak, were grown in the presence of bromodeoxyuridine (BrdU) for two generations and stained with the fluorescent dye Hoechst 33258. Chromatids containing "granddaughter DNA" appear dim when compared with those containing "grandparental DNA". The frequencies of the various anaphase patterns of bright and dim centromere regions were binomially distributed, indicating random distribution of chromatids with respect to the age of their DNA templates.