The validity of measurements made on standard foot orthoroentgenograms.

In certain clinical settings, standard x-rays may be misleading since they only provide two-dimensional representations of three-dimensional structures. After metatarsal osteotomy, the actual first metatarsal shortening may appear magnified on standard x-rays. We investigated variations in metatarsal and intermetatarsal angle (IMA) in a cadaver model and variations of first metatarsal length following in vivo Chevron osteotomies. For skeletal models, changing the foot arch from pes planus to pes cavus changed the first metatarsal length by as much as 19%, whereas the measured IMA remained relatively unchanged. Pronation of the first metatarsal was found to alter the IMA (decreased for planus, increased for cavus). In vivo studies revealed a 3.2-fold difference when actual metatarsal length change following chevron osteotomy was correlated to corrected x-ray change in length (9.5% versus 2.9% P < or = .005). Previous investigators have evaluated hallux valgus deformities with emphasis on metatarsal lengths and IMAs to determine choices of procedure. Based on the results of this study, treatment plans and further evaluation for forefoot surgery may be inaccurate if based solely on x-ray measurements.

Pulmonary artery catheterization: a prospective study of internal jugular and subclavian approaches.

We compared complications of pulmonary artery catheter (PAC) insertion and maintenance at internal jugular (IJ) vs. subclavian (SC) sites. Patients were randomized into groups using an IJ or SC route, and insertions were timed. An air-permeable dressing and anticontamination shield were used. Catheters were removed 72 h after insertion. If PAC monitoring was still needed, a new catheter was either inserted over a guidewire at the initial insertion site or inserted at a new site. On removal, the catheter tip, introducer-sheath tip, and catheter within the shield were submitted for semiquantitative culture. Sixty-six catheters were initially inserted, and 26 were changed. No determinative differences in the time for venous cannulation were found, but the IJ route was slightly faster. In 3% of the catheterizations, serious complications arose. The infection rate was 2% for initial catheters, 8% for second catheters placed over a guidewire, and 15% for second catheters placed at a new site. These differences were not consequential. No local infection or catheter-related sepsis occurred. Thus, using a standard, sterile-insertion technique and a catheter-maintenance protocol yielded a low risk of insertion and infectious complications at either the IJ or SC site. Our data indicated that PACs can be changed safely over a guidewire at 72 h, avoiding further insertion risks without increasing infectious complications.

Lichen planus-like keratosis. A clinicohistopathologic correlation.

We feel that it is possible to make a reasonably consistent clinical diagnosis of lichen planus-like keratosis on the basis of several criteria. These criteria include physical appearance, location and short duration of the lesion, clinical symptoms such as pruritus and pain, age and sex of the patient, and the frequent presence of a preceding lentigo. Clinical data on fifty-nine histologically confirmed cases are presented. Some interesting features of this curious condition are discussed. Because of the clinical similarity of lichen planus-like keratosis to other sometimes more ominous lesions, microscopic confirmation of the diagnosis is still recommended.

A familial epidemic of cutaneous sporotrichosis occurring in north Texas.

A small familial epidemic of cutaneous sporotrichosis occurring in North Texas is reported. The disease occurred in four out of six children in two separate families of paternal cousins. The presumed source of infection was old prairie hay used for mulching. Trauma at the time of exposure seemed minimal or absent. Response to oral potassium iodide therapy was prompt and satisfactory.

Industrial Grenz ray overexposure: report of a case.

A case of accidental industrial exposure to a single large dose of ultrasoft (Grenz) x-rays is reported. Certain inferences can be made by estimating average skin target dosage, average kilovoltage, milliamperage and duration of exposure. From these data the quality and skin depth dosage of the ray can be tentatively estimated. Comparison of these figures with known biological phenomena such as immediate x-ray burn reaction, late cutaneous sequelae and temporary epilation permits a reasonable estimate of probable skin surface dosage and prognosis.

General purpose cryosurgical units. The WSL Nitrosprays I and II.

Lightweight, hand-held, inexpensive cryosurgical instruments are described that combine the desirable features of most available units into a single instrument. As these units are capable of treating the entire spectrum of cryoresponsive lesions, they are believed to be general purpose instruments.

Hereditary hemorrhagic telangiectasia with cerebrovascular malformations.

Three cases of hereditary hemorrhagic telanglectasia (HHT) with cerebrovascular malformation are presented. Previous reports of HHT have given little attention to its association with cerebrovascular malformation, despite frequent neurological symptoms in patients with HHT. Eleven other cases of HHT with neuropathologic or radiographic evidence of cerebrovascular malformation have been reported in the literature. We think that this association may be more frequent than previously suspected. The subtlety of the symptoms in HHT is stressed, and it is suggested that patients with cerebrovascular malformation be examined carefully for HHT, and vice versa.