Delusions of parasitosis

BACKGROUND

Delusions of parasitosis (DP) is a rare psychiatric disorder in which the patient has a firm belief that she or he is infected by parasites. Although it is a psychiatric disorder, these patients often present to an emergency physician because they are convinced that they have a severe skin problem.

TREATMENT

Patients with DP often reject psychiatric referral. The diagnosis of DP can usually be made based on history alone. However, it is important that the patient does not have an organic skin disorder and that the delusion is not secondary to another mental or physical illness. The current treatments of choice are the antipsychotic medications risperidone and olanzapine.

CONCLUSIONS

In our experience, patients with DP seen in the emergency department who are suspected of having this condition can be a challenging diagnostic and treatment problem because they usually do not have health insurance. Consequently, we find it difficult to get dermatologic and psychiatric consultation to treat their illness.

Modern concepts of the diagnosis and treatment of psoriasis

Psoriasis is a papulosquamous skin disease that is recognized as one of the most common immune-mediated disorders. At least nine chromosomal psoriasis susceptibility loci have been identified. It is important to emphasize that management of psoriasis begins with identification of the extent of the cutaneous disease. There are three clinical forms of psoriasis, to include psoriasis vulgaris, pustular psoriasis, and erythrodermic psoriasis. Treatments currently available are topical agents used predominantly for mild disease and for recalcitrant lesions in more severe disease, phototherapy for moderate disease, and systemic agents, including photochemotherapy, oral agents, and newer injectable biological agents, which have revolutionized the management of severe psoriasis.

Scientific documentation of the relationship of vitamin D deficiency and the development of cancer

It is well known that vitamin D plays a key role in calcium homeostasis and is important for optimal skeletal growth. The major function of vitamin D is to enhance the efficiency of calcium absorption from the small intestine. Most physicians relate vitamin D deficiency to disorders of skeletal muscle. Vitamin D deficiency in children can manifest itself as rickets. In adults, vitamin D deficiency results in osteomalacia. Because most physicians do not appreciate the role of vitamin D deficiency in predisposing the development of cancer, we have written this important report as a wake-up call to physicians and other healthcare workers in documenting the relationship of vitamin D deficiency and cancer. Epidemiological data show an inverse relationship between vitamin D levels and breast cancer incidence. In addition, there is a well-documented association between vitamin D intake and the risk of breast cancer. Low vitamin D intake has also been indicated in colorectal carcinogenesis. A vitamin D deficiency has also been documented in patients with prostate cancer, ovarian cancer, as well as multiple myeloma. Larger randomized clinical trials should be undertaken in humans to establish the role of vitamin D supplementation in the prevention of these cancers.

A comparative cytogenetic study of the rice (Oryza sativa L.) autotetraploid restorers and hybrids

We studied pollen fertility, seed set and cytogenetic characteristics of restorer lines and F1 hybrids of autotetraploid rice. T4002, T4063, T461A x T4002 and T461A x T4063 showed significantly higher pollen fertility and seed set than T4132 and T461A x T4132. Meiotic pairing configurations of T4002, T4063, T4132, T461A x T4002, T461A x T4063 and T461A x T4132 were 0.051 + 19.96II (9.89 rod + 10.07 ring) + 0.01III + + 2.00IV, 0.11I + 19.17II (8.90 rod + 10.37 ring) + 0.09III + 2.26IV + 0.01VI, 1.34I + 9.46II (4.50 rod + 4.96 ring) + 0.80III + 6.02IV + 0.09VI + 0.09VIII, 0.02I + 14.36II (6.44 rod + 7.91 ring) + 0.01III + 4.80IV + 0.01VIII, 0.06I + 17.67II (11.01 rod + 6.67 ring) + 0.06III + 3.10IV + 0.01VI and 1.11I + 11.31II (5.80 rod + 5.51 ring) + 0.41III + 5.63IV + 0.03VI + 0.03VIII, respectively. Configuration 16II + 4IV and 12II + 6IV occurred in the highest frequency among the autotetraploid restorers and hybrids. Meiotic chromosome behaviors were less abnormal in the tetraploids with high seed set than those with low seed set. The hybrids had fewer frequencies of bivalents, univalents, trivalents and multivalents than the restorers, but higher frequency of quatrivalents than the restorers at MI. The frequency of univalents at MI had the most impact on pollen fertility and seed set, i.e., pollen fertility decreased with the increase of univalents. The secondary impact factors were trivalents and multivalents, and bivalents and quatrivalents had no effect on pollen fertility and seed set. The correlative relationship between pollen fertility and cytogenetic behaviors could be utilized to improve seed set in autotetraploidy breeding.

Revolutionary advances in the diagnosis and treatment of Familial Adenomatous Polyposis

During the last 25 years, there have been revolutionary advances in the treatment of Familial Adenomatous Polyposis (FAP). The purpose of this article is to describe the pathophysiology, genetic testing, surveillance, surgical interventions, and psychosocial issues. The genetic defect in FAP is germline mutation in the adenomatous polyposis coli (APC) gene. Syndromes once thought to be distinct from FAP are now recognized to be part of the phenotypic spectrum of FAP. Syndromes with a germline mutation in the APC gene include FAP, Gardner syndrome, Turcot syndrome, and Attenuated Adenomatous Polyposis Coli (AAPC). FAP is a germline mutation in the APC gene with onset of florid polyposis in childhood and development of colorectal cancer by age 30. Colectomy is advised because of the high risk of developing colorectal cancer. AAPC is a variant of this condition with later age of onset and milder clinical phenotype. However, colectomy is advised once polyposis develops and polyps cannot be managed endoscopically. Despite the unique advances in genetic testing, psychosocial management of these syndromes remains to be a challenging problem.

Citizen's Petition to Food and Drug Administration to ban cornstarch powder on medical gloves: Maltese cross birefringence

BACKGROUND

During the last 25 years, scientific experimental and clinical studies have documented the dangers of cornstarch powder on examination and surgical gloves because the cornstarch promotes wound infection, causes serious peritoneal adhesions and granulomatous peritonitis, and is a well-documented vector of the latex allergy epidemic in the world. Realizing the dangers of cornstarch on examination and surgical gloves, Germany's regulations of personal protective equipment banned the use of surgical glove powder cornstarch in 1997. In 2000, the Purchasing and Supply agency for the United Kingdom ceased to purchase any gloves lubricated with cornstarch.

DISCUSSION

Realizing the dangers of cornstarch-powdered gloves, many hospitals and clinics in the United States have banned the use of cornstarch-powdered examination and surgical gloves. Hospitals that have banned cornstarch in their examination and surgical gloves have noted a marked reduction in the latex allergy epidemic in their facilities. Realizing the dangers of cornstarch-powdered examination and surgical gloves, Dr Sheila A. Murphey, branch chief, Infection Control Devices Branch, Division of Anesthesiology, General Hospital, Infection Control, and Dental Devices Office of Device Evaluation, Center for Devices and Radiological Health of the Food and Drug Administration (FDA), recommended that a Citizen's Petition be filed to the FDA to ban cornstarch on surgical and examination gloves.

CONCLUSION

The 12 authors of this report have attached the enclosed petition to the FDA to ban the use of cornstarch on all synthetic and latex examination and surgical gloves used in the United States.

Breast cancer and ovarian cancer genetics: an update

The purpose of this report on breast cancer and ovarian cancer genetics is to review the evidence for the efficacy of surveillance for early detection, bilateral prophylactic mastectomy, prophylactic oophorectomy, and chemoprevention in preventing breast cancer and improving survival of BRCA1 and BRCA2 carriers. This collective review highlights radiologic screening of patients with this genetic predisposition for cancer as well as discusses cancer risk reduction strategies and reproductive concerns in female BRCA1/2 mutation carriers. It has now been well documented that magnetic resonance imaging (MRI) of the breast has a higher sensitivity than mammography for the diagnosis of breast cancer in patients predisposed to breast cancer. We also emphasize that a new diagnostic device, molecular breast imaging (MBI), is now available and may be as sensitive as MRI. To date, this exciting technology, MBI, has not been used in studies of patients with BRCA1/2 genes. We also discuss in more detail the unique psychological ramifications of female BRCA1/2 mutation carriers. These women face unique choices regarding management of their high risk for breast and ovarian cancer that impact their reproductive options. Despite their high levels of concern, few female BRCA1/2 mutation carriers consider assisted reproduction technologies such as pregnancy surrogate, cryopreservation of oocytes or embryos, or implantation genetic diagnosis to select embryos without BCRA1/2 mutation. Further research must be undertaken to explore the risk management of patients with inherited cancer predisposition and to incorporate these preferences into clinical care.

Legislation and informed consent brochures for dental patients receiving amalgam restorations

In 2008, Norway banned the use of mercury for amalgam restorations. Four states in the United States have developed Informed Consent Brochures for amalgam restorations that must be given to their dental patients. The authors describe a patient who had a large cavity in his left lower molar tooth no.18 that had to be removed by an oral surgeon. When the patient went to the oral surgeon, the surgeon told the patient that he would replace the carious tooth with a gold implant. He was not given an Informed Consent Brochure regarding dental restorative materials. The oral surgeon extracted the carious tooth, replacing the tooth with a supposed gold crown implant. On his yearly dental examination, his dentist took an x-ray of his dental implant and explained that the x-ray could not distinguish whether the implant contained either gold or mercury. Consequently, the dentist referred him to a dental clinic in which the dental implant could be removed without mercury contamination of the patient's neurologic system during the extraction of the implant from the root canal. During the removal of the dental restoration, the dentist found build up expanding into the root canal that had a black color. The crown and underlying tooth were sent to ALT BioScience for analysis. Elemental analysis of the crown and underlying tooth confirmed the presence of mercury in the restoration. The patient should have been given an Informed Consent Brochure by the dentist that described the dental restoration that was used in the dental implant.

Advances in the treatment of peanut allergy: a case report

BACKGROUND

Peanut allergies affect 1.5% of children. The majority of reactions to peanuts are mild, but peanut allergy is also the most common cause of fatal anaphylactic reactions to food.

CASE REPORT

The purpose of this case report was to describe a 1-year old boy who developed difficulty breathing after eating a peanut food product. The boy was taken immediately by his mother to an Emergency Department, exhibiting severe respiratory distress. After speaking to the child's mother, the emergency physician (EP) realized that the wheezing was due to a peanut food allergy. The child's respiratory symptoms responded within 10 min to bronchodilatator inhalation. The EP gave the mother educational information regarding the management of asthma and the proper use of metered dose inhalers with spacer devices. The EP referred the child to a clinical allergist who specializes in the management of food allergies. The diagnosis was made by skin prick testing as well as in vitro measurement of peanut-specific immunoglobulin E.

CONCLUSION

The allergist explained that the mainstay of management of peanut allergy is avoidance of the allergenic food. Patient education involved teaching the mother to avoid high-risk situations such as dinner with family members who are not informed about the child's allergy to peanuts, encouraging the child to wear a Medic Alert Bracelet, and teaching the family and child to recognize early symptoms of allergic reactions and to manage an anaphylactic reaction, including the use of self-injectable epinephrine, as well as activating emergency services.

Modern concepts of the diagnosis and treatment of purpura fulminans

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and accompanied by vascular collapse and disseminated intravascular coagulation. It usually occurs in children, but this syndrome has also been noted in adults. The purpose of this collective review is to provide modern concepts on the diagnosis and treatment of neonatal purpura fulminans, idiopathic purpura fulminans, and acute infectious purpura fulminans. There are three forms of this disease that are classified by the triggering mechanisms. First, neonatal purpura fulminans is associated with a hereditary deficiency of the natural anticoagulants Protein C and Protein S as well as Antithrombin III. Idiopathic purpura fulminans usually follows an initiating febrile illness that manifests with rapidly progressive purpura. Deficiency of Protein S is considered to be central to the pathogenesis of this form of the disease. The third and most common type of purpura fulminans is acute infectious purpura fulminans. The mortality rate has decreased with better treatment of secondary infections, supportive care, and new treatments, but it remains a disabling condition often requiring major amputations.

Endoluminal resection for sessile neoplasia in the GI tract is associated with a low recurrence rate and a high 5-year survival rate

BACKGROUND

Endoluminal resection (ELR) is an alternative to surgery for the removal of superficial neoplastic lesions of the GI tract. We previously reported a complete resection (CR) rate of 89% when using ELR techniques. However, the long-term efficacy of ELR for the eradication of sessile lesions, as well as patient survival after ELR, is not known.

OBJECTIVES

To assess the long-term recurrence rate of GI lesions that were completely resected by ELR and to determine the long-term (5-year) survival rate of patients who had ELR for GI lesions that contained high-grade dysplasia (HGD) or adenocarcinoma (AdCa).

DESIGN

From a larger cohort of 92 consecutive patients who had undergone ELR of sessile lesions from 1997 to 2000, long-term follow-up was obtained. Patient survival rates were considered in terms of disease-specific mortality.

RESULTS

Endoscopic follow-up was possible in 44 patients (48%) and 46 lesions (46%). At the time of the initial ELR, the median age was 68.5 years. The median duration of follow-up was 3.8 years after ELR (range 7 months to 8.1 years). Resected lesions were located in the esophagus (25%), stomach (11%), duodenum (25%), colon (27%), and rectum (11%). Post-ELR histopathology consisted of adenomas (46%), HGD (16%), AdCa (11%), lymphoma (2%), leiomyoma (2%), carcinoid (2%), lesions indeterminate for dysplasia (2%), and nondysplastic lesions (18%). CR was achieved in 42 patients and 44 lesions (96%) after initial ELR procedures (range 1-3). Thirty-seven of 39 neoplastic lesions (95%) in this cohort achieved initial CR. Two lesions (found in 2 patients) that did not achieve initial CR were excluded from analysis. Four of 37 neoplastic lesions (10.8%) that underwent successful ELR had local recurrence of neoplasia (median time to recurrence was 1.9 years). Two of the 4 neoplastic recurrences were successfully eradicated by subsequent endoscopic techniques (95% overall eradication rate). Long-term endoscopic follow-up was possible in 12 of 20 patients (60%) with HGD or AdCa who achieved initial CR. These 12 patients had HGD (n = 7) or AdCa (n = 5) and were observed for an average of 4.9 years (range 1.4-7.9 years) after an ELR. Two of these patients died during follow-up, but only 1 death (8%) was lesion related. When comparing post-ELR pathology, HGD and AdCa trended toward an increased risk of recurrence compared with other neoplastic lesions (hazard ratio 4.75 [95% CI, 0.49-46.35], P = .18).

LIMITATIONS

A retrospective study with 52% of patients lost to long-term endoscopic follow-up, which limited the sample size and the number of events.

CONCLUSIONS

ELR effectively eradicates sessile neoplastic lesions from the GI tract, with a low recurrence rate (10.8%) at long-term follow-up. Post-ELR surveillance is important, because local recurrences may be amenable to endoscopic eradication. HGD and cancers may carry an increased risk for a local recurrence, with a 5-year disease-specific survival of 92%. This study suggests that ELR is associated with a low recurrence rate for neoplastic lesions and appreciable long-term survival in patients with highly dysplastic lesions. Additional, long-term follow-up studies are necessary to investigate the role of ELR in the treatment of highly dysplastic lesions of the GI tract.

Implementation of revolutionary legislation for informed consent for dental patients receiving amalgam restorations

Mercury is one of the most dangerous environmental toxins. Realizing the environmental dangers of mercury, the Norwegian Minister of the Environment and International Development, Erik Solheim, has therefore prohibited the use of mercury in products in Norway. This ban will include dental filling materials (amalgam) and measuring instruments, as well as other products. This ban is valid from January 1, 2008. Sweden announced a similar ban, and dentists in Denmark will no longer be able to use mercury in fillings after April 1, 2008. It is indeed unfortunate that the United States has not taken a leadership role in enacting Informed Consent Legislations for patients receiving dental amalgam restorations. Informed Consent Legislations have been enacted by Maine, California, Connecticut, and Vermont.

Need for informed consent for dentists who use mercury amalgam restorative material as well as technical considerations in removal of dental amalgam restorations

Amalgam restorative material generally contains 50% mercury (Hg) in a complex mixture of copper, tin, silver, and zinc. It has been well documented that this mixture continually emits mercury vapor, which is dramatically increased by chewing, eating, brushing, and drinking hot liquids. Mercury has been demonstrated to have damaging effects on the kidney, central nervous system, and cardiovascular system, and has been implicated in gingival tattoos. While mercury amalgams may result in detrimental exposure to the patient, they can also be a danger in dental practices. In Europe, the federal governments of Norway, Finland, Denmark, and Sweden have enacted legislation requiring that dental patients receive informed consent information about the dental restorative material that will be used. In the United States, a few state governments have enacted informed consent legislation for dental patients receiving dental restorations. These state legislations were enacted by Maine, California, Connecticut, and Vermont. It is a sad tragedy that mercury is causing such health damage to many people. The American Dental Association has said for the past 150 years that the mercury in amalgam is safe and does not leak; however, no clinical studies were ever done and the Food and Drug Administration approved amalgam under a grandfather clause. Subsequent studies have shown this claim of safety not to be true. Over ten years ago, the Federation of American Societies for Experimental Biology Journal published a comprehensive article calling mercury restorative material a major source of mercury exposure to the U.S. population. The authors of this paper recommend that federal and state legislation be passed throughout our country to ensure that consent forms are given to patients receiving silver-mercury amalgam restorative material.

A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design

The Americans with Disabilities Act (ADA) gives all Americans with disabilities a chance to achieve the same quality of life that individuals without disabilities enjoy. In this case report, we will be discussing the consequences of having inaccessible ramps to persons with disabilities that can result in severe musculoskeletal injuries in a wheelchair user. While going down an inaccessible ramp in the garage of a hospital, a wheelchair tipped over, causing a fracture to the user's right femur. The injured patient was taken to the Emergency Department, where the diagnosis of a fracture of the right femur was made. The fracture then had to be repaired with an intramedullary rod under general anesthesia in the hospital. It was discovered that the ramps in the hospital garage did not comply with the guidelines of the ADA. The wheelchair ramps had a ramp run with a rise > 6 inches (150 mm) and a horizontal projection > 72 inches (1830 mm). This led to the redesign and construction of safe ramps for individuals using wheelchairs as well as for pedestrians using canes, within 1 month after the patient's injury, making it safe for wheelchair users as well as pedestrians using the parking facilities. The ADA specifies guidelines for safe ramps for patients with disabilities. It is important to ensure that hospital ramps comply with these guidelines.

Revolutionary advances in organic foods

'Organic' is a labelling term that denotes products produced under the authority of the Organic Foods Production Act. Before a product can be labelled 'organic', a government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet the US Department of Agriculture (USDA) organic standards. Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too. Along with the national organic standards, the USDA developed strict labelling rules to help consumers know the exact content of the food they buy. It is important to emphasise that the USDA has not made any health claims for organic foods. It is indeed fortunate that the US Department of Health and Human Services, Centers for Disease Control and Prevention, USDA and the Environmental Protection Agency are now expanding their research to explore the scientific basis for the health benefits of organic foods.

Update on the National Vaccine Injury Compensation Program

The National Childhood Vaccine Injury Act of 1986, as amended, established the Vaccine Injury Compensation Program (VICP). The VICP went into effect on October 1, 1988 and is a Federal "no-fault" system designed to compensate individuals, or families of individuals, who have been injured by covered vaccines. From 1988 until July 2006, a total of 2531 non-autism/thimerosal and 5030 autism/thimerosal claims were made to the VICP. The compensation paid for the non-autism/thimerosal claims from 1988 until 2006 was $902,519,103.37 for 2542 awards. There was no compensation for any of the autism/thimerosal claims. On the basis of the deaths and extensive suffering to patients and families from the adverse reactions to vaccines, all physicians must provide detailed information in the Vaccine Information Statement to the patient or the parent or legal guardian of the child about the potential dangers of vaccines as well as the VICP.

A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury

BACKGROUND

Resource-constrained triage occurs when the number of trauma patients exceeds the capacity for simultaneous transport and treatment. The objective of this article is to apply a new resource-constrained triage method (denoted Sacco triage method [STM]) to victims of penetrating trauma and compare it with existing methods.

METHODS

STM is a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time-dependent victim survival probabilities based on initial assessments and expected deteriorations. For application to penetrating trauma, an "RPM" score based on respiratory rate, pulse rate, and best motor response was used to predict survivability. Logistic function-generated survival probability estimates for scene values of RPM were determined from 7,274 penetrating injury patients from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. The accuracy of predicting survivability was assessed using calibration and discrimination statistics. STM was compared with START (Simple Triage and Rapid Treatment)-like triage methods with respect to process and outcomes (assessed by expected number of survivors in simulated resource-constrained casualty incidents).

RESULTS

RPM was shown to be an accurate predictor of survival probability for penetrating trauma, equivalent to the Revised Trauma Score and exceeding that of the Injury Severity Score, as measured by calibration and discrimination statistics. In the simulations, STM had substantially more expected survivors than did current triage methods.

CONCLUSIONS

Resource-constrained triage is modeled as an evidence-based, outcome-driven method (STM) that maximizes expected survivors in consideration of resources. STM offers lifesaving and operational advantages over current methods.

An innovative advance to increase the use of the vaccine information statement

Because many physicians do not use the Vaccine Information Statement (VIS), we created a revised statement that would alert the physician to the need to use the VIS. Even though the Centers for Disease Control (CDC) coordinated this evaluation, both the CDC and most of the State Board of Medical Examiners did not support this revision of the VIS. Despite the disinterest of the vast majority of the State Board of Medical Examiners, we would recommend that this updated VIS be implemented immediately to educate our society on the information in the VIS.

Management of Penetrating Neck Injuries: A New Paradigm for Civilian Trauma

PURPOSE

Improvements in imaging technology, particularly computed tomographic angiography (CTA), have altered the management of patients with penetrating neck injuries. Although some centers still advocate routine exploration for all zone 2 neck injuries penetrating the platysma, many civilian centers in the United States have adopted a policy of selective exploration based on clinical and radiographic examination. The purpose of this retrospective study is to evaluate our 5-year experience with the management of penetrating neck injuries, to further elucidate the role of CTA in clinical decision-making, and to assess treatment outcome.

PATIENTS AND METHODS

One hundred thirty-four consecutive patients were identified from the Legacy Emanuel Trauma Registry as having sustained penetrating neck injuries from 2000 to 2005. Using data collected from the Trauma Registry, as well as individual chart notes and electronic records, variables were collected and evaluated including age, gender, mechanism of injury, number of associated injuries, and the Injury Severity Score, Glasgow Coma Scale on admission, initial hematocrit, airway management techniques, diagnostic and therapeutic modalities, missed injuries, length of hospital stay, disposition, and outcome. Descriptive statistics were used to describe demographics, treatment, and outcome.

RESULTS

One hundred twenty patients met the inclusion criteria, 55 of which had only superficial injuries that did not penetrate the platysma. The primary study group consisted of 65 patients who sustained more significant injuries that violated the platysma including deep, complex, and/or avulsive wounds, vascular injuries, injuries to the aerodigestive tract, musculoskeletal system, cranial nerves, or thyroid gland. The overall mortality rate for the 65 patients with injuries penetrating the platysma was 3.0% (n = 2). Complications occurred in 7 of the surviving 63 patients (10.7%): 2 patients with zone 3 internal carotid artery injuries developed hemispheric ischemic infarcts and hemiplagia; as well as other complications including: infection (n = 2); deep venous thrombosis (n = 1); aspiration pneumonia (n = 1); and hematoma (n = 1). All surviving patients except the 2 stroke patients eventually healed uneventfully without significant functional deficit. The use of CTA as a guide to clinical decision-making led to a significant decrease in the number of neck explorations performed and a virtual elimination of negative neck explorations.

CONCLUSION

The management of stable patients with neck injuries that penetrate the platysma has evolved at our institution into selective surgical intervention based on clinical examination and CTA and has resulted in minimal morbidity and mortality.

Geometry of human ribs pertinent to orthopedic chest-wall reconstruction

Orthopedic reconstruction of blunt chest trauma can aid restoration of pulmonary function to reduce the mortality associated with serial rib fractures and flail chest injuries. Contemporary chest wall reconstruction requires contouring of generic plates to the complex surface geometry of ribs. This study established a biometric foundation to generate specialized, anatomically contoured osteosynthesis hardware for rib fracture fixation. On human cadaveric ribs three through nine, the surface geometry pertinent to anatomically conforming osteosynthesis plates was characterized by quantifying the apparent rib curvature C(A), the longitudinal twist alpha(LT) along the diaphysis, and the unrolled curvature C(U). In addition, the rib cross-sectional geometry pertinent to intramedullary fixation strategies was characterized in terms of cross-section height, width, area, and cortex thickness. The rib surface exhibited a curvature C(A) ranging from 3.8 m(-1) in the anteromedial section of rib seven to 17.3 m(-1) in the posterior section of rib three. All ribs had in common a longitudinal twist alpha(LT), ranging from 41-60 degrees. The unrolled curvature C(U) decreased gradually from ribs three to five, and increased gradually with reversed orientation from rib six to nine. The cross-sectional area remained constant along the rib diaphysis. However, the medullary canal increased in size from 29.9 mm(2) posteriorly to 41.2 mm(2) in anterior rib segments. Results of this biometric rib characterization describe a novel strategy for intraoperative plate contouring and provide a foundation for the development of specialized rib osteosynthesis strategies.

A tribute to Dr. Robert C. Allen, an inspirational teacher, humanitarian, and friend (Nov. 18, 1950-Mar. 24, 2005)

Dr. Robert C. Allen was a gifted educator, as well as experienced ophthalmologist, who was a close personal friend of Dr. Edlich at the University of Virginia Health System. While serving on the faculty at the University of Virginia Health System, Dr. Allen proved to be a compassionate physician, who developed close personal relationships with the residents, faculty, and his patients. Dr. Allen was invited by Dr Edlich to be a member of the Editorial Board of the Journal of Long-Term Effects of Medical Implants. When Dr. Allen told Dr. Edlich that he had ocular melanoma in 2000, this news was a wake-up call to Dr. Edlich on the need to prevent skin cancer, as well as ocular melanoma. Empowered by this news, Dr. Edlich was honored to co-author four articles on skin cancer prevention, as well as the latest article focusing on prevention of ocular melanoma. The Ocular Melanoma Foundation (Richmond, VA (USA)) was founded in 2003 by Dr. Robert C. Allen to increase awareness, enhance education, and provide advocacy among both patients and health care professionals regarding this rare, but potentially lethal cancer. It has a website that provides patient information, up-to-date information and enables communication/ discourse between and among patients and practitioners (admin@ocularmelanoma.org). Dr. Allen died on March 24, 2005, at his home surrounded by family and loved ones. When surgeons are faced with challenging healthcare diseases, Dr. Edlich's mentor, Dr. Owen Wangensteen, advised Dr. Edlich that he should seek the advice and guidance of skilled basic scientists, who are familiar with the problem. Dr. Wangensteen is recognized as the greatest surgical teacher during the 20th century. Consequently, Dr. Edlich enlisted the advice and guidance from the two co-authors of the next article regarding the scientific basis for the selection of sunglasses to prevent the development of cataracts, pterygia, skin cancer, as well as ocular melanoma. Dr. Reichow is a Professor of Optometry at Pacific University College of Optometry (Forest Grove, OR (USA)). Dr. Citek is Associate Professor of Optometry at Pacific University College of Optometry (Forest Grove (USA)). In their comprehensive evaluation of sunglasses, they found some disturbing results. Despite being endorsed by The Skin Cancer Foundation, the Walgreens eyewear samples offer only partial protection to the potential hazards of sunlight exposure. Those individuals who spend considerable time outdoors should seek sun filter eyewear with impact resistant polycarbonate lenses that provide 100% ultraviolet filtration, high levels of blue light filtration, and full visual field lens/frame coverage as provided by high wrap eyewear. There are several brands that offer products with such protective characteristics. Performance sun eyewear by Nike Vision (Nike Inc., Portland OR [USA]), available in both corrective and plano (nonprescription) forms, is one such brand incorporating these protective features, as well as patented optical and tint designs. Numerous Nike styles offer interchangeable lens options to meet the changing environmental conditions encountered outdoors. These technologies are incorporated into performance-driven frame designs inspired by feedback from some of the world's best athletes. Nonprescription Nike eyewear are available on-line at http://www.nike.com/nikevision, as well as at various well-known retail outlets. Nonprescription and prescription Nike eyewear are also available at the offices of many eye care professionals. Even though our latest report did not include soft contact lens, it is important to emphasize that Dr. Reichow and Dr. Citek have played a leadership role in coordinating the development of the Nike MAXSIGHT, an innovative fully tinted soft contact lens. This contact lens provides distortion-free optics, whether or not you wear prescription contacts. They filter out more than 90% of harmful blue light and 95% of UVA and UVB. For the contact lens, you should go to the website for more information http://www.nike.com/nikevision/content.html. The website has a list of practitioners who can service the patients with the respective sunglasses. With their exciting technologic advances in sunglass products, as well as tinted soft contact lens, the authors would encourage Nike Vision to develop an expanded international marketing program that allows all individuals in the world to easily purchase its products.