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Reflex lid closure often protects the eyes during facial burns. Although corneal burns are uncommon, other ophthalmic injuries occur more frequently. Ophthalmic burns are usually associated with marked facial damage and possible inhalation injury. Failure to recognize and appropriately treat ophthalmic burns can lead to catastrophic sequelae. We performed a 2-year survey of all facial burns in our burn unit. Forty-four patients with thermal facial burns were identified. Sixteen patients had ophthalmic injuries. Corneal injury was detected in 13 per cent (2/16). Intubation was required in 43.75 per cent (7/16) of patients with ophthalmic injuries. Mortality was 25 per cent (4/16). We conclude that patients with facial burns severe enough to cause ophthalmic injuries may be associated with other lethal injuries, and a high index of suspicion should be maintained until all lethal injuries are ruled out. All ophthalmic injuries should be evaluated by an ophthalmologist.

A compartmental syndrome arises in situations where increased pressure within a limited space restricts the circulation by lowering the arteriovenous gradient and function of tissues within that space. Hypotension, hemorrhage, arterial occlusion, and limb elevation all appear to reduce the tolerance of limbs for increased tissue pressure. In early cases, patients with decreased levels of consciousness or when clinical evaluation is equivocal, pressure measurements become mandatory. Usually a single pressure measurement at the appropriate time will reveal the need for decompression, although in equivocal cases, a constant pressure measurement becomes necessary. The Wick catheter method has been widely used for this type of measurement, but we have developed a simpler system which is described in this article.

The lithotomy position is known to decrease venous blood flow and predispose to lower extremity venous thrombosis. However, arterial thrombosis secondary to surgical positioning has rarely been discussed. One hundred patients underwent measurements of their ankle-arm index, the ratio of their ankle systolic pressure compared to their brachial blood pressure, preoperatively (AAI); immediately after being placed in the lithotomy position (AAII); and immediately prior to returning to the supine position (AAIII). Comparison of all the ankle-arm indexes revealed significant drops between preoperatively and immediately after being placed in the lithotomy position, and between preoperatively (p less than .01) and immediately prior to the supine position (p less than .05). When only preoperative ankle-arm indexes of 0.99 were examined, a very significant drop of p less than .005 was obtained. No significant drop was seen in the group with preoperative ankle-arm indexes less than 0.99. In view of this pressure drop, standard lithotomy stirrups, such as those usually utilized for OB procedures, should be used with caution for procedures requiring prolonged lithotomy position.

Recent literature has reported several series of synchronous adenocarcinoma of the colon, but there has not been a reported case of synchronous squamous carcinoma of the anus and adenocarcinoma of the rectum. This article describes a patient with a large squamous carcinoma of the anus along with a large adenocarcinoma of the rectum, and also discusses a current review of the etiology and treatment of squamous carcinoma of the anus.

Aortoenteric fistulas were first reported in 1822. Primary aortoenteric fistulas are uncommon (less than 200 cases reported). Secondary aortoenteric fistulas are a well-recognized complication of prosthetic grafts (incidence from 0.4 to 2.4%). Atherosclerosis, gallstones, foreign bodies, carcinomas, and diverticular disease are the most common etiologies. Diagnosis is difficult with most studies being nondiagnostic. A high incidence of suspicion is required to successfully diagnosis preoperatively. Surgical repair is required for survival of the patients and should consist of the following: 1) primary closure of the intestinal defect, 2) either primary anatomical repair with a prosthetic graft or extra-anatomical vascular reconstruction, depending upon the presence or absence of infection, and 3) treatment with appropriate antibiotics. One of the largest series of primary aortoenteric fistulas from a single institution consisting of three cases secondary to aneurysmal and granulomatous disease is discussed.

Carcinoma of the male breast is relatively rare and the prognosis is usually more ominous than in the female. Radical mastectomy is advocated for optimal therapy but lesser procedures are used for a variety of reasons. After observing several recent cases of male breast cancer, we reviewed the tumor registries for the past 27 years at Marshall University affiliated hospitals. Thirteen cases were found and evaluated. This article presents treatment, survival and a review of the current therapy.

A 59-year-old white male presented with symptoms of an upper respiratory infection and the sensation of nasal fullness or obstruction. There were no constitutional symptoms or history of previous oropharyngeal neoplasms. Examination revealed a fleshy tan-pink 2 cm. x 1 cm. pedunculated lesion at the base of the uvula posteriorly, extending into the posterior soft palate. Indirect laryngoscopy confirmed extension of the lesion base onto the posterior soft palate. There was no palpable cervical adenopathy. CT scan of the sinuses and neck revealed no abnormality except the soft tissue mass in the area of the uvula and soft palate. Excisional biopsy of the lesion revealed a plasmacytoma which produced a monoclonal lambda chain immunoglobulin. Hemoglobin was 17.2 g/d. Serum electrophoresis and immunophoresis, Bence-Jones protein, bone marrow, and bone scan were normal. Twenty-six months later, a 1.5 cm. pedunculated lesion was noted at the site of original tumor, which was demonstrated to be recurrent plasmacytoma on excisional biopsy. No other lesions were identified on direct laryngoscopy and skeletal survey was normal. Repeat laboratory studies were normal except for a slight hypergammaglobulinemia (total protein 6.4 g/d., albumin 51.5 percent, alpha 1 globulin 4.0 percent, alpha 2 globulin 11.4 percent, beta globulin 12.8 percent, and gamma globulin 20.2 percent). The patient refused further treatment and has had no further recurrences at one year.

Basal cell carcinoma accounts for 65-75 per cent of all skin carcinomas. We describe the case of a basal cell carcinoma of the back that was allowed to grow to a giant size. Even when this size, basal cell carcinomas rarely metastasize.

A three-year, retrospective, community-wide study reviewed all patients (n = 60) with positive Clostridium difficile stool cytotoxin assays. The appropriateness of antibiotic administration in hospitalized patients (n = 48) who developed antibiotic-associated colitis (AAC) was studied. Only 25 per cent had antibiotics used appropriately with positive culture results and organisms susceptible to the antibiotic(s) given. Another 25 per cent of cases had positive cultures, but the organisms were not susceptible to the antibiotics used. Cultures exhibited no growth or were not obtained in 50 per cent of cases, but empiric antibiotic administration led to the development of AAC. Our results point toward inappropriate antibiotic use as being a major factor in the development of AAC. AAC is rarely fatal but has significant morbidity, and is expensive to treat. Judicious use of antibiotics may decrease the incidence of AAC.

Leiomyomas involving the small bowel are rare benign tumors comprising 0.2% to 1.8% of all gastrointestinal tumors. We have presented a case with the rare complication of a free perforation between the tumor and the peritoneal cavity, causing an acute abdomen.

A twenty-four-year-old black female presented through the outpatient department complaining of "white urine". Pertinent history, physical examination, and diagnostic studies are reviewed with special emphasis on lymphangiography. The literature is reviewed particularly with regard to laterilization of the fistula, thoracic duct obstruction, and methods of therapy.

We report the case of a large venous aneurysm of a 22-year-old white man. After evaluation and diagnosis, the aneurysm was resected without difficulty. Cause, diagnosis, treatment, and possible complications are discussed.

Measurement of pulmonary ventilation in infants has been performed by a number of investigators.1-8In the last three decades plethysmographic methods have been used by most groups, although it has recently been demonstrated that the mask-and-bag technique is possible in small infants.7,8Observations have been chiefly limited to the newborn period, although one study has included a few infants up to 3 months of age.2 None of the studies to date have included data on flow rates. The purpose of this paper is to describe a method which permits direct measurement of ventilation. In addition, observations which have been extended to infants up to 8.9 months of age are included. Methods The apparatus (Fig. 1) employs the bag-in-box principle. The box is constructed of Lucite, is airtight, and has a 27 liter capacity. Within the box is a Neoprene balloon of 6 liter capacity. The box and the