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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.

In feeding and digestion trials with lactating dairy cows fed complete mixed diets ad libitum without or with limestone buffer, the complete dry matter ratio was 50:50 corn silage to concentrate. During the 44-wk feeding trial, lactating cows fed a complete diet containing 2.71% limestone had similar intakes of dry feed but produced 7.3% more milk than cows fed a complete diet containing .14% limestone. In digestion trials at maintenance intakes of feed, digestibilities of dry matter, energy, starch, cell wall, and crude protein were higher than when intakes of feed ranged from 2.8 to 3.4 multiples of maintenance during lactation. Addition of 2.71% limestone to the diet at the higher intakes of feed during lactation increased digestibility coefficients for dry matter from 66.1 to 69.5%, energy from 65.4 to 68.3%, starch from 85.9 to 94.6%, cell wall from 51.3 to 55.1%, and crude protein from 65.7 to 67.8%. Limestone as a buffer for this diet of high energy improved both production and diet efficiency possibly by maintaining an environment in gastrointestinal tract more desirable for utilization of both starch and cell wall at intakes of feed above maintenance.

A series of tests were made on cement kiln dusts to determine their capacity to sequester protons and to identify the active agents. The pH stat titration technique indicated little difference among kiln dusts in their capacity to neutralize acids. All kiln dusts were less reactive than calcium oxide but similar to reagent and feed grade calcium carbonates. Examination of kiln dusts by X-ray diffraction indicated that the major form of calcium was calcium carbonate and that little, if any, calcium was present as the oxide or hydroxide. The calcium carbonate in cement kiln dust, determined by the carbonate test, varied from 49.5 to 85.7%. All kiln dusts were much more reactive at pH 3.0 than at 6.0. Cement kiln dusts that did not show a favorable response when fed to animals showed less reactivity at pH 6.0 than dusts eliciting a favorable animal response. The active agent appears to be calcium carbonate in a finely divided state.

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.

Amphotericin B colloidal solutions were prepared according to the manufacturer's directions and filtered with membrane filters of different porosity to test for particulate matter; and the concentration and in vitro microbiological activity of filtered and nonfiltered solutions were determined. The amphotericin B solutions contained numerous particles. Filtration through 0.85- and 0.45-mum filters did not reduce the in vitro antimicrobial activity, and filtration through 5-, 0.45-, and 0.22-mum filters did not alter the concentration of the drug when assayed spectrophotometrically.

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.

For several years, I have used the previous editions of this book as a text for pediatric residents who "rotate" through our microbiology laboratory during their training. Almost invariably they have been delighted to discover a book on this subject which was brief, lucid, and seemed written especially for them. This new edition should prove no disappointment to them. Brought up-to-date, it is an authoritative introduction to clinical bacteriology, not a reference work where the details of unusual bugs can be found. It covers more than most pediatricians will want to know about bacterial cytology, metabolism, and genetics. However, most will profit by reading the section on antimicrobial chemotherapy, several times. Similarly, the section on allergy and hypersensitivity will motivate the reader to take a new look at autoimmune disease. To all but the most recent graduates, the sections on fungi and viruses will be fresh and packed with new