No abstract

The analysis of a large sample of skeletons from a number of Sudanese Nubian cemeteries demonstrates the usefulness of this material in the study of bone growth and development.A skeletal series from the Meroitic (B.C. 350-A.D. 350), X-Group (A.D. 350-5501, and Christian (A.D. 550-1400) period were utilized in determining the rate of bone development and age related changes in the internal structure of the femur. Specifically, we have been able to demonstrate the following: (i) The growth velocity determined from the long bones in the Nubian sample was similar but somewhat more irregular than the growth velocity of long bones in American boys studied longitudinally.(2) Growth symmetry of long bones determined by the ratio of lengths shows a greater stability than that which occurs in American boys.(3) Decrease in femoral cortical thickness with age was significant in Nubian females (P < O.OOl), while the decrease in males was not significant. The loss of cortical bone tissue in Nubian females appears to begin earlier than similar changes in modem females. (4) The density of femoral head trabecular bone organ volume decreases with age at similar rates in both males and females, but the females lose a larger percentage of density since they enter the age period (17 years) with a lower density. (5) The average thickness of femoral head trabeculae decrease with age in males, while in females there is an increase in thickness. It appears that as cross-members decrease in thickness with age, struts increase in thickness. (6) Microradiographic analysis of archeological material may provide an additional dimension to the study of bone turnover rates.

No abstract

No abstract

No abstract

Acute changes in electrolyte levels can result in severe physiologic complications. Rapid treatment of abnormally elevated potassium levels is essential due to the increased risk of potentially fatal cardiac arrhythmias. However, there are a number of circumstances that can lead to falsely elevated serum potassium levels, including fist clenching during phlebotomy and hemolysis of hematocytes during laboratory processing. Here we present a case of an elderly woman with chronic lymphocytic leukemia who presented with lower left quadrant pain and hematochezia. Laboratory tests revealed an elevated serum potassium level (7.5 mmol/L) on initial testing, in the absence of hyperkalemia symptoms, EKG changes, and hemolysis of the blood specimen. Abdominal CT revealed inflammatory changes consistent with diverticulitis. She was treated with intravenous calcium, insulin, glucose, and bicarbonate for her hyperkalemia and admitted for treatment for diverticulitis. A subsequent serum potassium level (3.9 mmol/L) and discussion with the hospitalist suggested a diagnosis of leukolysis-induced pseudohyperkalemia, and further treatment of hyperkalemia was halted. This case serves to remind current and future physicians about the importance of maintaining clinical suspicion and clarifying unexpected laboratory readings when the clinical picture and results do not completely align.

No abstract

Objective: While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. Design: This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a 2 week curriculum of instructional videos alone (n = 8, 47.1%) vs videos plus a home laparoscopic box trainer (n = 9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. Participants: Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. Results: For the box trainer group vs the videos alone group: mean change in mistakes was −10.0 (standard deviation [SD]:17.1) vs +.5 (SD:21.59) ( P = .28); mean change in time was −433.24 (SD:304.67) seconds vs −366.16 (SD:240.10) seconds ( P = .62); mean change in instrument path length was −4.27 (SD:4.38) meters vs −3.19 (SD:4.86) meters ( P = .64). The box trainer group ranked “I feel as though surgery comes naturally” 1.58 points higher (95% confidence interval [CI]: .85, 2.32; P < .01) and “I am worried about being skilled at surgery” 1.26 points lower (95% CI: 2.29, −.24; P = .02) upon completing the study. The videos alone group reported no significant changes in survey responses. Conclusion: Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.