Atypical femur fractures: a survey of current practices in orthopedic surgery.

The results of a self-administered online survey demonstrate that orthopedic surgeons' management practices for AFF are variable. These data will inform the development of clinical practice guidelines. INTRODUCTION: We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development. METHODS: A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016. Level of confidence in diagnosis and treatment as well as treatment preferences between respondents who self-identified as trauma surgeons vs. non-trauma surgeons were compared. RESULTS: A total of 172 completed surveys were obtained (OTA, N = 100, 58%; COA, N = 72, 8%). Seventy-eight percent of respondents had treated ≥1 AFF in the previous 6 months. Seventy-six percent reported feeling extremely or very confident in diagnosing AFF (trauma 84% vs. non-trauma surgeons 70%, p = 0.04), and 63% reported feeling extremely or very confident in treating AFF (trauma 82%, non-trauma surgeons 50%, p < 0.01). Preferred management for complete and symptomatic incomplete AFFs was surgical fixation with a cephalomedullary nail (CMN) by 88 and 79%, respectively, while close follow-up was preferred for asymptomatic incomplete AFFs in 72% of respondents. Trauma surgeons used the CMN more frequently than non-trauma surgeons (90 vs. 76% p = 0.03). In patients with bilateral AFFs, with one side surgically treated, 56% were extremely likely to surgically treat the contralateral side, if symptomatic. Most felt guidelines (81%) and educational resources (73%) would be valuable. CONCLUSIONS: Current orthopedic treatment practices for AFFs are variable. The results of this survey will inform the development of practice guidelines and educational resources.

Acute illnesses necessitating urgent abdominal surgery in neutropenic cancer patients: description of 14 cases and review of the literature.

Through a review of our experience and the literature, the cases of 56 neutropenic cancer patients requiring urgent abdominal surgery have been studied. The most common underlying diagnosis of malignant disease was leukemia (70%), and the most common intra-abdominal disease discovered at surgery was neutropenic enteropathy (61%). Major postoperative complications occurred in 50% of cases. The 30-day postoperative mortality was 32%, and the determinant 6-month survival was 34%. Abdominal pain in a neutropenic cancer patient calls for a thorough evaluation of its cause and careful serial examinations. Evidence of a surgically treatable disease or failure to respond to medical therapy for a presumed medically treatable disease should prompt surgical intervention.

Laryngeal papillomavirus infection during clinical remission.

Biopsy samples from 20 patients with a history of laryngeal papillomas were analyzed by Southern blot hybridization for the presence of human papillomavirus DNA. All papillomas examined contained papillomavirus DNA sequences. Four samples from uninvolved sites in two patients with active disease and eight samples from patients in remission also contained viral DNA. No human papillomavirus DNA was detected in a third patient seen during remission. These results explain the clinical pattern of frequent recurrences even after long-term remission in laryngeal papillomatosis.

Molecular heterogeneity of female genital wart (condylomata acuminata) papilloma viruses.

Florid condylomas from various anogenital sites were examined for the presence of papilloma viruses ( HPVs ) using DNA hybridization techniques. All the condylomas contained HPV DNA, but genetic variability was detected in the form of HPV types, subtypes, and possible recombinants. Morphologically similar lesions contained heterogeneous viral populations. Variation was also detected among the HPV genomes in a single patient, indicating the complex etiology of this disease.