Individualizing revascularization 
for peripheral arterial disease

, Anvar Babaev, MD, PhD, FACC March 05, 2012

Severely occluded arteries in patients at high risk of contrast-induced nephropathy require treatment with newer, catheter-based techniques.
 

An internal hernia causes abdominal pain and small bowel obstruction

, Sona James, RN, MA, ACNP-BC, CCRN January 09, 2012

This case of a woman with an internal hernia caused by a small bowel obstruction illustrates a relatively rare condition. Clinician awareness and suspicion are key to a good outcome—left untreated, bowel strangulation is fatal more than 50% of the time.
 

Intrathoracic hemorrhage after placement of a subpleural catheter

, Daniel J. Boffa, MD; Frank C. Detterbeck, MD; Anthony W. Kim, MD November 07, 2011

An already uncommon postoperative complication affects two patients in unusual locations and via different mechanisms.
 

Reduced lung function and bullae 
resulting from illicit drug use

Amy L. Jay, PA-C July 25, 2011

A male patient was transferred for evaluation of large left bullae at risk for rupture. CT and history confirmed an interesting cause for the air pockets: marijuana, tobacco, and cocaine use.
 

Wireless capsule endoscopy in the 
diagnosis of Crohn disease

, Michael D. Sarap, MD, FACS; Jennifer Childers, MS, PA-C May 23, 2011

In evaluating possible Crohn disease, capsule endoscopy is effective at showing the entire small bowel and tracking the progression of healing.
 

Evaluation and surgical management of melanoma of the head and neck

, Michael Kupferman, MD April 18, 2011

This article provides a review of cutaneous melanoma, including preoperative evaluation, surgical procedure, and adjuvant therapy.
 

Esophageal carcinoma: Matching 
patients with treatment methods

, Richard T. Miller, MD January 18, 2011

Since cancer of the esophagus has a high morbidity and mortality, choosing the correct treatment method and knowing the facts are key.
 

Small bowel necrosis in association with jejunal tube feeding

Andrea N. Sarap, PA-C; Michael D. Sarap, MD, FACS; Jennifer Childers, PA-C November 15, 2010

Despite successful gastrojejunostomy reconstruction and jejunal feeding tube placement, this patient died from a rare complication.
 

Hyperglycemia management in 
the urgent surgical patient

September 27, 2010

Stress-induced hyperglycemia presents a unique challenge. Avoidance of extreme fluctuations in blood glucose levels is critical.
 

Collis-Nissen fundoplication for a symptomatic paraesophageal hernia

Ashley L. Racette, PA-C, MPAS; Richard T. Miller, MD July 12, 2010

A laparoscopic approach leads to relief of the patient's gastroesophageal reflux, uneventful surgery, and a smooth recovery.
 

A practical guide for mechanical ventilation in adult patients who require respiratory assistance

Richard G. Winters, MSPAS, PA-C; Donald A. Reiff, MD May 10, 2010

Providing care for postoperative, acutely ill, or traumatically injured patients requires an understanding of mechanical ventilation.
 

Drain placement with antibiotics provides effective therapy for appendicitis in pregnancy

Megan Bales Fulton, PA-C; Bennett Fontenot, MD; Stuart M. Leon, MD, FACS March 15, 2010

Conservative management is used effectively to treat a woman with a ruptured appendix at 32 weeks' gestation.
 

Portal vein encasement complicates resection of Klatskin's tumor in the liver

Kathryn F. Hines, MSHS, PA-C; Timothy M. Pawlik, MD, MPH January 11, 2010

Right hemihepatectomy with en bloc resection of the extrahepatic biliary tree is performed on a perihilar cholangiocarcinoma.
 

An uncommon cause of mechanical small bowel obstruction

Joel Hill, PA-C November 09, 2009

An otherwise active and healthy, older man experiences a recurrence of GI symptoms that occur after eating.
 

Endovascular embolization with a vascular plug corrects a PAVM

Stephen Hu, MD; Christopher Davis, PA-C, MPAS October 19, 2009

A pulmonary arteriovenous malformation, discovered as an incidental finding on a chest CT, is corrected with a vascular plug.
 

Abdominal aortic aneurysm repair: Matching patients with approaches

James F. Ginter, MPAS, PA-C; Jessica Linzmeyer July 20, 2009

Knowing who needs open repair versus endografting is crucial in this condition with a mortality rate as high as 80%.
 

Managing recurrent pleural effusions with an indwelling pleural catheter

Julie M. Schrader, MPAS, PA-C; Peter F. Ferson, MD May 26, 2009

Case studies describe an alternative to repeat thoracentesis for patients who are at risk of reaccumulation of fluid in the chest cavity.
 

Spinal reconstruction in Hajdu-Cheney syndrome

Catherine Murtagh-Schaffer, PA-C; Ross R. Moquin, MD March 17, 2009

Hajdu-Cheney syndrome (HCS), or acroosteolysis, is described by the National Organization for Rare Disorders (NORD) as a rare, heritable disorder of connective tissue.
 

Infrapatellar contracture syndrome following ACL reconstruction

Joel G. McReynolds, PA-C, MPAS; Mark H. Meyer, MD; March 17, 2009

A 29-year-old woman had difficulty regaining full range of motion after patellartendon autograft ACL reconstruction.
 

Brain abscess as a sign of a hereditary disease

February 19, 2009

A 38-year-old white male presented to the emergency department (ED) with a 3-day history of persistent headache. The headache was located in the left temporoparietal area and had improved temporarily with the use of acetaminophen (Tylenol) at home. The patient denied fever, nausea, vomiting, or visual changes but admitted to some word-finding difficulties.
 

RFA is an effective alternative to lobectomy for lung cancer

Scott cackler, PA-C; Ghulam Abbas, MD January 01, 2009

Newer techniques can be used to treat patients who are poor candidates for lobectomy.
 

Hidradenitis suppurativa: A disease of apocrine gland physiology

, , November 01, 2008

Hidradenitis suppurativa is a disease affecting the apocrine sweat glands that often results in chronically draining sinus tracks and wounds. Physician assistants should possess the knowledge required to diagnose this condition, to initiate conservative medical treatments, and to judge when such management has reached its limitations and a surgical referral is necessary.
 

VATS lobectomy to treat early-stage non-small cell lung cancer

Andrea McNiel, MS, PA-C; Shanda Blackmon, MD, MPH September 01, 2008

As screening modalities such as low-dose spiral CT and molecular markers in sputum become available, the possibility of diagnosing lung cancer in earlier stages is increasing.
 

Kyphoplasty for osteoporotic vertebral compression fractures

HoiKee Ng, PA-C July 01, 2008

ajor reconstructive surgery is poorly tolerated by patients, but balloon kyphoplasty has established itself as a useful, minimally invasive treatment for acute osteoporotic vertebral compression fracture.
 

Hamstring avulsion repair without using a flexion splint

Stephanie L. Stradley, PA-C, MS, ATC; Rose A. Backs, PA-C, ATC; John Grosel, MD; Christopher C. Kaeding, MD January 01, 2008

A 43-year-old woman presented for examination 18 days after sustaining an injury while waterskiing slalom style. She reported a distinct "pop" in the back of her right knee and was unable to bear weight.
 

Use of a T-tube stent to treat a patient with tracheal stenosis

Julie M. Schrader, MPAS, PA-C; Peter F. Ferson, MD December 01, 2007

When tracheal stenosis is unresectable, a T-tube stent may be indicated. These stents are chosen as definitive treatment at only a few institutions around the nation, but any PA practicing in the hospital setting may encounter a patient with such a stent. The PA plays an important role in the management of patients with a T-tube stent.
 

Pentalogy of Cantrell: A rare congenital abnormality

Dinice Jimenez, PA-C; Richard D. Mainwaring, MD November 01, 2007

During fetal life, the patient in this case was found to have a two-vessel cord and evidence of a congenital cardiac defect during routine fetal ultrasonography. Fetal echocardiography performed by her pediatric cardiologist at 20 weeks of gestation demonstrated the following congenital cardiac conditions: dextrocardia, double outlet right ventricle, ventricular septal defect, pulmonary stenosis, and malpositioned arteries.
 

Anaphylaxis during sentinel lymph node mapping

Sara Saft, PA-C; Michael Sarap, MD, FACS September 01, 2007

Mammography was performed in a healthy 54-year-old female and uncovered a 7-mm solid lesion in the right breast. A biopsy of the lesion revealed invasive carcinoma surrounded by ductal carcinoma in situ. The patient had no family history of breast cancer and no history of smoking.
 

Lumbar artery avulsion after a low-energy Chance fracture

Kelly A. Larrabee, MPAS, PA-C; Mark H. Stevens, MD, FACS; Todd L. Allen, MD, FACEP July 01, 2007

Fractures of the lumbar spine are common, but vascular injuries associated with such fractures are rare. We describe the case of an elderly woman who sustained a lumbar fracture with an associated lumbar artery avulsion as the result of a ground-level fall.
 

An unusual cause of pancreatitis in a young man

Michael Binstock, MS, PA-C; Steven Sweet, BS; Rhonda Fishel, MD, FACS May 01, 2007

Although patients often have no symptoms, clinicians should be familiar with the signs, symptoms, laboratory findings, and other disease processes that might indicate hyperparathyroidism (HPT).
 

Circumferential electrical contact burn of a finger

Dixie Reid, PA-C; Duraid Younan, MD; Christopher W. Lentz, MD March 01, 2007

Circumferential electrical contact burns of the finger are relatively rare. Because these injuries are unusual, no well-defined treatment strategy has been reported.
 

Atraumatic snapping brachialis in a 37-year-old woman

Bruce S. Rudy, MS, PA-C; April D. Armstrong, MD January 01, 2007

Brachialis muscle (brachialis anticus) injury is an uncommon cause of pain or incapacitation in the adult population. Accurate diagnosis can be difficult even with today's technological advances. Surgical exploration may be necessary to make a definitive diagnosis.
 

An endovascular approach to the treatment of intracranial aneurysms

Bryan D. Walker, MHS, PA-C; John P. Deveikis, MD November 01, 2006

Although aneurysms occurring anywhere in the body can be problematic, aneurysms within the cerebrovasculature are especially problematic because the brain is the end organ. Subarachnoid hemorrhage (SAH) caused by rupture of an intracranial aneurysm occurs at a rate of 6 to 8 per 100,000 population, and aneurysms that rupture cause significant disability or mortality in up to 50% of affected patients
 

The management of clavicle fractures

, Herbert O. Bote, MD; Kevin G. Mitts, MD September 01, 2006

The clavicle is one of the most commonly injured bones in the body. Fractures of the middle third of the clavicle account for approximately 80% of all clavicle fractures, with 15% of fractures occurring in the lateral third and 5% in the medial end. The traditional treatment of fractures of the clavicle rarely involves surgical intervention; most are treated with immobilization with a sling or figure-of-eight strap for comfort.
 

Nonoperative management of penetrating abdominal trauma

July 01, 2006

Penetrating abdominal trauma is prevalent in most urban settings in the United States; for instance, 25% of trauma cases in Los Angeles are penetrating. Selective nonoperative management is practiced routinely for blunt abdominal trauma, but in most institutions laparotomy is still considered the standard of care for abdominal gunshot wounds. The traditional treatment of these injuries has been exploratory laparotomy for all gunshot wounds to the abdomen and for all stab wounds where peritoneal violation has been proven.
 

A rare and painful deformity of the wrist

May 01, 2006

A 13-year-old premenarchal female presented with a 1-year history of left wrist pain and progressive flexion deformity. She described the pain as a dull ache, predominantly on the ulnar side, that increased throughout the day. The pain was moderately severe and, apart from NSAIDs, which provided only minimal relief, nothing made the pain better or worse. The patient was left-handed, and the pain was limiting her ability to write in school.
 

The role of PAs in robotic-assisted laparoscopic radical prostatectomy

Folusho Ogunfiditimi, MPH, PA-C March 01, 2006

This article describes the role of PAs in robotic-assisted prostatectomy utilizing the model implemented at the Vattikuti Urology Institute of the Henry Ford Health System under the Vattikuti Institute Prostatectomy (VIP) program.
 

A percutaneous pinning misadventure

Michael Paul Riddle, MS, PA-C, CRT January 01, 2006

Drilling close to percutaneous pins in a patient's radius bone has unexpected consequences.
 

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