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Portsmouth, VA, United States

Arnold J.C.,Naval Medical Center | Bradley J.S.,University of California at San Diego
Infectious Disease Clinics of North America | Year: 2015

For a child with a suspected bone or joint infection, knowledge of the workup and initial therapy is important to provide quality care. Fever and pain are hallmarks of a pediatric osteoarticular infection, although occasionally the signs and symptoms can be more subtle. The use of C-reactive protein to diagnose and validate effective management of treatment has become standard. Multiple reports confirm the success of much shorter intravenous (IV) courses than traditionally taught. The ideal IV and oral antibiotic duration, as well as defining the markers indicating need for surgical intervention, are questions yet to be answered. © 2015.

Frumkin K.,Naval Medical Center
Annals of Emergency Medicine | Year: 2013

Life-threatening warfarin-associated hemorrhage is common, with a high mortality. In the United States, the most commonly used therapies - fresh frozen plasma and vitamin K - are slow and unpredictable and can result in volume overload. Outside of the United States, prothrombin complex concentrates are often used instead; these pooled plasma products reverse warfarin anticoagulation in minutes rather than hours. This article reviews the literature relating to warfarin reversal with fresh frozen plasma, prothrombin complex concentrates, and recombinant factor VIIa and provides elements for a management protocol based on this literature. © 2013 American College of Emergency Physicians.

Satter E.K.,Naval Medical Center
Dermatology Online Journal | Year: 2012

Atypical fibroxanthoma (AFX) is an undifferentiated pleomorphic sarcoma that typically has low-grade malignant potential. Although recurrences do occur, only approximately 25 cases of metastasizing AFX have been reported. Herein a patient with an AFX that metastasized and eventuated in death is described. Although AFX remains a diagnosis of exclusion, through this pedagogic case, the clinical, immunohistochemical, and genetic features that can assist in diagnosis are discussed. © 2012 Dermatology Online Journal.

Waibel J.S.,Laser Institute | Wulkan A.J.,University of Miami | Shumaker P.R.,Naval Medical Center
Lasers in Surgery and Medicine | Year: 2013

Background and Objectives Hypertrophic scars and contractures are common following various types of trauma and procedures despite skilled surgical and wound care. Following ample time for healing and scar maturation, many millions of patients are burdened with persistent symptoms and functional impairments. Cutaneous scars can be complex and thus the approach to therapy is often multimodal. Intralesional corticosteroids have long been a staple in the treatment of hypertrophic and restrictive scars. Recent advances in laser technology and applications now provide additional options for improvements in function, symptoms, and cosmesis. Fractional ablative lasers create zones of ablation at variable depths of the skin with the subsequent induction of a wound healing and collagen remodeling response. Recent reports suggest these ablative zones may also be used in the immediate post-operative period to enhance delivery of drugs and other substances. We present a case series evaluating the efficacy of a novel combination therapy that incorporates the use of an ablative fractional laser with topically applied triamcinolone acetonide suspension in the immediate post-operative period. Methods This is a prospective case series including 15 consecutive subjects with hypertrophic scars resulting from burns, surgery or traumatic injuries. Subjects were treated according to typical institutional protocol with three to five treatment sessions at 2- to 3-month intervals consisting of fractional ablative laser treatment and immediate post-operative topical application of triamcinolone acetonide suspension at a concentration of 10 or 20 mg/ml. Three blinded observers evaluated photographs taken at baseline and six months after the final treatment session. Scores were assigned using a modified Manchester quartile score to evaluate enhancements in dyschromia, hypertrophy, texture, and overall improvement. Limitations Small sample size and lack of a control arm. Results Combination same session laser therapy and immediate post-operative corticosteroid delivery resulted in average overall improvement of 2.73/3.0. Dyschromia showed the least amount of improvement while texture showed the most improvement. Conclusion Combination same-session therapy with ablative fractional laser-assisted delivery of triamcinolone acetonide potentially offers an efficient, safe and effective combination therapy for challenging hypertrophic and restrictive cutaneous scars. © 2013 Wiley Periodicals, Inc.

Riffenburgh R.,Naval Medical Center
Statistics in Medicine | Year: 2012

Medicine deals with treatments that work often but not always, so treatment success must be based on probability. Statistical methods lift medical research from the anecdotal to measured levels of probability. Statistics in Medicine, Third Edition offers a unique combination of reference information for practitioners and researchers, along with core statistical methods for medical and health care students. It makes medical statistics easy for the non-biostatistician by outlining the common statistical methods used in 90% of medical research and clearly explaining the underlying basics. The book does not require a significant level of statistical knowledge, and provides abundant clinical examples and exercises to reinforce concepts. Easy-to-follow format incorporates medical examples, step-by-step methods, and check -yourself exercises Appeals to readers with little or no statistical background, across medical and biomedical disciplines Two new opening chapters summarize the research development steps, from conceiving a study to putting obtained data in an analyzable form, to finishing analysis and publishing the study. (1) Designing a study, acquiring data, & writing for journals, and (2) Planning analysis: What should I do with my data? Allows the book to stand alone as an overview guide for research in medicine Fills the gap left in all other medical statistics books between the reader's knowledge of how to go about research and the books' coverage of how to analyze results of that research Within the opening "Plan of the Book" three recommend teaching plans will be listed: one recommending chapters/sections for a 2-credit-one-term introduction, one for a 3-credit-one-term introduction, and one for a 1-year course Enhances flexibility of book content for use in courses across medical and biomedical disciplines Saves researchers and professors time in looking for two separate books to teach a course and conduct research Unique separate section of chapter summaries at the end of the book - a sort of a Reader's Digest summary of the book that highlights the key results (formulas, method algorithms, and check lists) Clinician/researchers will appreciate a quick reference source when they may not have the time or patience to read through the entire book Students will be able to use these sections as a study guide or a quick refresher Companion web site hosts: Databases in Excel format that were used in the book, which can be downloaded and transferred into whatever format is needed PowerPoint slides of figures, tables, and graphs from the book Links to most commonly used statistical software packages (SAS, SPSS, Minitab), ISM, SSM Researchers and students can both use the databases to perform the exercises given in the book or to practice using any appropriate statistical methods Researcher/professors will use PowerPoint slides in their professional/course lectures Researchers and students may both need to know where to find recommended software packages to analyze their data. © 2012 Elsevier Inc. All rights reserved.

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