A neural loop of the deep motor branch of the ulnar nerve: an anatomic study

A motor neural loop of the deep branch of the ulnar nerve was encountered on three occasions during neurolysis of the ulnar nerve through Guyon's canal. An anatomic study of the course of the deep motor branch of the ulnar nerve at the wrist was done to define the incidence of this neural loop. Seventy-seven cadaveric upper extremities were examined and seven (9%) cases of a neural loop were encountered. One of these cases was bilateral. This variation should be considered when there is an atypical clinical presentation after penetrating injuries or compression neuropathy of the ulnar nerve at the wrist. In addition, care must be taken not to injure this branch during decompression of Guyon's canal or excision of an ununited of the hook of the hamate.     

The simultaneous presentation of peripheral T-cell lymphoma and hairy cell leukemia

A patient who presented simultaneously with B hairy cell leukemia (HCL) and peripheral T-cell lymphoma (PTL) is described. The diagnoses of the two neoplasms were made by standard morphologic and cytochemical study and confirmed immunologically. There was no evidence of overlap in markers to suggest that they arose from a single clone of malignant cells. It is suggested that the simultaneous occurrence of the two neoplasms in the same patient reflects an underlying predisposition to the development of neoplasia in HCL.     

Ensuring full participation of people with disabilities in an era of telehealth

The widespread use of telehealth resulting from the COVID-19 pandemic has the potential to further exacerbate inequities faced by people with disabilities. Although, for some members of the disability community, the option to engage with telehealth may result in reduced barriers to care, for others, inadequate attention to the design, implementation, and policy dimensions may be detrimental. Addressing such considerations is imperative to mitigate health inequities faced by the disability community.     

Epiglottitis due to nontypeable Haemophilus influenzae in a vaccinated child

Once a prevalent disease, acute epiglottitis in children has become a rare entity. The introduction of the Haemophilus influenzae type b vaccine has had a dramatic impact on the number of invasive infections caused by this organism. However, physicians must be aware that epiglottitis may result from vaccine failures or from infection with other pathogenic organisms. Vaccinated children with epiglottitis present in a similar fashion to those who are not vaccinated. We present a rare case of acute epiglottitis in a fully vaccinated child due to nontypeable H. influenzae and discuss the clinical presentation and management.     

Infant formula with protein-energy ratio of 1.7 g/100 kcal is adequate but may not be safe.

BACKGROUND: An adequate protein-energy ratio of infant formulas has been defined as one that permits growth similar to that of infants fed relatively generous protein-energy ratios, and serum concentrations of albumin and urea nitrogen no less than those observed in breast-fed infants. A safe ratio has been defined as one with no detectable adverse effects. The hypothesis was that a protein-energy ratio of 1.7 g/100 kcal is adequate and safe. METHODS: Healthy male infants were fed Formula 1.7, a milk-based formula, as the sole source of energy from the 8th to the 112th day of life. Weight, length, and energy intake were measured; serum albumin and urea nitrogen were determined; and the results were compared with data from appropriate reference groups of infants. RESULTS: Energy intake from 8 through 55 days was significantly higher than that of infants in the formula-fed reference group. Gain in weight was significantly more than that of the formula-fed reference group or of a breast-fed reference group, whereas gain in length was similar to that of the formula-fed reference group. Body mass index was significantly higher than that of either reference group, suggesting more fat accumulation in infants fed Formula 1.7. Plasma concentrations of albumin and urea nitrogen were similar to those of the breast-fed reference group. CONCLUSION: Infants fed Formula 1.7 received adequate intakes of protein. Because of the possibility that ad libitum feeding of diets with moderately inadequate protein-energy ratios is associated with increased food intake leading to excess weight gain, it is not possible to conclude that a protein-energy ratio of 1.7 g/100 kcal is safe.