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Review Article
Current Concepts: Dysfunction of the Diaphragm
The diaphragm is the dome-shaped structure that separates the thoracic and abdominal cavities. It is the principal muscle of respiration, is innervated by the phrenic nerves that arise from the nerve roots at C3 through C5, and is primarily composed of fatigue-resistant slow-twitch type I and fast…
- March 8, 2012
- McCool F.D. and Tzelepis G.E.
- N Engl J Med 2012; 366:932-942
- CME
- Video
Dysfunction of one or both hemidiaphragms is an underdiagnosed cause of dyspnea. Weakness or paralysis may be seen during mechanical ventilation, after surgery or trauma, with metabolic or inflammatory disorders, and with myopathy, neuropathy, or diseases causing lung hyperinflation.
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Original Article
Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury
Severe traumatic brain injury is a catastrophic event that frequently has devastating familial, economic, and societal consequences. Traumatic brain injury is the most common cause of death and disability in persons between 15 and 30 years of age. The most severe injuries can result in prolonged…
- March 1, 2012
- Giacino J.T., Whyte J., Bagiella E., et al.
- N Engl J Med 2012; 366:819-826
In this placebo-controlled trial of patients in a vegetative or minimally conscious state, amantadine accelerated functional recovery. Recovery slowed after amantadine was discontinued, and functional outcomes at 6 weeks were similar in the amantadine and placebo groups.
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Images in Clinical Medicine
Hemotympanum
Figure 1.
- March 1, 2012
- Watanabe K.
- N Engl J Med 2012; 366:e14
- Free Full Text
A 78-year-old man presented because of hearing loss and ear fullness after a head injury that had occurred during a walk 5 days earlier. Otoscopy of the left ear revealed a dark-bluish-purple eardrum, a finding suggestive of hemotympanum.
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Original Article
Brief Report: Three Patients with Full Facial Transplantation
Facial transplantation is a single, complex operation intended to transform severely deformed features to near-normal appearance and function with the use of techniques that conventional plastic surgery cannot match. Since 2005, a total of 18 patients have received transplants with promising…
- February 23, 2012
- Pomahac B., Pribaz J., Eriksson E., et al.
- N Engl J Med 2012; 366:715-722
- Video
The authors report on three patients who received full-face transplants in procedures aimed at functional restoration. Six months after transplantation, facial appearance and function were improved and glucocorticoids had been successfully withdrawn in all patients.
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Images in Clinical Medicine
Deep Sulcus Sign
Figure 1.
- February 9, 2012
- Sabbar S. and Nilles E.J.
- N Engl J Med 2012; 366:552
- Free Full Text
A 23-year-old man who been a passenger in a minivan was brought to the ER after a high-speed road accident. He had transient hypotension and tachycardia, which improved after the administration of intravenous fluids.
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Images in Clinical Medicine
Post-Traumatic Herniated Cervical Disk
Figure 1.
- February 2, 2012
- Diabira S. and Morandi X.
- N Engl J Med 2012; 366:462
- Free Full Text
An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.
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Images in Clinical Medicine
Lichtenberg Figures
Figure 1.
- December 29, 2011
- Schmidhauser T. and Azzola A.
- N Engl J Med 2011; 365:e49
- Free Full Text
A 19-year-old woman was brought to the ER after a nearby lightning strike in which her Great Dane dog had been instantly killed. She briefly lost consciousness and found herself on the wet ground, calling for help.
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Images in Clinical Medicine
A Head Shot
Figure 1.
- December 29, 2011
- Safarova M.S. and Ezhov M.V.
- N Engl J Med 2011; 365:2519
- Free Full Text
Cranial CT imaging revealed a metal foreign body at the edge of the foramen magnum in an 85-year-old man who had been hit by a bullet 82 years earlier. There was no evidence of neural damage.
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Correspondence
Acutely Injured Patients on Dabigatran
To the Editor: Trauma remains the fourth leading cause of death in the United States, with 40,000 deaths annually in persons over the age of 65. U.S. trauma centers are seeing an increasing number of severely injured elderly patients, and hemorrhagic complications and head injuries account for a…
- November 24, 2011
- N Engl J Med 2011; 365:2039-2040
- Free Full Text
The new oral direct thrombin inhibitor, dabigatran, is proving to be problematic in acutely injured patients, since it may promote bleeding and its effect cannot be easily reversed.
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Images in Clinical Medicine
Traumatic Diaphragmatic Hernia
Figure 1.
- October 6, 2011
- Picetti E. and Mergoni M.
- N Engl J Med 2011; 365:e30
- Free Full Text
A 6-year-old boy presented to the hospital after several hours of vomiting and dyspnea. He had been in a motor-vehicle accident 6 months earlier and had sustained a seatbelt injury that necessitated surgical repair of a right diaphragmatic hernia.
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Correspondence
In Vivo Biomechanical Measurements of a Football Player's C6 Spine Fracture
To the Editor: During an investigation of concussion in American football players, we captured in vivo biomechanical data on a cervical spine fracture as it occurred in a male athlete (age, 18 years; height, 189.0 cm; weight, 79.4 kg) who was performing a head-down tackling maneuver. The…
- July 21, 2011
- N Engl J Med 2011; 365:279-281
- Free Full Text
- Video
Sports are a common cause of spine injuries. Video footage documented an 18-year-old football player who sustained a cervical spine fracture during a head-down tackling maneuver. A telemetry system in the player's helmet measured the location and magnitude of the impact that caused the injury.
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Images in Clinical Medicine
Radiographic Zebra Lines from Cyclical Pamidronate Therapy
Figure 1.
- July 21, 2011
- Sarraf K.M.
- N Engl J Med 2011; 365:e5
- Free Full Text
A 6-year-old boy with type IV osteogenesis imperfecta presented to the ER with pain in the right leg after a fall. Plain radiographs revealed an undisplaced, transverse fracture of the right tibia. The images also revealed the presence of radiographic zebra lines.
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Correspondence
Closed-Eye Ocular Injuries in the Iraq and Afghanistan Wars
To the Editor: It was estimated in 2008 that 300,000 military personnel in the United States had blast-induced traumatic brain injury (TBI), the signature injury in current conflicts. Of concern to ophthalmologists are ocular injuries arising from exposure to such blast forces. Penetrating eye…
- June 2, 2011
- N Engl J Med 2011; 364:2172-2173
- Free Full Text
Comprehensive ophthalmic evaluation was conducted in 46 veterans hospitalized because of traumatic brain injury after blast exposure in Iraq or Afghanistan. Evidence of closed-eye injury was found in 20 of these patients.
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Original Article
Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel
In the current wars in Iraq and Afghanistan, the number of blast-related traumatic brain injuries may be as high as 320,000. Most of these injuries are categorized as uncomplicated "mild" or "concussive" traumatic brain injury on the basis of clinical criteria and the absence of intracranial…
- June 2, 2011
- Mac Donald C.L., Johnson A.M., Cooper D., et al.
- N Engl J Med 2011; 364:2091-2100
- Free Full Text
In this study of injured U.S. military personnel, an advanced MRI technique found abnormalities consistent with traumatic axonal injury in some patients with mild traumatic brain injury after blasts; these abnormalities were not detected with conventional MRI.
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Editorial
Brain Injuries from Blasts
For soldiers wounded in the wars in Iraq and Afghanistan, a disproportionate number of injuries are from blasts resulting from the numerous improvised explosive devices deployed by insurgent forces. Many soldiers with blast injury have sustained brain trauma, referred to as the signature injury of…
- June 2, 2011
- Ropper A.
- N Engl J Med 2011; 364:2156-2157
- Free Full Text
For soldiers wounded in the wars in Iraq and Afghanistan, a disproportionate number of injuries are from blasts resulting from the numerous improvised explosive devices deployed by insurgent forces. Many soldiers with blast injury have sustained brain ...
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Original Article
Decompressive Craniectomy in Diffuse Traumatic Brain Injury
Among patients who are hospitalized with severe traumatic brain injury, 60% either die or survive with severe disability.– Of Australia's population of 22 million, approximately 1000 patients annually sustain a severe traumatic brain injury, with associated lifetime costs estimated at $1 billion.…
- April 21, 2011
- Cooper D.J., Rosenfeld J.V., Murray L., et al.
- N Engl J Med 2011; 364:1493-1502
- Free Full Text
Patients with severe traumatic brain injury and refractory intracranial hypertension were randomly assigned to either decompressive craniectomy or standard care. Craniectomy was associated with a significant reduction in intracranial pressure but worse outcomes.
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Editorial
Clinical Value of Decompressive Craniectomy
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical deterioration and ultimately to death.…
- April 21, 2011
- Servadei F.
- N Engl J Med 2011; 364:1558-1559
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical ...
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Images in Clinical Medicine
Myositis Ossificans
Figure 1.
- February 24, 2011
- Martin D.A. and Senanayake S.
- N Engl J Med 2011; 364:758
- Free Full Text
A 40-year-old Korean woman who had been immobilized in bed for several weeks while recovering from tuberculous meningitis reported having pain in the right hip. Her right leg was externally rotated and flexed. She reported discomfort on any passive ...
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Review Article
Current Concepts: Point-of-Care Ultrasonography
Ultrasonography is a safe and effective form of imaging that has been used by physicians for more than half a century to aid in diagnosis and guide procedures. Over the past two decades, ultrasound equipment has become more compact, higher quality, and less expensive, which has facilitated the…
- February 24, 2011
- Moore C.L. and Copel J.A.
- N Engl J Med 2011; 364:749-757
- CME
- Video
Compact ultrasound technology has facilitated growth in point-of-care uses in many specialties. This review includes videos demonstrating the use of ultrasonography to guide central venous access, detect pneumothorax, detect evidence of hemorrhage after trauma, and screen for abdominal aortic aneurysm.
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Images in Clinical Medicine
Flail Chest
Figure 1.
- December 2, 2010
- Alexander P.
- N Engl J Med 2010; 363:e35
- Free Full Text
- Video
A 20-year-old man was injured while riding a tractor that fell into a gorge. He was taken to the hospital within an hour. On admission, he was normotensive and responsive to commands, and the oxygen saturation was 90% while he was receiving 4 liters of ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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