This prospective study evaluated the efficacy of an outpatient management protocol for patients with a gunshot-induced fracture with a stable, nonoperative configuration. Forty-one patients (44 fractures) with a grade I or II open, nonoperative fracture secondary to a lowvelocity missile comprised the study population. Patients were treated by a standard protocol, which included 1 g of cefazolin administered in the emergency room and a 7-day course of oral cephalexin. Follow-up visits were performed until complete wound and fracture heaiing were achieved. Thirty-two (78%) of 41 patients underwent full followup. Average follow-up was 5.2 months. One (2.8%) fracture (distal fibula) developed a superficial infection, which responded to an additional week of oral antibiotics, and no patient developed a deep infection. There was 1 delayed union and 2 patients with painful retained shrapnel. These results demonstrate that patients with stable, low-velocity, gunshot-induced fractures can be managed effectively and safely on an outpatient basis using this protocol.

A 62-year-old man presented to our family practice office with a skin lesion that developed over 8-10 months. Over the past 2-3 months the lesion grew more quickly. A 2-3 cm, hard brown projection was noted on the dorsal aspect of his hand. A decision was made to excise the lesion and send it for pathological evaluation. The lesion was found to be a cutaneous horn with invasive squamous cell carcinoma at the base. The margins of the sample were free of cancer cells. Cutaneous horns are raised skin lesions made of dead keratin derived from base keratinocytes. They are frequently found in areas of the body that have had solar exposure. There are a wide variety of histopathological findings at the base of these lesions. They range from benign to premalignant to malignant. Cutaneous horns should be completely excised and sent for pathological evaluation.

Chilaiditi's syndrome should be considered in the differential diagnosis of abdominal and chest pain. Although interposition of the right colon is a relatively common radiologic finding, there is a distinct paucity of information in the medical literature. Chilaiditi's syndrome is usually asymptomatic, but when symptoms occur, conservative treatment is usually effective. Recognition is important because this syndrome can be mistaken for more serious abnormalities, which may lead to unnecessary surgical intervention.

Amenorrhea, either primary (before menarche) or secondary (after menarche), is a frequently encountered clinical condition in the primary care office. A patient-oriented approach, utilizing focused diagnostic studies, provides an etiology in the majority of cases.

This case report describes a 54-year-old man who presented to his primary care physician with low back pain. During his workup, an incidental finding of a bladder mass was diagnosed. He underwent transurethral resection of the bladder tumour and the resulting pathology was consistent with extra nodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Presentation of MALT lymphoma in the urinary bladder is rare. This malignancy is more commonly found in the stomach. The prognosis for this rare tumour is excellent. Our patient showed no sign of recurrence with transurethral excision and radiation alone.