Best practices for centers of excellence in addressing periprosthetic joint infection.

Periprosthetic joint infection is a rare and devastating complication. Management of this complication often requires a multidisciplinary approach similar to that used for the care of patients with cancer. Several studies have reported better outcomes following total joint arthroplasties performed at specialized hospitals than those performed at general hospitals.

Interrogation of the aortic valve.

Objective: To review the essential elements of the transesophageal echocardiographic examination of the aortic valve, with emphasis on the technique for performing a two-dimensional examination, the quantification of aortic stenosis and regurgitation, and the effect of this modality on cardiac surgical decision making.

Design: Literature review.

Discussion: Transesophageal echocardiographic examination of the aortic valve can provide detailed information on aortic valve structure and function, provided proper technique is utilized.

Ketamine for long-term sedation and analgesia of a burn patient.

We present a case in which ketamine was used for long-term sedation and analgesia of a burn patient. Under escalating opiate dosages, the patient had developed persistent ileus as well as abdominal distension that caused respiratory compromise, without receiving sufficient analgesia. The opiate-sparing effect of the continuous ketamine infusion was more than 90%.