The robotic-assisted free jejunal flap for neovaginal canal creation in gender-affirming vaginoplasties.

Introduction: One of the biggest challenges with gender-affirming vaginoplasty was the creation of a long-lasting, durable, patent, and self-lubricating neovaginal canal that allowed for spontaneous, pain-free sexual intercourse. The jejunum was a durable, physiologic, and intestinal option to create the neovaginal canal that minimizes the adverse effects of skin graft, peritoneal, and colonic vaginoplasties. Free jejunal vaginoplasties had been performed in cis females for congenital genitourinary anomalies like Mullerian agenesis or after gynecologic-oncologic surgery but had yet to be reported for gender-affirming vaginoplasties.

Predictors of Timely Initiation and Completion of Adjuvant Chemotherapy in Stage II/III Colorectal Adenocarcinoma.

Adjuvant chemotherapy (AC) for colorectal cancer (CRC) has led to substantial improvement in survival. Several clinical trials advocate the initiation of AC within 6-8 weeks of surgical resection based on evidence of improved survival with early initiation of AC. We aim to evaluate factors that predict initiation and completion of AC, subsequently improving survival.

Low Rates of Colorectal Cancer Screening in First-Degree Relatives of Our Patients: Are We Failing Them?

Background: Guidelines recommend screening those with a family history of early-onset colorectal cancer at age 40 years or 10 years before the age of their relative's diagnosis. Currently, there is no literature reporting the screening rate in these individuals, and no protocols are in place to identify and target this population for screening awareness.

Objective: This study aimed to assess adherence to current screening guidelines among first-degree relatives of patients with early-onset colorectal cancer.

The Effect of Obesity on Vaginoplasty Outcomes.

Background: Some surgeons use body mass index criteria within the patient selection processes before vaginoplasty, thereby limiting access to select obese patients. We sought to better characterize the effect of obesity on postoperative outcomes across multiple vaginoplasty techniques.

Methods: A single-center retrospective review of all transfeminine patients undergoing primary vaginoplasty procedures from December 2018 to July 2022 was conducted.

Impact of Surgical Resident Education and EMR Standardization in Enhancing ERAS Adherence and Outcomes in Colorectal Surgery.

Objective: Our study aimed at investigating the degree of adherence to ERAS pathway at our institution and to evaluate the role of providing resident education and a standardized EMR order set in improving adherence and patient surgical outcomes.

Design: The study is prospective in nature and consists of two phases with a preintervention cohort to assess adherence to ERAS protocol and a postintervention cohort to evaluate improvement in adherence and patient outcomes. Adherence with the ERAS protocol was assessed across preoperative, intraoperative, and postoperative phases.

Robotic transanal minimally invasive surgery: a case series.

Introduction: This study describes the experience with robot-assisted transanal minimally invasive surgery (rTAMIS) at a single institution. TAMIS has become a popular minimally invasive technique for local excision of well-selected rectal lesions. rTAMIS has been proposed as another option as it improves the ergonomics of conventional laparoscopic techniques.

Surgical Management of Complicated Colon Cancer.

The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve.

Automated External Defibrillators and Emergency Planning for Sudden Cardiac Arrest in Vermont High Schools: A Rural State's Perspective.

Background: Sudden cardiac death (SCD) events are tragic. Secondary prevention of SCD depends on availability of automated external defibrillators (AEDs). High school athletes represent a high-risk group for SCD, and current efforts aim to place AEDs in all high schools.

Male genital trauma in sports.

Male genital trauma is a rare but potentially serious sports injury. Although such an injury can occur by many different mechanisms, including falls, collisions, straddle injuries, kicks, and equipment malfunction, the clinical presentation is typically homogeneous, characterized by pain and swelling. Almost all sports-related male genital injury comes from blunt force trauma, with involvement of scrotal structures far more common than penile structures.

Imaging of peripheral nerve lesions in the lower limb.

Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands.

Plasma Amyloid-β Peptides and Homocysteine in Depression in the Homebound Elderly.

Objectives: Both plasma amyloid-β peptide 40 (Aβ40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Aβ40 differs in those with and without depression.

Study Design And Methods: In a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score ≥ 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD).

MR imaging of traumatic and overuse injuries of the wrist and hand in athletes.

Traumatic and overuse injuries of the hand and wrist are common in athletes. Increasingly, MR imaging is being used to complement clinical and radiographic assessment in the diagnosis and management of these injuries. MR imaging is able to image accurately the bones, tendons, ligaments, nerves, and other small structures of the hand and wrist.

Overuse and impingement syndromes of the shoulder in the athlete.

Overuse and impingement syndromes in the shoulders of athletes are predominantly caused by instability of the glenohumeral joint. Glenohumeral joint instability is usually acquired from repetitive overuse of the rotator cuff and shoulder girdle muscles, or injury of the static and dynamic stabilizers of the glenohumeral joint. Congenital hypermobility of the joint may also contribute to these syndromes in some individuals.

Ultrasound evaluation of soft tissue masses and fluid collections.

Musculoskeletal ultrasound has utility as a first-line screening modality in the evaluation of soft tissue masses. The sonographic appearances of cysts or lipomas may be sufficient to obviate the need for further imaging. For other complex cystic or solid masses, ultrasound is an inexpensive, widely available imaging modality that can evaluate lesion vascularity, guide diagnostic and therapeutic aspiration or biopsy procedures, and be used for follow-up examinations to determine response to therapeutic interventions.

A "paneful" perforation.

Radiographs of a woman presenting with abdominal pain revealed a large foreign body within the pelvis. A diagnosis of perforation of the colon was made, and at laparotomy an 8.5 cm long glass fragment was removed from the bowel.

Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases.

Purpose: A relatively simple radiologically guided method for the treatment of enterocutaneous fistula by gelfoam embolization is described.

Methods: Three cases of chronic enterocutaneous fistula are presented. In each case, a sheath was positioned with its tip at the enteric opening of the fistula.

Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain.

Study Design: Fine-wire EMG rotator cuff onset time analysis in 2 matched groups of throwers with and without pain.

Objective: To identify if there is a difference in the activation patterns of the rotator cuff muscles during a rapid shoulder external rotation task between throwers with and without pain.

Background: The coordinated action of the rotator cuff is recognized as essential for glenohumeral joint control in the throwing athlete.

Managing the athlete with type 1 diabetes.

Type 1 diabetes is a chronic disease that can lead to many serious complications if not properly managed. The patient and physician must work together to optimize glucose control involving both insulin administration and caloric intake. Exercise has numerous benefits and the type 1 diabetic should take advantage of these benefits.

Exertional compartment syndrome in an equestrian does inadequate staffing compromise healthcare?

When evaluating lower-leg pain, the clinician must consider compartment syndrome resulting from exercise, even in the absence of trauma or if the exercise is seemingly benign. Equestrian sports would seem an unlikely source of acute compartment syndrome, but the examiner should consider unusual mechanisms of injury in any case. Although intracompartment tissue pressure measurements can help make the diagnosis, excessive pain is a more reliable early warning sign of acute compartment syndrome.