Skeletal Muscle Bioenergetics in Critical Limb Ischemia and Diabetes.

Introduction: Mitochondrial dysfunction is implicated in the metabolic myopathy accompanying peripheral artery disease (PAD) and critical limb ischemia (CLI). Type-2 diabetes mellitus (T2DM) is a major risk factor for PAD development and progression to CLI and may also independently be related to mitochondrial dysfunction. We set out to determine the effect of T2DM in the relationship between CLI and muscle mitochondrial respiratory capacity and coupling control.

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease.

Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD.

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain.

Background: Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction.

Who did the case? Perceptions on resident operative participation.

Background: The ACGME case log is one of the primary metrics used to determine resident competency; it is unclear if this is an accurate reflection of the residents' role and participation.

Methods: Residents and faculty were independently administered 16-question surveys following each case over a three-week period. The main outcome was agreement between resident and faculty on resident role and percent of the case performed by the resident.

Radial Artery Compression with Threatened Transection: Catfish Injury in a Pediatric Patient.

Marine animal injuries are rare causes of emergency room visits and vascular injuries worldwide. Penetrating injuries from marine animals risk damage to vasculature, and physicians must be alert to such possibilities. We report a 7-year-old boy with penetrating trauma and retained foreign body in the forearm from a catfish injury.

It depends on your perspective: Resident satisfaction with operative experience.

Introduction: Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors.

Methods: Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test.

Surgical and medical management of extracranial carotid artery aneurysms.

Objective: Extracranial carotid artery aneurysms (ECCAs) are extremely rare with limited information about management options. Our purpose was to review our institution's experience with ECCAs during 15 years and to discuss the presentation and treatment of these aneurysms.

Methods: A retrospective review of patients diagnosed with ECCAs from 1998 to 2012 was performed.

Emergency management of complicated jejunal diverticulosis.

Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis.

Exploring T cell reactivity to gliadin in young children with newly diagnosed celiac disease.

Class II major histocompatibility molecules confer disease risk in Celiac disease (CD) by presenting gliadin peptides to CD4 T cells in the small intestine. Deamidation of gliadin peptides by tissue transglutaminase creates immunogenic peptides presented by HLA-DQ2 and DQ8 molecules to activate proinflammatory CD4 T cells. Detecting gliadin specific T cell responses from the peripheral blood has been challenging due to low circulating frequencies and heterogeneity in response to gliadin epitopes.

Spiral vein graft for internal jugular bypass in a patient with multiple sclerosis and suspected chronic cerebrospinal venous insufficiency.

Chronic cerebrospinal venous insufficiency (CCSVI) has been implicated as a contributing factor to multiple sclerosis (MS). This theory is strongly debated within the neurology and radiology communities. This report presents the case of a 45-year-old man with known MS and suspected CCSVI who had undergone previous internal jugular angioplasty and stenting.

Bilateral pulmonary emboli secondary to indwelling hemodialysis reliable outflow catheter.

We present a 33-year-old dialysis-dependent female who presented with new onset split second heart sound. Following a failed left upper extremity dialysis fistula, a right upper extremity hemodialysis reliable outflow (HeRO) graft was performed in 2011. Her subsequent cadaveric renal transplant had delayed function necessitating concurrent use of hemodialysis.

Elimination of pneumothorax and hemothorax during placement of implantable venous access ports using ultrasound and fluoroscopic guidance.

Implantable venous access ports are essential for patients requiring chronic venous access. Ultrasound guided catheter placement has been recognized as a valuable adjunct for reducing complications during placement of access ports in the radiology and critical care medicine literature. We reviewed the medical records of patients undergoing insertion of implantable venous access ports from June 2006 through June 2009.

Vascular medicine: aortic and peripheral arterial disease.

The medical management of patients with an abdominal aortic aneurysm (AAA) includes modification of risk factors, smoking cessation, cardiovascular risk treatment, and hypertensive therapy. No specific therapy has been shown to alter disease outcome. Many AAA and thoracic aortic aneurysms are amenable to endovascular treatment.

Inflammatory aneurysms treated with EVAR.

Inflammatory abdominal aortic aneurysms (IAAA) are being treated more frequently by endovascular aneurysm repair (EVAR). Some authors caution against treating IAAA by EVAR because retroperitoneal inflammation may not subside post-operatively. A recent experience of 69 IAAA treated by open and endovascular methods is presented with results supporting the use of EVAR for IAAA.

Comparison of open and endovascular repair of inflammatory aortic aneurysms.

Objective: Inflammatory abdominal aortic aneurysms (IAAAs) have been traditionally managed with open repair. Endovascular aneurysm repair (EVAR) was approved September of 1999. Some authors have suggested that EVAR is not an acceptable option for management of an IAAA.

The minimally invasive management of visceral artery aneurysms and pseudoaneurysms.

Objective: Minimally invasive methods (MIMs) are now available for the management of visceral artery aneurysms and pseudoaneurysms (visceral artery aneurysms [VAA]). The purpose of this study was to review our 10-year experience with the MIM of treating VAA.

Methods: All patients evaluated from June 1999 to June 2009 with VAAs were reviewed.

Diagnostic value of inflammation markers in predicting perforation in acute sigmoid diverticulitis.

Background: The importance of inflammation markers in predicting perforation in acute sigmoid diverticulitis is not well known. Predicting perforation by clinical examination alone may be hazardous. If perforation is suspected, then appropriate diagnostic tools such as computed tomography (CT) are indicated, and surgical intervention might be necessary.

Use of the pedicled tensor fascia lata myocutaneous flap in the salvage of upper extremity high-voltage electrical injuries.

High-voltage electrical burns of the upper extremity are often limb threatening. Typically, emergency fasciotomies are followed by serial debridements until only viable tissue remains. After debridement, flap coverage is required to preserve viable but exposed tendons, nerves, vessels, bones, and joints and to salvage these seriously injured upper extremities.

C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis.

Objective: Very recently it has been shown that hyperbilirubinemia is a specific predictor of perforation in acute appendicitis. We compared the diagnostic importance of bilirubin, C-reactive protein (CRP), leukocyte count and age as markers of perforation in acute appendicitis.

Material And Methods: A two-center retrospective cohort study was completed.

Transthoracic Heller myotomy for esophageal achalasia: analysis of long-term results.

Background: Swallowing deteriorates over time in some patients after transthoracic esophagomyotomy for achalasia. The causes of decline are poorly understood.

Methods: We report a retrospective analysis of transthoracic esophagomyotomy for achalasia.