Good functional outcome following severe neutropenic enterocolitis and perforation in a 48-year-old woman undergoing chemotherapy for breast cancer.

Neutropenic enterocolitis (NEC) is a life-threatening bowel condition, usually resulting from chemotherapy, with a mortality rate thought to be as high as 50%. Markers of poor prognosis include gastrointestinal perforation and bowel wall thickness radiologically detected to be greater than 10 mm. NEC is associated with severe neutropenia and predominantly affects the large bowel; however, we present a case of severe NEC with oesophageal perforation requiring transfer to a specialist upper gastrointestinal unit for corrective stenting.

Austrian syndrome, ceftriaxone-induced agranulocytosis and COVID-19.

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to Transoesophageal echocardiogram demonstrated a large mitral valve vegetation with severe mitral regurgitation. She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication.

Oncoplastic breast surgery: the role of negative pressure wound therapy.

Wound-related problems following breast surgery are common. Delayed wound healing can lead to poor cosmesis and, among breast cancer patients, can result in delays in receiving adjuvant treatment. The aim of our review was to look at the literature in relation to the role of negative pressure wound therapy in oncoplastic breast surgery, as at the time of writing, there is no consensus on the use of prophylactic negative pressure dressings in closed wounds following breast surgery.

HIV Drugs Inhibit Transfer of Plasmids Carrying Extended-Spectrum β-Lactamase and Carbapenemase Genes.

Antimicrobial-resistant (AMR) infections pose a serious risk to human and animal health. A major factor contributing to this global crisis is the sharing of resistance genes between different bacteria via plasmids. The WHO lists , such as and , producing extended-spectrum β-lactamases (ESBL) and carbapenemases as "critical" priorities for new drug development.

Transitioning to a general practice placement for the foundation doctor.

Time spent training in general practice can be highly beneficial for junior doctors irrespective of their future specialty choice. A large number of foundation year two doctors from the United Kingdom will undertake time in general practice as part of the compulsory Foundation Programme for new medical graduates following recommendations for all such rotations to include a community placement. For the majority, this will be their first time working in primary care post-qualification and this role will bring significant new clinical and professional challenges.

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit.

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission).

Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017.

Rapid Discharge to Home After Total Knee Arthroplasty Is Safe in Eligible Medicare Patients.

Background: This study was aimed at assessing the risk of readmission for Medicare patients discharged home within a day of total knee arthroplasty (TKA) compared to those discharged on day 2 or beyond in a community medical center.

Methods: A hospital inpatient database was queried for all unilateral, primary TKAs performed on patients 65 years or older from January 1, 2013, to December 31, 2015. A total of 2287 patients met the study criteria, of which 1502 were discharged within a day (short stay), and 785 were discharged on day 2 or beyond (traditional stay).

The AAHKS Clinical Research Award: Liposomal Bupivacaine and Periarticular Injection Are Not Superior to Single-Shot Intra-articular Injection for Pain Control in Total Knee Arthroplasty.

Background: Intraoperative injections can help reduce early postoperative pain in total knee arthroplasty. We proposed that liposomal bupivacaine would not be superior to more common and cheaper injections.

Methods: A single-blinded prospective randomized study with 207 consecutive patients was completed.

An Algorithmic, Pie-Crusting Medial Soft Tissue Release Reduces the Need for Constrained Inserts Patients With Severe Varus Deformity Undergoing Total Knee Arthroplasty.

Background: We studied the need to use a constrained insert for residual intraoperative instability and the 1-year result of patients undergoing total knee arthroplasty (TKA) for a varus deformity. In a control group, a "classic" subperiosteal release of the medial soft tissue sleeve was performed as popularized by pioneers of TKA. In the study group, an algorithmic approach that selectively releases and pie-crusts posteromedial structures in extension and anteromedial structures in flexion was used.

Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis - a case report.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological syndrome characterized by various symptoms of neurological disease. It has commonly been reported in association with acute hypertension, pre-eclampsia, eclampsia, sepsis, and exposure to immunosuppressants. Here, we report on a normotensive woman who developed a severe frontal headache, visual disturbances, and hypertension 3 days after undergoing an emergency laparotomy for ischemic colitis during which she suffered an inadvertent dural puncture.

Death after closed adolescent knee injury and popliteal artery occlusion: a case report and clinical review.

A healthy adolescent male soccer player sustained a radiograph-negative, effusion-negative physeal injury of the proximal tibia from a ground-level fall with traumatic occlusion of the popliteal artery. Orthopaedic evaluation and arteriography were delayed for 72 hours after the injury. He arrived at a tertiary referral center in multisystem organ failure secondary to lower extremity ischemic necrosis, septic pulmonary thromboembolism, and systemic shock.

Effect of proximal femoral bone support on the fixation of a press-fit noncemented total hip replacement femoral component.

Purpose: Proximal femoral bone loss is a common challenge in revision hip arthroplasty. In this study, in-vitro fixation of a non-cemented, rectangular, dual-tapered, press-fit femoral component designed to achieve metadiaphyseal fixation was analyzed using an accelerated proximal femoral bone loss model to assess the potential use in revision cases.

Methods: The press-fit AlloclassicTM femoral stem was implanted in ten cadaveric femurs and tested under cyclic biomechanical loading in an intact state, and then again after sequential proximal femoral bone resections, simulating increasing amounts of bone deficiency.

Effects of 7 days of arginine-alpha-ketoglutarate supplementation on blood flow, plasma L-arginine, nitric oxide metabolites, and asymmetric dimethyl arginine after resistance exercise.

Background: Arginine-alpha-ketoglutarate (AAKG) supplements are alleged to increase nitric oxide production, thereby resulting in vasodilation during resistance exercise. This study sought to determine the effects of AAKG supplementation on hemodynamics and brachial-artery blood flow and the circulating levels of L-arginine, nitric oxide metabolites (NOx; nitrate/nitrite), asymmetric dimethyl arginine (ADMA), and L-arginine:ADMA ratio after resistance exercise.

Methods: Twenty-four physically active men underwent 7 days of AAKG supplementation with 12 g/day of either NO(2) Platinum or placebo (PLC).

Challenges to bone formation in spinal fusion.

Spinal arthrodesis continues to expand in clinical indications and surgical practice. Despite a century of study, failure of bone formation or pseudarthrosis can occur in individual patients with debilitating clinical symptoms. Here we review biological and technical aspects of spinal fusion under active investigation, describe relevant biomechanics in health and disease, and identify the possibilities and limitations of translational animal models.

Static and dynamic gait parameters before and after multilevel soft tissue surgery in ambulating children with cerebral palsy.

Background: Recent studies have questioned the efficacy of releasing hip flexion contractures and the resulting ankle position after tendoachilles lengthening in ambulating children with cerebral palsy (CP).

Methods: Twenty-three ambulatory children with CP underwent 96 soft tissue-lengthening procedures without bony surgery. Preoperative and postoperative clinical and computerized gait data were reviewed.

Variola virus immune evasion proteins.

Variola virus, the causative agent of smallpox, encodes approximately 200 proteins. Over 80 of these proteins are located in the terminal regions of the genome, where proteins associated with host immune evasion are encoded. To date, only two variola proteins have been characterized.