Utilization of Orthopaedic Trauma Surgical Time: An Evaluation of Three Different Models at a Level I Pediatric Trauma Center.

Objective: Over the past decade, our institution has instituted three different scheduling models in an attempt to care for pediatric trauma at our Level I Trauma Center. This has been in response to a number of factors, including a limited number of physicians covering the call schedule, increasing competition for operating room (OR) time after hours (pediatric surgery, urology, neurosurgery), an attempt to fully utilize OR time during the daytime, fully staffed hours, and optimizing patients' timeliness to surgery. We examined the three on-call systems in place at our institution to determine whether a more flexible approach to pediatric trauma call resulted in delays in treatment.

Comparison of custom to standard TKA instrumentation with computed tomography.

Purpose: There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components.

Periprosthetic femoral condyle fracture after total knee arthroplasty and saline-coupled bipolar sealing technology.

Saline-cooled bipolar radiofrequency technology has emerged as an effective method to reduce bleeding during total knee arthroplasty (TKA). No significant osseous complications have been previously reported, and animal studies have revealed no difference in bone healing, strength, or osteonecrosis compared to conventional monopolar electrocautery. This article presents 4 cases of early postoperative periprosthetic femoral condyle fractures after extensive use of saline-cooled bipolar radiofrequency requiring revision TKA.

Liver transplantation at Yale-New Haven Transplantation Center.

It is possible to achieve better results after liver transplantation in adult and pediatric patients. An approach driven by multidisciplinary protocol is the most important factor, along with excellent communication skills, technical expertise, application of new technologies such as MARS and Arctic-Sun for ALF, and new knowledge/treatment protocols such as escalating-dose interferon ribavirin treatment, protocol biopsies, routine use of IL28B gene mutation and new protease inhibitors as part of antiviral therapy for hepatitis C.

ICU management of acute liver failure.

Survival of patients presenting with acute liver failure (ALF) has improved because of earlier disease recognition, better understanding of pathophysiology of various insults leading to ALF, and advances in supportive measures including a team approach, better ICU care, and liver transplantation. This article focuses on patient management and evaluation that takes place in the ICU for patients who have acute liver injury. An organized team approach to decision making about critical care delivered during this period of time is important for achieving a good patient outcome.

Erectile dysfunction in men with congenital heart disease.

There has been a tremendous focus on gynecologic health with the increasing number of women with congenital heart disease (CHD). Conversely, experience in providing sexual health screening to men with CHD is lacking. The purpose of this study was to identify sexual health issues in men with CHD.

Critical analysis of the pediatric end-stage liver disease scoring system: a single center experience.

The Pediatric End-Stage Liver Disease (PELD) scoring system is a new nationally utilized formula developed to provide a continuous numerical assessment of the risk of death in order to allocate livers to children for transplantation. A retrospective review of the clinical course of children undergoing liver transplantation at the Mount Sinai Medical Center was performed in order to assess the effectiveness of this scoring system in the first 24 months of its utilization. Forty-eight patients underwent liver transplantation with overall patient and graft survival rates of 98% and 96%, respectively.

Medication adherence in pediatric and adolescent liver transplant recipients.

Objective: Nonadherence to medications is a leading cause of morbidity in children and adolescents who have had a transplant, yet there are no published data about the use of different methods for detecting whether these children are taking their medications. There are also no published data about the age of transition at which a child assumes responsibility over taking the medications. This information is important if interventions to improve adherence are contemplated.

Living liver donors: a coordinator's perspective.

Living donor liver transplantation is an acceptable alternative for many patients awaiting a liver transplant. The benefits of living donor liver transplantation to the recipient are many; however, there is also an appreciable risk to the donor. Many people, including healthcare professionals, believe that living donor liver transplantation is not ethically justified because any risk to a donor outweighs the benefit to the recipient.