Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke.

The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core infarcts, even when large volumes of salvageable brain tissue were present, due to the high risk of hemorrhagic transformation and reperfusion injury. However, recent retrospective and prospective studies have shown improved outcomes with endovascular thrombectomy, and several clinical trials were recently published to evaluate the efficacy of endovascular management of patients presenting with large-core infarcts.

Protocol and statistical analysis plan for the PREOXI trial of preoxygenation with noninvasive ventilation vs oxygen mask.

Background: Hypoxemia is a common and life-threatening complication during emergency tracheal intubation of critically ill adults. The administration of supplemental oxygen prior to the procedure ("preoxygenation") decreases the risk of hypoxemia during intubation.

Research Question: Whether preoxygenation with noninvasive ventilation prevents hypoxemia during tracheal intubation of critically ill adults, compared to preoxygenation with oxygen mask, remains uncertain.

Posterolateral Plating of Distal Tibia Fractures: Extending the Use of a Familiar Approach.

Background: Distal tibia fractures present challenges in surgical management and when nailing is not an option, plate osteosynthesis is performed. This is usually done with a minimally invasive approach to reduce the risk of wound complications in an already fragile soft-tissue envelope. We propose that a posterolateral open approach can lead to stable fixation construct and comes with advantages of approaching fibula fractures via same approach and has a thicker soft tissue envelope over the fixation.

Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19.

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality.

Metastatic Spine Tumor Surgery: A Comparative Study of Minimally Invasive Approach Using Percutaneous Pedicle Screws Fixation Versus Open Approach.

Study Design: Prospective cohort study.

Summary Of Background Data: Minimally invasive spinal surgery (MISS) has been gaining recognition in patients with metastatic spine disease (MSD). The advantages are reduction in blood loss, hospital stay, and postoperative morbidity.

Knee pain: a cautionary tale of lipoma arborescens.

We report a case of a 51-year-old man, presenting with non-specific symptoms of unilateral knee pain and swelling, who had experienced a 1-year period of multiple misdiagnoses. He was finally diagnosed with lipoma arborescens only after a MRI of the knee was performed, with postoperative histological confirmation after treatment with joint replacement surgery. The possible pathophysiology, diagnostic modalities and treatment of lipoma arborescens are discussed.

Survival Prognostication in Patients with Skeletal Metastases from Nasopharyngeal Carcinoma: An Evaluation of the Scandinavian Sarcoma Group, Katagiri and Bauer Scoring Systems.

Introduction: Nasopharnygeal carcinoma (NPC) is characterised by early metastases with the skeleton being the most common site of metastases. The ability to prognosticate survival is crucial in the decision whether or not to offer surgery to these patients and the choice of surgery offered. We aimed to evaluate the scoring systems namely: Bauer, Katagiri and Scandinavian Sarcoma Group (SSG) in NPC patients with skeletal metastases.

Black bone disease in a healing fracture.

Black bone disease refers to the hyperpigmentation of bone secondary to prolonged usage of minocycline. We present a report of a 34-year-old man who underwent femoral shaft fracture fixation complicated by deep infection requiring debridement. The implants were removed 10 months later after long-term treatment with minocycline and fracture union.

Versatility of percutaneous pedicular screw fixation in metastatic spine tumor surgery: a prospective analysis.

Background: Posterior percutaneous spinal fixation (PPSF) has evolved to address the problems associated with metastatic spinal disease (MSD). This study was designed to evaluate the feasibility and spectrum of application of PPSF in the management of MSD, highlighting its clinical advantages.

Methods: Twenty-seven consecutive patients with MSD treated with PPSF in our institution from January 2011 to June 2014 were studied.

Osteomyelitis in the diabetic foot.

Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer.

Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery.

Background: Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery due to the hypothetical concern of reinfusion of malignant cells. We evaluated the feasibility of IOCS in combination with leucocyte depletion filter (LDF) in metastatic spine tumour surgery (MSTS).

Methods: Patients with known primary epithelial tumour, operated for metastatic spinal disease, were recruited.

Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma.

Background Context: The decision for operative treatment of patients with spinal metastases is dependent on the patient's predicted survival. Tokuhashi, Tomita, Bauer, and Oswestry scores have been devised for survival prediction; however, none of these systems have been evaluated in nasopharyngeal carcinoma (NPC).

Purpose: To investigate the accuracy of these scoring systems in predicting survival and to identify prognostic factors for survival of the patients with spinal metastases from NPC.

A twist in the tale.

A 4-year-old girl presented with retching and abdominal colic and was initially diagnosed with gastroenteritis. However, progressive pain and epigastric distension led to a surgical review and she was discovered on CT scanning to have a gastric volvulus. She required urgent laparotomy to decompress the stomach and repair a perforation on the lesser curvature.

A silent acute abdomen in a patient with spinal cord injury.

A 52-year-old man with cervical spondylosis sustained a hyperextension injury to the neck and subsequently developed central cord syndrome after 2 weeks. The diagnosis was confirmed clinically and on MRI. During the admission he was febrile from Streptococcus anginosus bacteraemia from a gum infection and was started on penicillin.

Acute scoliosis in a 3-year-old boy.

The case describes the presentation of a fit and well 3-year-old boy to the emergency department of a district general hospital after he developed an acute scoliosis overnight. There was no history of trauma, his observations were normal and he had non-specific symptoms of lethargy and reduced appetite, but no fevers or respiratory distress. Bloods showed raised inflammatory markers and he was referred to orthopaedics as a septic disc as there was some spinal tenderness.

Prevention of shivering during therapeutic temperature modulation: the Columbia anti-shivering protocol.

Background: As the practice of aggressive temperature control has become more commonplace, new clinical problems are arising, of which shivering is the most common. Treatment for shivering while avoiding the negative consequences of many anti-shivering therapies is often difficult. We have developed a stepwise protocol that emphasizes use of the least sedating regimen to achieve adequate shiver control.

Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke.

Background: The impact of osmotic therapies on brain metabolism has not been extensively studied in humans. The authors examined if mannitol treatment of raised intracranial pressure will result in an improvement in brain metabolism together with the expected drop in intracranial pressure (ICP).

Methods: This is a retrospective review of prospectively collected data.

Impact of intraventricular hemorrhage upon intracerebral hematoma expansion.

Background: The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a "decompressive" effect that limits intracerebral hemorrhage (ICH) enlargement.

Methods: Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH.

Giant rectus sheath hematoma after therapeutic paracentesis resulting in hemodynamic instability in the intensive care unit.

Rectus sheath hematoma (RSH) is a rare but potentially serious complication that can occur after abdominal paracentesis. Although RSH is often self-limited, it can lead to life-threatening conditions when diagnosis and/or treatment are delayed. In the neuro-intensive care unit, the diagnosis is often difficult to make or delayed because most patients have poor mental status and are unable to communicate their RSH-related symptoms.

Role of antiplatelet agents in hematoma expansion during the acute period of intracerebral hemorrhage.

Background: Oral anticoagulants have been associated with greater hematoma expansion in patients with intracerebral hemorrhage (ICH). The purpose of this study was to determine whether the reported use of antiplatelet agents also results in greater hematoma expansion.

Methods: Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later.