Ketamine-Induced Sclerosing Cholangitis Associated With Early Inflammatory Bowel Disease During Chronic Topical Ketamine Use.

Ketamine-induced sclerosing cholangitis has been described with chronic intranasal and intravenous use. Our case follows chronic topical use for peripheral neuropathy. It is also uniquely associated with early inflammatory bowel disease, a known complication of primary sclerosing cholangitis.

Championing a move from sustainability to Planetary Health in nursing curriculum.

In this paper, we review the progress on developing sustainability-related content in the Bachelor of Nursing curriculum in Aotearoa New Zealand and engage with Planetary Health. Sustainability in nurse education is explored and the concept of sustainability-practising graduates is promoted. THE ISSUE: We have seen ambivalence towards sustainability persisting amongst nurse educators and students, and sustainability-related content discarded.

Three-dimensional vertebral shape changes confirm growth modulation after anterior vertebral body tethering for idiopathic scoliosis.

Purpose: To evaluate three-dimensional (3D) vertebra and disk shape changes over 2 years following anterior vertebral body tether (AVBT) placement in patients with idiopathic scoliosis (IS).

Methods: Patients with right thoracic IS treated with AVBT were retrospectively evaluated. 3D reconstructions were created from biplanar radiographs.

Maximizing mechanical advantage: surgical technique increases stiffness in spinal instrumentation.

Purpose: While there has been a great improvement in the treatment of adolescent idiopathic scoliosis, sagittal deformity correction has remained challenging. Increased rod stiffness has been shown to reduce thoracic flattening. We propose that the surgical technique can increase rod stiffness.

Effect of narcotic prescription limiting legislation on opioid utilization following pediatric spinal fusion for scoliosis.

Background Context: Since 2016, 35 of 50 US states have approved opioid-limiting and monitoring laws. The impact on postoperative opioid prescribing and secondary outcomes following pediatric scoliosis deformity correction surgery remains unknown.

Purpose: To evaluate the effect of CURES 2.

Remote endarterectomy to remove infected Viabahn stent-graft.

Infection of peripheral arterial vascular grafts and stent-grafts represents a complex surgical scenario, with a number of proposed management strategies. Surgical removal of infected material with adjunctive arterial reconstruction is often required. However, surgical removal is often difficult and complex.

Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?

Orthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person.

Pediatric On-Call Challenges for the General Orthopaedic Surgeon.

Taking call as an orthopaedic surgeon is commonplace and expected at many institutions. Taking general orthopaedic call without specialized backup physicians can be challenging and daunting. Pediatric patients commonly present to emergency departments around the country with a host of pathologies, many of which are different from those of adults.

Lumbar Discitis and Osteomyelitis After a Spinal Stem Cell Injection?: A Case Report and Literature Review.

Case: A 32-year-old man developed lumbar discitis and osteomyelitis after receiving a cell-based injection for the treatment of degenerative disc disease. Initial cultures were negative, but he continued to worsen, and a repeat set of cultures was taken. On day 10, Cutibacterium acnes was isolated.

Slipped Capital Femoral Epiphysis in an Adult Patient With Kabuki Syndrome.

Introduction: Slipped capital femoral epiphysis (SCFE) is a condition which predominantly occurs in adolescents. SCFE is extremely rare in adults, and nearly all previous reported cases have been associated with an endocrine disorder.

Methods: We present a case of a 19-year-old man with Kabuki syndrome who was diagnosed with an unstable SCFE requiring surgical fixation.

Focal Periphyseal Edema: An Uncommon Cause of Adolescent Knee Pain: A Report of Three Cases.

Case: Focal periphyseal edema (FOPE) zones have only recently been described as a cause of joint pain in adolescence. The literature is limited to a few case reports and radiologic studies describing this symptomatic physeal pathology. This series describes 3 adolescent patients with magnetic resonance imaging (MRI) confirmed FOPE zones of the distal femur.

Intramedullary Fixation of Both Bone Forearm Fractures in Children and Adolescents: Healing Correlates With Development of the Olecranon Apophysis.

Background: The purpose of this study was to determine whether healing of both bone forearm (BBFA) fractures in children and adolescents is associated with the stage of the olecranon apophysis development as described by the Diméglio modification of the Sauvegrain method.

Methods: Records were reviewed from 2 children's hospitals from 1997 to 2008 to identify all patients younger than 18 years of age who had BBFA fractures treated with intramedullary nail fixation. Sixty-three patients were identified meeting inclusion and exclusion criteria.

Case report: Unusual presentation of haemopericardium with haemodynamic instability secondary to a coronary graft pseudoaneurysm treated by an endovascular approach.

Background: We report the successful endovascular treatment of a coronary graft pseudoaneurysm using a technique often seen in intracranial aneurysm coiling.

Case Summary: We present an unusual case of a patient who presents with haemopericardium and haemodynamic instability after saphenous vein bypass grafting. A pseudoaneurysm rapidly expanded from 5 cm to 7 cm over the follow-up period producing compressive mass effect on the lateral right ventricle with transient haemodynamic instability.

The Rule of 57: Orthopaedic Trigonometry Made Easy.

Introduction: The Rule of 57 is an easy method for planning osteotomies and calculating translations when correcting spine and limb deformities.

Methods: The rule is based on the mathematical principle that a circle with a radius of 57 mm has a circumference of 360 mm where each 1° of the circle subtends an arc of 1 mm in length.

Results: Thus a 1 mm opening or closing wedge osteotomy with a width of 57 mm would result in 1° of angular correction.

Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options.

Background: Wound complications associated with soft tissue defects following total knee arthroplasty present challenges for the orthopedic surgeon. The scale of early complications include less morbid problems, such as quickly resolving drainage and small superficial eschars, to persistent drainage and full-thickness tissue necrosis, which may require advanced soft tissue coverage.

Methods: This review outlines current wound management strategies and provides an algorithm to help guide treatment and clinical decision-making.

Methane emissions: choosing the right climate metric and time horizon.

Methane is a more potent greenhouse gas (GHG) than CO2, but it has a shorter atmospheric lifespan, thus its relative climate impact reduces significantly over time. Different GHGs are often conflated into a single metric to compare technologies and supply chains, such as the global warming potential (GWP). However, the use of GWP is criticised, regarding: (1) the need to select a timeframe; (2) its physical basis on radiative forcing; and (3) the fact that it measures the average forcing of a pulse over time rather than a sustained emission at a specific end-point in time.

Magnetic Intramedullary Lengthening Nails and MRI Compatibility.

Background: Magnetic intramedullary nails (IMNs) are fully implantable lengthening devices that became available in the United States in 2011 for the correction of limb length discrepancies. This device represents a major advancement in the field of limb lengthening surgery as it is typically tolerated better than external fixation. Unlike traditional IMNs, surgeons recommend routine removal following limb lengthening.

Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population.

Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up.

Emergency Medical Service Personnel Recognize Pediatric Concussions.

Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are.

Dog bites to the upper extremity in children.

Aim: Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children.

Using growth curves to forecast regional resource recovery: approaches, analytics and consistency tests.

There is growing concern about the depletion of hydrocarbon resources and the risk of near-term peaks in production. These concerns hinge upon contested estimates of the recoverable resources of different regions and the associated forecasts of regional production. Beginning with Hubbert, an influential group of analysts have used growth curves both to estimate recoverable resources and to forecast future production.

Expression of ABA synthesis and metabolism genes under different irrigation strategies and atmospheric VPDs is associated with stomatal conductance in grapevine (Vitis vinifera L. cv Cabernet Sauvignon).

The influence of different levels of irrigation and of variation in atmospheric vapour pressure deficit (VPD) on the synthesis, metabolism, and transport of abscisic acid (ABA) and the effects on stomatal conductance were examined in field-grown Cabernet Sauvignon grapevines. Xylem sap, leaf tissue, and root tissue were collected at regular intervals during two seasons in conjunction with measurements of leaf water potential (Ψleaf) and stomatal conductance (gs). The different irrigation levels significantly altered the Ψleaf and gs of the vines across both seasons.

Optimal complement-mediated phagocytosis of Pseudomonas aeruginosa by monocytes is cystic fibrosis transmembrane conductance regulator-dependent.

Cystic fibrosis (CF) is caused by mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, and is characterized by chronic pulmonary infections. The mechanisms underlying chronic infection and inflammation remain incompletely understood. Mutant CFTR in nonepithelial tissues such as immune cells has been suggested to contribute to infection, inflammation, and the resultant lung disease.

The next generation HydroCoil: initial clinical experience with the HydroFill embolic coil.

Background: Complete packing of intracranial aneurysms has demonstrated a significant decrease in aneurysm recurrence rates with increased volumetric filling. The HydroCoil Embolization System (HES) was developed to increase volumetric filling within the aneurysm sac to maintain long term occlusion. To further enhance ease of HES deployment, a new next generation embolic coil, the HydroFill coil, was developed.