Preventing Acute Kidney Injury and Hypotension After Elective Total Joint Arthroplasty Is Possible: An Update to an Established Multidisciplinary Protocol.

Introduction: Based on preoperative and perioperative risk factors that have been found to correlate with the development of acute kidney injury (AKI), our institution developed a protocol aimed at managing and improving outcomes in all elective THA and TKA patients. This article highlights the continued success and growth of our protocol aimed at decreasing AKI and hypotension in elective total joint arthroplasty patients.

Method: A multidisciplinary team comprising orthopaedic surgeons, nephrologists, anesthesiologists, cardiologists, and internal medicine hospitalists created a comprehensive protocol aimed at decreasing complications after elective joint arthroplasty and improving clinical outcomes across multiple hospitals.

Reducing Hypotension and Acute Kidney Injury in the Elective Total Joint Arthroplasty Population: A Multi-Disciplinary Approach.

Background: When critically analyzing our hospital system's rate of hypotension and acute kidney injury (AKI) after total joint arthroplasty, our incidence rates (14.54%, 6.02%) were much higher than our peers (7.

Two-screw femoral neck fracture fixation: a biomechanical analysis of 2 different configurations.

In the study reported here, we evaluated 2-screw femoral neck fixation. Femoral necks from 5 paired fresh-frozen cadavers were fractured and then fixed with two 7.3-mm cannulated cancellous screws.

Arthroscopically-assisted removal of retrograde intramedullary femoral nails.

Retrograde nailing of femoral shaft fractures has become more prevalent as a result of its growing acceptance and familiarity to orthopaedic surgeons. Nail removal is occasionally indicated, which may require a formal arthrotomy. We describe an arthroscopic removal technique that has several advantages.

Bone morphogenetic proteins are expressed by both bone-forming and non-bone-forming lesions.

Context: Bone morphogenetic proteins (BMPs) are thought to be responsible for bone formation; they cause bone to form in soft tissues and are clinically used in helping fracture union or tumor reconstructions. Skeletal metastases from epithelial tumors may be either bone-forming (blastic) or non-bone-forming (lytic).

Objective: We studied the expression of BMPs in a variety of primary and secondary lesions of bone (both bone-forming and non-bone-forming) to determine if there was a consistent relationship between bone formation and BMP expression.

Bone Morphogenetic Proteins Are Expressed by Both Bone-Forming and Non-Bone-Forming Lesions.

Context.-Bone morphogenetic proteins (BMPs) are thought to be responsible for bone formation; they cause bone to form in soft tissues and are clinically used in helping fracture union or tumor reconstructions. Skeletal metastases from epithelial tumors may be either bone-forming (blastic) or non-bone-forming (lytic).

Organizing the orthopaedic trauma association mass casualty response team.

Physicians and surgeons in the United States have become increasingly aware of the requirement for an organized response to mass casualty and disaster situations. This has not always been the case. The terrorist acts in Oklahoma City in 1995 and at the World Trade Center in 1993 and 2001 showed the inefficiencies and confusion of the civilian managed disaster response.

Cytokines in patients with polytrauma.

Patients with multiple injuries have alterations in hemodynamic, metabolic, and immune responses that largely are orchestrated by endogenous mediators referred to as cytokines. At the molecular level cytokines act as architects constructing a blueprint which ultimately will become the clinical "Big Picture"; however, the exact role and extent each cytokine has is still in question. In addition, the surface of research opportunities has nearly been scratched regarding the best way to control or manipulate the cytokine response in efforts to improve care for the trauma patient.

Evaluation and treatment of spinal injuries in the patient with polytrauma.

Spinal injuries occur frequently in the patient with polytrauma making the knowledge of the evaluation and treatment of these injuries invaluable to the trauma team. In the immediate moments after these injuries, critical steps can be taken to prevent additional injury and insure maximum neurologic and functional recovery of the patient. A simple, standardized approach to treating the patient at the scene, examining the patient in the trauma admitting area, ordering appropriate radiographic studies, and instituting early treatment can markedly influence a patient's maximal recovery.

Mechanical properties of dilated human ascending aorta.

Dilation of the ascending aorta, associated with Marfan Syndrome, bicuspid aortic valve, or advanced age, may lead to aortic dissection and rupture. Mathematical models can be used to assess the relative importance of increased wall stresses and decreased strength in these mechanical failures. To obtain needed inputs for such models, mechanical properties of dilated human ascending aorta were measured in vitro.

From object to subject: pastoral supervision as an intersubjective activity.

The author sketches the development of psychoanalysis in terms of its trends from notions of objectivity to intersubjectivity and how this movement can inform contemporary pastoral supervision. The article argues that these same trends may be noted in the development of contemporary educational and theological theories.