Atherosclerotic Calcifications Have a Local Effect on the Peel Behavior of Human Aortic Media.

Aortic dissections, characterized by the propagation of a tear through the layers of the vessel wall, are critical, life-threatening events. Aortic calcifications are a common comorbidity in both acute and chronic dissections, yet their impact on dissection mechanics remains unclear. Using micro-computed tomography (CT) imaging, peel testing, and finite element modeling, this study examines the interplay between atherosclerotic calcifications and dissection mechanics.

Perspectives of Black Adults Living with Chronic Obstructive Pulmonary Disease on Barriers to Cardiovascular Disease Prevention.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women.

A Rare Presentation of Clozapine-Induced DRESS Syndrome.

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications. It causes a skin reaction, with eosinophilia and other organ involvement. This case describes a presentation of a 32-year-old female with a past medical history significant for schizophrenia and bipolar disorder who presented for a rash.

Evidence based public health: A review of the experience of the National Institute of Health and Clinical Excellence (NICE) of developing public health guidance in England.

This paper describes the application of the principles of evidence based medicine to public health. It recounts the experience of the National Institute for Health and Clinical Excellence in England (NICE) which acquired a remit to develop public health guidance in 2005. Some of the history of the origins of the evidence based approach is described in the writings of Cochrane and others, and the way that this came to be a critical part of the NICE approach to developing clinical cost effectiveness is outlined.

Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty.

An osteotomy technique for removal of distally fixed cemented and cementless femoral components is described. The anterolateral proximal femur is cut for one third of its circumference, extended distally, and levered open on an anterolateral hinge of periosteum and muscle. This creates an intact muscle-osseous sleeve composed of the gluteus medius, greater trochanter, anterolateral femoral diaphysis, and vastus lateralis, and exposes the fixation surface as well as distal cement.

Removal of a well-fixed cementless femoral component with an extended proximal femoral osteotomy.

Removal of a stable, well-fixed cementless femoral arthroplasty component occasionally is necessary because of infection, component malposition, persistent pain, or incompatibility with a femoral revision component. Restricted access to ingrowth surfaces may make implant removal exceedingly difficult and increases the risk of iatrogenic damage to the proximal femur. A new extended proximal femoral osteotomy technique is described for use in removing well-fixed cementless femoral components.

Hip revision surgery with cemented, cementless or hybrid prosthesis.

The authors report how the choice of a prosthesis for implantation (cemented or cementless), must be made only after a careful evaluation of the type of osteolysis present. This preoperative evaluation, based on a classification that was previously described, will also guide the choice of any grafts that may be of small size to massive depending on the loss of substance.

Acetabular reconstruction with massive allograft and cementless prosthesis.

The authors standardize the method to use for a correct approach to acetabular reconstruction in relation to the loss of bone tissue. In type 1 or 2A and C loss, cancellous bone and porous hemispheric acetabula may be used. In type 2B loss there are 3 options: a small acetabulum with a high rotation center, a larger component leaving 30% of the superoexternal portion uncovered, or a larger component with a supporting superoexternal graft.

Femoral reconstruction with massive allograft and cementless prosthesis.

Classification of loss of bone substance in cases of prosthetic loosening allow for planning of the most suitable type of reconstructive surgery. The use of cemented prostheses has revealed negative long-term results. For this reason a cementless implant which is entirely coated is preferred in order to allow for distal anchoring (particularly in type 2B and 2C loosening).

Classification of bone defects in failed prostheses.

The authors report a classification system in grades, based on preoperative x-rays of the bone loss surrounding a loosened implant that may be cemented or cementless. Moreover, this classification system allows for the prior choice of which prosthesis to use at the time of reimplantation, and which type of graft depending on whether or not the residual bone guarantees mechanical hold of the implant.