Top of Basilar Syndrome Presenting With Hyperekplexia Initially Diagnosed as a Convulsive Status Epilepticus.

Background: Hyperekplexia is a rare neurologic disorder characterized by pronounced startle responses to tactile or acoustic stimuli and increase tone. Acquired hyperekplexia is usually seen in brainstem pathologies and when it develops acutely it can be easily misdiagnosed as a convulsive seizure.

Case Report: A 38-year-old man presented with acute onset generalized brief involuntary jerky movements and a decreased level of consciousness.

Isolated Segmental Humeral Shaft Fracture Without Vascular Compromise Complicated by Brachial Compartment Syndrome: A Case Report.

Case: We report an unusual case of a closed humeral shaft fracture, with no vascular compromise, resulting in brachial compartment syndrome. Our patient was successfully treated with fasciotomy and external fixation, followed by staged open reduction and internal fixation and skin grafting.

Conclusion: Although uncommon in the upper arm, suspicion for compartment syndrome should remain high for patients with unrelieved pain and swelling after humeral shaft fracture.

Siponimod in the treatment of multiple sclerosis.

: Multiple sclerosis (MS) causes focal lesions of immune-mediated demyelinating events followed by slow progressive accumulation of disability. Over the past 2 decades, multiple medications have been studied and approved for use in MS. Most of these agents work by modulating or suppressing the peripheral immune system.

Osteomyelitis of the Distal Tibia: A Case Report.

infection is rare. We present the third documented case of infection and the first to involve the musculoskeletal system. A 55-year old immunocompetent male developed chronic osteomyelitis of the ankle and required antibiotic spacers, an Ilizarov external fixator and multiple antibiotic regimens to eradicate the infection.

At the Front Lines: Effectively Training Community Stakeholders to Recognize and Report Child Abuse and Neglect.

In states with universal mandatory reporting of child abuse and neglect (CAN), it is essential that people who work with children and youth in a community be appropriately trained to recognize and report CAN. The primary goal of CAN training is early detection and intervention with a secondary purpose of impacting rates of violence, disease, drug use, and teen pregnancies in the community. The purpose of this project was to implement a standardized, community-tailored CAN training for laypersons and a train-the-trainer program in a rural Oklahoma community.

Tobacco Smoking Associated With Increased Anastomotic Disruption Following Pancreaticoduodenectomy.

Background: The effect of cigarette smoking on postoperative morbidity following pancreaticoduodenectomy (PD) for cancer is unclear. We hypothesize that smoking is associated with higher morbidity following PD.

Methods: A retrospective review of patients undergoing PD for cancer from 2010 to 2016 at a single institution was performed.

Research Gaps in Wilderness Medicine.

Introduction: Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them.

An Acute Nocardia Infection in a Pediatric Hand.

Nocardia species are aerobic gram-positive filamentous organisms that may cause cutaneous or pulmonary disease in humans. Primary cutaneous nocardiosis may manifest as an acute superficial pyogenic infection that can mimic more common organisms such as Staphylococcus or Streptococcus. Acute pyogenic Nocardia infection of the pediatric hand is a rare manifestation of this condition.

Longitudinal comparison of low- and high-velocity resistance training in relation to body composition and functional fitness of older adults.

Background: Functional mobility disability affects more than one in five adults over 70 years and increases to 80% by 90 years. While negative changes in mobility are multifactorial, deleterious body composition changes contribute significantly. Resistance training alters the negative trajectory of physical function as well as increases lean mass among older adults.

Organ Donor Management: Part 1. Toward a Consensus to Guide Anesthesia Services During Donation After Brain Death.

Worldwide 715 482 patients have received a lifesaving organ transplant since 1988. During this time, there have been advances in donor management and in the perioperative care of the organ transplant recipient, resulting in marked improvements in long-term survival. Although the number of organs recovered has increased year after year, a greater demand has produced a critical organ shortage.

Femoropopliteal Artery Stent Thrombosis: Report From the Excellence in Peripheral Artery Disease Registry.

Background: There are limited data on femoropopliteal artery stent thrombosis (ST), which is a serious adverse outcome of peripheral artery interventions.

Methods And Results: Index procedures resulting in femoropopliteal ST were compared with stent procedures without subsequent ST in the Excellence in Peripheral Artery Disease registry. The study data had a total of 724 cases of stent procedures and 604 unique patients.

Radiographic Assessment of the Robert and Lateral Views in Trapeziometacarpal Osteoarthrosis.

Background: To evaluate the effectiveness of the Robert view in assessing trapeziometacarpal arthrosis and to compare the accuracy of the Robert and lateral views in staging trapeziometacarpal (TM) joint arthrosis.

Methods: Patient demographics were obtained. Four participating raters reviewed 62 randomly selected thumb x-rays of patients presenting with thumb TM joint pain.

Hexaminolevulinate blue-light cystoscopy in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on appropriate use in the USA.

Hexaminolevulinate (HAL) is a tumour photosensitizer that is used in combination with blue-light cystoscopy (BLC) as an adjunct to white-light cystoscopy (WLC) in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC). Since being licensed in Europe in 2005, HAL has been used in >200,000 procedures, with consistent evidence that it improves detection compared with WLC alone. Current data support an additional role in the reduction of recurrence of NMIBC.

Differential effects of selective frankincense (Ru Xiang) essential oil versus non-selective sandalwood (Tan Xiang) essential oil on cultured bladder cancer cells: a microarray and bioinformatics study.

Background: Frankincense (Boswellia carterii, known as Ru Xiang in Chinese) and sandalwood (Santalum album, known as Tan Xiang in Chinese) are cancer preventive and therapeutic agents in Chinese medicine. Their biologically active ingredients are usually extracted from frankincense by hydrodistillation and sandalwood by distillation. This study aims to investigate the anti-proliferative and pro-apoptotic activities of frankincense and sandalwood essential oils in cultured human bladder cancer cells.

Impact of complications and hospital-free days on health related quality of life 1 year after radical cystectomy.

Purpose: We determined the extent to which complications as well as number of hospital-free days within 30 and 90 days of surgery predicted health related quality of life 1 year after radical cystectomy.

Materials And Methods: We used data from a prospective health related quality of life study using a validated instrument, the Vanderbilt Cystectomy Index-15. Complications were graded by the Clavien system, and hospital length of stay and length of stay during readmissions were used to calculate 30 and 90-day hospital-free days, respectively.

Biochemical recurrence-free survival after robotic-assisted laparoscopic vs open radical prostatectomy for intermediate- and high-risk prostate cancer.

Objective: To compare biochemical recurrence (BCR)-free survival and predictors of BCR in intermediate-risk (IR) and high-risk (HR) patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs open radical prostatectomy (ORP).

Materials And Methods: We conducted a retrospective study on 1336 men with D'Amico IR or HR prostate cancer who underwent RALP or ORP between 2003 and 2009. Exclusion criteria were use of neoadjuvant therapy, <6 months of follow-up, and insufficient clinicopathologic data.

Current management of congenital branchial cleft cysts, sinuses, and fistulae.

Purpose Of Review: Branchial anomalies comprise approximately 20% of pediatric congenital head and neck lesions. This study reviews current literature detailing the diagnosis and management of first, second, third and fourth branchial cysts, sinuses and fistulae.

Recent Findings: Branchial anomalies remain classified as first, second, third and fourth cysts, sinuses and fistulae.

Status epilepticus in childhood.

Status epilepticus (SE) remains a life-threatening condition that afflicts both adults and children, and may occur at onset of epilepsy, especially in children. Febrile SE is the most common cause in children, while other symptomatic causes are less frequent compared to adults. The aetiological workup that must be undertaken in all cases includes neuroimaging and electroencephalography.

Endobronchial nodules in a patient with rheumatoid arthritis.

We report the case of a patient with rheumatoid arthritis who presented with endobronchial nodules. Endobronchial biopsy showed a large B cell lymphoma. Non-Hodgkin lymphoma rarely involves the endobronchial tree, and is typically treated with systemic chemotherapy, but in this case additional treatment with argon plasma coagulation was used for local control of the disease.

Back to basics: assessment, communication, caring, and follow-up: a lesson from a couple's journey with multiple myeloma.

Ian was a patient with multiple myeloma. His wife, Judi, chronicled their journey and experiences with myeloma and the healthcare system. Through her own eyes, Judi provides a view of the positive and negative consequences of actions or omissions by the healthcare team.

Radiographic changes following excisional tapering and reimplantation of megaureters in childhood: long-term outcome in 46 renal units.

Purpose: Despite the routine use of renal ultrasonography to document progressive improvement in hydronephrosis following ureteral tailoring and reimplantation of megaureters, there have been few reports characterizing the serial radiographic changes to be expected following this procedure. We evaluated the radiographic outcomes following surgical repair of megaureters at single institution, and assessed potential preoperative factors for predicting outcome.

Materials And Methods: We conducted a retrospective analysis of all patients who underwent surgical correction of clinically significant megaureters at our center between 1996 and 2003.

Acellular dermal matrix as an adjunct in treatment of neuropathic pain at the wrist.

Background: Traumatic or surgical injury to superficial sensory nerves at the wrist can lead to significant morbidity. Multiple treatment modalities have been proposed, including the use of flap coverage to provide soft-tissue padding and decrease tactile irritation. In this report, acellular dermal matrix (AlloDerm) was used as an alternative to flap coverage, thereby avoiding the need for a donor site.