Superficial femoral vein graft interposition in situ repair for femoral mycotic aneurysm.

Femoral mycotic aneurysms require surgical treatment to prevent progressive sepsis and hemorrhage. Some surgeons recommend simple debridement and ligation of the femoral artery, whereas others recommend reconstruction in selected cases or all cases due to concerns about high risk of limb loss. In situ reconstruction has been discouraged due to concerns about anastomotic or graft disruption by persistent infection.

Pediatric emergency medicine physicians' current practices and beliefs regarding mental health screening.

Background: Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population.

Objective: To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening.

Acetabular revision using a trabecular metal acetabular component for severe acetabular bone loss associated with a pelvic discontinuity.

Pelvic discontinuity can be encountered during acetabular revision in patients with severe bone loss. All patients who had an acetabular reconstruction for a type IIIB acetabular defect according to the classification of Paprosky et al [Paprosky WG, Perona PG, Lawrence JM. 1994.

A case of disassociation of a modular femoral neck trunion after total hip arthroplasty.

Modular femoral heads offer the advantages of increased intraoperative flexibility through the adjustment of leg length and offset, whereas a modular femoral neck can also allow independent adjustment of femoral anteversion. Despite the potential advantages of hip systems using increased modularity, these component designs also offer a greater number of junctions through which problems may occur. This case demonstrates the potential for dissociation of a Morse taper between a modular femoral neck and stem.

Porous-ingrowth revision acetabular implants secured with peripheral screws. A minimum twelve-year follow-up.

Background: During revision total hip arthroplasty, the acetabular component is often secured with screws to ensure initial press-fit stability. The purpose of the present study was to assess a series of acetabular revisions involving the use of a porous-coated acetabular component that was stabilized with peripheral screws and to evaluate the results in relation to the acetabular bone deficiencies that were present at the time of the revision procedure.

Methods: From 1987 to 1991, 203 consecutive acetabular revisions were performed.

The use of structural distal femoral allografts for acetabular reconstruction. Surgical technique.

Background: Acetabular fixation during revision total hip arthroplasty in patients who have a nonsupportive superior dome and proximal migration of the acetabular component (a Paprosky Type-IIIa defect) cannot be achieved reliably with use of a hemispherical porouscoated component alone. The purposes of the present study were to determine the long-term results associated with the use of a porous-coated hemispherical acetabular component, supported with a distal femoral structural allograft, for revision at the site of a Type-IIIa defect and to determine if graft resorption leads to late failure.

Methods: Thirty-one patients who had an acetabular reconstruction with use of a distal femoral allograft for the treatment of a Type-IIIa defect between January 1985 and December 1990 were followed annually with clinical and radiographic evaluations.

Posterior approach: back door in.

Minimally invasive THA is a controversial topic in adult reconstruction. While early reports championed this new technique for faster return of function, decreased hospital stay, and less pain, these findings are being questioned. More recent reports have highlighted increased complication rates during the surgeon's learning curve and noted a lack of benefit compared with a standard incision.

Prevention of triplets and higher order multiples: trends in reproductive medicine.

In the United States and throughout the world, today's healthcare providers are challenged by the risks of multiple gestation pregnancy. Assisted reproductive technologies (ARTs) often used to treat infertility raise ethical issues including informed consent, veracity, and nonmalificence. In the United States, there is the need to improve maternal and fetal/neonatal mortality and morbidity by proposing legislation regulating ART and supporting single embryo transfers with no more than 2 such transfers.

Inpatient management of asthma in the Chicago suburbs: the Suburban Asthma Management Initiative (SAMI).

Background: Assessment of inpatient asthma management has generally been limited to urban settings, including Chicago, which is known for its high asthma morbidity and mortality. Previously published data have been based on survey methodology. The Suburban Asthma Consortium (SAC) sought to obtain patient-based data unique to the Chicago suburbs to improve asthma care in those areas.

Decision analysis in orthopaedics.

Orthopaedic surgeons are faced with an ever-growing amount of clinical information from which they are required to make treatment decisions. Many of these decisions can be approached with relative certainty. However, there are many situations where the optimal decision is less clear.

Blood flow pattern and anastomotic compliance for interrupted versus continuous coronary bypass grafts.

Background: Use of the interrupted coronary anastomosis has largely been abandoned in favor of the more rapid continuous suturing technique. The Coalescent U-CLIP anastomotic device allows the surgeon to create an interrupted distal anastomosis in the same amount of time that it would take to create a continuous anastomosis. This acute bovine study examined the effect of the anastomotic technique on blood flow and vessel wall function.

The middle-aged patient with hip arthritis: the case for extensively coated stems.

Younger patients with a long life expectancy and higher activity levels who require total hip arthroplasty present a unique challenge to the reconstructive surgeon. To improve the longevity of total hip arthroplasty, particularly in younger, more active patients, femoral components inserted without cement have been used in an attempt to create a more durable reconstruction. Extensively-coated implants are an attractive option because they are associated with excellent initial implant stability and contact a large area of strong cortical bone in the femoral diaphysis where bony ingrowth reliably occurs.

A comparison of tonsillectomy with the harmonic scalpel versus electrocautery.

Objective: We sought to test whether the use of the harmonic scalpel would cause less pain and more rapid recovery in tonsillectomy patients versus the use of electrocautery.

Design And Setting: In a private practice community hospital, we conducted a prospective nonrandomized comparison of 156 pediatric tonsillectomy cases. Local anesthetic infiltrations and steroids were used at the discretion of the surgeon.

Neonatal glucose metabolism: differential diagnoses, evaluation, and treatment of hypoglycemia.

Hypoglycemia is one of the most common clinical care issues facing the neonatal practitioner. Increasing evidence indicates that neonatal hypoglycemia may have long-term neurologic effects. Care is complicated by the lack of a clearly defined threshold for hypoglycemia in term and preterm infants, however, and by highly variable clinical signs and symptoms.

Surgical treatment of pelvic osteolysis.

Sixty-eight well-fixed acetabular cups with osteolysis in the pelvis and polyethylene wear were identified from a series of 124 reoperations for failed cementless sockets. The well-fixed sockets requiring reoperation were subdivided based on whether the liner was exchanged and lytic lesion grafted (Type I case) or the socket was removed and a complete revision was done (Type II case). In 40 patients (Type I cases), the polyethylene liner was exchanged and the osteolytic lesions were debrided.

Stereotactic breast biopsy in a community hospital setting.

Our institution began using a stereotactic core needle breast biopsy system for mammographically detected breast lesions in November 1996. The system consists of a LORAD stereo imaging table and an 11-gauge vacuum-assisted mammotome (Biopsys Medical, Irvine, CA). All biopsies were performed with the combined efforts of a radiologist and a surgeon.

Cementless femoral design concerns. Rationale for extensive porous coating.

In the early 1980s increased interest in proximally porous coated stems was sparked by first generation cemented stem failures in young patients and concerns with extensively porous coated cementless stems regarding thigh pain and stress shielding. As a result, various proximally porous coated stems were produced, each with differing clinical results. Using 5-year minimal followup as a cut off, the evolution of proximally porous coated stems during the years is presented and compared with the long term results obtained with extensively porous coated stems.