Subintimal distal anchor technique for "balloon-uncrossable" chronic total occlusions.

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) presents unique challenges and potential complications. The two most common failure modes are inability to cross the lesion with a guidewire and failure to cross the CTO with a balloon after successful guidewire crossing ("balloon-uncrossable" CTO). We present a creative solution to assist crossing of balloon-uncrossable CTOs that entails use of a balloon placed over a wire that has been advanced though the subintimal space to "anchor" the guidewire that has crossed through the CTO true lumen enabling lesion crossing with a balloon.

Does lumbar dorsal ramus syndrome have an objective clinical basis?

Background: Degenerative processes can cause chronic low back pain that occasionally creates impingement of the lumbar dorsal rami, resulting in a clinical syndrome previously described as lumbar dorsal ramus syndrome (LDRS).

Objectives: To evaluate the clinical basis of LDRS by comparing pain, disability, and objective measures of pathophysiology in 3 groups of subjects defined by needle electromyography examination (NEE) findings.

Design: Prospective group cohort study with retrospective chart review.

Progression of major depression during pregnancy and postpartum: a preliminary study.

Objective: The purpose of this pilot study was to investigate major depressive symptoms among a high-risk group of pregnant women managed at a tertiary care setting.

Method: The study prospectively evaluated pregnant women who met DSM-IV criteria for a major depressive episode (MDE). Psychiatric measures for depression, anxiety and social impairment were administered at monthly intervals during pregnancy and immediate postpartum period.

Endomicroscopy in Barrett's esophagus.

Barrett's esophagus has been a focus of confocal laser endomicroscopy (CLE) research. There are two CLE systems available, one probe-based and the other with a microscope embedded in the tip of an endoscope. Several CLE image classification systems are available.

Endoscopic eradication therapy for mucosal neoplasia in Barrett's esophagus.

Purpose Of Review: Endoscopic eradication therapy is frequently used to treat dysplasia and early cancers in Barrett's esophagus. This review addresses some of the recent developments in the field of endoscopic eradication therapy for Barrett's esophagus.

Recent Findings: Data on the effectiveness of Barrett's esophagus ablation programs have been published recently, with excellent results for dysplasia eradication.

Risk factors for and impact of methicillin-resistant Staphylococcus aureus nasal colonization in patients in a medical intensive care unit.

This retrospective cohort study investigated the impact and predictive factors of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in 180 patients admitted to a medical intensive care unit between July 2009 and June 2010. No significant associations between MRSA nasal colonization and the incidence of health care-associated multidrug-resistant-related infections, intensive care unit length of stay, or inpatient mortality were found. Significant risk factors for MRSA colonization included previous medical history of diabetes mellitus and congestive heart failure.

Role of electrodiagnosis in patients being considered for epidural steroid injections.

Electrodiagnostic (EDX) evaluation, and, more specifically, electromyography (EMG), has a well-established role in the diagnostic confirmation of cervical and lumbar radiculopathy. The role of EMG in prognostication, however, is less established and remains a topic of debate. The purpose of this article is to evaluate the diagnostic and prognosticating role of EMG in cervical and lumbar radiculopathies, and to assess the utility of EMG in predicting outcomes after epidural steroid injections (ESI).

Littoral cell angioma of spleen: an uncommon presentation of a rare neoplasm.

Littoral cell angioma (LCA) is a rare primary splenic tumor that is difficult to differentiate preoperatively from other benign and malignant splenic lesions. Most of the cases present as multiple nodules in the spleen. We report a case of large solitary LCA of the spleen, an uncommon presentation.

New directions in the preoperative management of adenocarcinoma of the rectum.

Pathological complete response is observed in nearly 20% of patients with rectal cancer receiving preoperative chemoradiation. Patients who achieve a pathological complete response have better outcomes compared to patients experiencing no response or partial response. Current strategies have not demonstrated a substantial improvement in augmenting the ratio of responders to partial and nonresponders.

Biology of rectal cancer--the rationale for targeted therapy.

Rectal cancer will affect approximately 40,000 people per year in the United States. Surgical resection through meticulous total mesorectal excision, combined with preoperative chemoradiation, is considered the standard of care for patients with stage II or III disease. However, as many as a third of patients will develop local or distant progression of disease.

Critical concepts in the oncogenesis of adenocarcionoma of the rectum.

The current management of rectal cancer in the preoperative setting provides a unique opportunity to explore individualized patient care. The management of adenocarcinoma of the rectum must involve a multidisciplinary approach. The distinctive feature of rectal tumors to either achieve complete resolution or no response in patients submitting to the same treatment modalities demonstrates that the biology of rectal tumors requires further insights.

Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial.

Background: Obesity is a risk factor for colorectal cancer, and colonoscopy can be technically challenging in obese patients. It has been proposed (with little supporting data) that prone positioning of obese patients might facilitate a difficult colonoscopy.

Aim: The aim of this study was to determine if starting colonoscopy in the prone position for obese patients decreases cecal intubation times.

Percutaneous retrieval of a fractured guide catheter using contralateral snaring.

Guide catheter kinking and fracture is an uncommon complication of percutaneous coronary intervention and may require emergency surgical intervention if percutaneous retrieval fails. We present a case of guide catheter kinking and fracture during attempts to engage the left main coronary artery in a patient with marked iliac tortuosity. The retained guide catheter fragment was retrieved percutaneously by using a snare from the contralateral femoral artery and removing the "folded-over" catheter fragment through the contralateral arteriotomy.

Long-term mortality after pneumonia.

Although pneumonia is currently considered the eighth leading cause of death in the United States this estimate includes only short-term mortality. Evidence suggests that pneumonia may have significant longer-term effects and that hospitalization for pneumonia is associated with higher long-term mortality than for many other major medical conditions. Reasons for this increased mortality appear to be due to several factors, including cardiovascular disease, neoplasms, and alterations in immune function.

Reliability and repeatability of the Hoffmann sign.

Objective: To determine the inter-rater, intrarater, and intrasubject reliability of the Hoffmann sign.

Design: Observational, cross-sectional study.

Setting: Veterans Affairs medical center.

Thoracolithiasis: a case report.

We present a rare case of incidentally found mobile thoracolithiasis in a 76-year-old cirrhotic patient on serial computed tomography scans performed before and after transarterial chemoembolization for hepatocellular carcinoma. Mobility and calcification are the important clue to diagnosing this benign condition and avoiding unnecessary surgery.

Needle electromyography predicts outcome after lumbar epidural steroid injection.

Introduction: Needle electromyography (NEE) would be more valuable if it could predict outcomes after lumbar epidural steroid injections (LESIs) in lumbosacral radiculopathy (LSR).

Methods: We investigated the predictive value of NEE for outcome after LESI compared with other known predictive variables in 89 subjects with clinical LSR. Seventy patients completed the study, which included diagnostic lower extremity NEE and LESI.

Emerging concepts in the treatment of myofascial pain: a review of medications, modalities, and needle-based interventions.

Significant developments and changes in the use of interventions and treatments for the management of myofascial pain syndrome have occurred in the past 10 years. These emerging concepts have changed the approach for clinicians who manage these pain disorders. However, wide variations in practice patterns prevail, and no clear consensus exists regarding when and how to use these interventions; in addition, awareness of the evidence basis behind their use is limited.

Effect of lidocaine iontophoresis on pain during needle electromyography.

Objective: Pain during needle electrode examination (NEE) is often poorly tolerated. No previous studies have evaluated the effect of lidocaine iontophoresis on pain reduction during NEE. Our objective was to determine whether pretreatment with lidocaine iontophoresis mitigates the pain felt during NEE.

Fibroadenoma in male breast: case report and literature review.

We report a rare case of mammary fibroadenoma in a 75 year old male patient with emphasis on imaging findings and review of the previously reported cases.

The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery.

Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction.

Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs.