A Randomized Controlled Trial of Novel Loop Drainage Technique Versus Standard Incision and Drainage in the Treatment of Skin Abscesses.

Objectives: The objective was to compare the failure rate of incision and drainage (I&D) with LOOP technique versus I&D with standard packing technique in adults and children presenting to the emergency department (ED) with subcutaneous abscess.

Methods: This prospective, randomized controlled trial (NCT03398746) enrolled a convenience sample of patients presenting to two Level 1 trauma centers over 12 months with skin abscesses. Of 256 patients screened, 217 patients were enrolled, 109 randomized to I&D with packing (50%) and 108 (50%) to I&D with LOOP.

Hypoglycemia Associated With Insulin Use During Treatment of Hyperkalemia Among Emergency Department Patients.

Hypoglycemia is a common adverse event associated with insulin during treatment of hyperkalemia in hospitalized patients; however, limited data exist regarding hypoglycemia incidence and appropriate dosing strategies for treatment of patients in the emergency department. The study objective was to determine the incidence of hypoglycemia associated with insulin use during treatment of hyperkalemia among patients seen in the emergency department. This was an Institutional Review Board (IRB)-approved retrospective, chart-review study.

In Vivo Assessment of Ascending and Arch Aortic Compliance.

Background: Dynamic compliance (Cd) of the adult thoracic ascending and arch aorta has had limited in vivo evaluation in patients with aortic disease. This study evaluates aortic compliance using intravascular ultrasound (IVUS) across a range of thoracic aortic diseases.

Methods: Seventy-nine patients undergoing thoracic aortic endovascular procedures had Cd measurements of the ascending aorta proximal to the origin of the brachiocephalic trunk and distal to the origin of the left common carotid artery using IVUS before endograft deployment.

The burden of psychiatric illnesses in adult patients with beta-thalassemia: a 5-year nationwide inpatient evaluation in the United States.

Beta-thalassemia (ß-thalassemia) is a frequently inherited monogenic disorder worldwide with severe physical and mental health comorbidities. The aim of this study is to evaluate the burden of psychiatric disorders in adult patients hospitalized with ß-thalassemia in the United States (US). We utilized the discharge data from the National Inpatient Sample (NIS) from 2010 through 2014 to identify hospitalized ß-thalassemia patients who are 18 years and older.

Use of Metatarsophalangeal Joint Dorsal Subluxation in the Diagnosis of Plantar Plate Rupture.

A dorsal drawer exam, also known as a modified Lachman's test, is a common clinical test for plantar plate insufficiency. This disorder presents as a dislocated metatarsophalangeal joint. The aim of this cadaveric case study was to quantify the degree of the plantar plate pathology necessary to correlate with a positive Lachman's test.

Obesity-Related Foot Pain: Diagnosis and Surgical Planning.

Obese patients are at higher risk for surgical complications and consist of a large portion of podiatric patients. Obese patients are additionally at increased risk of developing specific podiatric conditions, and it is important to be able to identify and appropriately treat these conditions accordingly. Initially, conservative treatment is adequate for a variety of pathologic conditions related to obesity.

Fulminant Septicemia from Aeromonas hydrophilia in a Nonmobile Diabetic Patient.

We report an unusual case of Aeromonas hydrophilia septicemia in a nonmobile diabetic patient secondary to contaminated well water used for bathing with a portal of entry through chronic forefoot and heel ulcers. To date, there are no documented cases similar to this patient's presentation. Aeromonas hydrophilia is commonly distributed among aquatic environments and tends to be found during warmer months.

Comparison of portable handheld versus fixed isokinetic dynamometers in measuring strength of the wrist and forearm.

: The purpose of this study was to test the concurrent validity of using hydraulic dynamometers in comparison to the gold standard isokinetic dynamometers in measuring wrist and forearm strength. : Healthy adults between the ages of 18-65 participated, including 24 participants, 8 men and 16 women. The examiner used a handheld dynamometer, forearm/wrist dynamometer, and an isokinetic dynamometer to measure force/torque production in forearm rotation and wrist flexion/extension using a standardized protocol of two handle types for each motion.

An Open-Label Study of Sufentanil Sublingual Tablet 30 Mcg in Patients with Postoperative Pain.

Objective: To evaluate sufentanil sublingual tablet 30 mcg (SST 30 mcg) for postoperative pain in an older patient population with comorbidities.

Design: Multicenter, open-label, single-arm study.

Setting: Nine hospitals across the United States.

Image once, print thrice? Three-dimensional printing of replacement parts.

Objective: The last 20 years has seen an exponential increase in 3D printing as it pertains to the medical industry and more specifically surgery. Previous reviews in this domain have chosen to focus on applications within a specific field. To our knowledge, none have evaluated the broad applications of patient-specific or digital imaging and communications in medicine (DICOM) derived applications of this technology.

Exercise-Induced Acute Bilateral Upper-Arm Compartment Syndrome.

We present a rare case of acute exercise-induced bilateral upper-arm compartment syndrome in a patient who, after a year-long hiatus from exercise, subjected his upper-extremities to the stress of over 100 pushups. The patient presented with severe pain of the bilateral biceps and triceps and complaints of dark urine. Decompressive fasciotomy was performed followed by an intensive care unit (ICU) stay for associated myoglobinuria secondary to rhabdomyolysis.

Are oral and maxillofacial surgery residents being adequately trained to care for pediatric patients?

Objective: To evaluate whether current oral and maxillofacial surgery (OMS) residents are receiving adequate training and experience to perform specific surgical procedures and anesthesia for pediatric patients.

Study Design: A 17-question survey was sent electronically to fellows of the American Academy of Craniomaxillofacial Surgeons. Descriptive data for individual surgeons, their associated residency programs, and the quantity of specific pediatric procedures they performed were collected.

Functional, Structural, and Neurotoxicity Biomarkers in Integrative Assessment of Concussions.

Concussion is a complex, heterogeneous process affecting the brain. Accurate assessment and diagnosis and appropriate management of concussion are essential to ensure that athletes do not prematurely return to play or others to work or active military duty, risking re-injury. To date, clinical diagnosis relies primarily on evaluating subjects for functional impairment using instruments that include neurocognitive testing, subjective symptom report, and neurobehavioral assessments, such as balance and vestibular-ocular reflex testing.

New direct-acting antivirals in hepatitis C therapy: a review of sofosbuvir, ledipasvir, daclatasvir, simeprevir, paritaprevir, ombitasvir and dasabuvir.

Hepatitis C is a chronic infection associated with considerable morbidity and mortality. In recent years, there has been a shift in treatment paradigm with the discovery and approval of agents that target specific proteins vital for hepatitis C replication. The NS3/4A inhibitors simeprevir and paritaprevir, the NS5A inhibitors ombitasvir, ledipasvir, and daclatasvir, and the NS5B inhibitors sofosbuvir and dasabuvir have been newly FDA approved and incorporated as first-line agents into the latest IDSA-AASLD guidelines for Hepatitis C treatment.

Sufentanil Sublingual Tablet System for the Management of Postoperative Pain after Knee or Hip Arthroplasty: A Randomized, Placebo-controlled Study.

Background: Complications with IV patient-controlled analgesia include programming errors, invasive access, and impairment of mobility. This study evaluated an investigational sufentanil sublingual tablet system (SSTS) for the management of pain after knee or hip arthroplasty.

Methods: This prospective, randomized, parallel-arm, double-blind study randomized postoperative patients at 34 U.

Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series.

Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients.

A simple technique for repair of chronic tendinopathy.

A large number of tendon repair techniques have been described for acute tendon injury. However, after reviewing the literature, it was noted that there were limited descriptions of specific suture techniques that address repair processes of chronic tendon pathology. Generally, in chronic tendinopathy, others have described a process known as tendon tubularization, which consists of a running stitch using a nonabsorbable suture material along the external surface of the tendon.

Ecallantide for the acute treatment of angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter, randomized, controlled trial.

Study Objective: We compare the safety and efficacy of ecallantide with placebo in subjects undergoing assessment for acute angiotensin-converting enzyme inhibitor-induced angioedema (ACEIA) in an emergency department (ED).

Methods: This was a multicenter, phase 2, double-blind study with subjects randomized to receive a single subcutaneous dose of ecallantide (10, 30, or 60 mg) or placebo plus physician-directed conventional therapy. The primary endpoint was defined as meeting predetermined discharge eligibility criteria within 6 hours of study drug administration.

Antimicrobial salvage therapy for persistent staphylococcal bacteremia using daptomycin plus ceftaroline.

Purpose: Guidelines recommend daptomycin combination therapy as an option for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia after vancomycin failure. Recent data suggest that combining daptomycin with a β-lactam may have unique benefits; however, there are very limited clinical data regarding the use of ceftaroline with daptomycin.

Methods: All 26 cases from the 10 medical centers in which ceftaroline plus daptomycin was used for treatment of documented refractory staphylococcal bacteremia from March 2011 to November 2012 were included.

Lymphomas and lymphoproliferative disorders clinically presenting as renal carcinoma: a clinicopathological study of 14 cases.

Aims: Although uncommon, lymphomas and lymphoproliferative disorders (LPDs) that manifest as renal or perirenal masses can mimic primary renal cancers upon clinical and radiological evaluations. However, such distinction is critical as the management of these diseases are drastically different. This study reports the clinical, radiological and pathological features of 14 lymphomas/LPDs that were initially managed as primary renal carcinomas.

Mechanisms and efficacy of vismodegib in the treatment of basal cell carcinoma.

Historically patients with advanced basal cell carcinoma have been subjected to large surgical resections for the treatment of their disease. However, with the development of vismodegib, a first in class molecule that acts to inhibit the hedgehog pathway, patients with advanced and metastatic basal cell carcinoma may have renewed hope in limiting the morbidity involved with surgery. Preliminary data shows a relatively good safety profile and promising results, although further research remains to be conducted.

Preventing in-hospital newborn falls: a literature review.

In-hospital newborn falls are arguably one of the most underresearched and underreported issues for organizations that care for newborn patients. From the few published statistics of in-hospital fall rates, we know that perhaps 600 to 1,600 newborn falls occur annually. Many of these falls can result in injury or even death of the newborn, legal issues for the institution, and severe emotional stress to the caregiver(s) and parents.

Histologic evaluation of intermetatarsal Morton's neuroma.

Background: The present study was conducted in an attempt to obtain consistent similarities among histologic findings of surgically excised neuromas. Secondly, we looked for a correlation between the presence of a neuroma with certain comorbidities.

Methods: A total of 22 specimens with a preoperative diagnosis of Morton's neuroma were sent to the pathology laboratory, and evaluation was performed by a single pathologist.

Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice.

Background: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers.

Effects of mindfulness meditation on three individuals with aphasia.

Background: There is evidence to suggest that people with aphasia (PWA) may have deficits in attention stemming from the inefficient allocation of resources. The inaccurate perception of task demand, or sense of effort, may underlie the misallocation of the available attention resources. Given the lack of treatment options for improving attention in aphasia, Mindfulness Meditation, shown to improve attention in neurologically intact individuals, may prove effective in increasing attention in PWA.