A Case Report of Multimodal Analgesia for the Treatment of Refractory Chronic Nipple Pain.

Chronic nipple pain can be challenging to a multidisciplinary care team. We report a case of a patient who experienced years of ineffective treatment before presenting to the pain management clinic. Upon presentation, the patient was trialed on neuropathic agents, topical pain medications, acupuncture, calcium channel blockers, intercostal nerve blocks, pulsed radiofrequency, and a spinal cord stimulator trial.

Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report.

Importance: Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications.

Objectives: The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment.

Study Design: The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference.

Utilization of the Department of Defense Peer-Reviewed Orthopaedic Research Program (PRORP): Combating Musculoskeletal Disease With PRORP.

Introduction: Established in 2009, the Department of Defense (DoD) Peer-Reviewed Orthopaedic Research Program (PRORP) is an annual funding program for orthopaedic research that seeks to develop evidence for new clinical practice guidelines, procedures, technologies, and drugs. The aim was to help reduce the burden of injury for wounded Service members, Veterans, and civilians and to increase return-to-duty and return-to-work rates. Relative to its burden of disease, musculoskeletal injuries (MSKIs) are one of the most disproportionately underfunded conditions.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary for Limb Salvage or Early Amputation.

Clinical Practice Guideline for Limb Salvage or Early Amputation is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to address treatment for severe lower limb trauma below the distal femur by either amputation or limb salvage by providing evidence-based recommendations for key decisions that affect the management of patients with lower extremity trauma. This guideline contains 11 recommendations to evaluate the decision factors important for limb salvage versus early amputation.

Fast-Track Cardiac Anesthesia Aids in the Early Diagnosis of Lower Extremity Compartment Syndrome: A Case Report.

A 21-year-old otherwise healthy male with severe asymptomatic mitral regurgitation underwent a mitral valve repair via right thoracotomy and right femoral cannulation for cardiopulmonary bypass. Due to his age and health status, the anesthetic was planned to facilitate early extubation. Immediately on arrival to the intensive care unit, the patient complained of severe right calf pain with decreased sensation of the plantar foot.

Predictors of swallowing outcomes in patients with combat-injury related dysphagia.

Background: Traumatic injuries, such as those from combat-related activities, can lead to complicated clinical presentations that may include dysphagia.

Methods: This retrospective observational database study captured dysphagia-related information for 215 US military service members admitted to the first stateside military treatment facility after sustaining combat-related or combat-like traumatic injuries. A multidimensional relational database was developed to document the nature, course, and management for dysphagia in this unique population and to explore variables predictive of swallowing recovery using Bayesian statistical modeling and inferential statistical methods.

Ratio-driven resuscitation predicts early fascial closure in the combat wounded.

Background: Operation Iraqi Freedom and Operation Enduring Freedom have seen the highest rates of combat casualties since Vietnam. These casualties often require massive transfusion (MT) and immediate surgical attention to control hemorrhage. Clinical practice guidelines dictate ratio-driven resuscitation (RDR) for patients requiring MT.

Capsule-splitting phenomenon during capsulorhexis in pseudoexfoliation.

We present the case of a 78-year-old white woman with a 2+ nuclear sclerotic cataract and pseudoexfoliation syndrome who had cataract extraction with intraocular lens implantation. The initial continuous curvilinear capsulorhexis (CCC) was performed with a cystotome. Due to unusual tearing characteristics, there was concern that the anterior flap was pseudoexfoliative material instead of the lens capsule.

Clinical relevance of mold culture positivity with and without recurrent wound necrosis following combat-related injuries.

Background: Invasive fungal wound infections (IFIs) are a recognized threat for personnel who sustain combat-related blast trauma in Afghanistan. Blast trauma, particularly when dismounted, has wounds contaminated with organic debris and potential for mold infection. Trauma-associated IFI is characterized by recurrent wound necrosis on serial debridement with histologic evidence of invasive molds and/or fungal culture growth.

Multiple limbs salvaged using tissue transfers in the same casualty: a cohort comparison study chronicling a decade of war-injured patients.

Background: Extremity battlefield injuries from Operation Iraq and Enduring Freedom (Afghanistan) requiring multiple limbs salvaged with tissue transfers in the same patient are an understudied population. This study aimed to report the limb salvage outcomes in patients requiring multiple flap procedures for two or more concurrent extremity injuries.

Methods: A retrospective cohort comparison of warfare-related extremity injuries treated for limb salvage from 2003 through 2012 at the National Capital Consortium was completed.

The effect of cervical posterior foraminotomy on segmental range of motion in the setting of total disc arthroplasty.

Study Design: Human cadaveric biomechanical analysis.

Objective: To investigate the effect on cervical spine segmental stability that results from a posterior foraminotomy after cervical disc arthroplasty (CDA).

Summary Of Background Data: Posterior foraminotomy offers the ability to decompress cervical nerves roots while avoiding the need to extend a previous fusion or revise an arthroplasty to a fusion.

From battleside to stateside: the reconstructive journey of our wounded warriors.

Recent military operations in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom) have led to further refinements of the military medical system's ability to provide advanced surgical care. The deployment of a global trauma care system has directly contributed to improved combat casualty survival rates. As a consequence of improved survivorship, a high-volume patient population of individuals having challenging multiple extremity injuries/amputations has presented to military treatment facilities.

The management of pemphigus vulgaris in a burn intensive care unit: a case report and treatment review.

Pemphigus vulgaris is a rare, potentially fatal, autoimmune blistering disease of the skin and mucous membranes. Treatment of this disease is problematic because of a lack of high-grade, evidence-based recommendations, the side-effect profiles of the therapies available, and the extensive supportive care that afflicted patients require. The authors present the unfortunate course of a patient with severe pemphigus vulgaris who was admitted to the U.

Minimally invasive management of retropubic bleeding and hematoma evacuation after a TVT Secur or mini-sling procedure.

Background: Retropubic hematomas may complicate up to 4.1% of tension-free vaginal tape (TVT) procedures in the surgical treatment of stress urinary incontinence. Symptomatic or expanding hematomas often require intervention, usually accomplished through an abdominal incision.