Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance.

Background: Methadone is a synthetic mu-opioid receptor agonist used in the treatment of chronic pain and opioid dependence. Methadone is metabolized by several cytochrome P450 isoenzymes; primarily CYP3A4, CYP2B6, and CYP2D6 before renal and fecal elimination. Exposure to substances like grapefruit juice, that inhibit these isoenzymes may result in increased blood levels of methadone, and thus may manifest clinically as unexpected opioid toxicity.

Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: A systematic review.

Background: Pancreaticoduodenectomy (PD) with right hemicolectomy (RH) to treat locally advanced right colon cancer (LARCC) has been rarely reported in the literature. Herein, we characterize clinicopathologic factors and evaluate outcomes of en bloc PD and RH for LARCC.

Methods: A systematic review of the literature was conducted on PubMed using MeSH terms ("pancreaticoduodenectomy" or "pancreas/surgery" or "duodenum/surgery" or "colectomy") and ("colonic neoplasms").

Concepts in U.S. Food and Drug Administration Regulation of Artificial Intelligence for Medical Imaging.

Although extensive attention has been focused on the enormous potential of artificial intelligence (AI) technology, a major question remains: how should this fundamentally new technology be regulated? The purpose of this article is to provide an overview of the pathways developed by the U.S. Food and Drug Administration to regulate the incorporation of AI in medical imaging.

Seatbelt Use in Females of Childbearing Age at an Urban Safety-Net Level 1 Trauma Center.

Background: Safety restraint system (SRS) use is known to improve maternal and fetal outcomes in pregnant women. Factors associated with seatbelt use in females of childbearing age are largely unstudied despite global public health endeavors to increase use. We sought to define its use and uncover risk factors for not using a restraint system in this vulnerable patient cohort.

Preoperative patient preparation in enhanced recovery pathways.

Enhanced recovery pathways are a novel approach focused on enhancing the care of surgical patients. "Prehabilitation" is the term applied to any intervention administered before surgery to reduce surgery-related morbidity, decrease the length of hospital stay, expedite the return of organ function, and facilitate the patient's return to normal life. A PubMed search was performed with the following key words: enhanced recovery, preoperative preparation, cessation of smoking and euvolemia.

A Case Report of the Clinico-radiologic Challenges of Assessing Treatment Response after Stereotactic Radiation of Oligometastases Preceded by Immunotherapy: Pseudoprogression, Mixed Response Patterns, and Opportunities for Precision Radiation.

As immunotherapy continues to translate to the clinic and is combined with existing modalities, such as radiation therapy, novel treatment response patterns have been observed which complicate conventional clinical assessment and management. Herein, we describe a case study of a patient with non-small cell lung cancer treated initially with definitive chemoradiation who subsequently developed oligorecurrent disease which was managed with nivolumab and then comprehensive salvage stereotactic radiation. Serial radiographic assessment had shown worsening at these limited sites of disease after initiating immunotherapy, improvement after radiation, and then heterogeneous response behavior across sites during longer-term follow-up.

Biomimetic proteoglycans diffuse throughout articular cartilage and localize within the pericellular matrix.

Biomimetic proteoglycan (BPG) diffusion into articular cartilage has the potential to restore the lost proteoglycan content in osteoarthritic cartilage given these molecules mimic the structure and properties of natural proteoglycans. We examined the diffusion characteristics of BPGs through cartilage with the use of a custom-made in vitro cartilage diffusion model in both normal bovine and human osteoarthritic cartilage explants. BPGs were introduced into the cartilage through essentially one-dimensional diffusion using osteochondral plugs.

Multicenter investigation on the influence of climate in penile prosthesis infection.

The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records.

Practice makes perfect: The impact of Stop the Bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace.

Introduction: The national Stop the Bleed (STB) campaign was implemented in 2015 to provide hemorrhage control education to non-medical providers to reduce the number of deaths due to uncontrolled hemorrhage. Hands on training limits the availability of this program, and its importance is not known amongst lay providers. This study aimed to evaluate the efficacy of STB training for laypersons on knowledge and skill-based abilities in the workplace setting.

Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile dysfunction.

Background: The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LiESWT) for the treatment of erectile dysfunction (ED).

Materials And Methods: A comprehensive search of , and databases was performed from November 2005 to July 2018. RCTs evaluating efficacy of LiESWT in the treatment of ED were selected.

The Cost Effectiveness of Dilute Betadine Lavage for Infection Prophylaxis in Total Joint Arthroplasty.

Background: This article presents a break-even analysis for intraoperative Betadine lavage for the prevention of infection in total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: Protocol costs, baseline infection rates after arthroplasty, and average revision costs were obtained from institutional records and the literature. The break-even analysis determined the absolute risk reduction (ARR) in infection rate required for cost effectiveness.

Development of clinical tracheostomy score to identify cervical spinal cord injury patients requiring prolonged ventilator support.

Background: Cervical spinal cord injuries often necessitate ventilator support (VS). Prolonged endotracheal tube use has conveyed substantial morbidity in prospective study. Tracheostomy is recommended if VS is anticipated to be 7 days or longer, which defines prolonged ventilation (PV).

Prepectoral Breast Reconstruction: A Technical Algorithm.

Despite falling out of favor in the 1970s, prepectoral breast reconstruction has resurfaced in the recent years as a safe and effective alternative to subpectoral/partial subpectoral breast reconstruction in carefully selected patients. This article outlines an algorithmic technical approach to prepectoral breast reconstruction for new patients and revision patients.

Enhanced Recovery Pathways for Cardiac Surgery.

Purpose Of Review: Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care.

Acute pulmonary hemorrhage associated with metastatic testicular choriocarcinoma in a 46-year-old incarcerated male.

Pure testicular choriocarcinoma is a rare histological subtype of germ cell tumor (GCT) and typically presents with distant metastases and aggressive features leading to a generally poor prognosis. Unique to choriocarcinoma among GCT histological subtypes is the propensity of spontaneous hemorrhage into metastatic lesions. We report a case of pure testicular choriocarcinoma in a 46-year-old male with postoperative acute pulmonary hemorrhage secondary to tumor invasion of the lungs, and the subsequent management of his disease with a discussion of relevant literature.

Rapid, label-free genetic detection of enteropathogens in stool without genetic isolation or amplification.

Current genetic detection methods require gene isolation, gene amplification and detection with a fluorescent-tagged probe. They typically require sophisticated equipment and expensive fluorescent probes, rendering them not widely available for rapid acute infection diagnoses at the point of care to ensure timely treatment of the diseases. Here we report a rapid genetic detection method that can detect the bacterial gene directly from patient stools using a piezoelectric plate sensor (PEPS) in conjunction with a continuous flow system with two temperature zones.

Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma.

Pneumoscrotum is a rare complication that can result from various etiologies and can be essential in the diagnosis of those causative factors, especially life-threatening ones such as infection or trauma. We present here a case of a patient who presented in posttraumatic cardiac arrest and an extensive, grossly obvious, and rapidly expanding pneumoscrotum. Based on our patient's clinical presentation and a history of a high-speed mechanism with obvious torso trauma, a diagnosis of tension pneumothorax was quickly made resulting in immediate treatment.

Abdominal CT Scan Findings of Decompression Sickness: A Case Report.

This case report depicts the radiologic findings of a 51-year-old male presenting with Decompression Sickness. Decompression Sickness is diagnosed clinically, therefore radiologic imaging of this disease entity is limited. Our patient's history includes a scuba dive to depth of 110 feet with a descending time of 24 minutes and an ascending time of 8 minutes.

Sub-external oblique placement of inflatable penile prosthesis reservoirs-initial experience.

Multiple-component inflatable penile prostheses (IPPs) consist of paired intracorporal cylinders, a scrotal pump, and an abdominal fluid reservoir. In recent years, ectopic (e.g.

Thyroxine-induced periodic paralysis: a rare complication of nutritional supplements.

The consumption of daily nutritional supplements has risen dramatically all over the world. Many people believe that dietary supplements, if not useful, are at least safe to fulfil small dietary gaps. Many nutritional supplements have not been approved by Federal Drug Administration due to their unregulated active ingredients, but they are available as over the counter.

Incisional hernia after cystectomy: incidence, risk factors and anthropometric predisposition.

Introduction: Postoperative incisional hernias (PIH) are an established complication of abdominal surgery with rates after radical cystectomy (RC) poorly defined. The objective of this analysis is to compare rates and risk factors of PIH after open (ORC) and robotic-assisted (RARC) cystectomy at a tertiary-care referral center.

Materials And Methods: We performed a retrospective review of patients undergoing ORC and RARC from 2000-2015 with pre and postoperative cross-sectional imaging available.