Successful Treatment of an Atypical Presentation of Disseminated Retroperitoneal Seminoma: A Case Report.

Background: Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites.

An Incidental Finding of Idiopathic Hypertrophic Pachymeningitis: A Case Report.

In this case report, we discuss and explore the clinical, laboratory, and imaging findings, as well as the treatment options and follow-up measures, in an 83-year-old patient with idiopathic hypertrophic pachymeningitis (IHP), a rare disorder characterized by fibrosing, hypertrophic inflammation that thickens the dura mater. An 83-year-old female with a medical history of hypertension and hyperlipidemia presented with speech arrest and was taken to the emergency department, where she received a stroke code, a CT scan, and an MRI. The MRI results showed a temporal lobe meningioma and a pan-cranial pachymeningitis encasing the entire brain and cerebellum and extending into the upper cervical spine.

Feasibility of Addressing the Spiritual Well-Being of Persons With Multiple Sclerosis: A Mixed-Methods Program Evaluation.

Importance: Spiritual well-being is an important aspect of health-related quality of life for persons with chronic illnesses such as multiple sclerosis (MS), yet research on interventions remains limited.

Objective: To assess the feasibility of an occupational therapy intervention addressing the spiritual well-being of people with MS.

Design: Mixed-methods program evaluation using theoretical thematic analysis of qualitative data.

Challenges in closing the gap between evidence and practice: International survey of institutional surgical stabilization of rib fractures guidelines.

Background: Surgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade, yet few candidates who could benefit from SSRF undergo operative management. We conducted an international survey of institutional SSRF guidelines comparing congruence between practice and contemporary evidence. We hypothesized that few guidelines reflect comprehensive evidence to facilitate standardized patient selection, operation, and postoperative management.

Beneficial Effects of Amnion-Chorion Stem Cell Grafting in the Long Term Management of Nonuremic Calciphylaxis Wounds.

Calciphylaxis is a poorly understood disease with high morbidity and mortality. The current primary literature on treatment is lacking; however, disease management often involves a multifaceted approach with a primary focus on consistent wound care. This report describes a case outlining the long-term management of nonuremic calciphylaxis wounds in a patient with severe malnutrition with the use of human amniotic membrane grafts, aggressive surgical debridement, nutritional therapy, and advanced wound healing techniques.

Goblet Cell Carcinoma of the Appendix: A Case Report on Goblet Cell Carcinoid.

Description Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis.

10-kHz Spinal Cord Stimulation for Chronic Postsurgical Pain: Results From a 12-Month Prospective, Multicenter Study.

Background: Chronic postsurgical pain (CPSP) can be caused by peripheral nerve injury (PNI) resulting from surgical procedures and has a significant neuropathic component. This prospective, single-arm study was conducted to document the effectiveness of 10-kHz spinal cord stimulation (10-kHz SCS) as a treatment for patients with CPSP.

Methods: Subjects with CPSP who were refractory to conventional medical interventions and reported pain scores of ≥5 cm on a 10-cm VAS underwent trial stimulations lasting up to 14 days.

Pregnancy-Induced Exacerbation of Hereditary Angioedema in a Multiparous Caucasian Female.

Hereditary angioedema (HAE) manifests due to a deficiency of the C1-esterase inhibitor and can present with life-threatening swelling of multiple body regions such as the face, hands, upper respiratory tract, and intestinal walls. The present case describes the manifestation and symptomatic exacerbation of HAE in a multiparous Caucasian female. Very few trials and cases are available on HAE exacerbations during pregnancy, and our case describes the timeline and treatment in order to add to the clinical awareness of the disease.

Effect of a Behavioral Intervention to Increase Vegetable Consumption on Cancer Progression Among Men With Early-Stage Prostate Cancer: The MEAL Randomized Clinical Trial.

Importance: Guidelines endorsing vegetable-enriched diets to improve outcomes for prostate cancer survivors are based on expert opinion, preclinical studies, and observational data.

Objective: To determine the effect of a behavioral intervention that increased vegetable intake on cancer progression in men with early-stage prostate cancer.

Design, Setting, And Participants: The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) was a randomized clinical trial conducted at 91 US urology and medical oncology clinics that enrolled 478 men aged 50 to 80 years with biopsy-proven prostate adenocarcinoma (International Society of Urological Pathology grade group = 1 in those <70 years and ≤2 in those ≥70 years), stage cT2a or less, and serum prostate-specific antigen (PSA) level less than 10 ng/mL.

Preparing Fellows for Graduation: Perspectives on Career Guidance.

At the completion of a hematology/oncology fellowship, trainees are likely to enter into a career differing from the one modeled by the faculty providing mentorship and teaching during training. Fellows benefit from open communication with regard to career goals and opportunities starting early in training. To ensure honesty in the process, program directors must be accepting and supportive of house staff selecting careers different from those of the training environment.

Pseudotumor from Metal-on-Metal Total Hip Arthroplasty Causing Unilateral Leg Edema: Case Presentation and Literature Review.

Metal-on-metal (MoM) total hip arthroplasty (THA) can be associated with adverse metal reactions, including pseudotumors. This case report describes a 58-year-old female with an MoM THA-related pseudotumor that caused unilateral leg edema from compression of her external iliac vein. After thorough preoperative workup to rule out infection and deep vein thrombosis and consultation with a vascular surgeon, the patient underwent revision THA and excision of her pseudotumor.

A retrospective study of the impact of 21-gene recurrence score assay on treatment choice in node positive micrometastatic breast cancer.

To assess clinical utility of the 21-gene assay (Oncotype DX® Recurrence Score®), we determined whether women with HER2(-)/ER+ pN1mi breast cancer with low (<18) Recurrence Scores results are given adjuvant chemotherapy in a lower proportion than those with high scores (≥31). This was a multicenter chart review of ≥18 year old women with pN1mi breast cancer, HER2(-)/ER+ tumors, ductal/lobular/mixed histology, with the assay ordered on or after 1 January 2007. One hundred and eighty one patients had a mean age of 60.

Pharmacy management of postoperative blood glucose in open heart surgery patients: evaluation of an intravenous to subcutaneous insulin protocol.

Purpose: To develop and implement a protocol to improve blood glucose (BG) control during transition from intravenous (IV) to subcutaneous (SC) insulin, increase compliance with Surgical Care Improvement Project (SCIP) measures, and decrease sternal wound infections post open heart surgery (OHS).

Methods: An IV to SC protocol was developed and implemented. A retrospective chart review of patients who underwent OHS was conducted from January 2, 2009 to September 30, 2010 (pre protocol) and from October 1, 2010 to December 31, 2011 (post protocol).

Repiphysis prosthesis for limb preservation in pediatric patients with bone cancer: a literature review.

Osteosarcoma is the most common bone sarcoma in children and adolescents. It occurs mainly around the knee joint; the distal femur is the most common location. When it occurs in children who are skeletally immature, a significant limb length discrepancy can occur.

Impact of intimate partner violence on maternal child health.

This article synthesizes research that has examined the impact of abuse on women, fetuses, and developing children. Intimate partner violence affects the lives of millions of women, sometimes in ways we have yet to understand. Despite the research in this area, the full impact of abuse on the long-term physical and psychosocial well-being of women and their families is not fully understood.

A comparison of flexor tenosynovectomy, open carpal tunnel release, and open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome.

The purpose of this study was to identify the advantages and disadvantages of performing a flexor tenosynovectomy without dividing the transverse carpal ligament, an open carpal tunnel release, and an open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome. From 1990 to 1998, a retrospective study was done in which a flexor tenosynovectomy was performed in 133 patients without division of the transverse carpal ligament and compared with 68 patients who had an open carpal tunnel release and 75 patients who had an open carpal tunnel release and flexor tenosynovectomy. Patients were followed up for an average period of 30 weeks with history and physical findings and nerve conduction velocities and for an average period of 2.

The injection of nodules of Dupuytren's disease with triamcinolone acetonide.

Over a 4-year period 63 patients (75 hands) with Dupuytren's nodules were treated with a series of injections with the steroid triamcinolone acetonide directly into the area of disease. The purpose of this study was to determine whether intralesional injections of triamcinolone acetonide could produce softening and flattening in nodules of Dupuytren's disease as seen in the intralesional injections of hypertrophic scars and keloids. After an average of 3.

Twenty-five-year follow-up evaluation of an active silicone/Dacron tendon interposition prosthesis: A case report.

A 19-year-old man sustained a severe avulsion wound of the dominant distal forearm, dividing the radial and ulnar arteries, median and ulnar nerves, and all flexor tendons. Initial treatment consisted of revascularization. Shortly thereafter he had sural nerve grafting of the median and ulnar nerves.

Association of paralabral cysts with acetabular disorders.

Objective: Acetabular labral tears may cause considerable pain and predispose patients to premature osteoarthritis. Therefore, early and accurate examination is required. Acetabular labral tears are difficult to view on MR images.

Stress relief for critical care nurses.

Critical care nurses' stress levels have increased due to patient-focused care models that supplement staffing with unlicensed assistive personnel. Stat nurse programs can alleviate nurses' anxiety by providing short-term professional critical care assistance without disrupting structured health care models.

MRI of meniscal bucket-handle tears.

Objective: A meniscal bucket-handle tear is a tear with an attached fragment displaced from the meniscus of the knee joint. Low sensitivity of MRI for detection of bucket-handle tears (64% as compared with arthroscopy) has been reported previously. We report increased sensitivity for detecting bucket-handle tears with the use of coronal short tau inversion recovery (STIR) images.

Usefulness of MR imaging in the detection of talar dome injuries.

Objective: Patients with significant ankle injuries often have normal findings on conventional radiographs despite severe ligament, tendon, and bone injuries. MR imaging was used to assess the incidence of talar dome injuries in patients who had failed conservative therapy after ankle trauma.

Subjects And Methods: MR images were obtained in 30 patients with persistent ankle pain 6 weeks after an injury.

Intraosseus ganglia of the wrist.

Purpose: To determine the prevalence of intraosseous ganglion cysts in patients with unexplained wrist pain and evaluate the radiographic methods used for their detection.

Materials And Methods: Four hundred patients with unexplained wrist pain were prospectively examined. All patients underwent standard three-view radiography of the wrist.

Autotransfusion of unwashed mediastinal shed blood fails to decrease banked blood requirements in patients undergoing aortocoronary bypass surgery.

Infusion of unwashed mediastinal shed blood (MSB) is one technique advocated for decreasing use of donor blood in cardiac surgery patients. A commercially available system was prospectively evaluated in 96 consecutive patients. The control group was comprised of 78 consecutive patients.