Femoral Intramedullary Alignment in Total Knee Arthroplasty: Indications, Results, Pitfalls, Alternatives, and Controversies.

While femoral intramedullary alignment has been found to be the most accurate and reproducible method for proper femoral component orientation in total knee arthroplasty, certain situations preclude the use of intramedullary alignment, such as ipsilateral long-stem total hip arthroplasty, femoral shaft deformity (congenital or post-traumatic), capacious femoral canal, and retained hardware. These cases require alternative alignment guides, that is, extramedullary alignment. The purpose of this study was to determine the accuracy of intramedullary alignment in reproducing the femoral anatomic axis.

Treating Charcot Arthropathy Is a Challenge: Explaining Why My Treatment Algorithm Has Changed.

Charcot deformity is a challenge that foot and ankle surgeons struggle to manage successfully. Despite the advances in knowledge, technology, and treatment modalities, limb loss is still greater than 10%. This article discusses the efficacy of conservative measures and traditional surgical approaches.

First Metatarsophalangeal Joint Fusion With Use of Crossed Kirschner Wires and Intramedullary Steinmann Pin.

Primary arthrodesis is a thoroughly studied treatment option for end-stage pathologic entities of the first metatarsophalangeal joint. It is a commonly accepted treatment of many pathologic conditions, including hallux rigidus, severe hallux valgus, hallux varus, and other conditions pertaining to the first ray. Numerous fixation techniques are available for this procedure.

Cystic Diseases of Childhood: A Review.

Renal cystic lesions are considered the most common abnormality associated with the kidneys. Most renal cysts are usually uncomplicated simple cysts that are not life-threatening; however, fatal renal cystic diseases can develop from these space-occupying lesions. Although renal cystic diseases are similar in presentation, they possess distinct features, variable prognoses, and complications later in life.

Cancer of unknown primary (CUP) presenting as a Spigelian hernia: a case report.

Cancer of unknown primary (CUP) is a well-known entity that can present in a multitude of clinical presentations. Based on the extent and organ of involvement, the presentation will be varied. For instance, patients presenting with axillary lymphadenopathy would lead toward a primary breast cancer, whereas patients presenting with abdominal distention due to ascites would tend toward a gastrointestinal origin.

Quality of Life Perspectives of People With Amyotrophic Lateral Sclerosis and Their Caregivers.

This study explored differences in perspectives on quality of life (QOL) between people affected by amyotrophic lateral sclerosis (ALS) and their caregivers. QOL is often thought of as related to physical limitations, without consideration of other factors (e.g.

Stent graft repair of anastomotic pseudoaneurysm of femoral-popliteal bypass graft following patch angioplasty.

Pseudoaneurysm (PA) following vascular reconstruction is a complication of bypass surgery. Historically, the mainstay of treatment was an open repair; the surgical management consisted of resection of the initial graft with reimplantation of a new bypass either into the original arteriotomy or to a more distal target. Placement of a stent graft to exclude the PA is a viable option.

Recurrence of an inguinal hernia containing the dome of the bladder following laparoscopic repair with mesh: A case report.

Introduction: A sliding hernia is a rare type of inguinal hernia in which the hernia sac is partially formed by the wall of a viscus, such as the sigmoid colon, bladder, cecum, or appendix. Sliding hernias involving the bladder often present with obstructive urinary symptoms that could potential lead to serious complications.

Case Presentation: In this case, we present a 37-year-old male with a recurrent sliding hernia containing the dome of the bladder after prior laparoscopic repair of a direct inguinal hernia with mesh.

Mechanical Ventilation Antioxidant Trial.

Background: Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation.

Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study.

Background: The effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis is controversial. The objective of the present study was to test whether focused extracorporeal shock wave therapy is effective in relieving chronic heel pain diagnosed as plantar fasciitis.

Methods: Two hundred and fifty subjects were enrolled in a prospective, multicenter, double-blind, randomized, and placebo-controlled U.

External pancreatic duct stent reduces pancreatic fistula: a meta-analysis and systematic review.

Background: Postoperative pancreatic fistula formation (POPF) remains one of the most common and detrimental complications following pancreaticojejunostomy (PJ). The aim of this meta-analysis is to analyze the efficacy of external pancreatic duct stent placement in preventing POPF formation following PJ.

Methods: The primary end-point was the incidence of POPF formation following pancreaticoduodenectomy (PD) in the presence and absence of external stent placement.

A rare presentation of triple-negative apocrine breast carcinoma with metastases.

Apocrine breast carcinoma is a rare subtype of the invasive ductal carcinoma and accounts for as little as 0.3-1% of all breast cancers. It is usually positive for human epidermal growth factor receptor 2 (HER-2) and negative for both estrogen receptor and progesterone receptor.

Cardiopulmonary resuscitation in the hospitalized patient: impact of system-based variables on outcomes in cardiac arrest.

Background: A better understanding of the factors affecting the outcome of inpatient cardiopulmonary resuscitation (CPR) is crucial in making key clinical decisions. We aim to study the impact of various patient-related and hospital-related variables in a community-based teaching setup that could affect the prognosis of in-hospital cardiac arrests.

Methods: We analyzed the data on all patients who experienced cardiac arrest while hospitalized at a community teaching hospital in Youngstown, Ohio.

Is surgical intervention avoidable in cases of emphysematous gastritis? A case presentation and literature review.

Introduction: Gas located within the gastric wall is a rare finding that is associated with a mortality rate of 50%. It confers two main diagnoses: gastric emphysema and emphysematous gastritis. Due to its high mortality rate, emphysematous gastritis must be differentiated from gastric emphysema early to avoid adverse outcomes and plan the management of these patients.

Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review.

Background: The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age).

Methods: A systematic literature search was conducted using Embase, MEDLINE, Cochrane and PubMed databases on all studies published between January 1990 and April 2012 reporting peri-operative outcomes after a pancreaticoduodenectomy (PD) among the elderly. Primary end-points measured were peri-operative mortality and the incidence of post-operative complications.

Laparoscopic management of small bowel obstruction with associated intestinal ischemia.

Obstruction is the most common surgical disorder of the small bowel. Complete small bowel obstruction (SBO) is usually treated surgically because bowel strangulation cannot be excluded with certainty. Acute SBO has been previously considered a relative contraindication for laparoscopic management especially due to the laparotomy conversion rate.

Thoracic endovascular aortic repair for thoracic aortic mobile thrombus.

Thoracic aortic mobile thrombus is a rare and significant source of peripheral, visceral, as well as cerebral emboli. A 51-year-old female with a history of emergency left brachial artery embolectomy 5 months previously was referred to our unit for evaluation of a mobile thrombus in the descending thoracic aorta. We describe the successful primary treatment of a symptomatic mobile thrombus in the thoracic aorta by using a stent graft.

Role ambiguity and role conflict in nurse case managers: an integrative review.

Purpose/objectives: The purpose of this integrative review is to critically examine the relationship between the transition from a direct caregiver to a nurse case manager role and the perceived levels of role ambiguity and role conflict.

Primary Practice Setting(s): Nurse case managers in acute care, postacute care, and managed care settings.

Findings/conclusions: Nurses can expect to experience substantial role ambiguity and role conflict as they take on the case manager role, primarily because of inadequate role definition, unexpected ethical challenges, and lack of prior insight into the case manager role.

Aberrant mesoappendix vasculature: a unique cause of partial small bowel obstruction.

Small bowel obstructions are most frequently caused by hernias or adhesive bands. However, there have been several rare reported cases of mechanical small bowel obstructions caused by loops of bowel or vascular bands. We describe a case of a 30-year-old woman with a clinical presentation suggestive of appendicitis.

A retroperitoneal abscess caused by Haemophilus parainfluenza after endoscopic retrograde cholangiopancreatography and open cholecystectomy with a common bile duct exploration: a case report.

Introduction: Abscesses after open cholecystectomies have been reported to occur in less than 1% of patients. The majority of these abscesses are colonized by gastrointestinal tract flora. It is clearly known that Haemophilus parainfluenza is a normal inhabitant of the human respiratory tract.

Late presentation of a mucinous ovarian adenocarcinoma which was initially diagnosed as a primary pancreatic carcinoma: a case report and review of the literature.

Introduction: Adenocarcinoma of the ovary is an aggressive neoplasm which often metastasizes to the lung or liver. Metastases rarely occur to the pancreas, but a tissue diagnosis is required to confirm this event. Although most tumors of the pancreas are primary pancreatic neoplasms, metastatic lesions have been reported most commonly as arising from renal cell carcinoma.

Pericardial involvement as a rare manifestation of hypereosinophilic syndrome.

A 56-year-old female with idiopathic hypereosinophilic syndrome who presented with chest tightness, dyspnea and new-onset atrial fibrillation is reported. Work up revealed significant peripheral eosinophilia, pericarditis, and a pericardial effusion with tamponade physiology. Pericardiocentesis revealed predominant eosinophils (88%) in the pericardial fluid.

Ischemic volvulus of the transverse colon: A case report and review of literature.

A 75-year old male presented to the emergency room with worsening abdominal pain and distension. Plain radiographs were suggestive of a large bowel obstruction due to volvulus. An attempt to detorse the volvulus and decompress the colon endoscopically failed, after which the patient was taken for an exploratory laparotomy.