Atlanto-occipital Dissociation in the Setting of Relatively Normal Radiologic Findings.

Background: Craniocervical junction (CCJ) dislocations are often fatal. Atlanto-occipital dissociation can be challenging to diagnose, especially in patients who present with absent or subtle radiologic signs.

Case Description: A neurologically intact 37-year-old patient presented to the hospital following a high-speed motor vehicle accident.

High pooled performance of convolutional neural networks in computer-aided diagnosis of GI ulcers and/or hemorrhage on wireless capsule endoscopy images: a systematic review and meta-analysis.

Background And Aims: Diagnosis of GI ulcers and/or hemorrhage by wireless capsule endoscopy (WCE) is limited by the physician-dependent, tedious, time-consuming process of image and/ or video classification. Computer-aided diagnosis (CAD) by convolutional neural network (CNN)-based machine learning may help reduce this burden. Our aim was to conduct a meta-analysis and appraise the reported data.

Lymphatic flow modulation as adjunct therapy for septic shock.

The lymphatic system is an important component of human health and is critical in maintaining microcirculatory flow and immune system homeostasis. During septic shock, increased capillary permeability results in excess filtration of intravascular fluid and solutes producing interstitial edema with subsequent hydrostatic and oncotic gradient breakdown. The accumulation of interstitial fluid results in impaired solute exchange, leukocyte signaling, and aberrancy in capillary flow.

"Tear Drops in the Duodenum": Uncommon Cause of Iron Deficiency Anemia in Adults.

A 64-year-old man presented to the internal medicine resident clinic with fatigue and abdominal pain of six-month duration. He did not have diarrhea, hematemesis, melena, or hematochezia. Physical examination was unremarkable.

Peroneal Tendon Lengthening as an Adjunct Procedure to Aid in the Reduction of the Lateral Malleolus in Diabetic Ankle Fractures: 2 Case Reports.

It is well-documented that individuals with longstanding diabetes mellitus are at risk for specific metabolic abnormalities; this includes but is not limited to increased glycation of collagenous soft-tissue structures. It is also apparent that such changes can manifest as thickening and increased stiffness of tendinous structures. What remains unknown are the biomechanical ramifications of these changes and how they should affect the surgical management of lower extremity injuries.

Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma.

Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma.

Therapeutic Direction Versus Adverse Outcomes in Children Undergoing Lung Biopsy.

Background: Lung biopsy is part of the diagnostic workup for multiple diseases. Although the morbidity of the procedure has decreased with the use of thoracoscopy, lung biopsy still holds substantial risk for patients. Therefore, we evaluated the likelihood of lung biopsies impacting treatment compared to complications.

In adults with osteoarthritis of the knee, is conservative management more effective than intra-articular corticosteroid injections in relieving pain?

Clinical Question: In adults with osteoarthritis of the knee, do conservative management methods such as weight reduction, physical therapy, Tai Chi, non-steroidal anti-inflammatory drugs (NSAIDs), and others provide more and longer pain relief and functionality of the knee, as well as overall well-being, when compared to corticosteroid knee injections?

Answer: Yes. Although there are limited head-to-head trials directly comparing each alternative method to corticosteroid injections, overall evidence appears to indicate conservative methods as being more effective than injections, especially when considering long-term pain relief and functionality.

A case report of a rare, spontaneous external jugular vein aneurysm.

Introduction: Compared to arterial aneurysms, venous pseudoaneurysms are rare and even more rare are external jugular vein aneurysms (EJV). To our knowledge, there are less than 10 well-documented cases of EJV aneurysms accessible.

Presentation Of Case: Our patient is a 75 year old hispanic female who noticed a painless right neck mass two months prior.

Does muscle biopsy change the treatment of pediatric muscular disease?

Background: Muscle biopsy is performed to confirm the diagnosis of neuromuscular disease and guide therapy. The purpose of our study was to determine if muscle biopsy changed patient diagnosis or treatment, which patients were most likely to benefit from muscle biopsy, and complications resulting from muscle biopsy.

Materials And Methods: An IRB-approved retrospective chart review of all patients less than 18 years old undergoing muscle biopsy between January 2010 and August 2016 was performed.

Assessment of toxicology knowledge in the fourth-year medical students: Three years of data.

Background: Pharmacology and toxicology are core content knowledge for physicians. Medical students should demonstrate understanding of general pharmacology and basic treatment of poisoning. The objective of this study was to measure the knowledge of the 4th-year medical students (MS4) on these topics over 3 years.

STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass.

Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup.

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass.

Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup.

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass.

Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup.

Subtotal Calcanectomy for the Treatment of Chronic Ulcer Associated with Osteomyelitis: A Case Report.

Introduction: Subtotal calcanectomy is a therapeutic option for the treatment of chronic ulcer associated with calcaneal osteomyelitis. Closure of the surgical wound can be difficult due to the lack of local cutaneous coverage. We present the first case of subtotal calcanectomy in which the ankle was positioned in plantar flexion allowing the primary closure of the surgical wound without the need for flap.

Perioperative Stroke and Mortality After Surgical Aortic Valve Replacement: A Meta-Analysis.

Objective: Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.

A Newborn with Panhypopituitarism and Seizures.

Interstitial deletions on the short arm of chromosome 20 are uncommon, and therefore the clinical phenotype is poorly defined. Very few cases have been reported in the literature so far. In this report, we describe a 4-month-old female with a heterozygous deletion at 20p11.

Music therapy is a potential intervention for cognition of Alzheimer's Disease: a mini-review.

Alzheimer's Disease (AD) is a global health issue given the increasing prevalence rate and the limitations of drug effects. As a consequent, non-pharmacological interventions are of importance. Music therapy (MT) is a non-pharmacological way with a long history of use and a fine usability for dementia patients.

Nerve Transfer With Entubulated Nerve Allograft Transfers to Treat Recalcitrant Lower Extremity Neuromas.

Neuroma formation in the lower extremity can be debilitating to patients, especially when the neuromas are recurrent. The results of an advanced nerve reconstruction technique consisting of nerve transfer combined with nerve allograft and entubulation was evaluated in 4 patients with severe, debilitating, lower extremity neuromas. At a mean follow-up period of 26 months, the mean visual analog scale had improved from 9.

The Role of Antimicrobial Stewardship in the Clinical Microbiology Laboratory: Stepping Up to the Plate.

We report the development of a collaborative relationship between antimicrobial stewardship and clinical microbiology that incorporates stewardship practices into daily laboratory rounds. Antimicrobial stewardship involvement on rounds was a welcomed and effective initiative with substantial rates of intervention. New opportunities to positively impact use of antimicrobials and laboratory resources were realized.

Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe method with decreasing incidence of perioperative stroke. There is a void in literature concerning the impact of stroke after TAVI in predicting 30-day stroke-related mortality. The primary aim of this meta-analysis was to determine whether perioperative stroke increases risk of stroke-related mortality after TAVI.

Surgical Technique Utilizing Suture-Button Device for Central Metacarpal Ray Resection.

Certain technical demands must be overcome in order to accomplish the goals of creating a functional hand when performing a central digital ray resection of the hand. One of the biggest challenges is maintaining metacarpal gap closure and in such a way that the metacarpals are balanced and not rotated. Inadequate closure of the defect created between the metacarpals by a central ray resection will produce a persistent gap between the remaining fingers as well as the potential for malalignment.

Use of acid-fast bacilli staining to determine the need for airborne infection isolation precautions: a comparison of respiratory specimens.

Institution of appropriate airborne infection isolation (AII) precautions for patients with suspected Mycobacterium tuberculosis is critical to prevent disease transmission. We compared the yield of acid-fast bacilli smears from different types of respiratory specimens and found that smear sensitivity was highest for specimens obtained by endotracheal aspirates (92%), followed by sputum (79%), and then by bronchoalveolar lavage (37%). As a result of this study, our institutional policy regarding discontinuation of AII precautions was amended.