The Effect of Unilateral Hearing Protection on Vocal Intensity With Varying Degrees of Background Noise.

Introduction: The Lombard effect (LE) is a phenomenon in which speakers adjust their vocal production by raising the volume in noisy environments. As a result, the LE can create problems of vocal strain, fatigue and potential injury.

Objectives: This study aims to examine the difference in vocal intensity output in subjects wearing unilateral hearing protection versus no hearing protection in the presence of background noise.

Low-Grade Chondrosarcoma of the Proximal Phalanx: A Rare Presentation.

Case: Chondrosarcomas are the second most common primary malignant sarcoma of the bone, though it is overall a rare tumor. Our case presents a 36-year-old Caucasian male who complained of an enlarging mass at his third finger MCP joint. After assessing the full clinical scenario, it was determined that wide excision with ray resection would provide the best result for this patient.

Duodenal Pyloric Gland Adenoma in a 59-Year-Old Asian Male.

Pyloric gland adenomas (PGAs) are rare precancerous tumors typically arising from the stomach. Even more rarely do they arise in extragastric sites such as the duodenum and gallbladder. The identification of PGAs is important because they possess a risk of developing into invasive adenocarcinoma.

An Unforeseeable Complication; Posterior Ischemic Optic Neuropathy after Penetrating Injury to the Heart.

Trauma surgeons are currently encountering unusual adverse events after traumatic injuries. Ischemic optic neuropathy is a rare complication that may occur in trauma and burn patients that present in extremis and require massive resuscitation. A 29-year-old male patient sustains a penetrating injury to the heart that required primary repair.

Coccidioidomycosis.

A 23-year-old man presented with new-onset pruritic and painful urticarial lesions and targetoid erythematous plaques on both palms, the trunk, and the upper and lower extremities (Figure 1). Additionally, small pustules were discovered on the neck (Figure 2), and there with edematous erythematous vermillion lips with splaying onto the cutaneous lips without ulceration. The patient stated he had had a fever before the eruption, fatigue, chills, myalgias, and sore throat.

Panniculitis, pancreatitis, and polyarthritis: a rare clinical syndrome.

A rare triad composed of lobular panniculitis in the setting of pancreatitis and polyarthritis is termed panniculitis, pancreatitis, and polyarthritis (PPP) syndrome. Pancreatic panniculitis is a rare form of subcutaneous fat necrosis associated with underlying pancreatic disease. We describe a case of PPP syndrome and review the relevant literature associated with this rare clinical syndrome.

Endoscopic use of EpiFix-dehydrated Human Amnion/Chorion Membrane (dHACM) allograft in patients with Gastric Leak following Sleeve Gastrectomy.

Leak following laparoscopic sleeve gastrectomy is one of the most feared complications and its management can be difficult and frustrating for patients and physicians involved. Using multimodality approach and having variable options to plan management for patients presenting with leak following bariatric surgery can be advantageous for physicians. The use of endoscopic injection of EpiFix-dehydrated Human Amnion/Chorion Membrane (dHACM) allograft can be a novel adjunct in facilitating healing of the leak site by iatrogenic introduction of tissue growth factors, cytokines and building connective tissue matrix.

First Necrotizing Fasciitis Caused by Serotype a.

Necrotizing fasciitis (NF) is an infrequently encountered skin infection that has high morbidity and mortality, even with prompt medical and surgical intervention. We describe the case of a 67-year-old male presenting with significant NF in his left lower extremity, despite aggressive surgical intervention, and included multiple surgical debridements, ACell Matrix, split-thickness, and negative wound VAC therapy. Ultimately, this patient required a below the knee amputation.

Radiation and depression associated with complications of tissue expander reconstruction.

Purpose: Rates of implant failure, wound healing delay, and infection are higher in patients having radiation therapy (RT) after tissue expander (TE) and permanent implant reconstruction. We investigated pretreatment risk factors for TE implant complications.

Patients And Methods: 127 breast cancer patients had TE reconstruction and radiation.

Three-Port Laparoscopic Sleeve Gastrectomy: A Novel Technical Modification.

Laparoscopic sleeve gastrectomy has rapidly been adopted as a primary surgical procedure in bariatric patients. The technique of multiport sleeve gastrectomy is described using 4 to 6 ports and an additional port for a liver retractor. A technique of single-port sleeve gastrectomy has been described, the principal advantages of which appear to reduced postoperative pain and an improved cosmetic outcome.

A case of radiation-induced mucosal melanoma in an immunohistochemically S-100-negative patient.

We report a case of radiation-induced mucosal melanoma in a 41-year-old woman with a history of childhood rhabdomyosarcoma of the nasal cavity that had been treated with radiotherapy. During the workup for the melanoma, the patient was found to be negative for S-100 protein on immunostaining. While many melanotic markers for the histologic confirmation of melanoma exist, they can be negative in some cases, such as ours.

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative.

Background: Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data.

Impact of Ultrafiltration on Kidney Injury After Cardiac Surgery: The Michigan Experience.

Background: This study examines the relationship between the use and volume of conventional ultrafiltration (CUF) and the risk of acute kidney injury (AKI) after isolated on-pump coronary artery bypass graft surgery.

Methods: A total of 6,407 consecutive patients underwent isolated on-pump coronary artery bypass graft surgery between 2010 and 2013 at 21 medical centers participating in the PERFusion Measures and Outcomes (PERForm) registry. We assessed the effect of CUF use on AKI and other postoperative sequelae using a generalized linear mixed-effect model with a logit link.

Evaluation of the King-Devick test as a concussion screening tool in high school football players.

Objective: Concussion is the most common type of traumatic brain injury, and results from impact or impulsive forces to the head, neck or face. Due to the variability and subtlety of symptoms, concussions may go unrecognized or be ignored, especially with the pressure placed on athletes to return to competition. The King-Devick (KD) test, an oculomotor test originally designed for reading evaluation, was recently validated as a concussion screening tool in collegiate athletes.

Evaluation of Salivary Transcriptome Markers for the Early Detection of Oral Squamous Cell Cancer in a Prospective Blinded Trial.

Background: Oral squamous cell cancer (OSCC) is often diagnosed in late stages. Informative biomarkers could play a key role in early diagnosis. Prior case-control studies identified discriminatory salivary mRNA markers for OSCC.