Hepatic abscess associated with Salmonella serotype B in a chronic alcoholic patient.

Background: Hepatic abscess secondary to Salmonella is extremely rare in the United States and other Western countries.

Methods: A 43-year-old Caucasian man, with a history of chronic alcohol abuse, was admitted to the hospital for intermittent abdominal pain, fever and diarrhea. Clinical, radiological and laboratory results were analyzed.

Mood-altering drugs in the trauma population: hidden dangers, deadly combinations.

Depression is on the rise, and as a result, there is an increased use of psychotropic medications. Also, nonreversible anticoagulants have entered the market and are increasing in use. In combination, these developments have created new risk factors for trauma patients.

Hyponatremia - a rare but serious complication of amiodarone: a case report and review of the literature.

Introduction: Hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) during amiodarone therapy is a rare but potentially lethal adverse effect. We report a case of severe hyponatremia associated with amiodarone, and discuss its clinical implications.

Case Report: An 84-year-old Caucasian man with a past medical history of hypertension and diabetes was admitted to the hospital with a non-ST elevation myocardial infarction.

Iatrogenic tracheal stenosis presenting as persistent asthma.

Although the incidence of post-intubation tracheal stenosis has markedly decreased with the advent of large volume, low pressure endotracheal tube cuffs, it still occurs, commonly in patients after prolonged intubation. We report a case of tracheal stenosis that developed after a brief period of endotracheal intubation, and that was misdiagnosed and treated as asthma and panic attacks.

Gynecomastia: when is treatment indicated?

This algorithmic approach can simplify your clinical evaluation and help you decide whether intervention or watchful waiting is appropriate.

Univalve split plaster cast for postoperative immobilization in foot and ankle surgery.

Casting is an important part of the postoperative treatment in foot and ankle surgery. Applying a split plaster cast allows for swelling while maintaining surgical correction and alignment. Resecting approximately a 1-in.

Trauma activation patients: evidence for routine alcohol and illicit drug screening.

Background: Statistics from the National Trauma Data Bank imply that discretionary blood alcohol and urine drug testing is common. However, there is little evidence to determine which patients are appropriate for routine testing, based on information available at trauma center arrival. In 2002, Langdorf reported alcohol and illicit drug rates in Trauma Activation Patients.

Revision of failed ankle implants.

Total ankle joint replacement (TAR) has been offered as an alternative to ankle joint arthrodesis since the 1970s. TAR offers the benefit of perseveration of joint motion, with potential decreased occurrence of adjacent joint degeneration, and a more expedient path to weight bearing. Since their introduction, TAR devices have undergone a variety of modifications, specifically in regards to the number and type of components used.

Emergency department noninvasive (NICOM) cardiac outputs are associated with trauma activation, patient injury severity and host conditions and mortality.

Background: Anoninvasive cardiac output (CO) monitor (NICOM), using Bioreactance technology, has been validated in several nontrauma patient studies. We hypothesized that NICOM CO would have more significant associations with clinical conditions than would systolic blood pressure (sBP).

Methods: This is a prospective observational study of consecutive trauma activation patients during the first 10 to 60 minutes after emergency department arrival.

Ambulatory blood pressure monitoring in patients with chronic kidney disease and resistant hypertension.

The role of ambulatory blood pressure (BP) monitoring (ABPM) has not been well-studied in patients with chronic kidney disease and resistant hypertension. In a retrospective study of the outpatient chronic kidney disease population, 156 patients with chronic kidney disease and resistant hypertension who had 24-hour ABPM and clinic BP measurements were identified. Resistant hypertension was defined as uncontrolled clinic BP while taking ≥ 3 medications including a diuretic or controlled BP while taking ≥ 4 medications.

Laparoscopic repair of a traumatic bladder rupture.

Laparoscopic repair of the traumatic intraperitoneal bladder rupture is a proven, safe, and effective technique in the appropriate setting. A 23-year-old male with traumatic intraperitoneal bladder rupture proven by cystogram after a motor vehicle collision was successfully repaired via a laparoscopic approach. We describe the technique in detail including 2-layer closure and follow-up care.

Repair of lacerated anterior tibial tendon with acellular tissue graft augmentation.

In the present case report, we describe the surgical repair of a complete laceration of the anterior tibial tendon using acellular human dermal tissue matrix. A 17-year-old, elite league hockey player was injured in the locker room when a teammate still clad in ice skates stepped on his bare left foot. After evaluation at a local emergency department, the patient presented to our office the next day for additional evaluation.

A.S.P.E.N. position paper: recommendations for changes in commercially available parenteral multivitamin and multi-trace element products.

The parenteral multivitamin preparations that are commercially available in the United States (U.S.) meet the requirements for most patients who receive parenteral nutrition (PN).

Cutaneous vasculopathy associated with levamisole-adulterated cocaine.

We report a case of cutaneous vasculopathy associated with the use of levamisole-adulterated cocaine. This recently described clinical entity is characterized by a purpuric rash with a predilection for the ears, leukopenia, and anti-neutrophilic cytoplasmic antibody (ANCA) positivity. It is estimated that more than 70% of the current United States cocaine supply is contaminated with levamisole.

Limb salvage: revision of failed intramedullary nail in hindfoot and ankle surgery in the diabetic neuropathic patient.

Herein, we illustrate an operative technique to attain limb salvage after a failed intramedullary nail in the diabetic Charcot neuropathic patient. The use of the blade plate, or T-plate, in combination with external fixation, fastened into the body of the calcaneus allows for greater bone capture. Our experience has shown that this provides for a stable, long-lasting construct.

Modified rotational bowel vaginoplasty after total pelvic exenteration.

Vaginal reconstructive options commonly include the use of split-thickness skin grafts or intestinal conduits. When a colonic segment is chosen, the sigmoid colon is favored because of its location, size, and durability. When circumstances preclude the use of sigmoid colon and a colonic conduit is preferred, creative means of mobilization are required.

An alternative technique for transosseous calcaneal pinning in external fixation.

The authors describe a technique in which two 5.5-mm pins are inserted from the posterior aspect of the calcaneus and advanced anteriorly on a slightly convergent vector. The 2 points of fixation, with a 5/8 ring, provide a "steering wheel" effect allowing for leverage and control of the hindfoot and ankle.

Risk factors for upper extremity venous thrombosis associated with peripherally inserted central venous catheters.

Purpose: To identify clinically important risk factors associated with upper extremity venous thrombosis following peripherally inserted central venous catheters (PICC).

Methods: A retrospective case control study of 400 consecutive patients with and without upper extremity venous thrombosis post-PICC insertion was performed. Patient data included demographics, body mass index (BMI), ethnicity, site of insertion, size and lumen of catheter, internal length, infusate, and co-morbidities, such as diabetes mellitus, congestive heart failure, and renal failure.

Femoral neck fracture following hardware removal.

It is uncommon for femoral neck fractures to occur after proximal femoral hardware removal because age, osteoporosis, and technical error are often noted as the causes for this type of fracture. However, excessive alcohol consumption and failure to comply with protected weight bearing for 6 weeks increases the risk of femoral neck fractures.This article describes a case of a 57-year-old man with a high-energy ipsilateral inter-trochanteric hip fracture, comminuted distal third femoral shaft fracture, and displaced lateral tibial plateau fracture.

Incidence, correlates, and interventions used for pressure ulcers of the ear.

Skin prevalence audits revealed annual increases in incidence of pressure ulcers of the ear. A research study was conducted to assess correlates of the problem. Study results guided clinical practice changes that reduced the incidence to zero.