Incarcerated retroperitoneal hernia following total extraperitoneal laparoscopic radical nephrectomy.

Small bowel obstruction (SBO) is a common entity encountered in surgical patients. The most common causes of the SBO range from postoperative adhesions to cancer. We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO.

Tibiotalocalcaneal arthrodesis using a femoral locking plate.

The goal of a tibiotalocalcaneal arthrodesis is to create a pain-free, stable hindfoot and ankle. Although a reserved procedure, it is useful when simultaneous ankle and subtalar joint pathology exists. Numerous complications have been reported after tibiotalocalcaneal arthrodesis, most importantly nonunion.

Assessment of medial and lateral neurovascular structures after percutaneous posterior calcaneal displacement osteotomy: a cadaver study.

A prospective investigation of the effects on the medial and lateral neurovascular structures of the rearfoot after percutaneous posterior calcaneal displacement osteotomy was performed using 20 below the knee fresh frozen cadaver specimens. This anatomic study aimed to examine the medial and lateral neurovascular structures to determine whether they were jeopardized during execution of the osteotomy. After completion of the osteotomy, the medial plantar, lateral plantar, medial calcaneal, sural, and posterior tibial neurovascular structures, along with their respective branches, were inspected for iatrogenic injury.

Posterior approach using anterior ankle arthrodesis locking plate for tibiotalocalcaneal arthrodesis.

Tibiotalocalcaneal arthrodesis is a successful treatment for patients with severe pain and functional disability in the ankle and subtalar joint. Patients with post-traumatic ankle and subtalar joint arthritis, and/or Charcot deformity, often present with compromised skin and soft tissue structures. In the present report, we describe a technique using an anterior ankle arthrodesis locking plate placed posteriorly to obtain hindfoot and ankle fusion.

Double calcaneal osteotomy using single, dual-function screw fixation technique.

Historically, a variety of fixation techniques for calcaneal osteotomies have been used. The prevention of postoperative sequelae, including delayed or nonunion of the osteotomy sites and minimization of soft tissue damage, is always a primary consideration for foot and ankle surgeons. The present report describes a fixation technique for a double calcaneal osteotomy that entails use of a single screw that functions as both a positional tool, as well as a compressive fixation device.

Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation.

Background: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae.

Treatment of posterior tibial tendon dysfunction without flexor digitorum tendon transfer: a retrospective study of 34 patients.

A retrospective study of patients who underwent gastrocnemius recession, double calcaneal osteotomy (Evans osteotomy and percutaneous calcaneal displacement osteotomy), and medial column fusion for the treatment of posterior tibial tendon dysfunction was conducted. The senior author performed the procedures between November 2002 and January 2009 on 34 patients who displayed at least Johnson and Strom stage II deformity and had undergone 12 months of failed conservative treatment. The coauthors evaluated the patients' radiographs before and after the operation.

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients.

Background: Post-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP.

Bilateral, atraumatic, proximal tibiofibular joint instability.

Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Only 1 case of atraumatic proximal tibiofibular joint instability in a 14-year-old girl has been reported in the literature, however this condition might occur more frequently than once thought. A wide range of treatment options exist for tibiofibular dislocations.

Methicillin-resistant staphylococcus aureus screening and eradication in the surgical intensive care unit: Is it worth it?

Background: The problem of intensive care unit methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and eradication strategies.

Methods: Our surgical intensive care unit (SICU) admissions receive MRSA nares cultures and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed.

Impact of cervical spine management brain injury on functional survival outcomes in comatose, blunt trauma patients with extremity movement and negative cervical spine CT: application of the Monte Carlo simulation.

Cervical spine (CS) magnetic resonance imaging (MRI) and collar use may prevent quadriplegia, yet create brain injury. We developed a computer model to assess the effect of CS management strategies on outcomes in comatose, blunt trauma patients with extremity movement and a negative CS CT scan. Strategies include early collar removal (ECR), ECR & MRI, late collar removal (LCR), and LCR & MRI.

The bispectral index, a useful adjunct for the timely diagnosis of brain death in the comatose trauma patient.

Background: The bispectral index (BIS) is a processed electroencephalographic value (awake = 100, isoelectric = 0). The relationship of BIS and brain death (BD) is assessed.

Methods: BIS was evaluated in GCS 3 head-injured patients with BD (no brain function including apnea) or near BD (no apnea or negative ancillary test [cerebral perfusion and electroencephalogram]).

Malabsorption-associated warfarin resistance.

Purpose: A case of malabsorption- associated warfarin resistance is reported.

Summary: A 42-year-old, 111-kg, Caucasian man arrived at the emergency department with atypical pleuritic chest pain. The chest pain was associated with shortness of breath, diaphoresis, nausea, vomiting, and tachycardia.

Intramedullary hip screw versus standard compression hip screw: early postoperative rehabilitation comparisons.

Studies comparing the intramedullary hip screw and the compression hip screw for fixation of intertrochanteric hip fractures have shown little difference in final functional outcome. However, the characteristics of the rehabilitation process for these implants have not been analyzed. This study used the Functional Independence Measure (FIM Instrument; Uniform Data System for Medical Rehabilitation, Amherst, New York) to better characterize the subtle differences of the perioperative, clinical, and rehabilitative treatment of intertrochanteric fractures using the intramedullary hip screw or compression hip screw.

Inhalant abuse of 1,1-difluoroethane (DFE) leading to heterotopic ossification: a case report.

Background: Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO.

United States level I trauma centers are not created equal - a concern for patient safety?

Background: The American College of Surgeons delineates 108 requirements for level I trauma centers. Some of these requirements include: minimum of 1,200 trauma admissions per year; an average of 35 major trauma patients per surgeon; residency training programs; and 10 peer-reviewed journal submissions every three years. This study examines the variation in services provided among U.

The constricted heart.

Often indistinguishable from restrictive cardiomyopathy and hepatic cirrohis, clinical acumen is essential in the recognition and diagnosis of constrictive pericarditis. A thorough medical history should rule out infectious disease exposure. A physical examination may include variable signs such as Kussmaul's sign, pulsus paradoxus, and pericardial knock, while jugular venous distention is of cardinal significance in eliminating liver cirrhosis as the cause of ascites.

Laparoscopic splenectomy following embolization for blunt trauma.

Background: Grade III through V splenic injuries as defined by the American Association for the Surgery of Trauma (AAST) grading scale are associated with hemorrhage and nonoperative failure. Embolization has been reported to reduce splenic bleeding in 50% to 75% of patients with a high-grade injury. However, splenectomy following embolization may be necessary in patients who continue to bleed or develop splenic infarction with abscess formation.

Economic value of orthopaedic trauma: the (second to) bottom line.

Objectives: We evaluated the economic aspects of an orthopaedic trauma section at a regional Level I, semi-academic community hospital. This study analyzes the economics of a dedicated hospital-based orthopaedic trauma program.

Methods: Institutional financial reports were analyzed for 2 time periods.

NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.

Background And Objectives: Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models.