A multi-center phase II study of high dose interleukin-2 sequenced with vemurafenib in patients with BRAF-V600 mutation positive metastatic melanoma.

Background: Preclinical studies suggest that BRAF inhibitors enhance anti-tumor immunity and antigen presentation. Combination BRAF inhibition with immunotherapy is an appealing therapeutic approach. We sequenced vemurafenib with HD IL-2 in patients with BRAF-mutated metastatic melanoma to improve long term outcomes.

MammaPrint molecular diagnostics on formalin-fixed, paraffin-embedded tissue.

MammaPrint, a prognostic 70-gene profile for early-stage breast cancer, has been available for fresh tissue. Improvements in RNA processing have enabled microarray diagnostics for formalin-fixed, paraffin-embedded (FFPE) tissue. Here, we describe method optimization, validation, and performance of MammaPrint using analyte from FFPE tissue.

Neurologic complications of arrhythmia treatment.

An arrhythmia is defined as an abnormal heart rhythm. Certain arrhythmias have much higher rates of neurologic complications, including stroke, cognitive impairment, and dementia. The purpose of this paper is to review both the direct and indirect causes of neurologic problems caused by arrhythmias.

Diagnosis of gestational diabetes mellitus: can we avoid the glucose challenge test?

Objective: To identify risk factors for gestational diabetes mellitus (GDM) in patients who had either a normal or abnormal glucose tolerance test (GTT) after failing the initial glucose challenge test (GCT). If identified, consideration can be given to circumvent the glucose challenge test for those at risk.

Data Sources: A chart review was performed on 557 patients with abnormal GCT, 278 had an abnormal GTT (cases), and 279 had normal GTT (controls).

Traumatic obturator hip dislocation in a 9-year-old boy.

Traumatic hip dislocation is a rare but potentially devastating injury in a child. Although most hip dislocations are posterior, other variants have been described. An anterior dislocation in the pediatric population is uncommon and, to our knowledge, this is the first case of anterior-inferior (obturator) dislocation (ie, the femoral head lies in the obturator foramen), to be reported in the English-language literature.

Intercondylar synovial septum in two patients with nail-patella syndrome.

This case report describes the arthroscopic findings in two patients with nail-patella syndrome (NPS). In both cases, a midline synovial septum was encountered that completely subdivided the knee into medial and lateral compartments. One patient required two subsequent arthroscopic procedures, and the synovial septum was found to have recurred even after it had been resected at the initial surgery.

Retrospective review of propofol dosing for procedural sedation in pediatric patients.

Objectives: The purpose of this study was to determine the total propofol dose (mg/kg) for non-emergent pediatric procedural sedation and evaluate dosing differences with regard to a patient's sex, age, and body mass index. Adverse events were recorded and evaluated to determine whether certain patient groups were at a higher risk than others.

Methods: This study was a retrospective observational pilot study including patients 0 to 18 years of age admitted between January 2008 and November 2009 for non-emergent gastrointestinal endoscopic procedures or radiologic imaging, who received propofol for procedural sedation.

Risk factors for mesh extrusion after prolapse surgery: a case-control study.

Objectives: To identify risk factors for mesh extrusion in women undergoing pelvic organ prolapse repair by abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP).

Methods: A multicenter case-control study of patients who underwent ASC or VMP from 2006 to 2009 identified using diagnosis and procedure coding. Cases were defined as women who underwent eligible index procedure with synthetic mesh and had mesh visible through the vaginal epithelium at postoperative evaluation; controls were matched in an approximate 1:3 ratio by date and type of procedure.

Long-term survival after major trauma in geriatric trauma patients: the glass is half full.

Background: The objective is to examine the long-term survival status of geriatric trauma patients (GTPs) after major trauma.

Methods: A 10-year retrospective review at a Level I trauma center was performed. GTP were defined as age ≥ 65 years, with Injury Severity Score ≥ 30.

Comparison of resident and mid-level provider productivity and patient satisfaction in an emergency department fast track.

Objective: To evaluate productivity of mid-level providers (MLPs) compared with emergency medicine (EM) resident physicians in an emergency department (ED) low acuity area, and to compare patient satisfaction when cared for by MLPs versus EM residents.

Methods: This was a retrospective review of EM resident physicians and MLPs in an ED low acuity area. The number of patients seen and relative value units (RVUs) generated per clinical hour worked were evaluated.

Prior vancomycin use is a risk factor for reduced vancomycin susceptibility in methicillin-susceptible but not methicillin-resistant Staphylococcus aureus bacteremia.

Objective: Staphylococcus aureus is a cause of community- and healthcare-acquired infections and is associated with substantial morbidity, mortality, and costs. Vancomycin minimum inhibitory concentrations (MICs) among S. aureus have increased, and reduced vancomycin susceptibility (RVS) may be associated with treatment failure.

Error reporting in the emergency department: do we do what we say we do?

Background: The Joint Commission accreditation manual contains standards in improving organization performance related to report and review of patient care issues causing unexpected harm. In spite of regulations mandating reporting, it remains inconsistent, varying by provider type and hospital. Our purpose was to determine current attitudes, knowledge, and practice of error reporting among emergency department (ED) providers.

Logistic regression: a brief primer.

Regression techniques are versatile in their application to medical research because they can measure associations, predict outcomes, and control for confounding variable effects. As one such technique, logistic regression is an efficient and powerful way to analyze the effect of a group of independent variables on a binary outcome by quantifying each independent variable's unique contribution. Using components of linear regression reflected in the logit scale, logistic regression iteratively identifies the strongest linear combination of variables with the greatest probability of detecting the observed outcome.

Esophageal stenting in the setting of malignancy.

Esophageal cancer is often diagnosed at an advanced stage, with many patients found to have locoregional or metastatic disease at time of diagnosis. Because of this, cure may be unlikely, leading treatment efforts to focus more on symptom palliation and improving patient quality of life. The majority of patients with advanced disease suffer from some degree of dysphagia.

Exercise-induced bronchoconstriction: diagnosis and management.

Exercise-induced bronchoconstriction describes the narrowing of the airway that occurs with exercise. More than 10 percent of the general population and up to 90 percent of persons previously diagnosed with asthma have exercise-induced bronchoconstriction. Common symptoms include coughing, wheezing, and chest tightness with exercise; however, many athletes will present with nonspecific symptoms, such as fatigue and impaired performance.

Extra-adrenal Pheochromocytoma in an Adolescent.

A 17-year-old male with symptoms of headache and diaphoresis presented to the emergency department. He had eight months of noted hypertension attributed to medications. On arrival his blood pressure was 229/117mmHg, and he was ill-appearing.

Punch injuries: insights into intentional closed fist injuries.

Objectives: This study sought to investigate the patterns of injury resulting from a punch mechanism and to investigate the associated psychopathology present in patients with these injuries.

Methods: Retrospective analysis of patients with hand radiographs ordered from the emergency department allowed for identification of patients with a punch mechanism. We recorded injury patterns and queried patients' medical records for associated psychopathology.

Multidisciplinary approach for the treatment of gastric cancer.

Gastric cancer is a global phenomenon and is the second leading cause of cancer-related deaths worldwide. The highest rates of gastric cancer are seen in Asia and parts of Eastern Europe. In Western countries, the incidence of gastric cancer has declined over the last several decades.

Initiating palliative care in the emergency department.

Background: In 2006, nearly a quarter of a million patients either arrived dead or died in the Emergency Department (ED). The role of palliative care (PC) in the ED is not well defined, and education of medical students and residents in the area is sparse.

Objectives: We use an illustrative case to discuss important concepts in PC for the emergency physician (EP).

Intussusception Secondary to a Meckel's Diverticulum in an Adolescent.

A 13-year-old girl presented to the Emergency Department with vomiting and abdominal pain. On examination, she had only mild abdominal tenderness, but a mass was palpable in her right lower quadrant. Intussusception was diagnosed on ultrasound and confirmed on computed tomography (CT) scan, and operative findings revealed a jejunojejunal intussusception secondary to Meckel's diverticulum.

Vaginal hysterectomy at the time of transvaginal mesh placement.

Introduction: : Previous investigations have shown an increased risk of mesh erosion when concomitant vaginal hysterectomy is performed at the time of transvaginal reconstruction with mesh. We hypothesize that vaginal hysterectomy can be performed without a high risk of erosion.

Methods: : This is a retrospective, repeated-measures study of women with uterovaginal prolapse who underwent vaginal hysterectomy and pelvic reconstruction with a transvaginal mesh technique using the Prolift system.