Achieving Mastery of General Surgery Operative Skill in the Army Healthcare System.

Introduction: Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft.

Material And Methods: Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012-2016.

Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA.

Objective: Growing evidence supports that patients with chronic obstructive pulmonary disease (COPD) and coexisting obstructive sleep apnea (OSA) have poor prognosis. This association is described as overlap syndrome. Positive airway pressure (PAP) therapy is now the preferred treatment for OSA.

Changes in Hindfoot Alignment After High or Low Tibial Osteotomy.

Background: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle.

Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs.

The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions.

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years.

Effects of wearing shoes on the feet: Radiographic comparison of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet.

Background: Maasai tribe members walk long distances daily either barefoot or wearing traditional shoes made from recycled car tires, without any foot ailments. To figure out the characteristic of their feet, we designed a radiographic comparative study of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet.

Methods: Weight bearing radiographs of bilateral foot and ankle joints from 20 healthy middle-aged bush-living partially shod (PS) Maasai women were obtained.

Effect of the additional first ray osteotomy on hindfoot alignment after calcaneal osteotomy for the correction of mild-to-moderate adult type pes plano-valgus.

Purpose: To determine the effect of the additional first ray osteotomy on hindfoot alignment for the correction of pes plano-valgus.

Methods: Data obtained from 37 consecutive patients recruited from 2006 to 2014 who underwent medial displacement calcaneal osteotomy (MDCO) alone (group H) or MDCO followed by medial cuneiform opening wedge osteotomy (MCOWO) (group HF) with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up periods were 34 and 32 months.

Efficacy and safety of native versus pegylated Escherichia coli asparaginase for treatment of adults with high-risk, Philadelphia chromosome-negative acute lymphoblastic leukemia.

Native or pegylated (PEG) asparaginase (ASP) are commonly used in treatment of acute lymphoblastic leukemia (ALL), but have been scarcely compared in the same trial in adult patients. Native vs. PEG-ASP administered according to availability in each center were prospectively evaluated in adults with high-risk ALL.

The relationship between age, rotator cuff integrity, and osseous microarchitecture of greater tuberosity: Where should we put anchor?

Objective: The aim of this study was to compare the microarchitecture of the greater tuberosity with or without rotator cuff tear and to obtain optimum location for anchor screw insertion for rotator cuff repair.

Methods: Twenty-five humeral heads were harvested from 13 male cadavers of mean age 58.4 years, including 6 humeri with rotator cuff tear and 19 intact humeri.

Palmaris longus tendocutaneous arterialized venous free flap to reconstruct the interphalangeal collateral ligament in composite defects.

Unlabelled: We present 12 cases in which palmaris longus tendocutaneous arterialized venous free flaps were used for the reconstruction of the collateral ligament in compound defects of digits. There were nine cases involving the interphalangeal joint of the fingers and three of the interphalangeal joints of the thumb. The venous flaps survived completely in 10 of the 12 cases.

Microsurgical thumb repair and reconstruction.

In this article, we review microsurgical reconstructive techniques available to treat thumb amputation at different levels based on our experience. We reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumb reconstruction are summarized.

A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain.

Introduction: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion.

Objective: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude.

Material And Methods: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain.

The Fate of Chronic Burn Wounds Suspected as Marjolin's Ulcers.

Marjolin's ulcer is the malignant transformation of chronic nonhealing ulcers that have developed in burn scars or in any other chronic wound. Development of this malignancy tends to be slow and insidious, but it becomes more aggressive when the Marjolin's ulcer breaks free of the scar. We reviewed 24 cases of patients who complained of chronic burn wounds suspected to be Marjolin's ulcers.

Anatomical reconstruction of the fourth brachymetatarsia with one-stage iliac bone and cartilage cap grafting.

Background: We present a one-stage procedure for lengthening the fourth brachymetatarsia with autogenous iliac bone and cartilage cap grafting for the anatomical reconstruction of the metatarsophalangeal (MTP) joint METHODS: During the last 8 years, 56 feet in 41 patients with congenital brachymetatarsia of the fourth toe were corrected with a one-stage operation to reposition the articular cartilage cap to the distal part of interpositional iliac bone graft at the metatarsal epiphysis.

Results: The length of the harvested iliac bone graft was 22.9 mm on average.

Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

Purpose: To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus.

Methods: Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.

Twiddler's syndrome.

No abstract available.

Hand and Wrist Injuries in Golfers and Their Treatment.

A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome.

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction.

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO).

Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity.

International variations in application of the best-interest standard across the age spectrum.

Objective: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients.

Study Design: In this international study, physicians in Argentina, Australia, Canada, Ireland, The Netherlands, Norway and the United States were presented with eight hypothetical vignettes of incompetent critically ill patients of different ages.

RENEB - Running the European Network of biological dosimetry and physical retrospective dosimetry.

Purpose: A European network was initiated in 2012 by 23 partners from 16 European countries with the aim to significantly increase individualized dose reconstruction in case of large-scale radiological emergency scenarios.

Results: The network was built on three complementary pillars: (1) an operational basis with seven biological and physical dosimetric assays in ready-to-use mode, (2) a basis for education, training and quality assurance, and (3) a basis for further network development regarding new techniques and members. Techniques for individual dose estimation based on biological samples and/or inert personalized devices as mobile phones or smart phones were optimized to support rapid categorization of many potential victims according to the received dose to the blood or personal devices.

Recent Advances in Immediate Toe-to-Hand Transfer.

Toe-to-hand transfer is the last option for definitive reconstruction of the hand when digits have been lost as a result of traumatic amputations, congenital anomalies, or tumor ablation. Immediate toe-to-hand transfer for the treatment of acute hand injuries is defined as an emergency operation performed when replantation is impossible or failed. The aim of this article is to propose the indications, advantages and disadvantages of immediate toe to hand transfer as well as to compare the overall results with elective cases.

Impact of frailty on outcomes in geriatric femoral neck fracture management: An analysis of national surgical quality improvement program dataset.

Introduction: Frailty is a clinical state of increased vulnerability resulting from aging-associated decline in physiologic reserve. Hip fractures are serious fall injuries that affect our aging population. We retrospectively sought to study the effect of frailty on postoperative outcomes after Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) for femoral neck fracture in a national data set.

A comparative study of the feet of middle-aged women in Korea and the Maasai tribe.

Background: Members of the Maasai tribe spend their days either barefoot or wearing traditional shoes made from recycled car tires. Although they walk long distances (up to 60 km) daily, they do not generally experience foot ailments. Here, we compared parameters associated with the feet, ankles, and gait of middle-aged women in Korea and the Maasai tribe.

Management of complications relating to finger amputation and replantation.

There are many options in the management of fingertip or finger amputations. Injudicious revision amputation may cause complications. These complications can be prevented by tension-free closure of the amputation stump or primary coverage with appropriate flap.

Delayed and suspended replantation for complete amputation of digits and hands.

Purpose: To analyze the clinical outcome for delayed or suspended replantation of complete amputations of digits or hands, or both.

Methods: We analyzed 20 cases involving 28 digital and 4 hand amputations that underwent delayed or suspended replantation. In 15 cases of single-digit amputation, patients underwent delayed replantation the morning following amputation.