Transbiliary intravascular ultrasound-guided diagnostic biopsy of an inaccessible pancreatic head mass.

Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches.

Left Ventricular Pseudoaneurysm Dissecting into the Anterior Chest Wall: A Rare Cause of Sudden Onset Excruciating Chest Pain.

Unlabelled: Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis.

The effect of D-cycloserine on social anxiety treatment using a behavioral outcome measure and a post-session administration strategy.

Background: The drug D-Cycloserine (DCS) has been used as an adjunct to increase the pace of symptom reductions during exposure therapy for anxiety disorders. This procedure has met with mixed results andmany questions remain. Aims: The findings from two investigations are reported here, highlighting important domains for furthering our understanding of DCS effects.

Sushruta: Father of plastic surgery in Benares.

Sushruta has been regarded as one of the pioneers of surgery. He performed procedures with crude surgical instruments that paved the path for today's operations. However, his existence is shrouded in myth and mystery.

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study.

Objectives: In preparation for a clinical trial of therapeutic agents for children with moderate-to-severe blunt traumatic brain injuries (TBIs) in emergency departments (EDs), we conducted this feasibility study to (1) determine the number and clinical characteristics of eligible children, (2) determine the timing of patient and guardian arrival to the ED, and (3) describe the heterogeneity of TBIs on computed tomography (CT) scans.

Methods: We conducted a prospective observational study at 16 EDs of children ≤ 18 years of age presenting with blunt head trauma and Glasgow Coma Scale scores of 3-12. We documented the number of potentially eligible patients, timing of patient and guardian arrival, patient demographics and clinical characteristics, severity of injuries, and cranial CT findings.

Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma.

Study Objective: We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma.

Methods: This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture.

Retinopathy of prematurity screening leading to cardiopulmonary arrest: fatal complication of a benign procedure.

A 6-week-old female infant born at 31 weeks of gestation was brought to the ophthalmology office for retinopathy of prematurity (ROP) screening. One drop of phenylephrine (2.5%) and tropicamide (1%) ophthalmic solution was instilled in each eye for ROP evaluation.

A Case of Isolated Right Ventricle Noncompaction with ST-Elevation Chest Leads.

Non-compaction of ventricular myocardium (NCVM) is a rare genetic disorder caused by intrauterine arrest of endomyocardial development. Left ventricle is the usual site of NCVM with very rare reports of isolated right ventricular non-compaction (IRVNC). We describe a case of asymptomatic IRVNC with unique EKG changes.

Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma.

Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma.

Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known.

Air Medical Curricula in Emergency Medicine Residencies: A National Survey.

Objective: The aim of this study was to determine if a common air medical curriculum exists among Accreditation Council for Graduate Medical Education (ACGME) emergency medicine (EM) residencies.

Methods: Institutional review board exemption was obtained. A cross-sectional survey study design was used.

Optogenetic versus electrical stimulation of dopamine terminals in the nucleus accumbens reveals local modulation of presynaptic release.

The nucleus accumbens is highly heterogeneous, integrating regionally distinct afferent projections and accumbal interneurons, resulting in diverse local microenvironments. Dopamine (DA) neuron terminals similarly express a heterogeneous collection of terminal receptors that modulate DA signaling. Cyclic voltammetry is often used to probe DA terminal dynamics in brain slice preparations; however, this method traditionally requires electrical stimulation to induce DA release.

Displacement of impella post chest compressions.

The Impella is a left ventricular assist device which is implanted via the transcutaneous femoral route and is placed across the aortic valve into the left ventricle. We report an interesting case where cardiopulmonary resuscitation was associated with displacement of Impella device. Impella is being increasingly used these days especially in patients with cardiogenic shock.

Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) of axillary lymph nodes.

Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare entity, occurring most commonly in young Asian adults. KFD is characterised by fever with tender lymph node enlargement. The cervical group of lymph nodes is most commonly involved, and the diagnosis is conclusively made by lymph node biopsy and histopathology.

Does gender matter? Exploring mental health recovery court legal and health outcomes.

Background: Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking.

Glenohumeral mismatch affects micromotion of cemented glenoid components in total shoulder arthroplasty.

Background: The "rocking horse" phenomenon is considered the main cause of glenoid component loosening by eccentric loading of the glenoid rim. This study aimed to investigate the influence of increasing glenohumeral implant mismatch on bone-implant interface micromotion in a cemented all-polyethylene pegged glenoid biomechanical model.

Methods: Five glenoid sizes, 40 mm, 44 mm, 48 mm, 52 mm, and 56 mm, representing +2 mm, +6 mm, +10 mm, +14 mm, and +18 mm glenohumeral mismatch, respectively, were cyclically loaded according to ASTM Standard F2028-08 at a constant frequency of 2 Hz to a size-dependent humeral head subluxation translation.

A survey of simulation fellowship programs.

Background: A number of specialized educational programs (i.e., simulation fellowships) have been developed, but their characteristics are not well known.

Rare Red Rashes: A Case Report of Levetiracetam-Induced Cutaneous Reaction and Review of the Literature.

Cutaneous reactions secondary to medications are rare but can be serious events resulting in morbidity and mortality and can be caused by anticonvulsant medications. Levetiracetam has been considered relatively safe compared with other antiepileptics with regard to skin eruptions. We report a case of a cutaneous reaction secondary to levetiracetam.

Step-Cut Bone-Graft Technique for Osteoarthritis with Severe Glenoid Bone Loss.

Introduction: We describe a bone-graft technique, for shoulder arthroplasty in patients with severe glenoid bone loss, that utilizes a "step cut," a trapezoidal bone wedge from the resected humeral head, and graft fixation with screws placed from posterior to anterior through the graft.

Step 1 Preoperative Planning: Carry out preoperative planning for the step-cut procedure.

Step 2 Surgical Approach And Preparation Of The Glenoid: Expose the glenoid for bone graft insertion, taking care to avoid excessive reaming.

Taking library instruction into the online environment: one health sciences library's experience.

In 2012, an academic health sciences library serving a large research university and medical center introduced synchronous online training for a diverse group of users, including clinicians, researchers, faculty, and distance students. Participants in these "Express Training" classes completed two surveys to assess their experiences. Survey results indicated classes were well received but revealed some areas for improvement.