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Evaluation of fibula free flap donor site morbidity.

Alan Garrett, DPM - Wed, 01/30/2019 - 07:24
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Evaluation of fibula free flap donor site morbidity.

Am J Otolaryngol. 2006 Jan-Feb;27(1):29-32

Authors: Garrett A, Ducic Y, Athre RS, Motley T, Carpenter B

Abstract
OBJECTIVE: To evaluate foot and ankle function in a series of patients undergoing fibula microvascular free tissue transfer.
STUDY DESIGN: A nonrandomized, nonblinded analysis was performed using the ankle-hindfoot scale as well as radiographic analysis to determine donor site morbidity.
RESULTS: Overall, foot ankle function was deemed to be good in this series of patients. Average ankle-hindfoot score was 84.82 of a possible 100 (range, 55-100). Radiographic analysis of donor and contralateral ankles showed no difference in the syndesmotic space or medial clear space. Only 1 patient had increased talar tilt compared with the contralateral side, although this patient had preservation of stability.
CONCLUSION: Fibula free flap harvest appears to be associated with acceptable donor site morbidity and preservation of good foot and ankle function in most individuals.

PMID: 16360820 [PubMed - indexed for MEDLINE]

Using a hook plate as alternate fixation for fifth metatarsal base fracture.

Alan Garrett, DPM - Wed, 01/30/2019 - 07:24
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Using a hook plate as alternate fixation for fifth metatarsal base fracture.

J Foot Ankle Surg. 2003 Sep-Oct;42(5):315-6

Authors: Carpenter B, Garrett A

PMID: 14566727 [PubMed - indexed for MEDLINE]

Traumatic colon injury in damage control laparotomy-A multicenter trial: Is it safe to do a delayed anastomosis?

Adam Jennings, DO - Wed, 01/30/2019 - 07:24
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Traumatic colon injury in damage control laparotomy-A multicenter trial: Is it safe to do a delayed anastomosis?

J Trauma Acute Care Surg. 2017 Apr;82(4):742-749

Authors: Tatebe LC, Jennings A, Tatebe K, Handy A, Prajapati P, Smith M, Do T, Ogola GO, Gandhi RR, Duane TM, Luk S, Petrey LB

Abstract
BACKGROUND: Delayed colonic anastomosis after damage control laparotomy (DCL) is an alternative to colostomies during a single laparotomy (SL) in high-risk patients. However, literature suggests increased colonic leak rates up to 27% with DCL, and various reported risk factors. We evaluated our regional experience to determine if delayed colonic anastomosis was associated with worse outcomes.
METHODS: A multicenter retrospective cohort study was performed across three Level I trauma centers encompassing traumatic colon injuries from January 2006 through June 2014. Patients with rectal injuries or mortality within 24 hours were excluded. Patient and injury characteristics, complications, and interventions were compared between SL and DCL groups. Regional readmission data were utilized to capture complications within 6 months of index trauma.
RESULTS: Of 267 patients, 69% had penetrating injuries, 21% underwent DCL, and the mortality rate was 4.9%. Overall, 176 received primary repair (26 in DCL), 90 had resection and anastomosis (28 in DCL), and 26 had a stoma created (10 end colostomies and 2 loop ileostomies in DCL). Thirty-five of 56 DCL patients had definitive colonic repair subsequent to their index operation. DCL patients were more likely to be hypotensive; require more resuscitation; and suffer acute kidney injury, pneumonia, adult respiratory distress syndrome, and death. Five enteric leaks (1.9%) and three enterocutaneous fistulas (ECF, 1.1%) were identified, proportionately distributed between DCL and SL (p = 1.00, p = 0.51). No difference was seen in intraperitoneal abscesses (p = 0.13) or surgical site infections (SSI, p = 0.70) between cohorts. Among SL patients, pancreas injuries portended an increased risk of intraperitoneal abscesses (p = 0.0002), as did liver injuries in DCL patients (p = 0.06).
CONCLUSIONS: DCL was not associated with increased enteric leaks, ECF, SSI, or intraperitoneal abscesses despite nearly two-thirds having delayed repair. Despite this being a multicenter study, it is underpowered, and a prospective trial would better demonstrate risks of DCL in colon trauma.
LEVEL OF EVIDENCE: Therapeutic study, level IV.

PMID: 28323788 [PubMed - indexed for MEDLINE]

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Adam Jennings, DO - Wed, 01/30/2019 - 07:24
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Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank.

Injury. 2015 Nov;46(11):2113-7

Authors: Wang H, Phillips JL, Robinson RD, Duane TM, Buca S, Campbell-Furtick MB, Jennings A, Miller T, Zenarosa NR, Delaney KA

Abstract
OBJECTIVES: Pelvic fractures are associated with increased risk of death among trauma patients. Studies show independent risks predicting mortality among patients with pelvic fractures vary across different geographic regions. This study analyses national data to determine predictors of mortality in initially stable adult pelvic trauma patients in the US.
METHODS: This study is a retrospective analysis of the US National Trauma Data Bank from January 2003 to December 2010 among trauma patients ≥18 years of age with pelvic fractures (including acetabulum). Over 150 variables were reviewed and analysed. The primary outcome was all-cause in-hospital mortality. Logistic regression analysis was used to determine independent risk factors predictive of in-hospital mortality in stable pelvic fracture patients.
RESULTS: 30,800 patients were included in the final analysis. Overall in-hospital mortality rate was 2.7%. Mortality increased twofold in middle aged patients (age 55-70), and increased nearly fourfold in patients with advanced age ≥70. We found patients with advanced age, higher severity of injury, Glasgow Coma Scale (GCS) <8, GCS between 9 and 12, prolonged mechanical ventilation, and/or in-hospital blood product administration experienced higher mortality. Patients transported to level 1 or level 2 trauma centres experienced lower mortality while concomitantly experiencing higher associated internal injuries.
CONCLUSIONS: Geriatric and middle aged pelvic fracture patients experience higher mortality. Predictors of mortality in initially stable pelvic fracture patients are advanced age, injury severity, mental status, prolonged mechanical ventilation, and/or in-hospital blood product administration. These patients might benefit from transport to local level 1 or level 2 trauma centres.

PMID: 26377773 [PubMed - indexed for MEDLINE]

The Omega-3 Index in National Collegiate Athletic Association Division I Collegiate Football Athletes.

Michele Kirk, MD - Wed, 01/16/2019 - 07:37

The Omega-3 Index in National Collegiate Athletic Association Division I Collegiate Football Athletes.

J Athl Train. 2019 Jan 15;:

Authors: Anzalone A, Carbuhn A, Jones L, Gallop A, Smith A, Johnson P, Swearingen L, Moore C, Rimer E, McBeth J, Harris W, Kirk KM, Gable D, Askow A, Jennings W, Oliver JM

Abstract
CONTEXT: The essential omega-3 fatty acids (ω-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) exhibit vital biological roles and are critical for cardiovascular and neurologic health. Compared with the general population, football athletes may be at an increased risk of cardiovascular disease. Further, those same athletes are also exposed to repetitive head impacts, which may lead to long-term neurologic deficits. Both diets high in ω-3 FAs and supplementation with ω-3 FAs have been reported to reduce the risk of cardiovascular disease, and early evidence suggests a potential neuroprotective effect of supplementation.
OBJECTIVE: To determine the (1) erythrocyte content of DHA and EPA, as measured by the Omega-3 Index, expressed as a percentage of total fatty acids, in National Collegiate Athletic Association Division I football athletes and (2) the distribution across the Omega-3 Index risk zones established for cardiovascular disease: high risk, <4%; intermediate risk, 4% to 8%; and low risk, >8%.
DESIGN: Cross-sectional descriptive study.
SETTING: Multicenter trial.
PATIENTS OR OTHER PARTICIPANTS: Deidentified data including complete erythrocyte fatty acid profile from the 2017-2018 season, age at time of testing, height, weight, and ethnicity were collected from 404 athletes.
MAIN OUTCOME MEASURE(S): Omega-3 Index.
RESULTS: About 34% of athletes (n = 138) had an Omega-3 Index considered high risk (<4%), and 66% (n = 266) had a risk considered intermediate (4%-8%). None had a low-risk Omega-3 Index.
CONCLUSIONS: The Omega-3 Index is a simple, minimally invasive test of ω-3 FA status. Our data indicate that football athletes may be deficient in the ω-3 FAs DHA and EPA. The fact that no athlete had an Omega-3 Index associated with low risk suggests football athletes may be at increased risk for cardiovascular disease in later life.

PMID: 30645147 [PubMed - as supplied by publisher]

Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Hugo Sanchez, MD - Tue, 01/15/2019 - 10:54
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Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Arch Bone Jt Surg. 2018 Nov;6(6):517-522

Authors: Bernstein DN, Davis JT, Fairbanks C, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?
Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed.
Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. There was no association between vitamin D level and bone mineral density.
Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
Level of evidence: III.

PMID: 30637307 [PubMed]

Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Hugo Sanchez, MD - Tue, 01/15/2019 - 10:54
Related Articles

Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg. 2018 Nov;6(6):492-500

Authors: Crijns TJ, Caton T, Teunis T, Davis JT, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity, mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and can lower reimbursement. A better understanding of the patient and treatment characteristics associated with readmission may help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay is not associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of a proximal femur fracture, accounting for discharge destination and other factors.
Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admitted for treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regression models were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score (ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.
Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with a lower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASA class 3, 4 and 5.
Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmission within one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify and disseminate best practices might reduce readmission rates.
Level of evidence: III.

PMID: 30637304 [PubMed]

Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Related Articles

Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

Arch Bone Jt Surg. 2018 Nov;6(6):517-522

Authors: Bernstein DN, Davis JT, Fairbanks C, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?
Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed.
Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. There was no association between vitamin D level and bone mineral density.
Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
Level of evidence: III.

PMID: 30637307 [PubMed]

Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Related Articles

Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg. 2018 Nov;6(6):492-500

Authors: Crijns TJ, Caton T, Teunis T, Davis JT, McWilliam-Ross K, Ring D, Sanchez HB

Abstract
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity, mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and can lower reimbursement. A better understanding of the patient and treatment characteristics associated with readmission may help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay is not associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of a proximal femur fracture, accounting for discharge destination and other factors.
Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admitted for treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regression models were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score (ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.
Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with a lower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASA class 3, 4 and 5.
Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmission within one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify and disseminate best practices might reduce readmission rates.
Level of evidence: III.

PMID: 30637304 [PubMed]

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

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Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

World J Emerg Surg. 2018;13:37

Authors: Sartelli M, Kluger Y, Ansaloni L, Coccolini F, Baiocchi GL, Hardcastle TC, Moore EE, May AK, Itani KMF, Fry DE, Boermeester MA, Guirao X, Napolitano L, Sawyer RG, Rasa K, Abu-Zidan FM, Adesunkanmi AK, Atanasov B, Augustin G, Bala M, Cainzos MA, Chichom-Mefire A, Cortese F, Damaskos D, Delibegovic S, Demetrashvili Z, De Simone B, Duane TM, Ghnnam W, Gkiokas G, Gomes CA, Hecker A, Karamarkovic A, Kenig J, Khokha V, Kong V, Isik A, Leppäniemi A, Litvin A, Lostoridis E, Machain GM, Marwah S, McFarlane M, Mesina C, Negoi I, Olaoye I, Pintar T, Pupelis G, Rems M, Rubio-Perez I, Sakakushev B, Segovia-Lohse H, Siribumrungwong B, Talving P, Ulrych J, Vereczkei AG, Labricciosa FM, Catena F

Abstract
Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

PMID: 30140304 [PubMed - indexed for MEDLINE]

The role of the built environment and private rooms for reducing central line-associated bloodstream infections.

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The role of the built environment and private rooms for reducing central line-associated bloodstream infections.

PLoS One. 2018;13(7):e0201002

Authors: O'Neill L, Park SH, Rosinia F

Abstract
Private hospital rooms are believed to offer some protective effect against hospital-acquired infections, including central line-associated bloodstream infections. Yet a recent meta-analysis found the evidence-base to be lacking from a policy perspective. We sought to determine whether private rooms were associated with a lower risk of central-line infections. We examined the discharge records of more than one million inpatients from 335 Texas hospitals to determine patients that stayed in private rooms. Patients who stayed in bay rooms had 64 percent more central line infections than patients who stayed in private rooms. Even after adjusting for relevant covariates, patients assigned to bay rooms had a 21 percent greater relative risk of a central line infection (p = 0.005), compared with patients assigned to private rooms. At the hospital level, a 10% increase in private rooms was associated with an 8.6% decrease in central line infections (p<0.001), regardless of individual patients' room assignment. This study demonstrates and validates the use of private rooms as a structural measure and independent predictor of hospital quality.

PMID: 30052672 [PubMed - indexed for MEDLINE]

Choosing Wisely at the End of Life: Use of Shorter Courses of Palliative Radiation Therapy for Bone Metastasis.

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Choosing Wisely at the End of Life: Use of Shorter Courses of Palliative Radiation Therapy for Bone Metastasis.

Int J Radiat Oncol Biol Phys. 2018 10 01;102(2):320-324

Authors: Wallace AS, Fiveash JB, Williams CP, Kvale E, Pisu M, Jackson BE, Rocque GB

Abstract
PURPOSE: American Society for Radiation Choosing Wisely guidelines recommend ≤10 fractions of radiation therapy (RT) for bone metastasis, with consideration for 1 fraction in patients with a poor prognosis. The purpose of this analysis was to evaluate characteristic differences in guideline concordance to fractionation regimens in a modern cohort of older patients with a diagnosis of bone metastasis.
METHODS AND MATERIALS: Medicare beneficiaries aged ≥65 years treated with RT for bone metastasis from 2012 to 2015 were identified. Guideline-concordant RT fractionation was defined in the entire cohort as ≤10 fractions. Utilization of 1 fraction versus ≥2 fractions was analyzed in deceased patients. Patient demographic, disease, and facility characteristics associated with shorter fractionation were analyzed.
RESULTS: In 569 patients treated with RT, the median age at diagnosis was 73 years. The most common cancer types were lung (37%), genitourinary (26%), breast (15%), and gastrointestinal (10%). Among all patients, 34%, 30%, and 36% received 1 fraction, 2 to 10 fractions, and ≥11 fractions, respectively. In comparison with receipt of 1 to 10 fractions, receipt of ≥11 fractions was associated with a $1467 increase in per-patient cost to Medicare during the calendar quarter of RT. Almost two-thirds of patients who died within 30 days of RT completion were treated with >1 fraction.
CONCLUSIONS: Although guideline concordance was high overall, a large number of patients received longer courses of RT at the end of life. Strong consideration should be made for utilization of shorter courses, particularly in patients with a limited prognosis.

PMID: 30191866 [PubMed - indexed for MEDLINE]

The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study.

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The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study.

J Trauma Acute Care Surg. 2018 Dec 28;:

Authors: Savage SA, Li SW, Utter GH, Cox JA, Wydo SM, Cahill K, Sarani B, Holzmacher J, Duane TM, Gandhi RR, Zielinski MD, Ray-Zack M, Tierney J, Chapin T, Murphy PB, Vogt KN, Schroeppel TJ, Callaghan E, Kobayashi L, Coimbra R, Schuster KM, Gillaspie D, Timsina L, Louis A, Crandall M

Abstract
INTRODUCTION: Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay and mortality in skin and soft tissue infections (STI).
METHODS: This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics and outcomes such as mortality, overall complications, hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.
RESULTS: 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher LRINEC scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status and hospital-level volume. Grade V disease was significantly associated with mortality as well.
CONCLUSION: This validation effort demonstrates that Grade IV and V STI are significantly predictive of complications, hospital length of stay and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process, in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.
STUDY TYPE: Prognostic/Epidemiologic retrospective multicenter trial LEVEL OF EVIDENCE: III.

PMID: 30601458 [PubMed - as supplied by publisher]

Failed Early Intervention of Pyomyositis in an Immunocompetent Individual.

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Failed Early Intervention of Pyomyositis in an Immunocompetent Individual.

Case Rep Infect Dis. 2018;2018:4296976

Authors: Al-Dossari R, Zekri S

Abstract
Pyomyositis is a purulent infection of striated muscle tissue that usually leads to an abscess, commonly due to S. aureus. Pyomyositis is typically found in tropic regions, but it is increasingly being recognized in temperate climates, especially in immunocompromised individuals. Patient presentation ranges from afebrile with mildly elevated WBC to frank sepsis. In many reported cases, patients may develop multiple abscesses at different sites. We report a case of a 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) presenting with right pectoral infection. This case demonstrates the possibility that antibiotic therapy in early presentations may not effectively prevent abscess formation, contrary to treatment suggestions found in the literature.

PMID: 30595930 [PubMed]

Network proteomics of human dermal wound healing.

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Network proteomics of human dermal wound healing.

Physiol Meas. 2018 Nov 05;:

Authors: Gao X, Petricoin Iii EF, Ward KR, Goldberg SR, Duane TM, Bonchev D, Arodz T, Diegelmann RF

Abstract
Healing of wounds is critical to maintaining protection of human body against environmental factors. The mechanisms involving protein expression during this complex physiological process have not been fully elucidated. Here, we use the reverse-phase protein microarrays involving 94 phosphoproteins to study tissue samples from tubes implanted into healing dermal wounds in 7 human subjects tracked over 2 weeks. We compare the proteomic profiles to proteomes of controls obtained from skin biopsy from the same subjects. Compared to previous proteomic studies of wound healing, our approach is focused on wound tissue instead of wound fluid, and has the sensitivity to go beyond measuring only high-abundance proteins. To study the temporal dynamics of networks involved in wound healing, we applied two network analysis methods that integrate the experimental results with prior knowledge about protein-protein physical and regulatory interactions, as well as higher-level biological processes and associated pathways. We uncovered densely connected networks of proteins that are up- or down-regulated during human wound healing, as well as their relationships to microRNAs and to proteins outside of our set of targets we measured with proteomic microarrays.

PMID: 30524050 [PubMed - as supplied by publisher]

Prevention of Dopamine Dysregulation Syndrome in Parkinson's Disease: A Case Report.

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Prevention of Dopamine Dysregulation Syndrome in Parkinson's Disease: A Case Report.

Prim Care Companion CNS Disord. 2018 Apr 26;20(2):

Authors: Luchsinger WT, Gambhir N, DeMoss D

PMID: 29701928 [PubMed - indexed for MEDLINE]

Potential Overestimation of Racial Disparities in Response to the 8-Week Ledipasvir/Sofosbuvir Regimen for Hepatitis C Virus Genotype 1 Infection.

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Potential Overestimation of Racial Disparities in Response to the 8-Week Ledipasvir/Sofosbuvir Regimen for Hepatitis C Virus Genotype 1 Infection.

Gastroenterology. 2018 11;155(5):1646-1647.e2

Authors: Ojha RP, MacDonald BR, Chu TC, Marcus JL

PMID: 30118741 [PubMed - indexed for MEDLINE]

Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education.

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Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education.

Transl Behav Med. 2018 03 01;8(2):175-182

Authors: Rocque GB, Williams CP, Halilova KI, Borate U, Jackson BE, Van Laar ES, Pisu M, Butler TW, Davis RS, Mehta A, Knight SJ, Safford MM

Abstract
New treatments for chronic lymphocytic leukemia (CLL) with excellent response rates and varying toxicity profiles have emerged in recent years, creating an opportunity for a patient's personal preferences to contribute to treatment decisions. We conducted a prospective, quasi-experimental pre- and post-evaluation of a multilevel educational program and its impact on knowledge of CLL and shared decision-making (SDM). We educated patients, lay navigators, nurses/advanced practice providers (APPs), and physicians. Patients were evaluated for change in patient activation, distress, desired role in decision-making, perception of decision-making, satisfaction with oncologist explanation of treatment choice, and knowledge of CLL. Lay navigators, nurses/APPs, and physicians were evaluated for change in CLL knowledge and perception of decision-making. Forty-four patients, 33 lay navigators, 27 nurses/APPs, and 27 physicians participated in the educational program. We observed trends toward improved patient activation, with 68% before education versus 76% after education reporting a Patient Activation Measure (PAM) score of 3 or 4. The percentage of patients desiring and perceiving SDM trended upward from 47% to 67% and from 35% to 49%, respectively. The percentage of patients understanding that CLL is incurable increased from 80% to 90%, as did reporting awareness of signs of progression (64% to 76%). Patients' satisfaction with their oncologists' explanations of therapy increased significantly from 83% to 95% (p = .03). CLL knowledge increased after education for lay navigators (36% vs 63%) and nurses/APPs (35% vs 69%), and remained high for physicians (85% vs 87%). Nurses/APPs and physicians perceived at least some patient involvement in decision-making at baseline, whereas 12% of patients and 23% of lay navigators perceived that physicians made decisions independently. This project demonstrated trends toward improvements in patient engagement, prognostic awareness, knowledge of signs of progression, and SDM. These promising findings should be tested in larger samples. There remains an opportunity for further improvement in SDM.

PMID: 29390159 [PubMed - indexed for MEDLINE]

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Fayette C. Williams, DDS, MD, FACS - Mon, 11/26/2018 - 07:42
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Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Related Articles

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]

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