Articles: patients.
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No standard strategy exists for the management of cervical kyphotic deformity in patients with severe osteoporosis. In fact, in such subpopulation, standard algorithms commonly used in patients with normal bone mineral density may not be applicable. In this Grand Rounds, the authors present a challenging case of a patient with Hajdu-Cheney syndrome, a rare disorder of bone metabolism induced by a Notch-2 mutation, who presented with cervical kyphotic deformity and severe osteoporosis. ⋯ This case illustrates some intra-operative nuances as well as specific surgical recommendations for cervical deformity surgery in patients with severe osteoporosis, such as avoidance of Caspar pins for interbody distraction, use of intra-operative fluoroscopy for achievement of bicortical purchase of anterior cervical screws and placement of pedicle screws during posterior instrumentation. Moreover, such illustrative case demonstrates that, in the subpopulation of patients with severe osteoporosis, it may be possible to successfully apply cervical distraction after an isolated anterior approach with a satisfactory improvement in the cervical alignment, possibly avoiding more laborious 540-degree approaches such as the previously described back-front-back or front-back-front surgical algorithms.
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Pediatric emergency care · Dec 2015
The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls.
The purpose of our study was to evaluate the hypothesis that pediatric forearm fractures resulting from ground-level falls are associated with increased weight status (weight for age/sex percentile ≥ 95th) in comparison with those resulting from major trauma. ⋯ Ground-level falls are a common mechanism of pediatric forearm fracture and are significantly associated with increased weight status and radius-only fractures. These results suggest the need for further investigation into obesity and bone health in pediatric patients with forearm fractures caused by ground-level falls.
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The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries. ⋯ In our patient population, all significant C-spine injuries were identified by NEXUS criteria without considering the femur fracture a distracting injury and indication for computed tomographic imaging. Reconsidering femur fracture in this context may decrease radiation exposure and health care expenditure with little risk of missed diagnoses.
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Intraoperative ultrasound (iUS) is a valuable tool-inexpensive, adds minimal surgical time, and involves minimal risk. The diagnostic predictive value of iUS is not fully characterized in Pediatric Neurosurgery. Our objective is to determine if surgeon-completed iUS has good concordance with post-operative MRI in estimating extent of surgical resection (EOR) of pediatric brain tumors. ⋯ The results from this study suggest that iUS is reliable with both residual tumor (PPV-100%) and when it suggests no residual (NPV-98%) in tumors that are easily identifiable on iUS. However, tumors that were difficult to visualize on iUS were potentially excluded, and therefore, these results should not be extrapolated for all brain tumor types.
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As educators, we are charged with preparing emergency medicine residents for successfully intubating patients with even the most troublesome anatomy. This situation is encountered during the intubation of patients with angioedema. These patients are uncommon in the emergency department, and as a result, it is difficult to ensure that each resident is well trained in this intubation scenario before graduation. ⋯ Participants included 29 emergency medicine residents, with participants from all year groups. In response to the statement, "The angioedema model was high fidelity," 12 residents strongly agreed, whereas the remaining respondents agreed. In response to the statement, "The angioedema model was a good training model for angioedema," 13 residents strongly agreed, whereas the remaining respondents agreed. When solicited for comments on the model, one participant wrote, "Awesome opportunity, I will be markedly less terrified when I get an angioedema/anaphylaxis case."We have developed an angioedema training model using air insufflation in a fresh frozen cadaver. Our participants uniformly expressed positive impressions of both the fidelity and training quality of this model.