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Multicenter Study
Functional outcome of bilateral limb threatening: lower extremity injuries at two years postinjury.
To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. ⋯ The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to undergoing salvage versus amputation.
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Am J Ophthalmol Case Rep · Jun 2020
Case ReportsHorner Syndrome induced by toxoplasmosis infection in a patient with AIDS and disseminated herpes simplex virus.
This case report describes a case of Horner syndrome resulting from central nervous system (CNS) toxoplasmosis in an immunocompromised patient. Horner Syndrome is a neurological condition characterized by unilateral miosis, ptosis with apparent enophthalmos, and anhidrosis due to inhibition of the sympathetic pathway. The ocular sympathetic pathway runs from the posterolateral hypothalamus to the ophthalmic branch of the trigeminal nerve (cranial nerve V1). Central nervous system (CNS) toxoplasmosis infection is typically only seen in immunocompromised patients. To our knowledge, toxoplasmosis has never been reported as a cause of Horner syndrome. ⋯ This is the first reported case of Horner syndrome resulting from CNS toxoplasmosis. This case report and the accompanying questions provide an opportunity to review and explore the neuroanatomy and subtle symptomatic differences between various etiologies of Horner syndrome (primary, secondary, tertiary) in the context of a novel presentation. In conclusion, toxoplasmosis should be considered when investigating Horner syndrome in immunocompromised patients.
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Reversal with sugammadex reduces the incidence of post-operative nausea and vomiting compared with neostigmine.
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Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. ⋯ Patients with hypoalbuminemia have significantly increased mortality risk. Albumin level is regulated by nutritional intake and inflammation due to chronic disease, which make it a useful part of a preoperative frailty assessment. Further studies are needed to identify whether optimizing nutrition status will affect albumin levels or decrease mortality.