Effectiveness and Safety of Percutaneous CT-Guided Rib Biopsy

Purpose

To retrospectively evaluate effectiveness and safety of percutaneous CT-guided rib biopsy.

Erosive pustular dermatosis of the scalp in an adolescent with near‐total hair regrowth: Case report and review of the literature

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon chronic inflammatory response to scalp trauma that usually resolves with cicatricial alopecia. It most commonly affects elderly patients with a history of actinic damage. Herein, we describe a 16‐year‐old girl with acrofacial dysostosis type 1 presenting after surgery with crusting purulent scalp lesions, whose clinical presentation and histopathologic findings were consistent with EPDS. A review of the literature on EPDS in children is also detailed.     

Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians

ObjectivesTo describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU).BackgroundInspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients.MethodsPatients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set.ResultsUsing this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT.ConclusionsThis multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.     

Regulated necrosis and failed repair in cisplatin-induced chronic kidney disease

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Patients with end-stage renal disease have poor outcomes after endovascular abdominal aortic aneurysm repair

Objective

Although endovascular repair of abdominal aortic aneurysms (AAAs) has been demonstrated to have favorable outcomes, not all cohorts of patients with AAA fare equally well. Our goal was to investigate perioperative and 1-year outcomes in patients with end-stage renal disease (ESRD) on dialysis, who have traditionally fared worse after vascular interventions, to assess how ESRD affects outcomes in a large modern cohort of endovascular aneurysm repair (EVAR) patients.

Describing the mandible in patients with craniofacial microsomia based on principal component analysis and thin plate spline video analysis

Craniofacial microsomia (CFM) is most often described as a unilateral malformation of derivatives of the first and second branchial arches. The mandible has been classified using several classification systems. However, all are based on two-dimensional imaging. The aim of this study was to mathematically describe the deformed mandible based on principal component analysis (PCA) in a three-dimensional way. This may aid in defining the flaws in existing surgical corrections of the mandible through the identification of the differences in shape compared with a normal mandible in a holistic view with the help of videos. Forty-three homologous landmarks were defined to describe a mandible with CFM. Computed tomography scans of 22 patients and 30 controls were marked manually. The changes in shape between the mandibles were visualized using videos. A lateral rotation with increase in posterior rotation of the condyle due to shortening of the condyle–gonial height and a longitudinal rotation with outward bending of the mandibular angle were noted on the affected side, as well as an inward bending of the angle on the unaffected side. Due to the compensatory remodelling of the mandible on the unaffected side, one could suggest that CFM is never truly unilateral.